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A series of multiple-choice questions and answers related to the pmhnp ancc review exam. It covers various topics relevant to psychiatric-mental health nursing practice, including scope and standards of practice, legal considerations, therapeutic relationships, prevention strategies, and psychodynamic principles. The document can be a valuable resource for pmhnp students and professionals preparing for the ancc certification exam.
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HOSMERIT
The purpose of the American Nurses Association's Psychiatric-Mental Health Nursing: 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 medications c. Define the legal statutes of the role of the PMHNP d. Define the differences between the physician role and the NP role Correct Answer: A. The ANAs Psych-Mental Health Nursing Scope and Standards of Practice defines the role and actions of the nurse practitioner. 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 D. Information reduces incidence of disease. Correct Answer: Primary prevention care practices are an essential aspect of the PMHNP role. 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 person's 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 "red tape" associated with commitments so that commitments are faster and easier Correct Answer: B. Identifies the trend of ensuring the protection of individual civil liberties for psychiatric clients. Mr. Smithers, an involuntarily hospitalized patient experiencing psychotic symptoms, refuses to take any of his ordered medication because he believes "Jesus Christ told me I am the prophet 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 nurse's best clinical judgment should guide actions Correct Answer: C. As with any client, psychiatric clients can refuse treatment unless a legal process resulting in involuntary commitment or mandatory court order for treatment has been obtained. Which of the following statements best reflects the difference between the nurse-client (N-C) relationship and a social relationship?
a. In the N-C relationship, the primary focus is on the client and the client's needs. b .Goals in the N-C relationship are deliberately left vague and unspoken so that the client can work on any issue. c. In the N-C relationship, the nurse is solely responsible for making the relationship work. d. In the N-C relationship, there is no place for social interaction. Correct Answer: A. Social relationships are mutual interpersonal relationships in which the needs of both parties are addressed. The N-C relationship is most concerned with meeting the needs of the client. A community 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 is an example of? a. Primary prevention b .Secondary prevention c. Tertiary prevention d. Protective factorial prevention Correct Answer: A. This action focuses on interventions designed to reduce the incidence of new cases of disease. Mrs. Kemp is voluntarily admitted to the hospital. After 24 hours, she states she wishes to leave because "this place can't help me." The best nursing action that reflects the legal right of this client is
a. Discharge the client b. Explain that the client cannot leave until you can complete further assessment c. Allow the client to leave but have her sign forms stating she is leaving against medical advice d. Immediately start the paperwork to commit the client and to allow you to treat her against her wishes Correct Answer: B. Almost every state allows for a brief for a period detainment to assess a client for dangerousness to self or others before allowing the client to leave a hospital setting, even if the admission was voluntary. In forming a therapeutic relationship with clients, the PMHNP must consider developing many characteristics that are known to be helpful in relationship-building. Which of the following is an essential part of building a therapeutic relationship? a. Collecting a family history b. Like-mindedness c. Authenticity d. Accuracy in assessment Correct Answer: C. Authenticity. Being genuine, honest, and respectful are essential elements in establishing a working relationship with any client. Like-mindedness is not a part of the therapeutic relationship. Although an important aspect of the PMHNP role, collecting a family history and accuracy in assessment does not in and of itself facilitate relationship building. According to the DSM-5, which of the following is true? (Ch. 3) a. A mental disorder is equivalent to the need for treatment.
b. Diagnostic criteria are used to inform clinical judgment. c. Socially deviant behavior is considered a mental disorder. d. A culturally expected response to a stressor is not a mental disorder. Correct Answer: D. All DSM- 5 disorders need to be made taking a person's culture into account. A cultural expression of a response to grief, loss, or stress is not considered a DSM- 5 diagnosis. Mrs. French has been in individual therapy for 3 months. She has shown much growth and improvement in her functioning and insight and is to discontinue services within the next few weeks. In the next session, after you discuss service termination, she suddenly begins to demonstrate the original symptoms that had brought her to treatment initially. She is now hesitant to discharge, wants to continue services, and is displaying an increase in regressive defense mechanisms. What is the best explanation for Ms. French's behavior? a. An exacerbation of her symptoms related to stress b. The normal cyclic 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 Answer: C. Clients frequently display resistance and regression at the termination of a meaningful therapeutic process. The PMHNP is responsible for planning an effective termination and monitoring clients during the termination period.
