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Academic- Psychiatric Mental Health NP Posttest

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Ch. 1 - Post-Test
Pg. 2 - Posttest
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Assessment Passed
You Scored: 82% (You needed: 0%)
Date Started: 6/18/2024|Date Completed: 6/18/2024|Time spent: 02:24:10

1 of 150Hannah is a 48-year-old woman who is diagnosed with mild-to-

moderate depression characterized by feelings of worthlessness, fatigue, and
irritability that has lasted for over 2 years. She is generally healthy and her
medical history does not indicate any previous diagnosis or treatment of a
mental health disorder. After discussion with the PMHNP, it is decided to
initiate therapy with a low dose of an antidepressant. Which of the following
would be the most appropriate first-line treatment choice?
QID: 3661725
Mark For Review
Sertraline 150 mg QD
Paroxetine 20 mg QD
Trazodone 75 mg BID
Phenelzine 15 mg TID
YOU ANSWERED CORRECTLY
Sertraline is a SSRI that can also be used first-line for depression. However, the
initial starting dose is typically 50 mg daily, which can eventually be titrated
gradually to 150 mg daily (A). Other antidepressant classes are usually considered
following an inadequate response to an SSRI or intolerance of the SSRI agent.
Tricyclic antidepressants (e.g., desipramine) and MAOIs (e.g., phenelzine) can
also be used to treat depression, though their adverse effect profile and drug
interaction potential prevent them for consideration as first-line therapy (D).
Trazodone is typically used to treat depression in individuals who have trouble
sleeping due to the somnolence associated with this medication (C).
2 of 150Hannah returns in 1 week and reports that she has been taking her
medication as directed. Which of the following is the most important question
the PMHNP can ask Hannah at this visit?
QID: 3661726
Mark For Review
“Have you noticed any reduction in depressive symptoms?”
“Have you experienced any increase in suicidal ideation?”
“Have you experienced any headaches or GI adverse effects?”
“Do you want to switch to another medication?”
YOU ANSWERED INCORRECTLY
Though it is important to assess the mental status of patients at each visit,
including depression symptoms and suicidal/homicidal thoughts, this will not
provide the most useful information for the PMHNP after only 1 week of treatment
(A, B). Given that the full therapeutic potential of the medication can take 4 weeks
or longer, this is not the appropriate time to consider switching medication unless
there is a serious drug-related adverse effect (D).
3 of 150Five weeks after initiating antidepressant therapy, Hannah returns for
a follow-up visit. She reports some improvement is symptoms but was hoping
for a more substantial effect in lifting her mood. The PMHNP performs the
PHQ-9 and notes an improvement from a score of 14 at baseline to 11 today.
Hannah notes that she is tolerating the medication well. The next best course
of action is to:
QID: 3661727
Mark For Review
Remain on the current regimen and return in 4 weeks.
Increase the dose of medication and return in 4 weeks.
Switch to another antidepressant class and return in 2 weeks.
Discontinue therapy and initiate ECT.
YOU ANSWERED CORRECTLY
Though staying on the current regimen is an option, the small improvement with a
low-dose regimen suggests that a higher dose would be more beneficial for the
patient (A). Switching to another class can also be considered, though this comes
with uncertainty about the effectiveness and tolerability of initiating a new agent
(C). As pharmacotherapy has demonstrated some initial effect, it would not be
reasonable to discontinue therapy and switch to ECT at this point in management
(D).
4 of 150A 37-year-old man with bipolar disorder is being evaluated following a
suicide attempt. He is currently taking quetiapine for bipolar maintenance
therapy. The PMHNP considers the addition of:
QID: 3661728
Mark For Review
Perphenazine.
Clomipramine.
Bupropion.
Lithium.
YOU ANSWERED CORRECTLY
The addition of another antipsychotic would not be recommended (A).
Antidepressants such as clomipramine (B) and bupropion (C) are not
recommended in the management of bipolar disorder.
5 of 150A 19-year-old woman is undergoing psychotherapy for bulimia
nervosa. She states that she has been taking diuretics for the past year but is
ready to discontinue the medication. The PMHNP counsels that:
QID: 3661729
Mark For Review
Fluid intake should be limited for two weeks following diuretic discontinuation.
Rebound edema and weight gain will likely occur but will resolve in 1-2 weeks.
The diuretic should be slowly titrated to prevent a hypertensive emergency.
Exercise should be discouraged for a period after discontinuation.
YOU ANSWERED CORRECTLY
Discontinuation of the diuretic will not increase the risk of a hypertensive
emergency, particularly in an individual with no history of hypertension (C).
Though rebound fluid retention is likely with diuretic discontinuation, this is a
time-limited effect and fluid intake should not be restricted during this time (A).
Exercise should be encouraged for all individuals and tailored to their needs and
abilities. There are no specific warnings regarding light-to-moderate exercise
following termination of diuretic use (D).
6 of 150When initiating lithium therapy for mood stabilization, the PMHNP
recommends checking serum lithium level:
QID: 3661730
Mark For Review
In 2 days.
In 5 days.
In 14 days.
Only when adverse effects are reported.
YOU ANSWERED CORRECTLY
Testing after 2 days of initiating lithium treatment would not allow enough time to
get an adequate assessment of the steady-state lithium level (A). Waiting until 14
days or longer after initiating therapy is too long and would not allow timely dose
adjustment to ensure a safe and effective level is attained (D). Lithium levels
should be routinely monitored and not limited to only when adverse effects are
reported (D).
7 of 150A 27-year-old woman is being treated with a SSRI for generalized
anxiety disorder. She mentions that she is experiencing migraines about once
per week and asks what she can take to treat an acute migraine. The PMHNP
recommends:
QID: 3661731
Mark For Review
Ibuprofen.
Sumatriptan.
Topiramate.
Propranolol.
YOU ANSWERED INCORRECTLY
Ibuprofen or acetaminophen are appropriate choices to treat an acute migraine
episode for this patient. (A). These pain relievers are safe to use in patients taking
a SSRI agent.
8 of 150Deb is a 41-year-old female with a history of bipolar I disorder who
stopped taking her mood stabilizer because of a lapse in her health insurance.
At a follow-up visit, she presents with signs of moderate-to-severe depression.
The PMHNP realizes which of the following is FDA approved for the
treatment of bipolar depression?
QID: 3661732
Mark For Review
Divalproex sodium
Risperidone
Citalopram
Lurasidone
YOU ANSWERED CORRECTLY
SSRIs are not recommended for bipolar depression alone as this can trigger a
manic episode (C). The anticonvulsant divalproex sodium and the second-
generation antipsychotic risperidone are indicated for the treatment of acute
mania but not bipolar depression (A, B).
9 of 150Lanugo is a condition most often associated with which of the
following mental health disorders?
QID: 3661733
Mark For Review
Binge-eating disorder
Schizophrenia
Anorexia
Alzheimer’s dementia
YOU ANSWERED CORRECTLY
Lanugo associated with malnutrition is not an expected finding among those with
binge-eating disorder (A), schizophrenia (B), or Alzheimer’s dementia (D).
10 of 150When counseling a woman about discontinuing long-term
benzodiazepine therapy for panic disorder, the PMHNP discusses all of the
following except:
QID: 3661734
Mark For Review
Withdrawal symptoms can be serious and life-threatening.
The benzodiazepine dose should be slowly tapered over time.
Only benzodiazepines with a short half-life require tapering regimens.
The timing of withdrawal symptoms will depend on the drug’s half-life.
YOU ANSWERED CORRECTLY
Benzodiazepine withdrawal symptoms can include anxiety, dysphoria, intolerance
to light and sound, nausea, and muscle twitching. In severe cases, tremors,
hallucinations, seizures and a delirium tremens-like state can occur (A). Tapering
the medication over several weeks is required rather than rapid discontinuation
(B). Withdrawal symptoms will occur sooner after discontinuation with agents that
have a short half-life compared to those with a long half-life (D).
11 of 150Which of the following individuals with depression would be the best
candidate for fluoxetine therapy?
QID: 3661735
Mark For Review
An 81-year-old with multiple comorbid conditions
A 48-year-old with a long history of alcohol abuse
A 25-year-old with insomnia
A 35-year-old with a history of poor medication adherence
YOU ANSWERED INCORRECTLY
Given the prolonged half-life, fluoxetine is not recommended for those with
decreased metabolism of the drug as this can increase drug exposure. This can
include the elderly (A) as well as those with decreased hepatic function (B). This
agent is also energizing and can help exacerbate symptoms of insomnia (C).
12 of 150A 31-year-old man has been treated with venlafaxine for the past 8
months for moderate depression. He has noticed significant improvement with
therapy and little or no depressive symptoms over the past 3 months. The
PMHNP performs the Beck Depression Inventory (BDI) at today’s visit and he
scores a 10. He asks how much longer he will need to take his medication. The
PMHNP responds:
QID: 3661736
Mark For Review
Indefinitely given the risk of relapse.
Usually about 4 months total on average.
At least 6 months following remission of symptoms.
Treatment can stop once the BDI score is less than 5.
YOU ANSWERED CORRECTLY
The recommended duration of treatment is at least 6 months after remission is
achieved and not 4 months of total treatment duration (B). Discontinuation of
therapy can be considered once an adequate period of remission is achieved (A),
though ongoing maintenance therapy can be considered for those at high risk of
relapse. A BDI score of 0 to 13 indicates minimal depression and a score of <5 is
not required to indicate remission (D).
13 of 150Jessica is a 33-year-old woman with bipolar I disorder who will
initiate lithium for mood stabilization. The PMHNP counsels Jessica that an
anticipated adverse effect of lithium therapy is:
QID: 3661737
Mark For Review
Nausea and vomiting.
Hyperirritability of muscles.
Coarse hand tremor.
Sedation.
YOU ANSWERED INCORRECTLY
Lithium is an inexpensive and effective drug that is often used for mood
stabilization. However, lithium toxicity can be a life-threatening condition and,
thus, routine drug level monitoring is needed to ensure a therapeutic level is
maintained. Common adverse effects of lithium include nausea, vomiting, and
thirst, and these are not necessarily a sign of toxicity (A).
14 of 150Jessica returns about two weeks later and reports some improvement
in symptoms. Her lithium level is 0.4 mEq/L and she does not report any
unusual signs or symptoms other than mild thirst. The PMHNP will advise:
QID: 3661738
Mark For Review
This is within the normal therapeutic range.
The dose should be increased.
The dose should be decreased.
She should discontinue therapy immediately.
YOU ANSWERED CORRECTLY
As the expected lithium level should be in the range of 0.6 to 1.0 mEq/L, her dose
should be titrated higher rather than decreased or continued at the same dose (A,
B). There is no need to stop therapy as there is no report of a serious adverse
effect (D).
15 of 150A 44-year-old woman is being evaluated for panic disorder. When
asked to describe what she experiences during a panic attack, which of the
following is least likely to be mentioned?
QID: 3661739
Mark For Review
Chest pain
Profuse sweating
Vertigo
Shortness of breath
YOU ANSWERED CORRECTLY
Panic disorder is characterized by an abrupt surge of intense fear or discomfort
and can include a number of symptoms including palpitations, pounding heart,
sweating (B), trembling or shaking, sensation of shortness of breath (D), chest
pain (A), nausea, and dizziness, among others. Those with panic disorder will
adapt their behavior to avoid panic attacks or avoid unfamiliar surroundings in
case a panic attack occurs.
16 of 150When making a diagnosis of depression, the DSM-5 criteria require a
finding of either depressed mood and/or a finding of:
QID: 3661740
Mark For Review
Recurring thoughts of death.
Diminished self-worth.
Loss of interest or pleasure.
Fatigue.
YOU ANSWERED INCORRECTLY
A diagnosis of depression must include symptoms of depressed mood or lack of
interest or pleasure. Other symptoms can include a marked increase or decrease in
appetite with corresponding weight change, excessive or insufficient amounts of
sleep, motor activity changes, fatigue (D), diminished self-worth (B), difficulty
concentrating, and thoughts of death (A). However, these are not required for a
diagnosis of depression.
17 of 150During a neurological examination of a patient with mild dementia
and who experienced a fall, you ask if he can feel you lightly touching different
areas of the face when his eyes are closed. This exercise tests the function of
cranial nerve:
QID: 3661741
Mark For Review
III.
V.
VII.
VIII.
YOU ANSWERED CORRECTLY
Cranial nerve III (CN III) is the oculomotor nerve and is responsible for eye
movements and the eyelid (A). This can be evaluated by asking the patient to
follow movements with their eyes. CN VII is associated with facial muscles and is
responsible for Bell’s palsy that results in drooping of the mouth, facial
asymmetry, and impaired eyelid movement (C). CN VIII is the auditory and
vestibulocochlear nerve responsible for hearing and balance (D). This nerve can
be evaluated with the Rinne test or Weber test (for hearing), or the Rhomberg test
(for balance).
18 of 150Which of the following findings would be least expected in an
individual experiencing acute mania?
QID: 3661742
Mark For Review
Sense of invincibility
Binge eating
Decreased need for sleep.
