ENPC Exam Questions and Answers: A Comprehensive Guide for Medical Professionals, Exams of Nursing

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ENPC EXAM QUESTIONS AND ANSWERS/ ENPC 2025 UPDATED

VERSION OF THE EXAM ENPC EXAM

1. During a suicide intervention with your 28yo male patient, to which agreement should you ask for his consent, verbally or in writing? a. -“No Harm” contract- health care professionals are obligated to ask suicidal patients to agree to a no harm contract, verbally or in writing, detailing specifically that the patient will restrain from harming themselves b. “No Suicide” contract- typical contraajeminatincts used in the prevention of suicide c. “Prevention” Contract- typical contracts used in the prevention of suicide d. “Affirming Life” contract- typical contracts used in the prevention of suicide
2. Courtney 35 is a rape victim. You note that she has an expressed style of coping in her acute rape trauma syndrome. Which of the following would most lead you to this conclusion? a. Patients Masked face b. Patients Distractibiity c. Patient Smiling d. Patient having difficulty making decisions
3. Which of the following patients would not require hospitalization? a. A 29yo self-admitted bulimic male with bradycardia b. A 27yo female with repeated use of laxatives and diuretics at least two times a week for 3 months c. A 20yo male suffering from persistent hypothermia d. A 18yo young woman who is 5’4” and weighs 92 pounds
4. Terry, 35yo, visits your office with the assumption that he is experiencing depression. Terry explains that he has a history of substance abuse and a family history of mood disorders. He claims that he has recently been incredibly fatigued, possessing no energy to even perform day to day activities. Even with the sudden onset of fatigue. Terry explains that he is still experiencing insomnia. He also complains about recurring confusion and loss of weight, and confesses that he has been experiencing more recurrent suicidal thoughts. Of the following which is the best medication to prescribe Terry for his situation?

a. Sympathomimetics- thought to be most effective pharmacological treatment for depression, however they have a potential for abuse b. Bupropion- better choice due to history of substance abuse c. Olanzapine- mood stabilizer more effective for bipolar d. Risperidone- for mania

5. You are attending to a 30yo male after he was shot at and almost killed. By showing empathy, confrontation, and immediacy, you are exhibiting which of the following? a. Identifying the hazard and precipitating event- involves differentiating the precipitating event from long term psychological problems. Three of the counseling keystones relevant to assessment of a crisis are empathy, confrontation, and immediacy. c. Identifying coping mechanisms- does not involve wide-ranging keystones such as empathy, but rather specific actions such as questioning and increasing adaptive coping by recommending the patient seek information. d. Situational support
6. A patient with which of the following findings should be referred to primary care for cardiovascular problems? a. A patient with a blood pressure of 130/85- considered prehypertension and should be referred to primary care. b. Systole c. Diastole d. Low density lipoprotein level (LDL) of 69 mg/dl- is the desired LDL for patients, anything over 100 mg/dl should warrant a referral to primary care for evaluation of cholesterol.
7. Patients with severe and persistent mental illness (SPMI) exhibit symptoms which interfere with occupational, academic, and social functioning. Which of the following illnesses eventually touches 100% of patients affected with SPMI? a. Unipolar depression- affects 20-30% of SPMI patients b. Schizophrenia- affects 90% of SPMI patients c. Dementia- 100% of patients with SPMI are eventually affected by varying degrees of dementia which interfere with occupational, academic and social functioning d. Bipolar Depression- affects 40-50% of SPMI patients b. Counseling keystones relevant to assessment of a crisis-

8. Before patients enter a hospice they are advised of their right to refuse care, but only if they have which of the following? a. Decisional capability b. A living will c. A healthcare directive d. Informed consent
9. Which of the following statements is not a correct association with the Bronfenbrenner’s ecological system model? a. Children are dynamic entities and develop the skills necessary to _____ that setting b. The ___ child ____ may be established as _____ by the parents relationships c. Objective reality influences behaviors and development more than ones perception of environment d. Changes in family structure such as the birth of a sibling affect a child’s development
10. A 34yo man who recently had a major car accident comes to your office. He reports that his car hit the car in front of him. The man says he has a relative with intermittent explosive disorder and worries, that he may also have it. He is worried that if he has this disorder, it could lead to further problems in the future. When asked if he hit the car on purpose, he initially denies it, but then indicates that he was particularly annoyed with the driver in front of him. Which of the following would not be a typical characteristic of this disorder? a. The degree of aggression was out of proportion to the precipitating psychological stressor b. He had been drinking alcohol extensively earlier in the night c. He felt immediately guilty after the episode d. He experienced tingling and chest tightness shortly before episode.
11. Of the following antidepressant medications, which is a tetracyclic antidepressant? a. Maprotiline- a tetracyclic antidepressant, chemical compound consists of primarily 4 rings of atoms. b. Amitriptyline- tricyclic antidepressant c. Amoxapine- tricyclic antidepressant d. Phenetzine sulfate- MAOI
12. The sexually transmitted disease that causes superficial, painful ulcers surrounded by an erythematous halo in men but is usually asymptomatic in women is which of the following?

a. Chancroid- although women are usually asymptomatic, men usually have superficial painful, and erosive ulcers, which are surrounded by an erythematous halo, on the genitalia when affected by chancroid. b. Herpes Simplex virus type I- painful ulcers on face no halo c. Human Papillomavirus- single or multiple soft, fleshy, papillary, or sessile, painless keratinized growth around anus, vulvovaginal area, penis urethra, or perineum. d. Lymphogranuloma venereum- painless and involves bubo

