Question 1: An advanced practice psychiatric nurse (APPN) is using the
biopsychosocial model to assess a patient with major depressive disorder. Which of the
following is an example of a "biological" factor in this model?
A. The patient's recent job loss
B. The patient's dysfunctional family dynamics
C. The patient's history of a traumatic childhood
D. The patient's neuroendocrine dysfunction
CORRECT ANSWER: D. The patient's neuroendocrine dysfunction.
Rationale: The biopsychosocial model considers biological, psychological, and social
factors. Neuroendocrine dysfunction (e.g., HPA axis dysregulation) is a biological factor.
Job loss, family dynamics, and trauma are social and psychological factors.
Question 2: The APPN is considering a diagnosis of borderline personality disorder
(BPD). Which of the following is a core feature of BPD?
A. Grandiose sense of self-importance
B. A pervasive pattern of unstable relationships and a ect
C. Social inhibition and feelings of inadequacy
D. Excessive need for admiration
CORRECT ANSWER: B. A pervasive pattern of unstable relationships and a ect.
Rationale: Borderline personality disorder is characterized by a pervasive pattern of
instability in interpersonal relationships, self-image, and a ect, along with marked
impulsivity.
Question 3: The APPN is assessing a patient with a new-onset psychotic episode. The
patient is experiencing auditory hallucinations and paranoid delusions. Which of the
following is the most appropriate first-line medication class?
A. Selective serotonin reuptake inhibitors (SSRIs)
B. Mood stabilizers
C. First-generation antipsychotics
D. Second-generation antipsychotics
CORRECT ANSWER: D. Second-generation antipsychotics.
Rationale: Second-generation antipsychotics (e.g., risperidone, olanzapine) are
generally the first-line pharmacological treatment for acute psychosis due to their
e icacy and lower risk of extrapyramidal symptoms compared to first-generation
antipsychotics.
,Question 4: A patient with bipolar disorder is being started on lithium. The APPN should
order which baseline laboratory tests before initiating therapy?
A. Complete blood count (CBC) and liver function tests (LFTs)
B. Thyroid function tests (TFTs) and renal function tests
C. Fasting blood glucose and lipid panel
D. Serum creatinine and blood urea nitrogen (BUN) only
CORRECT ANSWER: B. Thyroid function tests (TFTs) and renal function tests.
Rationale: Lithium can a ect thyroid and renal function. Baseline and periodic
monitoring of thyroid function tests (TSH) and renal function (creatinine, BUN) are
essential.
Question 5: The APPN is using motivational interviewing with a patient who has alcohol
use disorder. Which statement is an example of the "OARS" technique?
A. "Why don't you just stop drinking?"
B. "You seem to be saying that you want to cut down, but you are worried about losing
your social connections."
C. "If you don't stop drinking, you will get liver disease."
D. "You should go to Alcoholics Anonymous."
CORRECT ANSWER: B. "You seem to be saying that you want to cut down, but you
are worried about losing your social connections."
Rationale: OARS stands for Open-ended questions, A irmations, Reflective listening,
and Summaries. This statement is an example of reflective listening, where the APPN
reflects the patient's ambivalence.
Question 6: A patient is prescribed clozapine for treatment-resistant schizophrenia. The
APPN must monitor the patient for which potentially fatal adverse e ect?
A. Neuroleptic malignant syndrome (NMS)
B. Agranulocytosis
C. Tardive dyskinesia
D. Seizures
CORRECT ANSWER: B. Agranulocytosis.
,Rationale: Clozapine carries a black box warning for agranulocytosis, a potentially fatal
drop in white blood cells. Strict monitoring of the absolute neutrophil count (ANC) is
required through the REMS program.
Question 7: The APPN is evaluating a patient for attention-deficit/hyperactivity disorder
(ADHD). Which of the following is a key diagnostic criterion for ADHD in adults?
A. Symptoms must have started before age 12.
B. Symptoms must be present only in the workplace.
C. Symptoms must be a result of another medical condition.
D. Symptoms must be caused by substance use.
CORRECT ANSWER: A. Symptoms must have started before age 12.
Rationale: The DSM-5-TR criteria for ADHD require that several symptoms were present
before age 12.
Question 8: A patient with generalized anxiety disorder (GAD) is being started on a
selective serotonin reuptake inhibitor (SSRI). Which is a common initial side e ect that
the APPN should warn the patient about?
