ANCC IQ Domains 1-5 Qbank answered all correctly answered; latest updated summer 2024.

ANCC IQ Domain • Domain 1: Scientific Foundation (40 questions with rationales) • Domain 2: Advanced Practice Skills (49 questions with rationales) • Domain 3: Diagnosis and Treatment (52 questions with rationales) • Domain 4: Psychotherapy and Related Theories (30 questions with rationales) • Domain 5: Ethical and Legal Principles (72 questions with rationales) ANCC Domain 1: Scientific Foundation (40 questions with rationales) As a PMHNP, you are aware of antipsychotic medication side effects. Which of the following side effects of antipsychotic medications has an insidious, delayed-onset typically 1 to 2 years after initiation of the medication? a. Dry mouth b. Tardive dyskinesia c. Sedation d. Weight gain In evaluating a 4-year-old, one would expect which of the following delays in Asperger's Disorder? a. Language development b. Cognitive development c. Motor skills coordination d. Social skills development Which area of the brain has been implicated to modulate pain and can help explain how transcranial magnetic stimulation can help decrease pain? a. Prefrontal cortex b. Insula cortex c. Dorsolateral prefrontal cortex d. Anterior cingulate cortex Which of the following antidepressants is associated with dose-related cardiovascular adverse effects which require adherence to maximum recommended dosing, unless higher doses are deemed appropriate despite risks? a. Citalopram (Celexa) b. Venlafaxine (Effexor) c. Mirtazapine (Remeron) d. Sertraline (Zoloft) Which of the following findings would raise concern in an annual sports exam for a 15-year-old girl? a. Scar tissue from hymenal tear at 11 o'clock (reported biking injury) b. Blood pressure 86/56 c. Height 67 inches, weight 102 pounds d. Pulse 60, respirations 26 A week after raising the dose of risperidone (Risperdal), a patient treated for schizophrenia presents to the clinic with reports of an acute change in mental status, fever, and rigidity. As the treating PMHNP, you know these symptoms are consistent with which of the following? a. Neuroleptic malignant syndrome (NMS) b. Anticholinergic withdrawal syndrome c. Extrapyramidal side effects d. Serotonin syndrome Which of the following statements regarding disulfiram (Antabuse is correct? a. Disulfiram should not be taken for at least 6 hours after drinking alcohol. b. Avoid anything containing alcohol (i.e., vinegar, mouthwash, aftershave, cough medication) while using disulfiram and for 2 weeks after discontinuing. c. A disulfiram-alcohol reaction can occur up to 1 week after discontinuing disulfiram. d. Disulfiram can lower liver function tests so monitoring is necessary. Which mood stabilizer is most associated with a potentially life-threatening rash? a. Divalproex (Depakote) b. Lamotrigine (Lamictal) c. Lithium (Eskalith) d. Carbamazepine (Tegretol) Which of the following statements most accurately reflects the predominant risk factors of antisocial personality disorders? a. Gang affiliation and early substance abuse b. Genetic predisposition of first-degree family member c. Childhood abuse and trauma from domestic violence d. Lower socioeconomic status from single-parent families A 37-year-old patient with schizophrenia is started on a high dose of chlorpromazine (Thorazine). The next day, he complains of lightheadedness after standing up. Vital sign changes reflect a significant decrease in blood pressure and an increase in heart rate. You suspect this is secondary to the alpha 1-adrenergic blockade which is causing a. Orthostatic hypotension b. Dry mouth c. Respiratory depression d. Decreased sweating A 74-year-old female presents for an evaluation. The psychiatric nurse practitioner has the patient complete the mini mental status examination and clock drawing. The patient is unable to correctly draw the face of the clock. Which area of the brain is likely to have a compromised functioning? a. Wernicke's Area b. Corpus Callosum c. Left Hemisphere d. Right hemisphere Your patient comes into the office for her middle of the year appointment. She is diagnosed with Bipolar I disorder. She has been maintained well for the past 3 years on Oxcarbazepine (Trileptal) 900 mg po QHS. Her labs are normal except for a blood sugar of 114 and her hemoglobin A1C is 5.6. She has a normal energy level and states that her mood is stable but complains of excessive urination and thirst. You suspect: a. Possible Diabetes 2 b. Possible hyponatremia c. Possible polydipsia d. Side effects of oxcarbazepine What is a rare but serious side effect of trazodone (Desyrel)? a. Confusion b. Priapism c. Rash d. Tremor When studying pharmacodynamics involving receptors, you know that an inverse agonist produces the following effect: a. Does not fully activate the receptor and causes only limited actions b. Causes the opposite effect of agonist, and causes the receptor to close the ion channel c. Blocks the agonist from opening the channel, and does not activate a biological response d. Activates a biological response, and opens the ion channel. Mr. Smith is a 56-year-old white male who has been successfully treated on Selegiline for over 4 years. Mr. Smith is going in for an elective surgical procedure. Which medication is strictly contraindicated with Selegiline? a. Non-steroidal anti-inflammatory drugs (NSAIDs) b. Meperidine c. Codeine d. Morphine Patty is a 62-year-old white female with Bipolar I Disorder and has been stable for 2 years on valproate and risperidone. She was recently diagnosed with shingles, and her primary care nurse practitioner started her on corticosteroids. As the PMHNP treating Patty, you are concerned that the addition of the corticosteroids may cause a. Neuroleptic Malignant Syndrome b. A hypertensive crisis c. A manic episode d. Stevens-Johnson syndrome Which serotonin receptor antagonism makes an antipsychotic "atypical"? a. 5HT4A b. 5HT1A c. 5HT3A d. 5HT2A What direct-acting dopamine receptor agonist is recommended to be used in the treatment of neuroleptic malignant syndrome (NMS) to help lower the dopamine receptor blockade? a. Benztropine (Cogentin) b. Bromocriptine (Parlodel) c. Trihexyphenidyl (Artane) d. Dantrolene (Dantrium) A 17-year-old female presents to your clinic reporting anhedonia, decreased energy, and hopelessness for the past two years. She denies drinking alcohol, smoking, or using illegal substances. Her physical examination results are within normal limits and she denies suicidal ideations. As the treating psychiatric mental health nurse practitioner, you decide to prescribe her bupropion (Wellbutrin). Of the following, which is contraindication for the use of bupropion? a. Bulimia b. Dysthymia c. Smoking d. Fatigue Which of the following statements reflects current understanding of neurodevelopment and best explains risk-taking behaviors of adolescent males? a. Hormonal flooding, especially testosterone and oxytocin, increase dopamine levels in the brain b. Maturation of the prefrontal cortex continues into mid-20s and early 30s c. Pruning of serotonin circuits in the adolescent brain is associated with increased impulsivity d. Stimulant and substance use impairs judgment and cognitive appraisal. Which of the following statements does not reflect current understanding of neurotransmitter pathways implicated in anxiety disorders? a. Decreasing norepinephrine in the locus coeruleus diminishes symptoms of anxiety. b. Increased levels of CRF in the amygdala, hippocampus and locus coeruleus increases symptoms of anxiety. c. Decreasing GABA in the mesolimbic cortex diminishes symptoms of anxiety. d. Increasing serotonergic activity in the amygdala diminishes symptoms of anxiety. Which of the following findings on MRI and PET scans would be uncommon in individuals with schizophrenia? a. Decreased glutamate and GABA release b. Decreased total brain volume c. Decreased electrical activity in the frontal lobes d. Decreased size of cerebral ventricles Which