13. The medical profession categories the various levels of prevention that caregivers practice on their patients. A pap smear screening corresponds to which of these types of prevention? a. Primary prevention b. Secondary prevention c. Quaternary Preventioin d. Tertiary Prevention
14. Schizophrenia is a complex illness with certain accepted phases; and often lifelong movement between phases, which of the following is not a phase of schizophrenia? a. Prodromal b. Premorbid c. Relapsable d. Acute
15. Eric, a 34yo male, diagnosed as schizophrenic 5yrs ago. Among his characteristics and features is an apparent emotional detachment from his action and surroundings. During interviews with him, you note his persistently confused speech and behavior. You are also informing Eric’s family members of his diagnosis, you should tell them that Eric displays characteristics of which type of schizophrenia? a. Disorganized b. Catatonic c. Residual d. Paranoid
16. In the treatment of GAD, benzos are advisable typically for short term use. Which of the following is not a risk associated with this treatment? a. Tolerance b. Blood clots c. Dependency

d. Withdrawal symptoms when discontinued

17. Vitamin B12 deficiency can lead to clinical symptoms of dementia. In patients with dementia, which of the following findings would you also expect to see as a result of this deficiency? a. Markedly increased neuritic plaques and neurofibrillary tangles- hallmark of Alzheimers as is decreased availability of acetylcholine. b. Demyelination and axon loss in the brain and spinal cord- dementia due to B12 is caused by demyelination and axon loss in brain and spinal cord. c. Decreased availability of acetylcholine d. Substantial reduction in neurons in the substantia nigra - aka atrophy of the substantia nigra is a clinical feature of Parkinson’s disease and not related to B12.
18. You are treating SergeI, who speaks limited English, and you do not know enough Russian to treat him. According to the standards of Culturally and Linguistically Appropriate Services, you must provide all of the following for Sergei, except: a, b, and c all are part of (CLAS)- One of the standards of Culturally and Linguistically Appropriate Services (CLAS) is the requirement that health organizations must provide language assistance Services. This includes bilingual staff or interpreter services at no cost to the patient. Their right to this service must be made known to the patient in their preferred language, both verbally and in written notices. Additionally, the patient’s family or friends may be used as translators unless specifically requested by the patient. a. Bilingual staff and interpreter services at no cost to the patient b. An English- Russian translator application on your computer- does not meet the stadards of CLAS c. Verbal and written notices in the patient’s native language d. A trusted family member or friend who can translate, if requested
19. Matthias, 8yo male, is having difficulty in school. His mother is concerned about his social withdrawal and isolation. His mother tells you that she is worried that it may be schizophrenia because her older brother has the condition. You tell her that Matthias may be in the premorbid phase of schizophrenia, which requires early intervention. The premorbid phase contains all of the following characteristics except: a. Echopraxia- the involuntary repetition of another individual’s observed actions. This is a feature of the acute or psychotic phase of schizophrenia, not the premorbid phase. b. Enuresis- premorbid phase can also include involuntary urination or enuresis c. Irritability and or anger- major characteristics of premorbid phase d. Depression- major characteristics of premorbid phase

20. A physical therapist helps Chris who was paralyzed below his waist after falling off a horse. He is now post spinal cord surgery and he is able to feel his legs and feet again. What level of prevention is occurring here? a. Secondary Prevention b. Tertiary Prevention c. Primary Prevention d. Quaternary prevention
21. The following choices represent the predisposing factors for enuresis except: a. African American b. Male c. Small bladder capacity d. Poor nutrition
22. You are meeting Ginger, a 10yo, who was brought to you by a social worker. You notice that Ginger is wary of adult contact, withdrawn and responds to your questions in monosyllabic answers. You also gather that she is frightened of her parents, yet she makes constant efforts to please them. The patient’s behavior is most indicative of which of the following? a. Neglect y caretakers b. Emotional abuse by caretakers c. Sexual abuse by caretakers d. Physical abuse by caretakers
23. Despite the fact that she claims she “forgot” to pay for the items. Cynthia was recently arrested for shoplifting at a clothing store. Looking at this 32yo, female’s history, you realize she has a history of shoplifting often by herself and with no apparent need or want for the items. Which of the following would you expect to see in Cynthia’s family history? a. Her sister was addicted to pain killers b. Her mother has OCD c. Her father was an alcoholic d. Her aunt suffered from panic attacks
24. You are performing a comprehensive health history of 20yo Ricky. He has been in and out of juvenile detention centers because of his violent history over the last 3 years. You are trying to delineate whether his propensity for violence is associated with internal or external factors. Yu should pay special attention to the following possible issues except:

a. GI problems b. History of substance abuse c. High fevers d. Head injury

25. Jameson, 47, is a self-described “neurotic overachiever” who is obsessed with growing his small business. During your interview, you note that he appears arrogant and grandiose. He is convinced that his largest business competitor is intent on sabotaging his company. He appears unable to empathize with the feelings and needs of others and has few friends or interests outside of work as a result. Which of the following personality disorders best explains Jameson’s behavior? a. Obsessive-Compulsive b. Histrionic c. Borderline d. Narcissistic
26. You see an Alzheimer’s patient you treat regularly, 77yo Jane. In your last checkup you have noticed bruises on her, and Jane is in no state to recall what occurred. In most states, which of the following would you be legally required to report to social services? a. Neither incident b. The incident of domestic abuse c. Both incidents d. The incident of elder abuse
27. When treating a patient with hyperactive delirium, you must help the patient in managing his or her symptoms until the delirium has resolved. Which of the following would be least appropriate for this type of patient? a. Schedule treatments and medications at times that will not interrupt nighttime sleep b. Clearly identify staff and their function c. Allow the patient to sit up partially d. Provide the patient with a semi-darkened room
28. Even though many types of dementia are permanent and become progressively worse, there is a potentially eversible form of dementia. This type of dementia impairs the return of cerebral spinal fluid to brain from the spinal column because of enlarged ventricles. Which of the following matches this description? a. Dementia due to Picks disease

b. Dementia due to normal-pressure hydrocephalus c. Dementia due to HIV d. Dementia due to Creutzfeld-Jacob disease

