Comprehensive PMHNP Prep with Answers and Rationales
Question 1
A PMHNP assesses a 40-year-old man with personality and behavioral changes. The presence of tau
protein tangles was noted in brain imagery. Based on the presenting symptoms and brain imaging, the
patient was diagnosed with which of the following diagnoses?
A. Creutzfeldt-Jakob disease
B. Huntington's disease
C. Dementia due to HIV disease
D. Frontotemporal dementia
Answer: D. Frontotemporal dementia
Rationale: Frontotemporal dementia Frontotemporal dementia is also called Pick's disease due to the presence of tau protein
tangles in the brain. It affects males more often, and personality and behavior changes occur before cognitive decline.
Creutzfeldt-Jakob disease's early signs are flu-like with fatigue and cognitive impairment. HIV dementia manifests as cognitive
decline. Huntington's disease first causes motor abnormalities with cognitive decline later in disease progression.
Question 2
A 53-year-old menopausal woman presents to your clinic with complaints of anhedonia, depressed
mood, and vasomotor symptoms. What medication effectively treats both depression and vasomotor
symptoms?
A. Paroxetine
B. Bupropion
C. Geodon
D. Amitriptyline
Answer: A. Paroxetine
Rationale: Paroxetine Paroxetine is a Selective Serotonin Reuptake Inhibitor (SSRI) and in studies has demonstrated efficacy
in treating depression and vasomotor symptoms in menopausal women. Bupropion, a Norepinephrine Dopamine Reuptake
Inhibitor (NDRI), Amitriptyline a Tricyclic antidepressant (TCA), and Geodon an antipsychotic have not been studied and found
effective in the treatment of vasomotor symptoms.
Question 3
In 2001, the Institute of Medicine published Crossing the Quality Chasm: A New Health System for the
21st Century. This report identified six goals for quality improvement in health care: safe, effective,
patient-centered, timely, efficient, and equitable. Which goal can be described as providing services
based on scientific knowledge to all who could benefit?
A. Effective
B. Timely
C. Efficient
D. Equitable
Answer: A. Effective
Rationale: Effective In 2001, the Institute of Medicine published Crossing the Quality Chasm: A New Health System for the
21st Century. This report identified six goals for quality improvement in health care: • Safe: Avoiding injuries to patients from the
care intended to help them • Effective: Providing services based on scientific knowledge to all who could benefit, and refraining
from providing services to those not likely to benefit • Patient-centered: Providing care that is respectful of and responsive to
individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions • Timely:
Reducing waits and sometimes harmful delays for both those who receive and those who provide care • Efficient: Avoiding the
waste of equipment, supplies, ideas, and energy • Equitable: Providing care that does not vary in quality because of personal
characteristics such as gender, ethnicity, geographic location, and socioeconomic status
Question 4
What factor can hinder or constrain growth for the nurse practitioner?
A. Growing competition in the job market for nurse practitioners
B. When the industry puts an emphasis on integrating services of the nurse practitioner
C. The emergence of the nurse practitioner role in health care
D. Decreasing stigmatization
, Answer: A. Growing competition in the job market for nurse practitioners
Rationale: Growing competition in the job market for nurse practitioners Other factors that hinder and constrict growth are as
follows: • Reimbursement struggles with Medicare and private insurance companies • Overlapping scope of practice with other
NPs • Increased concerns over reimbursement fraud and abuse • Scope of practice and the need for formal supervision by or
collaboration with a physician Factors that foster or facilitate growth are as follows: • Consumer demand for services •
Acceptance of the advanced practice nursing role • Emergence of the PMHNP role • Decreasing stigmatization • Emphasis on
integrated health care services
Question 5
Based on Erik Erikson's stages of psychosocial development, what indicates a successful resolution of the
Industry vs. Inferiority stage?