of the following findings would raise concern in a pre-school wellness exam for a 5-year-old girl? a. Blood pressure 92/52 b. Pulse 102, respirations 30 c. Completed immunizations: MMR, Varicella, DTap, IPV, PCV, Hib, HepB d. Height 43 inches, weight 55 lbs The PMHNP would expect to see which of the following during a physical exam for a patient with bulimia nervosa? a. Obesity b. Tachycardia c. Alopecia areata d. Erosion of dental enamel 1. While treating a 12-year-old boy for ADHD, the PMHNP observes which of the following physical features that raise concerns for genetic evaluation for Fragile X syndrome? a. Small head, short palpebral fissure, inner epicanthal folds b. Café au lait spots on face and arms, neurofibromas c. Long head and ears, short stature, hyperextensible joints d. Obesity, small stature, small hands and feet, hypotonia You are on call for your service. You arrive at the emergency department to find a 22-year-old male patient complaining of having trouble with his eyes. His vitals are stable. He is 5 foot and 7 inches tall; his weight is 140 pounds; his labs are all in the normal range. He states that he has been taking Aripiprazole (Abilify) for the last 2 months for his Bipolar 1 disorder. He had the dose raised to 15 mg po QAM 4 days ago to manage a manic episode. He states that one to three times a day for the past 2 days his eyes will roll upwards for 10 to 15 minutes and he will have trouble seeing until they roll back down. When you examine his eyes, he is able to fully open his eyes but he is not able to focus his eyes on you. His eyes are rolled upwards about 2/3rds of the way towards his upper eyelid. After examination you decide to: a. Discontinue the Aripiprazole and begin the patient on a gradually increasing regimen of Lamotrigine 25 mg 1 po QHS for 1 week. Have him return to his provider for further management of his bipolar disorder. b. Continue the Aripiprazole and give Benztropine Mesylate (Cogentin) 1 mg IM. Have him take Benztropine Mesylate (Cogentin) 1 mg po BID. Have him return to his provider for further management of his bipolar disorder the next day. c. Begin a cross titration downward of the Aripiprazole and upwards of Haloperidol (Haldol). Have him return to his provider for further management of his bipolar disorder. d. Discontinue the Aripiprazole and give Benztropine Mesylate (Cogentin) 1 mg IM. Have him take Benztropine Mesylate 1 mg po BID for 5 days. Have him return to his provider for a different medication for his bipolar disorder the next day. A 24-year-old mother of a 2-year-old child presents to the clinic. Which of the following facial characteristics would lead the psychiatric mental health nurse practitioner to believe the child has fetal alcohol syndrome? a. Large head, thick upper lip, and overdeveloped jaw b. Small head, thin upper lip, and smooth philtrum c. Long nose, large eyelid opening, and developed philtrum d. High nasal bridge, plump midface, and large eyelid opening A client is suffering from schizophrenia. Which of the following would be the appropriate question for the PMHNP to ask when assessing side effects produced by dopamine antagonism in the tuberoinfundibular pathway? a. Are you experiencing breast discharge? b. Are you experiencing drooling? c. Are you experiencing tremors? d. Are you experiencing dizziness? Which of the following patients with generalized anxiety disorder is most likely to be a CYP2C19 poor metabolizer and have an exaggerated response to diazepam (Valium) 5 mg TID with increased sedation, central nervous system, and cognitive side effects? a. 40-year-old Asian male b. 20-year-old African American female c. 50-year-old Caucasian male d. 30-year-old African American male Norepinephrine is a neurotransmitter that is implicated in alertness and anxiety. What areas of the brain has a large majority of norepinephrine neurons? a. Locus Coeruleus b. Amygdala c. Nucleus Accumbens d. Hippocampus When assessing an elderly patient who complains of tinnitus, the PMHNP would associate which of the following findings with an acoustic neuroma? a. Inflammation of middle ear b. Perforation of tympanic membrane c. Suppuration of the labyrinth d. Unilateral ringing in ear Which of the following medications has a unique mechanism of action in that it is both a dopamine and norepinephrine reuptake inhibitor? a. Bupropion (Wellbutrin) b. Imipramine (Tofranil) c. Venlafaxine (Effexor) d. Duloxetine (Cymbalta) Which of the following statements reflect the current understanding of dopamine (DA) pathways and clinical symptoms in schizophrenia? a. Negative symptoms are related to DA deficit in the mesolimbic system; positive symptoms are related to DA excess in the substantia nigra and ventral tegmental area b. Negative symptoms are related to DA excess in the cerebral cortex; positive symptoms are related to DA deficit in the nucleus accumbens and mesolimbic system. c. Negative symptoms are relat4ed to DA excess in the mesolimbic system; positive symptoms are related to DA deficit in the substantia nigra and ventral tegmental area. d. Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolimbic system Arcus senilis when seen before the age of 40 years, is associated with which of the following disorders? a. Hyperlipidemia b. Hypertension c. HIV infection d. Syphilis Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is treated on clozapine? a. 1A2 b. 2C9 c. 2D6 d. 2C19 A 43-year-old male is treated for Bipolar I on lithium. Which of the following hematologic changes is associated with lithium? a. Leukopenia b. Anemia c. Agranulocytosis d. Leukocytosis If given during pregnancy, lithium can cause which of the following medical problems in the baby? a. Spina bifida b. Ebstein's anomaly c. Neural tube defect d. Cleft palate Sandy, a 32-year-old separated female presents for an initial intake. Sandy states she recently left an abusive relationship, is living alone, and is experiencing fear, panic, and extreme anxiety. Which brain structure is activated in patients with severe anxiety, as expressed by Sandy? a. Thalamus b. Hippocampus c. Amygdala d. Cingulate gyrus The risk of bleeding on SSRI, non-steroidal anti-inflammatory drugs (NSAIDs), or aspirin, is an example of which of the following principles? a. Pharmacodynamic b. Absorption c. Distribution d. Pharmacokinetics You have a 17-year-old female patient who suffers with bipolar disorder. The patient has a history of impulsive acting out and promiscuity. You make a decision to add folic acid 0.8mg to her medication regimen of lamotrigine (Lamictal) 200 mg po QHS and Quetiapine XR (Seroquel XR) 50 mg 1 po QHS. Why is this important? a. The folic acid is important for the continuing development of the patient's neuroendocrine system. b. The folic acid is important to help her with the sleepiness induced by her bipolar medications. c. The folic acid is important to help her with her hypotension induced by the Quetiapine XR (Seroquel XR) 50 mg po QHS. d. The folic acid supports neural tube development during the first month that a woman is pregnant. ANCC Domain 2: Advanced Practice Skills (49 questions & Answers) 2022. A patient comes into your office inn a full manic episode. This patient has a diagnosis of Bipolar and Alcohol Use Disorder, moderate. You have a report from the patient's chemical dependency counselor indicating that inpatient chemical dependency counseling is needed. Your patient has been on the fence about inpatient chemical dependency treatment in the past. You assess the patient and find a strong odor of alcohol, auditory and visual hallucinations, flight of ideas, lack of sleep for 3 days, suicidal ideations without a firm plan, and plans to drive to another state to gamble. The patient's brother who accompanies him corroborates this information. In order to best treat this patient you: a. Admit him to the dual diagnosis chemical dependency unit with an order for the collection of laboratory values. b. Admit him to the