29. Which of the following are two risk factors for the recurrence of major depressive disorder? a. Prior history of multiple major depressive episode and a later age of onset— earlier age of onset not later b. Negative Cognitive style and persistent sleep disturbance- along with a prior history of major depressive episodes, ongoing psychosocial stress, negative cognitive style, and earlier age of onset, and persistent sleep disturbances are some of the risk factors for the recurrence of major depressive disorder. c. Sociopathic behavior and paranoid behavior- suggests less of a risk for mood disorders. d. Ongoing psychosocial stress and family history of major depressive disorder- family history of MDD not a risk factor for its recurrence
30. Which of the following statements about elder abuse is false? a. Elderly women are at higher risk of being abused than elderly men- elderly men at higher risk of being abused than women, especially if the elderly men were abusive in the past. b. About one in ten elders in the community are mistreated- true c. Elder abuse increases with increase in “caretaker burden”- true d. More than half of abused dependent elders are abused by their spouse- true
31. Abnormalities in neurotransmitters such as serotonin and dopamine may be a neurological predisposing factor for bipolar disorders. An abnormality of which of the following may also be a neurological predisposing factor? Neurological predisposing factors for bipolar disorders include, but are not limited to, abnormalities of cortisol, norepinephrine, glutamate, and acetylcholine. a. Somatostatin b. Epinephrine c. Cortisol d. dimethyltryptamine
32. Which of the following findings is not among the list of necessary symptoms for a diagnosis of dementia? a. Agnosia b. Aphasia c. Anosognosia d. Apraxia

33. Samuel is under your care for depression. Your medication of choice in his case is a prescription for a serotonin norepinephrine reuptake inhibitor (SNRI). This type of medication blocks the reuptake of neurotransmitters after their release from the presynaptic terminal. Which of the following medications did you prescribe? a. Venlafaxine b. Thioridazine c. Perphenazine d. Chlorpromazine
34. Of the following, which is not a goal of the “Healthy People 2020” program? a. Help Americans attain lives free of preventable conditions b. Promote accessibility to health care c. Provide healthcare for the uninsured- goal to promote not provide d. Provide measurable data and goals to guide policy decisions- the program collects and provides information to help healthcare providers, consumers, and policy makers make better informed decisions concerning healthcare.
35. A 47yo male presents with slurred speech, an unsteady gait, and overall drowsiness, as well as a sense of “wellbeing”. Which of the following substances is he most likely abusing? a. Alcohol- blackouts and headaches b. Amphetamines- autonomic hyperactivity and pupil changes c. Opioids- indicated by constricted pupils, and diarrhea d. Benzodiazepine s
36. A 19yo female comes to your office with her parents. She recently finished her first year of college, and her parents mention she has lost a significant amount of weight, even though she was not heavy when she began college. When discussing the issue with you, the patient clarifies that she is not preoccupied with losing weight, rather she has increased her workouts to avoid the unhealthy behavior of many other freshmen around her. Upon further delving into the issue, she mentions that she is not sexually active and that exercise and her weight help her feel better about herself. If the patient’s signs and symptoms are indicative of an eating disorder, which of the following would be most expected in this patient? a. Broken fingernails b. Amenorrhea c. Pale skin tone d. Binging followed by purging

37. You are practicing in a rural community hospital. You visit with Aaron, a 29yo male who has just received a diagnosis of schizophrenia. During and after college he lived in a large city, but he has returned to the rural community to get support for his illness. His 22yo sister, who has always lived in the rural community, pulls you aside and says she is worried that her Fiancés family will think her family is prone to mental illness. You inform her about her brother’s condition by using all of the following statements except: a. There is seemingly multigenic genetic vulnerability to schizophrenia that is not completely expressed- Schizophrenia is associated with an imbalance of neurotransmitters, it would be incorrect to say the imbalance is the definitive cause, since no single cause can currently account for Schizophrenia. Rather, it appears to be the result of multiple causes, such as genetic factors, environmental and psychological assaults, and possible hormonal changes that alter the brain’s chemistry. Second, the neurotransmitter imbalance is not thought to be related to brain shrinkage, rather, the disease may arise from unrelated structural changes. b. Schizophrenia is caused by an unusual imbalance of neurotransmitters in the brain, although some imbalances may be the results of treatments for the condition which can cause brain shrinkage over time c. Schizophrenia undoubtedly has a genetic component. The risk for inheriting schizophrenia is 15% in those who have one immediate family member with the disease and about 35% if the disease affect an identical twin or both parents.- explains genetic predisposition to Schizophrenia d. Over-involved, critical, and hostile families with high levels of expressed emotion often have more difficulty assisting the schizophrenic member with maintaining stability.- stress must be also taken into account for patients, including the types of families described here.
38. Which of the following predisposing factors in the occurrence of mental retardation? a. Prenatal factors b. Perinatal factors c. Postnatal factors d. Hereditary factors
39. After her parent was murdered, you suspect your 32yo patient may be exhibiting distortions in her cognitive thinking. You recall Beck’s cognitive triad, which describes individual behaviors that indicates cognitive distortions. Which of the following is not an example of that behavior? Beck’s triad is concerned with a patient’s outlook on events, and does not touch on actions such as a patient willfully disrupting coping systems. Holding a negative view of self and assuming a future holds no hope are aspects to Beck’s triad, and evaluating ongoing events in a negative way is counted as the same part as misinterpreting available data. a. Assuming the future holds no hope b. Willfully disrupting coping systems- an aspect of the patient’s assimilation c. Misinterpreting available data