Binge gambling
YOU ANSWERED CORRECTLY
During a manic episode, individuals will experience feelings of invincibility and
grandiosity (A) which can lead to risk-taking behavior, such as binge-gambling
and hypersexuality (D). Manic episodes are characterized by a decreased need for
sleep or eating (C).
19 of 150When considering the use of citalopram in adults 60 years and older,
what is the maximum recommended daily dose?
QID: 3661743
Mark For Review
10 mg
20 mg
40 mg
80 mg
YOU ANSWERED CORRECTLY
Citalopram dosing in older adults should not exceed 20 mg per day due to
cardiovascular effects (A, C, D).
20 of 150Which of the following best describes the residual phase of
schizophrenia (Select two correct answers)?
QID: 3661744
Mark For Review
Characterized by hallucinations, delusions, and significant distortion of thinking
Follows the active phase
Predominated by negative symptoms
Involves a slow or gradual onset of lack of interest in social activities, work, or
grooming/hygiene.
YOU ANSWERED CORRECTLY
The prodromal phase of schizophrenia can be present for months to years and can
be associated with a slow or gradual onset of lack of interest in social activities,
school, work, or grooming/hygiene (D). The active phase follows the prodromal
phase and is characterized by positive symptoms, such as delusions,
hallucinations, significant distortion of thinking, and alterations in behavior and
mood (A).
21 of 150Which of the following individuals would the use of bupropion be
least appropriate?
QID: 3661745
Mark For Review
A 22-year-old with moderate depression and had an inadequate response to
paroxetine
A 36-year-old with moderate depression and who experienced sexual adverse
effects with sertraline
An 18-year-old with bulimia nervosa and mild depression
A 27-year-old with depression and who is trying to stop smoking
YOU ANSWERED CORRECTLY
Bupropion can be considered for individuals with depression who fail treatment
with a SSRI (A). Bupropion does not cause sexual dysfunction and can be an
appropriate option for those who experience these adverse effects with a SSRI
agent (B). Bupropion can also be used to aid smoking cessation along with
depression (D).
22 of 150Which of the following are characteristics consistent with dementia?
(Select two answers)
QID: 3661746
Mark For Review
Rapid onset
Can be triggered by electrolyte imbalance
Cognitive dysfunction is irreversible
Can last months to years
YOU ANSWERED CORRECTLY
Delirium is a sudden state of rapid changes in the brain usually caused by an
underlying identifiable trigger (A). Delirium can be caused by infection, drug
reaction or toxicity, head trauma, electrolyte imbalance (B), or anemia, among
other reasons. Once the underlying cause is identified and addressed, the delirium
will usually resolve and cognitive function will return.
23 of 150A 53-year-old man with schizophrenia is experiencing an auditory
hallucination. An appropriate response by the PMHNP is any of the following
except:
QID: 3661747
Mark For Review
Turn on some music or the television.
Encourage the patient to go for a walk or engage in another activity.
Ask the patient to describe what he is hearing.
Repeating to the patient that the hallucination is not real until it passes.
YOU ANSWERED CORRECTLY
Several techniques can be used to help patients manage hallucinations. Using
competing auditory stimuli, such as listening to music or the TV or having the
patient read aloud, can help diminish the impact of the hallucination (A). The
PMHNP can also encourage activities that will take the patient’s mind off the
hallucination, such as going for a walk, cleaning, or talking to others (B). To gain
an understanding of the hallucination, the PMHNP can ask the patient what he is
experiencing and how that is making him feel (C).
24 of 150A 42-year-old woman has initiated sertraline therapy (100 mg daily)
for depression. At a follow-up visit, she reports some improvement in
depression symptoms but has noticed a diminished sex drive that is putting a
strain on her relationship with her partner. The PMHNP recommends:
QID: 3661748
Mark For Review
Advising that sexual adverse effects are transient and will resolve over time.
Decrease the dose to 50 mg daily.
Switch to paroxetine.
Switch to bupropion.
YOU ANSWERED CORRECTLY
Sexual adverse effects are a class effect of the SSRIs and so switching to another
SSRI agent will not likely resolve the issue (C). Lowering the dose will also not
likely resolve the issue and will result in a diminished effect on depression
symptoms (B). Sexual adverse effects are not transient and so a switch in therapy
is needed (A).
25 of 150When considering the use of a cholinesterase inhibitor for a 73-year-
old with early-stage Alzheimer’s dementia, the PMHNP counsels the patient’s
caretaker about all of the following potential adverse effects except:
QID: 3661749
Mark For Review
Sedation.
Diarrhea.
Hand tremors.
Lacrimation.
YOU ANSWERED INCORRECTLY
Parasympathetic activation results in slowing of heart rate and activation of the
gastrointestinal tract, which can result in diarrhea (B). Other common adverse
effects include salivation, lacrimation (D), and sedation (A).
26 of 150Mary is a 64-year-old woman who is accompanied by her son who
insists that she gets help for chronic alcohol abuse. Mary states, “I don’t have
a problem. I can stop whenever I want.” According to Prochaska’s stages of
preparation for change, she is most likely in which stage?
QID: 3661750
Mark For Review
Precontemplation
Contemplation
Preparation
Action
YOU ANSWERED CORRECTLY
Prochaska identified 5 stages of change and it is important for healthcare
providers to encourage change when needed and provide support to transition the
patient through the stages. Precontemplation describes the patient who is not
interested in change or does not even realize a change is needed (A).
27 of 150During patient history-taking, Mary states that she drinks about half
a bottle of alcohol during the day followed by a few beers at night. Which of
the following laboratory results would most likely be found?
QID: 3661751
Mark For Review
Elevated LDL-C
Elevated MCV
Proteinuria
Diminished TSH
YOU ANSWERED CORRECTLY
Chronic alcohol abuse is not associated with elevated LDL-C or the presence of
proteinuria (A, C). Diminished TSH levels is an indication of a thyroid disorder
and not derived from alcohol abuse (D).
28 of 150Mary returns 3 weeks later after participating in several therapy
sessions. She admits that she would like to cut down on her alcohol use but is
fearful of withdrawal effects. The PMHNP offers to prescribe which of the
following to help manage alcohol withdrawal symptoms?
QID: 3661752
Mark For Review
Naltrexone
Clonidine
Disulfiram
Naloxone
YOU ANSWERED CORRECTLY
Disulfiram is used to assist in maintaining abstinence from alcohol use by causing
noxious physical effects, such as nausea, vomiting, sweating and headache, when
alcohol is consumed (C). Naloxone is used to rapidly reverse the effects of opioids
during an overdose but would not be used for alcohol withdrawal symptoms (D).
Naltrexone is used to block the euphoric feeling when alcohol or opioids are
consumed but would not be helpful for alcohol withdrawal symptoms (A).
29 of 150At the request of his partner, a 51-year-old man is being evaluated
for obsessive-compulsive disorder. He admits that he finds it difficult to leave
his apartment without checking that the lights and water are turned off. It can
take him up to 30 minutes to exit the apartment and this is putting a strain on
his relationship. In addition to recommending psychotherapy, the PMHNP
suggests initiating pharmacologic therapy with:
QID: 3661753
Mark For Review
Duloxetine.
Bupropion.
Lurasidone.
Selegiline.
YOU ANSWERED CORRECTLY
SSRIs and SNRIs such as duloxetine are the first-line treatments for obsessive-
compulsive disorder, with a response rate ranging from 50–70% (A). High doses
are often needed to achieve the desired effect. Second-line treatment can include
clomipramine, while treatment can be augmented with the use of valproate,
lithium, or carbamazepine.
30 of 150A 28-year-old man will initiate pharmacotherapy for generalized
anxiety disorder. His records show that he has chronic hepatitis B. Which of
the following agents should be avoided?
QID: 3661754
Mark For Review
Sertraline
Duloxetine
Venlafaxine
Escitalopram
YOU ANSWERED INCORRECTLY
Liver toxicity is not associated with the use of sertraline (A), venlafaxine (C), or
escitalopram (D) and these would be appropriate first-line agents for this patient.
31 of 150Which of the following antidepressants should be avoided in a patient
with moderate depression and who has expressed some thoughts about
suicide?
QID: 3661755
Mark For Review
Fluoxetine
Desvenlafaxine
Nortriptyline
Escitalopram
YOU ANSWERED CORRECTLY
SSRIs and SNRIs are generally safe even in overdose amounts and would not likely
achieve a lethal dose (A, B, D).
32 of 150A 26-year-old reports experiencing low-level depression for the past 3
years that impacts most days. He also reports decreased appetite, fatigue, and
hypersomnia. The most likely diagnosis is:
QID: 3661756
Mark For Review
Major depressive disorder.
Bipolar II disorder.
Persistent depressive disorder.
Cyclothymic disorder.
YOU ANSWERED CORRECTLY
Major depressive disorder is characterized by persistently depressed mood lasting
at least 2 weeks with markedly depressed mood and/or diminished interest or
pleasure in all or nearly all activities (A). Bipolar II disorder is characterized by
broad changes in mood that range from major depressive episodes to hypomanic
episodes (B). Similarly, cyclothymic disorder is characterized by mood swings
ranging from mild-to-moderate depression to hypomanic episodes (D).
33 of 150A 29-year-old woman with generalized anxiety disorder presents for a
follow-up visit. She has not responded well to citalopram and a new agent is
needed. She is otherwise well but has a history of substance abuse. Which of
the following would be the most appropriate choice?
QID: 3661757
Mark For Review
Alprazolam
Buspirone
Dextroamphetamine
Fluoxetine
YOU ANSWERED CORRECTLY
Benzodiazepines such as alprazolam should be avoided in patients at risk of
substance abuse (A). Stimulant medications such as dextroamphetamine should be
avoided in patients with anxiety as this can exacerbate symptoms the condition
(C). Another SSRI agent, especially one with activating properties such as
fluoxetine, would likely not be the most appropriate choice when prior SSRI
therapy failed (D).
34 of 150An 81-year-old man with Parkinson’s disease is admitted to the
hospital with pneumonia and requires intubation. When considering his plan
of care, all of the following can qualify as an advance directive except:
QID: 3661758
Mark For Review
A living will.
Testimony from his wife of 55 years.
A directive to physician.
A durable power of attorney for healthcare.
YOU ANSWERED INCORRECTLY
Patients can communicate their wishes for healthcare through a living will (A), a
directive to physician (C), or a durable power of attorney for healthcare (D).
35 of 150The PMHNP is evaluating a 42-year-old man with social anxiety. He
recently got promoted at his job and is required to give weekly updates to the
team. Last week, he could not give his update because he got so anxious that he
lost his voice right before his presentation. This is an example of a
maladaptive use of which of the following defense mechanisms?
QID: 3661759
Mark For Review
Conversion
Intellectualization
Rationalization
Repression
YOU ANSWERED CORRECTLY
Defense mechanisms are ways that individuals cope from anxiety by blocking
feelings, conflicts, and memories. Conversion is the unconscious transformation of
anxiety into a physical symptom with no organic cause (e.g., losing your voice
right before making a speech) (A).
36 of 150Which of the following findings is not anticipated with binge-eating
disorder?
QID: 3661760
Mark For Review
Exhibiting a lack of control over amount and type of food eaten
A preference for eating meals alone
A feeling of relief following a binge episode
Obesity
YOU ANSWERED CORRECTLY
BED is characterized by episodes of binge eating where the individual lacks
control over the amount of food ingested during a discrete period of time (A).
Individuals with BED are typically overweight or obese (D) and prefer to eat alone
(B).
37 of 150A 26-year-old veteran is diagnosed with post-traumatic stress
disorder characterized by periods of intense fear and helplessness that has
persisted over the past 8 months. He also has developed alcohol abuse over this
time period. In addition to psychoeducation, the PMHNP considers
pharmacotherapy with any of the following except:
QID: 3661761
Mark For Review
Sertraline.
Paroxetine.
Mirtazapine.
Clonazepam.
YOU ANSWERED CORRECTLY
Sertraline and paroxetine are FDA-approved for the treatment of PTSD and can
offer an appropriate first-line choice with psychotherapy. Tricyclic antidepressants
or mirtazapine can also be considered if SSRIs are not well tolerated or effective
(C). These agents provide safer options than benzodiazepines when there is a risk
of alcohol use.
38 of 150According to Peplau’s theory of interpersonal relationships, which of
the following best describes the resource role of nurses?
QID: 3661762
Mark For Review
Helps a patient with hypertension assume responsibility in attaining blood pressure
goal
Gives instruction and provides training on identifying heart murmurs with
auscultation to fellow nurses
Provides guidance and encouragement to patient with substance abuse to make
behavioral changes
Answers questions and interprets data from a recently published clinical study
YOU ANSWERED INCORRECTLY
The teaching role is responsible for giving instruction and providing training (B).
This can involve analysis and synthesis of the learner’s experience. The active
leadership role helps patients assume maximum responsibility for meeting
treatment goals in a mutually satisfying way (A). The counseling role helps a
patient understand and integrate meaning of current life circumstances while also
offering guidance and encouragement to make changes (C).
39 of 150Prior to initiating lithium therapy for a 27-year-old woman with
bipolar disorder, baseline and routine measurement of which of the following
is required (Select two correct choices)?
QID: 3661763
Mark For Review
hCG
ANA
Procalcitonin
TSH
YOU ANSWERED CORRECTLY
Lithium can have dramatic effects as a mood stabilizer for bipolar disorder.