A client is displaying low self-esteem, poor self-control, self-doubt, and a high level of dependency. These behaviors indicate developmental failure of which of the following stages of development: a. Infancy b. Early childhood c. Late childhood d. School age Correct Answer: B. These signs indicate developmental failure of early childhood. Mr. Thompson has been forgetful lately, for example, forgetting where he has placed his keys or what time appointments are scheduled, and he has stated that he thinks these are just random behaviors that have no particular meaning. Which Freudian-based psychodynamic principle assumes that all behavior and actions are purposeful? a. Pleasure principle b. Psychic determinism principle c. Reality principle d. Unconsciousness principle Correct Answer: B. The psychic determinism principle states that all behavior has purpose and meaning, often unconscious in nature, and that no behaviors occur randomly or by coincidence. An example of a mature, healthy defense mechanism is a. Denial b. Rationalization
c. Repression d. Suppression Correct Answer: D. Suppression is the only defense mechanism listed in which the client channels conflicting energies into growth-promoting activities. 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: A. Immature regressive defense mechanism is a return to a behavior common to an earlier stage of development. Defense mechanisms are best viewed as a function of the ego a. To alert us to harm and danger b. To alert us to problems c. Used to resolve a conflict d. Used to protect the id Correct Answer: C. Defense mechanisms are a function of the ego used to resolve a conflict. One of the health care changes that has occurred as a result of the affordable care act (ACA) 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 health care clinics/systems doctors or hospitals that join together are called which of the following? a. Health Maintenance Organization (HMO) b. Preferred Provider Network (PPO) c. Accountable Care Organization (ACO) d. Individual Health Plan (IHP) Correct Answer: C. ACO's are groups of doctors or other health care providers who voluntarily come together and assume the care provided to Medicare patients. Health care economics is concerned with making decisions so the benefits outweigh the cost of resource utilization. What are two concepts that healthcare economics is concerned with in regard to fair distribution of resources and allocation? a. Equity and efficiency b. Cost and benefits c. Opportunity and waste d. Affordable and quality Correct Answer: A. Health care efficiency is making risk and benefit decision about how care resources are allocated and equity is ensuring that there is a fair distribution of the resources. What four elements need to be present for a malpractice lawsuit to be filed? a. Beneficence, Non-Maleficence, Truthfulness, and Justice b. Duty of care, Breach of standard of care, Injury, and Injury must be related to breach of the standard of care
c. Abandonment, Breach of care, Violation of ethics, and Reimbursement for poor care d. Breach of standard of care, Injury, Deceit, and Malpractice Correct Answer: B. The four elements that must be satisfied for malpractice to have occurred are a duty of care between clinician and patient, breach of standard of care, an injury to the patient, and the patient's injury must be related to the clinician's breach of care. Mary is a Psychiatric-Mental Health Nurse Practitioner (PMHNP) who is working in a hospitalist role. Mary has encountered over five incidences in which attending psychiatrists and medical residents have been demeaning to nursing staff and not answering calls in the middle of the night or telling the nursing staff to write orders and the MD would sign off in the a.m. Mary is concerned about errors and wants to improve quality, reduce errors to promote safety. What concept is Mary employing? a. Bullying b. Abuse c. Civil Disobedience d. Just Culture Correct Answer: D. The ANA has a position statement that nurses are responsible for developing health care settings that include just culture initiatives understanding that human error can cause error and harm by creating an open and fair environment. The role of neurotransmitters in the central nervous system is to function as a. A communication medium b. A gatekeeper for transmissions
c. A building block for amino acids d. An agent to break down enzymes Correct Answer: A. Neurotransmitters in the central nervous system function as a communication medium. Serotonin is produced in which of the following locations: a. Locus ceruleus b. Nucleus basalis c. Raphe nuclei d. Substantia nigra Correct Answer: C. Serotonin is produced in the raphe nuclei. Dopamine is produced in which of the following locations: a. Locus ceruleus b. Nucleus basalis c. Raphe nuclei d. Substantia nigra Correct Answer: D. Dopamine is produced in the substantia nigra. A client presents with complaints of changes in appetite, feeling fatigued, problems with sleep- rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions? a. Thalamus
