Fitzgerald Prep PMHNP II PRE-QUIZ

Fitzgerald Prep PMHNP II PRE-QUIZPre-Quiz On the national NP certification exam, you should expect to find specific questions on your state’s APRN practice act. False You plan to sit for the certification exam in a state where NPs have limited or no controlled substance prescribing authority. As a result, your certification exam will not contain questions about prescribing opioids. False Once an NP has achieved nationally recognized certification from a state and nationally recognized certification agency, this person can now practice as a nurse practitioner. False 1 Assessment of the optic disc is a component of the evaluation of cranial nerve: 2 (II) A 47-year-old woman with long-standing depression returns today for a medication recheck. On exam you find her affect is blunted and her hair is unwashed and unkempt. Usually she comes to her visits alone; however her husband is with her today. This patient’s symptom history is likely to include a report of: Suicidal Thoughts Of the following, which should be performed first in assessing a 48-year-old woman with suicidal ideation? What is the content of her thoughts? You are setting up a healthcare clinic for migrant farm workers. Which of the following sites is most desirable? Mobile van An 8-year-old boy presents for an evaluation for possible attention-deficit/hyperactivity disorder (ADHD). His parents report him to be a healthy 3rd-grader with “plenty of good friends.” They are concerned he could have ADHD because he is “hyperactive” and because his father had ADHD. The Vanderbilt screening tools completed by his parents strongly indicate inattention, with moderate hyperactivity symptoms. Your next best action is to: Arrange for parents to obtain Vanderbilt screening tool or other written feedback from his teacher and return in 2 weeks. The NP demonstrates fulfillment of the advanced practice nursing leadership role by participating in which of the following activities? Collaborating with the regional public health department on an initiative to prevent suicides by increasing awareness of community resources You are asked to speak to a group of healthcare executives on the NP role. Which of the following provides the strongest support for NP practice? NP practice outcomes Rank the following from highest to lowest level of research design. Case reports = 2 Randomized Control Trials = 1 Expert Opinion = 3 2 Which of the following constitutes a primary prevention strategy in a 78-year-old man with depression? Ensuring adequate home illumination A 46-year-old woman with type 2 diabetes mellitus and schizophrenia that is well-controlled with ziprasidone (Geodon®) presents for a check-up. Which of the following is a secondary prevention strategy? Checking stool for occult blood A 35-year-old man with bipolar disorder was recently hospitalized for a manic episode. On returning to work as an accountant in a large company, he accesses his company’s employee assistance program (EAP) to facilitate his return to work. This is an example of which prevention strategy? Tertiary Prevention ind Conducting a parent class to new parents on how to cope with stressors of having a newborn in the home True/False Influenza and pneumococcal immunizations cannot be given on the same day False Immune globulin is a concentrated solution of antibodies derived from pooled donated blood. True The 3-dose series of HPV vaccine should be given to males age 9 through 26 years to reduce the likelihood of genital wart acquisition. True Tdap (tetanus, diphtheria, acellular pertussis [Adacel®, Boostrix®]) vaccine should replace a single dose of Td (tetanus, diphtheria) vaccine for most adults who have not previously received a dose of Tdap in order to provide additional protection against pertussis. True Vaccination of incarcerated adults against hepatitis B is discouraged because it is a 3-shot series False According to the latest ACIP guidelines, routine influenza immunization is recommended for all of the following persons except: Infants under 6 months According to the ACIP guidelines, zoster vaccination should be given to all adults ≥ age ____ years. 60 3 Which of the following is not considered a secondary prevention strategy in a 48-year-old woman with bipolar I disorder? Correct answer: Administering influenza vaccination Which of the following provides the most accurate indicator for alcoholism? Positive response to two items on the CAGE questionnaire A 64-year-old male with COPD reports having smoked 2 packs-per-day for the past 20 years. You calculate that he has a pack-year history of: 40 According to ACS guidelines, an annual fecal occult blood test (FOBT) or fecal immunochemical test (FIT) should begin for men and women with average risk for colorectal cancer at age: 50 years According to the American College of Obstetricians and Gynecologists (ACOG), t should begin for women at age: 21 years 4 For a patient receiving valproate therapy, regular monitoring for all of the following is recommended except: TSH A 76-year-old woman presents with fatigue and the following laboratory results: Hb=9.3 g/dL (13–17) (93 g/L [130−170]) MCV=71 fL (80–96 fL) A critical diagnosis to consider is: Gastrointestinal Blood Loss A potential laboratory indicator for alcohol abuse is: Elevated ALT The most accurate laboratory measurement for kidney function is: serum glomelular filtration rate (GFR) Which of the following medications does not require initial laboratory testing prior to implementing therapy? Lamotrigine In order to prevent an outbreak of hepatitis D infection, the NP plans to: Immunize against Hepatitis B True/False True The hepatitis B virus is efficiently transmitted via sexual fluids. False The most efficient route of transmission for the hepatitis C virus is sexual activity. False Vertical transmission of hepatitis C is quite common. A 45-year-old man with schizophrenia and alcohol dependence presents with the following laboratory results: Anti-HCV with HCV RNA HBsAb: Positive Anti-HAV: Negative You offer immunization against: Hepatitis A A 44-year-old woman is referred to you from her primary care provider for possible bipolar disorder. On review of her records you note the following laboratory data: HBsAg=Present AST=56 units/L (0–40 units/L) ALT=98 units/L (0–40 units/L) These findings are most consistent with: Chronic Hepatitis B The cranial nerve responsible for facial expressions and secretion of tears and saliva is: VII The cranial nerve responsible for chewing is: V Untreated Hyperthyroidism or Hypothyroidism or both? HypothyroidismDry Skin Hyperthyroidism Fine Tremor HypothyroidismHung Up DTR Both Mental Status Change Both Atypical Presentation in elder Both Thyroid enlargement HypothyroidismMenorrhagia Hyperthyroidism Exopthalmos Hyperthyroidism Lid Retraction Which of the following is most consistent with untreated hypothyroidism? Correct answer: TSH=24 mIU/mL (0.5–4.0 mIU/mL), free T4=3 pmol/L (10–27 pmol/L) Which of the following is most consistent with untreated hyperthyroidism? Correct answer: TSH 0.15 mIU/mL (0.5–4.0 mIU/mL), free T4=79 pmol/L (10–27 pmol/L) Which of the following second-generation antipsychotics should be avoided in an overweight patient at risk for diabetes? Olanzapine On medication review your patient states that he is taking something for “heart burn.” Which of the following medications would be most concerning for a drug-drug interaction? Omeprazole Melvin is a 45-year-old man with obsessive compulsive disorder, schizoid personality disorder, hypertension, hyperlipidemia, and type 2 diabetes. Which of the following is Melvin least likely to be taking? Pravastatin 20mg Melvin develops psychotic symptoms requiring medication treatment. Based on his metabolic profile, which medication would be most appropriate for Melvin? Based on below scenario: Melvin is a 45-year-old man with obsessive compulsive disorder, schizoid personality disorder, hypertension, hyperlipidemia, and