PMHNP Psychopharm Exam 8 2024
1. Scientific Foundation
You are treating a patient for his first episode of major depression. You decide to initiate
citalopram (Celexa). How much time should you allow for the medication to provide its
initial therapeutic effect and the patient to see improvement of symptoms?
8 months
4 to 6 weeks
2 weeksterm-2
2 months - Correct answer: 4 to 6 weeks
The initial time frame for this medication to have a therapeutic effect is 4 to 6 weeks. Once
the patient begins treatment on an SSRI, and the nurse practitioner and patient agree on the
regimen, patients are expected to continue this treatment for 6 to 12 months.
Reference:
Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and
resource manual, Fourth Edition. Pg 151.
1. Scientific Foundation
What is the primary purpose of the corpus callosum?
To connect the right and left hemispheres and facilitate sensorimotor information exchange
To allow for multimodal sensory input and trigger memories
To coordinate movement of multiple muscles
To control voluntary motor movement, working memory, and behavioral cueing - Correct
answer: To connect the right and left hemispheres and facilitate sensorimotor information
exchange
The corpus callosum is a large bundle of white matter that connects the right and left
hemispheres and provides an area of sensorimotor information exchange.
Reference:
Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and
resource manual, Fourth Edition. Pg 65.
1. Scientific Foundation
When assessing for genetic influences, the PHMNP understands which of the following about
single nucleotide polymorphisms (SNPs)?
Single-gene disorders are common
SNPs detect single-base changes during the DNA-sequencing process
To be classified as an SNP, the variant must be found in 10% of the population
SNPs are the rarest type of genetic variation among humans - Correct answer: SNPs detect
single-base changes during the DNA-sequencing process
Single nucleotide polymorphisms detect single-base changes during DNA sequencing. SNPs
are the most common gene variant in the population and must occur in 1% of the population
to be considered an SNP.
Reference:
Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition.
Pg 75.
1. Scientific Foundation
Systemic effects of hypernatremia include which of the following?
Restlessness
,Confusion
Apprehension
Lethargy - Correct answer: Restlessness
Systemic effects of hyponatremia include confusion, apprehension, and lethargy.
Reference:
Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition.
Pg 91.
1. Scientific Foundation
Which of the following amino acids is implicated in bipolar disorder, seizures, and
schizophrenia?
Aspartate
Glycine
Glutamate
GABA - Correct answer: Glutamate
Glutamate is also known as the universal excitatory neurotransmitter and has been connected
to bipolar disorder, seizures, mood imbalance, and schizophrenia.
Aspartate is another excitatory neurotransmitter and works in conjunction with glutamate.
GABA and glycine are inhibitory neurotransmitters.
Reference:
Psychiatric-Mental Health Nurse Practitioner Review and Resource Manual, 4th Edition. Pg
69.
1. Scientific Foundation
A 29-year-old African American female was diagnosed with schizophrenia approximately
three years ago. After many trials of antipsychotics, she was finally stabilized on haloperidol
during the past six months. Three weeks ago she began exhibiting mild pseudo-Parkinson's
symptoms.
Which class of medications would be most appropriate for treating these side effects?
Muscarinic 1 antagonist
Histamine 1 antagonist
Alpha 1 adrenergic agonist
Cholinesterase inhibitor - Correct answer: Muscarinic 1 antagonist
Extrapyramidal symptoms are drug-induced side effects that affect motor functioning and
muscle movement. Extrapyramidal symptoms are associated with a deficiency of dopamine
and an excess of acetylcholine in the nigrostriatal pathway. A common type of
extrapyramidal symptom is called pseudo-Parkinson's, which presents with a shuffling gait,
motor slowing, mask-like facial expression, tremors, and muscle rigidity. Muscarinic 1
antagonist medications reduce the effects of excess acetylcholine and relieve extrapyramidal
symptoms.
Reference:
Johnson, K., & Vanderhoef, D. Psychiatric-Mental Health Nurse Practitioner Review
Manual, Fourth Edition. Pg 251-252.
1. Scientific Foundation
As a nurse practitioner, you are responsible for assessing cranial nerves as a part of the
neurological exam. What cranial nerve assessment tests hearing?
