PMHNP ANCC Review Questions and
correct Answers
A 20-year-old Asian man who was recently diagnosed with schizophrenia
comes to your office for a follow-up appointment. During the assessment, he
talks about his experience in the group home, thinking that the television is
sending him messages through news anchors during the 10 p.m. evening
news. What symptom is the client describing?
a. Paranoia
b. Illusions
c. Ideas of reference
d. Neologisms - ----ANS:C. Ideas of reference are misinterpretations of
incidents and events that one believes have a direct personal reference to
oneself.
A 23-year-old woman is brought into the ER after attempting suicide by cutting
her wrists. Which nursing action by the PMHNP would be of highest priority
initially?
a. Assess her coping behaviors
b. Assess her current level of suicidality
c. Take her vital signs
d. Assess her health history - ----ANS:C. The PMHNP needs to ensure that
her suicide attempt has not led to medical instability.
A 74-year-old married white woman was referred to you by her primary care
provider for a psychiatric evaluation. She had a normal medical and
neurological examination in the last 2 months. The client presents with her
husband of 45 years who states, "My wife is just not the same anymore, she is
irritable and asks the same question several times, even though I've answered
it many times." The client responds, "Oh, Henry, you do the same thing, it's
just a normal part of getting older, and the kids think everything is fine." During
the assessment you compete the mini mental status examination (MMSE) and
the client scores 18. As the PMHNP treating the client, you know the results of
her MMSE indicate which level of cognitive impairment?
a. No cognitive impairment
b. Mild cognitive impairment
c. Moderate cognitive impairment
,d. Severe cognitive impairment - ----ANS:C. Cut points on the MMSE are as
follows: total score 30, 25-30 questionable significance, 20-25 mild
impairment, 10-20 moderate impairment, and 10 or lower severe impairment.
A client comes into the clinic with a longstanding history of depression and
chronic renal failure. He is on an antidepressant and a diuretic and complains
of increased depression, mild confusion, irritability, and overall apathy from
being too tired to do anything. The best initial PMHNP action to take at this
time is
a. Increase his dose of antidepressant medication to better capture symptoms
b. Change him to another antidepressant for better symptom control
c. Augment his antidepressant with an atypical antipsychotic medication
d. Order a comprehensive metabolic panel - ----ANS:D. Client symptoms are
consistent with electrolyte imbalance and a physical cause of his symptoms
must be ruled out first.
A client is displaying low self-esteem, poor self-control, self-doubt, and a high
level of dependency. These behaviors indicate developmental failure of which
of the following stages of development:
a. Infancy
b. Early childhood
c. Late childhood
d. School age - ----ANS:B. These signs indicate developmental failure of early
childhood.
A client presents with complaints of changes in appetite, feeling fatigued,
problems with sleep-rest cycle, and changes in libido. What is the
neuroanatomical area of the brain that is responsible for the normal regulation
of these functions?
a. Thalamus
b. Hypothalamus
c. Limbic system
d. Hippocampus - ----ANS:B. Appetite, sleep, and libido are regulated by the
hypothalamus.
A client returns for a follow-up appointment 3 weeks after starting on
fluoxetine 20 mg. During this appointment you notice that her speech is a little
rapid, in marked contrast to the psychomotor retardation and paucity of
spontaneous speech she displayed on her first visit. Instead of looking at the
floor, she now makes normal eye contact. Her affect has gone from
, constricted to expansive. She continues to have difficulty sleeping, but her
energy has improved and she states she feels "so much better!" What should
you conclude about the shift in the client's presentation?
a. She is experiencing the activating side effects of fluoxetine.
b. She is becoming euthymic.
c. She is becoming hypomanic.
d. She is in a mixed state. - ----ANS:C. In this case, you see a shifting set of
symptoms, the most important being her expansive mood and statement "so
much better" that indicates she
has gone beyond euthymia.
A client says to the PMHNP, "Some days life is just not worth it. All my wife
and I ever do is fight and scream. Things at home would be calmer and
simpler if I just wasn't there anymore." The most therapeutic response for the
PMHNP to make is
a. "Do you mean that you are thinking about leaving your wife and moving
out?"
b. "Tell me what you mean by 'it would be simpler if you just weren't there
anymore.'"
c. "So you are thinking suicide might be an option for you?"
d. Remain silent - ----ANS:B. This response is the most therapeutic, allowing
the client to further clarify and express feelings.
A client who has been addicted to opioids has not used in 15 days. During
your medication management visit, the client states, "I'm going to die from not
having my Opanas. You need to give me something now." The PMHNP's best
response is:
a. "I know you are feeling very uncomfortable and we need to get you to the
emergency room immediately to prevent a seizure."
b. "I know you are feeling very uncomfortable, let's take your vital signs and
talk about a trial on Catapres to treat your withdrawal symptoms."
c. "You have been using Opana for a long time and it is going to take several
months for the withdrawal to end. In the meantime, I will see you weekly."
d. "There is no treatment for opioid withdrawal; you will have to wait it out." -
----ANS:B. Opioid withdrawal symptoms can be treated with central alpha
agonists.