inpatient chemical dependency program. c. Send the patient home with his brother and a prescription for a new antipsychotic medication. d. Admit him to the local psychiatric unit, with an order for the collection of laboratory values. Appraisal of the patient's suicidal ideation, plan, method, intent, and access to implement plan would be documented in which part of the standard psychiatric evaluation? a. History of Presenting Illness b. Review of Systems c. Diagnosis d. Mental Status Exam Violence directed toward women by an intimate partner is a serious health problem worldwide. Which of the following women has the greatest risk factors for being the victim of violence? a. 26 years old, recently separated, Asian American woman living in Boston, Massachusetts b. 42 years old, divorced, Caucasian woman dating a recently divorced man in Denver, Colorado c. 17 years old, single, Native American woman living with employed boyfriend in Galena, Alaska d. 35 years old, pregnant, African American woman living with her husband in suburb of Dallas, Texas Which of the following statements would be most likely to be effective in changing sexual behavior when counseling a sexually active 15-year-old adolescent girl? a. Always use condoms when having sex. b. Use this sample condom c. Require your partner to use a condom d. Always carry condoms in your purse. A PMHNP is working in an integrated care clinic and his family nurse practitioner colleague asks for a consult. The family nurse practitioner asks the PMHNP what antidepressant to start for a patient who has a score of 15 on the PHQ-9. What is the appropriate response? a. A score of 15 on the PHQ9 indicates moderate depression, so the patient should be started on a selective serotonin norepinephrine reuptake inhibitor. b. A score of 15 on the PHQ9 indicates severe depression, so you should start a SSRI and an atypical antipsychotic c. A score of 15 on the PHQ9 indicates moderate depression, so y9ou can refer the patient to therapy and start an antidepressant. d. A score of 15 on the PHQ9 indicates possible moderate depression, but a follow-up interview is required to assess for depression. I can see this patient today and further assess for depression and the appropriate treatment. A 10-year-old child lost her father to an unexpected heart attack. Normally confident, sociable and an excellent student, her teachers and mother report that she has withdrawn, become disinterested in schoolmates and schoolwork, and easily becomes tearful if anyone mentions her father. What non-pharmacological intervention would be most helpful at this time to facilitate her grieving and loss? a. Bibliotherapy b. Play therapy c. Individual therapy d. Psychoeducation group A mother presents to the clinic with her 9-year-old daughter because she is worried about her. The mother tells you that her daughter has been waking up in the middle of the night screaming off and on for the past several months. When she goes into her daughter's room, she is sitting up in bed and is initially inconsolable but eventually will go back to sleep. The mother is crying and tells you she is unable to go back to sleep after her daughter's episodes and feels exhausted all of the time. Which is the most appropriate initial response? a. I know you are upset, but it will get better b. Are you worried that this is your fault? c. I can see this is very upsetting for you d. Tell me why you are unable to fall back asleep after your daughter does In assessing possible sexual abuse of a 4-year-old child, which of the following would not be indicated? a. Has anyone ever taken your picture without your clothes on? b. Has anyone else asked you to take off your clothes? c. Has anyone invited you to a birthday pool party? d. Has anyone done something you didn't like to your body? A 78-year-old cattleman referred for treatment of refractory depression by his primary care provider reports continued thoughts of failure, lack of purpose in life, lack of interest in ranching, fishing, hunting, or family since losing his driver's license due to DUI six months ago. Which of the following areas is an assessment priority? a. Extent of alcohol use and motivation to reduce to safe levels b. Prior and current medications, dose, clinical response, side effects c. Sleep patterns (early-middle-late awakening), sleep hygiene d. Thoughts of self-harm, plan, intent, access During an initial psychiatric evaluation, the patient reports use of alcohol and illicit drugs. This information would be most appropriate in which part of the evaluation? a. Review of Systems b. Personal and social history c. Chief complaint d. Mental Status Exam The American College of Obstetricians and Gynecologists (ACOG) recommends screening for postpartum depression with a validated screening tool. Which of the following is a validated screening tool which has been recommended by ACOG? a. Major Depression Inventory (MDI) b. Montgomery-Asberg Depression Rating Scale (MADRS) c. Edinburgh Postnatal Depression Scale (EPDS) d. Hamilton Rating Scale for Depression (HRSD) A 67-year-old Vietnamese immigrant, who has been a resident in the U.S. for 3 years, comes to your clinic for an evaluation. Her first language is Vietnamese, but she does speak some English. She has problems with reading and writing, as she did not finish high school, or earn a GED (General Educational Development) equivalency. As the PMHNP, what is your priority disparity to address with this patient? a. Age b. Health literacy c. Reading level d. Race An adult female patient has been prescribed an SSRI for an initial episode of major depression. She is fearful of side effects and of becoming suicidal. Which of the following initial responses is most appropriate? a. SSRI's are generally quite safe and rarely cause suicidal thoughts. I could call you every few days to see if you are having any of these thoughts. b. SSRI's are the safest antidepressant medications and rarely cause suicidal thoughts. Try the medication and we can watch closely for any side effects. c. Have you ever had feelings of hurting yourself? If you took the medication and had thoughts like that, would you be willing to call the crisis hotline? d. Have you ever had feelings of hurting yourself? If you took the medication and had thoughts like that, what would you do? The Mini-Mental Status Exam (MMSE) is a brief, standardized screening tool designed for use: a. Across the lifespan to document mental status b. In older adults ³ 65 years to quantify cognitive status c. In adults ³18 years to document mental status d. In adults to quantify cognitive status. A patient who works the night shift presents for a follow-up appointment to see the PMHNP and states, "I can't sleep when I get home from work." Upon assessment, the PMHNP learns the patient recently started an exercise regimen and is now exercising after work. Which response about sleep hygiene should the PMHNP provide to the patient? a. Exercising is a good way to help you get sleep, so keep up your schedule and your body will adjust to your new routine. b. Regular exercise can help promote sleep but should not be performed too close to your bedtime or it can interfere with sleep; try exercising before work. c. Exercise dose not promote or help deepen your sleep, so you should consider making changes in your daily routine. d. Regular exercise helps with sleep, so continue to exercise, and when you get home, watch television to help promote sleep. A 36-year-old woman was fired from her job as a paralegal at a law firm. She had worked for the same attorney for 10 years. As soon as she came in the door from work, her husband noticed she appeared upset and asked her if she was alright. She immediately started yelling at her husband because he had not given their 5-year-od daughter a bath and had not cleaned the house. Which of the following defense mechanisms is being demonstrated by this woman? a. Dissociation b. Conversion c. Rationalization