Psychiatric Mental Health Nurse Exam

1) A 45-year-old patient is concerned about his mental health and has a family history of schizophrenia. The psychiatric-mental health nurse practitioner’s initial action is to:
a) Reassure the patient that genetic factors alone do not determine mental health.
b) Recommend immediate genetic testing for a precise diagnosis.
c) Suggest starting antipsychotic medication as a preventive measure.
d) Assess the patient’s current stressors and coping mechanisms.
Answer: D
Explanation: To understand the mental health status of the patient and formulate an appropriate plan, an initial assessment of the patient’s current stressors and coping mechanisms is essential.

2) A 35-year-old patient is considering medication-assisted treatment having a history of substance use disorder. The psychiatric-mental health nurse practitioner’s primary consideration should be:
a) Administering a benzodiazepine for immediate relief.
b) Prescribing an opioid antagonist to deter substance use.
c) Assessing the patient’s readiness for behavioral therapy.
d) Evaluating liver function before initiating any pharmacotherapy.
Answer: C
Explanation: Before considering medication-assisted treatment, assessing the patient’s readiness for behavioral therapy is crucial. This ensures a comprehensive and tailored approach to recovery.

3) A patient is at risk for a serious drug interaction as both a monoamine oxidase inhibitor (MAOI) and a selective serotonin reuptake inhibitor (SSRI) are prescribed. The psychiatric-mental health nurse practitioner recognizes this risk primarily involves:
a) Pharmacodynamic interactions altering receptor sensitivity.
b) Therapeutic duplication leading to cumulative effects.
c) Dietary supplement-drug interactions impacting SSRI efficacy.
d) Pharmacokinetic interactions affecting drug metabolism.
Answer: D
Explanation: Due to pharmacokinetic interactions, the coadministration of an SSRI and an MAOI poses a risk of serious drug interaction, which affects drug metabolism. This interaction can potentially result in adverse effects or therapeutic failure.

4) A patient diagnosed with a bacterial infection is on a stable dose of an antipsychotic medication and prescribed an antibiotic. The psychiatric-mental health nurse practitioner anticipates potential interactions related to the following:
a) Pharmacodynamic interactions altering receptor sensitivity.
b) Therapeutic duplication leading to cumulative effects.
c) Pharmacokinetic interactions affecting drug metabolism.
d) Dietary supplement-drug interactions influencing medication efficacy.
Answer: C
Explanation: The combination of an antibiotic and an antipsychotic medication potentially impacts the antipsychotic’s efficacy and safety and raises concerns about pharmacokinetic interactions affecting drug metabolism.

5) A 55-year-old patient is asking about the potential benefits of complementary and alternative medicine (CAM), diagnosed with PTSD. The psychiatric-mental health nurse practitioner should:
a) Discuss various CAM modalities and their potential benefits.
b) Dismiss CAM as ineffective and potentially harmful.
c) Recommend surgery as a more effective treatment option.
d) Suggest increasing medication dosage instead.
Answer: A
Explanation: The psychiatric nurse practitioner should discuss various CAM modalities and their potential benefits. This allows the patient to explore complementary treatment options.

6) A 22-year-old patient with schizophrenia is prescribed clozapine, a drug known for potential variations in drug response due to genetic factors. What precautions should the psychiatric-mental health nurse practitioner consider when managing this patient’s medication?
a) Monitor for changes in environmental and developmental factors.
b) Conduct genetic testing to identify potential drug-metabolizing enzyme variations.
c) Adjust the medication dosage based on patient feedback.
d) Explore alternative antipsychotic medications to minimize genetic variability.
Answer: B
Explanation: Clozapine response can be influenced by genetic factors. Performing genetic testing to identify drug-metabolizing enzyme variations helps optimize the dosage and minimize the risk of adverse effects.

7) An 8-year-old child is prescribed medication for attention-deficit/hyperactivity disorder (ADHD). The psychiatric-mental health nurse practitioner recognizes the need for specialized monitoring due to the child’s age. What consideration should be prioritized in the management of potential adverse drug reactions for this pediatric patient?
a) Increased risk of fatal reactions in children under 5 years old
b) Regular monitoring for therapeutic drug levels
c) Genetic factors influencing drug metabolism in children
d) Potential adverse effects associated with ADHD medications
Answer: D
Explanation: For pediatric patients, monitoring for potential adverse effects associated with specific medications, especially those used for ADHD, is crucial for early detection and intervention.

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8) A 45-year-old patient, recently started on a new antipsychotic medication, reports involuntary movements and muscle stiffness. The psychiatric-mental health nurse practitioner recognizes these symptoms as indicative of:
a) A predictable dose-related adverse drug reaction.
b) An idiosyncratic adverse drug reaction.
c) An allergic adverse drug reaction.
d) A therapeutic response to the medication.
Answer: B
Explanation: Involuntary movements and muscle stiffness suggest an idiosyncratic adverse drug reaction unrelated to dose or allergy.

9) A patient develops an itchy rash, upper airway edema, and hypotension after taking a new medication. The psychiatric-mental health nurse practitioner identifies these symptoms as indicative of:
a) Predictable dose-related adverse drug reaction.
b) Allergic adverse drug reaction.
c) Idiosyncratic adverse drug reaction.
d) Therapeutic response to the medication.
Answer: B
Explanation: Itchy rash, upper airway edema, and hypotension suggest an allergic adverse drug reaction, typically occurring after initial exposure.

10) A patient on long-term medication experiences dose-related adverse reactions. The psychiatric-mental health nurse practitioner contemplates modifying the dose or eliminating precipitating factors. This approach is most applicable when adverse reactions involve:
a) Idiosyncratic responses.
b) Allergic reactions.
c) Opioid-induced constipation.
d) Hypotension and upper airway edema.
Answer: C
Explanation: Modifying the dose or eliminating precipitating factors is often effective for dose-related adverse reactions, such as opioid-induced constipation. Psychiatric Mental Health Nurse Exam.

11) A patient on psychiatric medications presents with nasal congestion. What intervention should the psychiatric-mental health nurse practitioner recommend to manage this side effect?
a) Prescribe a systemic antihistamine; consider a medication change.
b) Dark glasses and sunblock; cover all exposed areas.
c) Monitor for infections; withhold medication for sinus tachycardia.
d) Nasal drops and moisturizer; avoid nasal spray.
Answer: D
Explanation: Nasal drops and moisturizer can alleviate nasal congestion, and avoiding nasal spray is essential to prevent worsening symptoms.

12) A 30-year-old patient is prescribed a new psychiatric medication with a history of anaphylactic reactions. What term describes the situation where retaking the medication could harm the patient?
a) Absolute contraindication.
b) Relative contraindication.
c) Pharmacokinetics.
d) Bioavailability.
Answer: A
Explanation: Anaphylactic reactions create an absolute contraindication, indicating potential life- threatening harm if the medication is taken again.

13) A 60-year-old patient is prescribed medication for a psychiatric condition, and the nurse practitioner is concerned about potential complications due to the patient’s fluid status and body habitus. What aspect of drug distribution is the nurse considering?
a) Diffusion and convection.
b) Liberation in the stomach.
c) Effective drug concentration.
d) Volume of distribution.
Answer: D
Explanation: The nurse is considering the volume of distribution, which influences how a substance is spread throughout the body based on fluid status and body habitus.

14) A psychiatric-mental health nurse practitioner prescribes a lipophilic medication with a large volume of distribution (Vd) to a patient with significant adipose tissue. How does the patient’s adipose tissue influence the Vd of the drug?
a) Reduces Vd due to decreased distribution into extracellular fluid.
b) Increases Vd as the drug distributes throughout adipose tissues.
c) Maintains a constant Vd despite adipose tissue composition.
d) Renders lipophilic medications ineffective.
Answer: B
Explanation: Adipose tissue increases the Vd of lipophilic drugs, allowing distribution throughout fat stores and impacting dosing considerations.

15) A psychiatric-mental health nurse practitioner treats a patient with decreased serum protein levels due to malnutrition. How might this nutritional status impact the pharmacological effects of protein-bound medications?
a) Decreases the risk of adverse effects.
b) Has no impact on protein-bound medications.
c) Increases the risk of adverse effects.
d) Accelerates drug metabolism.
Answer: C
Explanation: Malnutrition-induced decrease in serum protein levels increases the risk of adverse effects by elevating the amount of free, active drug, impacting drug efficacy. Psychiatric Mental Health Nurse Exam.

16) In an interprofessional team caring for a patient, what role does the psychiatric-mental health nurse practitioner play in ensuring the safety and efficacy of pharmacotherapy?
a) Primary responsibility for administering medications.
b) Verifying dosing, drug interactions, and monitoring plasma concentrations.
c) Solely educating the patient on self-administration of medications.
d) Minimizing communication with other team members to avoid conflicts.
Answer: B
Explanation: The psychiatric-mental health nurse practitioner contributes to safety by verifying dosing, performing drug interaction checks, and monitoring plasma concentrations, ensuring optimal pharmacotherapy outcomes.

17) As part of the interprofessional team caring for a patient, the psychiatric-mental health nurse practitioner plays a crucial role in ensuring the safety and efficacy of pharmacotherapy by:
a) Primary responsibility for administering medications.
b) Verifying dosing, drug interactions, and monitoring plasma concentrations.
c) Solely educating the patient on self-administration of medications.
d) Minimizing communication with other team members to avoid conflicts.
Answer: B
Explanation: The psychiatric-mental health nurse practitioner contributes to safety by verifying dosing, performing drug interaction checks, and monitoring plasma concentrations, ensuring optimal pharmacotherapy outcomes.

18) A 22-year-old patient is prescribed methylphenidate and diagnosed with attention deficit hyperactivity disorder (ADHD). The psychiatric-mental health nurse practitioner considers the drug’s pharmacokinetics. Why is it important to monitor the patient’s response over time?
a) To determine the patient’s financial capacity for long-term medication use.
b) To estimate the time it takes for the drug to leave the patient’s system.
c) To assess the patient’s ability to self-administer and store the medication.
d) To evaluate the medication’s popularity among other patients.
Answer: B
Explanation: Monitoring the patient’s response over time helps estimate how long it will take for methylphenidate to leave the patient’s system, guiding appropriate dosing adjustments.

19) In pharmacodynamics, drugs can interact with various protein targets. What drug interaction occurs when a drug binds a receptor but does not activate it, preventing its normal action?
a) Inhibitor action, blocking receptor activation.
b) Stabilizing action, maintaining general receptor activation.
c) Agonist action, mimicking receptor activation.
d) Exchanging action, replacing substances for reserve formation.
Answer: A
Explanation: When a drug binds a receptor but does not activate it, it exhibits inhibitor action, blocking the normal receptor activation and preventing downstream effects.

20) A 45-year-old patient prescribed first-generation antipsychotic presents with abnormal posturing, repetitive movements, and muscle contractions. The psychiatric-mental health nurse practitioner recognizes these symptoms as:
a) Akathisia
b) Tardive dyskinesia
c) Dystonia
d) Drug-induced parkinsonism
Answer: C
Explanation: Dystonia manifests with abnormal posturing and repetitive movements due to involuntary muscle contractions. It can occur acutely with dopamine-receptor-blocking agents, necessitating prompt recognition and intervention.