However, careful dosing and monitoring is essential due to toxicity associated with
this agent. Clinical and laboratory assessments are needed prior to initiation of
lithium, particularly renal function and thyroid status. Routine monitoring of TSH
(D) and CBC is needed to assess for toxicity caused by lithium treatment. A basic
metabolic panel (BMP) can provide an assessment of fluid and electrolyte levels.
In women, hCG should be monitored and lithium should be avoided in women who
are pregnant or breastfeeding (A).
40 of 150When examining a patient seeking treatment for substance abuse,
which of the following statements best supports a finding of physical
dependence (Select two correct answers)?
QID: 3661764
Mark For Review
“I only use drugs once in a while.”
“I can stop taking drugs if I really wanted to.”
“If I stop taking drugs, I start to go through withdrawal symptoms.”
“I need to use more drug to get the same euphoric effect.”
YOU ANSWERED CORRECTLY
Signs of addiction include continued use of a drug despite negative consequences
and spending an inordinate amount of time obtaining drugs. Occasional use of a
drug would not indicate addiction or physical dependence on a drug (A). If true,
being able to stop taking a drug would not indicate physical dependence (B). This
can also be a statement of denial of a substance abuse problem.
41 of 150When comparing the use of antidepressants for the treatment of
anxiety and depression, which of the following statements is false?
QID: 3661765
Mark For Review
Both SSRIs and SNRIs are effective against anxiety and depressive disorders.
Duration of therapy for depression is shorter compared to anxiety disorders.
Onset of action of SSRIs is similar when treating depression or anxiety.
Higher doses of SSRIs are generally needed to treat anxiety than depression.
YOU ANSWERED INCORRECTLY
SSRIs and SNRIs can be effective choices to treat both depression and anxiety
disorders (A). The onset of action with SSRIs would be similar when treating
anxiety or depression (C). Generally, the doses used to treat anxiety are higher
than those used to treat depression (D).
42 of 150Janice is a 64-year-old woman who is newly-diagnosed with moderate
depression and will initiate SSRI treatment. She is currently taking
medications for hypothyroidism, diabetes mellitus, rheumatoid arthritis, and
fibromyalgia. Which of the following would be the most appropriate choice for
this patient?
QID: 3661766
Mark For Review
Fluoxetine
Paroxetine
Escitalopram
Sertraline
YOU ANSWERED INCORRECTLY
Fluoxetine and paroxetine act as inhibitors to several CYP450 isoenzymes
including strong inhibition of CYP 2D6 (A, B). Sertraline is a moderate inhibitor
of CYP 2C19 as well as a mild inhibitor of several other isoenzymes (D). Because
of the long half-life of fluoxetine, this agent should also be avoided in older adults.
43 of 150After 5 days of SSRI treatment, Janice calls the PMHNP and reports
a dull, constant headache since starting treatment. The headache diminishes
with some acetaminophen. The PMHNP recommends:
QID: 3661767
Mark For Review
Discontinuing treatment immediately.
Maintaining the current regimen with reassurance that the headaches will
likely resolve.
Switch to another SSRI agent.
Switch to another class of antidepressants.
YOU ANSWERED CORRECTLY
Since the adverse effect is generally mild and resolved with acetaminophen,
switching therapy is not warranted. Adverse effects that severely impact quality of
life and ability to function normally is sufficient reason to discontinue therapy and
switch to another agent (A, D). As the adverse effects could be due to a class
effect, switching to another SSRI agent may not be helpful (C).
44 of 150Which of the following is not expected for an individual with
delirium?
QID: 3661768
Mark For Review
Rapid onset over hours or days
Cognitive dysfunction is largely irreversible
Hallucinations are commonly reported
Incoherent speech
YOU ANSWERED CORRECTLY
Delirium is caused by an acute underlying condition that can develop rapidly, over
hours or days (A). This contrasts with dementia, which will progress over months
to years. Signs of delirium can include incoherent or confused speech (D) as well
as hallucinations (C).
45 of 150The PMHNP is considering a SSRI for a 44-year-old woman with
generalized anxiety disorder associated with an occasional panic attack.
Before starting treatment, the PMHNP counsels the patient on which of the
following (Select two correct answers)?
QID: 3661769
Mark For Review
The full therapeutic effect is observed after 7 days of treatment.
A sedating agent is preferred.
An overdose of these agents is often fatal.
An activating agent can lead to a transient increase in anxiety symptoms.
YOU ANSWERED CORRECTLY
SSRIs can take at least 2 weeks before any effect is observed and up to 4 to 6
weeks for the full therapeutic potential to be appreciated (A). SSRIs are generally
safe and taking an overdose of these medications are not lethal, unlike other
classes such as the tricyclic antidepressants (C).
46 of 150Greg is a 37-year-old single father who is being evaluated for
depression. He reports feelings of hopelessness, anhedonia, and difficulty
sleeping that started about 1 year ago. He presents with a flat affect, avoids
eye contact, and provides terse responses to questions. Which of the following
statements would least likely support a diagnosis of depression?
QID: 3661770
Mark For Review
“I’m not a very good father.”
“I feel numb most of the time.”
“I just can’t seem to relax at night and am always finding something to do.”
“I gained 15 pounds in the past 4 months.”
YOU ANSWERED CORRECTLY
Feelings of worthlessness and low self-esteem are common findings in depression
(A). Significant weight loss (without dieting) or weight gain (5% or more change in
body weight over the past month) can be an indication of depression (D). Persons
with a flat affect due to depression will convey sadness and dejection or no facial
expression at all. These patients will express that they feel numb or are unable to
cry (B).
47 of 150Additional evaluation of Greg reveals a Beck Depression Inventory
(BDI) score of 22, suggesting moderate depression. He denies any suicidal
thoughts and does not have a history of suicide attempts. The PMHNP
recommends:
QID: 3661771
Mark For Review
A follow-up visit in 2 weeks to see if the BDI score changes.
Initiating pharmacotherapy.
Referral for electroconvulsive therapy.
Schedule a head CT scan.
YOU ANSWERED CORRECTLY
With a diagnosis of moderate depression, there is no need to delay therapy. As
Greg has reported these symptoms for at least 12 months, it is unlikely that the
BDI score will change in 2 weeks (A). Though electroconvulsive therapy can be an
effective option to treat depression, it is usually not considered a first-line
treatment in individuals who can safely take antidepressant medication (C). A head
CT scan is not warranted for a depression diagnosis (D).
48 of 150A 64-year-old Hispanic man is being evaluated for depression
following the death of his only son in a car accident. During history-taking, the
PMHNP asks about anxiety, and he replies, “I used to have anxiety, especially
when I was in large groups of people. But I started taking valerian and it
calms my nerves.” The most appropriate response by the PMHNP is:
QID: 3661772
Mark For Review
“There is no valid evidence that valerian has any effect on anxiety.”
“You will likely need to stop taking valerian in order to manage your depression.”
“This is likely caused by a placebo effect.”
“Can you explain what you mean by ‘calm my nerves’?”
YOU ANSWERED CORRECTLY
Herbal supplements can provide benefits for certain conditions, though the
evidence is rarely definitive and can depend on dosing and preparation. Studies
suggest that valerian can offer some benefits in diminishing anxiety and stress,
though other studies show no benefit (A). The use of herbal supplements should not
be automatically dismissed as the patient believes in its benefits (C). If there is a
harm identified with its use, then the provider should discuss with the patient
about discontinuing the treatment and provide other options (B).
49 of 150A 36-year-old with social anxiety has been asked to give a
presentation to the company on next year’s budget. He states that “If I don’t
do a good job, they are going to fire me and I’ll never be able to work again.”
This is an example of which of the following cognitive distortions?
QID: 3661773
Mark For Review
Personalization
Mind-reading
Catastrophizing
Mental filter
YOU ANSWERED CORRECTLY
Personalization describes when an individual assumes responsibility for an
external event or situation that was likely out of the person’s control (e.g.,
someone breaks into a neighbor’s car and you feel responsible since you didn’t
notice it) (A). Mind-reading occurs when an individual assumes negative thoughts,
responses, or motives of others (e.g., people laughing as you walk into a room and
you assume they are laughing at you) (B). A mental filter describes when a person
focuses on a negative detail or bad event and allows it to taint everything else
(e.g., despite throwing a successful dinner party, you obsess that you called one
guest by the wrong name and vow to never have another party) (D).
50 of 150A mother brings in her 7-year-old son, Caleb, for evaluation after
being referred by their pediatrician. For the past year, the boy has been
pulling out his hair and now has a large bald spot on his head. He has also
been observed chewing and swallowing the hair. The mother states that she
shaved his head at one point to stop the hair pulling, but he then started to
pick at his skin, leaving sores on his face and scalp. In considering a diagnosis
of trichotillomania, the PMHNP realizes that:
QID: 3661774
Mark For Review
This will eventually resolve on its own.
Hair-pulling disorder is more common in children than adults.
The scalp should be examined for fungal infection.
Treatment of this condition is not required unless the hair is ingested.
YOU ANSWERED CORRECTLY
Though it is possible that the condition will resolve on its own, this can take
months to decades and so active treatment is recommended (A). The condition is
not triggered by a scalp condition, such as an infection or infestation, and so
diagnostic testing of the scalp is not warranted without other signs or symptoms
present (C). Swallowing the pulled hair, also known as trichophagia, is a common
observation in these individuals and can lead to serious GI adverse effects, such as
the development of a hair mass that causes GI obstruction or perforation.
However, treatment of trichotillomania should not be limited to only those
presenting with trichophagia (D).
51 of 150In addition to recommending therapy for Caleb to work on coping
skills, the PMHNP recommends which of the following pharmacologic agents?
QID: 3661775
Mark For Review
Methylphenidate
Fluvoxamine
Atomoxetine
Nortriptyline
YOU ANSWERED CORRECTLY
Methylphenidate and atomoxetine are used to manage ADHD in children but
would not be effective in managing anxiety disorders (A, C). Nortriptyline is a
tricyclic antidepressant and not considered a first-line treatment for
trichotillomania (D).
52 of 150A 46-year-old woman with schizophrenia reports that she is hoarding
canned food in her basement because of a belief that an impending comet will
collide with Earth. This is an example of which type of delusion?
QID: 3661776
Mark For Review
Referential
Grandiose
Nihilistic
Somatic
YOU ANSWERED INCORRECTLY
A referential delusion is the belief that events or circumstances that have no
connection to the individual are somehow related to that individual. Thus, an
example can be believing that the ads on the tv are specifically targeting the
patient (A). A grandiose delusion is believing that one is a very important or
powerful person, such as a king or president (B). A somatic delusion is the belief
that the body is changing in unusual ways, such as believing your bones are
changing to rubber (D).
53 of 150A 27-year-old woman enjoys singing but gets deathly afraid of singing
in front of large groups of people. To overcome this, the therapist volunteers
her to perform at an open microphone night at a local club. This provides an
example of which type of behavioral therapy?
QID: 3661777
Mark For Review
Modeling
Systemic desensitization
Flooding
Thought stopping
YOU ANSWERED INCORRECTLY
Modeling involves having the patient observe a role model that demonstrates
appropriate behavior in the feared situation and then the patient imitates it (A).
Systemic desensitization involves having the patient be gradually introduced to the
feared object or experience through a series of steps from least to most frightening
(e.g., perform in front of 1 or 2 friends before moving on to larger and larger
audiences) (B). Thought stopping is a technique that involves interrupting a
negative thought with distraction, such as saying “stop” or snapping a rubber
band on the wrist (D).
54 of 150Because of a potential for drug-drug interaction, fluoxetine should be
avoided in a patient who is concurrently taking:
QID: 3661778
Mark For Review
Lisinopril.
Atorvastatin.
Warfarin.
Metformin.
YOU ANSWERED CORRECTLY
There are no warnings on the use of fluoxetine concomitantly with atorvastatin
(B), metformin (D), or lisinopril (A). Fluoxetine is also a potent inhibitor of the
CYP2D6 enzyme pathway.
55 of 150Which of the following agents would be most appropriate for a
patient with post-traumatic stress disorder who complains of recurrent
nightmares?
QID: 3661779
Mark For Review
Zolpidem
Clonazepam
Ramelteon
Prazosyn
YOU ANSWERED CORRECTLY
Sleep medications can assist with sleep initiation and maintenance but will not be
helpful in diminishing the frequency and intensity of nightmares (A, C). As
individuals with PTSD are at higher risk of substance abuse, medications with
dependence potential should be avoided, such as the benzodiazepines (B).
56 of 150A 61-year-old man requires pharmacotherapy for moderate
depression. He has a history of type 2 diabetes and poorly-controlled
hypertension. Which of the following agents should be avoided in this patient?
QID: 3661780
Mark For Review
Sertraline
Escitalopram
Duloxetine
Venlafaxine
YOU ANSWERED CORRECTLY
The use of sertraline (A), escitalopram (B), or duloxetine (C) do not have a
clinically significant effect on blood pressure and can be used without caution in
this patient. Efforts should continue to adjust his antihypertensive medication to
attain blood pressure goal.
