NRNP 6675 MIDTERM EXAM (100-100 POINTS), Exams of Nursing

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1. Which of the following are risk factors for neuroleptic malignant syndrome? Select all that apply  Age  Rapid dose escalation  Parental route of administration  Higher potency typical antipsychotics 2. Antipsychotic medications provide D2 blockade in the mesocortical pathway causing which of the following effects?  Reduces negative symptoms  Increases extra pyramidal symptoms (EPS)  Causes prolactinemia  Reduces positive symptoms 3. Phencyclidine (PCP) and Ketamine exert their unique behavioral effects by blocking which of the following receptors?  GABA type receptors  Serotonin receptors  Dopamine receptors  NMDA type receptors 4. The diagnosis used to describe a syndrome characterized by specific signs and symptoms resulting from recent ingestion or exposure to a substance is known as which of the following?  Substance intoxication  Substance withdrawal  Substance use disorder  Any of the above 5. Abnormal involuntary movements in a rhythmic pattern affecting face, mouth, tongue, jaw is known as which of the following?

 Akathisia  Dystonia  Tardive dyskinesia  Extrapyramidal side effects

6. A deeply held belief despite evidence to the contrary, lasting at least one month, without prominent hallucinations, with functional impairment that relates to the delusional system  Schizophrenia  Delusional disorder  Brief psychotic disorder  Schizophreniform disorder 7. Which of the following is true about preoccupation with castration?  This can be serious and life-threatening if castration is carried out without medical supervision.  This is consistent with Transvestic Disorder  This is consistent with other specified paraphilic disorder  This is consistent with sexual masochism disorder 8. Which of the following is a system that provides a uniform language for describing medical and surgical procedures and diagnostic services rendered by clinicians?  HIPPA  DSM-  CPT  DRG 9. A patient on Chlorpromazine states that his orgasm is dry and afterward he will commonly have milky urine. The ARNP realizes which of the following?  This is likely a harmless response to the Chlorpromazine  This is abnormal and needs to be evaluated by a specialist  It is critical to stop the Chlorpromazine immediately

14. Having an adequate legal description of nurse practitioner (NP) scope of practice according to state law is important for which of the following reasons?  To avoid any charges of practicing medicine without a license  To place accountability for both benefits and harm to patients squarely on the NP  To get reimbursement for physician services when provided by an NP  All of the above 15. Which of the following is the most widely consumed psychoactive substance?  Alcohol  Caffeine  Heroine  Cannabis 16. Which of the following is used to treat Tardive Dyskinesia?  Cogentin (benztropine)  Artane (trihexyphenidyl)  Catapress (Clonidine)  None of the above 17. The APRN consensus model did which of the following?  Merged adult, gerontology and pediatric foci so that all NPs could truly work across the....  Adult and gerontology were merged and identified as primary care or acute care  Psychiatric mental health foci were stipulated as across the lifespan  B and C 18. Which of the following behaviors are associated with an alcohol blood level of 0.05 percent?  Voluntary motor actions usually become perceptibly clumsy  Thought judgment, and restraint are impaired  Confusion, stupor

 None of the above

19. According to HIPPA, which of the following must the NP share their NPI with? Check all that apply.  Health plans  Other providers  Any entity that may need it for billing purpose  A and C only 20. A patient presents with delusions, disorganized thoughts, and speech with poor self care all of which have persisted for the past 7 months. The APRN this presentation is.......with which of the following diagnosis?  Schizophrenia  Schizophreniform disorder  Brief psychotic disorder  Delusional disorder 21. Major neurotransmitters possibly involved in developing substance abuse and substance dependence..... which of the following?  Dopamine  GABA  Serotonin  A and B only 22. The Dopamine hypothesis of schizophrenia....which of the following?  Schizophrenia results from too much dopaminergic activity  Schizophrenia results from a deprivation of dopamine.  Schizophrenia is not related to dopamine activity  None of the above

 Fear  Stress  Normal anxiety  Pathological anxiety

28. If a pregnancy begins while the woman is taking high doses of methadone and withdrawal is desired, during which trimester is this least hazardous?  First trimester  Second trimester  Third trimester  Withdrawal from methadone should never be done while the woman is pregnant 29. Neurochemical or neurophysiologic changes in the body that result from the repeated administration of a drug is known as which of the following?  Cross-tolerance  Neurotransformation  Neuroadaptation  Neurocognitive adjustment 30. The recurrent and intense sexual arousal from the physical and psychological suffering of another person is known as which of the following?  Frotteurism  Voyeurism  Sexual sadism  Sexual masochism 31. Which of the following is not consistent with the onset of OCD?  More than half of patients with OCD have a sudden onset of symptoms  The onset of symptoms for about 50-70 percent of patients occurs after a stressful event.  Most patients keep their symptoms secret initially.  The onset of OCD is typically preceded by OCD personality traits.