type 2 diabetes. Ziprasidone Laboratory testing of a 34-year-old male who has been receiving valproate therapy for the past 2 months for bipolar disorder reveals AST=168 units/L and ALT=132 units/L. The PMHNP considers: Discontinuing valproate therapy A 54-year-old man presents in the ED with symptoms of lethargy, weakness, blurred vision, and confusion. His medical history includes manic depression, dyslipidemia, and hypertension. He is currently being treated with lithium, a statin, and an antihypertensive medication that was started in the past week. Suspecting lithium toxicity, which of the following is least likely to contribute to his current symptoms? Calcium Channel Blocker When considering the use of clozapine, regular monitoring of which of the following is required? ANC 5 Match the concepts or theorists to the theories. Stresses wholism Unconditional positive regard Person-centered Gestalt Id, ego and superego Based on attachment theory and Sullivan Logotherapy Irrational beliefs lead to anxiety and depression Triangulation ABC model Self-actualization Feedback Correct answer: Stresses wholism- GestaltUnconditional positive regard- Person-centeredId, ego and superego - FreudBased on attachment theory and Sullivan - InterpersonalLogotherapy- ExistentialIrrational beliefs lead to anxiety and depression - CognitiveTriangulation - Family systems ABC model - Behavioral Self-actualization - Maslow Which psychological theory emphasizes “humanistic” psychology? Person-centered The psychological theory that incorporates assertiveness training and social skills training is: Behavioral The 3 Cs of behavioral psychological theory include all of the following except: Consequence awareness Which of the following is not a nursing role identified by Peplau? Authoritative Which of the following of Erikson’s Stages of Psychological Development comes latest in life? intimacy vs. isolation According to the Biopsychosocial Theory of Mental Illness, substance use accounts for a ________ cause of mental illness. Biologic According to the Biopsychosocial Theory of Mental Illness, abuse accounts for a ________ cause of mental illness. Psychologic A 16-year-old adolescent is failing out of high school and frequently argues with his parents. He confides that he is confused by a same-sex attraction and is desperate to avoid telling his parents. An important consideration when working with adolescents is that their major developmental task according to Erikson is: Identity vs. Role Confusion The mother of a 4-year-old boy expresses frustration that her child has yet to understand right from wrong. One example is when she found her son drawing on the walls with markers and could not explain why he did it. An appropriate response from the NP would be: Correct answer: Reasoning skills and following rules typically begin around 7 years of age. True or False? Ensuring early skin-to-skin contact post birth is one method to facilitate attachment in the mother-baby dyad. True According to Ainsworth, the type of insecure attachment associated with clinging to inconsistent parents is: Freud Interpersonal Existential Cognitive Family systems Behavioral Maslow Insecure-ambivalent According to Bowlby, attachment disorders are linked to all of the following conditions except: Autism According to Kohlberg, a 9-year-old would fall under which stage of moral reasoning? Conventional morality Problematic attachment can be due to all of the following except: Early Breastfeeding The Oedipus complex is typically observed in children at age: 5 years 6 Match the medications and involved neurotransmitters. A. GABA B. Serotonin C. Norepinephrine D. Dopamine Benzodiazapines A Fluoxetine B Venlafaxine B&C Methylphenidate C&D Antipsychotics D Bupropion C&D Match the clinical effects with neurotransmitters. A. Serotonin B. Norepinephrine C. Dopamine Loose bowels after starting medication A Galactorrhea C Focus and concentration B & C Elevated blood pressure B Sexual dysfunction after starting medication A Dyskinesias C Substance dependence and abuse C The mechanism of action of bupropion is as a selective reuptake inhibitor of: Dopamine & norepinephrine A patient diagnosed with Alzheimer’s dementia is likely to have dysfunction of which part of the brain? Hippocampus Second-generation antipsychotics (SGAs) are preferred over first-generation antipsychotics primarily due to: Lower rates of adverse effects The ability of a person who has had a stroke to regain the ability of speech by recruiting other areas of the brain to compensate for damaged regions is an example of: Neural plasticity The dopamine pathway responsible for the positive symptoms of schizophrenia is the: Mesolimbic dopamine pathway Match the dopamine pathway with its appropriate function/ symptoms. A. Mesolimbic dopamine pathway B. Nigrostriatal dopamine pathway C. Mesocortical dopamine pathway D. Tuberoinfundibular dopamine pathway Prolactin regulation D Voluntary movements B Mood disorders A Cognition and planning C 7 A 45-year-old man was brought to the ED by the police after being called by neighbors due to loud shouting. The patient and his wife had engaged in a physical altercation, both are treated for minor injuries. The PMHNP is called to do a psychiatric evaluation. On review of the ED records, you find that the patient has a 20-year history of bipolar disorder, last hospitalization was 5 years ago, and he reports adherence to his treatment regimen that consists of lithium and risperidone. When you enter the exam room, you observe that he is red-faced, sitting cross-legged, and is refusing to answer any questions. Your best response is: “You’re angry because you were brought to the emergency department by the police.” Chan, 19, is a college sophomore who is being seen by the PMHNP in follow-up after discharge from a hospitalization one week ago for a psychotic episode. Chan’s parents live in Taiwan and he lives in an apartment with his brother who is a PhD student. Chan is polite, well-groomed and quiet. He answers questions about his sleep and medication with one word responses and is unable to provide detail when questioned further. He sits on the edge of the couch, his eye contact is minimal and he looks frequently to the floor and then to the door. The PMHNP’s next best option is to: Obtain a release of information from Chan to have you speak with his brother. Edna, a 72-year-old woman, is brought in to the ED by her neighbor who reports finding her outside in her nightgown talking to no one in particular. The neighbor reports that he has known Edna for years and has never seen any unusual behavior in the past. Edna lives by herself but has a daughter living nearby that occasionally checks on her. An appropriate initial step in Edna’s evaluation would be to: Order CBC with differential and urinalysis. When evaluating a patient with schizophrenia, which of the following statements provides an indication of the patient’s judgment? “I should just quit my job and live in my car for a while.” A 27-year-old ex-Marine is being evaluated during a follow-up visit for post-traumatic stress disorder. He has been taking an SSRI for the past 3 weeks but does not report any improvement in his symptoms. During the evaluation, he mentions that he has thoughts of suicide and specifically mentions a firearm in his house. An appropriate next course of action would be to: Refer for inpatient care. 8 A 68-year-old man of Asian ancestry with generalized anxiety disorder presents for follow-up. He tells you that he is taking different herbs to help “clean his blood.” An appropriate response will be: “Can you tell me more about these herbs?” Mrs. Sanchez is a 38-year-old Spanish-speaking woman who comes in to the clinic to follow-up for her treatment of depression. She is accompanied by Tomas, her 10-year-old nephew. Tomas states, “I am here to help my aunt since she does not speak English.” Which of the following is the most appropriate approach to this clinical encounter? Contact a professional telephone-based language translation service. When compared to White psychiatric patients, Black psychiatric patients are more likely to: Be involuntarily hospitalized for care. A 56-year-old Muslim woman presents for an office visit. Her records show that she has been in the U.S. for less than a year and has not had an examination in over 10 years. She mentions that she does not want to disrobe or remove her head cover. You consider that: The option of having a modified physical examination with minimal disrobing should be discussed with the patient. The PMHNP is aware that the LGBTQ population is a marginalized group so she modifies office forms and her history-taking approach accordingly. Which of the following is not an appropriate question while taking a patient history as it demonstrates a lack cultural awareness by the PMHNP? Do you have a girlfriend? 