Psychiatric Nurse Practitioner: Role, Responsibilities, Clinical Decisions, Exams of Nursing

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1. A 14-year-old patient has nonspecific complaints about pain in his or her legs. The physical examination is unremarkable. Laboratory results are within normal limits except for a markedly elevated alkaline phosphatase level. The psychiatric- mental health nurse practitioner - Correctinterprets the findings as normally occurring during a rapid adolescent growth spurt
2. Laboratory findings for a patient with an alcohol use disorder indicate increased liver function values and: - Correctincreased MCV and elevated triglyceride levels.
3. A new patient arrives at the office for treatment for depression. The patient reports taking simvastatin (Zocor) and lisinopril (Zestril). When selecting an antidepressant, the psychiatric-mental health nurse practitioner eliminates fluoxetine (Prozac), based on the knowledge that the combination can lead to increased plasma levels of the statin, resulting in an increased risk of muscle damage and rhabdomyolysis. The nurse practitioner's reason is that: - Correctone medication is a CYP450 3A4 substrate and one is a CYP450 3A inhibitor.
4. A 28-year-old patient who is psychotic arrives at the clinic with family members but refuses to meet if the family members are present. The psychiatric-mental health nurse practitioner - Correctasks the family members to leave for the appointment.
5. The psychiatric-mental health nurse practitioner is responsible for initiating quality improvement at a community mental health clinic. The effective strategy for evaluating the clinic's services is to: - Correctuse a survey to elicit patient satisfaction responses.
6. The psychiatric-mental health nurse practitioner evaluates a new adult patient via telemedicine. The patient has questions about a new medication that he or she recently started. The nurse practitioner decides to provide psychoeducation and to: - Correcte-mail drug information and resources
7. Any court of law that evaluates the standards of care provided by a psychiatric- mental health nurse practitioner - Correctconsiders what a reasonably prudent health care provider would do.

8. The psychiatric-mental health nurse practitioner and a team of local mental health professionals are asked to provide crisis counseling service, after a gunman recently took a class hostage at a local elementary school, wounded several students, and then shot himself. In preparing for this assignment, the nurse practitioner recognizes that: - Correcta child's developmental stage will influence his or her response to catastrophic stress
9. Which community-based program is a tertiary level intervention? - CorrectPartial hospitalization program that provides intensive group therapy for rehabilitation.
10. A 32-year-old female patient informs the psychiatric-mental health nurse practitioner that she is three months pregnant. She has been stable on fluoxetine (Prozac) for the last two years. The patient asks whether she may safely continue this medication during her pregnancy. The nurse practitioner responds:
    • Correct"Let's review the risks and benefits of continuing or discontinuing Prozac for you and your baby."
11. Established clinical guidelines suggest that suicidality is decreased by treating patients who have borderline personality disorder with: - Correctdialectical behavioral therapy.
12. A six-year-old patient with autistic spectrum disorder has not responded to six months of psychosocial interventions and continues to demonstrate aggressive tendencies toward a younger sibling. The psychiatric-mental health nurse practitioner prescribes: - Correctrisperidone (Risperdal) 0.25 mg once a day.
13. The psychiatric-mental health nurse practitioner working in a crisis stabilization unit evaluates a patient verbalizing suicidal thoughts after being sexually assaulted. Before processing through the traumatic event, the nurse practitioner first attempts to - Correctprovide an environment of safety.
14. The psychiatric-mental health nurse practitioner uses a cognitive-behavioral approach to help a patient address self-defeating behaviors. After identifying the stressor that causes the inappropriate behavior, the initial strategy is to explore: - Correctrational and irrational beliefs about the stressor.
15. A patient who has borderline personality disorder experiences intense anxiety when the psychiatric-mental health nurse practitioner goes on vacation. The most appropriate explanation for this reaction is that the patient: - Correcthas not developed object constancy.
16. An initial psychiatric evaluation of a patient reveals a normal mental status and appropriate behavior, despite a parent's reports of "disobedience, poor grades, and laziness." To further assess the patient's functioning, the psychiatric-mental health nurse practitioner: - Correctmeets with the parent and patient together to explore the discrepant report.

