Georgette’s PMHNP Clinical Review – Verified Exam Questions and Neuropsychiatric Concepts for Board Prep (2025)

Georgette’s PMHNP Clinical Review – Verified Exam Questions and Neuropsychiatric Concepts for Board Prep (2025) Description: This comprehensive study guide provides verified exam questions and clinical insights for PMHNP certification preparation. Covering diagnostic criteria, treatment interventions, neuroanatomy, psychopharmacology, therapeutic communication, and psychiatric emergencies, this document is ideal for advanced practice nurses preparing for board exams. Includes real-world case scenarios and rationales involving suicide risk, bipolar disorder, serotonin syndrome, cognitive disorders, and therapeutic frameworks. A 16-year off boy presents with a long head, large ears, and hyper extensible joints, is very shy, and starts rocking and flapping his hands when he is upset. Which of the following is your most likely diagnosis? A. Tourette disorder B. Autism C. Fragile X D. Rett disorder - -Fragile X a 17 year old arrives at the emergency department with nonspecific complaints The patient's temperature is 100.8, pulse rate and blood pressure are elevated, and pupils are dilated with decreased reaction to light. Two days ago, the patient began taking sertraline for the treatment of depression. the patient has a history of substance use and smoked marijuana one week ago. The diagnosis is - serotonin syndrome A 23 year old woman is Brought in to to the ER after attempting to commit suicide by cutting her wrists. Which action by the PMHNP would be of highest priority initially? A. Assess her coping behaviors B. Assess her current level of suicidality C. Take her vital signs D. Asess her health history - -take her vital signs A 24 year olf female attempts suicide by overdose on an MAOI phenelzine. She is stabilized in the hospital. Ten days later she is started on venlafaxine and becomes tachycardia and diaphoretic, and develops myoclonic jerks. What condition is this? A. NMS B. Opisthotonos C. Akathisia D. Serotonin syndrome - -serotonin syndrome a 48 year off Caucasian male presents for his therapy appointment. He is sad about losing his wife recently to covid 19. He reports feeling thoughts of hurting himself. He has a past history of overdosing on propranolol several years ago. Which of the following places him at higher risk of suicide? A. Previous attempt B. Age C. Gender D. Marital Status - -A previous attempt A 64 year old caucasian male referred for treatment of refractory depression by his PCP reports continued lack of purpose, insomnia, decreased energy, reduced interest in pleasurable activities since losing his wife hit by a drunk driver 3 months ago. Which of the following is an assessment priority? A. Prior and current meds, dose, clinical response, side effects. B. Thoughts of self-harm, plan, intent, access C. Extent of alcohol use, and motivation to reduce to safe levels D. Sleep patterns and hygiene - -thoughts of self-harm, plan, intent, access A 69 year old man with diagnosis of delirium has symptoms of psychosis which include frightening auditory and visual hallucinations and paranoid delusions. Which of the following medications should be chosen first for this man's symptoms? A. Haloperidol B. Quetiapine C. Valium D. Olanzapine - -haloperidol. A 72 year old is brought in by her husband with increasing forgetfulness, decreased activity, and decreased appetite for 2 months. She has a history of hypertension and is being treated with lisinopril. The exam is normal and the mini mental status exam provides a score of 24 but she declines to answer some questions and needs to be urged to participate in the assessment. What is the most likely diagnosis? A. Alzheimers disease B. Vascular dementia C. Depression D. Delirium - -depression A client experiencing difficulties with working memory, planning, and prioritizing, insight into his problems, and impulse control presents for assessment. In planning his care, the PMHNP should apply his knowledge that these symptoms represent problems with the A. frontal lobe B. Temporal lobe C. Parietal lobe D. Occipital lobe - -frontal lobe A client presents with complaints of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical areas off the brain that is responsible for the regulation of these functions? - -Hypothalamus A client says to the PMHNP, Some days life is just not worth it. All my wife and I do is fight and scream. Things at home were