9 Mr. Jackson is a 72-year-old man who is recently diagnosed with prostate cancer. Prior to his next appointment, he speaks with two prostate cancer survivors, joins an online chat-group for patients with prostate cancer, and spends at least 2 hours a day on the web reading about prostate cancer. His actions are an example of: Intellectualization The above-mentioned mechanism Mr. Jackson is using would be an example of which of the following? Neurotic Which of the following is a defense mechanism that is helpful to the patient and likely to move the patient forward in meeting his or her coping needs? Suppression A 56-year-old woman, Mrs. Davis, drinks at least a 12-pack of beer every evening. She refuses to believe that her drinking is problematic though her relatives report several examples of situations where her drinking has resulted in harm. For example, one evening she started a small house fire after starting dinner and then passing out, and on another occasion she drove her truck into the ditch. Had it not been for neighbors and family she might have died. She is exhibiting an example of which defense mechanism? Denial Based on the scenario: A 56-year-old woman, Mrs. Davis, drinks at least a 12-pack of beer every evening. She refuses to believe that her drinking is problematic though her relatives report several examples of situations where her drinking has resulted in harm. For example, one evening she started a small house fire after starting dinner and then passing out, and on another occasion she drove her truck into the ditch. Had it not been for neighbors and family she might have died. Which of the following best describes the type of defense mechanism exhibited by Mrs. Davis? Primitive In the above-mentioned example of Mrs. Davis, a rationalization statement would be: “I don’t even leave the house when I drink so I’m not hurting anyone.” Rationalization is an example of which of the following? Neurotic A 32-year-old man being treated for depression describes his attempt to socialize at a recent party as a “complete nightmare” and “nothing went right.” This is an example of which cognitive distortion? Catastrophizing Labeling of distortions is a technique often used in: Cognitive behavioral therapy Mr. Jacobs is a 65-year-old man with COPD and a 60 pack-year history who is currently smoking 1.5 packs of cigarettes per day. He is reading a pamphlet in your office about smoking cessation. You ask him if he has any questions and he states, “I don’t plan to quit smoking. My health is pretty good.” According to the Transtheoretical Model of Change, he is most likely in which of the following stages? Precontemplation You see a 55-year-old woman with major depressive disorder, type 2 diabetes mellitus, hypertension, and dyslipidemia. Evaluation today reveals a BMI=36 kg/m2 . She states, “I just do not know where to start in trying to lose some weight.” Which of the following is the most appropriate response to this statement? “What barriers do you see to losing weight?” The “miracle” question is a technique used in: Solution-focused therapy Which of the following is not a technique used in motivational interviewing? Silence The communication skill that involves repeating what was being said in a different way and with different words is: Reflection Examining the pros and cons of change is conducted during which stage of change? Contemplation Which of the following is not a goal of the maintenance stage of change? Make the change When the NP experiences feelings or thoughts towards a client, this is termed: Countertransference While conducting a therapeutic session with a 24-year-old male with major depressive disorder, all of the following techniques are utilized during cognitive behavioral therapy except: “Miracle” question Mary is a 36-year-old accountant who is undergoing psychotherapy for postpartum depression. Which of the following techniques is consistent with an Interpersonal Psychotherapy (IPT) approach? Role playing John, a 26-year-old barista at the local coffeehouse, is being seen routinely to address generalized anxiety disorder. He is also taking a SSRI. At this session, he reports that he went on a date last weekend, but states “It went horribly wrong from the start. Absolutely nothing went right that night.” The PMHNP recognizes that these are catastrophizing statements. An appropriate response would be: “Can you tell me one thing that went correct that night?” 10 Which of the following statements is false regarding the diagnosis of major depression? More likely to occur in men than women Karen, a 48-year-old married woman with 2 teenage children who works as an administrative assistant at the local community college, presents for concerns about irritability. You administer a PHQ-9 and she scores a 17. With this score, you assess that she has: Moderately severe depression Which of the following is not a DSM criterion for major depressive episode? Altered mood associated with bereavement Ben, a 22-year-old who works as a short order cook, is being evaluated for persistent depressive disorder (dysthymic disorder). Which of the following characteristics is most attributed to this mood disorder? Early onset of illness Jeremy, a 36-year-old married attorney, was referred from his primary care provider for a consultation of his depression. He relates problems with what he would call “minor” depression and “mood swings” for at least 15 years. He denies ever having any suicidal ideation, hospitalization or legal difficulty. On the MDQ he checks 4 items positive and 3 as “possibly positive.” Which disorder most likely fits his symptoms? Cyclothymic Disorder The patient with bipolar disorder who is most likely to be misdiagnosed as having a unipolar depression most likely has: Bipolar II Of the following in need of an antidepressant, who is the best candidate for fluoxetine (Prozac®) therapy? A 28-year-old woman who occasionally “skips a dose” of her prescribed medication and is using a progestin implant (Nexplanon®, Implanon®) for contraception You see a 45-year-old woman with major depressive disorder (MDD) who started taking standard-dose sertraline one week ago. She returns today with a chief complaint of “not really feeling any better. In fact, I think I might feel worse. I have this on-and-off headache right over my eyes since I started the medication.” Results of physical examination reveal the following: Well-groomed and appropriately-dressed for the occasion, PERLA, fundi WNL, CN 2–12 intact, clear, fluid speech. A lag of a number of weeks in the onset of SSRI therapeutic effect is expected. Frontal headache is a common short-term problem with early SSRI use A 26-year-old married woman with a 2-year-old daughter presents for evaluation of depression that she believes began after the birth of her daughter. She has a BDI score of 23. She relates that she is overall healthy and that she is 16-weeks pregnant. Which of the following would not be an appropriate course of action? Advise no medication or therapy at this