PB PMHNP Review Questions – Targeted Practice for Psychiatric-Mental Health NP Board Exam., Exams of Nursing

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The purpose of the ANA's PMHNP Scope and Standards of Practice is to: A. Define the role and actions for the NP B. Establish the legal authority for the prescription of psychotropic meds C. Define the legal statutes of the role of the PMHNP D. Define the differences between the physician role and NP role - - # CORRECT ANSWERS A. Define the role and actions for the NP. Primary prevention care practices are an essential aspect of the PMHNP role. Which of the following is the best example of a primary prevention care strategy for community behavioral health? A. Aftercare program for chronically mentally ill clients recently discharged from the hospital. B. Court ordered counseling for abusive parents. C. 24 hour crisis hotlines D. Parenting skills classes for pregnant adolescents - - # CORRECT ANSWERW The trend in legal rulings on cases involving mental illness over the past 25 years has been to A. Encourage juries to find defendants, not guilty by reason of insanity. B. Protect the persons, freedoms or rights when he or she is committed to a mental hospital. C. Place increasing trust in mental health professionals to make good and ethical decisions. D. Decrease the redtape associated with commitments so that commitments are faster and easier. - - # CORRECT ANSWER # Mr. Smith an involuntarily hospitalized patient experiencing psychotic symptoms, refuses to take any of his ordered medication because he believes Jesus Christ told him that he is a profit and must fast for a year. Your actions should be based on your knowledge of which of the following. A. Psychiatric clients cannot refuse treatment. B. Psychiatric clients do not always know what is good for them. C. Psychiatric clients can refuse treatment. D. Psychiatric clients cannot be trusted to make good healthcare decisions, and therefore the nurses best clinical judgment should be guiding actions. - - # CORRECT ANSWER Which of the following statements best reflects the difference between the nurse-client relationship, and a social relationship? A. The nurse client relationship has a primary focus on the client and the clients needs. B. Goals in the nurse, client relationship or deliberately left, vague and unspoken so that the client can work on any issue. C. In the nurse, client relationship, the nurse is solely responsible for making the relationship work. D. In the nurse client relationship there is no place for social interaction. - - # CORRECT ANSWER® A. The nurse client relationship has a primary focus on the client and the clients needs. Acommunity has an unusually high incidence of depression and drug use among the teenage population. The public health nurses decide to address this problem, in part by modifying the environment and strengthening the capacities of families, to prevent the development of new cases of depression and drug use. What is this an example of? A. Primary prevention. B. Secondary prevention C. Tertiary prevention. D. Protective factorial prevention. - - #” CORRECT ANSWER® A. Primary prevention. demonstrate the original symptoms that had brought her to treatment initially. She is now hesitant to discharge and wants to continue services while displaying an increase in regressive defense mechanisms. What is the best explanation for Ms. French's behavior? A. And exacerbation of her symptoms related to stress B. The normal cyclical nature of chronic mental health symptoms. C. A sign of normal resistance to termination seen in the termination phase of therapy. D. A sign of pathological attachment to the therapist that must be addressed. - - # CORRECT ANSWERS A client is displaying low self-esteem, poor self control, self-doubt, and a high level of dependency. These behaviors indicate developmental failure to which of the follawing stages of development A, Infancy. B. Early childhood. C. Late childhood. D. School-age. - - # CORRECT ANSWER Mr. Thompson has been forgetful lately. For example, forgetting where he has placed his keys or what time appointments are scheduled he has stated that she thinks these are just random behaviors that have no particular meaning. Which Freudian based psychodynamic principal assumes that all behavior and actions are purposeful? A. Pleasure principle. B. Psychic, determinism principal. C. Reality principle. D. Unconsciousness principal. - - ~# CORRECT ANSWERY An example of a mature, healthy defense mechanism is A. Denial. B. Rationalization C. Repression. D. Suppression. - - # CORRECT ANSWER? Mr. Johnson is a 54-year-old client. You have been seeing for several weeks in therapy. While discussing his current concerns of marital stress, he lies on the floor and assumes the fetal position. This is most likely an example of. A. Immature, regressive, defense mechanism. B. Denial of reality. C. Immature, fantasy defense mechanism. D. Repressive behavior. - - ~# CORRECT ANSWER Defense mechanisms are best food as a function of the ego A. To alert us to harm and danger. B. To alert us to problems C. Used to resolve conflict. D. Used to protect the Ed.