b. Hypothalamus c. Limbic system d. Hippocampus Correct Answer: B. Appetite, sleep, and libido are regulated by the hypothalamus. 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: C. A client with a pacemaker should not receive an MRI of the head. The primary excitatory neurotransmitter is a. GABA b. Serotonin c. Dopamine d. Glutamate Correct Answer: D. Glutamate is the primary excitatory neurotransmitter. A client who is experiencing difficulties with working memory, planning and prioritizing, insight into his problems, and impulse control presents for assessment. In planning his care, the PMHNP should apply his or her knowledge that these symptoms represent problems with the
a. Frontal lobe b. Temporal lobe c. Parietal lobe d. Occipital lobe Correct Answer: A. Problems with working memory, planning and prioritizing, insight into problems, and impulse control indicate a problem in the frontal lobe. Which of the following is a function of the psychiatric interview? a. Understand the client's psychosocial needs and 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. During a psychiatric interview, the PMHNP is responsible to identify symptoms and needs of a client to develop an appropriate treatment plan. 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 Answer: C. Cut points on the MMSE are as follows: total score 30, 25-30 questionable significance, 20 - 25 mild impairment, 10 - 20 moderate impairment, and 10 or lower severe impairment. 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 individualized symptoms reasonably expected to improve with medication c. Identification of the secondary messenger system syndrome d. Intentional modulation of synaptic pathways Correct Answer: B. Target symptom identification is the identification of specific, precise, and individualized symptoms reasonably expected to improve with a given medication. You are treating a client with schizophrenia who takes clozapine. What laboratory values will indicate the client needs to discontinue treatment? a. White blood cell count of less than 1,800/mm3 and absolute neutrophil count of less than 1,200/mm
b. Absolute neutrophil count of less than 1,000/uL c. White blood cell count of less than 1,200/mm d. Absolute neutrophil count of less than 2,000/uL Correct Answer: B. The recent change in monitoring clozapine clients using the risk evaluation and mitigation strategy (REMS) indicates persons treated on clozapine need to have absolute neutrophil count monitored and, if it drops below 1,000/uL, treatment must be interrupted and can be resumed once the absolute neutrophil count normalizes above 1,000/uL. You have been working with a 54 - year-old man who has been treated for schizophrenia since age
b. Illusions c. Ideas of reference d. Neologisms Correct Answer: C. Ideas of reference are misinterpretations of incidents and events that one believes have a direct personal reference to oneself. You are working with a family: mother, father, and two biological children. Sam, the father, is very rigid and controlling, which seems to be out of fear that something might happen to his family. He worries daily and it affects his family relationships. You give Sam a paradoxical directive and instruct him to intensely worry about everything he can think of for 1 hour a day. Using a paradoxical directive is part of which therapy? a. Experimental b. Structural c. Strategic d. Cognitive Correct Answer: C. Paradoxical directives may be used in strategic family therapy. Following evidence-based (EB) practice, which laboratory screening tests and assessments should be completed prior to placing a person on a second-generation ("atypical") antipsychotic medication? a. Serum glucose, lipid profile, weight, blood pressure, waist circumference, and family history of cardiovascular disease b. Comprehensive metabolic panel, body mass index, complete blood count, and thyroid panel
c. Serum glucose or hemoglobin A1c, lipid profile, weight, body mass index, blood pressure, waist circumference, and family history of cardiovascular disease d. Serum glucose, complete blood count, assessment of family history of cardiovascular disease and cancer Correct Answer: C. EB practice guidelines indicate that all clients should have the following prior to starting antipsychotic medication: fasting glucose or A1c, lipid profile, weight, body mass index, blood pressure, waist circumference, and family history of cardiovascular disease. As a PMHNP working in a crisis evaluation center, you are aware that the initial focus of a crisis assessment is on which of the following? a. Client's past diagnosis and medication trials b. Psychosocial history and supports c. Safety of the client and others d. Current living situation and coping skil Correct Answer: C. In a crisis, the first assessment should be safety of the client and those near the client. When conducting a neurological examination on a client, the PMHNP asks the client to hold out her arms and stick out her tongue while assessing for tremors. Which cranial nerve is being assessed? a. Glossopharyngeal b. Vagus