17. The psychiatric-mental health nurse practitioner is employed in a newly created attending role on a psychiatric inpatient unit. To promote an interprofessional environment, the nurse practitioner: - Correctassigns a role for all staff members in improving patient outcomes.
18. The psychiatric-mental health nurse practitioner sees a 12-year-old patient who takes lisdexamfetamine (Vyvanse) 50 mg daily for attention-deficit hyperactivity disorder. The nurse practitioner observes a tic, which the parents report began after the patient began taking the psychostimulant, and it has been increasing in severity. Both the parents and the school report that the medication is helpful. The nurse practitioner: - Correctdiscontinues the psychostimulant, prescribes guanfacine extended release (Intuniv), and monitors the patient.
19. A patient from India emphasizes a strong feeling that he or she is one with Brahma and connected to life through this being. While developing a treatment plan, the psychiatric-mental health nurse practitioner realizes that this patient's spirituality also guides his or her: - Correctinterpretation of life events.
20. The psychiatric-mental health nurse practitioner is tasked with continually improving the quality of care on an inpatient unit. The nurse practitioner implements: - Correcta plan-do-study-act process
21. To improve treatment and patient outcomes, the psychiatric-mental health nurse practitioner utilizes evidence-based practices. An acceptable resource for evidence-based meta analysis is the: - CorrectCochrane database.
22. The psychiatric-mental health nurse practitioner is concerned about access-to- care issues in the local community and wants to help develop health care policy to help patients access care more effectively. The nurse practitioner knows one of the most effective avenues for developing and advocating for policy is: - Correctworking with the local chapter of the nurse's professional association.
23. A patient is referred to an outpatient psychiatric clinic for evaluation of depressive episodes after bouts of overeating. Assessment reveals a five-year history of episodes of uncontrollable overeating precipitated by feelings of tension. This occurs about two to three times per week and for the past year has been associated with laxative use, self-induced vomiting, and periods of fasting to maintain body weight. The patient reports becoming increasingly depressed and has considered suicide in the past. The treatment plan includes medical evaluation with electrolyte studies and: - Correctreferral for cognitive behavioral therapy.
24. The psychiatric-mental health nurse practitioner evaluates a female patient referred with a three-month history of moderate to severe postpartum depression. The patient has been in therapy for three weeks and has not been

prescribed medication, despite several interactions with her obstetrician and primary care provider. After researching the health care system's organizational factors that contributed to this fragmented care, the nurse practitioner - Correctfiles a complaint with the appropriate regulatory boards regarding the patient's prior care.

25. The neuroprotective treatment of choice for bipolar disorder is: - Correctlithium (Eskalith).
26. Which of the following would not be included in a progress note - Correctincident report on medication error (are included in organizational reporting but not in a patient's record)
27. Which is not insured by the University Bill of Rights for Mental Health patients? - CorrectThe right to refuse a particular mode of treatment is insured unless danger to self or others.
28. NP contacts 8 patients to ask them to phone their state senator who heads HHS to approve bill for housing the mentally ill. The nurse practitioner is acting as a... - CorrectAdvocate
29. (not necessarily a policymaker)
30. Greatest risk factors for major depressive disorder? - CorrectWomen have 2 x greater risk than men, mean age is 40 with range between (20-50) without close relationships (divorced).
31. 2015 consenses model for PMHNP.... - CorrectPsychiatric NP from birth to geriatrics
32. Outcomes measurements is the collecting and reporting about the effect of an intervention. Purposes in outcome measurements include all but... - CorrectTo observe errors in data collection
33. Yes to
34. Suggest changes
35. Intervention effectiveness
36. Profile practice patterns of providers
37. Reflex prominent risk for anti-social behavior - CorrectAntisocial behavior is 5 times more prevelant in first degree male relatives. Genetic risk factor is the greatest risk factor.
38. Older gentleman comes into the clinic for depression. Man is able to complete his own ADL's nurse notes that wife is verbally abusive to him and he has come in with bruises. He admits abuse is going on but does not want to do anything about it. - CorrectNurse has to obey his wishes as long as he is competent.

