ANCC Practice PMHNP Exam Sample

ANCC Practice PMHNP Exam Sample Prostate, mammogram, lung, colorectal, and cervical cancer screenings are all listed under which medical coverage: Medicare Part B Medicare Part C Medicare Part A Medicare Part D - ANS Medicare Part B Which of the following populations has the highest rates of serious mental illnesses to include PTSD, MDD, Bipolar Disorder, and schizophrenia? College campuses Low-income urban areas Migrant workers Prisoners - ANS Prisoners The governing body responsible for the approval of new drugs and determining when a medication can be sold and be available to the public as either a prescription or over-the-counter option is the : Centers for Medicare and Medicaid Services Food and Drug Administration Centers for Diseases Control and Prevention World Health Organization - ANS Food and Drug Administration What circumstance places homeless individuals at a greater risk for experiencing violence, medication noncompliance, and treatment resistance as compared to other populations? Unemployment Poverty No obvious risk Co-occurring disorders - ANS Co-occurring disorders A 22-year-old male patient is evaluated by the psychiatric mental health nurse practitioner. She notes muscle rigidity, flat affect, slowed motor responses, and tremors. Upon further review of medications, the provider notes that the patient is currently taking 30 milligrams of Abilify (aripiprazole) daily. The practitioner annotates the physical signs as which class of extrapyramidal (EPS) side effects? Acute dystonia Akathisia Parkinsonian symptoms Tardive dyskinesia - ANS Parkinsonian symptoms The psychiatric-mental health nurse practitioner at a local health clinic is implementing a quality improvement project to assess current clinic services available to patients. What is an effective plan for evaluating the clinic's services: Conduct an initial search for epidemiological studies Conduct a patient satisfaction survey Conduct a root cause analysis Interview patient family members - ANS Conduct a patient satisfaction survey Which rating scale is commonly used for the measurement of akathisia? HAM-A CTS-R BARS MAP - ANS BARS The psychiatric mental health nurse practitioner understands that Maslow's Hierarchy of Needs was developed to assist in care planning to help patients obtain their highest potential and self-fulfillment. To achieve the highest level of potential, lower-level needs must be met. Which of the following choices are placed in the appropriate order - from lowest level to highest level of needs? Physiological, safety and security, love/belonging, self-esteem, and self-actualization Love/belonging, physiological, safety and security, love/belonging, self-esteem, and self-actualization Physiological, love/belonging, safety and security, self-esteem, and self-actualization Safety and security, physiological, love/belonging, self-esteem, and self-actualization - ANS Physiological, safety and security, love/belonging, self-esteem, and self-actualization Which of the following laboratory findings indicate an alcohol use disorder: Increased urine, alkaline phosphatase, and serum creatinine levels Increased liver function values and decreased MCV with normal triglyceride levels Elevated potassium and chloride levels Increased MCV and elevated triglyceride levels - ANS Increased MCV and elevated triglyceride levels The mother of a seven-year-old patient calls to inform you that she has considered the medication options for her child diagnosed with ADHD and would like to start methylphenidate. As the PMHNP you understand what to be an important aspect of this care plan: He may need additional dosing depending on how he presents later in the day This child is too young for this medication It is important to first assess any family history of cardiac events or illness This is an inappropriate medication choice for this diagnosis, and he should first be started on clonidine - ANS It is important to first assess any family history of cardiac events or illness A 25-year-old male presents to the mental health clinic with complaints of gynecomastia following initiation of antipsychotic medication due to an acute psychotic episode and inpatient treatment. The nurse practitioner understands that this is likely caused by the medication's effect on which area of the brain? Nigrostriatal Mesolimbic pathway Tuberoinfundibular pathway Mesocortical pathway - ANS Tuberoinfundibular pathway An office manager reads a recent patient satisfaction card. The patient reported that he felt comfortable being treated by the PMHNP and that she was respectful of his wishes and extremely knowledgeable about his condition and medication plan. Additionally, he spoke to her professional behavior and integrity. The manager reports to the PMHNP and congratulates her on successfully accomplishing which ethical principle? Justice Veracity Beneficence Role Fidelity - ANS Role Fidelity A psychiatric mental health nurse practitioner recently increased a 20-year-old male patient's olanzapine (Zyprexa) prescription from a 5 mg to 10 mg daily dose for symptoms related to schizophrenia. During his most recent appointment, he presented with increased delusions and incoherent speech patterns. Which of the following assessment findings is most concerning? Started 600 mg Ibuprofen for muscle pain Began eating grapefruit with breakfast every morning Started smoking again after recent break-up with his girlfriend Reported increased thoughts of suicide - ANS Reported increased thoughts of suicide Which communication method focuses on specific goals and is fundamentally nonconfrontational with an overall objective of eliciting a behavioral change? Humanistic Therapy Cognitive Behavioral Therapy Dialectical Behavior Therapy Motivational Interviewing - ANS Motivational Interviewing Following two months of psychotherapy, the provider, patient, and her parents decide it would be beneficial to initiate pharmacological adjunctive therapy. Which of