time A drug demonstrated to cause teratogenic effects in human study but benefits usually outweigh risk of use in a life-threatening situation is assigned pregnancy risk category: D The majority of prescription medications are assigned pregnancy risk category: C There is positive evidence that the use of lithium by a breastfeeding woman can pose a risk to the infant. This medication meets Hale's Lactation Risk Category: L4 An overdose of which of the following medications is most likely to be fatal? Amitriptyline SSRI withdrawal syndrome is best characterized as: Bothersome but not life threatening A 56-year-old woman is seen in the emergency department with headache, dizziness, and marked hypertension (BP=205/145 mm Hg). She is taking “some medication” for a psychiatric condition but cannot remember the name. She reports that she felt fine the previous night as she celebrated her wedding anniversary with a “wonderful dinner” out at a local German restaurant. She is most likely taking which of the following medications? Phenelzine A 28-year-old man who works at an accounting firm is being treated with paroxetine 20 mg for major depressive disorder. After 6 weeks, there is little improvement and he continues to feel depressed, having a difficult time focusing at work, and low interest in his usual enjoyable activities. Prior to therapy his Zung score was 68. Currently his Zung score is 65 and his symptoms are not remarkably different after 6 weeks of paroxetine therapy. Which of the following would not be recommended for this patient? Discontinue paroxetine and start psychotherapy sessions Problems with treatment adherence in the patient with bipolar disorder can be addressed in part by acknowledging the ambivalence the patient has towards treatment. True Patients with bipolar disorder are more likely to attempt suicide during manic episodes. False Patients rarely volunteer information about manic or hypomanic symptoms. True Patients usually exhibit limited insight during a manic phase. True A 22-year-old male with type I diabetes mellitus and generalized anxiety disorder is currently being successfully treated for major depressive disorder, recurrent. He has been symptom-free for the past 6 months and he asks if he can stop taking his sertraline. You counsel that he has a high risk of recurrence due to which of the following (more than one option can apply): Past episodes of depression. Presence of chronic medical condition. Co-occurring anxiety disorder. His age. Which of the following is false when considering discontinuation of treatment for stable major depressive disorder? Treatment should be discontinued immediately rather than tapering doses. 11 During a panic attack, symptoms tend to peak at approximately ____ minutes into the episode. 10 Which of the following symptoms is not consistent with a panic attack? Fatigue The comorbidity of panic disorders with other psychiatric disorders is 90%. The lifetime prevalence of major depressive disorder in patients with panic disorder is 50%. True; True A 68-year-old man presents with symptoms of anxiety. He provides a list of medications he is currently taking. Which of the following is least likely to contribute to his anxiety symptoms? Methotrexate The abnormal regulation of all of the following is implicated in panic disorder except: Thyroid Stimulating Hormone (TSH) Which of the following is not an essential diagnostic component of GAD? Sexual dysfunction Medical conditions associated with anxiety-like symptoms include all of the following except: Hyperglycemia A 28-year-old female presents for help in managing a generalized anxiety disorder. An appropriate first-line agent is: Sertraline In which of the following anxiety disorders is the proportion of the population with the disorder equal between men and women? Obsessive-Compulsive Disorder (OCD) Jared, a 24-year-old dental student, establishes care for treatment of OCD. Predictors of poorer prognosis include all of the following except: Episodic Nature Evan, a 26-year-old factory worker, describes intense anxiety and excessive worry. This occurs any time he has to speak to his boss. He has a difficult time approaching his coworkers because he feels very self-conscious. He believes he is missing out on possibly important work information because he cannot join into the group of coworkers. He relates racing heart rate, shallow breathing and chest tightness. Evan’s symptoms are most consistent with: Social anxiety disorder. An appropriate rating scale to use for patients with obsessive compulsive disorder is: Y-BOCS Ashley, 28 years old, presents for a psychiatric evaluation stating, “The doctor thought I might have panic disorder.” She states that she has had 2 panic attacks that caused her to go to the emergency department (ED) where she had a thorough work-up that did not reveal any serious physical health problems. She was told to seek psychiatric care. Which of the following statements would not be consistent with the diagnosis of panic disorder? “My attacks always happen after I’ve had a bad argument with my boyfriend.” Approximately what percent of patients with post-traumatic stress disorder (PTSD) recover completely without treatment? 30% One of the major contributors to the development of PTSD is a lack of coping skills. PTSD treatments with the most robust outcomes are those that include pharmacotherapy as the primary The diagnosis of PTSD is usually made within the first 4 weeks after a traumatic event. False False False A 32-year-old female with generalized anxiety disorder has been on alprazolam 1 mg TID for 6 months. When considering discontinuation, which of the following is false? Withdrawal symptoms are generally considered minimal and non-life-threatening Essential aspects of trauma-informed care include all of the following except: Encouraging the individual to expose him/herself to triggers associated with re-traumatization. A construction crane has collapsed onto a crowded city block, resulting in multiple injuries, including families waiting to enter a nearby museum. Psychological first aid efforts include all of the following elements except: Separating the physically injured from the uninjured. 12 Which of the following statements is false regarding schizophrenia? Patients with schizophrenia are more likely to commit a homicide than a member of the general public According to DSM criteria, which of the following are characteristics of schizophrenia? (More than one option can apply.) Delusions, Hallucinations, Disorganized speech Laura, a 24-year-old woman, was diagnosed with schizophrenia 18 months ago and presents for follow-up. She mentions that she has felt “out of it” most of the day since her medication change 5 weeks ago. She also states that she has gained 10 lbs (4.54 kg) since her last visit. This patient is most likely taking: Quetiapine Indicate whether each of the following is a positive (P) or negative (N) schizophrenia symptom. _p___ Hallucination __n__ Poverty of speech _n__ Avoidance of eye contact _p___ Disorganized behavior Mrs. Engel is a 75-year-old woman with a 25-year history of type 2 diabetes mellitus who was referred for consultation of new-onset visual hallucinations. She describes that she sees pictures of familiar scenes and people but does not hear voices. She is aware that these are not real and during the periods of hallucination she is lucid and alert. She has no cognitive impairment and no past psychiatric history. Her vision has been slowly deteriorating for the past 7 years due to macular degeneration. Which of the following is the most likely explanation for this patient? Charles Bonnet syndrome A 22-year-old male diagnosed with paranoid schizophrenia has been taking haloperidol for the past 6 months. During this visit, the PMHNP acknowledges involuntary repetitive muscle movements and excessive eye-blinking that were not documented at his last visit. An appropriate next course of action will