57 of 150The PMHNP is interviewing a 21-year-old for methamphetamine
addiction. Which of the following statements would indicate tolerance?
QID: 3661781
Mark For Review
“I start to feel sick if I wait too long for my next hit.”
“I need to take higher amounts of drug to get the effect I want.”
“I am constantly craving that euphoric feeling.”
“I feel that I cannot quit without help.”
YOU ANSWERED CORRECTLY
Physical dependence occurs when an individual takes a tolerance-forming drug for
a long enough period that abrupt discontinuation or lower doses of the drug
results in the development of withdrawal symptoms. (A). Constantly craving the
euphoric feeling of drug use can be an indication of psychological dependence (C).
A person who states they require help to quit drug use is an indication that they
are in the contemplation stage for making change and should be offered resources
and counseling to push towards making a change (D).
58 of 150The PMHNP will initiate valproate for maintenance therapy for a 25-
year-old with bipolar disorder. Prior to starting therapy, the PMHNP advises
the patient on the need for periodic monitoring of which of the following?
QID: 3661782
Mark For Review
Sodium
CBC
Renal function
TSH
YOU ANSWERED CORRECTLY
With long-term valproate use, there is no need for routine monitoring of sodium
(A), renal function (C), or TSH (D).
59 of 150Which of the following findings is more commonly found in those
with bulimia nervosa compared with anorexia nervosa?
QID: 3661783
Mark For Review
Lack of control when eating
Abnormally low BMI
Lanugo
Amenorrhea
YOU ANSWERED CORRECTLY
Both bulimia nervosa and anorexia nervosa stem from a fear of gaining weight and
having self-worth heavily influenced by body shape and weight. Bulimia nervosa is
characterized by recurrent episodes of binge eating and a sense of a lack of
control with eating during the episode (A). This is usually followed by
inappropriate compensatory behavior (e.g., vomiting, laxative use, excessive
exercise) to prevent weight gain.
60 of 150The PMHNP will initiate clozapine for managing schizophrenia in a
51-year-old woman. Prior to starting therapy, the PMHNP counsels the patient
on all of the following except:
QID: 3661784
Mark For Review
This agent has minimal extrapyramidal effects.
Some weight loss is expected.
Regular monitoring of absolute neutrophil count is needed.
The medication should be taken right before bed due to sedation.
YOU ANSWERED CORRECTLY
One of the advantages of clozapine is that it is able to exert its antipsychotic
effects without the associated extrapyramidal side effects observed with other
second-generation antipsychotics (A). Clozapine is associated with moderate
sedation and so should be taken just prior to bedtime (D). A serious adverse effect
of this medication is agranulocytosis, which can increase the risk of infection.
ANC should be measured on a weekly basis for the first 6 months of treatment and
then every other week for the next 6 months if levels are normal (C).
61 of 150Which of the following statements from family members of a 76-year-
old man would suggest a diagnosis of dementia versus delirium?
QID: 3661785
Mark For Review
“He just started to take a new medication for insomnia.”
“He acted perfectly fine when we saw him two days ago.”
“He is having a difficult time remembering the names of his family.”
“The neighbors found him outside in his pajamas talking to himself.”
YOU ANSWERED CORRECTLY
Delirium is characterized by a sudden onset of symptoms, usually within hours or
days (B). This is in contrast to dementia, which progresses slowly over months to
years. Delirium can be triggered by infection, electrolyte imbalance, head trauma,
or a new medication, especially those with anticholinergic effect (A). Delirium can
trigger delusions and hallucinations in some cases (D).
62 of 150A mother is undergoing counseling for grief following the death of
her young child one month ago. In considering the use of pharmacotherapy,
the PMHNP advises the goal of therapy can include all of the following except:
QID: 3661786
Mark For Review
Elevated mood.
Eliminate sadness.
Improved ability to perform daily functions.
Improve thought processes.
YOU ANSWERED CORRECTLY
Treatment of grief is aimed at relieving the symptoms of depression and should
result in restoring or elevating mood (A) and function (C) as well as improving
decision-making ability (D). However, treatment should not aim to eliminate
sadness, which is a normal response to the loss of a loved one.
63 of 150The initial assessment of an individual who is suspected of
schizophrenia should include all of the following except:
QID: 3661787
Mark For Review
Family history.
Medication and drug use history.
Head CT scan.
Interview of close acquaintances.
YOU ANSWERED INCORRECTLY
A comprehensive evaluation for a patient with suspected schizophrenia should
include medical, surgical, medication (B), family (A), and social history. The
patient should also be asked about illicit substance use and abuse as this can
contribute to symptoms. Interviews of close acquaintances can also be helpful as
patients can sometimes hide or minimize symptoms (D).
64 of 150A 16-year-old presents for a follow-up visit for depression. During
the discussion, he mentions that he smokes marijuana with his friends almost
on a daily basis. The next best course of action is to:
QID: 3661788
Mark For Review
Administer the CAGE questionnaire.
Order a drug screen.
Notify his parents.
Provide resources on overcoming drug addiction.
YOU ANSWERED CORRECTLY
For those suspected of alcohol or substance abuse, the CAGE questionnaire offers
the best sensitivity and specificity in identifying problematic use and abuse (A).
The questionnaire consists of four questions, with a positive response for two
questions indicating problem substance abuse.
65 of 150The PMHNP sees a 52-year-old woman with a history of major
depressive disorder. She has been treated with the highest tolerated dose of a
SNRI along with psychotherapy for the past 8 months. Her symptoms have
resolved and the PMHNP considers starting the continuation phase of
treatment. This will typically involve:
QID: 3661789
Mark For Review
Gradually titrating down the SNRI dose.
Switching to a low dose of SSRI.
Continuing SNRI therapy for up to an additional 9 months.
Discontinuing psychotherapy.
YOU ANSWERED CORRECTLY
The goal of the continuation phase is to reduce the risk of relapse and so
pharmacotherapy and psychotherapy should be continued (A, D). Unless there are
concerns about adverse effects, her medication should not be adjusted to another
class of agent (B).
66 of 150For an individual with bipolar II disorder, which of the following is
not experienced by the patient?
QID: 3661790
Mark For Review
Major depressive episode
Mild-moderate depressive episode
Hypomanic episodes
Manic episodes
YOU ANSWERED CORRECTLY
The range of symptoms of bipolar II disorder can include major depressive
episodes, mild-to-moderate depression, a normal mood, and hypomanic episodes
(C).
67 of 150When evaluating an individual with suspected schizophrenia, which
of the following is considered a positive symptom (Select two correct answers)?
QID: 3661791
Mark For Review
Flat affect
Hallucinations
Anhedonia
Paranoia
YOU ANSWERED CORRECTLY
Negative symptoms in schizophrenia describe the absence of something that should
be present. This can include anhedonia (C), avolition (loss of motivation),
asociality (decreased desire for social interaction), apathy, alogia (reduction in
speech), or flat affect (A).
68 of 150A 46-year-old woman with generalized anxiety disorder returns for a
follow-up visit 3 weeks after starting treatment with a SSRI. She reports little
improvement in symptoms and actually feels more jittery with the medication.
The PMHNP considers the use of buspirone and recognizes all of the following
except:
QID: 3661792
Mark For Review
The agent is indicated for GAD.
There is little risk of physical addiction.
It often has a delayed onset of action.
It is effective in treating acute anxiety.
YOU ANSWERED INCORRECTLY
Buspirone was developed as an alternative to benzodiazepines and is considered
non-physically addicting (B). Onset of action with this agent is often delayed (C).
Though it is approved for GAD (A), buspirone does not have an indication for
other anxiety sub-types.
69 of 150A 28-year-old man with schizophrenia will initiate therapy with a
second-generation antipsychotic (SGA). He asks the PMHNP how the
medication works. The PMHNP explains all of the following except:
QID: 3661793
Mark For Review
These agents target both the negative and positive symptoms of schizophrenia.
SGAs produce fewer extrapyramidal symptoms than first-generation
antipsychotics.
SGAs have a similar safety profile as SSRIs.
SGAs work as both dopamine and serotonin antagonists.
YOU ANSWERED CORRECTLY
SGAs predominantly work as dopamine (D2) and serotonin (5-HT2A) antagonists
(D). The medication decreases psychosis by blocking the mesolimbic dopamine
pathway. Compared to first-generation antipsychotics, SGAs have a lower
potential to cause EPS (B) and are able to target positive and negative symptoms
of schizophrenia (A).
70 of 150Which of the following agents is preferred for a 10-year-old boy with
attention-deficit/hyperactivity disorder and who has a simple vocal tic
disorder comprised of grunting and throat clearing?
QID: 3661794
Mark For Review
Dextroamphetamine (Dexedrine®)
Methylphenidate (Metadate® ER)
Proamphetamine (Vynase®)
Atomoxetine (Strattera®)
YOU ANSWERED CORRECTLY
Stimulants used in the treatment of ADHD can exacerbate tic disorder and
includes methylphenidate stimulants (B), dextroamphetamine preparations (A), and
proamphetamine preparations (C).
71 of 150Bryan is a 32-year-old financial planner who is being evaluated for
bipolar disorder. He describes alternating periods of “up” and “down” moods.
His “up” periods are characterized by a lack of a need for sleep and adverse
behavior (primarily gambling). He is not as concerned with the “down”
periods that result in a depressed mood and fatigue. He is currently
experiencing an “up” period. The PMHNP considers treatment with:
QID: 3661795
Mark For Review
Nortriptyline.
Lurasidone.
Olanzapine.
Lithium.
YOU ANSWERED INCORRECTLY
Antidepressants such as nortripyline are not recommended for the management of
bipolar disorder (A). Lurasidone is approved for bipolar depression but not acute
mania (B). Though lithium can be used for acute mania and bipolar maintenance
therapy, it would not be considered a first-line therapy due to toxicity risk and
need for routine monitoring (D).
72 of 150Bryan returns for a follow-up visit 3 weeks later with little
improvement in symptoms. He is adamant that he has been taking the
medication as directed and does not report any adverse effects. The PMHNP
considers adding which of the following to his treatment plan?
QID: 3661796
Mark For Review
Desvenlafaxine
Phenelzine
Valproic acid
Sertraline
YOU ANSWERED CORRECTLY
Antidepressants, including SSRIs (sertraline), SNRIs (such as desvenlafaxine), and
MAOIs (such as phenelzine) are not effective in the management of bipolar
disorder (A, B, D).
73 of 150The PMHNP is considering prescribing an antipsychotic agent for a
79-year-old man with moderate-stage Alzheimer’s dementia who is beginning
to exhibit aggressive behavior towards his family. Prior to starting treatment,
the PMHNP counsels the family that the medication is associated with:
QID: 3661797
Mark For Review
Increased risk of wandering.
Accelerated cognitive decline.
Increased mortality rate.
Diminished vocal communication.
YOU ANSWERED CORRECTLY
The use of antipsychotics will not affect cognitive function or communication in
individuals with dementia (B). Antipsychotics are not associated with seizures (C,
D). There is also no expected change in wandering risk associated with these
agents (A).
74 of 150A 33-year-old woman seeks treatment for panic disorder
characterized by panic attacks occurring multiple times each week. She has
avoided treatment because there is a family history of substance abuse and she
“doesn’t want to get addicted to anything.” In considering the use of
benzodiazepines, the PMHNP realizes:
QID: 3661798
Mark For Review
Benzodiazepines should be used on an as-needed basis.
Benzodiazepines would not be effective for this patient.
An agent with a short half-life is preferred.
An agent with a slow onset of action is preferred.
YOU ANSWERED INCORRECTLY
Benzodiazepines offer an effective option for the treatment of panic disorder as
their rapid onset of action can diminish symptoms while other pharmacologic
agents, such as SSRIs, have time to reach therapeutic level (B). Agents with a short
half-life and rapid onset of action can give a sensation of intoxication and promote
psychological dependence (C). The use of benzodiazepines on an as-needed basis
is not recommended as this will heighten the patient’s awareness of the drug
versus no-drug state (A). With a family history of drug abuse, precautions should
be taken to ensure the medication is used appropriately by the patient and not by
others in the household.
75 of 150A 37-year-old male with bipolar I disorder is currently experiencing
a manic episode. He is not taking any maintenance therapy. Recommended
treatment can include:
QID: 3661799
Mark For Review
Buspirone.
Lamotrigine.
Carbamazepine.
Venlafaxine.
YOU ANSWERED CORRECTLY
Treatment of bipolar disorder will depend on whether the patient is in a manic or
depressive state. Lamotrigine, an anti-epileptic medication, can be used during
bipolar depression (B). SNRIs such as venlafaxine or buspirone are not
recommended for bipolar disorder (A, D).
76 of 150During a session with Colin, a 17-year-old with social anxiety, he
reports that he recently failed his driving exam. He states, “I’m such a lousy
driver. I should never be allowed on the road.” This is an example of which
cognitive distortion?
QID: 3661800
Mark For Review
Jumping to conclusions
Personalization
Overgeneralization
Mind-reading
YOU ANSWERED CORRECTLY
Mind-reading is drawing a negative conclusion before receiving any of the facts
(D). Personalization is blaming oneself for a negative outcome of an event or
situation even though they were not primarily responsible (B). Jumping to
conclusions occurs when a negative interpretation is made with little or no
supporting evidence (A).