d. Evaluating ongoing events in a negative way

40. Alex’s husband is in his final days of life with terminal cancer. Over the past six months that her husband has been in the hospital. Alex has been progressively losing weight, almost 60 pounds. She is also having difficulty with persistent insomnia. Which model and stage of grief is Alex experiencing? a. 5 th^ stage of Elizabeth Kubler-Ross’ model- acceptance, resignation, and peace b. 1 st^ stage of Edward John Mostyn Bowlby’s model— disbelief with the loss that occurred c. 4 th^ stage of Edward John Mostyn Bowlby’s model- reorganization and demonstrating a readiness to move forward. d. 4 th^ stage of Elizabeth Kubler-Ross’ model- is depression with symptoms including sleep disturbances and weight changes.
41. Of the following which type of relational orientation is characterized by a value of group goals over individual goals and a tendency toward ordered succession? a. Individualistic orientation - characterized by more frequent interpersonal relationship with outsiders rather than family b. Future orientation- deals more with how a patient temporarily views accomplishments and self- value, and is not considered a type of relational orientation c. Collateral orientation- characterized by a more concentrated focus on group goals and on relationships with others at one’s own level. d. Lineal orientation- characterized by a higher placed value on group goals over individual goals and a tendency toward ordered succession.
42. In evaluating the health beliefs and practices of a patient which of the following is the first step a nurse practitioner should take in his or her assessment? a. The NP should ask patients to define and explain how they view health b. The NP should ask patients to explain their views on death- this is after the patient has disclosed their views on health in general, as well as their own health c. The NP should tell patients how they can improve their health- only after completion of the cultural assessment, so as to give a more culturally sensitive, relevant, and appropriate recommendation d. The NP should ask patients about who prepares their food and drink at home- this is asked when evaluating a patient’s family roles
43. Robert’s wife had died after a protracted battle with lymphoma. He is angry at the doctor for not diagnosing her condition sooner or being better able to help her. Robert also feels guilty for not having been kinder towards her while she was alive. Which stage of grief is Robert experiencing according to Bowlby’s model?

a. Stage 4: Reorganization- features an acceptance or resignation regarding the loss, including a readiness to move forward and view the loss as a treasured memory b. Stage 1: Numbness and Protest- describes those in grief as unable to believe that the loss has occurred c. Stage 3: Disorganization and Despair- aimless or distracted behavior, isolation, and loneliness are common d. Stage 2: Disequilibrium- Robert’s somewhat erratic swings between guilt and anger represent a state of disequilibrium and reflect a preoccupation with loss. The inward or outward expression of anger or guilt also define the second stage of Bowlby’s model

44. An 82yo man comes to your office accompanied by his daughter. He works part-time as a janitor. In recent years, he has become increasingly confused and forgetful. At work, he often forgets his daily tasks and either repeats jobs he has already complet4ed or does not correctly perform the job. His daughter states that she spoke to some of his co-workers and learned that her father sometimes speaks in incoherent phases. When performing a cognitive exam, which of the following would you not ask the patient during the mini-mental status exam? a. Ask the patient about his sleep patterns b. Ask the patient what is today’s date c. Ask the patient to name an object to which you pointed d. Ask the patient to recall three words that he previously registered
45. Which of the following key concepts is not a part of the SLAP assessment for suicidal risk? a. Lethal b. Plan and previous c. Abuse of substances d. Access
46. Of the following, which is not a special population to be considered by the nurse practitioner in the context of a cultural assessment? Special populations to be considered by the NP within the context of a cultural assessment include the homeless population, migrant workers, people who are fearful of discrimination based on gender and sexual identity differences, the correctional population, and the forensic population a. Forensic population b. LGBT population c. Physically handicapped population- not considered a special population within the context of a cultural assessment

d. Correctional population

47. Sani, 83 was diagnosed with mild to moderate stage Alzheimer’s 18 months ago. Since his diagnosis, he has experienced progressively worsening depression. You wish to alleviate his depression, sparring his cognitive facilities as much as possible, but do not want significantly increase his risk for seizures. Which of the following medications should you not prescribe? a. Bupropion b. Venlafaxine c. Ducxetine d. Fluoxetine
48. A patient throws a vase across the room, smashing it. You are treating him for violent outbursts. Of the following, which is the best way to deal with him at this moment? a. The NP should leave the room until the patient has calmed b. Speak only to give short directions c. Process the patient’s problems d. Attempt to give the patient a solution to problems.
49. A 34yo man comes to your office saying that he may be suffering from depression. When taking a Zung depression inventory, which of the following scores indicates an increased risk of depression? The Zung Depression Inventory is made up of 20 items, a patient who scores above 50 may have increased risk of depression. A normal score would be 34 or less. The other 3 choices are all too low to indicate an increased risk for depression a. Scores of 31 b. Score of 53 c. Score of 44 d. Score of 39
50. Which of the following is known as “double depression”? a. Dysthymia and melancholic depression b. Dysthymia and cyclothymia c. Major depressive disorder d. Major depressive disorder and dysthymia