be to: Administer AIMS questionnaire and compare to baseline value. A 22-year-old patient is newly diagnosed with schizophrenia without hallucinations. Which of the following does the PMHNP realize is the most critical task to complete at this visit? Educate patient on the importance of medication adherence. The PMHNP would anticipate that treatment commonly employed to reduce the morbidity of schizophrenia include all of the following except: Electroconvulsive Therapy (ECT) A 34-year-old male is brought into the ED with symptoms of muscle rigidity, hyperthermia, and altered mental status. He has been receiving fluphenazine for the past 2 months and initiated lithium therapy only recently. An expected finding from this patient is: Serum creatine kinase 1000 IU/L. 13 Marcus, a 24-year-old student who is at risk for failing out of law school, is referred by his academic advisor for psychiatric evaluation. He states that he drinks an average of 6 beers per night and last year had a driving under the influence (DUI) arrest. Marcus states, “I don’t think my beer drinking has anything to do with my bad grades. I really only have a couple of beers every night and it helps me to relax.” This statement is an example of: Denial The PMHNP’s response to Marcus that best illustrates motivational interviewing would be: “Relaxing is important to you after you have worked hard at school.” Rank the following from highest alcohol content (1) to lowest (3). 12 oz. (0.36 L) beer (7.2-proof)-- 3 6 oz. (.18 L) wine (22-proof)-- 2 3 oz. (0.09 L) liquor (80-proof)—1 Consider that each person listed below has been consuming drinks that meet the standard definition. Which of the following is likely to have the highest BAC? A 120-lb (54.43 kg) woman after 3 drinks per hour Gary, a 54-year-old man with moderate liver disease, has a history of alcohol abuse but has been abstinent for the past 3.5 years. At this visit, he reports a number of unfortunate events that have happened recently, including the death of a close sibling and loss of employment. As a result, he states that he is having increased urges to drink again. The PMHNP realizes that: Stressful life events can be a trigger for relapse. To prevent a possible relapse by Gary, the PMHNP recommends counseling and treatment with: Acamprosate Sarah is 27 years old and smokes 1 marijuana cigarette on average, 2 to 3 days per week. She weighs 145 pounds (65.77 kg). She decides to stop smoking for a job interview that includes a urine drug screen. Detection of cannabis in her urine can last up to: 1 month Match the substance with the withdrawal symptoms below. Correct answers are: Amphetamine withdrawal-- Depressed mood, fatigue, vivid dreams, psychomotor agitation Cocaine withdrawal-- Depressed mood, fatigue, vivid dreams, psychomotor agitation Alcohol withdrawal-- Increased HR, increased BP, diaphoresis, hand tremor, agitation, hallucinations Opioid withdrawal-- Muscle cramps, arthralgia, diarrhea Randy, a 32-year-old single manager of a sporting goods store, is being seen for follow-up after a 30-day inpatient stay for alcohol dependence. He has been sober for 45 days and continues to crave alcohol throughout the day. Which medication can be prescribed for Randy as a part of his treatment recovery plan to target alcohol cravings? Naltrexone Dana, a 44-year-old registered nurse, is preparing to be discharged from a 30-day inpatient treatment facility for alcohol and methamphetamine dependence. She wishes to start a medication to help keep her abstinent from alcohol. She has extensive dental work planned to begin within the next month. Which medication would be contraindicated for use given this information? Naltrexone The region of the brain that is responsible for conditioned learning and connecting an experience with emotion is the: Amygdala Strategies to prevent remission among patients with substance use disorders include all of the following except: Confront drug-using peers for closure When deciding on a treatment setting to manage withdrawal symptoms for a 46-year-old man with a history of alcohol abuse, which of the following factors is most prominent in favoring hospitalization? Prior history of delirium tremens A 19-year-old man is brought into the emergency department by his friends who are concerned about his health. Physical examination reveals muscle weakness, dilated pupils, heart rate=140 bpm, blood pressure=180/115 mm Hg. His friends say that he may have “taken something” orally about 2 hours ago. Which of the following is the most likely illicit substance? Dextroamphetamine 14 Match the personality disorder symptom to the disorder type. No conscience and no remorse Suspicious of others’ motives Need for admiration and lacks empathy Unstable interpersonal relationships, self-image and impulsivity Excessive emotionality and attention-seeking Submissive, fears separation, clinging Detached from social relationships and a restriction of affect interpersonally Answers: No conscience and no remorse: Antisocial Suspicious of others’ motives: Paranoid Need for admiration and lacks empathy: Narcissistic Unstable interpersonal relationships, self-image and impulsivity: Borderline Excessive emotionality and attention-seeking: Histrionic Submissive, fears separation, clinging: Dependent Detached from social relationships and a restriction of affect interpersonally: Schizoid Which of the following is not a Cluster B personality disorder? Obsessive-Compulsive Which of the following is not a Cluster B personality disorder? Obsessive-compulsive Cluster A disorders are best characterized as: Odd, eccentric, aloof disorders. Aamil is a 34-year-old married physician you see approximately monthly for counseling related to various work and relationship issues. He is diagnosed with Cluster B traits. He recently presented with a one-month history of symptoms consistent with major depressive disorder. An appropriate first-line psychotropic agent would be: Sertraline 24- You are interviewing Adriana, a 34-year-old married mother of two, who has feelings of depression. As the interview progresses, you become concerned that borderline personality disorder is a possible diagnosis and you ask more focused questions. Which of the following statements is least likely to be characteristic of a statement made by a person with borderline personality disorder? “I left the party after about 20 minutes. Not one person had commented on my 10-pound (4.54 kg) weight loss and new dress.” Jamie is a 27-year-old single mother who is being seen every two weeks for counseling regarding borderline personality disorder. She describes an episode last week when her significant other left for a trip for a few days and she became enraged when he did not call one night, fearing that he will not return. In her rage, she destroyed most of his belongings. The PMHNP recognizes that this behavior likely stems from which of the following? An inability to attain object constancy When initiating psychotherapy for a patient with borderline personality disorder, an important first step in establishing the therapistpatient relationship is: Setting limits and defining roles 15 Among the elderly (age 65 years and older), the highest suicide rate is observed in: White men Suicide: True or false? True Males represent nearly 80% of all completed suicides. When compared to males, female attempts at suicide are approximately 2−3 times more common. The highest rate of completed suicide is found in adolescent males. Inquiring about suicidal ideation could precipitate the act. Correct answers: TRUE- Males represent nearly 80% of all completed suicides. TRUE- When compared to males, female attempts at suicide are approximately 2−3 times more common. FALSE- The highest rate of completed suicide is found in adolescent males. FALSE- Inquiring about suicidal ideation could precipitate the act. Which of the following is false regarding suicides? The highest suicide rate in men is from age 