77 of 150The PMHNP asks Colin if he plans to repeat the driver’s test. Which
of the following responses provides the best example of a mind-reading
statement?
QID: 3661801
Mark For Review
“What’s the point. I’m just going to fail again.”
“Even if I pass, there’s really no place I need to drive to.”
“I will never pass because the instructor absolutely hates me.”
“I decided I don’t want to drive because I will probably kill someone with the
car.”
YOU ANSWERED INCORRECTLY
Assuming that he will fail again can be considered a fortune-telling error or
overgeneralization (A). Disqualifying the positive involves maintaining a negative
view while rejecting the positive (e.g., the joy of passing the exam is diminished by
having no place to drive to) (B). Catastrophizing is assuming the very worst
situation will likely happen (D).
78 of 150Stacy is a 23-year-old woman who is being evaluated for symptoms of
depression. She gave birth 3 months ago and for the past month, she has been
experiencing mood swings, intense irritability, insomnia, and fatigue. Her
relationship with her partner has been under intense stress due to financial
issues. She mentions that she occasionally has thoughts of harming the baby,
which is why she is seeking help. The most likely diagnosis is:
QID: 3661802
Mark For Review
Postpartum depression.
Postpartum psychosis.
Generalized anxiety disorder.
Bipolar depression.
YOU ANSWERED CORRECTLY
Postpartum depression occurs around 2 to 4 months following delivery and can
involve loss of appetite, insomnia, intense irritability and anger, severe mood
swings, and withdrawal from friends and family (A). Postpartum depression can
interfere with the mother’s ability to care for the newborn and can be associated
with thoughts of harming the infant or themselves. Risk factors can include history
of depression, stressful events during the past year, relationship problems with
spouse or partner, or financial difficulties.
79 of 150Treatment for Stacy can include all of the following except a:
QID: 3661803
Mark For Review
SSRI.
First- or second-generation antipsychotic.
Psychotherapy.
Hormone therapy.
YOU ANSWERED CORRECTLY
Treatment of postpartum depression can include the use of an antidepressant (A),
psychotherapy (C), and hormone therapy, such as estrogen replacement therapy
(D). With effective treatment, the condition can resolve within a few months.
80 of 150Which of the following best demonstrates the fulfillment of the
counselor role of nursing?
QID: 3661804
Mark For Review
Presenting original research at a medical congress
Explaining treatment options to a parent whose son has ADHD
Volunteering to teach a group of RNs how to properly screen for depression
Ensuring the medical decisions for an elderly patient with dementia are appropriate
YOU ANSWERED CORRECTLY
The leadership role can involve training other healthcare providers in improving
practice performance and patient care (C). The advocate role involves helping to
support the decisions made by a patient and ensuring the patient’s rights are
protected (D). Presenting research at a medical congress can be related to the
educator role of nursing (A).
81 of 150The PMHNP is evaluating a 19-year-old who recently had an opioid
overdose episode. When considering a diagnosis of substance use disorder,
which of the following is not included in the DSM-5 criteria?
QID: 3661805
Mark For Review
Having a craving or strong desire to use
Unsuccessful attempts to cut down on drug use
Two or more substance-related hospitalizations in the prior 6 months
Excessive amount of time spent in obtaining, using, and recovering from a
substance
YOU ANSWERED CORRECTLY
According to DSM-5 criteria, a diagnosis of substance use disorder requires two
or more of the 11 criteria to be present within the past 12 months. These criteria
include substance use in larger amounts or over longer periods of time (A), a
desire to cut down and/or unsuccessful attempts in the past (B), excessive amount
of time spent on obtaining and using a substance and recovering from its effects
(D), craving or strong desire to use, inability to maintain major role obligations,
and substance use in potentially hazardous positions. Additionally, criteria related
to tolerance, withdrawal, and impact on social, occupational, and recreational
activities can be considered.
82 of 150A 42-year-old man with a history of multiple episodes of major
depressive disorder has not had a relapse over the past 12 months while taking
pharmacotherapy. In considering discontinuing therapy, the PMHNP realizes
that the rate of relapse in the first year for a patient with multiple MDD
episodes is:
QID: 3661806
Mark For Review
<10%.
20%.
45%.
>75%.
YOU ANSWERED INCORRECTLY
Once treatment is discontinued, depression relapse can occur at high rates even if
patients were successfully treated for the recommended amount of time. Though
the risk of relapse is highest during the first 2 months after discontinuation, there
is still significant risk for the first year after stopping therapy (A, B, C).
83 of 150When evaluating patients with schizophrenia, the PMHNP realizes
the two most common types of hallucinations are (Select two correct answers):
QID: 3661807
Mark For Review
Visual.
Auditory.
Olfactory.
Tactile.
YOU ANSWERED CORRECTLY
Hallucinations are perceptions felt by the patient through one of the five senses
and are not based on reality (i.e., there is no stimulus present). The most common
type is auditory, which can consist of one or more voices speaking clearly and
usually in a rude or threatening manner (B). Visual hallucinations are the second
most common type of hallucination experienced by those with schizophrenia and
they tend to occur along with auditory hallucinations (A).
84 of 150A 47-year-old woman is being evaluated for severe anxiety. Her sister
was recently diagnosed with breast cancer and now she believes she will also
have breast cancer. She has become obsessed with thoughts of illness and
mentions that she feels some tenderness in her right breast. A recent
mammogram did not reveal any unusual findings. Suspecting illness anxiety
disorder, the PMHNP realizes which of the following is true?
QID: 3661808
Mark For Review
The individual is consciously pretending to be sick to fulfill emotional needs.
The individual is consciously pretending to be ill to become eligible for financial
benefits.
Symptoms of the reported illness are typically mild or absent.
An organic cause of the symptoms are usually confirmed.
YOU ANSWERED CORRECTLY
The individual with illness anxiety disorder fully believes that they have or will
have the illness and are not pretending to have an illness for emotional or other
gain (A, B). Individuals will continue to seek care despite an absence of any
diagnosis or somatic cause of symptoms (D).
85 of 150Lucas is an 11-year-old boy who is being evaluated after the parents
received several reports of unruly behavior. In considering a diagnosis of
oppositional defiant disorder, the PMHNP would likely expect each of the
following findings except:
QID: 3661809
Mark For Review
Easily loses his temper.
Poor communication skills.
Argumentative to authority figures.
Vindictiveness.
YOU ANSWERED INCORRECTLY
Oppositional defiant disorder is characterized by a pattern of angry or irritable
mood, argumentative and defiant behavior, or vindictiveness (D). Signs include
quickly losing temper (A) and easily annoyed, and frequently argues with
authoritative figures such as parents or teachers (C).
86 of 150When considering a management plan for Lucas, the PMHNP
recommends:
QID: 3661810
Mark For Review
Family behavioral therapy.
Buspirone.
Venlafaxine.
Valproate.
YOU ANSWERED CORRECTLY
Treatment of ODD includes family behavioral therapy, which can help teach and
coach families on praising and reinforcing appropriate behavior and not
reinforcing undesirable behavior (A). Pharmacologic therapy is not considered
first-line treatment but can be considered in the presence of a concomitant
disorder.
87 of 150A 29-year-old with bipolar I disorder is being considered for mood
stabilization therapy. She indicates that she is trying to get pregnant. Which of
the following medications would provide the safest choice?
QID: 3661811
Mark For Review
Valproic acid
Carbamazepine
Lamotrigine
Lithium
YOU ANSWERED CORRECTLY
Valproic acid (A), carbamazepine (B), and lithium (D) are all contraindicated in
pregnant women due to a potential for fetal harm. If she is actively trying to get
pregnant, lamotrigine will offer the safest option though it may also come with
some risks.
88 of 150When managing a 15-year-old with suspected anorexia nervosa, the
PMHNP recognizes all of the following are accurate except:
QID: 3661812
Mark For Review
Anorexia nervosa predominantly occurs in females.
Most individuals with anorexia nervosa present with normal to slightly above
normal BMI.
Comorbid depression is commonly found in individuals with anorexia nervosa.
Specialty referral is often needed for effective treatment.
YOU ANSWERED CORRECTLY
Those with eating disorders typically have a high rate of comorbid depression (C).
This is one explanation of why anti-depression medications are frequently useful in
the treatment of eating disorders. Anorexia nervosa is predominantly found in
females, which can account for over 90% of cases (A). Onset of the condition
typically occurs during the teen years for females (peaks around 14 to 18 years of
age), with onset in males occurring a few years later. Effective treatment of
anorexia nervosa and other eating disorders will require specialty referral and an
interdisciplinary approach that can include a psychiatrist and nutritionist to
ensure success during the long recovery period (D).
89 of 150When considering the use of a second-generation antipsychotic (SGA)
for schizophrenia, which of the following is least accurate?
QID: 3661813
Mark For Review
SGAs are not as effective as first-generation antipsychotics.
The doses used in schizophrenia are higher than those used for mood disorders.
Both SGAs and first-generation antipsychotics have D2 antagonist effects.
SGAs have a lower propensity for extrapyramidal effects compared to first-
generation antipsychotics.
YOU ANSWERED CORRECTLY
SGAs, including risperidone and aripiprazole, can be an effective choice in
treating psychoses associated with schizophrenia. These agents are at least as
effective as first-generation products and have a generally better safety profile (A).
90 of 150A 56-year-old woman with depression is taking a SSRI that is
metabolized by CYP2D6. She develops an infection and is prescribed an
antibiotic that is a known inducer of CYP2D6. The most likely outcome is:
QID: 3661814
Mark For Review
Increased exposure of the SSRI.
Decreased exposure of the SSRI.
There will be an accumulation of potential toxic metabolites.
Decreased exposure of the antibiotic.
YOU ANSWERED CORRECTLY
A CYP2D6 enzyme inhibitor, rather than inducer, will result in decreased
metabolism of the SSRI that leads to increased SSRI exposure (A). Though
increased metabolism of the SSRI is anticipated, this will not likely result in an
accumulation of toxic metabolites with normal renal function (C). The exposure of
the antibiotic should not be affected with the presence of the SSRI (D).
91 of 150A 31-year-old man with schizophrenia reports that he could not stop
laughing during his mother’s funeral despite feeling great sadness. This is an
example of which type of affect?
QID: 3661815
Mark For Review
Flat
Blunted
Constricted
Inappropriate
YOU ANSWERED CORRECTLY
A flat affect reflects an immobile or blank expression, often seen during depression
(A). A blunted affect describes reduced or minimal emotional response (B). A
constricted affect has a reduced range or intensity of expression, such as showing
sadness but no other emotions (C).
92 of 150A mother presents for a follow-up visit with her 9-year-old son who is
diagnosed with ADHD. He started on dexmethylphenidate (Focalin® XR)
about 4 weeks ago. Today, the mother reports that his symptoms show some
improvement but she is concerned that he is not eating as much as usual. A
physical evaluation reveals that he lost 7 pounds since his last visit and his
BMI is 21 kg/m2. The PMHNP recommends:
QID: 3661816
Mark For Review
Reducing the dose by 50%.
Switching therapy to dextroamphetamine (Dexedrine®).
Switching therapy to atomoxetine (Strattera®).
Switching to electroconvulsive therapy.
YOU ANSWERED INCORRECTLY
When there is concern with weight loss with stimulant treatment for ADHD, a non-
stimulant alternative should be considered rather than replacing the drug with
another stimulant drug (B). Lowering the dose may or may not improve appetite,
though this will likely reduce the therapeutic effectiveness of the drug (A).
Electroconvulsive therapy is used for the treatment of depression and not ADHD
(D).
93 of 150Jordan is a 10-year-old boy who is diagnosed with ADHD
characterized by disruptive behavior in school and at home. Further
assessment also reveals comorbid anxiety. The most appropriate first-line
agent is:
QID: 3661817
Mark For Review
Dexmethylphenidate (Focalin®).
Dextroamphetamine (Dexedrine®)
Methylphenidate HCl (Concerta®)
Bupropion (Wellbutrin®)
YOU ANSWERED CORRECTLY
Though stimulant medications such as dexmethylphenidate (A),
dextroamphetamine (B), and methylphenidate HCl (C) are often used first-line for
the treatment of ADHD, these medications can exacerbate pre-existing anxiety.
Other non-stimulant alternatives should be considered in these patients.
94 of 150Gary is a 39-year-old man with a history of binge-eating disorder and
depression who presents for a follow-up visit. He underwent bariatric surgery
5 months ago and has lost over 15% body weight. He continues to take a SNRI
for depression. At today’s visit, he complains of constant fatigue, muscle
weakness, and tingling in his fingers and toes that began about 2 weeks ago.
Laboratory results find Hb = 8.6 g/dL (12-14 g/dL), MCV = 108 fL (81-96 fL),
and RDW = 18.6% (11.5-15%). The most likely cause of his anemia is:
QID: 3661818
Mark For Review
Chronic low-volume blood loss.
Vitamin B12 deficiency.
Beta thalassemia minor.
Anemia of chronic disease.
YOU ANSWERED CORRECTLY
Chronic low-volume blood loss will result in iron deficiency anemia, which is a
microcytic anemia (A). Beta thalassemia minor is a genetic disorder that can
result in microcytosis, though it usually does not result in clinical symptoms (C).