Oculomotor nerve (CN III)
Trochlear nerve (CN IV)
Vestibulocochlear nerve (CN VIII)
,Trigeminal nerve (CN V) - Correct answer: Vestibulocochlear nerve (CN VIII)
Olfactory nerve (CN I)
The olfactory nerve transmits information to the brain regarding a person's sense of smell.
This cranial nerve assessment is performed by having the client close their eyes to identify
familiar odors.
Optic nerve (CN II)
The optic nerve transmits information to the brain regarding a person's vision.
Oculomotor nerve (CN III)
The oculomotor nerve helps control muscle movements of the eyes. The oculomotor nerve
provides movement to most of the muscles that move the eyeball and upper eyelid, known as
extraocular muscles. The oculomotor nerve also helps with involuntary functions of the eye.
Trochlear nerve (CN IV)
The trochlear nerve is also involved in eye movement. The trochlear nerve, like the
oculomotor nerve, originates in the midbrain. It powers the contralateral superior oblique
muscle that allows the eye to point downward and inward.
Trigeminal nerve (CN V)
The trigeminal nerve is the largest cranial nerve and has both motor and sensory functions. Its
motor functions help a person to chew and clench the teeth and gives sensation to muscles in
the tympanic membrane of the ear. This test is performed by touching the face and corneal
reflex of the eye with a wisp of cotton and pin-pricking the skin and mucosa to test touch.
Abducens nerve (CN VI)
The abducens nerve also helps control eye movements. It helps the lateral rectus muscle,
which is one of the extraocular muscles, to turn the gaze outward.
Facial nerve (CN VII)
The facial nerve functions to produce facial expressions and has both motor and sensory
functions.
Vestibulocochlear nerve (CN VIII)
The vestibulocochlear nerve is involved with a person's hearing and balance. It is assessed by
checking the client's hearing using an audiometer or by simply whispering in the client's ear.
Hearing
1. Scientific Foundation
Marijuana use during pregnancy is associated with all of the following symptoms in neonates
except:
Decreased desire for human contact
Severe vomiting
Low birth weight
Withdrawal-like symptoms - Correct answer: Decreased desire for human contact
Marijuana is used by 3% of all pregnant women. Chronic marijuana use is associated with the
following symptoms in neonates:
Low infant birth weight
Prematurity
Withdrawal-like symptoms
Excessive crying
Tremors
Hyperemesis (severe vomiting)
Reference:
Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry, 11th Edition. Pg 1086.
, 1. Scientific Foundation
Bipolar disorder is believed to be related to an increase in what neurotransmitter?
Dopamine
Glutamate
GABA
Norepinephrine - Correct answer: Glutamate
Bipolar disorder is believed to be related to an increase in glutamate. Glutamate is an
excitatory amino acid neurotransmitter. While the exact connection between glutamate and
bipolar disorder remains unclear, proton magnetic resonance spectroscopy studies have found
increased glutamate in those with bipolar disorder compared with healthy controls. Glutamate
is also implicated in seizure disorders and schizophrenia.
Reference:
Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and
resource manual, Fourth Edition. Pg 69.
1. Scientific Foundation
Which of the following is an example of combined structural and functional imaging
currently mainly used in research?
Fluorine magnetic spectroscopy
Functional imaging
Computed tomography
Magnetic resonance imaging - Correct answer: Fluorine magnetic spectroscopy
Fluorine magnetic spectroscopy is one of the newest imaging attempts to examine structure in
connection with function and is mainly used in research. CT, MRI, and functional imaging
tests such as EEG and PET scans are currently used to examine either structure or function
but not both.
Reference:
Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition.
Pg 72-73.
1. Scientific Foundation
Which of the following is a biological factor influencing gender identity?
Family and religious views on transsexuality
Cultural attitudes toward sexual orientation
Pre- and postnatal hormone levels
Messages spread by the mass media related to sexual identity - Correct answer: Pre- and
postnatal hormone levels
Gender identity is a person's sense of identity along a continuum between normative
constructs of masculinity and femininity. Both biological and social factors influence gender
identity.
Biological factors include pre- and postnatal hormone levels and gene expression.
Social factors include gender messages from a person's culture, family, and the mass media.
Reference:
Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and
resource manual, Fourth Edition. Pg 23-28.
