PMHNP ANCC Review Questions & Answers 2024, Exams of Nursing

Download PMHNP ANCC Review Questions & Answers 2024 and more Exams Nursing in PDF only on Docsity! PMHNP ANCC Review Questions & Answers 2024 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 Answers ✅A. The ANAs Psych-Mental Health Nursing Scope and Standards of Practice defines the role and actions of the nurse practitioner. D. Information reduces incidence of disease. - Correct Answers ✅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 The trend in legal rulings on cases involving mental illness over the past 25 years has been to PMHNP ANCC Review Questions & Answers 2024 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 Answers ✅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 Answers ✅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. PMHNP ANCC Review Questions & Answers 2024 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 Answers ✅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 PMHNP ANCC Review Questions & Answers 2024 d. A sign of pathological attachment to the therapist that must be addressed - Correct Answers ✅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 Answers ✅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 PMHNP ANCC Review Questions & Answers 2024 d. Unconsciousness principle - Correct Answers ✅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 Answers ✅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 Answers ✅A. Immature regressive defense mechanism is a return to a behavior common to an earlier stage of development. PMHNP ANCC Review Questions & Answers 2024 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 Answers ✅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 Answers ✅A. Neurotransmitters in the central nervous system function as a communication medium. Serotonin is produced in which of the following locations: a. Locus ceruleus PMHNP ANCC Review Questions & Answers 2024 b. Nucleus basalis c. Raphe nuclei d. Substantia nigra - Correct Answers ✅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 Answers ✅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 Answers ✅B. Appetite, sleep, and libido are regulated by the hypothalamus. PMHNP ANCC Review Questions & Answers 2024 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 Answers ✅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 Answers ✅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 PMHNP ANCC Review Questions & Answers 2024 b. Recognizing c. Validating d. Sequencing - Correct Answers ✅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 Answers ✅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. 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 PMHNP ANCC Review Questions & Answers 2024 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 Answers ✅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 Answers ✅B. This response is the most therapeutic, allowing the client to further clarify and express feelings. 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? PMHNP ANCC Review Questions & Answers 2024 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 Answers ✅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 Answers ✅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. A client comes into the clinic with a longstanding history of depression and chronic renal failure. He is on an antidepressant and a diuretic 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 PMHNP ANCC Review Questions & Answers 2024 c. Pharmacokinetics d. Distribution - Correct Answers ✅C. Pharmacokinetics is the study of what the body does to drugs. Your client Sam is being treated for panic disorder with agoraphobia. He currently is being prescribed paroxetine (Paxil CR, 37.5 mg q.d.) and clonazepam (Klonopin, 0.5 mg q.d., p.r.n.). He has been on clonazepam for 2 years and admits to needing 4 pills to achieve the same effect that 1 pill initially produced. This is possibly an example of which process? a. Kindling b. Addiction c. Tolerance d. Potency - Correct Answers ✅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 enables participants to acquire therapeutic factors d. It is always time limited - Correct Answers ✅D. Group therapy is beneficial because it increases social skills, is cost-effective, and enables participants to acquire the curative factors. PMHNP ANCC Review Questions & Answers 2024 Which of the following is the best rationale for using cognitive behavioral therapy? a. Recognize and change his or her automatic thoughts b. See reality as you see it c. Change his or her reality by changing his or her environment d. Recognize and accept that automatic thoughts suggest delusional thinking - Correct Answers ✅A. Cognitive behavioral therapy helps clients recognize and change their automatic thoughts. When working with a dysfunctional family, you find that the father, Jim, worries excessively and is resistant to change. You give Jim a paradoxical directive to worry extremely well for 1 hour per day, knowing that he will likely be noncompliant, 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 Answers ✅C. Paradoxical directives are used in strategic therapy. 