Anemia of chronic disease is a normocytic anemia that is not evolving (normal
RDW) (D).
95 of 150The next-best course of action for Gary is:
QID: 3661819
Mark For Review
Check serum iron.
Check serum vitamin B12.
Discontinue SNRI therapy.
Switch the SNRI to bupropion.
YOU ANSWERED CORRECTLY
Though iron can be checked along with vitamin B12, iron deficiency is not
consistent with the hemogram (A). The anemia is not drug-induced and so there is
no need to discontinue or alter the SNRI therapy (C, D).
96 of 150Prior to initiating a first-generation antipsychotic for a 32-year-old
with schizophrenia, the PMHNP uses which of the following tests to assess for
tardive dyskinesia at baseline and at routine follow-up visits?
QID: 3661820
Mark For Review
Ham D
MADRS
PANSS
AIMS
YOU ANSWERED CORRECTLY
The Hamilton Depression Rating Scale (Ham D) and the Montgomery-Asberg
Depression Rating Scale (MADRS) are used to screen and monitor for depression.
The Positive and Negative Syndrome Scale (PANSS) can measure the severity of
schizophrenia symptoms but does not assess for tardive dyskinesia symptoms (C).
97 of 150Which of the following individuals is most likely to be diagnosed with
bulimia nervosa?
QID: 3661821
Mark For Review
A 19-year-old female with BMI of 17 kg/m2 and amenorrhea
A 35-year-old male with BMI of 36 kg/m2 and type 2 diabetes mellitus
A 42-year-old male with BMI of 33 kg/m2 with new-onset headaches and
unexplained weight loss of 12 pounds in the past 2 months
A 24-year-old female with BMI of 23 kg/m2 and hypokalemia
YOU ANSWERED CORRECTLY
Those with bulimia nervosa are frequently at normal or slightly above normal body
weight rather than obese (B). Findings of severe underweight with amenorrhea is
consistent with anorexia nervosa which may or may not include bulimic tendencies
(A). Unexplained weight loss is not an indication of bulimia nervosa but could be
due to another condition that warrants investigation (C).
98 of 150The PMHNP is evaluating a 42-year-old man with a history of bipolar
I disorder who is experiencing a manic episode. He is not currently taking any
maintenance medication. The PMHNP understands that each of the following
are FDA approved for acute mania except:
QID: 3661822
Mark For Review
Aripiprazole.
Cariprazine.
Lamotrigine.
Risperidone.
YOU ANSWERED CORRECTLY
Antipsychotic agents are generally effective for acute mania, including cariprazine
(B) and risperidone (D). Aripiprazole is approved for acute mania as well as
maintenance therapy (A).
99 of 150Paolo is a 67-year-old man who was referred for evaluation for
depression symptoms that have persisted for multiple years. While taking the
patient history, which of the following statements from the patient would be
most consistent with depression?
QID: 3661823
Mark For Review
“I occasionally experience episodes of extreme fear and chest pain that last a few
minutes.”
“I often have difficulty falling asleep as my mind keeps racing.”
“Even though I’m losing weight, I just don’t have much of an appetite.”
“I occasionally forget my appointments.”
YOU ANSWERED CORRECTLY
Experiencing extreme fear and chest pain is more consistent with a panic disorder
rather than depression (A). Insomnia can be a key finding in depression, but is
more likely to be characterized as difficulty with sleep maintenance and early
morning wakening with difficulty falling back to sleep. Difficulty initiating sleep
because of racing thoughts is more likely due to an anxiety disorder (B).
Depression can result in reduced cognitive function, especially in older adults.
However, occasionally forgetting an appointment is likely caused by a normal age-
related change (D).
100 of 150Which of the following statements is most accurate when assessing a
patient with depression about suicidal thoughts?
QID: 3661824
Mark For Review
Asking a patient about suicide can increase the risk of a suicide attempt.
Those with depression will rarely have ideas of death unless they have an actual
intent to commit suicide.
Hospitalization should be considered for those who express intent to commit
suicide.
For those who express having a suicide plan, the lethality of the plan provides little
indication of suicide risk.
YOU ANSWERED CORRECTLY
For those with depression, suicidal ideation and passive thoughts of death are
often present though it is much less common to actually have a discrete plan to
commit suicide (B). It is important to note that inquiring about suicide will not
increase the risk of attempted suicide (A). For those who express having a suicide
plan, the lethality of the plan can be an indication of suicide risk (D). A higher risk
of suicide is associated with hard methods, such as using a gun, jumping from a
high place, or hanging. Lower risk is associated with soft methods, such as
ingesting pills or breathing noxious gas.
101 of 150Withdrawal syndrome from which of the following substances can
result in severe symptoms, including delirium and seizures (Select two correct
answers)?
QID: 3661825
Mark For Review
Alcohol
Cannabis
Amphetamines
Benzodiazepines
YOU ANSWERED CORRECTLY
In severe cases, alcohol withdrawal can lead to seizures that occur within 12 to 24
hours of alcohol cessation, as well as delirium tremens that could result in death
(A). Benzodiazepine withdrawal symptoms can include anxiety, dysphoria,
intolerance to light and sound, nausea, and muscle twitching. In severe cases,
tremors, hallucinations, seizures and a delirium tremens-like state can occur (D).
Tapering the medication is required rather than rapid discontinuation.
102 of 150A husband brings in his wife, Lucille, who has a history of bipolar
disorder for evaluation. She gave birth 2 weeks ago and he reports that she
would go through episodes of confusion or disorientation, sometimes sitting in
a room for long periods of time while rocking the baby and muttering
incoherent words. He is afraid to leave the baby alone with her. The most
likely diagnosis is:
QID: 3661826
Mark For Review
Postpartum blues.
Postpartum depression.
Postpartum psychosis.
Delirium.
YOU ANSWERED INCORRECTLY
Postpartum blues can occur within days of delivery and is characterized by
weeping or crying for no apparent reason, impatience, irritability, restlessness,
insomnia, anxiety, mood changes, and sadness (A). The symptoms typically resolve
within 2 weeks after giving birth. Postpartum depression is associated with more
severe depression symptoms than postpartum blues and occurs 2 to 4 months after
giving birth (B). Thoughts of harming the baby or themselves can occur. Delirium
typically occurs in older adults and related to infection, medications, electrolyte
imbalance, or other condition. Onset is fairly rapid and resolution involves
identifying and treating the underlying cause (D).
103 of 150The most appropriate intervention for Lucille is:
QID: 3661827
Mark For Review
Ensuring she gets assistance in baby care and sufficient sleep.
Treatment with an antidepressant.
Psychotherapy.
Immediate hospitalization.
YOU ANSWERED CORRECTLY
Postpartum psychosis is a serious condition that puts the individual and baby at
risk. Thus, sending the patient home is not recommended (A). A combination of
medications is usually needed to stabilize the patient (B). Psychotherapy could be
considered at later stages; however, she initially requires hospitalization for
evaluation and initial treatment (C).
104 of 150A 33-year-old female with moderate depression has had an
inadequate response after taking a SSRI for 8 weeks. The PMHNP is
considering switching to another antidepressant class. Which of the following
classes should not be initiated immediately after SSRI discontinuation?
QID: 3661828
Mark For Review
SNRI
TCA
MAOI
NDRI
YOU ANSWERED CORRECTLY
A washout period is not needed when switching from a SSRI to a SNRI (A), TCA
(B), or NDRI (D).
105 of 150In considering the management of adolescents, which of the
following would parental consent be required before providing treatment?
QID: 3661829
Mark For Review
A 16-year-old with conjunctivitis
A 15-year-old seeking treatment for substance abuse
A 16-year-old who thinks she has a sexually transmitted disease
A 17-year-old seeking treatment for depression
YOU ANSWERED CORRECTLY
All 50 states have legislation that protects adolescents to ensure confidentiality for
treatment related to reproductive health and mental health issues. Otherwise,
parental consent is required for treatment in children under the age of 18. Thus,
the adolescent seeking treatment for conjunctivitis would require parental consent
for treatment (A).
106 of 150A 50-year-old man is undergoing psychotherapy and group
counseling for alcohol abuse. He has abstained from alcohol use for the past
month but is concerned about relapse. The PMHNP considers prescribing
which of the following for short-term aversion therapy to help establish a long-
term pattern of sobriety?
QID: 3661830
Mark For Review
Disulfiram
Naloxone
Clonidine
Acamprosate
YOU ANSWERED CORRECTLY
Disulfiram is an aversion medication that causes a noxious reaction when taken
with alcohol (A). Effects can include flushing, headache, dyspnea,
hyperventilation, tachycardia, sweating, and anxiety. The medication is used short-
term for individuals beginning abstinence from alcohol to help establish a long-
term pattern of sobriety.
107 of 150A woman brings in her 81-year-old husband for a follow-up visit. He
was recently diagnosed with mild cognitive impairment. The wife reports that
her husband seems more irritable than usual, especially when he forgets
something or has a difficult time understanding a simple question. This often
leads him to isolate himself for prolonged periods of time. Suspecting that the
man is experiencing depression, the PMHNP explains all of the following
except:
QID: 3661831
Mark For Review
This is a normal and accepted part of the dementia process.
Some of these changes are reversible with treatment.
Treatment of depression will likely improve cognitive function.
Depression is a common condition among individuals with early-stage dementia.
YOU ANSWERED CORRECTLY
For many older patients with dementia, a component of depression is commonly
found and should be actively treated as this can result in improved cognitive
function. Depression should not be accepted as a normal part of the disease
process (A).
108 of 150A 58-year-old man was initiated on fluoxetine 40 mg daily for the
treatment of depression. After counseling the patient on the use of this
medication, the PMHNP realizes additional education is needed when the
patient states:
QID: 3661832
Mark For Review
“I should take the medication in the morning.”
“If I miss a dose, I should take 2 doses as soon as possible.”
“I should take the medication with food.”
“I should call if I experience any adverse effects.”
YOU ANSWERED CORRECTLY
Gastrointestinal upset is a common and usually transient adverse effect of SSRI
therapy. To minimize GI upset, the medication can be taken with food (C).
Fluoxetine is also activating and can interfere with sleep when taken close to
bedtime. The effect on sleep is minimized when the medication is taken in the
morning (A). For patients starting a new therapy, the healthcare provider should
be informed of any drug-induced adverse effects as soon as possible to ensure
patient safety (D).
109 of 150Kendra has a history of bipolar disorder and will initiate treatment
with valproic acid. Prior to starting therapy, baseline and routine monitoring
of which of the following is recommended (Select two correct answers)?
QID: 3661833
Mark For Review
LDL-C
CBC
LFTs
K+
YOU ANSWERED CORRECTLY
With valproic acid therapy, routine monitoring of LDL-C (A) and potassium levels
(D) are not warranted.
110 of 150After starting valproic acid for Kendra, when should she return to
check her drug level?
QID: 3661834
Mark For Review
3-4 days
1-2 weeks
3-4 weeks
Only if she experiences adverse effects
YOU ANSWERED INCORRECTLY
Valproic acid requires 3 to 4 weeks to reach steady state and should not be
checked earlier than this as it would result in an inaccurate reading (A, B). Drug
level should be monitored after starting therapy and after a dose adjustment and
not solely with the emergence of a drug-related adverse effect (D).
111 of 150A 67-year-old man is diagnosed with moderate depression. The
PMHNP prescribes paroxetine 40 mg daily with follow-up in 2 weeks. At the
follow-up, the patient reports some improvement in symptoms and no
substantial adverse effects. The PMHNP realizes that the dose is beyond the
maximum recommended dose for his age. This scenario does not describe a
malpractice event because:
QID: 3661835
Mark For Review
Duty of care was not established.
There was no breach of duty.
There were no actual damages.
There was no negligence.
YOU ANSWERED INCORRECTLY
Duty of care was established between the PMHNP and the patient when the nurse
prescribed the medication (A). Prescribing the wrong dose of a medication that
can cause a serious adverse effect is an example of a breach of duty and
negligence (B, D).
112 of 150Which of the following statements is most accurate regarding SSRI
withdrawal symptoms?
QID: 3661836
Mark For Review
Withdrawal symptoms can be minimized by slowly titrating down the dose.
Hallucinations and seizures are possible after discontinuing long-term SSRI
therapy.
Benzodiazepines can be used to minimize withdrawal symptoms.
Withdrawal symptoms are only associated with SSRI agents with a short half-life.
YOU ANSWERED CORRECTLY
Symptoms of SSRI/SNRI withdrawal can include dizziness, paresthesia, anxiety,
nausea, sleep disturbance and insomnia. The most effective way to minimize the
risk of withdrawal symptoms is to slowly titrate the SSRI dose over several weeks
(A).
113 of 150Which of the following antidepressants should be avoided in a 19-
year-old with depression and who has a history of seizures?
QID: 3661837
Mark For Review
Fluoxetine
Citalopram
Bupropion
Desvenlafaxine
YOU ANSWERED CORRECTLY
The SSRIs fluoxetine and citalopram are appropriate choices for first-line
treatment of depression and are not associated with increased seizure risk (A, B).
Similarly, the SNRI venlafaxine can also be considered for first-line therapy (D).