A. Sedation
B. Weight loss
C. Insomnia
D. Gastrointestinal upset and increased anxiety
CORRECT ANSWER: D. Gastrointestinal upset and increased anxiety.
Rationale: SSRIs commonly cause GI upset and can initially increase anxiety
(jitteriness) before therapeutic e ects are seen. Starting at a low dose and titrating
slowly can help mitigate this.
Question 9: The APPN is performing a mental status examination on a patient. The
patient is unable to interpret the proverb, "People in glass houses shouldn't throw
stones." This indicates a deficit in:
A. Memory
B. Judgment
C. Abstract reasoning
D. Attention
CORRECT ANSWER: C. Abstract reasoning.
, Rationale: The ability to interpret proverbs tests abstract reasoning, which is a higher-
level cognitive function. Inability to do so can indicate a frontal lobe or other cognitive
deficit.
Question 10: A patient with panic disorder is prescribed a benzodiazepine for acute
symptom management. Which statement about benzodiazepine therapy is accurate?
A. They are the first-line long-term treatment for panic disorder.
B. They have a high risk of tolerance and dependence.
C. They are safe for use in patients with a history of substance abuse.
D. They are safe to use with alcohol.
CORRECT ANSWER: B. They have a high risk of tolerance and dependence.
Rationale: Benzodiazepines have a high potential for tolerance and physical
dependence. They are typically used for short-term management or as an adjunct to
antidepressants in panic disorder.
Question 11: The APPN is assessing a patient with a diagnosis of social anxiety disorder
(social phobia). The patient reports intense fear and avoidance of social situations.
Which medication is considered a first-line treatment for this condition?
A. Sertraline
B. Propranolol
C. Alprazolam
D. Buspirone
CORRECT ANSWER: A. Sertraline.
Rationale: SSRIs (e.g., sertraline, paroxetine) are first-line treatments for social anxiety
disorder. Propranolol can be used for performance anxiety but is not first-line for
generalized social anxiety.
Question 12: The APPN is evaluating a patient who has been taking fluoxetine for 6
weeks for depression. The patient reports no improvement in symptoms. The APPN
should:
A. Discontinue the fluoxetine immediately.
B. Increase the dose of fluoxetine.
C. Consider a trial of another antidepressant or augmenting strategy.
D. Tell the patient to wait another 6 weeks.
biopsychosocial model to assess a patient with major depressive disorder. Which of the
following is an example of a "biological" factor in this model?
A. The patient's recent job loss
B. The patient's dysfunctional family dynamics
C. The patient's history of a traumatic childhood
D. The patient's neuroendocrine dysfunction
CORRECT ANSWER: D. The patient's neuroendocrine dysfunction.
Rationale: The biopsychosocial model considers biological, psychological, and social
factors. Neuroendocrine dysfunction (e.g., HPA axis dysregulation) is a biological factor.
Job loss, family dynamics, and trauma are social and psychological factors.
Question 2: The APPN is considering a diagnosis of borderline personality disorder
(BPD). Which of the following is a core feature of BPD?
A. Grandiose sense of self-importance
B. A pervasive pattern of unstable relationships and a ect
C. Social inhibition and feelings of inadequacy
D. Excessive need for admiration
CORRECT ANSWER: B. A pervasive pattern of unstable relationships and a ect.
Rationale: Borderline personality disorder is characterized by a pervasive pattern of
instability in interpersonal relationships, self-image, and a ect, along with marked
impulsivity.
Question 3: The APPN is assessing a patient with a new-onset psychotic episode. The
patient is experiencing auditory hallucinations and paranoid delusions. Which of the
following is the most appropriate first-line medication class?
A. Selective serotonin reuptake inhibitors (SSRIs)
B. Mood stabilizers
C. First-generation antipsychotics
D. Second-generation antipsychotics
CORRECT ANSWER: D. Second-generation antipsychotics.
Rationale: Second-generation antipsychotics (e.g., risperidone, olanzapine) are
generally the first-line pharmacological treatment for acute psychosis due to their
e icacy and lower risk of extrapyramidal symptoms compared to first-generation
antipsychotics.
,Question 4: A patient with bipolar disorder is being started on lithium. The APPN should
order which baseline laboratory tests before initiating therapy?
A. Complete blood count (CBC) and liver function tests (LFTs)
B. Thyroid function tests (TFTs) and renal function tests
C. Fasting blood glucose and lipid panel
D. Serum creatinine and blood urea nitrogen (BUN) only
CORRECT ANSWER: B. Thyroid function tests (TFTs) and renal function tests.