d. Displacement The Five A's for Health Behavior Change include the following: a. Assess, Appraise, Advise, Act, Assist b. Assess, Appraise, Agree, Access, Arrange c. Assess, Advise, Act, Access, Assist d. Assess, Advise, Agree, Assist, Arrange Dementia screening for the general population is not recommended for the following reason: a. The service benefits few people: target condition has high prevalence in the chosen population b. The service is unfocused for target condition: sensitivity and specificity of dementia screening measures do not currently warrant widespread use. c. The service has unknown balance of benefit and harm: current treatments have limited effectiveness in modifying instrumental activities of daily living. d. The screening causes net harm in the target population: time involved in screening detracts from higher priority preventive health measures in general population. What opening question or statement by a PMHNP facilitates communication at an initial visit? a. Tell me what you think the problem is b. What seems to be the problem today? c. What problem does your primary care physician want us to evaluate? d. Tell me your concerns and how I may help. When assessing a client, what is the most important predictor of potential violence? a. History of substance abuse b. History of seizures c. History of aggressive rage d. History of head injury As the PMHNP working with a young female recently diagnosed with bipolar disorder and using a recovery model, what will be the focus of your interactions with this patient? a. Psychoeducation about her disease process b. Assisting in gainful employment c. Focus on the side effects of her medications d. Focus on her feelings, experience, and what she wants to achieve A 32-year-old Caucasian Catholic female patient presents for her therapy session. She is upset because she and her husband have been in an argument over finances. She does not work and stays at home to take care of the children. She reports feeling sad and has had thoughts of hurting herself. She has a past history of overdosing with Tylenol several years ago. Which of the following places her at high-risk for suicide? a. Age b. Previous suicide attempt c. Marital status d. Gender During an initial assessment, the PMHNP asks the patient to perform the serial 7's. What aspect of the mental status exam would the nurse practitioner be assessing? a. Memory b. Concentration c. Speech d. Affect Which of the following illustrates the role of the PMHNP in reducing the stigma of mental illness through community education as primary prevention? a. Professional speaker interviewed by morning television talk show anchor on depression. b. Expert witness for standard of care regarding psychiatric nursing staff in wrongful death lawsuit c. Teaching high school class about depression and teen suicide d. Volunteering to help with depression screenings at a community health fair - A In a psychiatric emergency, the PMHNP is aware that the most important goal of the interview is self-protection. What can the PMHNP do to keep himself or herself safe? a. Make sure the patient is restrained before beginning the evaluation b. Enter the room alone, in order to build a therapeutic alliance c. Know as much about the person as possible prior to starting the interview d. Inform the patient that violence is not acceptable. When questioning a patient regarding alcohol use during an intake, the patient t3ells you he only drinks socially. Which initial response is most appropriate? a. What amount and what kind of alcohol do you drink in a week? b. I am glad you are a responsible drinker. c. Many people with alcohol issues say they are social drinkers. d. Do other people in your household drink alcohol? - A During a follow-up medication visit with a 13-year-old male, his mother stayed longer to ask the PMHNP a question. Specifically, his mother states, "The school sent home information about the human papillomavirus and suggested my son see his primary care provider to get an immunization. Why did I get this information for my son? Furthermore, he is not sexually active." Which of the following would be the PMHNP's best response? a. I understand your concern with talking to your son about becoming sexually active. Let's address how to start the conversation. b. You are correct, only females need to receive the human papillomavirus vaccination. This letter must have been sent to you by mistake. c. Decisions about immunizations can be difficult. The Centers for Disease Control and Prevention recommend that all males between the ages of 11-12, or as early as 9 years of age, receive this vaccination. What concerns do you have? d. As your son's PMHNP, I cannot provide you with information about immunizations. The World Health Organization has predicted that depression will be the number one world health problem in the 21st century. Lifetime prevalence for major depressive episode is 12% (with a 5-17% range). Which of the following individuals has the greatest risk factors for MDD? a. 16-year-old, high school male, honors student, who runs cross-country track b. 28-year-old, single woman, working toward partner in a large law firm c. 43-year-old, divorced woman, schoolteacher, raising three children d. 58-year-old, married male, computer analyst, whose work requires frequent travel Which of the following interventions has greatest relevance when counseling parents of a 20-year-old male patient who has recently been diagnosed with schizophrenia? a. Family therapy to facilitate gradual independence for the patient while addressing parental desire to protect their son b. Patient and family education about the disease course, treatment regimens, support systems, and life management skills c. Multi-system family therapy that includes in-home therapy as well as multiple family group therapy to facilitate shared learning from other families with members with schizophrenia d. Supportive psychotherapy group for the parents to facilitate their grief and build coping skills to help manage their son's life-changing mental illness. A patient was started on an antipsychotic medication two weeks ago and is now experiencing the following symptoms: inability to sit still, pacing, and feelings of inner restlessness. He does not complain of any anxiety or being worried about anything in particular. Which of the following rating scales would be the most appropriate to assess these symptoms? a. Abnormal Involuntary Movement Scale (AIMS) b. Barnes Akathisia Rating Scale (BARS) c. Dyskinesia Identification System d. Simpson Angus EPS Scale Which of the following screening tests has high sensitivity and specificity for identifying cognitive impairment in older adults while requiring the least amount of time to administer in a clinical setting? a. Global Deterioration Scale b. Clock Drawing Test c. Mini-Mental Status Exam d. Dementia Rating Scale The PMHNP understands which factor to be the most important in therapeutic communication: a. Verbal communication b. Feedback c. Clarification d. Nonverbal communication In evaluating the functional status of a 68-year-old woman who has depression, the Instrumental Activities of Daily Living Scale includes which of the following activities? a. Toileting b. Filing taxes c. Using telephone d. Bathing Which of the following lifestyle factors poses the greatest risk for depression, irritability, liver problems, and hypertension in a college student? a. Binge drinking b. Marijuana use c. Anabolic steroid use d. Cocaine use A female client has gradually assumed increasing responsibility for the care of her aging parents. Her mother was diagnosed with Alzheimer's type dementia three years ago and is increasingly disoriented to her home surroundings. Her father insists on keeping her mother at home to provide care until she dies. What is the first priority in counseling this couple and their caretaking adult daughter? a. Anticipatory guidance b. Caregiver strain c. Patient safety