51. Of the following which population’s manic episodes are often misdiagnosed as Schizophrenic, attention- deficit hyperactivity disorder, or a personality disorder? a. Elder population b. African Population c. Female Population d. Adolescent Population
52. Which of the following disorders is inherited, typically develops symptoms between the ages of 30 and 50, causes dementia, and stems from a defect on chromosome 4? a. Early onset familial Alzheimer’s disease- mostly caused by single-gene mutations on chromosomes 21, 14, or 1 b. Huntington’s disease- caused by a genetic defect on chromosome 4 c. Parkinson’s disease- classified as idiopathic, many experts think the disease is caused by a combination of genetic and environmental factors, which may vary from person to person, rather than a mutation in chromosome 4. Additionally most cases develop after age 50 d. Creutzfeldt-Jacob disease- 5-10% are inherited, these cases arise from a mutation in the gene that controls formation of the normal prion protein, and typically chromosome 20 is involved
53. According to the Centers for Disease Control, which of the following is not true about self-directed violence? a. Suicidal ideation includes thinking about suicide b. A suicide attempt may or may not result in injury c. Suicide is defined only as the act of killing one’s self- The CDC defies suicide as “death caused by self- directed injurious behavior with any intent to die as a result of the behavior”. Hence the implication is not only the act, but the intent is necessary for this definition. All the other statements are true regarding suicide or suicidal ideation d. Suicidal ideation includes planning for suicide
54. Josh, a 9yo patient is experiencing a chronic motor tic disorder, which does not respond successfully to psychotherapy. After prescribing haloperidol and failing to observe a considerable improvement in the patient’s symptoms, the NP decides to use Pimozide in the course of Josh’s treatment. What diagnostic procedure should the NP consider before prescribing this drug? a. Urinalysis- used to diagnose enuuresis b. Electroencephalogram- use with ADHD if seizures are suspected c. Electrocardiogram- recommended prior to using pimozide because of the risk of QT prolongation.

d. Metabolic screening for liver function enzymes- although widely recommended diagnostic procedure for patients diagnosed with tic disorder, it is not performed as a precautionary measure prior to the use of pimozide

55. Vivian, 26 has volunteered to go to Mumbai with her fellow Christian missionaries. She will be working and living with the poor and destitute. She has received all her vaccines as a child but was advised to check with her healthcare provider. Because Vivian will be staying in a crowded part of the city with poor sanitation, which vaccination is most warranted? a. Hepatitis B vaccine- blood and body fluid b. Hepatitis A vaccine c. Pneumococcal vaccine- 65 or older, or children 2 and older and are immunocompromised d. Mumps vaccine-
56. You have been treating Elizabeth, a 56yo, for her anxiety. She was driving, against your recommendation, and had a car accident. She is on Medicare, and asks if her health insurance covers inpatient hospitalization. What version of Medicare covers inpatient hospitalization? Medicare A & C cover inpatient hospitalization a. Neither Medicare A nor B b. Medicare A- intended for hospitalization and other forms of inpatient services, such as skilled nursing facility services and hospice c. Both Medicare A and B d. Medicare B- covers outpatient hospitalization but no overnight stay, provides coverage aimed at medical tests and treatments, such as laboratory and diagnostic procedures, as well as the use of medical equipment during tests and treatment
57. At 11years of age, Lorena reports an intense dislike of school, especially since her English class has been broken into groups to write and perform their own version of A Midsummer Night’s Dream. Because she has gotten into trouble for her lack of follow-through with various past projects, the teacher has assigned her a small role. Lorena thinks she is being singled out and ridiculed. She tells you that she hates the idea of having to come up with her own version of the play. She also states that she is afraid of dealing with her English group because they act “all cliquey” and that she has no friends in the group. Lorena is in which of the following Eriksonian stages of development? a. Generativity vs stagnation- occurs later in life (40-59yo), and concerns attempts to contribute to the world via a career and/or family life b. Identity vs role confusion- adolescence 12-20yo c. Intimacy vs isolation- early adulthood 20-39yo and is concerned with developing close, committed relationships with other people rather than mastering tasks and group relationships d. Industry vs inferiority- a period of development in which a child’s productivity is associated with his or

her self-esteem

58. A 55yo patient has battled alcoholism in the past, but he has been sober for several years. However, his recent work-related stress, recent late nights out, and the smell of his breath have all caused his wife to believe he has recently relapsed. Which of the following could detect whether the patient has been drinking? a. Aspartate aminotransferase of 34 IU/L- normal 10-34IU/L if elevated may have signs of liver damage due to alcoholism b. Carbohydrate deficient transferrin of 5%- Carbohydrate-deficient transferrin levels higher than 2.6% indicate than an individual is consuming at least 5 drinks a day for the past two weeks. c. Gamma glutamyl transferase of 45 IU/L- normal is between 0-51IU/L if elevated may have signs of liver damage due to alcoholism d. Mean corpuscular volume of 90 fL- normal 80-100fL
59. Your clinically depressed patient has attempted suicide twice in the last five years. He recently told you that he has been having overwhelming suicidal thoughts over the last week. Which of the following is the best way to proceed? a. Contact the police to have the patient arrested b. Refer the patient for a psychiatrist appointment c. Restrain the patient d. Involuntary commitment
60. Which childhood disorder usually develops prior to the first birthday with clinical presentation normally beginning at six months of age? a. TIC disorder- typically occurs between ages of 6-12, but can be observed as late as age 18 b. Rett syndrome- uncommon neurodegenerative disease which usually develops prior to the first birthday, with clinical presentation normally beginning at 6 months. c. Attention Deficit Hyperactivity Disorder- manifests before the age of 7 d. Classical autism- does not have any particular age incidence associated with it
61. As part of the therapeutic intervention for a patient who was recently in a house fire, you have the patient restate the problem. This involves allowing the patient to assimilate multiple aspects related to his or her crisis. Which of the following is not one of those aspects? a. Clearly identify support- aspect of situational support, which pertains to assessing crisis, not therapeutic intervention b. Examples of failed coping- therapeutic aspects of restating the problem

c. Simple dynamics of hazardous situation- therapeutic aspects of restating the problem d. Disruption of support system- therapeutic aspects of restating the problem