21) A psychiatric-mental health nurse practitioner teaches a colleague about receptor binding and effect. How does the law of mass action govern the binding of ligands (drugs) to receptors?
a) It determines receptor occupancy, and the equilibrium dissociation constant is the total duration of a substance.
b) It governs the relationship between occupancy and pharmacological response, with the equilibrium dissociation constant indicating ligand-receptor binding.
c) It relates to offset phase in drug use, and the equilibrium dissociation constant represents peak concentration.
d) It measures the fraction of receptor bound by the ligand, and the equilibrium dissociation constant is the onset phase.
Answer: B
Explanation: The law of mass action governs the relationship between occupancy and pharmacological response, and the equilibrium dissociation constant indicates ligand-receptor binding.

22) A 45-year-old patient on an atypical antipsychotic reports a compelling urge to move and exhibits repetitive leg movements. The psychiatric-mental health nurse practitioner plans to manage the symptoms. What is the most appropriate intervention specific to akathisia?
a) Benzodiazepines
b) Beta-blocker (propranolol)
c) Botulinum toxin injection
d) Amantadine
Answer: A
Explanation: Benzodiazepines are effective in managing akathisia. They provide relief from the subjective restlessness and the compelling urge to move associated with akathisia.

23) A 50-year-old patient with acute akathisia receives pharmacologic treatment. The psychiatric- mental health nurse practitioner administers a medication commonly used to manage akathisia.
What is the primary pharmacologic intervention?
a) Clonidine
b) Amantadine
c) Mianserin
d) Propranolol
Answer: D
Explanation: Propranolol, a beta-blocker, is commonly used to manage akathisia by reducing the subjective restlessness and the compelling urge to move. Psychiatric Mental Health Nurse Exam.

24) A 30-year-old patient, prescribed haloperidol for schizophrenia, presents with high fever, rigid muscles, and altered mental status. The nurse practitioner recognizes the symptoms. What should be the immediate action?
a) Prescribe a higher dose of haloperidol.
b) Switch to an atypical antipsychotic.
c) Monitor symptoms and reassess later.
d) Call 911 and transfer to the nearest hospital.
Answer: D
Explanation: The presentation suggests neuroleptic malignant syndrome (NMS), a life-threatening reaction requiring immediate medical attention.

25) A 40-year-old patient with bipolar disorder reports having difficulty swallowing, sweating excessively, and an elevated heart rate. What should the nurse practitioner prioritize in the assessment?
a) Monitoring blood pressure.
b) Checking for signs of dehydration.
c) Assessing neuroleptic medication history.
d) Ordering a throat culture for possible infection.
Answer: C
Explanation: The symptoms may indicate NMS, and assessing the patient’s history of neuroleptic medication is crucial in identifying potential causes.

26) A patient diagnosed with neuroleptic malignant syndrome (NMS) has delayed treatment. What complications could the nurse practitioner anticipate in this situation?
a) Increased risk of pneumonia.
b) Reduced likelihood of seizures.
c) Improved kidney function.
d) Decreased chances of blood clot formation.
Answer: A
Explanation: Delayed NMS treatment can lead to severe complications, including an increased risk of pneumonia due to prolonged ICU stays.

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27) A 7-year-old child displays persistent challenges with social interactions, repetitive behaviors, and limited interests. The nurse practitioner suspects a neurodevelopmental disorder. What condition aligns with these symptoms?
a) Conduct disorder
b) Autism spectrum disorder (ASD)
c) Attention-deficit/hyperactivity disorder (ADHD)
d) Schizophrenia
Answer: B
Explanation: Persistent challenges with social interactions, repetitive behaviors, and limited interests are indicative of Autism Spectrum Disorder (ASD).

28) A 6-year-old child exhibits weakness in arms, difficulty speaking, and excessive drooling. The nurse practitioner suspects a neurodevelopmental disorder. What condition aligns with these symptoms?
a) Autism spectrum disorder (ASD)
b) Cerebral palsy
c) Tourette syndrome
d) Attention-deficit/hyperactivity disorder (ADHD)
Answer: B
Explanation: Weakness in arms, difficulty speaking, and excessive drooling are symptoms associated with cerebral palsy, a neurodevelopmental disorder affecting movement and coordination.

29) A child has sudden, repetitive, involuntary vocalizations and movements. What neurological disorder frequently co-occurring with ADHD might the nurse practitioner consider?
a) Intellectual disabilities
b) Schizophrenia
c) Conduct disorder
d) Tourette syndrome
Answer: D
Explanation: Sudden, repetitive, involuntary vocalizations and movements align with Tourette syndrome, which is frequently observed co-occurring with ADHD.

30) A 10-year-old child with neurodevelopmental disorders exhibits disruptive behaviors causing distress. What could be the possible underlying cause of these negative interactions?
a) Excessive self-regulation skills.
b) Adequate emotional control.
c) Poor self-regulation, common in children with NDs.
d) Lack of self-expression.
Answer: C
Explanation: Negative interactions in children with neurodevelopmental disorders often result from poor self-regulation, a common feature in these conditions. Psychiatric Mental Health Nurse Exam.

31) A 25-year-old patient with depression expresses interest in trying complementary and alternative medicine (CAM) for symptom management. The psychiatric-mental health nurse practitioner’s initial response is to:
a) Prescribe an antidepressant medication
b) Discuss the potential benefits and risks of CAM
c) Refer the patient to a psychotherapist
d) Recommend immediate hospitalization
Answer: B
Explanation: The nurse practitioner should engage in shared decision-making, discussing the potential benefits and risks of CAM with the patient.

32) A parent seeks guidance on early prevention strategies for neurodevelopmental disorders. The psychiatric-mental health nurse practitioner advises that, for genetic and environmental conditions, proper prenatal care can:
a) Guarantee a cure for neurodevelopmental disorders.
b) Decrease the likelihood of neurological issues in the child.
c) Eliminate the risk of developing neurodevelopmental disorders.
d) Ensure the child’s developmental milestones are advanced.
Answer: B
Explanation: While not ensuring prevention, proper prenatal care increases the likelihood of having a healthy, full-term baby with a lower risk of neurological issues associated with neurodevelopmental disorders.

33) A 25-year-old patient with pediatric bipolar disorder is prescribed a combination of mood stabilizers and atypical antipsychotics. The nurse practitioner’s rationale for this specific treatment approach is primarily based on the following:
a) The patient’s preference for combination therapy.
b) Long-term efficacy demonstrated in pediatric bipolar disorder.
c) The avoidance of potential drug-drug interactions.
d) The patient’s resistance to monotherapy with mood stabilizers.
Answer: B
Explanation: Research indicates that a combined treatment with two mood stabilizers or a mood stabilizer and an antipsychotic holds promising results for pediatric bipolar I, supporting long-term remission of symptoms. Psychiatric Mental Health Nurse Exam.

 

34) A 40-year-old patient diagnosed with major depressive disorder is prescribed an antidepressant. The psychiatric-mental health nurse practitioner orders genetic testing to assess the patient’s cytochrome P450 enzyme system. What is the primary purpose of this genetic testing?
a) Determine the patient’s ancestry for research purposes.
b) Identify potential gene-drug interactions and optimize drug therapy.
c) Explore the patient’s environmental and socioeconomic factors.
d) Assess the patient’s risk for adverse effects based on genetic markers.
Answer: B
Explanation: Genetic testing for cytochrome P450 enzymes helps identify variations influencing drug metabolism, aiding in personalized treatment and minimizing adverse effects.

35) A 30-year-old patient diagnosed with major depressive disorder is contemplating electroconvulsive therapy (ECT). The nurse practitioner explains the neurophysiological mechanism of ECT, emphasizing its impact on:
a) The hypothalamus-pituitary-adrenal (HPA) axis.
b) The modulation of serotonin and norepinephrine.
c) Cortical excitability and neurotransmitter release.
d) Anterior cingulate gyrus connectivity.
Answer: C
Explanation: ECT influences cortical excitability and neurotransmitter release, leading to therapeutic effects in major depressive disorder.

36) A 40-year-old patient with a history of anxiety reports experiencing vivid nightmares and night sweats. The nurse practitioner attributes these symptoms to dysregulation in the:
a) Prefrontal cortex.
b) Limbic system.
c) Basal ganglia.
d) Hippocampus.
Answer: B
Explanation: Nightmares and night sweats often result from dysregulation in the limbic system, particularly the amygdala, and hypothalamus, contributing to heightened emotional responses and disrupted sleep.

37) A 28-year-old patient with schizophrenia is prescribed clozapine. The psychiatric-mental health nurse practitioner reviews the patient’s genetic profile and notes a deficiency in the gene associated with clozapine metabolism. What consideration should the nurse prioritize based on this information?
a) Adjusting the dosage to enhance therapeutic effects.
b) Monitoring for potential drug-drug interactions.
c) Evaluating the patient’s response to psychoeducation.
d) Implementing additional interventions to address genetic factors.
Answer: B
Explanation: Recognizing gene-drug interactions informs the nurse about potential variations in drug metabolism, guiding monitoring strategies for drug efficacy and safety.

38) A 35-year-old patient with schizophrenia exhibits disorganized thinking and impaired executive function. The nurse practitioner recognizes these symptoms are linked to dysfunction in the:
a) Frontal lobe.
b) Temporal lobe.
c) Occipital lobe.
d) Parietal lobe.
Answer: A
Explanation: Disorganized thinking and impaired executive function are associated with dysfunction in the frontal lobe, which plays a crucial role in cognitive processes and decision-making.

39) A 25-year-old patient expresses concerns about the potential side effects of antidepressant medications as the patient is diagnosed with major depressive disorder. The psychiatric-mental health nurse practitioner’s initial response should be:
a) Reassure the patient that side effects are rare and not to worry.
b) Discuss the common side effects and the importance of monitoring.
c) Recommend stopping medications to avoid side effects.
d) Suggest alternative non-pharmacological interventions.
Answer: B
Explanation: The promotion of informed decision-making and patient collaboration is a result of the nurse practitioner’s engagement in open communication about potential side effects.

40) With a history of substance abuse, a 45-year-old patient helps manage stress without medication. The psychiatric-mental health nurse practitioner’s response is to:
a) Prescribe an anxiolytic medication to manage stress.
b) Discuss non-pharmacological stress management strategies.
c) Ignore the request and focus on medication options.
d) Refer the patient to a substance abuse counselor.
Answer: B
Explanation: The psychiatric-mental health nurse practitioner should discuss non-pharmacological stress management strategies. It aligns with the patient’s preference and holistic care.

41) Concern about a child’s sudden behavioral changes is expressed by a parent. The initial step of a psychiatric-mental health nurse practitioner is:
a) Schedule a family therapy session.
b) Conduct a comprehensive psychiatric evaluation.
c) Recommend over-the-counter supplements for behavioral support.
d) Advise the parent to monitor the child’s behavior at home.
Answer: B
Explanation: Conducting a comprehensive psychiatric evaluation is essential for the nurse. This step helps assess the child’s mental health, gather information, and determine appropriate interventions.

42) A patient exhibits signs of distress and does not speak English but struggles to communicate verbally. To ensure effective communication, what action should a psychiatric-mental health nurse practitioner take?
a) Encourage the patient to communicate through written notes.
b) Assume the distress is unrelated to the language barrier.
c) Use gestures and body language to convey empathy.
d) Seek the assistance of an interpreter for effective communication.
Answer: D
Explanation: Interpreter seeking recognizes the importance of effective communication. Ensuring accurate understanding while promoting culturally competent care. Psychiatric Mental Health Nurse Exam.

43) How should the nurse respond to address the patient’s concerns and facilitate engagement in the recommended program when a 65-year-old patient with substance use disorder questions the need for a 12-step program?
a) Insist on the 12-step program as the only effective approach.
b) Refer the patient to a different therapist with alternative recommendations.
c) Discontinue the recommendation and explore other intervention options.
d) Collaboratively explore the patient’s doubts and concerns about the 12-step program.
Answer: D
Explanation: To address the patient’s concerns and facilitate engagement in the recommended program, the nurse should collaboratively explore the patient’s doubts and concerns about the 12-step program.