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 PMHNP ANCC Review Questions & Answers 2024 c. Need for change and balance in a family d. Calm in a family that returns after a crisis - Correct Answers ✅B. Homeostasis is balance or stability that the family returns to despite its dysfunction. 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 awoke 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 ✅B. Miracle questions are used in solution-focused therapy. Ms. Thomas has been diagnosed with major depressive disorder (MDD) and is placed on 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 a standardized rating scale of depression b. Monitoring for potential abuse of the medication c. Monitoring of labs for renal functioning PMHNP ANCC Review Questions & Answers 2024 d. Yes, adjustment disorder with mixed features - Correct Answers ✅C. The student does not meet criteria for alcohol use or other disorder at this point, but if he does not learn alternative coping skills to deal with his shyness, he is at risk of developing an alcohol use disorder. Jason misses several appointments. The PMHNP notes she feels resentful toward Jason and is struggling with how to respond to Jason 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 ambivalent about seeking treatment." d. "Jason, help me understand what's going on so we can figure out how to proceed." - Correct Answers ✅D. Although the PMHNP's resentment is in response to actual behavior by Jason (his missing several appointments), clarifiying what is going on for him, his expectations for treatment and the PMHNP's (and the clinic's) expectations in a non-judgemental manner will help to develop a therapeutic alliance. Which is true about pharmacologic treatment of anxiety in older adults? a. Course of treatment is generally shorter than for younger adults. PMHNP ANCC Review Questions & Answers 2024 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 young adults. d. Highly lipophilic drugs have a more linear elimination in older adults. - Correct Answers ✅B. Liver enzyme functioning (among other things) diminishes as we age. All of the other statements are false. A client returns for a follow-up appointment 3 weeks after starting on fluoxetine 20 mg. During this appointment you notice that her speech is a little rapid, in marked contrast to the psychomotor 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 gone from constricted to expansive. 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 client's 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 Answers ✅C. In this case, you see a shifting set of symptoms, the most important being her expansive mood and statement "so much better" that indicates she has gone beyond euthymia. PMHNP ANCC Review Questions & Answers 2024 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 work day. He drinks 1 glass of wine most evenings. He denies any illicit substance use. He denies any symptoms of a mood or anxiety disorder, but is feeling increasingly frustrated and concerned about his sleep. Which of the following is the most likely contributing factor to Mr. D.'s ongoing middle insomnia? a. Obstructive sleep apnea (OSA) b. Caffeine dependence c. Alcohol withdrawal d. Attention-deficit hyperactivity disorder (ADHD) - Correct Answers ✅A. OSA is the only plausible possibility if the rest of the information given by the client is accurate. OSA causes clients to have frequent awakenings and a sense that they are not sleeping deeply ("tossing and turning") that is caused by apnea. The client should be assessed further for snoring and awareness of apnea. Although the client states he drinks a lot of coffee, this is driven by his sleep issues. Drinking 1 glass of wine in the evening would not cause the degree of sleep pathology PMHNP ANCC Review Questions & Answers 2024 b. Plan, do, study, act project c. A task that is outside of the PMHNP's scope of practice d. Quality improvement initiativ - Correct Answers ✅D. Engaging in a project to assess whether a standard of care was met is a quality improvement project. A PMHNP who is working on the consult liaison service is referred to a patient in the medical intensive care unit by the attending hospitalist. The consult note read "Evaluate the patient for competency to make independent medical decisions and consent for a surgical procedure." Based on the scope of practice of a PMHNP, which response would be most appropriate? a. Complete the patient assessment and write up the findings in the patient's medical record. 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 Answers ✅C. The legal system makes determination whether a person is competent; practitioners can assess and make a determination about a person's capacity to make medical decisions. PMHNP ANCC Review Questions & Answers 2024 You are asked by a church organization to work with members within your health 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 Answers ✅D. Prevention of illness is primary prevention and administration of flu vaccinations in a community is intended to prevent a flu outbreak. A client with bipolar I disorder presents to your PMHNP office for a follow-up visit. During the visit the client informs you that he no longer wants to be treated with medication, and he does not have bipolar disorder, that was a misdiagnosis. He further informs you he stopped all his medication 2 months ago and 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. Nonmaleficence c. Justice d. Beneficence - Correct Answers ✅A. Clients who are legally competent have the ability to make medical decisions and maintain individual autonomy. PMHNP ANCC Review Questions & Answers 2024 A new 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 son. 