32. The recurrent urge to expose one's genitals to a stranger is known as which of the following?  Fetishism  Voyeurism  Exhibitionism  Paraphilic disorder 33. Which of the following patients would be appropriate for hospitalization for substance use disorder? Select all that apply.  Patients who have a substance overdose who cannot be safely treated in an outpatient setting  Patients who are at risk for severe or medically complicated withdrawal syndromes  Patients who have a history of not benefiting from treatment in a less intensive setting  A and B only 34. The nursing practice model recommended for NPs by the National Academy of Medicine and the National Council of State Boards of Nursing is which of the following?  Full practice  Reduced practice  Restricted practice  Arbitrary practice 35. Which of the following groups does Medicare cover? Select all that apply.  Individuals 65 years and older who have enrolled and pay premiums  Disabled individuals who qualify for Social Security Disability payments and benefits  Adults who are disabled for one year or less and who qualify on the basis of poverty  Mothers and children who qualify on the basis of poverty. 36. Which of the following neurotransmitters increases libido?

 Motivational interviewing  Cognitive behavioral therapy

41. The conditions in which people are born, grow, work, live, and age are known as which of the following?  Health literacy  Health disparities  Health vulnerabilities  Social determinants of health 42. All the following is consistent with ANCC rules regarding recertification EXCEPT:  You are required to have a maximum of 25 credit hours during each certification period  You can start the recertification process 1 year before your expiration date, but no later than 3 months before.  You must have 1000 clinical practice hours in the clinical specialty within the preceding 5 years.  You must have at least 25 contact hours in pharmacotherapy. 43. Risk factors for school violence include which of the following? Select all that apply.  Bullying  Being bullied  Isolation  Involvement in school organizations. 44. Persons who subordinate their own needs to those of others, get other to assume responsibility for major areas of the lives, lack of self-confidence, and may experience intense discomfort when alone for more than a brief period of time are demonstrating characteristics consistent with which of the following personality disorders?  Avoidant personality disorder  Passive personality disorder

 Dependent personality disorder  Antisocial personality disorder

45. Generalized convulsions, oliguria, and renal failure are symptoms seen with which of the following lithium levels?  0.8-1.5 mEq/L  1.5-2.0 mEq/L  2.0-2.5 mEq/L  >2.5 mEq/L 46. .....form of child abuse in which a patient or character repeatedly fabricates or actually inflicts injury or illness in a child for whom medical intervention is then sought in an emergency setting is known as which of the following?  Korsakoff's syndrome  Snyder's syndrome  Munchausen syndrome  Munchausen syndrome by proxy 47. Self-care strategies for the ARNP in preparing for the certification exam include all of the following EXCEPT?  Study in a distraction free environment  Six to eight hours of sleep is recommended  Drink lot of caffeine and eat high concentrated sugars  Plan to study for short periods of time over a longer time period. 48. A patient presents with a formal, tense manner. He reluctantly reports a longstanding (since early adulthood) pervasive suspiciousness of others, preoccupied with...trustworthiness of friends, unjustified concerns about others deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP. The ARNP suspects that the patient likely has which of the following personality disorders?  Schizoid personality disorder  Paranoid personality disorder  Borderline personality disorder

 Neglect  Physical abuse  Financial abuse/exploitation  Emotional/psychological abuse

54. The ARNP recognizes which of the following as long term effects of sex trafficking on victims?  Severe depression  Spiritual questions  Trauma bonding  All of the above 55. In about half of the cases in which suicides occur while parents are on a psychiatric unit, a lawsuit results. Which of the following is not consistent with what courts....related to impatient psychiatric unit suicide events?  Courts expect suicides to occur in inpatient settings  Courts require zero suicide rates in inpatient setting  Periodic patient evaluation for suicide risk  Evidence of formulation of a treatment plan with a high level of security 56. Cultural Dimensions Therapy is a framework for cross-cultural communication that describes the effects of a society's culture on the values of its members....by which of the following theorists?  Hofstede  Leininger  Purcell  Campinha-Bacote 57. The treatment of choice for patients with paranoid personality disorder includes which of the following?  Group therapy  Behavioral therapy  Psychotherapy  B and C

58. The differences in the quality of healthcare across individuals or groups in regard to access, treatment options, and p....following?  Racism  Health disparities  Vulnerable populations  Social determinants of health 59. The incidence of suicide is highest for which of the following populations?  Older Latino men  Older Caucasian men  Older Caucasian women  Older African American men 60. A patient on lithium with a history of alcohol use disorder presents with dry mouth, ataxia, dizziness, abdominal pain, and slurred speech. The ARNP should do which of the following?  The ARNP recognizes this is likely a relapse on alcohol so sends the patient home to sleep it off.  The ARNP recognizes these are symptoms of mild to moderate lithium toxicity, decreases the lithium by half, and encourage the patient to drink more fluids  The ARNP recognizes these are symptoms of mild to moderate lithium toxicity, discontinues the lithium immediately, orders lithium level, serum electrolytes, and renal function tests  The ARNP recognizes these are symptoms of moderate to severe lithium toxicity, discontinues the lithium and tells the patient hemodialysis will most probably be needed. 61. An ARNP takes a position in which a specific amount is paid according to a set job description. This type of pay structure is known as which of the following?  Straight salary  Average percentage of net receipts  Base salary plus percentage  Hourly rate