44) Forgetfulness is the cause of medication non-adherence in a patient with schizophrenia. The nurse practitioner explores technology-based interventions. To increase medication adherence, what is an example of a technology-based intervention?
a) Reminder phone calls from the nurse practitioner.
b) Daily text messages for medication reminders.
c) Weekly in-person medication administration.
d) Written medication schedules.
Answer: B
Explanation: To enhance adherence by providing regular prompts, daily text messages for medication reminders is an example of a technology-based intervention.

45) Distressing nightmares are reported by a patient with post-traumatic stress disorder (PTSD). What is the rationale for using prazosin in post-traumatic stress disorder (PTSD) when a nurse practitioner considers prazosin as an adjunctive treatment?
a) It acts as a selective serotonin reuptake inhibitor.
b) It enhances cognitive-behavioral therapy outcomes.
c) It reduces nightmares by blocking alpha-1 receptors.
d) It increases rapid eye movement (REM) sleep.
Answer: C
Explanation: By blocking the effects of norepinephrine, an alpha-1 adrenergic antagonist, Prazosin is used to reduce nightmares in post-traumatic stress disorder (PTSD).

46) Debilitating panic attacks are experienced by a 22-year-old patient with generalized anxiety disorder. What is the first-line medication when the psychiatric nurse decides on pharmacological intervention?
a) Alprazolam
b) Buspirone
c) Fluoxetine
d) Imipramine
Answer: C
Explanation: Because of its effectiveness and safety, Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) and is a first-line medication for generalized anxiety disorder.

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47) The psychiatric-mental health nurse practitioner suspects lithium toxicity when a 28-year-old patient with bipolar disorder, stabilized on lithium, presents with polyuria, polydipsia, and mild tremors. The immediate action is to:
a) Discontinue lithium and initiate divalproex.
b) Order a lithium level and renal function tests.
c) Prescribe a diuretic to manage fluid imbalance.
d) Switch to an atypical antipsychotic.
Answer: B
Explanation: To assess the severity of toxicity and determine the appropriate management, ordering lithium level and renal function tests is crucial.

48) Despite antipsychotic treatment, a 55-year-old patient with schizophrenia continues to experience persistent cognitive impairment. The nurse practitioner considers adjunctive treatment with the following:
a) Memantine.
b) Donepezil.
c) Rivastigmine.
d) Galantamine.
Answer: A
Explanation: Memantine, considered an adjunctive option for cognitive impairment in schizophrenia, is an NMDA receptor antagonist.

49) A typical antipsychotic is prescribed to a 50-year-old patient with schizophrenia. The nurse practitioner should educate the patient about the potential side effects of:
a) Weight gain
b) Tardive dyskinesia
c) Orthostatic hypotension
d) Sedation
Answer: B
Explanation: Typical antipsychotics have a potential side effect known as tardive dyskinesia. For early detection and intervention, it is crucial to educate the patient about monitoring for involuntary movements. Psychiatric Mental Health Nurse Exam.

 

50) A brief screening tool is preferred by a patient with suspected anxiety. Which alternative scale is appropriate for rapid anxiety assessment in primary care, focusing on the first two questions of the GAD-7?
a) Clinical Anxiety Scale (CAS)
b) GAD-2
c) HAM-A
d) GAD-Q-IV
Answer: B
Explanation: The GAD-2 is an ultra-quick tool ideal for brief anxiety assessments in primary care settings, focusing on the first two questions of the GAD-7.

51) In evaluating alternative thresholds for the VADPRS comorbidity scales, what is the rationale behind prioritizing sensitivity over specificity?
a) To minimize false positives
b) To reduce the risk of overlooking mental health problems
c) To increase the positive predictive power
d) To enhance the tool’s overall sensitivity
Answer: B
Explanation: To identify mental health problems, prioritizing sensitivity is crucial. Despite potential false positives, it minimizes the risk of overlooking cases.

52) The PMHNP decides to use the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) when assessing a 9-year-old child referred for ADHD. What does this tool specifically screen for besides ADHD symptoms?
a) Autism Spectrum Disorder
b) Conduct Disorder
c) Oppositional Defiant Disorder
d) Anxiety Disorders
Answer: C
Explanation: Besides evaluating the ADHD symptoms, the VADPRS also includes screening scales for Oppositional Defiant Disorder (ODD).

53) The nurse practitioner notes a lack of emotional expression while evaluating a patient’s affect during the mental status examination. This finding is consistent with:
a) euthymic affect.
b) blunted affect.
c) labile affect.
d) expansive affect.
Answer: B
Explanation: During the mental status examination, the assessment of affect is impacted by a lack of emotional expression. This is a characteristic of the blunted effect.

54) What type of thought process does the psychiatric-mental health nurse practitioner likely observe if a patient speaks rapidly and exhibits disorganized thoughts during a mental status examination?
a) Linear thought process
b) Circumstantial thought process
c) Flight of ideas thought process
d) Perseveration thought process
Answer: C
Explanation: A flight of ideas and thought processes that emerge from the patient’s rapid, disorganized speech, which is a characteristic of certain psychiatric conditions.

55) A patient struggles to count backward from 100 to 7 during cognition evaluation. The practitioner documents this as a potential indication of:
a) Anxiety
b) Depression
c) Poor sleep
d) Neurocognitive disorder
Answer: D
Explanation: Impaired performance may indicate a neurocognitive disorder in tasks requiring attention and concentration, prompting further evaluation with appropriate screening tools.

56) How should the nurse practitioner interpret the inconsistency when a patient denies hallucinations despite exhibiting behavior suggesting otherwise?
a) Consider the patient’s denial as factual.
b) Document the behavior and monitor for changes.
c) Confront the patient about the inconsistency.
d) Explore potential reasons for the denial.
Answer: D
Explanation: The nurse practitioner should explore potential reasons for denial. It allows the nurse to provide appropriate care and understand underlying factors.

57) A patient demonstrates fair insight into their depression but poor judgment during a mental status examination. The nurse practitioner interprets this finding as:
a) A positive sign of medication effectiveness
b) A potential for inpatient stabilization
c) Limited cognitive ability
d) Conflicting information requiring reevaluation
Answer: B
Explanation: Poor judgment suggests a risk of repeated mistakes, while fair insight indicates some understanding. This combination often leads to poor functioning, requiring inpatient psychiatric treatment.

58) Despite active suicidal ideation, a 32-year-old patient with depression refuses hospitalization. The psychiatric-mental health nurse practitioner’s ethical responsibility is to:
a) Force hospitalization against the patient’s will.
b) Respect the patient’s autonomy while implementing intensive outpatient care.
c) Discharge the patient with outpatient follow-up.
d) Convince the patient to consider hospitalization voluntarily.
Answer: B
Explanation: While implementing intensive outpatient care, maintaining a balance between safety and respect for the patient’s choices involves respecting the patient’s autonomy. Psychiatric Mental Health Nurse Exam.

59) A 35-year-old patient reports chronic suicidal thoughts and a desire to explore assisted suicide options. The nurse practitioner’s response should prioritize:
a) Advocating for the patient’s autonomy and assisting in end-of-life planning.
b) Referring the patient to a psychiatrist for a medication review.
c) Initiating discussions about the patient’s support network.
d) Conducting an ethical consultation with the healthcare team.
Answer: D
Explanation: Complex ethical considerations are involved in assisted suicide discussions. Ethical consultation ensures a thorough and informed decision-making process.

60) Sudden mood swings and impulsivity faced by a 45-year-old patient with a history of borderline personality disorder. The psychiatric-mental health nurse practitioner’s immediate action is to:
a) Recommend dialectical behavior therapy (DBT) for emotion regulation.
b) Adjust the current mood stabilizer to target mood swings.
c) Prescribe an antipsychotic medication for impulsivity.
d) Refer the patient for inpatient psychiatric hospitalization.
Answer: A
Explanation: In the context of borderline personality disorder, Dialectical behavior therapy (DBT) is an evidence-based intervention to address emotion dysregulation and impulsivity.

61) Sudden-onset panic attacks with chest pain and shortness of breath are reported by a 50-year- old patient with a history of panic disorder. The psychiatric-mental health nurse practitioner’s immediate action is to:
a) Prescribe a benzodiazepine for acute anxiety relief.
b) Refer the patient for a thorough cardiovascular evaluation.
c) Recommend exposure therapy for panic attack desensitization.
d) Adjust the current selective serotonin reuptake inhibitor (SSRI) for panic control.
Answer: B
Explanation: Before considering psychiatric interventions, sudden-onset panic attacks with chest pain warrant a thorough cardiovascular evaluation.

62) A 25-year-old patient with depression is prescribed fluoxetine. The psychiatric-mental health nurse practitioner considers potential drug interactions and determines that fluoxetine increases the plasma levels of certain medications by:
a) Inhibiting CYP450 3A4
b) Inducing CYP450 3A4
c) Acting as a substrate for CYP450 3A4
d) Blocking CYP450 3A4
Answer: A
Explanation: Fluoxetine inhibits CYP450 3A4, affecting the metabolism of other medications potentially leading to increased plasma levels and risk of adverse effects.

63) A 40-year-old patient, newly diagnosed with schizophrenia, is provided psychoeducation. The nurse practitioner anticipates improved treatment compliance, recognizing that psychoeducation:
a) Increases denial about the illness
b) Enhances insight and adherence
c) Fosters resistance to medications
d) Promotes isolation from support networks
Answer: B
Explanation: Psychoeducation improves insight and adherence, leading to better treatment compliance and a higher quality of life for patients with schizophrenia.

64) A patient on lithium for bipolar disorder is admitted with symptoms of lithium toxicity. The psychiatric-mental health nurse practitioner correctly identifies the potential cause as:
a) Inadequate lithium dose
b) Dehydration
c) Excessive sodium intake
d) Low renal function
Answer: B
Explanation: Lithium toxicity can result from dehydration, as it leads to increased lithium reabsorption in the kidneys

65) When developing a therapeutic presentation for clients with social anxiety disorder, the nurse practitioner should focus on:
a) Encouraging avoidance of social situations.
b) Role-playing small talk scenarios.
c) Minimizing interaction to reduce anxiety.
d) Exploring complex psychological theories.
Answer: B
Explanation: Therapeutic presentations for social anxiety should include practical skills like role-playing small talk helping clients build confidence in social interactions.

66) In psychoeducational groups for trauma survivors, the nurse practitioner’s primary goal is to:
a) Provide medication management.
b) Explore deep emotional trauma.
c) Share personal narratives.
d) Teach coping strategies.
Answer: D
Explanation: Psychoeducational groups for trauma survivors aim to teach coping strategies, empowering individuals to manage and overcome trauma-related challenges.

67) In a presentation on stigma reduction, the nurse practitioner should emphasize:
a) Reinforcing stereotypes.
b) Encouraging discrimination.
c) Promoting understanding and acceptance.
d) Discouraging help-seeking behavior.
Answer: C
Explanation: Presentations on stigma reduction in psychology should emphasize promoting understanding and acceptance to create a supportive environment for mental health.

68) A 28-year-old patient diagnosed with major depressive disorder reports persistent fatigue and difficulty concentrating. The psychiatric-mental health nurse practitioner recognizes these symptoms as potential indicators of:
a) Bipolar disorder
b) Attention-deficit/hyperactivity disorder (ADHD)
c) Hypothyroidism
d) Substance use disorder
Answer: C
Explanation: Persistent fatigue and difficulty concentrating may be associated with hypothyroidism, a condition that can coexist with major depressive disorder.