A. Development of a sense of competence
B. Feelings of trust in environmental support
C. Awareness of uniqueness of self
D. Development of loving relationships
Answer: A. Development of a sense of competence
Rationale: Development of a sense of competence Erik Erikson's stages of psychosocial development: • Trust vs. Mistrust:
birth to 12-18 months • Autonomy vs. Shame and Doubt: 12-18 months to 3 years • Initiative vs. Guilt: 3 to 5-6 years • Industry
vs. Inferiority: 5-6 years to adolescence • Identity vs. Role Confusion: adolescence to adulthood • Intimacy vs. Isolation:
adulthood • Generativity vs. Stagnation: middle adulthood • Ego Integrity vs. Despair: late adulthood A successful resolution of
the Industry vs. Inferiority stage includes the development of a sense of competence. Awareness of the uniqueness of self
indicates a successful resolution of the Identity vs. Role Confusion stage. The Trust vs. Mistrust stage is successfully resolved
by developing feelings of trust in one's environmental support. The Intimacy vs. Isolation stage is successfully resolved by the
development of loving relationships.
Question 6
A decrease in serotonin is related to all of the following psychiatric disorders except:
A. Obsessive-compulsive disorder
B. Major depressive disorder
C. Schizophrenia
D. Alzheimer's disease
Answer: D. Alzheimer's disease
Rationale: Alzheimer's disease A decrease in serotonin is related to major depressive disorder, obsessive-compulsive
disorder, and schizophrenia. Alzheimer's disease is related to a decreased in acetylcholine, not serotonin.
Question 7
All of the following words describe a Cluster A personality disorder except:
A. Cold
B. Withdrawn
C. Suspicious
D. Theatrical
Answer: D. Theatrical
Rationale: Theatrical Theatrical more accurately describes Cluster B personality disorders. Personality disorders are
chronically maladaptive patterns of behavior that result in functional impairment in work, school, or relationships. The American
Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders Fifth Edition defines 10 specific personality
disorders divided into three clusters: Cluster A, Cluster B, and Cluster C. Cluster A patients are characterized as withdrawn,
cold, suspicious, and irrational. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Cluster B patients
are characterized as theatrical, emotional, and attention-seeking. They often experience intense interpersonal conflicts and
exhibit an extremely labile mood. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders.
Cluster C patients tend to be anxious, fearful, tense, and overcontrolled. Cluster C includes avoidant, dependent, and
obsessive-compulsive personality disorders.
Question 8
,For a community health clinic, which of the following depression screenings would be best to implement
during wellness visits?
A. QIDS
B. PHQ-2/9
C. HAM-D
D. GDS
Answer: B. PHQ-2/9
Rationale: PHQ-2/9 The Patient Health Questionnaire is a self-administered screening tool commonly used in primary care
settings for reliable measurement of symptoms of depression. The Hamilton Rating Scale for Depression or HAM-D is more
commonly used to establish a baseline and then measure the progression of treatment. The Geriatric Depression Scale is
age-specific. The Quick Inventory of Depressive Symptomatology or QIDS is primarily used with individuals who already have a
diagnosis of depression.
Question 9
Dopamine is a major neurotransmitter that can affect psychiatric disorders when imbalanced. Which of
the following psychiatric findings is suspected when dopamine deficit is suspected as a contributor?
A. Endocrine alterations and movement disorders such as Parkinson’s disease
B. Stereotypical behaviors
C. Disordered thinking and improved spatiality
D. Decreased prolactin levels
Answer: A. Endocrine alterations and movement disorders such as Parkinson’s disease
Rationale: Endocrine alterations and movement disorders such as Parkinson’s disease Dopamine’s general functions impact
thinking, decision-making, reward-seeking, fine muscle action, and integrated cognition. Increases in dopamine would produce
an increase in fine movement disorders such as tics, stereotypical behaviors, and disordered thinking, including loose
associations. A drop in dopamine can impact and dull thinking processes and contribute to endocrine abnormalities and
movement disorders. Dopamine is instrumental in curbing prolactin, so a decrease in dopamine levels can impact prolactin.