A client who is experiencing difficulties with working memory, planning and
prioritizing, insight into his problems, and impulse control presents for
correct Answers
A 20-year-old Asian man who was recently diagnosed with schizophrenia
comes to your office for a follow-up appointment. During the assessment, he
talks about his experience in the group home, thinking that the television is
sending him messages through news anchors during the 10 p.m. evening
news. What symptom is the client describing?
a. Paranoia
b. Illusions
c. Ideas of reference
d. Neologisms - ----ANS:C. Ideas of reference are misinterpretations of
incidents and events that one believes have a direct personal reference to
oneself.
A 23-year-old woman is brought into the ER after attempting suicide by cutting
her wrists. Which nursing action by the PMHNP would be of highest priority
initially?
a. Assess her coping behaviors
b. Assess her current level of suicidality
c. Take her vital signs
d. Assess her health history - ----ANS:C. The PMHNP needs to ensure that
her suicide attempt has not led to medical instability.
A 74-year-old married white woman was referred to you by her primary care
provider for a psychiatric evaluation. She had a normal medical and
neurological examination in the last 2 months. The client presents with her
husband of 45 years who states, "My wife is just not the same anymore, she is
irritable and asks the same question several times, even though I've answered
it many times." The client responds, "Oh, Henry, you do the same thing, it's
just a normal part of getting older, and the kids think everything is fine." During
the assessment you compete the mini mental status examination (MMSE) and
the client scores 18. As the PMHNP treating the client, you know the results of
her MMSE indicate which level of cognitive impairment?
a. No cognitive impairment
b. Mild cognitive impairment
c. Moderate cognitive impairment
,d. Severe cognitive impairment - ----ANS:C. Cut points on the MMSE are as
follows: total score 30, 25-30 questionable significance, 20-25 mild
impairment, 10-20 moderate impairment, and 10 or lower severe impairment.
A client comes into the clinic with a longstanding history of depression and
chronic renal failure. He is on an antidepressant and a diuretic and complains
of increased depression, mild confusion, irritability, and overall apathy from
being too tired to do anything. The best initial PMHNP action to take at this
time is
a. Increase his dose of antidepressant medication to better capture symptoms
b. Change him to another antidepressant for better symptom control
c. Augment his antidepressant with an atypical antipsychotic medication
d. Order a comprehensive metabolic panel - ----ANS:D. Client symptoms are
consistent with electrolyte imbalance and a physical cause of his symptoms
must be ruled out first.
A client is displaying low self-esteem, poor self-control, self-doubt, and a high
level of dependency. These behaviors indicate developmental failure of which
of the following stages of development:
a. Infancy
b. Early childhood
c. Late childhood
d. School age - ----ANS:B. These signs indicate developmental failure of early
childhood.
A client presents with complaints of changes in appetite, feeling fatigued,
problems with sleep-rest cycle, and changes in libido. What is the
neuroanatomical area of the brain that is responsible for the normal regulation
of these functions?
a. Thalamus
b. Hypothalamus
c. Limbic system
d. Hippocampus - ----ANS:B. Appetite, sleep, and libido are regulated by the
hypothalamus.
A client returns for a follow-up appointment 3 weeks after starting on
fluoxetine 20 mg. During this appointment you notice that her speech is a little
rapid, in marked contrast to the psychomotor retardation and paucity of
spontaneous speech she displayed on her first visit. Instead of looking at the
floor, she now makes normal eye contact. Her affect has gone from
, constricted to expansive. She continues to have difficulty sleeping, but her
energy has improved and she states she feels "so much better!" What should
you conclude about the shift in the client's presentation?
a. She is experiencing the activating side effects of fluoxetine.
b. She is becoming euthymic.
c. She is becoming hypomanic.
d. She is in a mixed state. - ----ANS:C. In this case, you see a shifting set of
symptoms, the most important being her expansive mood and statement "so
much better" that indicates she
has gone beyond euthymia.
A client says to the PMHNP, "Some days life is just not worth it. All my wife
and I ever do is fight and scream. Things at home would be calmer and
simpler if I just wasn't there anymore." The most therapeutic response for the
PMHNP to make is
a. "Do you mean that you are thinking about leaving your wife and moving
out?"
b. "Tell me what you mean by 'it would be simpler if you just weren't there
anymore.'"
c. "So you are thinking suicide might be an option for you?"
d. Remain silent - ----ANS:B. This response is the most therapeutic, allowing
the client to further clarify and express feelings.
A client who has been addicted to opioids has not used in 15 days. During
your medication management visit, the client states, "I'm going to die from not
having my Opanas. You need to give me something now." The PMHNP's best
response is:
a. "I know you are feeling very uncomfortable and we need to get you to the
emergency room immediately to prevent a seizure."
b. "I know you are feeling very uncomfortable, let's take your vital signs and
talk about a trial on Catapres to treat your withdrawal symptoms."
c. "You have been using Opana for a long time and it is going to take several
months for the withdrawal to end. In the meantime, I will see you weekly."
d. "There is no treatment for opioid withdrawal; you will have to wait it out." -
----ANS:B. Opioid withdrawal symptoms can be treated with central alpha
agonists.
A client who is experiencing difficulties with working memory, planning and
prioritizing, insight into his problems, and impulse control presents for
