NR668 PMHNP Final Diagnostic Exam
1. A 45 year old male presents with progressive hoarseness lasting four weeks after a recent
upper respiratory infection. He denies smoking, weight loss, dysphagia, or neck masses.
Flexible laryngoscopy reveals mild vocal cord inflammation without structural lesions.
What is the most likely diagnosis?
A. Laryngeal carcinoma
B. Acute laryngitis ✓ ✅
C. Vocal cord paralysis
D. Gastroesophageal reflux disease
2. A 38 year old man reported a sudden change in his voice after a week long upper
respiratory infection. He notes mild discomfort while speaking, but no breathing difficulty
or swallowing problems. Examination reveals mild vocal cord edema, and he is advised
voice rest and hydration. What is the most likely resolution of his symptoms?
A. Brain sensory disorder
B. Voice disorder ✓ ✅
C. Anxiety, panic, emotional stress
D. Neurologic disorder
Question 3
Abdullah, a 22 year old male from Indonesia swung a sword at a doctor shortly after the
sudden death of his mother. He lost consciousness, collapsing to the floor after the violent
attempt to hurt the doctor. Which culture bound syndrome best describes Abdullah's
behavior?
A.Latah
B. Amok ✓ ✅
C. Ataque de nervios
D. Koro
Question 4
Which action demonstrates cultural sensitivity when a PMHNP is working with a patient
who has religious beliefs that impact their view on mental health treatment?
A. Suggesting that religious beliefs should not interfere with medical treatment
B. Avoiding any mention of religion to keep the treatment strictly clinical
C. Encouraging the patient to set aside religious beliefs in favor of treatment adherence
D. Exploring the patient's beliefs and discussing how these might inform treatment choices
✓✅
,Question 5
A PMHNP is developing a community based mental health initiative in a culturally diverse
area. To ensure cultural competency, which approach should they prioritize?
A. Relying on their own cultural understanding to make decisions for the community
B. Conducting community assessments and involving local leaders to understand specific
cultural needs ✓ ✅
C. Direct the focus on reducing barriers like language to increase access to care
D. Designing a one size fits all program based on national mental health standards
Question 6
An elderly patient with a history of CAD, DMII, OA, weight loss and Major
Neurocognitive Disorder is exhibiting increased agitation and aggression, causing concern
among family members. Before initiating antipsychotic therapy, what should the PMHNP
prioritize?
A. Assess for possible environmental triggers or underlying medical issues ✓ ✅
B. Trial Dextromethorphan Quinidine
C. Trial a cholinesterase inhibitor
D. Stop all current medications to identify potential side effects
Question 7
A 40 year old patient with a family history of Huntington's disease presents with mild and
subtle cognitive changes, such as difficulty with complex tasks and slight irritability. What
diagnostic approach is most appropriate to confirm Huntington's disease as the underlying
cause?
A.PET scan to assess glucose metabolism in the frontal lobes
B. Structural MRI to assess hippocampal volume
C. Neuropsychological testing
D. Genetic testing for the huntingtin (HTT) gene mutation ✓ ✅
Question 8
,A 75 year old man who lives alone has a history of alcohol use disorder is admitted to the
ICU with a COPD exacerbation. He develops severe agitation, visual hallucinations, and
fluctuating levels of consciousness. His current treatment includes supplemental oxygen, a
corticosteroid taper, and albuterol nebulizers. Which factor is most likely contributing to
his delirium, and what is the best initial approach?
A. Albuterol induced delirium; reduce albuterol dosage
B. Steroid induced delirium; initiate haloperidol
C. Hypoxia related delirium; increase oxygen supplementation
D. Alcohol withdrawal delirium; initiate benzodiazepines ✓ ✅
Question 9
The cognitive processes that allows us to organize, plan, sequence and initiate tasks are
collectively know as what?
A. Executive functions ✓ ✅
B. Thought content
C. Thought stream
D. Affective regulations
Question 10
The spouse of your patient asks you to describe how Donepezil helps her husband who has
mild Alzheimer's disease. Which of the following is the best response?
A. Donepezil helps increase the breakdown of acetylcholine
B. Donepezil has no effect on function or cognition in Alzheimer's disease
C. Donepezil cures Alzheimer's dementia in clinical trials
D. Donepezil helps prevent the breakdown of acetylcholine ✓ ✅
Question 11
, In HIV associated neurocognitive disorder, what is an essential part of the management
plan to help prevent further cognitive decline?
A. Thiamine and Vitamin B12
B. Antiretroviral therapy (ART) ✓ ✅
C. High dose corticosteroids
D. Donepezil
Question 12
The most common complaint and reason the acetylcholinesterase inhibitors are sometimes
discontinued is what?
A. Gastrointestinal side effects ✓ ✅
B. Constipation
C. Dizziness
D. Weight gain
Question 13
Frank is a 71 year old retired house painter who dropped out of high school in the 10th
grade. Frank is concerned with his self reported "memory difficulty" the past 1.5 years. He
has no reported changes in activities of daily living or functional ability. He scored a 24 on
the Montreal Cognitive Assessment and a 26 on the Mini Mental State Examination. He is
accompanied by his daughter who acknowledges that her father is having some memory
issues. Which is the most likely diagnosis given the information provided?
A. Normal aging
B. Mild Cognitive Impairment ✓ ✅
C. Major Neurocognitive Disorder
D. Pseudo Dementia
Question 14
Glenn's doctor tells him he needs to avoid carbohydrates in his diet. Glenn questions what
this means. He asks the PMHNP which food fits this diet?