Some patients are monitored for breast development when prescribed antipsychotic medication, as it can impact dopamine
levels in the body.
Question 10
Which of the following alpha-agonists is used to treat anxiety in children?
A. Buspar
B. Guanfacine
C. Propranolol
D. Gabapentin
Answer: B. Guanfacine
Rationale: Guanfacine The FDA has approved certain medications for children for the treatment of anxiety. Due to the safe
nature of these pharmaceuticals, they are appropriate for using off-label for anxiety. Clonidine and guanfacine are
alpha-agonists prescribed for anxiety in children. Non-benzodiazepine anxiolytics include beta-blockers, gabapentin, and
buspirone.
Question 11
Nonpharmacological management of ADHD includes all of the following except:
A. Behavior therapy
B. Diet modifications
C. Treatment for learning disorders
D. Family therapy and education
Answer: B. Diet modifications
Rationale: Diet modifications Nonpharmacological management of ADHD includes all of the following: • Behavior therapy •
Treatment for learning disorders • Family therapy and education • Psychoeducation • Patient and parent cognitive behavioral
training
Question 12
, Which term best describes the use of a software application for placing medical orders in both inpatient
and outpatient settings?
A. Nursing informatics
B. Health information technology
C. Barcoding medication administration (BCMA)
D. Computerized provider order entry (CPOE)
Answer: D. Computerized provider order entry (CPOE)
Rationale: Computerized provider order entry (CPOE) Computerized provider order entry (CPOE) is the use of a software
application for the ordering of medications, laboratory and radiology testing, consultation, and referral requests. The CPOE is a
replacement for written orders in both inpatient and outpatient settings. It is cited as an important tool in avoiding medical errors
and improving patient safety. Barcoding medication administration (BCMA) is the use of a scanner to identify medication
ordered in an electronic medical record and administered to a patient. Nursing informatics is the specialty that integrates
nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate
data, information, knowledge, and wisdom in nursing practice. Health information technology is a broad concept that
encompasses an array of technologies to store, share, and analyze health information.
Question 13
Tanner Stages define physical measurement in the development of primary and secondary sex
characteristics in both females and males. What is stage 2 of a female's breast development?
A. Prepubertal
B. Breast bud stage with elevation of breast and papilla
C. Projection of papilla and recession of areola
D. Areola and papilla form secondary mound above the level of the breast
Answer: B. Breast bud stage with elevation of breast and papilla
Rationale: Breast bud stage with elevation of breast and papilla Tanner Stages define physical measurement in the
development of primary and secondary sex characteristics in both females and males. Tanner Stages of a girl's breast
development are as follows: • Stage 1: Prepubertal • Stage 2: Breast bud stage with elevation of breast and papilla • Stage 3:
Further enlargement of breast and areola • Stage 4: Areola and papilla form a secondary mound above the level of the breast •
Stage 5: Projection of papilla related to recession of areola
Question 14
What term describes a system where the insurer is not only the payer but also the provider of health
care?
A. Preferred provider organization
B. Accountable care
C. Managed care
D. Affordable care
Answer: C. Managed care
Rationale: Managed care Managed care is a system where the insurer is not only the payer but also the provider of health
care. Prior to managed care, insurance companies paid bills submitted by health care providers, and the insurer had no control
over the quality or quantity of care being given. In a managed care system, the insurer monitors how the health care services
are utilized and the cost of those services. The insurer agrees to pay only a flat fee for each patient regardless of what services
are required, and thus the provider shares in the financial risk. This system incentivizes insurers and clinicians to provide the
highest quality care.
Question 15
How do managed care organizations control health care costs?