d. Patient and family education There is a growing recognition that adverse life experiences due to a variety of reasons underlie a wide range of psychiatric disorders and medical problems. According to a seminal research study on adverse childhood experiences (ACE), a positive relationship exists between ACE and which of the following disorders? a. Alcoholism, anxiety, heart disease, sleep disorders, and schizophrenia b. Alcoholism, anorexia, depression, diabetes, and schizophrenia c. Alcoholism, anxiety, depression, diabetes, and schizophrenia d. Alcoholism, anxiety, depression, diabetes, and heart disease A 44-year-old man presents to the PMHNNP at his wife's insistence. The patient was hospitalized for a mild head injury after a motor vehicle accident four weeks ago. He reports a 3-year history of drinking alcohol. The patient states he was at the store a week ago when he realized the store clerk was an imposter replacing his wife. The patient's wife insists that her husband is delusional and she intends to file for divorce if he does not get help. Which of the following types of delusions is the patient expressing? a. Fregoli phenomenon b. Capgras syndrome c. Delusion of doubles d. Clerambault syndrome In advising parents how to reduce the risk for teen substance abuse when there is positive family history of alcohol dependence, a PMHNP encourages all of the following recommendations except: a. Acknowledgement of family risk factor and open discussion with teen b. Parental presence and involvement in child's school and sports activities c. Random urine testing using home drug testing kits d. Parental networking and supervision of any teen parties. In assessing patient risks for binge drinking, which of the following statements is not accurate? a. Binge alcohol use rates are similar across different levels of education b. Binge drinking is higher in urban, densely populated areas than rural, sparsely populated areas. c. Whites have a higher rate of binge drinking than black or Hispanics. d. Men are much more likely than women to be binge drinkers. A 14-year-old girl admitted to a psychiatric unit following an overdose on alcohol and benzodiazepines after the breakup of a relationship has made seductive comments to her roommate, which is upsetting her roommate. In assessing the girl's behavior toward her roommate, the PMHNP needs to include the topic of sexual orientation. What is the best introductory approach to this topic? a. Are you sexually active? b. Are you attracted to girls rather than boys? c. What is your experience in sexual relationships? d. Did you overdose after breaking up with a girlfriend or boyfriend? An example of a screening tool that measures severity and tracks change in specific symptoms is a. The CAGE b. The Mini-Mental State Examination (MMSE) c. The Short Form 36 (SF-36) d. The Behavior and Symptom Identification Scale (BASIS) Which of the following risk factors is not amenable to lifestyle changes in reducing lifetime risk of depressive disorders? a. Alcohol use b. Stressful family life c. Personality d. Work-related stress A 31-year-old married woman with a history of anorexia nervosa, binging-purging type, during her teens and early 20's, is pregnant. She has had two prior spontaneous abortions in late 20's. She is worried whether this pregnancy may trigger recurrence of her prior eating disorder, adversely impact fetal development, or affect the likelihood of full-term delivery. At 5'7" she maintains a weight of 120 pounds by running 6-10 miles daily as conditioning for marathons and a 2,000 calorie daily vegan diet. What lifestyle modifications would reduce risks of exacerbating an eating disorder and increasing likelihood of normal fetal development full-term delivery. a. Increase daily caloric intake by 1,000 calories, continue running as tolerated with reduction in second or third trimester, add pre-natal vitamin, vitamin E supplement, and B-complex supplement, plan 20-30-pound gradual weight gain over the course of pregnancy. b. Increase daily caloric intake by 500 calories, reduce running to 2-4 miles daily, alternate with stretching and yoga in second and third trimesters, add prenatal vitamin and vitamin B-12 supplement, plan a 28-40-pound gradual weight gain over the course of pregnancy. c. Increase daily caloric intake by 250 calories, reduce running to 4-8 miles daily with reduction in second or third trimester, add prenatal vitamin, Calcium supplement, and plan a 20-30-pound gradual weight gain over the course of pregnancy. d. Increase daily caloric intake by 700 calories, continue running as tolerated with reduction in second or third trimester, add prenatal vitamin E supplement, and B-complex supplement, plan a 25-35-pound gradual weight gain over the course of the pregnancy. In the aftermath of a tornado that destroyed over 100 homes in a rural Midwest community, the PMHNP draws on principles of crisis intervention while working with an elderly couple who lost everything in the storm during the night. Which of the following statements is most appropriate at the initial encounter? a. "What medications were you taking? Let me work on that first." b. "Tell me everything that happened. We'll sort through the next steps." c. "What is your biggest concern right now? I will help you as much as possible." d. "You will be able to stay in the shelter until the FEMA trailers arrive. It's going to be OK." When child, adult partner, or elder abuse is suspected, the PMHNP needs to conduct an abuse assessment screen in privacy, away from the partner, the child's parents or guardians, or the elder person's relative or companion. Simple, direct questions in a nonjudgmental interview are indicated. Which of the following would be an appropriate abuse screening question? a. Within the past year, have you been hit, slapped, kicked or otherwise physically hurt by someone? b. Within the past year, has anyone ever forced you to do something by threatening you with a gun? c. Within the past year, have you ever threatened or tried to commit suicide to escape the abuse? d. Within the past year, has anyone ever threatened to kill you? - A A PMHNP realizes she is frustrated and easily angered with one of her patients for no apparent reason. When discussing the situation with a colleague, she states the patient reminds her of her abusive stepfather. Which of the following best describes the nurse practitioner's reaction? a. Projection b. Displacement c. Transference d. Countertransference When assessing for alcohol use, what does the CAGE questionnaire ask? a. Have you ever felt that you should cut down on your drinking, do you get angry when you drink, do you feel good about your alcohol use, have you ever had an eye-opener in the morning to get rid of a hang over? b. Have you ever felt you should cut down on your drinking, have people annoyed you by criticizing your drinking, have you felt guilty about your drinking, have you ever had an eye opener in the morning to get rid of a hangover? c. Have you ever felt you should cut down on your drinking, do people get angry when you drink, do you feel good about your alcohol use, have you ever had an eye-opener in the morning? d. Have you ever felt you should cut down on your drinking, do you become avoidant when you drink, do you feel guilty about your alcohol use, have you ever had an eye opener in the morning to get rid of a hangover? Which of the following would not be advised to divorced parents to facilitate recovery for their children? a. The divorced couple must provide an age-appropriate truthful explanation why they divorced b. The divorced couple must show consistent behavior toward the child c. The divorced couple must avoid arguing with one another d. The divorced couple must continue to relate to the child despite the child's anger - A A 53-year-old male with a history of schizophrenia s being discharged from an inpatient admission to a psychiatric hospital and was referred for to you