62. Tom, your 40yo patient, has an extensive history of taking hallucinogenic drugs while attending rock concerts in his younger years. Tom stopped taking hallucinogenic drugs about 10 years ago when he started getting panic attacks, he now feels like he is detached from the environment and sometimes detached from his body. During these episodes, he loses track of time and thinks that he is going crazy. Tom adds that these episodes occur unprovoked and do not feel like panic attacks. Which of the following is Tom most likely experiencing? a. Anxiety disorder b. Multiple personality disorder c. Depersonalization disorder d. Schizophrenia
63. A patient who takes desipramine regularly presents with a recent onset of cardiac dysrhythmia and severe hypotension. Which of the following amounts of desipramine would you expect to find in his system? Cardiac dysrhythmia and severe hypotension indicate toxic desipramine levels. This can occur when desipramine is mixed with alcohol or when levels of the drug in the patient’s blood are above 300 ng/ml a. Above 25 ug/ml- toxic barrier for gabapentin b. Above 200 ng/ml- toxic level for flurazepam c. Above 300 ng/ml d. Above 0.2 mg/ml- toxic level for fluoxetine and norfluoxetine
64. Which of the following is not a treatment option for a patient with trichotillomania? a. Pimozide b. Buspirone- treatment for another impulse control disorder, pathological gambling, as well as anxiety conditions. c. Naltrexone d. SSRIs
65. Jeff, 39, was diagnosed with generalized anxiety disorder six months ago and has been taking citalopram. Jeff says that although his anxiety has improved somewhat he still does not “feel right.” He experiences near constant feelings of worry, nervousness, and heat intolerance. Moreover, he has lost nearly 20 pounds without changes I diet or exercise and is having difficulty falling and staying asleep. You initially suspect that Jeff may need a different anti-depressant, however, during your consultation, you learn that the patient has not family or childhood history of anxiety, no avoidant behavior, and no anxiety-provoking events to explain his experience. Based on his symptoms, which of the following is the most likely differential diagnosis? a. Hyperthyroidism b. Hypoglycemia

c. Diabetes mellitus type 1 d. Diabetes mellitus type 2

66. When a patient has sudden inability to recall important personal information, it is defined as dissociative amnesia. Of the following, all are different categories of dissociative amnesia except: a. Continuous b. Localized c. Generalized there is not physiological category of dissociative amnesia. Brain tumors, which are physiological, can lead to depersonalization but is not itself a depersonalization disorder.
67. Monica’s situation at work has been impacting her mental health. She is experiencing stress over workplace politics and interpersonal tensions. This has caused her to experience breathing difficulty and feelings as though her world were “caving in.” She has elevated levels of 5-hydroxytryptamine and norepinephrine. Which of the following is most associated with these labs? a. Anxiety disorders b. Bipolar disorder c. Thought disorder d. Depression
68. For a urinalysis, which of the following substances has the longest detection periods? a. Cocaine b. Morphine c. Heroin d. Cannabis
69. A 28yo African American male has a family history of prostate cancer. At what age should he begin receiving an annual prostate screening? a. At age 35 b. At age 50 c. At age 40- it is recommended that males with a family history of prostate cancer, or African-American males, begin prostate screening at age 40. Apart from these risk factors, all males 50 or older should receive a digital rectal exam and a prostate surface antigen test annualy d. At age 45
70. The parents of Jimmy, a 4yo male, like to joke that he took a liking to girls at a younger age that expected. He seems to prefer the company of girls his age and often engages in games and activities with them. The parents start to wonder if there is a developmental explanation for his interests and disassociation with other boys his age. Using the development of human sexuality as a model, what would your response to Jimmy’s parents be? d. Physiological-

a. Jimmy should not be drawn to heterosexual activities at his age, and this could be a sign of a developmental deficiency b. It is common for children of Jimmy’s age to engage in heterosexual play c. The conceptualization of love begins very early, usually between the ages of 4 and 6 d. Jimmy has not yet understood his gender and i’s meaning which usually happens about four years of age.

71. Your patient has been prescribed chlorpromazine to treat schizophrenia which of the following is a lifethreatening condition that could result directly from the use of antipsychotics? a. Neuroleptic malignant syndrome b. Metabolic syndrome c. Metabolic malignant syndrome d. Neuroleptic syndrome
72. Which of the following is not true about the phases of a crisis? a. Emergency problem-solving resources may still work- don’t work they are called upon and fail, further increasing the temporary disequilibrium produced in a crisis. b. Crisis produces temporary disequilibrium c. Major disorganization occurs d. Self-concept is threatened- after being confronted by a hazard
73. When counseling a patient with an anxiety disorder about the goals of treatment, which of the following statements is most accurate? a. The goal of treatment is to increase tolerance of anxiety b. The goal of treatment is to decrease the capacity for anxiety c. The goal of treatment is to do what is necessary to eliminate anxiety triggers d. The goal of treatment is to eliminate the source(s) of the anxiety all together
74. You witness a MVA in which a woman was hit by an oncoming bus. She did not have the right of way and the bus was unable to stop in time. As a NP, you rush to her aid, get someone to call 911, and perform CPR until the ambulance arrives. The woman, Nancy survived the incident but is now suing you for denying her right to commit suicide. How would the Good Samaritan statue protect you in this case? a. It protects healthcare providers from lawsuits when they aid at the scene of an

accident b. It protects healthcare workers from frivolous lawsuits c. It would reveal the suicidal plaintiff to be mentally ill and without merit d. By law, it obligates healthcare workers to provide reasonable care at the scene of an accident

