,Question 1
A patient with borderline personality disorder experiences intense anxiety when an adult
psychiatric and mental health nurse practitioner goes on vacation. The best explanation for this
reaction is that the patient:
A. has failed to develop clear ego boundaries.
B. has failed to master object constancy.
C. is employing primitive idealization.
D. is employing projective identification.
Correct Answer: B. has failed to master object constancy
Rationale:
Individuals with borderline personality disorder have difficulty maintaining an internal, stable
image of others when they are physically absent. The nurse practitioner’s vacation disrupts this
emotional continuity, resulting in anxiety and fear of abandonment.
Question 2
A patient has been taking escitalopram (Lexapro) 10 mg daily for four weeks. Initially, the
patient reported depression and suicidal thoughts. The patient’s sleep, appetite, energy, and
appearance have now begun to improve. Which statement applies to this patient?
A. The medication should be discontinued.
B. The medication should be increased.
C. The patient’s risk for suicide is not a concern.
D. The patient’s suicide potential is increased.
Correct Answer: D. The patient’s suicide potential is increased
Rationale:
Antidepressants may improve energy and motivation before mood fully improves. This can
increase the patient’s ability to act on suicidal thoughts during early treatment, requiring close
monitoring.
Question 3
Which behavior reflects existentially oriented therapy?
,A. Attempting to understand a patient’s subjective world
B. Challenging a patient’s irrational beliefs
C. Developing specific plans for change
D. Establishing general group goals
Correct Answer: A. Attempting to understand a patient’s subjective world
Rationale:
Existential therapy focuses on personal meaning, freedom, responsibility, and understanding the
individual’s lived experience rather than symptom reduction or behavioral change.
Question 4
Serving as a member on a crisis team, an adult psychiatric and mental health nurse practitioner
provides crisis intervention to the survivors of a plane crash. Forty-eight hours after the accident,
the survivors describe vivid flashbacks, startle reactions, and disrupted sleep patterns. The nurse
practitioner responds by:
A. advising the survivors to consider using a hypnotic medication for a brief period.
B. educating the survivors about prodromal symptoms of posttraumatic stress disorder.
C. encouraging the survivors to rest during the day.
D. suggesting that the survivors join a posttrauma support group.
Correct Answer: B. educating the survivors about prodromal symptoms of posttraumatic
stress disorder
Rationale:
Within the first few days following trauma, these symptoms are consistent with an acute stress
reaction. Education and normalization help reduce anxiety and promote adaptive coping.
Question 5
An adult psychiatric and mental health nurse practitioner uses the interpersonal therapy model
with a patient to establish a therapeutic alliance based on empathy and trust. The nurse
practitioner recognizes the patient’s readiness to terminate therapy when the patient
demonstrates:
A. an understanding that leaving a significant other may be painful, but also presents an
opportunity for growth.
B. breathing and muscle relaxation exercises that decrease muscle tension and anxiety.
C. free association and consideration of dream interpretation.
D. new adaptive skills after completing homework assignments.
Correct Answer: A. an understanding that leaving a significant other may be painful, but
also presents an opportunity for growth
, Rationale:
Interpersonal therapy emphasizes relationship patterns and role transitions. Insight into
emotional growth and interpersonal change indicates readiness for termination.
Question 6
An Hispanic patient informs an adult psychiatric and mental health nurse practitioner during a
wellness visit that he or she occasionally uses hot chili juice to relieve a “nervous condition.”
The patient denies any adverse effects. The nurse practitioner’s best response is to:
A. actively discourage the patient from continuing this treatment.
B. offer a medication to treat the nervous condition.
C. suggest an alternative food to relieve the nervous condition.
D. view this as a self-care ritual that needs to be preserved.
Correct Answer: D. view this as a self-care ritual that needs to be preserved
Rationale:
Culturally competent care respects traditional practices that are not harmful and do not interfere
with treatment.
Question 7
Before an older adult patient initiates pharmacotherapy with a medication that is cleared by the
kidneys, an adult psychiatric and mental health nurse practitioner assesses the patient’s:
A. blood urea nitrogen level.
B. creatinine clearance.
C. specific gravity.
D. urinary sediment.
Correct Answer: B. creatinine clearance
Rationale:
Creatinine clearance provides the most accurate estimate of renal function for medication dosing
in older adults, as serum creatinine alone may underestimate impairment.