69) A 45-year-old patient with a history of schizophrenia presents with tongue protrusion and lip- smacking movements. The psychiatric-mental health nurse practitioner identifies this as a side effect of:
a) Clozapine
b) Olanzapine
c) Risperidone
d) Quetiapine
Answer: C
Explanation: Tongue protrusion and lip-smacking are extrapyramidal side effects associated with risperidone, a second-generation antipsychotic.

70) During a therapy session, a patient reveals persistent thoughts of self-harm and a desire to end their life. The psychiatric-mental health nurse practitioner’s immediate action is to:
a) Establish a safety plan
b) Encourage art therapy
c) Explore childhood memories
d) Recommend mindfulness meditation
Answer: A
Explanation: The priority is to establish a safety plan to address the patient’s immediate risk of self-harm or suicide.

71) A patient with bipolar disorder expresses interest in an experimental drug study. The nurse practitioner’s initial response should be:
a) All drug treatments are too risky for you at this time.
b) Let’s discuss the risks of potentially changing your medications.
c) We will have to see if you meet the inclusion criteria for this research study.
d) You will have only a small chance of receiving the experimental drug.
Answer: C
Explanation: The nurse practitioner should assess the patient’s eligibility before discussing risks, ensuring alignment with inclusion criteria for research studies.

72) A 14-year-old reports leg pain, normal examination, and elevated alkaline phosphatase. The nurse practitioner interprets this as:
a) Normal during a rapid adolescent growth spurt.
b) Early rheumatic fever, ordering a rheumatoid profile.
c) Ordering a repeat blood test.
d) Suspecting acute pancreatitis.
Answer: A
Explanation: Elevated alkaline phosphatase in a growing adolescent is often a normal occurrence during a growth spurt.

73) In a patient with alcohol use disorder, increased liver function values and:
a) Decreased MCV and normal triglyceride levels.
b) Elevated potassium and chloride levels.
c) Increased MCV and elevated triglyceride levels.
d) Increased urine and serum creatinine levels.
Answer: C
Explanation: Alcohol use disorder may lead to increased MCV and elevated triglyceride levels, indicating potential liver dysfunction.

74) During a mental status examination, a patient expresses intense fear of leaving their home and avoiding public spaces. The psychiatric-mental health nurse practitioner recognizes this as:
a) Agoraphobia, and considers exposure therapy.
b) Social anxiety disorder, and suggests group therapy.
c) Panic disorder with agoraphobia, and recommends benzodiazepines.
d) Generalized anxiety disorder, and prescribes selective serotonin reuptake inhibitors (SSRIs).
Answer: A
Explanation: The patient’s fear of leaving home aligns with agoraphobia, characterized by avoidance of situations due to fear of panic-like symptoms. Exposure therapy is an evidence-based treatment.

75) A 25-year-old patient diagnosed with schizophrenia is prescribed clozapine. The nurse practitioner monitors for potential adverse effects, emphasizing the importance of regular blood tests to assess:
a) Liver function and lipid levels.
b) Complete blood count (CBC) and neutrophil count.
c) Blood glucose and thyroid function.
d) Electrolytes and kidney function.
Answer: B
Explanation: Clozapine requires regular CBC monitoring due to the risk of agranulocytosis. Neutrophil count assessment helps prevent severe and potentially fatal hematological complications.

76) A patient with bipolar disorder presents with a recent onset of elevated mood, increased energy, and impulsivity. The psychiatric-mental health nurse practitioner considers pharmacotherapy, recognizing the first-line treatment for acute mania is:
a) Lithium, and orders thyroid function tests.
b) Valproate, and monitors liver function.
c) Carbamazepine, and checks CBC.
d) Olanzapine, and assesses metabolic parameters.
Answer: D
Explanation: Olanzapine is an atypical antipsychotic effective in treating acute mania. Monitoring metabolic parameters, such as weight and lipid levels, is crucial due to potential metabolic side effects.

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77) A patient with bipolar disorder expresses interest in joining a research study testing an experimental drug. The nurse practitioner’s initial response should be:
a) All drug treatments are too risky for you at this time in your illness.
b) Let’s discuss the risks of potentially changing your medications.
c) We will have to see if you meet the inclusion criteria for this research study.
d) You will have only a small chance of receiving the experimental drug.
Answer: C
Explanation: Evaluating inclusion criteria is essential before discussing risks or chances of receiving the experimental drug, ensuring the patient’s eligibility.

78) A patient with nonspecific leg pain has elevated alkaline phosphatase. The nurse practitioner’s action is to:
a) Interpret it as a normal occurrence during rapid adolescent growth.
b) Obtain a rheumatoid profile for potential early rheumatic fever.
c) Order a repeat blood test to confirm the alkaline phosphatase level.
d) Suspect acute pancreatitis based on elevated alkaline phosphatase.
Answer: A
Explanation: Elevated alkaline phosphatase in an adolescent is often related to rapid growth, and additional rheumatoid profiles or tests may not be necessary.

79) In a patient with alcohol use disorder and increased liver function values, which finding is concerning?
a) Decreased mean corpuscular volume (MCV) and normal triglyceride levels.
b) Elevated potassium and chloride levels.
c) Increased MCV and elevated triglyceride levels.
d) Increased urine and serum creatinine levels.
Answer: C
Explanation: Increased MCV and elevated triglyceride levels indicate potential liver damage due to alcohol use, requiring further assessment and intervention.

80) A 45-year-old patient with a history of alcohol dependence presents with increased liver function values. The nurse practitioner suspects alcohol-related liver disease. Which laboratory findings support this suspicion?
a) Elevated potassium and chloride levels.
b) Decreased mean corpuscular volume (MCV) and normal triglyceride levels.
c) Increased MCV and elevated triglyceride levels.
d) Increased urine and serum creatinine levels.
Answer: C
Explanation: Alcohol-related liver disease often presents with increased MCV and elevated triglyceride levels, indicative of the impact of chronic alcohol use on liver function.

81) In a psychiatric hospital, a patient with suicidal tendencies is assessed using the AUDIT screening tool. What is the rationale for utilizing the AUDIT in this setting?
a) To identify hazardous and harmful alcohol use.
b) To assess for early rheumatic fever.
c) To predict future indicators of alcohol-related problems.
d) To estimate the prevalence of alcohol use disorders.
Answer: A
Explanation: The AUDIT is used to identify hazardous and harmful alcohol use, which is crucial in assessing the patient’s overall well-being and risk factors.

82) A 22-year-old patient presents with complaints of auditory hallucinations and disorganized thinking. The psychiatric-mental health nurse practitioner suspects schizophrenia. What type of hallucination is commonly associated with this disorder?
a) Hypnagogic hallucination.
b) Hypnopompic hallucination.
c) Tactile hallucination.
d) Gustatory hallucination.
Answer: C
Explanation: Auditory hallucinations are common in schizophrenia, representing sensory perceptions not based on external stimuli, such as hearing voices. Psychiatric Mental Health Nurse Exam.

83) A patient undergoing drug abuse screening reports experiencing “blackouts” or “flashbacks” due to drug use. Which class of drugs is commonly associated with these symptoms?
a) Hallucinogens (e.g., LSD)
b) Stimulants (e.g., speed)
c) Cocaine
d) Tranquilizers (e.g., Valium)
Answer: A
Explanation: “Blackouts” or “flashbacks” are commonly associated with hallucinogens, such as LSD. These substances can cause altered perceptions and memory disturbances.

84) A 28-year-old patient presents with disorganized speech, delusions, and impaired social functioning, with a history of schizophrenia. The psychiatric-mental health nurse practitioner’s priority intervention is:
a) Encouraging the patient to join group therapy sessions.
b) Initiating antipsychotic medication to manage symptoms.
c) Recommending cognitive-behavioral therapy for insight.
d) Suggesting relaxation techniques to reduce anxiety.
Answer: B.
Explanation: The priority intervention of the psychiatric-mental health nurse practitioner is to initiate antipsychotic medication to manage symptoms, stabilize acute psychotic episodes, promote safety, and improve overall functioning.

85) Feelings of sadness, loss of interest, and difficulty concentrating for over six months were reported by a 45-year-old patient. The psychiatric-mental health nurse practitioner suspects:
a) Acute stress disorder.
b) Bipolar disorder.
c) Major depressive disorder.
d) Schizophrenia.
Answer: C.
Explanation: The psychiatric-mental health nurse practitioner suspects a major depressive disorder, which is characterized by persistent sadness, loss of interest, and impaired cognitive function for more than two weeks, affecting daily functioning.

86) Recurrent panic attacks accompanied by palpitations, sweating, and a sense of impending doom are experienced by a 50-year-old patient. The psychiatric-mental health nurse practitioner suspects:
a) Generalized anxiety disorder (GAD).
b) Panic disorder.
c) Social anxiety disorder.
d) Specific phobia.
Answer: B.
Explanation: The psychiatric-mental health nurse practitioner suspects panic disorder, characterized by recurrent panic attacks with a sudden onset of intense fear or anxiety, often accompanied by physical symptoms.

87) What adjunctive therapy should the PMHNP consider to stabilize the mood of a 55-year-old patient who is experiencing recurrent manic episodes despite a diagnosis of bipolar disorder?
a) Lamotrigine
b) Lithium
c) Quetiapine
d) Carbamazepine
Answer: C
Explanation: The PMHNP should consider adjunctive quetiapine therapy to stabilize mood, as it effectively manages the manic symptoms of bipolar disorder.

88) Which class of mental illness is most likely associated when a patient exhibits symptoms of preoccupation with weight, food, and body image, leading to severe disturbances in eating behaviors?
a) Feeding and eating disorders
b) Obsessive-compulsive and related disorders
c) Neurodevelopmental disorders
d) Dissociative disorders
Answer: A
Explanation: Symptoms of preoccupation with weight, food, and body image leading to severe disturbances in eating behavior are characteristic of feeding and eating disorders.

89) A patient reports feeling hopeless, experiencing a loss of appetite, and having trouble sleeping during a mental health assessment. The nurse practitioner suspects:
a) Major depressive disorder with melancholic features.
b) Bipolar disorder with psychotic features.
c) Generalized anxiety disorder.
d) Adjustment disorder with depressed mood.
Answer: A
Explanation: The nurse practitioner suspects the patient may have a major depressive disorder with melancholic features characterized by anhedonia, psychomotor changes, and vegetative symptoms.

90) Which class of medications would be most appropriate for long-term symptom management when a patient with generalized anxiety disorder experiences chronic worry and muscle tension?
a) Antidepressants
b) Mood stabilizers
c) Antipsychotics
d) Anti-anxiety medications
Answer: A
Explanation: Antidepressant medications are most appropriate for long-term symptom management as they address both psychological and physical symptoms.

91) Which of the following medications would be the most appropriate initial treatment for a 25- year-old patient presenting with depression, insomnia, and decreased appetite?
a) Antipsychotics
b) Mood stabilizers
c) Antidepressants
d) Anti-anxiety medications
Answer: C
Explanation: Antidepressants would be the most appropriate choice for initial treatment, as they target symptoms such as insomnia and appetite changes commonly associated with depression.

92) A 50-year-old patient without evidence of medical pathology presents chronic somatic symptoms. The psychiatric-mental health nurse practitioner suspects:
a) Somatic symptom disorder
b) Illness anxiety disorder
c) Factitious disorder
d) Conversion disorder
Answer: A
Explanation: The psychiatric-mental health nurse practitioner suspects somatic symptom disorder, characterized by persistent somatic symptoms causing significant distress or impairment.