75. Your patient, Daniel, who is of Argentine descent, moved to Japan with his family at the age of 15. He left Japan years ago to make a new home in the US, as he feared being perceived as different and foreign while in Japan. Daniel has spent the last ten years learning the cultural norms of his new environment. However, as Daniel is proud of his heritage, he has pledged to himself to keep close his own cultural values and norms. He still speaks his first language with his family, and attempts to teach his neighbors and new friend’s words and phrases in his native language. Of the following, which socialization issue has Daniel been dealing with for the last ten years? a. Assimilation- losing all of cultural relation b. Acculturation- attempts to maintain his own cultural values and norms, while accepting and learning a new culture c. Xenophobia- what Daniel experienced in Japan fear of being perceived as foreign d. Ethnocentrism- would have to use heritage as base of judgment, and he does not
76. You suspect that 10yo Joann is being emotionally abused by her mother. Which of the following behavioral sign would most lead you to this conclusion? a. Joann steals food at the behest of her mother- suggests emotional abuse b. Joann answers in short words and sentences- suggests physical abuse c. Joann is afraid to go home after your sessions with her- suggests physical abuse d. Joann acts seductive towards adults when she wants something- indicate sexual abuse
77. Your therapy with your client, Ben, is highly structured and short term. You explain that therapy will last 12- 16 weeks. Ben is severely depressed and says that nothing he does will ever make a difference in his life. You tell ben that his attitude is rooted in a systemic bias because he is depressed. Your strategy is to modify Ben’s dysfunctional thinking through collaborative empiricism. What therapeutic theory are you practicing? a. Person centered therapy b. Cognitive behavioral therapy c. Gestalt therapy d. Psychoanalytic Therapy
78. What is the purpose of the reporting system established by The Patient Safety and Quality Improvement Act?

a. Resolve patient safety and health care quality issues- by providing measurable data for research and analysis. Healthcare providers submit patient data safety events to the reporting system without risk of incurring any liability. The resulting database from the reporting system is then used only by “Patient Safety Organizations” and healthcare providers for research and analysis. The database may provide some information concerning patients with pre-existing conditions to healthcare providers, but this information is only incidentally part of the patient safety event. b. List patients with pre-existing conditions to healthcare providers c. List medial errors of healthcare providers and allocate liability d. Provide patients information about healthcare provider error rates

79. A 30yo comes to your office admitting he has a serious substance abuse problem. He drinks alcohol regularly throughout the day and recognizes several alcoholic traits within himself. While it has not caused any serious problems thus far, he wants to get to the roof of the problem and quit “cold turkey.” Which of the following medications would be most useful in deferring his regular alcohol consumption? a. Benzodiazepines b. Disulfiram c. Clonidine d. Thiamine
80. An 8yo child whose judgments and actions are guided by a fear of punishment as well as the possibility of reward is said to be within the pre-conventional levels according to Lawrence Kohlberg. This stage is most analogous to which of Jean Piaget’s stages of moral development? a. Moral realism b. Autonomous morality c. Social morality d. Amoral
81. You consult with a social worker who is concerned about the erratic and aggressive behavior of 15yo James. The social worker informs you that James comes from a large family and that his father has been incarcerated for domestic violence. In addition, James himself has been linked to a local gang and found guilty of petty theft. Lastly, laboratory tests conducted on James indicate elevated levels of plasma testosterone. What is the most likely diagnosis for James’s disorder? a. Attention-deficit hyperactivity disorder b. Conduct disorder c. Communication disorder

d. Oppositional defiant disorder

82. A 23yo presents to your office to tell you that he has been having trouble sleeping recently, so he began smoking marijuana. He says that the marijuana helps calm him down before going to sleep, otherwise he has been feeling well. However, according to his parents, he also drinks heavily before he goes to sleep. In addition, he dropped out of college six months ago because of a lack of interest and inability to focus. Additionally, after dropping out, he bought a plane ticket insisting that it was for a trip he was taking with his new girlfriend. His parents slowly realized there was no girlfriend at all, yet he insisted that she was at a nearby restaurant. Finally, the parents decided to send him to a professional. For which of the following should the patient be examined? a. Attention-deficit hyperactivity disorder and delirium tremens b. Schizophrenia and substance abuse c. Insomnia and substance abuse d. Bipolar disorder and substance abuse
83. Alma is being treated for depression with phenetzine sulfate. Which of the following is not a side effect typically associated with the class of this drug? Phenetzine sulfate is a MAOI, which can cause side effects of insomnia, dizziness, vertigo, and headaches. a. Headaches b. Dizziness c. Insomnia d. Nervousness – side effect of SSRIs not MAOIs
84. You are seeing a patient, who is committed to a facility, is threatening the safety of the other patients. What is the best initial course of action? During a possible crisis in the clinical setting, it is of utmost importance to ensure the safety of the patients and the staff. If a patient is making threats against another patient, security personnel should be present to maintain safety. a. Call the police b. Restrain the patient- could injure the patient c. Call security d. Eject the patient
85. Anna presents with an abdominal circumference greater than 37 inches, elevated triglycerides at 150mg/dl, and blood pressure of 136/85 mm Hg. Additionally, she is taking olanzapine for bipolar disorder. Which of the following is the most likely diagnosis? a. Neuroleptic malignant syndrome b. Neuroleptic syndrome