1. Scientific Foundation
The definition of primary care is:
The production of integrated, accessible health care tests by clinicians who are accountable
for addressing all populations and their personal health care needs by developing a sustained
1. Scientific Foundation
You are treating a patient for his first episode of major depression. You decide to initiate
citalopram (Celexa). How much time should you allow for the medication to provide its
initial therapeutic effect and the patient to see improvement of symptoms?
8 months
4 to 6 weeks
2 weeksterm-2
2 months - Correct answer: 4 to 6 weeks
The initial time frame for this medication to have a therapeutic effect is 4 to 6 weeks. Once
the patient begins treatment on an SSRI, and the nurse practitioner and patient agree on the
regimen, patients are expected to continue this treatment for 6 to 12 months.
Reference:
Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and
resource manual, Fourth Edition. Pg 151.
1. Scientific Foundation
What is the primary purpose of the corpus callosum?
To connect the right and left hemispheres and facilitate sensorimotor information exchange
To allow for multimodal sensory input and trigger memories
To coordinate movement of multiple muscles
To control voluntary motor movement, working memory, and behavioral cueing - Correct
answer: To connect the right and left hemispheres and facilitate sensorimotor information
exchange
The corpus callosum is a large bundle of white matter that connects the right and left
hemispheres and provides an area of sensorimotor information exchange.
Reference:
Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and
resource manual, Fourth Edition. Pg 65.
1. Scientific Foundation
When assessing for genetic influences, the PHMNP understands which of the following about
single nucleotide polymorphisms (SNPs)?
Single-gene disorders are common
SNPs detect single-base changes during the DNA-sequencing process
To be classified as an SNP, the variant must be found in 10% of the population
SNPs are the rarest type of genetic variation among humans - Correct answer: SNPs detect
single-base changes during the DNA-sequencing process
Single nucleotide polymorphisms detect single-base changes during DNA sequencing. SNPs
are the most common gene variant in the population and must occur in 1% of the population
to be considered an SNP.
Reference:
Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition.
Pg 75.
1. Scientific Foundation
Systemic effects of hypernatremia include which of the following?
Restlessness
,Confusion
Apprehension
Lethargy - Correct answer: Restlessness
Systemic effects of hyponatremia include confusion, apprehension, and lethargy.
Reference:
Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition.
Pg 91.
1. Scientific Foundation
Which of the following amino acids is implicated in bipolar disorder, seizures, and
schizophrenia?
Aspartate
Glycine
Glutamate
GABA - Correct answer: Glutamate
Glutamate is also known as the universal excitatory neurotransmitter and has been connected
to bipolar disorder, seizures, mood imbalance, and schizophrenia.
Aspartate is another excitatory neurotransmitter and works in conjunction with glutamate.
GABA and glycine are inhibitory neurotransmitters.
Reference:
Psychiatric-Mental Health Nurse Practitioner Review and Resource Manual, 4th Edition. Pg
69.
1. Scientific Foundation
A 29-year-old African American female was diagnosed with schizophrenia approximately
three years ago. After many trials of antipsychotics, she was finally stabilized on haloperidol
during the past six months. Three weeks ago she began exhibiting mild pseudo-Parkinson's
symptoms.
Which class of medications would be most appropriate for treating these side effects?
Muscarinic 1 antagonist
Histamine 1 antagonist
Alpha 1 adrenergic agonist
Cholinesterase inhibitor - Correct answer: Muscarinic 1 antagonist
Extrapyramidal symptoms are drug-induced side effects that affect motor functioning and
muscle movement. Extrapyramidal symptoms are associated with a deficiency of dopamine
and an excess of acetylcholine in the nigrostriatal pathway. A common type of
extrapyramidal symptom is called pseudo-Parkinson's, which presents with a shuffling gait,
motor slowing, mask-like facial expression, tremors, and muscle rigidity. Muscarinic 1
antagonist medications reduce the effects of excess acetylcholine and relieve extrapyramidal
symptoms.
Reference:
Johnson, K., & Vanderhoef, D. Psychiatric-Mental Health Nurse Practitioner Review
Manual, Fourth Edition. Pg 251-252.
1. Scientific Foundation
As a nurse practitioner, you are responsible for assessing cranial nerves as a part of the
neurological exam. What cranial nerve assessment tests hearing?
Oculomotor nerve (CN III)
Trochlear nerve (CN IV)
Vestibulocochlear nerve (CN VIII)
,Trigeminal nerve (CN V) - Correct answer: Vestibulocochlear nerve (CN VIII)
Olfactory nerve (CN I)
The olfactory nerve transmits information to the brain regarding a person's sense of smell.