for follow up in your private practice. During your initial assessment with the patient, you ask him about his education level and he talks about where he went to high school, his high school friends, activities he involved in, and his high school graduation. He then states, "that was the end of my education." Which of the following does the patient's answer demonstrate? a. Loosening of associations b. Tangentiality c. Circumstantiality d. Perseveration ANCC IQ Domain 3: Diagnosis and Treatment (52 questions & Answers 2022) In distinguishing HIV-related depression from HIV dementia, which of the following findings would be indicative of HIV dementia? a. Apathy and inertia b. Incoordination c. Decreased motivation d. Diminished attention and concentration Clozapine is associated with severe neutropenia (absolute neutrophil count (ANC) less than 500/?L). The requirements to prescribe, dispense, and receive Clozapine are incorporated into a single, shared program called the Clozapine Risk Evaluation and Mitigation Strategy (REMS). Who implement the Clozapine Risk Evaluation and Mitigation Strategy (REMS)? a. A Federal Drug Administration (FDA) b. Centers for Disease Control and Prevention (CDC) c. Health and Human Services d. The manufactures of Clozapine (Clozaril) You have a 16-year-old patient who suffers from Binge Eating Disorder. She is 5 foot 10 inches tall (70 inches) and has a BMI of 30. You consult the National Guideline Clearing House for the best information on treating the patient. Part of your treatment plan includes: a. Implementing non-diet health at every size therapy in addition to psychotherapy to help with weight stabilization and binge eating b. Treatment with Duloxetine (Cymbalta) long-term at low doses and a reduced calorie diet. It is associated with significant weight loss. c. Urine specific gravity, orthostatic vital signs, and oral temperatures taken on a regular basis. d. Use of Sibutramine (Meridia) 10 mg po QAM and a reduced calorie diet. It is associated with significant weight loss. When evaluating a 5-year-old child with language deficits, which of the following is a key indicator in differentiating autistic disorder from a mixed receptive-expressive language disorder. a. Imaginative play is predominant form of expression b. Language abnormalities such as echolalia are common c. Family history of speech delay or language problems d. Level of intelligence ranges from mild to severe impairment A client says that because he wished his sister was dead, and your client's sister subsequently was killed in a motor vehicle accident, the death was caused by the client's wishes. The client also revealed that he can read other's minds. This client is most likely suffering from which personality disorder? a. Schizotypal Personality Disorder b. Schizoid Personality Disorder c. Paranoid Personality Disorder d. Delusional Personality Disorder Which of the following atypical antipsychotic medications has U.S. FDA approval for treatment of bipolar depression when combined with fluoxetine (Prozac)? a. Quetiapine (Seroquel) b. Olanzapine (Zyprexa) c. Aripiprazole (Abilify) d. Risperidone (Risperdal) The PMHNP treating a patient for schizophrenia on ziprasidone orders and EKG. Which QTc interval result places the patient at greatest risk for torsade's de points? a. 160-260 milliseconds b. 300-500 milliseconds c. 500-700 milliseconds d. 100-200 milliseconds A pervasive pattern of grandiosity, lack of empathy, and need for admiration suggests the diagnosis of which of the following personality disorders? a. Paranoid b. Borderline c. Schizotypal d. Narcissistic When counseling a 52-year-old perimenopausal woman with nocturnal hot flashes, anxiety, depressed mood, low energy, little motivation, diminished sex drive, and work-related stress, what lifestyle changes and complementary therapies would be evidence-based recommendations to consider when this patient does not want to be on hormone replacement or antidepressant medication? a. Yoga, isoflavinoids, and black cohosh b. Walking, St. John's Wort, and black cohosh c. Tai chi, dietary soy, and flaxseed d. Current evidence does not support the efficacy of complementary therapies for perimenopausal or depressive symptoms In managing the maintenance phase for Bipolar I Disorder, which of the following statements is not supported by current evidence in the literature? a. Lamotrigine, but not lithium, is superior to placebo in preventing a depressive episode. b. Extended-release formulation of carbamazepine is equivalent to lithium in preventing a manic, hypomanic, or mixed episode. c. Both lamotrigine and lithium are superior to placebo in delaying onset of mood-related episodes. d. Lithium, but not lamotrigine, is superior to placebo in preventing a manic, hypomanic, or mixed episode. Which of the following interventions does not have evidence-based findings that demonstrate reduced symptoms in individuals with non-combat related PTSD? a. Eye-movement, desensitization, and reprocessing (EMDR) b. Anticonvulsants c. Exposure-based cognitive behavior therapy (CBT) d. Selective Serotonin Reuptake Inhibitors (SSRIs) After two weeks of treating a client for psychosis, the client develops symptoms of neuroleptic malignant syndrome (NMS). The following factors enable the PMHNP to differentiate NMS from serotonin syndrome: a. Autonomic instability, diaphoresis, tremors b. Rigidity, hyperreflexia, orthostatic hypotension c. Mutism, leukocytosis, myoglobinuria d. Hyperthermia, leukopenia, tachycardia A 20-year-old male with no previous psychiatric history arrives at the emergency room with his college roommate. The roommate reports that the patient has been acting erratic for the past month, talking to people who do not exist, walking around naked, and accusing the roommate of spying on him. The patient's vital signs are WNL and his neur9ological examination does not show any abnormalities. The most important first laboratory test would be which of the following? a. Complete blood count b. Non contrast CT scan of the brain c. Liver function tests d. Toxicology test Mr. Ready is a 58-year-old new patient at a community mental health center. He's seen by the PMHNP for depression, anxiety, and co-morbid substance use disorder, which the patient describes as effective in treatment of his symptoms. He does not have a primary care provider and does not know when he last had laboratory values drawn. Ready takes Tylenol p.r.n. for his knee pain, Prilosec OTC 20 mg BID, and has been on his current psychotropic medications for over two years: Buspirone 20 mg BID, Sertraline 200 mg po daily, and Aripiprazole 2 mg daily. What screening labs are appropriate for this patient? a. BMP, LFT, and vitamin D b. Lipid Profile, CMP, CBC, Thyroid Profile, and Vitamins B12 and D c. CBC, CMP, Lipid Profile, and Vitamin B12 d. CBC and CMP In distinguishing borderline personality disorder from chronic post-traumatic stress disorder related to childhood sexual abuse and victimization, which of the following would be more indicative of borderline personality disorder? a. Feeling of detachment or estrangement from others b. Efforts to avoid real or imagined abandonment c. Affect lability often associate with intense fear d. Irritability or intense outbursts of anger Which of the following findings would raise concern in an annual exam of a 76-year-old woman? a. Fasting glucose 76 mg/dL; Hg 11.8 gm/dL; HCT 38% b. AST 85 u/L; ALT 45 u/L c. Height 65 inches; weight 140 lbs d. Blood pressure 130/86; pulse 82; respirations 25 An 8-year-old boy is referred to you by his school nurse because he has been complaining of stomach aches every morning in school for the past month. When interviewing the boy's mother, she states that he does not like to go to school, insists on coming home immediately after school, and sleeps with his parents at night. The mother denies any other complaints. Which of the following is the most likely diagnosis? a. Reactive attachment