- - # CORRECT ANSWERS One of the healthcare changes that has occurred as a result of the affordable care act is that doctors, hospitals, clinic groups, or health systems are coming together, and assuming the responsibility for quality care to large groups of individuals insured by Medicare. The healthcare clinic/systems doctors or hospitals that join together are called, which of the following? A. Health maintenance organization. B. Preferred provider network. C. Accountable care, organization. D. Individual health plan.- - # CORRECT ANSWERW C. A building block for amino acids. D. An agent to break down enzymes. - - # CORRECT ANSWER Serotonin is produced in which of the following locations A. Locus ceruleus B. Nucleus basalis C. Raphe nuclei D. Substantia nigra - - # CORRECT ANSWERY Dopamine is produced in which of the following locations A. Locus ceruleus B. Nucleus basalis C. Raphe nuclei D. Substantia nigra - - #&# CORRECT ANSWERS Aclient presents with complaints of changes in appetite, feeling fatigued, problems with sleep, rest cycle, and changes in libido. What is the Nuro anatomical area of the brain that is responsible for the normal regulation of these functions? A. Thalamus. B. Hypothalamus. C. Limbic system. D. Hippocampus. - - # CORRECT ANSWERYW In considering whether to order an MRI of the head for a client, which of the following would be a contraindication to this diagnostic test? A. Prosthetic limb. B. History of head trauma. C. Pacemaker. D. Pregnancy. - - # CORRECT ANSWER The primary excitatory neurotransmitter is A. Gaba B. Serotonin C. Dopamine. D. Glutamate. - - # CORRECT ANSWERY A client is experiencing difficulties with working memory, planning and prioritizing, insight into his problems, and impulse control and presents for assessment. In planning his care, the PMHNP should apply their knowledge that these symptoms represent problems with the. A. Frontal lobe. B. Temporal lobe. C. Parietal lobe. D. Occipital lobe - - # CORRECT ANSWER The concept of target symptom identification is best explained as A. Identification of the major clinical presentation of the client. B. Identification of specific, precise and individualize symptoms reasonably expected to improve with medication. C. Identification of the secondary messenger system syndrome. D. Intentional modulation of synaptic pathways. - - # CORRECT ANSWERS The goal of the psychiatric assessment process performed by the PMHNP is to A. Gain an understanding of the life experiences of the client. B. Correctly diagnose the client. B. Client has a probable anxiety disorder. C. Client has limited intellectual ability. D. Unable to interpret the findings without knowing the clients age. - - # CORRECT ANSWER The PMHNP is planning to work with a client using an individual therapy model of care. During the first session, the client makes the following statement "this is the third time my son has run away. | have grounded him, taken away his bike, even tried cutting off his allowance and confining him to his room. What should | do now? " The most therapeutic response for the PMHNP to make is: A. | wonder if confining him to his room was abusive B. Maybe that depends on what you are trying to accomplish. C. Perhaps talking to his friends and teachers would help. D. Remain silent. - - # CORRECT ANSWER A client says to the PMHNP quote. Somedays life is just not worth it. All my wife and | ever do is fight in scream. Things at home would be calmer and simpler if | just wasn't there anymore. The most therapeutic response for the PMHNP to make is. A. Do you mean that you are thinking about leaving your wife and moving out? B. Tell me what you mean by it would be simpler if you just weren't there anymore. C. So you are thinking suicide might be an option for you? D. Remain silent. - - # CORRECT ANSWERS Miss Shay has come to the mental health center seeking treatment for depression. She has a history of suicide attempt by overdose one month ago. She was started on imipramine (TCA) after that event, but stop taking the medication one week later, because it "did no good". The PMHNP meets with Miss Shay to plant care with her. Which of the following is the most appropriate initial action? A. Asking Miss Shay how to help her B. Providing client teaching about the long time frame for TCAs to work. C. Contracting with Miss Shay for six sessions of individual therapy. D. Providing miss Shay with feedback about how suicide might affect her family - - #7 CORRECT ANSWER In completing the PMHNP assessment for Miss Shay, the most appropriate lab test for the PMHNP to order at this time is A. CBC. B. TSH C. LFTs. D. Electrolyte panel. - - ## CORRECT ANSWER A client comes into the clinic with a long-standing history of depression and chronic renal failure. He is on an antidepressant, antidiuretic and complains of increased depression, mild confusion, irritability, and overall apathy from being too tired to do anything. The best initial PMHNP action to take at this time is. A. Increases dose of antidepressant medication to better capture symptoms. B. Change him to another antidepressant for better symptom control. C. Augment his antidepressant with an atypical