A. Hamburger
B. Scrambled eggs ✓ ✅
C. Tortilla
D. Egg McMuffin sandwich
Question 15
1. A 45 year old male presents with progressive hoarseness lasting four weeks after a recent
upper respiratory infection. He denies smoking, weight loss, dysphagia, or neck masses.
Flexible laryngoscopy reveals mild vocal cord inflammation without structural lesions.
What is the most likely diagnosis?
A. Laryngeal carcinoma
B. Acute laryngitis ✓ ✅
C. Vocal cord paralysis
D. Gastroesophageal reflux disease
2. A 38 year old man reported a sudden change in his voice after a week long upper
respiratory infection. He notes mild discomfort while speaking, but no breathing difficulty
or swallowing problems. Examination reveals mild vocal cord edema, and he is advised
voice rest and hydration. What is the most likely resolution of his symptoms?
A. Brain sensory disorder
B. Voice disorder ✓ ✅
C. Anxiety, panic, emotional stress
D. Neurologic disorder
Question 3
Abdullah, a 22 year old male from Indonesia swung a sword at a doctor shortly after the
sudden death of his mother. He lost consciousness, collapsing to the floor after the violent
attempt to hurt the doctor. Which culture bound syndrome best describes Abdullah's
behavior?
A.Latah
B. Amok ✓ ✅
C. Ataque de nervios
D. Koro
Question 4
Which action demonstrates cultural sensitivity when a PMHNP is working with a patient
who has religious beliefs that impact their view on mental health treatment?
A. Suggesting that religious beliefs should not interfere with medical treatment
B. Avoiding any mention of religion to keep the treatment strictly clinical
C. Encouraging the patient to set aside religious beliefs in favor of treatment adherence
D. Exploring the patient's beliefs and discussing how these might inform treatment choices
✓✅
,Question 5
A PMHNP is developing a community based mental health initiative in a culturally diverse
area. To ensure cultural competency, which approach should they prioritize?
A. Relying on their own cultural understanding to make decisions for the community
B. Conducting community assessments and involving local leaders to understand specific
cultural needs ✓ ✅
C. Direct the focus on reducing barriers like language to increase access to care
D. Designing a one size fits all program based on national mental health standards
Question 6
An elderly patient with a history of CAD, DMII, OA, weight loss and Major
Neurocognitive Disorder is exhibiting increased agitation and aggression, causing concern
among family members. Before initiating antipsychotic therapy, what should the PMHNP
prioritize?
A. Assess for possible environmental triggers or underlying medical issues ✓ ✅
B. Trial Dextromethorphan Quinidine
C. Trial a cholinesterase inhibitor
D. Stop all current medications to identify potential side effects
Question 7
A 40 year old patient with a family history of Huntington's disease presents with mild and
subtle cognitive changes, such as difficulty with complex tasks and slight irritability. What
diagnostic approach is most appropriate to confirm Huntington's disease as the underlying
cause?
A.PET scan to assess glucose metabolism in the frontal lobes
B. Structural MRI to assess hippocampal volume
C. Neuropsychological testing
D. Genetic testing for the huntingtin (HTT) gene mutation ✓ ✅
Question 8
,A 75 year old man who lives alone has a history of alcohol use disorder is admitted to the
ICU with a COPD exacerbation. He develops severe agitation, visual hallucinations, and
fluctuating levels of consciousness. His current treatment includes supplemental oxygen, a
corticosteroid taper, and albuterol nebulizers. Which factor is most likely contributing to
his delirium, and what is the best initial approach?
A. Albuterol induced delirium; reduce albuterol dosage
B. Steroid induced delirium; initiate haloperidol
C. Hypoxia related delirium; increase oxygen supplementation
D. Alcohol withdrawal delirium; initiate benzodiazepines ✓ ✅
Question 9
The cognitive processes that allows us to organize, plan, sequence and initiate tasks are
collectively know as what?
A. Executive functions ✓ ✅
B. Thought content
C. Thought stream
D. Affective regulations
Question 10
The spouse of your patient asks you to describe how Donepezil helps her husband who has
mild Alzheimer's disease. Which of the following is the best response?
A. Donepezil helps increase the breakdown of acetylcholine
B. Donepezil has no effect on function or cognition in Alzheimer's disease
C. Donepezil cures Alzheimer's dementia in clinical trials
D. Donepezil helps prevent the breakdown of acetylcholine ✓ ✅
Question 11
, In HIV associated neurocognitive disorder, what is an essential part of the management
plan to help prevent further cognitive decline?
A. Thiamine and Vitamin B12
B. Antiretroviral therapy (ART) ✓ ✅
C. High dose corticosteroids
D. Donepezil
Question 12
The most common complaint and reason the acetylcholinesterase inhibitors are sometimes
discontinued is what?
A. Gastrointestinal side effects ✓ ✅
B. Constipation
C. Dizziness
D. Weight gain
Question 13
Frank is a 71 year old retired house painter who dropped out of high school in the 10th
grade. Frank is concerned with his self reported "memory difficulty" the past 1.5 years. He
has no reported changes in activities of daily living or functional ability. He scored a 24 on
the Montreal Cognitive Assessment and a 26 on the Mini Mental State Examination. He is
accompanied by his daughter who acknowledges that her father is having some memory
issues. Which is the most likely diagnosis given the information provided?
A. Normal aging
B. Mild Cognitive Impairment ✓ ✅
C. Major Neurocognitive Disorder
D. Pseudo Dementia
Question 14
Glenn's doctor tells him he needs to avoid carbohydrates in his diet. Glenn questions what
this means. He asks the PMHNP which food fits this diet?
A. Hamburger
B. Scrambled eggs ✓ ✅
C. Tortilla
D. Egg McMuffin sandwich
Question 15