25−34 years. True or False? Asking about suicide will make the person think more about committing suicide. Most people who die from suicide do not talk about it ahead of time. If a person has a firm plan to commit suicide, clinical intervention is unlikely to alter the outcome. Correct Answers: False, False, False The PMHNP is evaluating a 38-year-old man, an Iraq war veteran, in the emergency department (ED) for admission. He has a history of post-traumatic stress disorder and says, “This isn’t about the war, it is about my crazy wife.” He is angry and agitated and makes a direct threat against his wife. An appropriate response includes all of the following except: Contact the Veteran’s Administration for a next-day appointment. Mr. Adams is a 38-year-old construction worker seen in the ED for suicidal ideation. He has a history of major depressive disorder and Cluster B personality traits. He has not been on psychiatric medication for 10 months. His wife found him seated at the kitchen table with a gun and bullets and called the police. His blood alcohol concentration is 0.05 mg/dL. The ED provider has cleared him medically and you are asked to evaluate him for admission to the hospital. As you begin to talk to him you notice that he appears agitated and he states “I’m really angry! Why do I have to be in this goofy gown and why doesn’t someone let me go home? Just let me out of here!” Which of the following would be a sign of impending violence? (More than one option can apply.) Verbal threats, Increasing psychomotor agitation, Escalation in volume of voice Which of the following is the least sensitive in predicting potential escalation of violence? The NP’s sense of impending danger Which of the following is false regarding complicated grief? Psychotropic medications can be used to reduce sadness associated with grief The PMHNP is working with Mrs. Randolph whose husband is seriously ill with stage 4 lung cancer. Mr. Randolph’s oncology healthcare providers have stated that hospice care is the most appropriate option at this point and that comfort is the main therapeutic goal. The patient states, “He seems fine with the prognosis but I have told the doctors that I want a second opinion.” According to Kubler-Ross, which stage of grief does this statement reflect? Bargaining The PMHNP’s best response to Mrs. Randolph is “You feel scared that there may be no hope for his survival?” Which of the following statements is least accurate regarding suicide risk assessment documentation principles? An adequate assessment can reliably predict suicide. When considering the use of a no-suicide contract, all of the following should be considered except: Well-designed studies demonstrate their effectiveness in preventing suicide attempts 16 True or false? Most standardized screening instruments for depression are not valid in people 65 years of age. True False False False False False Advanced age is a risk factor for developing depression. Most elderly persons who commit suicide do not talk about their plans. Up to 50% of people with dementia also are depressed. False- Most standardized screening instruments for depression are not valid in people 65 years of age. False- Advanced age is a risk factor for developing depression. False- Most elderly persons who commit suicide do not talk about their plans. True- Up to 50% of people with dementia also are depressed. A 73-year-old man who lives independently is accompanied by his daughter for evaluation. The daughter expresses concern that her father seems to be more forgetful, especially in keeping appointments and paying bills on time. The daughter notes that his change in mental function has become more apparent after his wife of 45 years passed away about 6 months ago. You administer the mini mental status exam and he scores 22. This would suggest: Mild cognitive impairment A PMHNP is asked to evaluate a 78-year-old woman residing in a nursing home for potential dementia. Which of the following would support a diagnosis of dementia? (Indicate all that apply.) -Unable to recall recent events, such as what she had for breakfast -Presence of visual hallucinations -Difficulty finding the right word to use in conversation -Failure to recognize objects Mrs. Little is a 78-year-old woman with recently-diagnosed Alzheimer disease (AD) who is here today for an office visit with her 55-year-old daughter. According to her daughter, Mrs. Little struggles with word finding and has difficulty following directions. She seems “not to care about what is going on around her,” while other times is engaged in family activities. According to her daughter, Mrs. Little will have an angry verbal outburst that is triggered by a minor problem. Her daughter states, “This is not like my mother. Usually she is very patient.” Mrs. Little currently resides with her daughter’s family and they voice a desire for this to continue “as long as possible and safe.” When evaluating Mrs. Little’s healthcare needs, choose all the pertinent options. A home safety evaluation should be conducted and appropriate modifications carried out. If Mrs. Little has a sudden change in mental status; her healthcare provider should be contacted as soon as possible. Behavioral difficulties often arise in individuals with AD if their usual routine is disrupted. The use of a cholinesterase inhibitor will likely improve her mental status to a point that is nearly equivalent to her predementia baseline. Mrs. Little should be evaluated for a concomitant mood disorder. The most common adverse effects from cholinesterase inhibitor use include nausea and diarrhea. A second-generation antipsychotic* should be started to help avoid the angry outbursts. Correct answers: -A home safety evaluation should be conducted and appropriate modifications carried out. -If Mrs. Little has a sudden change in mental status; her healthcare provider should be contacted as soon as possible. -Behavioral difficulties often arise in individuals with AD if their usual routine is disrupted. -Mrs. Little should be evaluated for a concomitant mood disorder. -The most common adverse effects from cholinesterase inhibitor use include nausea and diarrhea. Which of the following is the least likely characteristic of Alzheimer disease? Perceptual disturbances including hallucinations A 74-year-old male is brought into the clinic for evaluation after recent erratic behavior, including confusion that can last a few hours at a time, up to three times per day, over the past month. The caregiver reports that he recently started to take a new medication. Which of the following medications is least likely to cause these episodes? Sertraline Which of the following is least likely to be noted in the person with Lewy body dementia? Short-term memory loss In what stage of dementia do cholinesterase inhibitors demonstrate the most benefit? Mild cognitive impairment Early AD Mild-to-moderate AD Severe AD Correct: Mild-to-moderate AD Your patient with dementia develops severe bradykinesia, gait disturbances, rigidity and tremor after taking a low-dose SGA for severe hallucinations. Which of the following dementia types do you suspect? Lewy body dementia Which of the following is least essential to the work up for ACUTE memory loss? Head CT Scan Bill is a 67-year-old retired plumber who is accompanied by his wife. She expresses concern about Bill’s mental ability as he seems to be having increasing difficulty with word-finding and following conversations. The PMHNP performs a mini mental status exam and he scores an 18. This would indicate: Moderate Mental Impairment When assessing a 73-year-old woman with sudden-onset mental status change, all of the following initial diagnostic tests would be essential except: HIV Test When considering therapy for a 71-year-old man with mild-to-moderate depression, the PMHNP considers all of the following except: ECT should be avoided in those over 65 years Indicate whether each of the following