114 of 150When considering treatment for severe anxiety with panic attacks,
the PMHNP realizes the following advantages of benzodiazepines versus SSRI
agents (Select two correct answers)?
QID: 3661838
Mark For Review
Low risk of physical dependence
Rapid onset of action
Can help diminish insomnia
Absence of withdrawal symptoms
YOU ANSWERED CORRECTLY
Long-term use of benzodiazepines should be avoided due to the risk of physiologic
dependence (A). When discontinuing these agents, the dose should be gradually
tapered over several weeks to avoid withdrawal symptoms, which can be severe
and life-threatening in some cases (D).
115 of 150A mother brings in her 15-year-old son, Jonah, for evaluation. She
reports that he has bouts of uncontrolled anger that seem to be triggered by
the smallest thing, such as losing at a video game. His room has numerous
holes in the walls from him punching them during his outbursts. The most
likely diagnosis is:
QID: 3661839
Mark For Review
Oppositional defiant disorder.
Conduct disorder.
Intermittent explosive disorder.
Asperger’s syndrome.
YOU ANSWERED CORRECTLY
Oppositional defiant disorder is mainly directed towards authoritative figures,
such as parents or teachers, and can present as angry or irritable mood,
argumentative or defiant behavior, or vindictiveness (A). Conduct disorder is a
pattern of behavior that involves infringing on the rights of others and can include
initiating fights or bullying (B). Asperger’s syndrome is a neurodevelopmental
disorder that is associated with difficulty with social interactions (D).
116 of 150The PMHNP recommends a combination of pharmacology and
psychotherapy for Jonah. In considering an appropriate medication, which of
the following classes should be avoided?
QID: 3661840
Mark For Review
SSRIs
Anticonvulsants
Benzodiazepines
Beta blockers
YOU ANSWERED CORRECTLY
SSRIs have been shown to have some effectiveness in reducing intermittent
explosive disorder and can improve social cognition and empathy (A). Lithium or
anticonvulsants can be used in combination with SSRIs to increase their effect (B).
Beta blockers can help to calm the individual by reducing the heart rate and
lowering blood pressure (D).
117 of 150A 13-year-old boy is diagnosed with ADHD that is characterized by
angry outburst and a quick temper. The mother sometimes feels threatened as
her son easily outweighs her. The most appropriate treatment would be:
QID: 3661841
Mark For Review
Clozapine.
Clonazepam.
Guanfacine.
Sertraline.
YOU ANSWERED CORRECTLY
SSRIs such as sertraline (D) or antipsychotic medications such as clozapine (A)
are not typically used in the treatment of ADHD. Benzodiazepines such as
clonazepam are not recommended for the treatment of ADHD (B).
118 of 150A 51-year-old woman was diagnosed with moderate depression that
is associated with depressed mood, low self-esteem, and difficulty initiating
and maintaining sleep. She tried citalopram but had to stop after 5 days
because it caused jitteriness, headaches, and exacerbated her insomnia. Which
of the following is the most appropriate next-step intervention?
QID: 3661842
Mark For Review
Switch to paroxetine and take with the first meal of the day
Switch to suvorexant and take 30 minutes prior to bedtime
Switch to trazodone and take 1 hour prior to bedtime
Switch to buspirone and take with dinner
YOU ANSWERED CORRECTLY
Following the adverse reaction after initiating citalopram, switching to another
SSRI agent should be avoided due to a possible class effect (A). Suvorexant can be
used to treat insomnia but will not be helpful in treating the depression (B).
Buspirone is a non-sedating agent used to treat anxiety and not depression (D).
119 of 150A 32-year-old woman with bipolar disorder is initiated on
carbamazepine for acute mania. The PMHNP realizes additional patient
education on the medication is needed when the patient says:
QID: 3661843
Mark For Review
“I will need to have the drug level checked to avoid toxicity.”
“This medication will decrease my mood swings.”
“A rash is an expected adverse effect of this medication.”
“I should call if I experience any bothersome side effects.”
YOU ANSWERED INCORRECTLY
Carbamazepine is an anticonvulsant that is used as a mood stabilizer (B). When
using carbamazepine, routine monitoring of drug blood levels is recommended to
avoid drug toxicity (A). Additionally, prior to initiating treatment, baseline levels
of LFTs, CBC, electrocardiogram, and electrolytes should be obtained. Patients
should be advised to contact a healthcare professional if a bothersome or serious
drug-related adverse effect emerges (D).
120 of 150Which of the following would be considered first-line therapy for a
51-year-old woman with depression and panic disorder but without
agoraphobia?
QID: 3661844
Mark For Review
Selegiline
Aripiprazole
Escitalopram
Lurasidone
YOU ANSWERED CORRECTLY
Aripiprazole and lurasidone are second-generation antipsychotics that would not
be considered first-line for panic disorder or depression (B, D). Selegiline is a
monoamine oxidase inhibitor that would not be considered first-line treatment of
panic disorder (A).
121 of 150A 56-year-old woman reports sudden-onset blindness that occurred
immediately after learning of her sister’s death in a car accident. Neurological
examination does not reveal an organic cause of the blindness. The most likely
diagnosis is:
QID: 3661845
Mark For Review
Illness anxiety disorder.
Factitious disorder.
Malingering.
Conversion disorder.
YOU ANSWERED CORRECTLY
Illness anxiety disorder describes a state of severe worry and fear of an impending
illness, which develop into obsessive thoughts (A). Those with factitious disorder
will consciously pretend to be ill in order to get their emotional needs met by
having the status of a patient (B). Malingering occurs when an individual pretends
to have an illness or exaggerates symptoms to become eligible for benefits, such as
disability compensation, getting prescriptions, or evading military service (C).
122 of 150Which of the following characteristics of benzodiazepines is
preferred when prescribing for an individual with a history of substance
abuse?
QID: 3661846
Mark For Review
Long half-life
Short half-life
Rapid onset of action
Hepatically metabolized
YOU ANSWERED CORRECTLY
Benzodiazepines with longer half-lives do not produce the post-dose euphoria
associated with shorter-acting forms, but rather provide a more steady-state
control of excitability. Consequently, benzodiazepines with a long duration of
action and long half-life are less likely to be misused (A).
123 of 150The PMHNP sees a 19-year-old man with opioid use disorder. He
states, “I realize this drug is ruining my life but I just can’t seem to stop.”
Which of the following would be the most helpful approach for this patient?
QID: 3661847
Mark For Review
Directly tell him that he needs to stop using drugs.
Advise him that opioid use disorder is a treatable disease.
Discuss with the patient the short- and long-term consequences of opioid abuse.
Provide contact information for a drug rehabilitation center.
YOU ANSWERED CORRECTLY
Advising the patient to stop using drugs is not effective without a more
comprehensive plan that involves counseling along with possible pharmacotherapy
(A). Similarly, the use of scare tactics, such as informing the patient about the
health consequences, is not helpful as an initial approach, especially as the patient
has acknowledged the adverse impact of drug use on his life (C). Referral to a
rehabilitation center would not be helpful without the patient first making a
commitment to change (D).
124 of 150A 32-year-old woman with a history alcohol abuse presents for a
follow-up visit for depression. At today’s visit, she reports that she is 12-weeks
pregnant. The PMHNP counsels the patient that:
QID: 3661848
Mark For Review
No amount of alcohol is safe for the developing fetus.
Low alcohol ingestion is safe after the first trimester.
Very little alcohol will pass through the placenta to the fetus because of the large
molecular size of alcohol.
The effects of alcohol on the fetus typically resolve within weeks after delivery.
YOU ANSWERED CORRECTLY
Alcohol use during pregnancy can inhibit fetal growth and postnatal development.
Fetal alcohol syndrome is the leading cause of intellectual disability in the United
States. It is generally accepted that no amount of alcohol ingestion during
pregnancy is safe for the developing fetus (A).
125 of 150A 54-year-old man is diagnosed with moderate depression and
initiated on paroxetine 20 mg daily. After 2 weeks, he reports no noticeable
adverse effects and little change in symptoms and the dose is increased to 40
mg daily. At the next follow-up visit 4 weeks later, he reports only a slight
improvement in symptoms. The Beck Depression Inventory (BDI) is
administered and he scores an 24 today compared with 27 at the initial visit.
Which of the following would be the most appropriate next step?
QID: 3661849
Mark For Review
Continue with the current regimen for an additional 4 weeks
Increase the paroxetine dose to 60 mg daily
Add venlafaxine to the current regimen
Switch to bupropion
YOU ANSWERED CORRECTLY
With little change in symptoms on the current therapy, treatment should be
adjusted rather than maintaining the current regimen for an additional 4 weeks
(A). The maximum recommended dose of paroxetine is 40 mg daily in younger
adults due to cardiovascular effects observed at higher doses (B). Adding a SNRI
agent is not a recommended option when treating depression and can result in
increased risk of adverse effects (C).
126 of 150For an individual who is trying to abstain from alcohol after years
of alcohol abuse, what is the intended effect of naltrexone (Select two correct
answers)?
QID: 3661850
Mark For Review
Induces noxious effects if alcohol is consumed
Reduces craving of alcohol
Reduces withdrawal symptoms
Prevents the euphoric feeling from alcohol use
YOU ANSWERED CORRECTLY
Disulfiram is an aversion medication that causes a noxious reaction if taken with
alcohol including flushing, headache, dyspnea, hyperventilation, and anxiety (A).
Naltrexone does not minimize withdrawal symptoms, though the benzodiazepines
are sometimes used for this effect (C).
127 of 150Justin is a 15-year-old boy who is being evaluated for post-traumatic
stress disorder. About 4 weeks ago, there was a shooting at his school where he
witnessed a teacher getting shot and killed. He has been experiencing insomnia
and nightmares and is very jittery around loud noises. Considering a PTSD
diagnosis, the PMHNP would anticipate which of the following findings (Select
two correct answers)?
QID: 3661851
Mark For Review
Difficulty concentrating
Auditory hallucinations
Impaired social functioning
Acute mania
YOU ANSWERED CORRECTLY
PTSD can be associated with a number of findings that can vary person-to-person
and can include feelings of detachment, an intrusive recall of the precipitating
event, a numbing of emotions, hyperarousal, and impaired social and occupational
functioning (C). Hyperarousal can be characterized by insomnia, irritability,
hypervigilance, difficulty concentrating (A), and an exaggerated startle response.
128 of 150During the evaluation with Justin, he expresses remorse about the
shooting and states “I could have done something to save my teacher.” The
most appropriate response would be:
QID: 3661852
Mark For Review
“I have no idea what I would have done in your situation.”
“I can’t imagine what you could have done.”
“I’m here for you if you want to talk about it.”
“You’re lucky you didn’t get shot.”
YOU ANSWERED CORRECTLY
Statements that attempt to minimize the precipitating event of PTSD should be
avoided as well as statements that can add to a patient’s feeling of guilt related to
the event (A, B, D).
129 of 150Following a comprehensive evaluation of Justin, the PMHNP
recommend a management plan that includes psychotherapy and
pharmacologic therapy to treat his PTSD and depression. Which of the
following class of agents would be the most appropriate first-line agent?
QID: 3661853
Mark For Review
SSRI
TCA
Benzodiazepine
SGA
YOU ANSWERED CORRECTLY
When managing PTSD, a combination approach of psychotherapy and
pharmacologic therapy is most effective. SSRI treatment is the first-line approach
for management of PTSD as this can address symptoms of arousal along with
depression (B).
130 of 150Five days after initiating treatment, the PMHNP receives a phone
call from Justin’s mother. She sounds very concerned about Justin because he
has been acting peculiar the past couple of days, including giving away his
baseball card collection and looking up websites about suicide. He has not yet
participated in a psychotherapy session. The PMHNP recommends:
QID: 3661854
Mark For Review
Increasing the dose of his medication.
Scheduling a psychotherapy session in the next 72 hours.
Providing the number for the suicide hotline.
Having him admitted immediately for inpatient care and evaluation.
YOU ANSWERED CORRECTLY
In situations where the risk of self-harm is high, the patient should seek immediate
medical help. Increasing the medication dose (A) or scheduling psychotherapy
sessions can be considered once the patient is stabilized but would not be helpful
in dealing with the immediate situation (B). If the mother refuses to admit her son,
then other resources on suicide prevention should be provided, such as the suicide
prevention hotline number (C).
131 of 150A 62-year-old is being evaluated for depression characterized by
depressed mood, hypersomnia, and weight gain. He has a long history of type 2
diabetes and is having difficulty attaining A1C goal despite taking a
combination of antihyperglycemic medications. He has a strong aversion to
starting insulin therapy. He is also taking pravastatin and lisinopril. Which of
the following agents should be avoided due to a potential for glucose elevation?
QID: 3661855
Mark For Review
Venlafaxine
Sertraline
Escitalopram
Paroxetine
YOU ANSWERED INCORRECTLY
Other SSRIs and SNRIs are less likely to increase serum glucose levels when
combined with pravastatin, including sertraline (B), escitalopram (C), and
venlafaxine (A).
