Purple Book PMHNP 100 multiple choice questions w answers ANCC.pdf, Exams of Nursing

Download Purple Book PMHNP 100 multiple choice questions w answers ANCC.pdf and more Exams Nursing in PDF only on Docsity!

1. 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 Establish the legal authority for the prescription of psychotropic B. 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 Correct Answer: A. The ANA's Psychiatric-Mental Health Nursing: Scope and Standards of Practice defines the role and actions of the nurse practitioner. 2) 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 far abusive parents c) 24-hour crisis hotlines d) Parenting skills classes for pregnant adolescents - ##” CORRECT ANSWER Correct Answer: D. Information reduces incidence of disease. 3 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. 4 Mr. Smithers, an involuntarily hospitalized patient experiencing psychotic symptoms, refuses to take any of his ordered medication because he believes "Jesus Christ told me | 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 un- less a legal process resulting in involuntary commitment or mandatory court order for treatment has been obtained. 5. 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 con- cerned with meeting the needs of the client. 6. A community has an unusually high incidence of depression and drug use among the teen- age population. The public health nurses decide to address this problem, in part, by modifying mindednessis 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. 9 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® 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 con- sidered a DSM-5 diagnosis. 10 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. lee A client is displaying low self-esteem, poor self-control, self-doubt, and a high level of de- pendency. 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 Correct Answer: B. These signs indicate developmental failure of early childhood. 12 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 BB. 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. 13 1) An example of a mature, healthy defense mechanism is a) Denial b) b. Rationalization c) Repression d) Suppression - ## CORRECT ANSWER Correct Answer: D. Suppression is the only defense mechanism listed in which the client channels conflicting energies into growth-promoting activities. d) Individual Health Plan (IHP) - # CORRECT ANSWER® 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. 17 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® 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 distribu- tion of the resources. 18 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 ANSWERW 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. 19 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 offin 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. 20 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 - #4 CORRECT ANSWER® A. Neurotransmitters in the central nervous system function as a communication medium. 24. 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. 22 Dopamine is produced in which of the following locations: b) b. Serotonin c) c. Dopamine d) d. Glutamate - # CORRECT ANSWER D. Glutamate is the primary excitatory neurotransmitter. 26 Aclient 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. aT 1) 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. 28 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® Correct Answer: C. Although diagnosis is an important aspect of the assessment process, the assessment ultimately should identify the needs of the client. 29 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 pracess. 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 re- quired during the assessment d) In the treatment room with the door closed, a neutral location - ~# CORRECT ANSWERW C. One PMHNP role is to control the milieu as an aspect of as- sessment, 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. 30 Which communication technique is the PMHNP using in the following situation? Client: "Sorry | was late. | didn't realize what time it was." PMHNP: "This is the third time now that you have been late for our sessions. | am wondering how committed you are to our working on your problems." a) Theming b) Recognizing c) Validating 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 BB. This response is the most therapeutic, allowing the client to further clarify and express feelings. 34 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 (tri- cyclic 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® 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. 35: Mrs. Shea has come ta 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 (tri- cyclic antidepressant [TCA]) after that event but stopped taking the medication 1 week later because it "did no good." 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. 36 A client comes into the clinic with a longstanding history of depression and chronic renal fail- ure. 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 a) Increase his 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 medication d) Order a comprehensive metabolic panel - # CORRECT ANSWER D. Client symptoms are consistent with electrolyte imbalance and a physical cause of his symptoms must be ruled out first. 37 Sarah presents for her initial intake appointment with complaints of depression. She is be- ing treated for hypertension and asthma by her primary care provider. Knowing that certain medications can cause or exacerbate depression, you obtain a complete medication history. Which of the following medications is known to exacerbate or cause depression? a) Omeprazole b) Propranolol c) Levothyroxine d) Clarithromycin - # CORRECT ANSWER® 8. Beta blockers can cause or exacerbate depression. 38 When treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which of the following reasons? 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- #7 CORRECT ANSWER® C. Tolerance means needing more to achieve the same effect. 42 1) 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 ANSWER D. Group therapy is beneficial because it increases social skills, is cost-effective, and enables participants to acquire the curative factors. 43 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 ANSWER®. A. Cognitive behavioral therapy helps clients recognize and change their automatic thoughts. 44 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 ANSWER C. Paradoxical directives are used in strategic therapy. 45 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 change and balance in a family d) Calm in a family that returns after a crisis - # CORRECT ANSWER B. Homeostasis is balance or stability that the family returns to despite its dysfunction. 46 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 ANSWER® 8. Miracle questions are used in solution- focused therapy. 47 50 Which of the following interventions by the PMHNP for a person experiencing ataque de nervios demonstrates culturally informed care? a) Offering brief supportive psychotherapy b) Offering a brief hospitalization c) Requesting a family member act as an interpreter d) Offering low-dose, short-term anxiolytic - # CORRECT ANSWER® A. The literature suggests that although short-term anxiolytic medication may be offered in an emergency room setting, ataque de nervios is best treated by brief supportive therapy by a Spanish-speaking Latino therapist. 51) The PMHNP working at a student mental health clinic has now been working with a fresh- man student for several weeks. The PMHNP learns that the student considers himself shy. He tells the NP that he has always felt uncomfortable in social situations or when he has to do oral presentations in class. He had few friends up until his senior year of high school when he discovered he could enjoy himself if he "had a couple of drinks before going out." He has continued this pattern in college and now occasionally drinks "2 to 3 beers" on weekends as well. According to the DSM-5, does the student have a mental disorder? a) Yes, alcohol use disorder, mild b) Yes, generalized anxiety disorder c) No, at this point, the student does not meet criteria for a mental disorder. d) Yes, adjustment disorder with mixed features - # CORRECT ANSWER® 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. 52 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 appoint- ment. 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 ANSWER 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. 53 Which is true about pharmacologic treatment of anxiety in 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 young adults. d) Highly lipophilic drugs have a more linear elimination in older adults. - # CORRECT ANSWER*® B. Liver enzyme functioning (among other things) diminishes as we age. All of the other statements are false. 54 1) 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 tothe psychomotor retardation and paucity of spontaneous speech she displayed an 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.