be calmer and simpler if I just wasn't there anymore." The most therapeutic response is: A. Do you mean yo are thinking about leaving your wife to moving out?" B. Tell me what you mean by "it would be simpler if you weren't there anymore." C. So you are thinking suicide might be an option for you? D. Remain silent. - -B. Tell me what you mean by "it would be simpler if you weren't there anymore" A male patient informs as adult PMHNP that he has not slept in three days, has poor concentration, and denies fatigue. The patient's diagnosis is: A. ADHD B. Bipolar disorder C. Panic disorder D. Primary insomnia - -bipolar disorder A married female patient has been in therapy with an adult psychiatric and mental health nurse practitioner for 3 months. The patient's husband abuses alcohol and refuses treatment. The night before the next scheduled appointment, the patient telephones the clinical nurse specialist stating that her husband is drunk, violent, and threatening to kill her. The PMHNPs priority intervention is A. To arrange for an emergency psychiatric intervention B. Arrange for the woman's safety C. Request a restraining order D. Request to speak to the husband - -Arrange for the woman's safety. A patient has been treated for the past several years with fluphenazine (Prolixin). You tonic that he is drooling and has a slight pill rolling movement of the fingers. These are EPS symptoms known as A. pseudo parkinsonism b. anticholinergic effects C. Tardive dyskinesia D. Acute dystonia - -A. Pseudoparkinsonism A patient is diagnosed with schizophrenia. Which of the following would be the appropriate question for the PMHNP to ask when assessing side effects produced by dopamine antagonism in the nigrostriatal pathway? A. Are you experiencing constipation? B. Are you experiencing pill rolling tremors, shuffling gait, and mask like facial expression? C. Are you experiencing increased thirst? D. Are you experiencing breast discharge? - -Are you experiencing pill rolling tremors, shuffling gait, and mask like facial expression A patient with a known diagnosis of bipolar I disorder presents to your clinic complaining of manic symptoms and insomnia. Your patient has been stable on lithium for the past six months To determine if a medication change or increase is warranted, it is important to gather more information. You suspect a possible medication-induced manic episode when the patient endorses what? A. She was recently placed on a beta blocker for anxiety. B. She was recently prescribed a benzo C. She recently had a flare up of her rheumatoid arthritis and received treatment for one week (aka a steroid) D. She recently began a new retroviral agent for hepatitis - -recently treated for RA A week after raising the dose of clomipramine, a patient treated for depression presents to the clinic with reports of change in mental status, fever, and hyperreflexxia. As the treating PMHNP, you know these symptoms are consistent with which of the following? A. NMS B. EPS C. Hypertensive crisis D. Serotonin syndrome - -serotonin syndrome Absence of movement or difficulty initiating movement - -akinesia Treatment: cogentin According to the current clinical guidelines for treating a patient with bipolar I disorder mania with psychotic features, an adult psychiatric and mental health nurse practitioner prescribes: A.) Lithium B. Citalopram C. Lamotrigine D. Quetiapine - -quetiapine Acetylcholine is made - -basal nucleus of Meynert action in contemplation - -help the person find a change strategy that is realistic, acceptable, accessible, and effective. action in precontemplation - -give information to raise awareness of the problem, but do not try to tell the person what to do. action step in action - -support and advocate help accomplish steps for change. action step in maintenance - -help the person identify the possibility of a relapse identify strategies to prevent relapse. action step in preparation - -help the person find the change strategy that is realistic, acceptable, appropriate, and effective. Acute onset altered level of consciousness inattenion poor prognosis--1 year mortality rate of is up to 40% - -delirium ADHD causes DNS - -dopamine noreip serotonin ADPIER - -Assessment, diagnosis, Plan, intervention, evaluate, refer out last. Adverse effects of depakote - -alopecia hepatotoxicity (RUQ pain or brown/red urine--order LFTs) AST 5-40, ALT 5-35, yellowing of skin or eyes, fatigue Adverse reaction to Lamictal - -Steven J