A. Enroll only those aged 18 and older
B. Bargain with medical practices for reduced rates on visits
C. Exclude preexisting conditions
D. Charge higher premiums than traditional insurers
Answer: B. Bargain with medical practices for reduced rates on visits
Question 1
A PMHNP assesses a 40-year-old man with personality and behavioral changes. The presence of tau
protein tangles was noted in brain imagery. Based on the presenting symptoms and brain imaging, the
patient was diagnosed with which of the following diagnoses?
A. Creutzfeldt-Jakob disease
B. Huntington's disease
C. Dementia due to HIV disease
D. Frontotemporal dementia
Answer: D. Frontotemporal dementia
Rationale: Frontotemporal dementia Frontotemporal dementia is also called Pick's disease due to the presence of tau protein
tangles in the brain. It affects males more often, and personality and behavior changes occur before cognitive decline.
Creutzfeldt-Jakob disease's early signs are flu-like with fatigue and cognitive impairment. HIV dementia manifests as cognitive
decline. Huntington's disease first causes motor abnormalities with cognitive decline later in disease progression.
Question 2
A 53-year-old menopausal woman presents to your clinic with complaints of anhedonia, depressed
mood, and vasomotor symptoms. What medication effectively treats both depression and vasomotor
symptoms?
A. Paroxetine
B. Bupropion
C. Geodon
D. Amitriptyline
Answer: A. Paroxetine
Rationale: Paroxetine Paroxetine is a Selective Serotonin Reuptake Inhibitor (SSRI) and in studies has demonstrated efficacy
in treating depression and vasomotor symptoms in menopausal women. Bupropion, a Norepinephrine Dopamine Reuptake
Inhibitor (NDRI), Amitriptyline a Tricyclic antidepressant (TCA), and Geodon an antipsychotic have not been studied and found
effective in the treatment of vasomotor symptoms.
Question 3
In 2001, the Institute of Medicine published Crossing the Quality Chasm: A New Health System for the
21st Century. This report identified six goals for quality improvement in health care: safe, effective,
patient-centered, timely, efficient, and equitable. Which goal can be described as providing services
based on scientific knowledge to all who could benefit?
A. Effective
B. Timely
C. Efficient
D. Equitable
Answer: A. Effective
Rationale: Effective In 2001, the Institute of Medicine published Crossing the Quality Chasm: A New Health System for the
21st Century. This report identified six goals for quality improvement in health care: • Safe: Avoiding injuries to patients from the
care intended to help them • Effective: Providing services based on scientific knowledge to all who could benefit, and refraining
from providing services to those not likely to benefit • Patient-centered: Providing care that is respectful of and responsive to
individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions • Timely:
Reducing waits and sometimes harmful delays for both those who receive and those who provide care • Efficient: Avoiding the
waste of equipment, supplies, ideas, and energy • Equitable: Providing care that does not vary in quality because of personal
characteristics such as gender, ethnicity, geographic location, and socioeconomic status
Question 4
What factor can hinder or constrain growth for the nurse practitioner?
A. Growing competition in the job market for nurse practitioners
B. When the industry puts an emphasis on integrating services of the nurse practitioner
C. The emergence of the nurse practitioner role in health care
D. Decreasing stigmatization
, Answer: A. Growing competition in the job market for nurse practitioners
Rationale: Growing competition in the job market for nurse practitioners Other factors that hinder and constrict growth are as
follows: • Reimbursement struggles with Medicare and private insurance companies • Overlapping scope of practice with other
NPs • Increased concerns over reimbursement fraud and abuse • Scope of practice and the need for formal supervision by or
collaboration with a physician Factors that foster or facilitate growth are as follows: • Consumer demand for services •
Acceptance of the advanced practice nursing role • Emergence of the PMHNP role • Decreasing stigmatization • Emphasis on
integrated health care services
Question 5
Based on Erik Erikson's stages of psychosocial development, what indicates a successful resolution of the
Industry vs. Inferiority stage?