disorder b. Posttraumatic stress disorder c. Social phobia d. Separation anxiety disorder A PMHNP treating a 32-year-old woman after hospitalization for postpartum psychosis after the birth of her first child needs to consider which as the most important risk factor when monitoring her response to treatment? a. As many as two thirds of patients have a second episode of an underlying affective disorder during the year after the baby's birth b. Incidence of postpartum psychosis is about 1 to 2 per 1,000 childbirths and 50 t 60 percent of affected women have just had their first child c. Subsequent pregnancies are associated with increased risk of another episode, as high as 50 percent d. Data suggest that an episode of postpartum psychosis is essentially an episode of a mood disorder and is usually an indicator of bipolar disorder Which is the only medication that is approved by the U.S. FDA to treat depression in children? a. Paroxetine (Paxil) b. Sertraline (Zoloft) c. Fluoxetine (Prozac) d. Citalopram (Celexa) When suspecting a patient has NMS, which laboratory values would help confirm the diagnosis? a. Leukocytosis and elevated creatine phosphokinase b. Leukocytosis and thrombocytosis c. Leukopenia and decreased creatine phosphokinase d. Leukocytosis and thrombocytopenia A 34-year-old African American female presents for an initial psychiatric evaluation. On examination, she reports she thinks she has attention deficit disorder because she has a short attention span, poor recent memory, nervousness, and mood lability, and she is sweating more. Which laboratory test should the PMHNP order to rule out an organic etiology of her symptoms? a. CMP b. Thyroid profile c. Cortisol level d. Prolactin level Which lab test should be ordered to rule out a medical cause of dementia symptoms? a. Thiamine b. Vitamin B12 c. Albumin d. Vitamin D3 Making an evidence-based decision regarding implementation of an intervention includes current research evidence and all of the following except the: a. Patient's clinical status, circumstances, and preferences b. Generalizability of findings c. Clinician's expertise d. Availability of healthcare resources Which of the following is not characteristic of individuals with antisocial personality disorder (APD)? a. APD is five times more common in first-degree biologic relatives for men b. APD is strongly associated with alcohol and drug abuse c. APD is identified predominantly in European and Western industrialized countries d. APD is correlated with low dopamine levels in the frontal cortex implicated in aggression and impulsivity A WBC of 4,000 in a patient taking clozapine would prompt the PMHNP to take3 which of the following actions? a. Consult with hematologist to determine appropriate antibiotic regimen and monitor closely b. Discontinue clozapine, initiate alternative antipsychotic medication and monitor closely c. Institute twice-weekly complete blood count with differentials and monitor closely d. Institute daily complete blood count with differentials and monitor closely Your patient suffers from insomnia and bipolar disorder. She tells you that she likes to take her Lurasidone 20 mg (Latuda) at bedtime because it is easier for her to remember. She does not like to gain weight so she eats two 90-calorie packages of ham slices with the Lurasidone before she goes to bed. She complains of not being able to go to sleep very quickly. You respond: a. Improve your sleep hygiene, and continue to eat the ham at bedtime b. I will increase the Lurasidone dosage to 40 mg at bedtime to increase the soporific component c. I recommend that you take in 360 calories of carbohydrates at bedtime to induce sleepiness d. Increase the ham so that you are taking in 360 calories for full absorption An 88-year-old nursing home patient presents to the emergency department with recent mental status changes, including aggression, confusion, and dizziness, over the past two days. The patient scored a 20 on the Mini-mental status exam (MMSE). In addition to the MMSE, what additional information is needed to complete a thorough evaluation? a. Blood chemistry, complete blood count, and urinalysis b. Hamilton depression scale (HAMD) score c. Patient Health Questionnaire (PHQ-9) score d. Electrocardiography and pharmacogenomics testing A patient being treated for major depressive disorder and on sertraline (Zoloft), 150 mg po daily for the past 16 months, presents to the psychiatric mental health nurse practitioner for an outpatient follow-up visit. During the visit, the patient states she has not been feeling well, reporting the flu. She also states she has not taken her medication in the last five days. Which of the following symptoms would she be describing if you suspect SSRI discontinuation syndrome? a. Agitation, diaphoresis, tremor, and ataxia b. Restlessness, tremor, fever, and shivering c. Restlessness, headache, increased heart rate, and diarrhea d. Agitation, nausea, dysphoria, and disequilibrium For a patient who has a long history of opiate dependence and is newly in recovery, which of the following is most likely to aid in the treatment process? a. Acamprosate (Campral) b. Buprenorphine (Buprenex) c. Bupropion (Wellbutrin) d. Varenicline (Chantix) Lorazepam is the preferred benzodiazepine when managing alcohol withdrawal symptoms if a patient with co-morbid: a. OxyContin abuse b. Hepatic disease c. Seizure disorder d. Folate-deficiency anemia Following best practice guidelines, which pharmacologic and non-pharmacologic treatments are the best studied and have the highest level of evidence for the treatment of nightmares in adults with nightmares in adults with PTSD? a. Prazosin (Minipress) and image rehearsal therapy b. Quetiapine (Seroquel) and eye-movement desensitization and reprocessing (EMDR) c. Venlafaxine (Effexor) and hypnosis d. Clonidine (Catapres) and progressive muscle relaxation A patient presents for a clinic appointment and tells the PMHNP, "My depression is a little better, but I read about acupuncture, and I want to add this to my treatment." What is the PMHNP's best response to this patient? a. Integrative therapies have no effectiveness in improving depressive symptoms, ad if your depression has not improved ad you have not achieved remission of your symptoms, I recommend that we increase your antidepressant b. Acupuncture is one of many integrative therapies, but it has the least effectiveness in improving depression c. Integrative therapies such as acupuncture are not well studied, and I cannot recommend that you add this to your current treatment d. Acupuncture has been found to help some individuals with depression. While the data is limited, if this is something you would like to consider, let's talk about where you might find a reputable practitioner for acupuncture treatments In distinguishing between dementia and pseudodementia which of the following findings would be expected in a patient with pseudodementia? a. Struggle to perform tasks b. Nocturnal accentuation of dysfunction common c. "Don't know" answers typical d. Attention and concentration usually faulty Sally is a 27-year-old attorney who recently moved to your area. Sally presents with social anxiety disorder, specifically symptoms of performance anxiety. Sally's only other medical condition is exercise-induced asthma, and she is treated on Albuterol. Sally states she was in cognitive behavioral therapy (CBT), without relief, and would like to try a medication. Which is the most suitable initial treatment for Sally? a. Sertraline (Zoloft) b. Inderal (Propranolol) c. Risperidone (Risperdal) d. Clonazepam (Klonopin) A new patient comes to you on a medication regimen of Adderall XR 30 mg 1 po QAM, Seroquel 300 mg po QHS, Mirtazapine 45 mg po QHS, Diazepam 5 mg TID, Zolpidem 10 mg po QHS and Zolpidem 10 mg po QHS in addition if initial dose does not help the patient to sleep. You confirm the medication regimen with the patient's past records. You diagnose the patient