93) With a history of alcohol use disorder, a patient expresses persistent sadness, loss of interest, and feelings of worthlessness during a therapy session. The PMHNP suspects a coexisting depressive disorder. What is the appropriate initial step in managing this patient?
a) Adjust the patient’s current substance use treatment plan.
b) Evaluate the patient for potential medication-induced mood changes.
c) Refer the patient to a specialized addiction treatment center.
d) Explore the patient’s childhood trauma as a contributing factor.
Answer: B
Explanation: An appropriate initial step is to evaluate the patient for potential medication-induced mood changes.

94) What condition should the PMHNP consider when a patient presents with mood swings, impulsivity, inflated self-esteem, and decreased need for sleep?
a) Major Depressive Disorder
b) Bipolar Disorder
c) Schizophrenia
d) Generalized Anxiety Disorder
Answer: B.
Explanation: The psychiatric-mental health nurse practitioner considers bipolar disorder, which is characterized by mood swings, impulsivity, inflated self-esteem, and decreased need for sleep.

95) What is the nurse practitioner’s initial response when a patient with bipolar disorder expresses interest in a research study involving an experimental drug?
a) All drug treatments are too risky for you at this time.
b) We will have to see if you meet the inclusion criteria for this research study.
c) You will have only a small chance of receiving the experimental drug.
d) Let’s discuss the risks of potentially changing your medications.
Answer: D
Explanation: The nurse practitioner’s initial response involves discussing potential risks, as well as considering inclusion criteria, as part of the informed decision-making process regarding research study participation. Psychiatric, Mental Health, Nurse Exam.

96) In social or occupational functioning, a patient presents with persistent difficulty initiating or maintaining sleep, along with daytime fatigue and impairment. The nurse practitioner suspects:
a) Insomnia disorder.
b) Narcolepsy.
c) Sleep apnea.
d) Circadian rhythm sleep-wake disorder.
Answer: A
Explanation: The psychiatric-mental health nurse practitioner suspects that the patient’s symptoms are indicative of insomnia disorder, which is characterized by persistent difficulty initiating or maintaining sleep, leading to impairment in daytime functioning.

97) Which of the following disorders is consistent with the presentation of a 30-year-old patient who exhibits excessive fear of separation from their spouse, leading to avoidance of leaving home?
a) Generalized Anxiety Disorder
b) Separation Anxiety Disorder
c) Agoraphobia
d) Panic Disorder
Answer: B
Explanation: The patient’s fear of separation from their spouse and avoidance behaviors aligns with the diagnostic criteria for Separation Anxiety Disorder.

98) When a patient taking a new medication seeks information, which of the following methods is most effective for providing psychoeducation in a telemedicine setting?
a) Encourage seeking information on the internet.
b) Have a phone conference with a family member.
c) Email drug information and resources.
d) Refer to a local primary care provider.
Answer: C
Explanation: Emailing drug information and resources ensures direct communication and easy access to educational materials in telemedicine.

99) For fear of experiencing panic-like symptoms, a 50-year-old patient avoids using public transportation and open spaces. Which diagnosis should the psychiatric nurse consider?
a) Agoraphobia
b) Panic Disorder
c) Specific Phobia
d) Social Anxiety Disorder (Social Phobia)
Answer: A
Explanation: The psychiatric-mental health nurse practitioner considers agoraphobia for a patient who avoids using public transportation and open spaces due to fear of experiencing panic-like symptoms.

100) A 30-year-old patient with depression has inquired about Bach Flower remedies and wishes to explore complementary and alternative medicine (CAM) options. The nurse practitioner’s response should be:
a) Bach Flower remedies may help address emotional imbalances. Let’s discuss if it’s suitable for you.
b) Bach Flower remedies lack scientific evidence. Stick to conventional treatments.
c) Bach Flower remedies are only effective for physical ailments.
d) Bach Flower remedies are unsafe and should be avoided.
Answer: A
Explanation: The response of the psychiatric-mental health nurse practitioner is to acknowledge the patient’s interest, provide information, and encourage dialogue, thus promoting shared decision-making.

101. A 20-year-old patient who has bipolar disorder asks about qigong for mood stabilization. The nurse practitioner should:
a) Discourage, as qigong lacks evidence for bipolar disorder.
b) Recommend qigong as the primary treatment for mood stabilization.
c) Suggest without assessing individual preferences.
d) Provide information on potential benefits and risks.
Answer: D
Explanation: The psychiatric-mental health nurse practitioners should provide information on potential benefits and risks.

102. A 25-year-old patient reports a recent onset of irregular menstrual periods with schizophrenia and has been stable on risperidone (Risperdal) for two years. The initial action of PMHNP is to:
a) Discontinue risperidone and start a different antipsychotic medication.
b) Order a pregnancy test to rule out pregnancy.
c) Evaluate prolactin levels with a blood test.
d) Refer the patient to a gynecologist for further evaluation.
Answer: C
Explanation: The psychiatric-mental health nurse practitioner’s initial action is to evaluate prolactin levels with a blood test. This approach helps determine the need for medication adjustment. Risperidone can elevate prolactin levels, leading to menstrual irregularities.

103. A 50-year-old patient, Buspar, was diagnosed with generalized anxiety disorder. Which laboratory test should the nurse prioritize before starting treatment?
a) Liver Function Test (LFT)
b) Complete Blood Count (CBC)
c) Electrolyte Panel
d) Thyroid Function Test (TFT)
Answer: A
Explanation: Buspirone can cause hepatotoxicity. Therefore, it is essential to prioritize Liver Function Testing (LFT) before initiating treatment.

104. A 16-year-old patient exhibits severe irritability, persisting over many months. The psychiatric-mental health nurse practitioner suspects disruptive mood dysregulation disorder (DMDD). How does DMDD differ from bipolar disorders in terms of mood presentation?
a) DMDD is episodic with discrete episodes of mood perturbation.
b) DMDD includes elevated or expansive mood and grandiosity.
c) DMDD presents as persistent irritability over many months.
d) Bipolar disorders manifest as severe and recurrent outbursts.
Answer: C
Explanation: DMDD is characterized by persistent irritability over many months, differentiating it from the episodic nature of bipolar disorders.

105. A 16-year-old patient exhibits distractibility and sadness. How can the nurse practitioner distinguish between Attention-Deficit/Hyperactivity Disorder (ADHD) and Major Depressive Disorder in this case?
a) Prioritize ADHD diagnosis if sadness is present
b) Rule out ADHD in the presence of distractibility
c) Diagnose both ADHD and Major Depressive Disorder concurrently
d) Be cautious not to overdiagnose a major depressive episode in the presence of irritability
Answer: D
Explanation: Distractibility and low frustration tolerance in ADHD may lead to misdiagnosis if not cautious, especially when irritability is the prominent mood disturbance.

106. A 29-year-old female presents with irritability, mood swings, and sleep disturbance occurring regularly before menstruation. She reports a history of these symptoms for at least two consecutive menstrual cycles. What is the most appropriate initial action for the psychiatric-mental health nurse practitioner?
a) Prescribe an antidepressant for premenstrual dysphoric disorder.
b) Recommend lifestyle modifications to manage stress.
c) Order a complete blood count to rule out anemia.
d) Assess for other mood disorders unrelated to the menstrual cycle.
Answer: D
Explanation: The nurse practitioner should first evaluate if the symptoms meet the criteria for premenstrual dysphoric disorder (PMDD) and then consider other mood disorders with a similar presentation.

107. A 22-year-old female with a history of bipolar disorder presents with mood swings and irritability that occur throughout her menstrual cycle. How should the psychiatric-mental health nurse practitioner differentiate between bipolar disorder and premenstrual dysphoric disorder (PMDD)?
a) Assess for symptoms only during the premenstrual phase.
b) Confirm symptoms through daily prospective ratings.
c) Rely on retrospective symptoms for diagnosis.
d) Prescribe mood stabilizers to manage both conditions.
Answer: B
Explanation: Daily prospective ratings help differentiate between chronic symptoms of bipolar disorder and intermittent symptoms related to the menstrual cycle, ensuring an accurate diagnosis of PMDD.

108. A patient exhibits depersonalization symptoms following substance use. The psychiatric- mental health nurse practitioner needs to differentiate between substance-induced symptoms and depersonalization/derealization disorder. What factor aids in this differentiation?
a) Persistence of symptoms after substance use discontinuation.
b) Level of phobia and aversion to the triggering substance.
c) Presence of hallucinations during substance use.
d) Onset of symptoms during panic attacks.
Answer: B
Explanation: The level of phobia and aversion to the triggering substance helps differentiate depersonalization symptoms induced by substances from depersonalization/derealization disorder.

109. A 27-year-old patient presents with severe localized pain and insists on extensive medical tests despite multiple negative results. The nurse practitioner observes an overriding fear of a rare, life-threatening condition. What diagnostic considerations should the nurse prioritize?
a) Conversion Disorder
b) Somatic Symptom Disorder
c) Delusional Disorder
d) Obsessive-Compulsive Disorder
Answer: C
Explanation: The patient’s intense fear of a rare, severe condition, despite negative results, raises concerns about Delusional Disorder, a somatic subtype.

110. A 45-year-old patient with epilepsy is prescribed tiagabine. What caution should the psychiatric-mental health nurse practitioner exercise regarding the initiation of tiagabine in patients concurrently taking enzyme-inducing medications?
a) Initiate at a standard dose of 4 mg per day.
b) Rapidly load tiagabine to achieve therapeutic levels.
c) Administer tiagabine without regard to meals.
d) Gradually increase tiagabine by 4 mg per day weekly.
Answer: A
Explanation: Tiagabine should be initiated cautiously at 4 mg per day and increased weekly by 4 to 8 mg when patients are taking enzyme-inducing medications to prevent adverse effects.

111. A patient with fibromyalgia exhibits inadequate response to pregabalin therapy. What skill is essential for the psychiatric-mental health nurse practitioner to employ in optimizing the patient’s treatment plan?
a) Dose escalation
b) Medication substitution
c) Adverse event management
d) Shared decision-making
Answer: A
Explanation: The nurse practitioner should skillfully employ dose escalation to enhance the efficacy of pregabalin in managing fibromyalgia symptoms.

112. The psychiatric-mental health nurse practitioner is assessing a patient with insomnia. Which medication, with its appropriate initial dose, would be suitable for a male patient experiencing difficulty falling back asleep after waking up in the middle of the night?
a) Zolpidem (Edluar) – 5 mg.
b) Eszopiclone – 1 mg.
c) Zaleplon – 5 mg.
d) Intermezzo – 1.75 mg.
Answer: C
Explanation: Zaleplon, with a short duration of action, is appropriate for patients needing to return to sleep after waking in the middle of the night, starting at 5 mg.

113. The psychiatric-mental health nurse practitioner is reviewing the use of modafinil and armodafinil. In addition to narcolepsy, what off-label use of these agents is supported by small studies?
a) Treatment of major depressive disorder
b) Improvement in cognitive deficits
c) Augmentation to antipsychotics
d) Enhancement of physical performance
Answer: A
Explanation: Small studies support modafinil’s use as an augmentation to antidepressants in major depressive disorder to address fatigue.

114. In diagnosing mental health disorders, why is familiarity with the Diagnostic and Statistical Manual of Mental Disorders (DSM5) crucial for therapists?
a) To establish a common language among mental health professionals
b) To simplify the diagnostic process
c) To adhere strictly to standardized criteria
d) To exclude cultural considerations from the diagnosis
Answer: A
Explanation: The DSM5 provides a standardized framework, ensuring a common language among mental health professionals for accurate diagnosis and communication.