antipsychotic. D. Order a CMP. - - # CORRECT ANSWERW Sarah presents for her initial intake appointment with complaints of depression. She is being treated for hypertension and asthma by her primary care provider. Knowing that certain medication can cause or exacerbate depression, you obtain a complete medication history. Which of the following medication is known to exacerbate or cause depression A, Omeprazole. B. Propranolol. C. Synthroid. b. Addiction c. Tolerance d. Potency - - # CORRECT ANSWER C. Tolerance means needing more to achieve the same effect. Why is group therapy beneficial? A. It assists the client to focus on self. B. It lacks theoretical frameworks. C. It's enables participants to acquire therapeutic factors. D. It is always time-limited. - - # CORRECT ANSWERS Which of the following is the best rationale for using cognitive behavioral therapy? A, Recognize and change automatic thoughts B. See reality as you see it. C. Change reality by changing the environment. D. Recognize and except that automatic thoughts, suggest delusional thinking. - - # CORRECT ANSWER® A. Recognize and change automatic thoughts When working with a dysfunctional family, you find that the father worries excessively and is resistant to change. You give the father a paradoxical directive to worry extremely well for one hour per day, knowing that he will likely be non-compliant, and thus change will occur. With this technique you are using which type of therapy? A. Experiential therapy. B. Structural therapy. C. Strategic therapy. D. Solution focused therapy. - - # CORRECT ANSWERW Which of the following best describes homeostasis in a family system? A. Choices a family makes to keep the peace. B. Balance or stability that the family returns to despite its dysfunction. C. Need for a change and balance in a family. D. com In a family that returns after a crisis. - - # CORRECT ANSWERS In an attempt to bring the client toward the goal, he or she is working on you ask the client "if a miracle were to happen tonight while you slept, and you were woke in the morning, and the problem no longer existed, how would you know and what would be different?" This technique is used in which type of therapy? A. Behavioral therapy. B. Solution focused therapy. C. Adlerian therapy. D. Existential therapy. - - # CORRECT ANSWERS Miss Thomas has been diagnosed with major depressive disorder and is placed an fluoxetine 20 mg for her depression. For the PMHNP to effectively monitor her use of the medication, which of the following actions should be part of ongoing care? A. Use of standardize rating scale of depression. B. Monitoring for potential abuse of the medication. C. Monitoring of labs for renal functioning D. Monitoring for potential cardiac side effects. - - #” CORRECT ANSWERW A Which of the following is the best reason for considering the SSRI among the first line drug choices for treating major depression A. Need to stairstep additional dosage. B. Sedated and calming effect of the medication. C. Safe use in suicidal overdose clients. D. Adjustment disorder with mixed features. - - # CORRECT ANSWER C. No at this point the student does not meet criteria for a mental disorder. Jason, Mrs. several appointments. The PMHNP Notes she feels resentful toward Jason, at the struggling with how to respond to him when he finally comes in for his appointment. Which of the following demonstrates a therapeutic response. A. Jason, since you have missed several appointments, we are closing your case. B. Jason, it's pretty clear to me that you don't want to be here. C. Jason, you are a Beveland about seeking treatment. D. Jason help me understand what is going on so we can figure out how to proceed. - - # CORRECT ANSWER D. Jason help me understand what is going on so we can figure out how to proceed. Which is true about pharmacological treatment of anxiety and older adults? A. Course of treatment is generally shorter than for younger adults. B. Drugs that are highly oxidized are more unpredictable than drugs that are mostly conjugated. C. The therapeutic dose of SSRIs is generally lower than for younger adults. D. High lipophilic drugs have a more linear elimination in older adults. - - # CORRECT ANSWER® Fee. Drugs that are highly oxidized or more unpredictable, the drugs that are more conjugated. Liver enzyme functioning diminishes as we age. A client returns for a follow up appointment three weeks after started on fluoxetine 20 mg. During this appointment, you noticed that her speech is a little rapid. It marked contrast to the psycho motor, retardation and paucity of spontaneous speech. She displayed on her first visit. Instead of looking at the floor, she now makes normal eye contact. Her affect has God from constricted too expensive. She continues to have difficulty sleeping, but her energy has improved and she states she feels so much better!. What should you conclude about the shift in the clients presentation? A. She is experiencing the activating side effects of fluoxetine. B. She is becoming euthymic. C. She is becoming hypomanic. D. She is in a mixed state. - - # CORRECT ANSWER C. She is becoming hypomanic. Mr. D is a 35-year-old, married, high tech