Question 8
An adult psychiatric and mental health nurse practitioner uses a cognitive-behavioral approach to
help an adolescent patient change self-defeating behaviors. After identifying the initial stressor
that is causing the inappropriate behavior, the therapeutic intervention is to identify:
A. alternative positive responses to the stressor.
B. negative consequences of the behavioral response to the stressor.
A patient with borderline personality disorder experiences intense anxiety when an adult
psychiatric and mental health nurse practitioner goes on vacation. The best explanation for this
reaction is that the patient:
A. has failed to develop clear ego boundaries.
B. has failed to master object constancy.
C. is employing primitive idealization.
D. is employing projective identification.
Correct Answer: B. has failed to master object constancy
Rationale:
Individuals with borderline personality disorder have difficulty maintaining an internal, stable
image of others when they are physically absent. The nurse practitioner’s vacation disrupts this
emotional continuity, resulting in anxiety and fear of abandonment.
Question 2
A patient has been taking escitalopram (Lexapro) 10 mg daily for four weeks. Initially, the
patient reported depression and suicidal thoughts. The patient’s sleep, appetite, energy, and
appearance have now begun to improve. Which statement applies to this patient?
A. The medication should be discontinued.
B. The medication should be increased.
C. The patient’s risk for suicide is not a concern.
D. The patient’s suicide potential is increased.
Correct Answer: D. The patient’s suicide potential is increased
Rationale:
Antidepressants may improve energy and motivation before mood fully improves. This can
increase the patient’s ability to act on suicidal thoughts during early treatment, requiring close
monitoring.
Question 3
Which behavior reflects existentially oriented therapy?
,A. Attempting to understand a patient’s subjective world
B. Challenging a patient’s irrational beliefs
C. Developing specific plans for change
D. Establishing general group goals
Correct Answer: A. Attempting to understand a patient’s subjective world
Rationale:
Existential therapy focuses on personal meaning, freedom, responsibility, and understanding the
individual’s lived experience rather than symptom reduction or behavioral change.
Question 4
Serving as a member on a crisis team, an adult psychiatric and mental health nurse practitioner
provides crisis intervention to the survivors of a plane crash. Forty-eight hours after the accident,
the survivors describe vivid flashbacks, startle reactions, and disrupted sleep patterns. The nurse
practitioner responds by:
A. advising the survivors to consider using a hypnotic medication for a brief period.
B. educating the survivors about prodromal symptoms of posttraumatic stress disorder.
C. encouraging the survivors to rest during the day.
D. suggesting that the survivors join a posttrauma support group.
Correct Answer: B. educating the survivors about prodromal symptoms of posttraumatic
stress disorder
Rationale:
Within the first few days following trauma, these symptoms are consistent with an acute stress
reaction. Education and normalization help reduce anxiety and promote adaptive coping.
Question 5
An adult psychiatric and mental health nurse practitioner uses the interpersonal therapy model
with a patient to establish a therapeutic alliance based on empathy and trust. The nurse
practitioner recognizes the patient’s readiness to terminate therapy when the patient
demonstrates:
A. an understanding that leaving a significant other may be painful, but also presents an
opportunity for growth.
B. breathing and muscle relaxation exercises that decrease muscle tension and anxiety.
C. free association and consideration of dream interpretation.
D. new adaptive skills after completing homework assignments.
Correct Answer: A. an understanding that leaving a significant other may be painful, but
also presents an opportunity for growth
, Rationale:
Interpersonal therapy emphasizes relationship patterns and role transitions. Insight into
emotional growth and interpersonal change indicates readiness for termination.
Question 6
An Hispanic patient informs an adult psychiatric and mental health nurse practitioner during a
wellness visit that he or she occasionally uses hot chili juice to relieve a “nervous condition.”
The patient denies any adverse effects. The nurse practitioner’s best response is to:
A. actively discourage the patient from continuing this treatment.
B. offer a medication to treat the nervous condition.
C. suggest an alternative food to relieve the nervous condition.
D. view this as a self-care ritual that needs to be preserved.
Correct Answer: D. view this as a self-care ritual that needs to be preserved
Rationale:
Culturally competent care respects traditional practices that are not harmful and do not interfere
with treatment.
Question 7
Before an older adult patient initiates pharmacotherapy with a medication that is cleared by the
kidneys, an adult psychiatric and mental health nurse practitioner assesses the patient’s:
A. blood urea nitrogen level.
B. creatinine clearance.
C. specific gravity.
D. urinary sediment.
Correct Answer: B. creatinine clearance
Rationale:
Creatinine clearance provides the most accurate estimate of renal function for medication dosing
in older adults, as serum creatinine alone may underestimate impairment.
Question 8
An adult psychiatric and mental health nurse practitioner uses a cognitive-behavioral approach to
help an adolescent patient change self-defeating behaviors. After identifying the initial stressor
that is causing the inappropriate behavior, the therapeutic intervention is to identify:
A. alternative positive responses to the stressor.
B. negative consequences of the behavioral response to the stressor.