115. Why is the goal-oriented approach of Cognitive-Behavioral Therapy (CBT) beneficial for individuals seeking therapy?
a) To emphasize cognitive restructuring
b) To provide an unstructured therapeutic experience
c) To foster a sense of direction and purpose
d) To focus solely on collaborative and educational aspects
Answer: C
Explanation: The goal-oriented nature of CBT emphasizes setting clear and measurable therapeutic objectives, fostering a sense of direction and purpose in therapy.

116. When preparing a patient for electroconvulsive therapy (ECT), the psychiatric-mental health
nurse practitioner orders a set of baseline laboratory tests. What specific assessments are typically included in the pre-ECT evaluation to ensure patient safety?
a) Fasting lipid panel and hemoglobin A1c
b) CBC, serum electrolytes, urinalysis, and LFTs
c) Liver function tests and CBC with differential
d) Blood pressure measurement and waist circumference
Answer: B
Explanation: The pre-ECT evaluation includes CBC, serum electrolytes, urinalysis, and LFTs to ensure patient safety and monitor potential complications during the procedure.

117. In psychiatric medication management, which psychotropic agent requires weekly CBC with differential during the initial six months of treatment to monitor for potential complications?
a) Valproate
b) Carbamazepine
c) Lithium
d) Clozapine
Answer: D
Explanation: Clozapine requires frequent monitoring, including weekly CBC with differential during the initial six months, to detect and manage potential hematological abnormalities.

118. In telehealth medication management, what distinguishes it as a convenient option, and what aspect requires in-person visits for controlled substances?
a) Convenience due to virtual communication
b) Flexibility in scheduling appointments
c) Requirement for controlled substance prescriptions
d) Accessibility for individuals with mobility challenges
Answer: C
Explanation: Telehealth is convenient, but controlled substance prescriptions require in-person visits to ensure proper monitoring.

119. When considering psychiatric medication management, why is it important for the psychiatric-mental health nurse practitioner to emphasize the collaborative nature of the treatment plan?
a) To address medication affordability
b) To enhance patient-provider communication
c) To encourage medication adherence
d) To involve other healthcare providers in the process
Answer: B
Explanation: Emphasizing collaboration enhances patient-provider communication, ensuring the treatment plan aligns with the patient’s goals and preferences.

120. In prescribing tricyclic antidepressants (TCAs) for a patient with major depressive disorder, what considerations should the psychiatric-mental health nurse practitioner keep in mind to ensure safe and effective treatment?
a) TCAs are first-line drugs for MDD due to their broad spectrum of neurotransmitter effects.
b) TCAs should be avoided in patients with suicidal thoughts as they can induce mania.
c) Regular monitoring of serum blood levels is unnecessary for TCAs.
d) Combining TCAs with monoamine oxidase inhibitors (MAOIs) is safe and enhances efficacy.
Answer: B
Explanation: The psychiatric-mental health nurse practitioner should be cautious in prescribing TCAs for patients with suicidal thoughts, as TCAs may induce hypomania in susceptible individuals.

121. Which therapy model is most likely to be effective in addressing symptoms of dissociation and avoidance behaviors in a 45-year-old patient with a history of trauma?
a) Psychodynamic therapy
b) Cognitive-behavioral therapy
c) Supportive interpersonal therapy
d) Dialectical behavior therapy
Answer: D
Explanation: Dialectical behavior therapy (DBT) emphasizes acceptance and change strategies. This therapy is suitable for addressing trauma-related dissociation and avoidance behaviors.

122. A patient aged 30 who has panic disorder is undergoing cognitive behavioral therapy (CBT). The patient expresses frustration about not being able to control their anxious thoughts during a session. The PMHNP responds by:
a) Exploring the patient’s childhood experiences
b) Introducing relaxation techniques
c) Challenging irrational thoughts
d) Scheduling more frequent therapy sessions
Answer: C
Explanation: Challenging irrational thoughts is a core principle of CBT, aiming to modify negative thinking patterns associated with anxiety disorders.

123. A 30-year-old patient who has a history of trauma is seeking therapy. The patient expresses a fear of discussing certain topics during therapy sessions. The therapist’s most appropriate response is to:
a) Avoid discussing sensitive topics to prevent distress.
b) Explore the patient’s concerns and establish trust.
c) Immediately confront the patient’s fears to desensitize them.
d) Refer the patient to a different therapist who specializes in trauma.
Answer: B
Explanation: Establishing trust and exploring concerns is crucial in humanistic therapy. It allows the patient to feel safe to discuss sensitive topics and promote self-discovery.

124. A 28-year-old patient who is diagnosed with chronic depression seeks therapy. This patient expresses difficulty in maintaining relationships and feelings of isolation. In this case, which type of psychotherapy would be most suitable for addressing the patient’s concerns?
a) Cognitive Behavioral Therapy (CBT)
b) Interpersonal Psychotherapy (IPT)
c) Psychodynamic Therapy
d) Dialectical Behavior Therapy (DBT)
Answer: B
Explanation: Interpersonal Psychotherapy (IPT) is an appropriate choice for addressing the patient’s difficulties in maintaining relationships. This therapy focuses on improving interpersonal relationships and communication.

125. A patient is diagnosed with social anxiety disorder. He expresses reluctance to attend social gatherings due to fear of judgment. The psychiatric-mental health nurse practitioner’s initial response is to:
a) Recommend individual therapy as an alternative to group sessions
b) Explore the patient’s specific concerns and collaboratively develop coping strategies
c) Suggest switching to dialectical behavioral therapy to address social anxiety
d) Encourage the patient to confront fears by attending group sessions immediately
Answer: B
Explanation: In social anxiety disorder, collaboratively addressing specific concerns fosters therapeutic rapport and enhances treatment engagement.

126. There is a client with a history of substance abuse. During a therapy session, he expresses reluctance to change his behavior despite acknowledging its negative impact. In this case, which stage of the Transtheoretical Model (TTM) is the client likely in?
a) Precontemplation
b) Contemplation
c) Preparation
d) Action
Answer: A
Explanation: It is characteristic of the pre-contemplation stage when a client with a history of substance abuse acknowledges the behavior but does not intend to change.

127. A 45-year-old patient has a history of alcohol use disorder. He has been contemplatingseeking treatment but is feeling unsure of where to start. According to the Transtheoretical Model, what intervention strategy aligns with the patient’s current stage?
a) Consciousness Raising
b) Dramatic Relief
c) Self-Reevaluation
d) Reinforcement Management
Answer: C
Explanation: Self-revaluation aligns with the contemplation stage of change. It involves self-appraisal and recognizing healthy behavior as part of one’s desired identity.

128. Which strategy would be most effective for initiating the change process when a psychiatric- mental health nurse practitioner is implementing change within a community mental health clinic?
a) Conducting a root cause analysis
b) Analyzing data from epidemiological studies
c) Interviewing patient families
d) Using a survey to elicit patient satisfaction responses
Answer: D
Explanation: Using a survey to gather patient satisfaction responses is the most effective strategy for initiating the change process. It allows for direct feedback and helps tailor the change process to effectively meet the clinic’s needs.

129. Which activity would be most appropriate during the “Refreeze” stage when a PMHNP evaluates the effectiveness of a change initiative using Lewin’s Change Model?
a) Generating easy wins to motivate the team
b) Conducting a root cause analysis of any challenges
c) Establishing the change as the new habit or standard
d) Providing ongoing feedback and support to employees
Answer: C
Explanation: The main focus of the “Refreeze” stage is to stabilize the change and ensure it becomes the new norm or habit within the organization.

130. At school, a 10-year-old child with a history of trauma presents with disruptive behaviors. The initial intervention of the psychiatric-mental health nurse practitioner is to:
a) prescribe a low dose of an antipsychotic medication.
b) recommend individual psychotherapy focused on trauma-informed care.
c) suggest school suspension to address disruptive behavior.
d) refer the child to a pediatrician for a complete physical examination.
Answer: B
Explanation: Trauma-informed psychotherapy is the initiative intervention for children with a history of trauma. This therapy addresses disruptive behaviors and promotes mental well-being.

131. The PMHNP suspects developmental issues in a 5-year-old child who consistently exhibits aggressive behavior towards classmates. The Practitioner asks the parents about the child’s early social interactions. In this case, what aspect of development is the PMHNP primarily focusing on?
a) Cognitive development
b) Social development
c) Emotional development
d) Physical development
Answer: B
Explanation: The main focus of PMHNP is on social development to understand the child’s aggressive behavior in the context of early social interactions.

132. A 15-year-old patient is diagnosed with attention-deficit/hyperactivity disorder (ADHD). The patient exhibits difficulty in maintaining peer relationships and struggles academically. The psychiatric-mental health nurse practitioner recognizes this as a potential manifestation of:
a) Oppositional Defiant Disorder (ODD)
b) Autistic Spectrum Disorder (ASD)
c) Intellectual Disability (ID)
d) Conduct Disorder (CD)
Answer: B
Explanation: In an adolescent with ADHD, Social and academic challenges may suggest coexisting conditions, such as ASD, which often co-occurs with ADHD.

133. A 6-year-old child exhibits extreme resistance to attending school and leaving his mother’s side. The psychiatric-mental health nurse practitioner suspects a developmental issue related to:
a) Separation anxiety disorder
b) Oppositional defiant disorder
c) Autism spectrum disorder
d) Conduct disorder
Answer: A
Explanation: The child’s reluctance to separate from the mother and attend school aligns with symptoms of separation anxiety disorder. It is a common developmental issue in early childhood.

134. There is a 6-year-old child who has difficulty understanding abstract concepts and struggles with hypothetical situations. During which stage of cognitive development is this behavior most likely to occur, as described by Piaget?
a) Sensorimotor Stage
b) Pre-Operational Stage
c) Concrete Operational Stage
d) Formal Operational Stage
Answer: B
Explanation: Children in the Pre-Operational Stage (ages 2 to 6) struggle with abstract thinking and hypothetical concepts, according to Piaget’s Cognitive Developmental Theory.

135. A family with teenage children seeks therapy due to escalating conflicts and communication breakdowns. The psychiatric-mental health nurse practitioner (PMHNP) suggests a therapy approach focusing on restructuring family dynamics. What theoretical framework aligns with this approach?
a) Psychoanalytic therapy
b) Cognitive-behavioral therapy
c) Structural family therapy
d) Gestalt therapy
Answer: C
Explanation: Structural family therapy focuses on restructuring family dynamics and improving communication, making it suitable for resolving conflicts within families with teenage children.

136. A PMHNP observes dysfunctional family dynamics. He aims to introduce strategies to strengthen the family as a system. In this case, which aspect of structural family therapy is the PMHNP focusing on?
a) Joining
b) Mapping
c) Enactment
d) Reframing
Answer: C
Explanation: In this case, the PMHNP is focusing on “Enactment.” In structural family therapy, enactment involves introducing ideas and practices for the family to execute, aiming to strengthen the family as a system.

137. A 45-year-old client has been struggling with depression. During a therapy session, the client feels overwhelmed by a sense of failure due to past life events. The therapist employs a technique that involves externalizing the problem and encourages the client to view their experiences as separate from their identity. In this case, which therapeutic approach is the therapist most likely utilizing?
a) Cognitive-behavioral therapy (CBT)
b) Dialectical behavior therapy (DBT)
c) Narrative therapy
d) Psychodynamic therapy
Answer: C
Explanation: Narrative Therapy focuses on deconstructing problematic narratives and rewriting them to empower individuals. The therapist’s approach of externalizing the problem and helping the client view their experiences as separate from their identity aligns with the principles of Narrative Therapy.