with PTSD, Panic disorder, MDD, ADHD, and alcohol use disorder-moderate by history in recovery. You treat the patient and find that the patient is resistant to changing the past medication regimen. The patient calls you stating that the pharmacy will not refill the Zolpidem at this time. The patient wants you to rewrite the script so that the medication is available. In checking with the pharmacy, you find out that the patient has potentially used 60 tablets of Zolpidem in a 20-day period. Your best action is to: a. Refill the order for the medication. Then, send the patient for a chemical dependency evaluation. The patient is on too many sedative-type medications and is harming himself. b. Discontinue the prescription for the Zolpidem. Talk to the patient about the overuse of Zolpidem and the danger it poses to his health and wellbeing. c. Refill the order for the medication as requested. This medication has not harmed the patient so far. d. Give an order for the Zolpidem. Talk with the patient about the danger of using too much sleeping medication. Then, discontinue the medication. A 33-year-old female patient has been diagnosed with bipolar disorder. Before starting this patient on lithium (Eskalith) for mood stabilization, which of the following laboratory tests are appropriate to obtain for this patient? a. Thyroid function tests, creatinine, complete blood count b. Thyroid function tests, creatinine, pregnancy test c. Thyroid function tests, liver function tests, pregnancy test d. Thyroid function tests, creatinine, liver function tests Which of the following antipsychotic medications has dosage formulations which include oral tablets, orally disintegrating tablets, short-acting injections, and long-acting injections? a. Olanzapine (Zyprexa) b. Ziprasidone (Geodon) c. Paliperidone (Invega) d. Clozapine (Clozaril) A patient with a diagnosis of schizophrenia has a history of suicidal ideation and suicide attempts. The PMHNP should consider which antipsychotic medication that is the only known antipsychotic to reduce the risk of suicide in schizophrenia? a. Latuda (lurasidone) b. Abilify (aripiprazole) c. Clozaril (clozapine) d. Invega (iloperidone) Mr. Jones, a 78-year-old male patient, presents to the PMHNP for a follow-up medication appointment. Mr. Jones' depression has been successfully treated with citalopram 20 mg by mouth daily. During the visit, Mr. Jones complains that in the last 2 or 3 weeks, he has had nausea, fatigue, feeling weak, with a headache and decreased appetite. Which action would be the most appropriate for Mr. Jones? a. Assess for other symptoms of hyponatremia and check a serum sodium level b. Discuss rates of relapse on SSRI and recommend switching his medication to a different antidepressant class c. Discuss rates of relapse on an SSI and increase his medication to citalopram 40 mg by mouth daily d. Discuss SSRI discontinuation syndrome and stress the importance of medication adherence. When evaluating a woman with major depressive disorder, which of the following would not be a major consideration in the differential diagnosis a. Prior pregnancies b. Any episodes of hypomania c. Prior episodes of depression d. Any periods without sleep yet no fatigue Which of the following interventions have evidence-based findings to reduce co-morbid substance use in patients with schizophrenia? a. Voucher-based behavioral reinforcement b. Manualized group intervention with motivational enhancement c. Three-session individual motivational enhancement d. Psychosocial support group targeting coping skills In bipolar I disorder, men are more prone than women to have: a. Rapid cycling b. Manic episodes c. Mixed episodes d. Depressive episodes The PMHNP evaluates a 3-year-old male and makes the diagnosis of attention deficit disorder Following the FDA's labeling of approved medication for children, which medication can be started in a child at age 3? a. Fluoxetine b. Amphetamines c. Methylphenidate d. Bupropion Electroconvulsive therapy (ECT) is a treatment for depression. What adverse effect is uncommon for a patient to experience after receiving ECT treatments? a. Fractures b. Memory disturbances c. Headaches d. Muscle soreness In the American Journal of Psychiatry, you read an article that discusses a recent study's evidence that the nicotine exposure in pregnant women increases the risk for schizophrenia in offspring (i.e., 38% increased likelihood of schizophrenia in young adults whose mothers smoked heavily while pregnant). This inspires you to translate this information in practice and teaching roles as a nurse practitioner. What considerations are needed to translate this in to practice based on the best evidence? a. If the research is published in a peer-reviewed journal such as the American Journal of Psychiatry, it is sound research b. Analyze the original study only to determine that the research is sound and meets the criteria for effectiveness of an intervention c. Determine if any other psychiatric or medical journal articles have commented on the validity or generalizability of the original study d. Analyze the original and repeat studies for methodical rigor and verify that there were randomized and non-randomized clinical trials with the same results. You are seeing a female patient who is morbidly obese. She also suffers from major depression, anxiety, and antidepressant-induced decreased libido. She has been stabilized on desvenlafaxine (Pristiq) 50 mg 1 po QAM and bupropion (Wellbutrin) 50 mg. She also takes Mononessa (Ortho-cyclen) 1 po QAM and Vitamin D 1000 IU po QAM. She has had trouble maintaining weight loss on a diet support programs, diet medications, and self-directed food reduction plans. She asks you about using Phentermine to help her lose weight. You discuss options with her and decide to: a. Prescribe a one-month course of phentermine (Adipex-P) 37.5 mg po QAM. Have her come back in one month for a checkup. b. Discontinue her current bupropion. Prescribe bupropion and naloxone (Contrave) 90mg/8mg for one week. Have her come back in one week for a checkup. You may have to increase the dosage at one-week intervals. c. Prescribe a one-month course of Phentermine and Topiramate (Qsymia) 7.5/46 for 30 days. Have her return to the clinic in 1 month for a checkup. d. Prescribe a 1-month course of Topiramate (Topamax) 50 mg 1 po QHS. Have the patient come back in 1 month for a checkup. Let the patient know that you may have to increase the dosage at one-month intervals. In distinguishing between cortical and subcortical dementias, which of the following findings would be indicative of subcortical dementia? a. Late dysarthria b. Early aphasia c. Euthymic mood d. Early gait disturbances You are seeing a client for an initial psychiatric evaluation. The client complains of persistent irritability, racing thoughts, decreased need for sleep, distractibility, episodes of unusually high energy, and auditory hallucinations. The episodes of disturbed mood last approx.. 5 days and the psychotic symptoms occur even if mood is euthymic. The most likely diagnosis is: a. Bipolar I disorder with psychotic features b. Schizoaffective disorder bipolar type c. Bipolar II disorder with psychotic features d. Schizophrenia A middle-school boy repeatedly lies, steals, bully's peers, instigates fights, and inflicts harm without feeling any regret or remorse. These are characteristics of which disorder? a. Conduct disorder b. Oppositional defiant disorder c. Disruptive behavior disorder d. Antisocial personality disorder Your 37-year-old female patient suffers from schizophrenia. She has been maintained in stable condition for four years on Quetiapine (Seroquel). She tells you that her gynecologist has recommended that she have a total hysterectomy. You asked her if her gynecologist plans to prescribe hormone replacement after the total hysterectomy. She responds "no". You initiate a call to the gynecologist to discuss hormone replacement therapy a.