This cranial nerve assessment is performed by having the client close their eyes to identify
familiar odors.
Optic nerve (CN II)
The optic nerve transmits information to the brain regarding a person's vision.
Oculomotor nerve (CN III)
The oculomotor nerve helps control muscle movements of the eyes. The oculomotor nerve
provides movement to most of the muscles that move the eyeball and upper eyelid, known as
extraocular muscles. The oculomotor nerve also helps with involuntary functions of the eye.
Trochlear nerve (CN IV)
The trochlear nerve is also involved in eye movement. The trochlear nerve, like the
oculomotor nerve, originates in the midbrain. It powers the contralateral superior oblique
muscle that allows the eye to point downward and inward.
Trigeminal nerve (CN V)
The trigeminal nerve is the largest cranial nerve and has both motor and sensory functions. Its
motor functions help a person to chew and clench the teeth and gives sensation to muscles in
the tympanic membrane of the ear. This test is performed by touching the face and corneal
reflex of the eye with a wisp of cotton and pin-pricking the skin and mucosa to test touch.
Abducens nerve (CN VI)
The abducens nerve also helps control eye movements. It helps the lateral rectus muscle,
which is one of the extraocular muscles, to turn the gaze outward.
Facial nerve (CN VII)
The facial nerve functions to produce facial expressions and has both motor and sensory
functions.
Vestibulocochlear nerve (CN VIII)
The vestibulocochlear nerve is involved with a person's hearing and balance. It is assessed by
checking the client's hearing using an audiometer or by simply whispering in the client's ear.
Hearing
1. Scientific Foundation
Marijuana use during pregnancy is associated with all of the following symptoms in neonates
except:
Decreased desire for human contact
Severe vomiting
Low birth weight
Withdrawal-like symptoms - Correct answer: Decreased desire for human contact
Marijuana is used by 3% of all pregnant women. Chronic marijuana use is associated with the
following symptoms in neonates:
Low infant birth weight
Prematurity
Withdrawal-like symptoms
Excessive crying
Tremors
Hyperemesis (severe vomiting)
Reference:
Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral
Sciences/Clinical Psychiatry, 11th Edition. Pg 1086.
, 1. Scientific Foundation
Bipolar disorder is believed to be related to an increase in what neurotransmitter?
Dopamine
Glutamate
GABA
Norepinephrine - Correct answer: Glutamate
Bipolar disorder is believed to be related to an increase in glutamate. Glutamate is an
excitatory amino acid neurotransmitter. While the exact connection between glutamate and
bipolar disorder remains unclear, proton magnetic resonance spectroscopy studies have found
increased glutamate in those with bipolar disorder compared with healthy controls. Glutamate
is also implicated in seizure disorders and schizophrenia.
Reference:
Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and
resource manual, Fourth Edition. Pg 69.
1. Scientific Foundation
Which of the following is an example of combined structural and functional imaging
currently mainly used in research?
Fluorine magnetic spectroscopy
Functional imaging
Computed tomography
Magnetic resonance imaging - Correct answer: Fluorine magnetic spectroscopy
Fluorine magnetic spectroscopy is one of the newest imaging attempts to examine structure in
connection with function and is mainly used in research. CT, MRI, and functional imaging
tests such as EEG and PET scans are currently used to examine either structure or function
but not both.
Reference:
Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition.
Pg 72-73.
1. Scientific Foundation
Which of the following is a biological factor influencing gender identity?
Family and religious views on transsexuality
Cultural attitudes toward sexual orientation
Pre- and postnatal hormone levels
Messages spread by the mass media related to sexual identity - Correct answer: Pre- and
postnatal hormone levels
Gender identity is a person's sense of identity along a continuum between normative
constructs of masculinity and femininity. Both biological and social factors influence gender
identity.
Biological factors include pre- and postnatal hormone levels and gene expression.
Social factors include gender messages from a person's culture, family, and the mass media.
Reference:
Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and
resource manual, Fourth Edition. Pg 23-28.
1. Scientific Foundation
The definition of primary care is:
The production of integrated, accessible health care tests by clinicians who are accountable
for addressing all populations and their personal health care needs by developing a sustained