Rationale: Lithium can a ect thyroid and renal function. Baseline and periodic
monitoring of thyroid function tests (TSH) and renal function (creatinine, BUN) are
essential.
Question 5: The APPN is using motivational interviewing with a patient who has alcohol
use disorder. Which statement is an example of the "OARS" technique?
A. "Why don't you just stop drinking?"
B. "You seem to be saying that you want to cut down, but you are worried about losing
your social connections."
C. "If you don't stop drinking, you will get liver disease."
D. "You should go to Alcoholics Anonymous."
CORRECT ANSWER: B. "You seem to be saying that you want to cut down, but you
are worried about losing your social connections."
Rationale: OARS stands for Open-ended questions, A irmations, Reflective listening,
and Summaries. This statement is an example of reflective listening, where the APPN
reflects the patient's ambivalence.
Question 6: A patient is prescribed clozapine for treatment-resistant schizophrenia. The
APPN must monitor the patient for which potentially fatal adverse e ect?
A. Neuroleptic malignant syndrome (NMS)
B. Agranulocytosis
C. Tardive dyskinesia
D. Seizures
CORRECT ANSWER: B. Agranulocytosis.
,Rationale: Clozapine carries a black box warning for agranulocytosis, a potentially fatal
drop in white blood cells. Strict monitoring of the absolute neutrophil count (ANC) is
required through the REMS program.
Question 7: The APPN is evaluating a patient for attention-deficit/hyperactivity disorder
(ADHD). Which of the following is a key diagnostic criterion for ADHD in adults?
A. Symptoms must have started before age 12.
B. Symptoms must be present only in the workplace.
C. Symptoms must be a result of another medical condition.
D. Symptoms must be caused by substance use.
CORRECT ANSWER: A. Symptoms must have started before age 12.
Rationale: The DSM-5-TR criteria for ADHD require that several symptoms were present
before age 12.
Question 8: A patient with generalized anxiety disorder (GAD) is being started on a
selective serotonin reuptake inhibitor (SSRI). Which is a common initial side e ect that
the APPN should warn the patient about?
A. Sedation
B. Weight loss
C. Insomnia
D. Gastrointestinal upset and increased anxiety
CORRECT ANSWER: D. Gastrointestinal upset and increased anxiety.
Rationale: SSRIs commonly cause GI upset and can initially increase anxiety
(jitteriness) before therapeutic e ects are seen. Starting at a low dose and titrating
slowly can help mitigate this.
Question 9: The APPN is performing a mental status examination on a patient. The
patient is unable to interpret the proverb, "People in glass houses shouldn't throw
stones." This indicates a deficit in:
A. Memory
B. Judgment
C. Abstract reasoning
D. Attention
CORRECT ANSWER: C. Abstract reasoning.
, Rationale: The ability to interpret proverbs tests abstract reasoning, which is a higher-
level cognitive function. Inability to do so can indicate a frontal lobe or other cognitive
deficit.
Question 10: A patient with panic disorder is prescribed a benzodiazepine for acute
symptom management. Which statement about benzodiazepine therapy is accurate?
A. They are the first-line long-term treatment for panic disorder.
B. They have a high risk of tolerance and dependence.
C. They are safe for use in patients with a history of substance abuse.
D. They are safe to use with alcohol.
CORRECT ANSWER: B. They have a high risk of tolerance and dependence.
Rationale: Benzodiazepines have a high potential for tolerance and physical
dependence. They are typically used for short-term management or as an adjunct to
antidepressants in panic disorder.
Question 11: The APPN is assessing a patient with a diagnosis of social anxiety disorder
(social phobia). The patient reports intense fear and avoidance of social situations.
Which medication is considered a first-line treatment for this condition?
A. Sertraline
B. Propranolol
C. Alprazolam
D. Buspirone
CORRECT ANSWER: A. Sertraline.
Rationale: SSRIs (e.g., sertraline, paroxetine) are first-line treatments for social anxiety
disorder. Propranolol can be used for performance anxiety but is not first-line for
generalized social anxiety.
Question 12: The APPN is evaluating a patient who has been taking fluoxetine for 6
weeks for depression. The patient reports no improvement in symptoms. The APPN
should:
A. Discontinue the fluoxetine immediately.
B. Increase the dose of fluoxetine.
C. Consider a trial of another antidepressant or augmenting strategy.
D. Tell the patient to wait another 6 weeks.