c. Metabolic Syndrome d. Metabolic malignant syndrome

86. John is a violent drunkard who often beats his children. His wife, Jane, has instructed their two children to never speak to anyone about their father’s violence for fear the police would take them away and put them in foster care. As a result, the siblings would never see each other again. Jane believed this was the best way to appease John and keep the family together. The result was that one child has stopped talking and the other has taken to beating other kids in school. Which of the following theorists posited a key concept regarding family therapy that most characterized this situation? a. Jay Haley- a key concept is that families inadvertently develop strategies to solve problems and then the strategies used become problems, such as in the case with this family. b. Salvador Minuchin- focuses on diffused and rigid boundaries causing problems in a family dynamic c. Murray Bowen- stresses triangulation as the building block of the family’s emotional system d. Joseph Wolpe- known for theories in behavioral therapy, not family therapy
87. Susan, 9, is brought in by her parents because they think Susan’s erratic behavior is due to a condition. Her parents say that Susan is very hyperactive and is often times inattentive. They mention that they has seen this before but attributed it to her being a child, yet she continues to exhibit the behavior despite attempts to discipline her. The NP notices Susan fidgets and squirms, then gets up and paces while she talks. Which of the following test should the NP use to confirm the suspected diagnosis? a. Folstein Mini-Mental Status Exam b. Denver II exam c. Vanderbilt assessment d. Dubowitz Ballard Exam
88. You are called to treat a patient in the emergency room who presents with confusion and agitation. The patient has received primary care at this hospital for several years, yet is currently unable to recognize her location. She is also unable to tell you the date. Which of the following is the most likely cause of the patient’s current condition? a. Delirium b. Schizophrenia c. Sundowner’s syndrome d. Substance Induced Persisting dementia

89. You are working with the Adams family. The 13yo daughter, Emily is pregnant. Emily is extremely anxious about the pregnancy, and she has not yet revealed it to her parents. Instead, today Emily complains about her father. She feels that he is a tyrant and insists that she can’t come home with anything less than an A on her report card. Using the key concepts outlined by Murray Bowen about the family system theory, what is the dynamic presented here by Emily? a. Cutoffs b. Emotional reactivity c. Fusion d. Triangulation
90. A disheveled, 32yo female visits your office. She presents with bruises and a black eye that she said resulted from “running into a door”. However, you suspect a case of possible domestic violence. Which of the following is initially necessary in managing this patient’s care? a. Prescribe SSRI b. Check the patient’s vitals c. Immediately report abuse to the police d. Refer the patient to a crisis intervention counselor
91. Nina, 39, presents to the emergency room with a severe laceration on her hand while trying to set a “booby trap” outside her bedroom window. Nina says she is psychic and had a premonition that someone was going to break into her house that night. She also says that when she has premonitions, she feels her arms and legs become heavy as if “someone is tugging at me, trying to tell me something.” You note that Nina has a disheveled appearance and an eccentric style of dress, with colorfully dyed hair and clothes. She is also agitated and has difficulty communicating, often struggling for words and stuttering frequently. You strongly suspect that she has a personality disorder. Which of the following is the most likely diagnosis based on your observations? a. Schizotypal personality disorder b. Schizoid personality disorder- exhibit significant social withdrawal and introversion as a key part of their presentation c. Narcissistic Personality disorder- exhibit grandiose sense of self-importance, need for attention, an arrogant personality d. Histrionic personality disorder- eccentric and flamboyant behaviors, and have seductive, superficial relationships
92. Ingrid is being treated with an MAOI for her depression. She also has high blood pressure, and you know that her medications present the risk of hypertensive crisis. In order to prevent a hypertensive crisis, which of the following is a compound in foods, Ingrid should avoid?

a. Thorazine b. Tryptophan c. Cholesterol d. Tyramine

93. According to the literature, the crisis is not the precipitating event in a patient. Which of the following is? a. The threat to self-concept- the crisis is not the precipitating event the reaction is b. The temporary disequilibrium- the threat to self-concept and disequilibrium presents when a crisis occurs. c. The hazard- confronting the hazard is often the beginning of the crisis, preceding the precipitating event d. The reaction
94. Which of the following is not a cultural assessment issue consideration? a. Registered political party b. Dietary practices c. Ethnic origin d. Religious beliefs
95. You are studying localized mental activities within a psychotic patient’s brain. As part of a test, you administer a radiographic substance into the patient’s circulatory system. Over the next two to three hours the test will show either increased or decreased activity in various brain areas. Since this test is primarily used on an experimental basis, it is very expensive. What test are you utilizing on this patient? a. Magnetic resonance imaging- takes 35-45 min, shows the gross structure of the brain, and is used in diagnosing new onset psychosis or dementia b. Electroencephalography- detects brain rhythm abnormalities, which can identify possible causes of seizures to diagnose epilepsy, and evaluate brain tumors or brain abscesses. c. Brain mapping- shows the topographic map of the brain and spinal cord but does not show localized activities d. Positron emission tomography- shows localized mental activities, either decreased or increased. The patient is administered a radiographic substance into the circulatory system in order to chart pathways, metabolic activity and blood flow within the brain
96. Ralphi presents with findings of neuroleptic malignant syndrome (NMS), the result of his thorazine treatment. Which of the following describes the classic symptoms of NMS?