characteristics is consistent with delirium, dementia, or both. Sudden onset of mental status change Irreversible mental status change Precipitated by an acute underlying condition Duration can last months to years Correct answers: Sudden onset of mental status change- Delirium Irreversible mental status change- Dementia Precipitated by an acute underlying condition- Delirium Duration can last months to years- Dementia 17 You see a healthy child who was born at 39-weeks’ gestation. She can pull to standing position with ease, is not walking solo, enjoys playing peek-a-boo, and recently began to respond appropriately to the request, “Pick up the spoon.” This baby is approximately ____ months old. 10-11 Stranger anxiety typically starts with children at: 9 months old A 15-year-old adolescent female presents with finger-shaped ecchymotic areas on her right shoulder but denies abuse or assault. You respond: “I notice the bruises on your arm are in the shape of a hand.” Kitana is a 14-year-old girl seen at your clinic for evaluation because her mother found out that she had been using a razor blade to cut her wrists. the following is false regarding parental consent? You do not require parental consent prior to treating a psychiatric condition. Kitana, the patient in the above question, meets the criteria for major depressive disorder. Which of the following is true regarding depression treatment in children? Based on the scenario below: Kitana is a 14-year-old girl seen at your clinic for evaluation because her mother found out that she had been using a razor blade to cut her wrists. Fluoxetine is one of only two medications FDA-approved for use with adolescents. Cara, a 12-year-old 7th-grader, is diagnosed with juvenile myoclonic epilepsy (JME) and her seizures are well-controlled on topiramate. Before her JME diagnosis, Cara had been diagnosed with ADHD. She had been treated with methylphenidate, however this was discontinued after her seizure disorder was diagnosed. Now Cara is failing in school and the Vanderbilt form from the teacher demonstrates significant inattention and distraction. Cara and her mother request that she be put on a medication for ADHD. Which of the following is the best option for Cara? Start methylphenidate and follow-up in 1–2 weeks When considering management of ADHD in a 15-year-old, the use of a stimulant medication should be avoided or used with caution in the presence of which of the following? (Choose all that apply.) Correct answers: -Hypertension -Cardiac abnormality -Prior history of substance abuse -Presence of motor tics -History of anxiety or agitated states An 8-year-old recently diagnosed with ADHD is prescribed a methylphenidate stimulant (Ritalin SR®) as initial treatment. At the follow-up visit 2 weeks later, the mother reports some improvement in ADHD symptoms but she has noticed the development of a tic consisting of eye blinking and neck jerking. The NP recommends: Switching to atomoxetine (Strattera®). Peter is a healthy 7-year-old second-grader who lives with his 4-year-old sister and his parents. He is brought to the clinic by his parents who are concerned about an 8-month history of behavioral issues. He has an explosive temper, argues with his parents, and blames others for his mistakes. The teacher reports that he often does not follow directions and when corrected he becomes defensive and argumentative. The teacher witnessed him repeatedly prod a pencil into a classmate’s back. When he was confronted about this he denied doing it. You consider the most appropriate course of action is: Initiate family behavioral therapy Which of the following is an expected characteristic of a person with severe intellectual disability? Can perform work-related tasks with supervision The most common inherited form of intellectual disability is: Fragile X True or false? The following are risk factors for conduct disorder. Male gender Chaotic parenting environment Chronic exposure to violence Past diagnosis of oppositional defiant disorder Low socio-economic status Correct answers: TRUE- Male gender TRUE- Chaotic parenting environment TRUE- Chronic exposure to violence TRUE- Past diagnosis of oppositional defiant disorder TRUE- Low socio-economic status Parents have the right to know what their teenager reports to the NP during the psychotherapy appointment. False True or false? The patient with anorexia nervosa seldom does not feel hungry. Patients with bulimia nervosa usually maintain a normal body weight. Bulimia nervosa is more prevalent than anorexia. Mood disorders occur in 20% of people with anorexia nervosa and bulimia nervosa. People with bulimia nervosa are more secretive about their illness than people with anorexia. Correct answers: FALSE- The patient with anorexia nervosa seldom does not feel hungry. TRUE- Patients with bulimia nervosa usually maintain a normal body weight. TRUE- Bulimia nervosa is more prevalent than anorexia. TRUE- Mood disorders occur in 20% of people with anorexia nervosa and bulimia nervosa. TRUE- People with bulimia nervosa are more secretive about their illness than people with anorexia. When evaluating a 4-year-old boy during an initial visit for signs of separation anxiety disorder, appropriate techniques include all of the following except: Ensure child is interviewed separately from parents. Clinical features supporting in the diagnosis of conduct disorder in a 14-year-old boy include all of the following except: Poor academic performance. During an evaluation of a 16-year-old female with substance-use disorder, she confides that she is increasingly confused about her sexual orientation. An appropriate action by the PMHNP is to: Routinely screen for depression and suicidality. When initiating methylphenidate therapy for a 9-year-old boy with ADHD, the PMHNP educates the family on the possibility of all of the following potential adverse effects except: Hypersomnia Which of the following is not a diagnostic criterion for Tourette’s syndrome? Disorder is associated with substance abuse or medical condition Tourette’s syndrome is more frequent in males than females. One-third of children with Tourette’s syndrome will be symptom-free in adulthood. The most common comorbid disorder in patients with Tourette’s syndrome is obsessive compulsive disorder. Correct answers: TRUE- Tourette’s syndrome is more frequent in males than females. TRUE- One-third of children with Tourette’s syndrome will be symptom-free in adulthood. TRUE- The most common comorbid disorder in patients with Tourette’s syndrome is obsessive compulsive disorder. True or false? SSRIs are the first-line treatment for separation anxiety disorder. Functional capacity can help distinguish separation anxiety disorder from normal developmental fears. Correct answers: FALSE- SSRIs are the first-line treatment for separation anxiety disorder. TRUE- Functional capacity can help distinguish separation anxiety disorder from normal developmental fears. The mother of a 5-year-old boy expresses concern about her son who will be starting school soon. She states that “he has always been very anxious to go anywhere without me or my husband. He would sometimes have major crying fits that often cause him to choke and vomit.” The NP replies: He should be evaluated for separation anxiety disorder. 