39. Which women has the greatest risk for domestic/violence? - CorrectAsian/Pacific Islander (lowest), African American/Native American/Alaska Native. Single, divorced, separated (Greatest risk). Pregnant, low income (high risk)
40. When assessing children of divorced parents... - CorrectOne-third have psychological trauma.
41. Integrated care - CorrectWhen one provider introduces a patient to another provider and then steps out.
42. Employers can't discriminate against those with a mental illness - CorrectProtected by the American's with Disability act of 1990
43. Obese female patient, depression, anxiety. She is on Desvenlafaxine, Wellbutrin, Mononessa. Has a hard time losing weight wants to know if she should take Phentermine? - CorrectNaltrexone should be added to bupropion to help decrease cravings for food. Phentermine would be a bad choice since she already has anxiety.
44. To advocate for the skills of an NP? - CorrectLocal news station to interview about the job of an NP
45. Lurasidone - CorrectEat 360 calories (preferably carbs) at night to induce sleep.
46. Woman taking Quetiapine (Seraquel) is getting a hysterectomy. NP asks if the Dr. is going to prescribe hormone replacement... - CorrectThe abrupt loss of estrogen from the ovaries can precipitate deterioration of mental state, hallucinations, delusions, and depression as well as stress from surgical menopause. Estrogen therapy can help keep the patient in a stable mental state. Estrogen exerts neuroprotection to the brain cells. It is one of the best antidepressants
47. The Mental Health and Addiction Equity Act of 2008 insures which of the following? - CorrectDollar amounts are the same for mental health disorders as they are for medical disorders.
48. PMHNP is seeking admitting privileges at a community hospital with inpatient psychiatric services need to influence lawmakers at what level? - CorrectLocal hospital
49. County board of health
50. State Board of Nursing
51. State Legislators
52. Patient has used 60 tablets of Zolpidem in 20-day period. - CorrectPharmacy calls to refill what do you say?

53. When working with adolescents who have poor affect regulation and limited response flexibility therapist strive to provide a therapeutic frame open enough for changes and consistent enough for stability and safety, which characterizes which frame? - CorrectMindful, reflective and intentional
54. This is the core of individual, group and family therapy.
55. 67 year old Vietnamese immigrant, US resident for 3 years. Speaks some English, problems with reading and writing, didn't finish school, no GED. What is your priority disparity to address with patient? - CorrectHealth Literacy
56. 6 year old female presents with mother for a new psychiatric evaluation, mother reports Sam is not making friends, stays by herself, doesn't read aloud, requests adult assurance before making a decision. What stage of Erickson's stages is Sam having difficult with? - CorrectIndustry vs inferiority stage
57. Children 5-13 working towards learning new skills and taking pride in those skill, pleasure and boundaries.
58. The risk of being overly empathetic as a therapist is commonly characterized by which response by client? - CorrectRe-enacted attachment with dependency and acting out.
59. Dependency often forms a result of parent's genuine affection, extreme attachment and overprotection. Overly empathetic can foster transference and dependency
60. 74 year old completes mini mental status exam. The patient is unable to draw the face of the clock. Which are of the brain is likely to have compromised functioning? - CorrectRight Hemisphere
61. Nigerian refugee seems to be suffering from sever PTSD since arriving in the US 3 months ago. Social worker referred him to an African American female PMHNP. PHMNP striving to build rapport. - CorrectCulturally competent care
62. 8 year old male presents with foster mom who indicates stepfather sexually abused him You know which of the following are evidence-based treatments. - CorrectTrauma-focused cognitive behavioral therapy is the minimum standard of therapy for a chid with history of trauma.
63. A normal anxiety response includes all of the following except... - CorrectDecreased perceptual field with attention focused on a small area is indicated of severe anxiety.
64. In bipolar 1 men are more prone than women to have - CorrectManic episodes
65. When manic episodes do occur in women they are more likely to have mixed (mania and depression). Woman are more likely to be rapid cyclers.

66. What best illustrates the psychosocial theory of intergenerational transmission of violence in explaining why men become batterers? - CorrectMen who witness violence in parental homes of batterers. This supports the intergenerational transmission of violence theory.
67. Tornado destroys home. Elderly couple who lost everything in the storm during the night-which is the most appropriate statement from NP at initial encounter? - CorrectWhat are your biggest concerns right now?
68. Child seen by PMHNP has difficulty feeling safe with caregiver and is unable to feel comfort. which theorist's theory would explain behavior to NP? - CorrectBowlby
69. According to Bowlby and attachment theory, children who come from parent's with increased expressed emotion and unresolved losses tend to develop disorganization attachment. Characterized by not feeling safe or comfort.
70. Core values that underlie APN and culturally competent care include... - CorrectRespect, advocacy, partnership
71. Co-leading group of elementary student of divorcing parents, a child shared his parents were arguing over the weekend and calling each other names. What intervention by the Np? - CorrectAsk child how he was affected and facilitate sharing similar incidents by other children.
72. A WBC count of 4,000 in patient taking clozapine would prompt the NP to? - CorrectDo a twice weekly blood count and monitor.
73. Cut off points for clozapine are WBC of 2,000-3,000 or granulocytes of 1,000- 1,500,
74. One of the group members states that the sexual assault group has enabled her not to feel alone. Example of Yalom curative factor? - CorrectUniversality
75. Similar problems, thoughts, feelings, you are not alone.
76. Patient comes in with symptoms of ADHD what lab test should be ordered to rule out other diagnoses? - CorrectThyroid Panel to test for hyperthyroidism
77. A normal anxiety response to anxiety does not include - CorrectPerceptual field is diminished with focus on a small area
78. Which does not reflect understanding of neurotransmitter pathways in anxiety disorder - CorrectDecreasing GABA increases anxiety
79. What QT interval result places the patient at greatest risk for torsadas de pointes? - Correct500-700 milliseconds
80. 350-440 is normal