A. Development of a sense of competence
B. Feelings of trust in environmental support
C. Awareness of uniqueness of self
D. Development of loving relationships
Answer: A. Development of a sense of competence
Rationale: Development of a sense of competence Erik Erikson's stages of psychosocial development: • Trust vs. Mistrust:
birth to 12-18 months • Autonomy vs. Shame and Doubt: 12-18 months to 3 years • Initiative vs. Guilt: 3 to 5-6 years • Industry
vs. Inferiority: 5-6 years to adolescence • Identity vs. Role Confusion: adolescence to adulthood • Intimacy vs. Isolation:
adulthood • Generativity vs. Stagnation: middle adulthood • Ego Integrity vs. Despair: late adulthood A successful resolution of
the Industry vs. Inferiority stage includes the development of a sense of competence. Awareness of the uniqueness of self
indicates a successful resolution of the Identity vs. Role Confusion stage. The Trust vs. Mistrust stage is successfully resolved
by developing feelings of trust in one's environmental support. The Intimacy vs. Isolation stage is successfully resolved by the
development of loving relationships.
Question 6
A decrease in serotonin is related to all of the following psychiatric disorders except:
A. Obsessive-compulsive disorder
B. Major depressive disorder
C. Schizophrenia
D. Alzheimer's disease
Answer: D. Alzheimer's disease
Rationale: Alzheimer's disease A decrease in serotonin is related to major depressive disorder, obsessive-compulsive
disorder, and schizophrenia. Alzheimer's disease is related to a decreased in acetylcholine, not serotonin.
Question 7
All of the following words describe a Cluster A personality disorder except:
A. Cold
B. Withdrawn
C. Suspicious
D. Theatrical
Answer: D. Theatrical
Rationale: Theatrical Theatrical more accurately describes Cluster B personality disorders. Personality disorders are
chronically maladaptive patterns of behavior that result in functional impairment in work, school, or relationships. The American
Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders Fifth Edition defines 10 specific personality
disorders divided into three clusters: Cluster A, Cluster B, and Cluster C. Cluster A patients are characterized as withdrawn,
cold, suspicious, and irrational. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Cluster B patients
are characterized as theatrical, emotional, and attention-seeking. They often experience intense interpersonal conflicts and
exhibit an extremely labile mood. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders.
Cluster C patients tend to be anxious, fearful, tense, and overcontrolled. Cluster C includes avoidant, dependent, and
obsessive-compulsive personality disorders.
Question 8
,For a community health clinic, which of the following depression screenings would be best to implement
during wellness visits?
A. QIDS
B. PHQ-2/9
C. HAM-D
D. GDS
Answer: B. PHQ-2/9
Rationale: PHQ-2/9 The Patient Health Questionnaire is a self-administered screening tool commonly used in primary care
settings for reliable measurement of symptoms of depression. The Hamilton Rating Scale for Depression or HAM-D is more
commonly used to establish a baseline and then measure the progression of treatment. The Geriatric Depression Scale is
age-specific. The Quick Inventory of Depressive Symptomatology or QIDS is primarily used with individuals who already have a
diagnosis of depression.
Question 9
Dopamine is a major neurotransmitter that can affect psychiatric disorders when imbalanced. Which of
the following psychiatric findings is suspected when dopamine deficit is suspected as a contributor?
A. Endocrine alterations and movement disorders such as Parkinson’s disease
B. Stereotypical behaviors
C. Disordered thinking and improved spatiality
D. Decreased prolactin levels
Answer: A. Endocrine alterations and movement disorders such as Parkinson’s disease
Rationale: Endocrine alterations and movement disorders such as Parkinson’s disease Dopamine’s general functions impact
thinking, decision-making, reward-seeking, fine muscle action, and integrated cognition. Increases in dopamine would produce
an increase in fine movement disorders such as tics, stereotypical behaviors, and disordered thinking, including loose
associations. A drop in dopamine can impact and dull thinking processes and contribute to endocrine abnormalities and
movement disorders. Dopamine is instrumental in curbing prolactin, so a decrease in dopamine levels can impact prolactin.