18 Age-related changes in older adults can result in a decreased drug effect for all of the following except: Warfarin For a patient who is 60 years old, with hepatic impairment, or taking concomitant cimetidine, the recommended daily dose of citalopram should not exceed: 20mg Which of the following psychotropic medications would be preferred in the elderly due to its low anticholinergic and sedation effect? Sertraline Accordi The A1C goal for older adults who are frail or with limited anticipated life expectancy of ≤5 years is: ≤8.0% Age-related changes in the elder include all of the following except: Increase in serum albumin Potential adverse effects from medications with significant anticholinergic effect include all of the following except: Hypothermia Absorption of which of the following is least affected by long-term PPI use? Calcium citrate PPIs such as lansoprazole, omeprazole and esomeprazole are all inhibitors of CYP450: 2C19 TMP-SMX should be avoided in elders who are being concomitantly treated with: ARBs or ACEIs 19 A 78 Year-old woman with a 30-year history of hypertension and dyslipidemia and a 10-year history of type 2 diabetes presents with suspected acute coronary syndrome. She is most likely to report a recent onset of: Unusual fatigue Jack is a 16 year-old varsity basketball player who presents for a sports clearance physical examination. His health history is unremarkable and reports excellent activity tolerance. Which of the following would be a finding on Jack’s cardiac examination that would warrant immediate evaluation? A grade 2/6 midsystolic murmur that increases in 10%intensity with position change from supine to standing accompanied by a loud S4 Jane is a 27 year-old woman who presents for a “pap test.” She is new to your practice, has not significant health history and reports excellent exercise tolerance, running up to 5 miles 5-7 days a week and recently was first place in her age division in a 6K road race. Jane reports taking a low-dose combined oral contraceptive and a daily multivitamin. Physical examination reveals a BMI=22.1 kg/m2, mild pectus excavatum, PMI WNL with both heart sounds intact. There is a midsystolic click with late systolic murmur and the murmur moves forward with position change from supine to stand. The rest of her physical examination is unremarkable. The next most appropriate step in her care is to: Inform Jane that obtaining an echocardiogram is a prudent next step. Mrs. Rivera is an 82 year-old woman with infrequent contact with her HCP. She presents for sick visit with the following chief complaint, “I get really dizzy when I walk up a flight of stairs.” She denies chest pain, agrees that she feels “a bit winded” when physically active; this symptom resolves quickly with cessation of trigger activity. Physical examination reveals the following: BP=110/90, gr 2/6 harsh systolic murmur with radiation to the neck, loudest along USB, softer towards axilla, both heart sounds preserved, no S3 or S4, no neck vein distention, no carotid bruit, delayed carotid upstroke. Her clinical presentation is most consistent with the presence of: Calcific aortic stenosis. Raymond is an 18 year-old high school basketball player. He is in for a sports clearance physical examination and denies activity intolerance, chest pain, and syncope. Today’s Assessment Reveals the Following: 74” (188 cm), 220 lb (99.8 kg), Tanner Stage 5. Both heart sounds intact, a grade 2/6 harsh systolic murmur with radiation to the neck, loudest along USB, softer towards axilla, somewhat softer with position change from supine to standing, no delay in carotid upstroke, other pulses intact. Raymond’s findings are most likely the result of: Aortic stenosis Richard is a 62 year-old man w/ HTN heart disease and HF. He presents today for follow up and is without new symptoms. Physical examination reveals the following: PMI @ 5th ICS AAL with a sustained impulse, Gr 3/6 blowing holosystolic murmur with radiation to axilla. The murmur accentuated by rolling patient onto left side, softens when going from supine to standing position, louder with hand grip, 2d heart sound not preserved, and full carotid upstroke bilaterally is noted. These findings are most consistent with: Mitral regurgitation 20 The NP certification exam will contain a number of questions about my state’s NP practice act. False Since each state has distinct requirements for NP scope of practice, no questions specific to a certain state’s practice act will appear on national certification exams. True The charge of the State Board of Nursing is to ensure public safety. True State level authorization dictates the ability of the NP to obtain a Federal DEA number. True The majority of NPs are eligible to obtain a Federal DEA number. True Which of the following describes the ethical principle of beneficence? The obligation of the healthcare provider to help people in need. Which of the following describes the ethical principle of utilitarianism? Healthcare resources are allocated so that the best is done for the greatest number of people. Which of the following describes the ethical principle of veracity? The healthcare provider must be truthful and avoid deception. An organization has donated 1000 pediatric vaccines to a community clinic. Ensuring that the distribution of the vaccines is done in a fair and unbiased manner is an example of: Justice A mother presents her 3-year-old son with a 2-day history of cough and runny nose without fever. The NP explains that this is likely a viral infection and treatment should focus on symptom management. However, the mother is insistent on getting a prescription for antibiotics despite the NP’s explanation that antibiotics will have limited effectiveness and may cause adverse effects. In this scenario, which of the following best demonstrates the ethical principle of nonmaleficence? Denying a prescription for antibiotics While walking in the parking lot of a grocery store, an NP notices an elderly man fall and hit his head on the ground. The NP quickly rushes to provide aid to the man. This is an example of: Beneficence A patient who underwent CABG following a MI develops a surgical site infection. Upon reviewing the patient’s records, the NP notices that standard antimicrobial prophylaxis was not provided prior to surgery. The ethical principle of ________ requires the NP to report this finding. Veracity A mentally competent patient with advanced cancer is explained 2 treatment options. He decides to take the less invasive technique, despite counseling him that his choice has a lower chance for success. Respecting the patient’s choice demonstrates the ethical principle of: Autonomy A 90-year-old woman with moderate dementia, heart failure, and chronic renal insufficiency presents with a new onset of weakness. Further evaluation reveals marked hyperkalemia with a eGFR=22 mL/min/1.73 m2. Nephrology recommends hemodialysis. When discussing this option with the patient, she declines this treatment. She also inaccurately reports the current year, location, and name of the USA president. When asked why she does not want dialysis, she states, “I do not want to be on a machine. I am quite old and my health is not good.” When asked what she believes will happen if she does not have dialysis, she states, “I guess I will die. That is OK.” In reflecting on this patient, the NP appreciates that: She demonstrates competency in this situation and her wishes can be followed. Mr. Nelson is a 75-year-old man in need of surgery. Mr. Nelson has been treated unsuccessfully with conservative therapy for a bowel obstruction. Documented on his record is his consent to surgery that was obtained by the chief surgical resident. During your preoperative visit with Mr. Nelson, he is alert and relatively comfortable. His wife mentions that her husband had a dose of promethazine (Phenergan®) to manage his nausea around the time the surgical consent was obtained. Mrs. Nelson asks, “Is the consent OK since my husband clearly does not feel well?” You respond: You will call the chief surgical resident to clarify the issue of consent. Which of the following best demonstrates the intent of informed consent? Advising a 48-year-old woman about the likely course of illness if no treatment is rendered The adult daughter of an 88-year-old man telephones the nurse practitioner to inquire about her father’s medications. The daughter reports that “my father relies upon me to explain everything to him.” The nurse practitioner's initial response is to: Tell the daughter that the NP can discuss the information only with the patient