81. Schizophrenic patient on Risperidal presents with fever, rigidity, and change in mental status. What is this? - CorrectNeuroleptic Malignant Syndrom (NMS)
82. Basic signs are autonomic instability, acute mental status change, and muscular rigidity.
83. Arcus senilis that presents before the age of 40 is associated with? - CorrectHyperlipidemia
84. What lab tests should be ordered to rule out dementia? - CorrectLow vitamin B levels have been associated with dementia
85. Maintenance phase for Bipolar 1 includes... - CorrectExtended release Carbamazepine is for acute treatment but not the maintenance phase of Bipolar
86. Tommy is a 10 year old boy who is fixated on rules and is distressed when things are out of place. According to Piaget what stage of development is he having trouble mastering? - CorrectStage of concrete operations...age 7-
87. What area of the brain has been implicated to modulate pain and can explain how transcranial magnetic stimulation can decrease pain? - CorrectPrefrontal cortex modulates pain and the perception of pain. Loss of gray matter has been associated with chronic pain.
88. 23 year old hispanic mother comes in with her 4 year old son for "mal de ojo" with fitful sleep, diarrhea, vomiting and fever. - CorrectNP respects the understanding of the mother of what is wrong with her child. The NP would then negotiate with mother for the best outcome of the child.
89. Negative group outcomes are associated with what qualities of group leaders? - CorrectLeaders that are too confrontational
90. The following is an example of defense mechanism sublimation? - CorrectA mother whose child is killed by a drunk driver becomes involved in legislation. Sublimation is redirecting unacceptable feelings into acceptable channels.
91. Patient presents with flu-like symptoms after not taking sertraline Zoloft) for 5 days. Which symptoms would indicate SSRI discontinuation syndrome? - CorrectAgitation, nausea, dysphoria and disequilibrium. If it was
92. Teenagers with poor affect and limited response flexibility which therapeutic frame open enough for changes consistent enough for stability and safety? - CorrectMindful, reflective, intentional

93. What direct-acting dopamine receptor agonist is recommended to be used in the treatment of NMS to help lower the dopamine receptor blockade? - CorrectBromocriptine (parlodel), dantrium is a muscle relaxant, cogentin and artane are anticholinergics for extrapyramidal side effects.
94. Mother asks a question about why her son should get the HPV vaccine - CorrectCDC recommends all males between the ages of 11-12. NP is involved in health promotion.
95. What features on a 12-year-old boy would raise concern for Fragile X syndrome?
    • CorrectLong head and ears, short stature, hyperextensible joints
96. A girls states this group has made me not feel so alone - CorrectExample of Yalom's currative factor "universality"
97. When working with an avoidant patient with a history of trauma, what type of communication techniques are helpful? - CorrectTechniques to increase arousal
98. Which of the following statements reflect the current understanding of dopamine pathways and clinical symptoms in schizophrenia? - CorrectPositive symptoms (halluncinations and delusions) are thought to be caused by dopamine hyperactivity in the mesolimbic tract which regulates memory and emotion???????
99. Which serotonin receptor antagonism makes an antipsychotic "atypical?" - Correct5HT2A
100. Which of the following findings on MRI and PET scans would be uncommon in individuals with schizophrenia? - CorrectIndividuals with schizophrenia have enlarged cerebral ventricles. There is a decrease in electrical activity in the frontal lobes, decreased glutamate and GABA release, and decreased total brain volume.