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 Answers ✅B. PMHNPs are mandated reporters of child abuse. The 3-year-old is being exposed to violence and although not the target, could have been injured when the boyfriend threw the glass of water. 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 Answers ✅B. During a psychiatric interview, the PMHNP is responsible to identify symptoms and needs of a client to develop an appropriate treatment plan. PMHNP ANCC Review Questions & Answers 2024 b. Vagus c. Trigeminal d. Hypoglossal - Correct Answers ✅D. The tongue is controlled by the hypoglossal cranial nerve. A 20-year-old Asian man who was recently diagnosed with schizophrenia comes to your office for a follow-up appointment. During the assessment, he talks about his experience in the group home, thinking that the television is sending him messages through news anchors during the 10 p.m. evening news. What symptom is the client describing? a. Paranoia b. Illusions c. Ideas of reference d. Neologisms - Correct Answers ✅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? PMHNP ANCC Review Questions & Answers 2024 a. Experimental b. Structural c. Strategic d. Cognitive - Correct Answers ✅C. Paradoxical directives may be used in strategic family therapy. 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 Answers ✅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 PMHNP ANCC Review Questions & Answers 2024 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 Answers ✅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. 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 Answers ✅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 PMHNP ANCC Review Questions & Answers 2024 profile, weight, body mass index, blood pressure, waist circumference, and family history of cardiovascular disease. 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 Answers ✅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 Answers ✅A. Typical antipsychotic medications block D2 receptors; atypical antipsychotic medications block D2 receptors and have 5HT2a antagonist properties. PMHNP ANCC Review Questions & Answers 2024 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/mm3 b. Absolute neutrophil count of less than 1,000/uL c. White blood cell count of less than 1,200/mm3 d. Absolute neutrophil count of less than 2,000/uL - Correct Answers ✅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. 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. PMHNP ANCC Review Questions & Answers 2024 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 Answers ✅A. Benzodiazepines are contraindicated in clients with a TBI due to increase rates of confusion and memory problems. 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? a. "You are correct that you cannot form new brain cells at your age but you should continue with your activities because they offer excellent physical and mental health benefits and in turn will lower your risk for dementia." b. "Although most brain development occurs early in life, we stil - Correct Answers ✅B. While it was once thought that brain PMHNP ANCC Review Questions & Answers 2024 a. Mild withdrawal b. Moderate withdrawal c. Severe withdrawal d. Delirium tremens - Correct Answers ✅B. CIWA cut off scores are as follows: 0-9, absent or very mild withdrawal; 10-15, mild withdrawal; 16-20, moderate withdrawal; and 21-67, severe withdrawal. A client who has been addicted to opioids has not used in 15 days. During your medication management visit, the client states, "I'm going to die from not having my Opanas. You need to give me something now." The PMHNP's best response is: a. "I know you are feeling very uncomfortable and we need to get you to the emergency room immediately to prevent a seizure." b. "I know you are feeling very uncomfortable, let's take your vital signs and talk about a trial on Catapres to treat your withdrawal symptoms." c. "You have been using Opana for a long time and it is going to take several months for the withdrawal to end. In the meantime, I will see you weekly." d. "There is no treatment for opioid withdrawal; you will have to wait it out." - Correct Answers ✅B. Opioid withdrawal symptoms can be treated with central alpha agonists. Signs and symptoms of cannabis intoxication include: a. Increase sensitivity to external stimuli PMHNP ANCC Review Questions & Answers 2024 b. Enhanced motor skills c. Fast passage of time d. Lower heart rate - Correct Answers ✅A. Persons intoxicated on cannabis exhibit distorted perceptions, increase relaxation and sensitivity, and loss of coordination. 