138. A family attends therapy sessions to address unresolved conflicts and communication breakdowns. To promote understanding and empathy, the therapist encourages family members to share personal stories and perspectives. Which core aspect of narrative therapy is being implemented by the therapist?
a) Breaking the narrative into manageable chunks
b) Administering medication management
c) Focusing on physiological symptoms
d) Exploring genetic predispositions
Answer: A
Explanation: Breaking the narrative into manageable chunks fosters understanding and empathy within the family. It allows individuals to explore personal stories and perspectives.

139. A client reveals a traumatic experience during a therapy session. The therapist acknowledges the client’s emotions but feels overwhelmed. In this situation, what action is most appropriate by the therapist to ensure effective therapeutic facilitation?
a) The therapist abruptly ends the session to collect their thoughts.
b) The therapist shares their own similar traumatic experience.
c) The therapist maintains composure and validates the client’s feelings.
d) The therapist avoids discussing the traumatic experience further.
Answer: C
Explanation: Maintaining composure and validating the client’s feelings is the most appropriate action by the therapist to demonstrate empathy and facilitate effective therapy.

140. During a therapy session, a client discloses suicidal ideation. In this case, how can the psychiatric-mental health practitioner appropriately manage this crisis while maintaining a therapeutic alliance?
a) Immediately hospitalize the client for safety
b) Explore the reasons behind the suicidal thoughts
c) Disregard the disclosure to prevent further distress
d) Terminate therapy due to potential liability
Answer: B
Explanation: The PMHNP should explore the reasons behind suicidal thoughts. This strategy allows the nurse practitioner to assess risk, provide appropriate intervention, and maintain a therapeutic alliance during a crisis.

141. A client with a history of childhood trauma becomes emotionally overwhelmed and starts to dissociate during a therapy session. The psychiatric-mental health nurse practitioner notices distress and rapid breathing of the client. In this situation, what should be the most appropriate action of PMHNP?
a) Offer the client a tissue and continue the session as normal.
b) Acknowledge the client’s distress and gently guide them back to the present moment with grounding techniques.
c) Redirect the conversation to a lighter topic to avoid further distress.
d) Ignore the client’s distress and focus on discussing treatment options.
Answer: B
Explanation: The PMHNP should acknowledge the client’s distress and gently guide them back to the present moment with grounding techniques. These techniques align with trauma-informed care principles, promoting safety and therapeutic alliance development.

142. A 22-year-old patient who is diagnosed with an eating disorder expresses a strong desire for rapid weight loss and requests the psychiatric-mental health nurse practitioner to prescribe a medication not indicated for this purpose. The appropriate response is to:
a) Prescribe the requested medication to address the patient’s concerns.
b) Educate the patient on the risks and ineffectiveness of the requested medication for weight loss.
c) Ignore the request and focus solely on the psychiatric aspects of the eating disorder.
d) Refer the patient to a nutritionist without addressing the medication request.
Answer: B
Explanation: While considering the patient’s overall well-being, the nurse practitioner needs to provide education on the risks and ineffectiveness of the requested medication for weight loss.

143. How should the nurse practitioner best explain the concept when a psychiatric-mental health nurse practitioner is discussing privacy and confidentiality with a newly admitted patient and the patient asks about the distinction between privacy and confidentiality?
a) Privacy involves protecting information from government intrusion, while confidentiality is about nondisclosure of shared information.
b) Both privacy and confidentiality pertain to protecting an individual from society’s laws and government intrusion.
c) Privacy is only violated when an individual’s actions are observed, whereas confidentiality relates to sharing information with others.
d) Privacy is exclusively a legal matter, while confidentiality is an ethical duty of nondisclosure between two individuals.
Answer: B
Explanation: Confidentiality is an ethical duty of nondisclosure, which involves two individuals sharing information, while privacy refers to protecting an individual from government intrusion.

144. What distinguishes voluntary admission from involuntary commitment when a patient with severe depression is considering inpatient treatment?
a) Voluntary admission involves mutual agreement on treatment; involuntary commitment is court-ordered. Both maintain full civil rights.
b) Voluntary admission requires court approval; involuntary commitment is self-initiated. Civil rights are restricted in both cases.
c) Voluntary admission allows immediate discharge; involuntary commitment mandates a minimum stay. Full civil rights are retained in voluntary admission, but some are restricted in involuntary commitment.
d) Voluntary admission is for minor mental health issues; involuntary commitment is for severe cases. Civil rights are maintained in both, with no restrictions.
Answer: A
Explanation: Voluntary admission entails a mutual agreement between the individual and the provider to maintain civil rights. Civil rights are still retained, differentiating them from voluntary admission during involuntary commitment, which involves court orders.

145. How does the lack of specificity impact the ethical considerations when a patient makes a vague threat without a clearly identified victim and a psychiatric-mental health nurse practitioner is consulting?
a) Mandatory duty to warn state, where specificity is essential for disclosure.
b) Permissive duty to warn state, providing flexibility in disclosing nonspecific threats.
c) No duty to warn state, granting more discretion when threats lack specificity.
d) Voluntary duty to warn state, allowing practitioners to decide on disclosure based on clinical judgment.
Answer: C
Explanation: The lack of specificity impacts ethical considerations by affording practitioners greater autonomy in decision-making. When the threat lacks specificity or a clearly identified victim, providing more discretion in maintaining confidentiality, in a “no duty to warn” state, the practitioner typically faces fewer legal obligations.

146. While considering electroconvulsive therapy (ECT), a 50-year-old patient with major depressive disorder. The nurse practitioner’s role is to:
a) Dismiss ECT as an outdated and ineffective treatment.
b) Provide information on the benefits, risks, and alternatives of ECT.
c) Advocate for medications as the only appropriate treatment.
d) Recommend ECT without discussing other treatment options.
Answer: B
Explanation: Supporting informed decision-making and patient autonomy provides information on the benefits, risks, and alternatives of ECT.

147. A 45-year-old patient refuses to participate in the development of a treatment plan during the initial assessment when a patient with a history of schizophrenia is admitted to a psychiatric facility. How should the psychiatric-mental health nurse practitioner approach?
a) Respect the patient’s decision and proceed with the treatment plan independently.
b) Document the refusal and continue with the treatment plan without patient involvement.
c) Engage in collaborative dialogue, respecting the patient’s autonomy, and exploring alternative approaches to involve them in the treatment planning process.
d) Coerce the patient into the treatment planning process to ensure compliance with recommended interventions.
Answer: C
Explanation: To promote collaborative decision-making, respecting the patient’s autonomy is essential. The nurse practitioner explores alternative methods to involve the patient in the treatment planning process and should engage in open communication.

148. Considering evidence-based practices, the patient is interested in creative therapies. How can the nurse practitioner incorporate creative therapies into the treatment plan when a psychiatric-mental health nurse practitioner is treating a patient with depression?
a) Discourage creative therapies, emphasizing the efficacy of prescription medications.
b) Incorporate physical activity and exercise as alternative therapies.
c) Recommend electroconvulsive therapy (ECT) as an effective creative intervention.
d) Integrate art, music, movement, or writing as creative therapies.
Answer: D
Explanation: Acknowledging their effectiveness in mental health treatment, the nurse practitioner can integrate art, music, movement, or writing and align with the patient’s preference for creative therapies.

149. While falling asleep, a 28-year-old patient with anxiety reports difficulty. The first-line recommendation of the nurse practitioners is:
a) Prescribing a benzodiazepine for immediate relief.
b) Encouraging a consistent sleep schedule and good sleep hygiene.
c) Ignoring the sleep concerns as they may be related to anxiety.
d) Referring the patient to a sleep specialist for further evaluation.
Answer: B
Explanation: To improve sleep practice, encouraging a consistent sleep schedule and good sleep hygiene. This strategy promotes non-pharmacological approaches.

150. A new antipsychotic medication is prescribed to a patient diagnosed with schizophrenia. During the medication discussion, the psychiatric-mental health nurse practitioner emphasizes the importance of informed consent. The patient asks, “What does informed consent mean?”
a) It’s a legal formality; just sign it, and we can proceed with your treatment.
b) Informed consent ensures you receive treatment without knowing the details.
c) It means you’ll be informed about the medication, its risks, benefits, and alternatives, allowing you to make an educated decision about your care.
d) It’s a routine process; don’t worry too much about it.
Answer: C
Explanation: Informed consent allows one to make an educated decision about the patient’s care and provides comprehensive information to the patient about the treatment, including risks, benefits, and alternatives.

151. Despite antipsychotic treatment, a 45-year-old patient with schizophrenia experiences persistent auditory hallucinations. The next step for nurse practitioners is to:
a) Increase the dosage of the current antipsychotic medication.
b) Add a second antipsychotic medication to the treatment plan.
c) Discontinue all antipsychotic medications to assess symptom changes.
d) Ignore the hallucinations as they may be a normal response to stress.
Answer: A
Explanation: While maintaining the current treatment plan, the initial step is increasing the dosage of the current antipsychotic to address persistent symptoms.

152. A patient who has expressed a generalized intent to harm others is assessed by a psychiatric- mental health nurse practitioner in a state following a “mandatory duty to warn” approach. How does the lack of a specific threat impact the practitioner’s ethical considerations?
a) Disclose the general threat to potential victims without patient consent, prioritizing public safety.
b) Document the non-specific threat in the patient’s chart and inform the patient of potential consequences.
c) Seek legal advice before taking any action, ensuring compliance with state-specific duty to warn laws.
d) Reassure the patient that confidentiality will be maintained, focusing on building trust in the therapeutic relationship.
Answer: D
Explanation: In a “mandatory” duty to warn state, where a specific threat is a condition for disclosure, reassuring the patient that confidentiality will be maintained and focusing on building trust in the therapeutic relationship to emphasize the patient fosters trust.

153. By a legal representative acting on behalf of a patient with cognitive disabilities, a psychiatric-mental health nurse practitioner is evaluating a request for access to mental health records. In this situation, what is the nurse practitioner’s responsibility?
a) Withhold the records to protect privacy.
b) Grant access without considering potential risks.
c) Seek approval from the Executive Officer.
d) Provide support to the representative during record review.
Answer: D
Explanation: During the review of the mental health records, the nurse practitioner ensures that the legal representative receives privacy-compliant assistance, considering potential negative consequences for the patient.

154. Requesting a change in medication due to sexual dysfunction, a 55-year-old patient with bipolar disorder expresses desire. The approach of nurse practitioners is to:
a) Ignore the concern as sexual dysfunction is a common side effect of bipolar medications.
b) Discuss the impact of sexual dysfunction and explore alternative medications with fewer sexual side effects.
c) Discontinue all medications to address the sexual dysfunction.
d) Refer the patient to a urologist for further evaluation.
Answer: B
Explanation: To promote patient-centered care and address concerns, discuss the impact of sexual dysfunction and explore alternative medications with fewer sexual side effects.

155. The patient is hesitant about electroconvulsive therapy (ECT) when a psychiatric-mental health nurse practitioner is treating a patient with severe depression. Regarding informed consent for ECT, what is the nurse practitioner’s primary responsibility?
a) Assure the patient that ECT is risk-free and will guarantee improvement.
b) Explain the benefits of ECT while downplaying potential side effects.
c) Facilitate an informed consent process, ensuring the patient understands the procedure, risks, and alternatives.
d) Proceed with ECT without obtaining formal consent due to the patient’s severe depression.
Answer: C
Explanation: The primary responsibility of nurse practitioners is to ensure the patient understands the procedure, risks, and alternatives and to facilitate the informed consent process.