132 of 150A 49-year-old man presents at the clinic with symptoms of anxiety,
shortness of breath, and headache. He reports feeling this way soon after
eating a meal with friends consisting of smoked meats and aged cheese. His
blood pressure is 176/108 mm Hg. He says he is taking a medication for
depression but cannot remember the name. The most likely class of medication
is:
QID: 3661856
Mark For Review
SSRIs.
SNRIs.
TCAs.
MAOIs.
YOU ANSWERED CORRECTLY
A hypertensive crisis will not occur when taking other classes of antidepressants,
such as SSRIs, SNRIs, or TCAs, and ingesting tyramine-rich foods (A, B, C).
133 of 150When considering the use of cariprazine for a patient with bipolar
disorder, the PMHNP realizes which of the following is true?
QID: 3661857
Mark For Review
Cariprazine is approved for bipolar depression.
Cariprazine is approved for maintenance therapy.
Cariprazine is not approved for manic episodes.
Cariprazine has little risk for extrapyramidal symptoms.
YOU ANSWERED CORRECTLY
Cariprazine is an atypical antipsychotic that is approved for treatment of manic or
mixed episodes associated with bipolar I disorder as well as bipolar depression
(A).
134 of 150A 54-year-old man has been taking a MAOI for depression for the
past 4 weeks with moderate results. At today’s visit, he mentions that a friend
told him that he should try St. John’s wort for his depression. The PMHNP
responds:
QID: 3661858
Mark For Review
St. John’s wort is generally harmless and he can try it on a trial basis with the
MAOI.
He should only use USP certified preparations of the supplement.
Concomitant use of the supplement with the MAOI can result in serious
adverse effects.
The MAOI dose should be halved prior to starting St. John’s wort.
YOU ANSWERED CORRECTLY
The concomitant use of MAOIs and St. John’s wort can lead to serotonin syndrome
and so should be avoided (A, B, D). Any patient considering the use of herbal
supplements should be made aware of a general lack of quality control of these
products and the potential for clinically significant interactions when used
concomitantly with other medications.
135 of 150A 63-year-old woman is being evaluated for anxiety and depression.
She has a long history of type 2 diabetes mellitus that has resulted in
peripheral neuropathy, as well as hypertension and atrial fibrillation. Which
of the following would be the most appropriate treatment option?
QID: 3661859
Mark For Review
Duloxetine
Paroxetine
Nortriptyline
Phenelzine
YOU ANSWERED INCORRECTLY
The SNRIs, such as duloxetine, are an effective option for the treatment of
depression and anxiety. Additionally, these agents also exhibit a therapeutic effect
against neuropathic pain, such as diabetic neuropathy (A).
136 of 150A 72-year-old man is being evaluated for grief after his wife of 46
years passed away recently. During the discussion, he makes statements of
“There is nobody here left for me,” and “I don’t know if I can go on.” The
PMHNP realizes which of the following statements about suicide is most
accurate?
QID: 3661860
Mark For Review
Asking a patient about suicidal thoughts can precipitate the act.
The rate of completed suicide is higher among females.
Males attempt suicide more often than females.
Suicide risk tends to increase with older age.
YOU ANSWERED CORRECTLY
Asking a patient about suicidal thoughts has not been linked to an increased rate
of suicide or suicide attempts (A). Healthcare providers should not hesitate to ask
if there are any concerns. Conversely, it is clear statistically that while females
attempt the act more often (C), more males successfully complete suicide than
females (B).
137 of 150When considering initiating a monoamine oxidase inhibitor for a
patient with depression, the PMHNP advises to avoid all of the following
except:
QID: 3661861
Mark For Review
Triptans.
Carbonated beverages.
Oral decongestants.
Wine.
YOU ANSWERED CORRECTLY
Any medication that blocks serotonin reuptake should be avoided in individuals
taking a MAOI as it can lead to serotonin syndrome. These can include triptans
and SSRIs (A). Individuals should also avoid medications with sympathomimetic
properties, such as oral decongestants, as this can result in serious adverse effects
(C). Foods rich in tyramine should be avoided and can include dried, aged,
smoked or fermented meats, tap and unpasteurized beer, wine, and aged cheeses
(D).
138 of 150A PMHNP has been hired by a physician to work at a mental health
clinic and is evaluating a 27-year-old patient with bipolar disorder for a
follow-up visit. “Incident to” billing can be considered for this visit if all of the
following criteria are met except:
QID: 3661862
Mark For Review
The physician is present in the office suite but not necessarily in the same room as
the patient.
The physician remains involved in the care of the patient.
The physician conducts the visit if there is a new episode of illness or a change in
the plan of care.
The visit does not exceed 30 minutes.
YOU ANSWERED CORRECTLY
Criteria for an “incident to” office visit include the physician must be in the office
suite at the time of the patient visit (but not necessarily the same room), the
physician must have documented the plan of care, the physician conducts the
initial visit and if there is a new episode of illness or a change in plan of care (C),
the physician must employ the nurse (or they both must be employed by the same
entity), and the physician must remain involved in the care of the patient. NPs, like
physicians, are able to bill the services of an assistant "incident to" if the rules on
incident to billing are followed.
139 of 150A 42-year-old woman has been referred for evaluation for
depression characterized by fatigue, lethargy, hypersomnia, muscle weakness
and cold intolerance. Her PCP prescribed a SSRI but this has not resulted in
any improvement in symptoms. The PMHNP suspects an underlying condition
may be causing the symptoms. Which of the following would support the
argument that an underlying medical condition is causing the psychiatric
presentation (Select two correct answers)?
QID: 3661863
Mark For Review
Abnormal vital signs
Poor response to treatment
Classic presentation of psychiatric condition
Family history of psychiatric condition
YOU ANSWERED CORRECTLY
An ongoing or pre-existing medical condition can be the cause of psychiatric
symptoms in some patients and a careful evaluation should investigate this
possibility. The presence of abnormal vital signs (A) as well as poor response to an
appropriate treatment for the psychiatric condition (B) would indicate that an
underlying medical condition is actually causing the psychiatric symptoms.
140 of 150A 39-year-old woman comes into work the day after her husband
was killed in a car accident. When a co-worker tells her that she should go
home to mourn, she replies, “No, I’m fine. I have a lot of work to do.” This is
an example of which of the following defense mechanisms?
QID: 3661864
Mark For Review
Passive-aggression
Denial
Displacement
Repression
YOU ANSWERED CORRECTLY
Passive-aggression is a method to indirectly express anger (A). Repression is the
process of blocking information from conscious awareness (D). Displacement is
the process of taking out frustrations or anger on people or objects that are less
threatening (C).
141 of 150A 35-year-old man with a history of bipolar disorder is experiencing
an episode of acute mania. He has a BMI of 35 kg/m2 and hypertension that is
well controlled with an ACE inhibitor. In considering treatment with
aripiprazole or olanzapine, the PMHNP considers:
QID: 3661865
Mark For Review
Both agents are associated with hyperglycemia.
Both agents are contraindicated in the presence of hypertension.
Olanzapine is associated with less sedation than aripiprazole.
Olanzapine is associated with weight loss.
YOU ANSWERED CORRECTLY
Antipsychotics in general are effective in treating acute mania and so selection of
a specific agent can depend on the clinical properties and patient factors. Second-
generation antipsychotics can increase insulin resistance leading to hyperglycemia
(A). Patients should be monitored for symptoms of hyperglycemia and undergo
fasting blood glucose monitoring periodically.
142 of 150An 8-year-old boy presents for evaluation of separation anxiety. His
mother was recently hospitalized for an illness and he now becomes highly
agitated whenever he needs to leave his mother. This has made drop-off at
school very difficult. An appropriate initial approach for this patient is:
QID: 3661866
Mark For Review
Methylphenidate.
Nortriptyline.
Electroconvulsive therapy.
Behavioral therapy.
YOU ANSWERED CORRECTLY
When pharmacologic therapy is warranted for an anxiety disorder, the SSRIs are
typically the preferred class of agents. Stimulant medication will likely exacerbate
anxiety in the child (A) and nortriptyline would not be considered an appropriate
option (B). Electroconvulsive therapy is used in the treatment of depression and
would not be considered for this patient with separation anxiety (C).
143 of 150Gemma is a 58-year-old woman who is being evaluated for hoarding
disorder after the town determined her house to be uninhabitable. She states
that she started hoarding about 20 years ago after her husband died. The
PMHNP realizes all of the following about hoarding disorder except:
QID: 3661867
Mark For Review
Hoarding behavior is usually triggered by a traumatic life event.
Hoarding disorder is frequently associated with bipolar disorder.
Those with hoarding disorder usually do not see hoarding as a problem.
There is a heritable tendency for hoarding disorder.
YOU ANSWERED CORRECTLY
Hoarding disorder has a strong heritable tendency with many hoarders adopting
behaviors learned from a family member (D). Hoarders can frequently identify a
specific life event that triggered or exacerbated their hoarding behavior, such as a
divorce or death of a loved one (A). They often do not see hoarding as a problem
but will seek help for other mental health conditions, such as depression, anxiety,
or obsessive-compulsive disorder (C).
144 of 150Appropriate intervention for Gemma can include which of the
following (Select two correct answers)?
QID: 3661868
Mark For Review
Identify and treat any underlying mental health condition.
Initiate a second-generation antipsychotic.
Removal of the hoard (either voluntarily or forcibly).
Psychotherapy.
YOU ANSWERED CORRECTLY
For those with hoarding disorder, a combination of psychotherapy and
pharmacologic therapy can be an effective approach, especially when an
underlying mental health condition has been identified (D). SSRIs are typically the
first-line agent used to treat depression, anxiety, or obsessive-compulsive disorder
commonly found in these patients (A).
145 of 150A 51-year-old transit driver is being evaluated for a 6-month history
of depression symptoms characterized by feelings of anhedonia, fatigue,
weight gain, and insomnia. He scores a 14 on the PHQ-9 survey. This would
most likely indicate:
QID: 3661869
Mark For Review
Dysthymia.
Mild depression.
Moderate depression.
Moderately severe depression.
YOU ANSWERED CORRECTLY
Dysthymia, or persistent depressive disorder, is characterized by low-level
depression that has lasted for at least 2 years (A). In the PHQ-9 survey, a score of
5 to 9 would indicate mild depression (B), while a score between 15 and 19 would
suggest moderately severe depression (D).
146 of 150A 42-year-old man will initiate treatment with lamotrigine for
bipolar maintenance therapy. Prior to starting therapy, the PMHNP counsels
the patient to seek medical help immediately with the development of which of
the following adverse effects?
QID: 3661870
Mark For Review
Headache
Dizziness
Nausea
Generalized rash
YOU ANSWERED CORRECTLY
The development of headache (A), nausea (C), and dizziness (B) are common mild
adverse effects associated with this medication and would not normally require
immediate medical attention.
147 of 150Aaron is a 43-year-old man who lives alone and has never been
married. The few relationships he has had were short-lived because of trust
issues. He only pays with cash and never carries a cell phone for fear that the
government is tracking him. When he requires healthcare, he is reluctant to
give any contact information or personal history, citing “You already know
that information.” This behavior is most reflective of:
QID: 3661871
Mark For Review
Paranoid personality disorder.
Schizotypal personality disorder.
Narcissistic personality disorder.
Avoidant personality disorder.
YOU ANSWERED CORRECTLY
Paranoid personality disorder is characterized by a constant feeling of distrust
and suspiciousness of others based on an unfounded belief that others want to
exploit, harm, or deceive the person. This leads to hypervigilance and hostility
when interacting with others (A).
148 of 150When considering treatment for Aaron, the PMHNP considers
which of the following as a first-line approach?
QID: 3661872
Mark For Review
Individual psychotherapy
Group therapy
Electroconvulsive therapy
Lithium
YOU ANSWERED CORRECTLY
Individuals with paranoid personality disorder can be difficult to accept treatment
due to their suspicious nature. Individualized therapy can be considered first-line
treatment to help develop a trusting relationship with the therapist (A). Once this
is established, other interventions are more likely to be accepted.
149 of 150A 13-year-old boy is diagnosed with ADHD. He has a history of
Tourette’s syndrome and the PMHNP considers prescribing atomoxetine.
Prior to initiating therapy, the PMHNP counsels the parents about the
possibility of which of the following adverse effects (Select two correct
answers)?
QID: 3661873
Mark For Review
Grand mal seizures
Severe liver injury
Respiratory depression
Suicidal ideation
YOU ANSWERED CORRECTLY
Common adverse effects of atomoxetine include GI upset, reduced appetite, weight
loss, urinary retention, dizziness, fatigue, and insomnia. The medication is not
associated with increased seizure risk or respiratory depression (A, C).
150 of 150When considering the use of the NMDA receptor antagonist
memantine for a patient with Alzheimer’s dementia, the PMHNP realizes all of
the following are true except:
QID: 3661874
Mark For Review
This agent is typically used following cholinesterase inhibitor therapy.
Adverse effects include dizziness, agitation, and confusion.
Its use is associated with increased mortality.
This agent is reserved for moderate to severe Alzheimer’s dementia.
YOU ANSWERED CORRECTLY
Memantine is approved for use in patients with moderate-to-severe Alzheimer’s
dementia (D) and is typically added on to cholinesterase inhibitor therapy (A).
Adverse effects associated with memantine include dizziness, agitation, headache,
constipation, and confusion (B).
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