c. Trigeminal d. Hypoglossal Correct Answer: D. The tongue is controlled by the hypoglossal cranial nerve. Sean is a 47 - year-old Gulf War veteran who was in combat during Operation Desert Storm. Sean has been treated by the PMHNP for major depressive disorder and associated anxiety symptoms. During the most recent visit, the PMHNP learns that Sean sustained a traumatic brain injury during his service, which was recently diagnosed at the TBI clinic in the Veterans Affairs clinic. What is the rationale for the PMHNP to taper Sean off clonazepam? a. Benzodiazepines causes memory problems and confusion in clients with a history of a TBI. b. Benzodiazepines lower the seizure threshold in clients with a history of a TBI. c. Veterans Affairs has banned benzodiazepines from the medication formulary. d. Benzodiazepines place clients with a TBI at risk for a second head injury. Correct Answer: A. Benzodiazepines are contraindicated in clients with a TBI due to increase rates of confusion and memory problems. 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 c. Identify the mental health needs of the client d. Be able to communicate with other staff about the client's health needs
Correct Answer: C. Although diagnosis is an important aspect of the assessment process, the assessment ultimately should identify the needs of the client. Mr. Johnson is a client newly admitted to an inpatient psychiatric hospital. The PMHNP on call at the facility plans to perform the initial intake assessment and diagnostic process. Mr. Johnson asks to please talk in his room because, he says, "People make me nervous." His room is at the end of the hallway and is the farthest away from the nursing station. The PMHNP's action should be based on awareness that the best location to do the assessment is a. In Mr. Johnson's room, because it is least noisy and most comfortable for him, thus facilitating data collection b. In the dayroom, which is full of people, to observe his interactions with other people c. In a quiet place, but public enough to get assistance with client care should it be required during the assessment d. In the treatment room with the door closed, a neutral location Correct Answer: C. One PMHNP role is to control the milieu as an aspect of assessment, so the PMHNP should choose a quiet place that is public enough to get assistance with client care should it be required during the assessment. Which communication technique is the PMHNP using in the following situation? Client: "Sorry I was late. I didn't realize what time it was." PMHNP: "This is the third time now that you have been late for our sessions. I am wondering how committed you are to our working on your problems." a. Theming
b. Recognizing c. Validating d. Sequencing Correct Answer: B. This exchange is an illustration of the technique of recognizing. In assessing a client, you ask him the meaning of the proverb "People who live in glass houses shouldn't throw stones." He replies, "Because it will break the windows." The correct interpretation of this findings is a. Client has a probable mood disorder b. Client has a probable anxiety disorder c. Client has limited intellectual ability d. Unable to interpret the finding without knowing the client's age Correct Answer: D. The answer demonstrates concrete thought processes, which are normal in persons younger than age 12 but are abnormal after age 12. To interpret the finding, the PMHNP must know the age of the client. Signs and symptoms of cannabis intoxication include: a. Increase sensitivity to external stimuli b. Enhanced motor skills c. Fast passage of time d. Lower heart rate Correct Answer: A. Persons intoxicated on cannabis exhibit distorted perceptions, increase relaxation and sensitivity, and loss of coordination.
Which type of hallucination is rare in persons with psychotic illnesses and is often associated with an organic etiology? a. Auditory hallucinations b. Gustatory hallucinations c. Visual hallucinations d. Combination hallucinations Correct Answer: B. The most common type of hallucinations in persons with psychotic illnesses are auditory and visual. Tactile and gustatory hallucinations are less common and more likely related to an organic illness. What differentiates atypical antipsychotic medications from first-generation or typical antipsychotic medications? a. 5HT2a receptor antagonist properties b. 5HT2a receptor agonist properties c. Specific dopamine receptor 3 and 5HT2a blockade d. Dopamine receptor 2 antagonist properties Correct Answer: A. Typical antipsychotic medications block D2 receptors; atypical antipsychotic medications block D2 receptors and have 5HT2a antagonist properties. As a PMHNP working in an outpatient addiction clinic, you often refer your clients to community AA and NA meetings. Using Yalom's therapeutic factors, you are aware that peer-led
groups can inspire and encourage other group participants. Which therapeutic factor is instilled in AA and NA group members? a. Hope b. Altruism c. Catharsis d. Existential factors Correct Answer: A. Working in support groups such as AA and NA, hearing stories of others who had similar struggles, instills hope. Which of the following client statements best describes imitative behavior as a therapeutic factor in group therapy? a. Group members talk over one another so the loudest person is heard b. Group members begin to model aspects of other members of the group and group leaders c. Group members discuss past situations when they were bullied and felt ashamed d. Group leaders take charge of the group and redirect members when they monopolize the group Correct Answer: B. As group progresses the leader is less active and the members of the group take over and begin to model other members and the leaders. Which defense mechanisms are commonly used by persons with obsessive-compulsive personality disorder? a. Rationalization, isolation, and intellectualization b. Projection, distortion, and hypochondriasis