156. What legal rights does the patient retain in a voluntary admission scenario when a patient with bipolar disorder refuses hospitalization despite acute symptoms?
a) The patient loses civil rights in voluntary admission; the nurse practitioner must advocate for hospitalization.
b) Civil rights are retained in voluntary admission, allowing the patient to leave at any time. The nurse practitioner supports the patient’s decision while monitoring safety.
c) Voluntary admission requires court approval; the nurse practitioner can override the patient’s decision.
d) The patient must comply with all treatment recommendations during voluntary admission. The nurse practitioner enforces compliance.
Answer: B
Explanation: When monitoring safety, civil rights are retained, allowing the patient to leave at any time in voluntary admission. The nurse practitioner respects the patient’s decision.

157. While considering to participate in a research study testing an experimental drug by a patient diagnosed with bipolar disorder. As part of the study, the patient expresses a desire to share their mental health records. In the release of the information authorization form, ensuring the patient’s informed consent, what critical information should the psychiatric-mental health nurse practitioner emphasize?
a) Patient’s current medication list and dosage
b) Comprehensive discussion on the potential risks and benefits of study participation
c) Detailed overview of the patient’s family medical history
d) Specific dietary preferences of the patient
Answer: B
Explanation: To ensure the patient is well-informed before authorizing the release of their mental health records, the nurse practitioner should emphasize discussing the comprehensive risks and benefits of participating in the research study.

158. During a therapy session, a 30-year-old patient with depression expresses suicidal thoughts. The immediate action of the nurse practitioners is to:
a) Document the patient’s statements and continue with the session.
b) Assess the patient’s safety, implement crisis intervention, and involve appropriate support.
c) Ignore the statements as they may be attention-seeking behavior.
d) Advise the patient to keep such thoughts private to avoid hospitalization.
Answer: B
Explanation: When a patient expresses suicidal thoughts, immediate actions of the nurse involving appropriate support, assessing the patient’s safety, and implementing crisis intervention are critical.

159) A psychiatric-mental health nurse practitioner is caring for a patient who believes in a traditional healing practice from a different cultural background. What is the nurse practitioner’s best course of action when the patient expresses a desire to incorporate this practice into their mental health treatment?
a) Encourage the patient to prioritize Western medical treatments over traditional practices.
b) Collaborate with the patient to integrate the traditional healing practice into their overall mental health plan.
c) Suggest dismissing the traditional healing practice as it may conflict with evidence-based interventions.
d) Disregard the patient’s request and follow standard treatment protocols.
Answer: B
Explanation: Collaborating with the patient to incorporate traditional practices fosters cultural competence and patient-centered care. Recognizing and respecting diverse cultural beliefs is crucial in mental health care.

160) A psychiatric-mental health nurse practitioner is treating an adolescent who has a history of self-harm. By citing cultural beliefs, the adolescent’s parents refuse psychiatric medication that emphasizes non-pharmacological approaches. How should the nurse practitioner approach this situation?
a) Overrule the parents’ decision for the adolescent’s safety and initiate psychiatric medication.
b) Respect the parents’ cultural beliefs and solely rely on non-pharmacological interventions.
c) Engage in open communication, educate the parents about treatment options, and explore a compromise.
d) Report the parents to child protective services for neglecting the adolescent’s mental health needs.
Answer: C
Explanation: The nurse practitioner should educate and discuss treatment options, aiming for a shared decision that respects both cultural beliefs and the adolescent’s safety. Fostering collaboration and communication is essential.

161) A 35-year-old African American patient refuses to disclose crucial medical information by expressing mistrust in the healthcare system. Considering potential disparities in healthcare, what ethical principle should guide the psychiatric-mental health nurse practitioner’s response?
a) Autonomy
b) Beneficence
c) Justice
d) Veracity
Answer: C
Explanation: The ethical principle should guide the psychiatric-mental health nurse practitioner’s response. It emphasizes fairness and equal treatment for all individuals.

162) A psychiatric-mental health nurse practitioner encounters a patient from a rural area. The patient has limited mental health resources. In this case, what legal principle should guide the nurse practitioner in advocating for improved access to mental health services in rural communities?
a) Negligence
b) Fidelity
c) Advocacy
d) Confidentiality
Answer: C
Explanation: Advocacy legal principles should guide the nurse practitioner for improved access to mental health services in rural communities.

163) A 30-year-old patient from a diverse cultural background reports feeling misunderstood in previous mental health encounters. The psychiatric-mental health nurse practitioner recognizes the importance of cultural competence. What initial action should the nurse take to address this patient’s concerns and enhance the therapeutic relationship?
a) Schedule additional sessions to delve into the patient’s cultural background and experiences.
b) Seek supervision to better understand the patient’s cultural nuances and tailor care accordingly.
c) Apologize for any past misunderstandings and assure the patient of improved communication.
d) Refer the patient to a mental health professional with expertise in their specific cultural group.
Answer: B
Explanation: To address the patient’s concerns and improve the therapeutic relationship, the nurse should seek supervision to gain a better understanding of the patient’s cultural nuances and tailor care accordingly.

164) In a healthcare setting, a 35-year-old patient discloses experiencing discrimination and identifies as LGBTQ+. The nurse practitioner aims to create an inclusive and affirming therapeutic environment. To address issues related to sexual orientation and gender identity, which approach best demonstrates the nurse’s commitment to these concerns?
a) Integrate LGBTQ+ cultural competency training for the entire healthcare team.
b) Encourage the patient to overlook discriminatory experiences for the sake of treatment.
c) Document the patient’s concerns without taking any immediate action.
d) Refer the patient to LGBTQ+ support groups outside the healthcare system.
Answer: A
Explanation: The nurse should promote integrated LGBTQ+ cultural competency training for the entire healthcare team to address issues related to sexual orientation and gender identity.

165) As a PMHNP, explain the crucial role that leadership commitment plays in promoting diversity, equity, and inclusion (DEI) within healthcare organizations. Emphasizing the impact on both staff and patients, provide specific examples of how executive leaders can authentically contribute to DEI efforts.
a) By creating DEI committees.
b) By involving a patient community representative in leadership decisions.
c) By hosting occasional DEI training sessions.
d) By assigning DEI responsibilities to specific departments.
Answer: B
Explanation: Emphasizing the impact on both staff and patients, involving a patient community representative in leadership decisions can ensure authentic and inclusive leadership in DEI efforts.

166) In healthcare organizations, developing a comprehensive strategy for promoting DEI is crucial. Provide specific examples of factors to focus on over a fixed time and explain the significance of identifying indicators of success. For achieving meaningful and measurable progress in DEI initiatives, how does this targeted approach contribute?
a) By routinely assessing organizational culture through surveys.
b) By delegating DEI responsibilities to specific departments.
c) By conducting a root cause analysis periodically.
d) By focusing solely on hiring practices.
Answer: C
Explanation: In order to achieve meaningful and measurable progress in DEI initiatives, it’s important to periodically conduct a root cause analysis to identify indicators of success for targeted interventions.

167) When working with a patient of diverse sexual orientation, how would you, as a Psychiatric- mental health nurse practitioner, integrate cultural competence into your assessment?
a) Avoid discussing the patient’s sexual orientation to maintain professional boundaries.
b) Assess the patient’s sexual orientation with predetermined assumptions.
c) Acknowledge and respect the patient’s sexual orientation, adapting your approach accordingly.
d) Assume that all patients of the same sexual orientation share similar mental health concerns.
Answer: C
Explanation: Acknowledging and respecting the patient’s sexual orientation would integrate cultural competence when working with a patient of diverse

168) What ethical responsibility does the nurse practitioner have in the situation where a PMHNP is treating a patient with severe depression who lacks decision-making capacity?
a) Respect patient autonomy without intervention.
b) Proceed with treatment based on the best interests of the patient.
c) Seek consent from family members without patient involvement.
d) Disregard the patient’s preferences in favor of medical judgment.
Answer: B
Explanation: The nurse practitioner should make decisions in the best interest of the patient, considering potential benefits, harms, and the patient’s well-being in the absence of decision-making capacity.

169) In a jurisdiction, involuntary treatment is allowed for those deemed “gravely disabled,” and a psychiatric nurse is working with them. What criterion distinguishes this type of involuntary treatment from others?
a) Risk of psychological deterioration
b) Presence of psychiatric symptoms
c) Severity of mental health disorder
d) Diagnosed infectious disease
Answer: A
Explanation: Involuntary treatment focuses on reducing the risk of psychological deterioration rather than treating present symptoms of mental health disorders for the “gravely disabled.”

170) How can the psychiatric-mental health nurse practitioner incorporate the concept of ‘dignity of risk’ when developing a care plan for an older person?
a) Avoid all risks to prioritize safety.
b) Assess the older person’s values and involve community services.
c) Disregard the older person’s values to follow institutional protocols.
d) Minimize involvement of family members to avoid conflicts.
Answer: B
Explanation: When developing a care plan for an older person, incorporating the concept of ‘dignity of risk’ involves assessing the older person’s values and involving community services.

171) What is the primary criterion a patient must meet to demonstrate capacity in the context of decision-making capacity?
a) Ability to agree with the medical recommendation.
b) Acknowledgment of the problem and possible solutions.
c) Agreement with the team’s recommendation.
d) Compliance with the standard medical practice.
Answer: B
Explanation: Acknowledgment of the problem and possible solutions is the primary criterion a patient must meet to demonstrate capacity in the context of decision-making.

172) As a psychiatric-mental Health nurse practitioner, a patient with severe mental illness expresses concerns about the side effects of prescribed medications. What ethical and cultural considerations should guide your response to ensure patient autonomy and well-being?
a) Encourage the patient to adhere strictly to the medication regimen to avoid exacerbating their condition.
b) Explore the patient’s concerns, discuss potential alternatives, and collaborate on a culturally sensitive treatment plan.
c) Disregard the patient’s worries, emphasizing the medical necessity of the prescribed medications.
d) Report the patient’s noncompliance to higher authorities for legal intervention.
Answer: B
Explanation: To ensure patient autonomy and well-being, explore the patient’s concerns, discuss potential alternatives, and collaborate on a culturally sensitive treatment plan.

173) How can the nurse practitioner contribute to addressing the issue while upholding principles of educational equity when PMHNP recognizes that students from less privileged backgrounds may face challenges when given accommodations?
a) Implement standardized accommodations for all students to avoid disparities.
b) Advocate for additional resources and academic support for students from less privileged backgrounds.
c) Disregard socioeconomic factors and provide accommodations uniformly.
d) Focus on providing accommodations to students with visible disabilities.
Answer: B
Explanation: The nurse can advocate for additional resources and academic support for students from less privileged backgrounds.

174) How can the nurse practitioner ethically address the issue to ensure fair provision of accommodations when a psychiatric-mental health nurse practitioner working in a school setting encounters disparities in disability identification rates, particularly in wealthy schools?
a) Increase disability identifications uniformly across all schools.
b) Advocate for evidence-based disability evaluations and accommodations.
c) Disregard socioeconomic factors and provide accommodations uniformly.
d) Prioritize disability identifications for students with higher socioeconomic status.
Answer: B
Explanation: To ensure fair provision and address disparities in disability identification rates, advocate for evidence-based disability evaluations and accommodations.

175) For special education delivery, a nurse is evaluating a school system’s approach. When should students be considered for formal disability classification and accommodations, according to modern Multi-Tiered Systems of Support (MTSS)?
a) After the first intervention fails
b) Immediately upon identification of a disability
c) Without any interventions
Answer: A
Explanation: According to modern Multi-Tiered Systems of Support, students should be considered for formal disability classification and accommodations only after the first intervention fails.