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 Answers ✅A. Persons with obsessive-compulsive personality disorder use defense mechanisms of rationalization, isolation of affect, and intellectualization to make sense of their behavior. You have been working with Cody, a 30-year-old single man, in weekly individual psychotherapy for 3 weeks. At the start of session 4 he says, "I noticed when I came in that your usual parking spot has a new car in it with temporary tags, and it's a BMW. Nice car." What is the best response from the PMHNP psychotherapist to Cody? a. "Thanks for noticing, it is a nice car." b. "How do you know what spot I park in?" PMHNP ANCC Review Questions & Answers 2024 c. "I noticed you drive a BMW as well, how do you like your car?" d. "Sounds like having expensive things is important to you." - Correct Answers ✅D. In a therapy relationship, the therapist should try to understand the meaning of a client's statement rather than engage in social conversations. When working in individual psychotherapy with a client who has a personality disorder, what are the primary treatment goals? a. Change the client's personality structure and make him or her more adaptable in everyday life. b. Reparent the client, following Bowlby's theoretical framework. c. Allow the client to reprocess his or her childhood trauma because all clients with personality disorders have a history of severe abuse. d. Assist the client in changing dysfunctional interpersonal relationships and use of immature defense mechanisms. - Correct Answers ✅D. Persons with personality disorders have a pervasive maladaptive pattern of behavior and the goal of therapy is to slowly shift how they relate in the world and begin to use higher-order defenses. For a client who has paranoid personality disorder, what are the best treatment strategies? a. Confront negative and misinterpreted thoughts and feelings. b. Deflate grandiose thoughts. c. Engage the client in detailed and emotional responses and dialog. PMHNP ANCC Review Questions & Answers 2024 should a personality disorder be coded? a. Coded with the major psychiatric disorder b. Coded on Axis II c. Coded on Axis III d. Coded on Axis IV - Correct Answers ✅A. DSM-5 no longer uses the axial system. When prescribing a selective serotonin reuptake inhibitor (SSRI) for a child or young adult up to age 24, what education must be included? a. Black box warning about increased suicidality in this population b. Black box warning about increased risk of mania in this population c. Risk of sexual side effects on this class of medication d. Risk of stomach upset and headaches, to prevent unnecessary primary care visits - Correct Answers ✅A. The SSRIs all carry a black box warning for increased suicidal ideation for this age group. Tommy is an 8 year-old who presents to the PMHNP for evaluation of attention-deficit hyperactivity disorder. His mother completed the Vanderbilt ADHD rating scale and brought in the Vanderbilt teaching rating scale. Both your clinical interview and the rating scales indicate Tommy has ADHD. What assessment indicator(s) need to be completed prior to starting a stimulant mediation? a. Get a copy of the rating scale completed by his grandparents. PMHNP ANCC Review Questions & Answers 2024 b. Assess for family history of cardiovascular disease and, if positive for conduction problems, order an electrocardiogram before prescribing medication. c. Obtain blood pressure, and pulse, and begin the stimulant medication. d. Assess for a family history of bipolar disorder. - Correct Answers ✅B. American Academy of Child and Adolescent Psychiatry practice parameters require physical exam, pulse, weight, height, and blood pressure workup prior to the start of stimulant medication. Because his grandfather had a cardiac conduction problem, an electrocardiogram (ECG) should also be obtained prior to the start of medication. A mother brings in her 7-year-old son for a psychiatric follow-up visit with the PMHNP. This is the fourth visit the PMHNP has had with the client, his mother, and his younger sister, Renee, now 7 months old. You notice that she has a decrease in head growth, along with stereotypic motions of the hands, often licking and slapping. Renee has also lost her language skills. What medical condition do you suspect Renee has developed? a. Autism spectrum disorder b. Rett syndrome c. Selective mutism d. Childhood onset diabetes - Correct Answers ✅B. Girls with Rett's syndrome develop normally and around the 7th month regress, with a decrease in head size and language loss. PMHNP ANCC Review Questions & Answers 2024 You are treating Timothy, a 16-year-old boy, for an eating disorder. Timothy is of normal weight and socially extroverted, at times appearing to seek attention when in a peer group or class. Timothy's symptoms are most consistent with which eating disorder? a. Anorexia nervosa b. Bulimia nervosa c. Binge eating disorder d. Anxiety-induced eating disorder - Correct Answers ✅B. Clients with bulimia are often of normal weight or overweight and are outgoing. You are treating a 14-year-old female for attention-deficit hyperactivity disorder (ADHD) who has a family history of bipolar disorder. As a PMHNP familiar with symptoms of both ADHD and pediatric bipolar disorder, you know the following are overlapping symptoms of both disorders: a. Excessive talking, increased activity, and distractibility b. Irritability, sleep problems, and mood swings c. Excessive talking, irritability, and sleep problems d. Sleep problems, mood swings, and distractibility - Correct Answers ✅A. Clients with ADHD and bipolar disorder often have excessive talking, increased activity, and distractibility.