Some patients are monitored for breast development when prescribed antipsychotic medication, as it can impact dopamine
levels in the body.
Question 10
Which of the following alpha-agonists is used to treat anxiety in children?
A. Buspar
B. Guanfacine
C. Propranolol
D. Gabapentin
Answer: B. Guanfacine
Rationale: Guanfacine The FDA has approved certain medications for children for the treatment of anxiety. Due to the safe
nature of these pharmaceuticals, they are appropriate for using off-label for anxiety. Clonidine and guanfacine are
alpha-agonists prescribed for anxiety in children. Non-benzodiazepine anxiolytics include beta-blockers, gabapentin, and
buspirone.
Question 11
Nonpharmacological management of ADHD includes all of the following except:
A. Behavior therapy
B. Diet modifications
C. Treatment for learning disorders
D. Family therapy and education
Answer: B. Diet modifications
Rationale: Diet modifications Nonpharmacological management of ADHD includes all of the following: • Behavior therapy •
Treatment for learning disorders • Family therapy and education • Psychoeducation • Patient and parent cognitive behavioral
training
Question 12
, Which term best describes the use of a software application for placing medical orders in both inpatient
and outpatient settings?
A. Nursing informatics
B. Health information technology
C. Barcoding medication administration (BCMA)
D. Computerized provider order entry (CPOE)
Answer: D. Computerized provider order entry (CPOE)
Rationale: Computerized provider order entry (CPOE) Computerized provider order entry (CPOE) is the use of a software
application for the ordering of medications, laboratory and radiology testing, consultation, and referral requests. The CPOE is a
replacement for written orders in both inpatient and outpatient settings. It is cited as an important tool in avoiding medical errors
and improving patient safety. Barcoding medication administration (BCMA) is the use of a scanner to identify medication
ordered in an electronic medical record and administered to a patient. Nursing informatics is the specialty that integrates
nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate
data, information, knowledge, and wisdom in nursing practice. Health information technology is a broad concept that
encompasses an array of technologies to store, share, and analyze health information.
Question 13
Tanner Stages define physical measurement in the development of primary and secondary sex
characteristics in both females and males. What is stage 2 of a female's breast development?
A. Prepubertal
B. Breast bud stage with elevation of breast and papilla
C. Projection of papilla and recession of areola
D. Areola and papilla form secondary mound above the level of the breast
Answer: B. Breast bud stage with elevation of breast and papilla
Rationale: Breast bud stage with elevation of breast and papilla Tanner Stages define physical measurement in the
development of primary and secondary sex characteristics in both females and males. Tanner Stages of a girl's breast
development are as follows: • Stage 1: Prepubertal • Stage 2: Breast bud stage with elevation of breast and papilla • Stage 3:
Further enlargement of breast and areola • Stage 4: Areola and papilla form a secondary mound above the level of the breast •
Stage 5: Projection of papilla related to recession of areola
Question 14
What term describes a system where the insurer is not only the payer but also the provider of health
care?
A. Preferred provider organization
B. Accountable care
C. Managed care
D. Affordable care
Answer: C. Managed care
Rationale: Managed care Managed care is a system where the insurer is not only the payer but also the provider of health
care. Prior to managed care, insurance companies paid bills submitted by health care providers, and the insurer had no control
over the quality or quantity of care being given. In a managed care system, the insurer monitors how the health care services
are utilized and the cost of those services. The insurer agrees to pay only a flat fee for each patient regardless of what services
are required, and thus the provider shares in the financial risk. This system incentivizes insurers and clinicians to provide the
highest quality care.
Question 15
How do managed care organizations control health care costs?
A. Enroll only those aged 18 and older
B. Bargain with medical practices for reduced rates on visits
C. Exclude preexisting conditions
D. Charge higher premiums than traditional insurers
Answer: B. Bargain with medical practices for reduced rates on visits