c. Regression, somatization, and dissociation d. Sexualization, displacement, and reaction formation Correct Answer: A. Persons with obsessive-compulsive personality disorder use defense mechanisms of rationalization, isolation of affect, and intellectualization to make sense of their behavior. 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. I've grounded him, taken away his bike, even tried cutting off his allowance and confining him to his room. What should I do now?" The most therapeutic response for the PMHNP to make is a. "I 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: B. This response will be the most therapeutic in moving forward with the client. A client says to the PMHNP, "Some days life is just not worth it. All my wife and I ever do is fight and scream. Things at home would be calmer and simpler if I 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 Answer: B. This response is the most therapeutic, allowing the client to further clarify and express feelings. Alice is a 68-year-old woman who presents to you with concerns about her memory. She explains that her mother and grandmother both experienced dementia and she wants to do what she can to prevent this terrible disease. Alice is treated for hypertension, which is well controlled; other than that she is in good health. She is socially and physically active and participates in a monthly cooking class, volunteers at her church, and plays bridge twice a week at the senior center. She says, "I understand that I am losing brain cells at my age, but I would still like to keep my mind and body active." Which is the best response to Alice? Correct Answer: B. While it was once thought that brain neurons did not regenerate, we now known that while most brain development occurs early in life, we continue to form some new brain cells throughout life. As we age, we need to engage in activities that keep our brains healthy by encouraging this growth. Examples are diet, exercise, socialization, and cognitive stimulation. Dialectical behavioral therapy (DBT) draws on cognitive theory and behavioral theory, along with other theories. Elements of behavioral theory in DBT include which of the following? a. Skills training and exposure b. Examination of feelings and relating feelings to visceral sensations
c. Working through the transference with the therapist d. Cognitive interpretation of past traumatic experiences Correct Answer: A. DBT focuses on cognitive and behavioral techniques, mindfulness including meditation, and emotional regulation. Dialectical behavioral therapy (DBT) affirms dialectical thinking, which involves examining and discussing opposing ideas to find the truth. This philosophy is a supportive principle of DBT training. The central dialectical pattern emphasized in DBT involves the tension between: a. Radical acceptance and change b. Cue exposure and block avoidance c. Problem avoidance and problem-solving d. Crisis survival and acceptance Correct Answer: A. DBT emphasis acceptance of the current reality of what is and the ability to engage in personal change. What is the best treatment for AIDS dementia complex? a. Acetylcholinesterase inhibitors b. Symptom-targeted pharmacologic treatments c. Nonpharmacologic supportive care d. Antiretroviral therapy Correct Answer: D. All persons with AIDS should be treated with antiretroviral therapy. Those who develop dementia complex should have those symptoms treated with appropriate pharmacological or nonpharmacological interventions.
Mrs. Shea has come to the mental health center seeking treatment for depression. She has a history of a suicide attempt by overdose 1 month ago. She was started on imipramine (tricyclic antidepressant [TCA]) after that event but stopped taking the medication 1 week later because it "did no good." The PMHNP meets with Mrs. Shea to plan care with her. Which of the following is the most appropriate initial action? a. Asking Mrs. Shea how to help her b. Providing client teaching about the long time frame for TCAs to work c. Contracting with Mrs. Shea for 6 sessions of individual therapy d. Providing Mrs. Shea with feedback about how suicide might affect her family Correct Answer: A. Asking the client how to help is an aspect of assessment—all other answers are aspects of interventions, which are not initial actions of the PMHNP. In completing the PMHNP assessment for the Mrs. Shea, the most appropriate lab test for the PMHNP to order at this time is a. CBC b. TSH c. Liver function tests d. Electrolyte panel Correct Answer: C. Client overdosed and then was placed on a medication that affects the liver. The PMHNP needs to assess the client's liver function as an aspect of care planning for her.