industry executive who is referred to the PMHNP for insomnia. Mr. D reports that he falls asleep quickly, but has difficulty staying asleep. He wakes up several times during the night, and believes he tosses and turns, even when he is sleeping. He wakes up, feeling exhausted and drinks a pot of coffee to stay awake and concentrate during his long workday. He drinks one glass of wine most evenings. He denies any illicit substance use. He denies any symptoms of a mood or anxiety disorder, but it's feeling increasingly frustrated and concerned about his sleep. Which of the following is the most likely contributing factor to Mr. D's on going middle insomnia? A. Obstructive sleep apnea. B. Caffeine dependence C. Alcohol withdrawal. D. ADHD. - - &# CORRECT ANSWERS Tina is a 54-year-old single white woman who has been a PMHNP for over 20 years. She is considering applying to a doctorate program, but states "if a DNP is required to practice, I'll get grandfathered in, no need for me to go back to school "following the 2008 license, accreditation, certification, and education consensus model for APRNs, which statement is correct? A. Tina is correct. If the DNP becomes a requirement, she will be grandfathered in and obtain a DNP degree. B. The DNP is an academic terminal degree and there will not be an opportunity for Tina to be grandfathered in a DNP. C. Tina will be grandfathered in and obtain a DNP old leave. Her state requires a DNP to practice as a nurse practitioner D. The DNP is a certification, and Tina will have to take it examination to be grandfathered in to obtain a DNP. - - # CORRECT ANSWER® B. The DNP is an academic terminal degree and there will not be an opportunity for Tina to be grandfathered in a DNP. b. Complete a patient assessment, including the mini mental status examination and family collateral data to determine competency. c. Call the hospitalist and provide education that competency is a legal concept and explain that you can assess the patient for the capacity to make medical decisions. d. Refuse the consult and inform the hospitalist that this is outside your scope of practice. - - « CORRECT ANSWER A You are asked by a church organization to work with members within your healthcare system to develop a flu vaccination program. According to public health principles, this is an example of what level of prevention? A. Secondary. B. Preventative. C. Tertiary. D. Primary. - - # CORRECT ANSWER A client with bipolar | disorder presents to your office for a follow up visit. During the visit the client informed you that he no longer wants to be treated with medication and he does not have bipolar disorder. That was a missed diagnosis. He further in Forbes, you, he stopped all his medication two months ago. It is here to thank you for your care and tell you that he no longer needs follow up appointments. Understanding the ethical conflict you use which of the following ethical principles in working with this client? A. Autonomy B. Non malfeasance. C. Justice. D. Beneficence - - # CORRECT ANSWER A. Autonomy. Anew client reveals to the PMHNP that her boyfriend screams at her and has repeatedly slapped and pushed her in front of her 3-year-old san. She goes on to say that the boyfriend has thrown things at her and on one occasion threw a glass of water at her that hit her son in the back. Should the PMHNP report this to child protective services (CPS)? a. Yes, the client is issuing a cry for help for her son. b. Yes, the PMHNP has a duty to report. c. No, this does not constitute a reportable offense. d. No, a report to CPS will escalate the violence. - - #” CORRECT ANSWER® BB. Yes, the PMHNP has a duty to report. Which of the following is a function of the psychiatric interview? A. Understand the clients psychosocial needs to communicate them to the treatment team. B. Identify the mental health needs of the client. C. Review previous Medical Records. D. Evaluate a treatment plan. - - # CORRECT ANSWER® B. Identify the mental health needs of the client. A 74-year-old married white woman was referred to you by her primary care provider for a psychiatric evaluation. She had a normal medical and neurological examination in the last 2 months. The client presents with her husband of 45 years who states, "My wife is just not the same anymore, she is irritable and asks the same question several times, even though I've answered it many times." The client responds, "Oh, Henry, you do the same thing, it's just a normal part of getting older, and the kids think everything is fine." During the assessment you compete the mini mental status examination (MMSE) and the client scores 18. As the PMHNP treating the client, you know the results of her MMSE indicate which level of cognitive impairment? a. No cognitive impairment b. Mild cognitive impairment c. Moderate cognitive impairment d. Severe cognitive impairment - - #” CORRECT ANSWERY You are the PMHNP treating Tim, a 10-year-old child, for ADHD and social anxiety disorder. His mother presents with Tim for his scheduled individual therapy session. At the end of the session his mother says, "I need to take Tim to see his pediatrician and at the last visit | was told he