66. A patient with history of hypoglycemia reports feelings of fear, worry, and restlessness that has persisted over the past 6 months. The patient states these feelings are worse when glucose is low. The ARNP suspects the patient has which of the following diagnoses?  Generalized anxiety disorder attributable to another medical condition  Panic attacks attributable to another medical condition  Hypoglycemia with anxiety  None of the above 67. Which of the following is not consistent with benzodiazepine withdrawal?  Benzodiazepine withdrawal can continue to develop for several weeks  The best way to proceed with benzodiazepine withdrawal is to stop it immediately and treat withdrawal symptoms  It may be helpful to switch to a long-acting benzodiazepine for withdrawal  If patient is on a therapeutic benzodiazepine dose, initiate 10-25 percent dose reduction and evaluate response. 68. Which of the following is true about the legal practice of the psychiatric-mental health nurse practitioner?  All have some degree of prescriptive privileges in all states and the District of Columbia.  All are considered primary providers in all states and the District of Columbia.  All have the ability to manage patients medically within their scope of practice without a collaborative practice agreement.  A and B only 69. Flashbacks in which the individual may act and feel as if the trauma were reoccurring represent which of the following clinical features of PTSD?  Intrusion symptom  Symptom of avoidance  Symptom of increased autonomic arousal  Derealization

70. In which ways are nurse practitioners (NPs) and physician's assistants (Pas) different?  NPs differ from PAs in legal definition, scope of practice, licensure, and independence of practice.  NPs practice under their own license and independent of the physician, PAs always work under the supervision of a physician.  There is essentially no difference functionally between an NP and a PA.  A and B 71. Which of the following initials would a psychiatric-mental health nurse practitioner use to designate appropriate credentials?  ANP-C  CPNP  CPNP-AC  PMHNP-BC 72. Variations from norms in gender role behavior such as toy preferences, rough- and-tumble play, aggression, or playmate gender is known as which of the following?  Gender discordance  Gender role behavior  Gender identity variance  Childhood gender non-conformity 73. The three major neurotransmitters associated with anxiety, based on animal studies and response to drug treatment include which of the following?  Glutamate, Norepinephrine, Serotonin  GABA, Norepinephrine, Serotonin  GABA, Dopamine, Glutamate  Dopamine, Norepinephrine, Serotonin 74. Which of the following is consistent with the epidemiology of schizophrenia in the United States?

 Autism, apperception, amotivation, automatism.

79. The fear of or anxiety regarding places from which escape might be difficult is known as which of the following?  Depression  Panic disorder  Agoraphobia  Generalized anxiety disorder 80. All of the following are one of the five major categories of third-party payers EXCEPT:  Medicare/Medicaid  Managed-care organizations (MCOs)  Indemnity insurance companies  Only A and B 81. Discrepancy between anatomical sex and gender identity is known as which of the following?  Gender role behavior  Gender discordance  Gender nonconformity  Internalized sexual prejudice 82. Which of the following is not a common physical effect of cannabis?  Mild tachycardia  Mild bradycardia  Orthostatic hypotension  Dilation of the conjunctival blood vessels 83. A conscious standardized recurrent behavior such as counting, checking, avoiding that interferes significantly with the person's normal routine and functioning is known as which of the following?

 A compulsion  An obsession  Obsessive-Compulsive Disorder  Obsessive-Compulsive Personality Disorder

84. Most everyone has a firm conviction that they are male or female by which age range?  0-1 years of age  2-3 years of age  4-5 years of age  6-7 years of age 85. A patient who presents absent movement with difficulty starting activities flat affect, and avolition would be assessed as having which of the following?  Dystonia  Akathisia  Akinesia  Pseudo-Parkinson's 86. Which of the following is consistent with current epidemiology literature about gender and Obsessive-Compulsive Disorder (OCD)?  Adult men are more likely to have OCD than adult women.  Adult women are more likely to have OCD than adult men  Adolescent girls are more likely to have OCD than adolescent boys.  Adult men and adult women are equally likely to have OCD. 87. A type of schizophrenia in which the individual has a marked disturbance in motor function and may involve stupor, negativism, rigidity, excitement or posturing or mutism is  Residual Type  Catatonic Type  Disorganized Type  Undifferentiated Type