the following medications would be appropriate for a 15-year-old female patient with a known history of depression? Duloxetine (Cymbalta) Bupropion (Wellbutrin) Fluoxetine (Prozac) Amitriptyline (Elavil) - ANS Fluoxetine (Prozac) A psychiatric nurse practitioner works with a community outreach program to treat mental health disorders within the homeless population. Which of the following situations would the provider most likely encounter within this group: Schizophrenia Depression with comorbid substance use Generalized Anxiety Disorder Bipolar disorder Score0/1P - ANS Depression with comorbid substance use It is important for the psychiatric nurse practitioner to understand the body's response to mental health conditions. Which system is involved in acute fear and/or anxiety? Parasympathetic nervous system Sympathetic nervous system Renin-angiotensin system Mesolimbic system - ANS Sympathetic nervous system A patient presents with a two-year history of impulsive behavior with self-harm tendencies. The 23-year-old male exhibits inappropriate anger that is disproportionate to the severity of situations, leading to affective instability. He notes relationship concerns and a need to constantly be with his partner. The psychiatric nurse practitioner identifies which personality disorder as the most likely to cause these issues? Narcissistic Histrionic Borderline Antisocial - ANS Borderline Becoming familiar with confidentiality standards is a priority for all psychiatric mental health nurse practitioners. Which of the following principles identifies a provider's "duty to warn" responsibility during an imminent danger involving a homicidal client? Respect for Autonomy Principle The Principle of Evidence Tarasoff Principle The Harm Principle - ANS Tarasoff Principle A PMHNP that is actively engaged in strategies designed to reduce homelessness within the community by providing comprehensive inpatient discharge planning, discussing housing options, and scheduling a follow-up care appointment with a plan to contact the patient to check-up on and remind of upcoming appointments is an example of: Prevention Supportive housing services Autonomy Integrated care - ANS Prevention A 13-year-old male patient complains about generalized pain in his lower extremities. The provider does not record any significant findings during the physical examination and laboratory results are within normal limits except for an alkaline phosphatase level of 294 IU/L. What is the most appropriate next step for the psychiatric-mental health nurse practitioner? Suspect viral hepatitis Note the findings as normally occurring during rapid adolescent growth Suspect leukemia and refer to a specialist Order a repeat blood test - ANS Note the findings as normally occurring during rapid adolescent growth A patient that presents to the clinic with a history of bipolar spectrum disorder should be assessed using which of the following questionnaires at both baseline assessment and periodically throughout care? AIMS GDS HAM-D MDQ - ANS MDQ Which of the following options is most appropriate for a five-year-old patient with newly diagnosed ADHD? Behavioral therapy with classroom behavioral interventions Strattera (Atomoxetine) Intuniv (Guanfacine) Adderall (Dextroamphetamine-amphetamine) - ANS Behavioral therapy with classroom behavioral interventions A 16-year-old female presents for a psychiatric evaluation. She has a two-year history of obsessive-compulsive behaviors. Her mother is distraught because she has been complaining of seeing bugs on her skin, even though she is informed that nothing is there. This has resulted in obsessive picking to the point where she causes bleeding. The psychiatric nurse practitioner observes various sores on her upper extremities, chest, and stomach in varying stages of healing. How would the nurse practitioner classify the visible physical injuries found on her body Symptom Disorder Sign Behavior - ANS Sign During a psychotherapy session, the PMHNP is confronted by a distraught and angry patient who abruptly rises during the session, pounds his chest, and screams, "I'm done; I'm finally going to end Jared!" The patient then runs out of the room heading for the exit. The PMHNP, knowing there is an imminent threat to an identified person, is duty bound to do what action? Immediately attempt to warn the potential victim Notify the patient's emergency contact and report the issue so they can contact Jared Contact the local authorities and report the threat Maintain the patient's confidentiality at all times - ANS Immediately attempt to warn the potential victim An 18-year-old patient diagnosed with bipolar disorder wants to enter a research study that will test an experimental drug. The psychiatric-mental health nurse practitioner's initial response is,: "All drug treatments are too risky for you at this time in your illness." "Let's discuss the risks of potentially changing your medications." "We will have to see if you meet the inclusion criteria for this research study." "You will have only a small chance of receiving the experimental drug." - ANS Let's discuss the risks of potentially changing your medications. A 14-year-old patient has nonspecific reports of pain in their legs. The physical examination is unremarkable. Laboratory results are within normal limits except for a markedly elevated alkaline phosphatase level. The psychiatric-mental health nurse practitioner: interprets the findings as normally occurring during a rapid adolescent growth spurt. obtains a rheumatoid profile because elevated alkaline phosphatase is a sign of early rheumatic fever. orders a repeat blood test. suspects that the patient has acute pancreatitis. - ANS interprets the findings as normally occurring during a rapid adolescent growth spurt. Laboratory findings for a patient with an alcohol use disorder indicate increased liver function values and: decreased mean corpuscular volume (MCV) and normal triglyceride levels. elevated potassium and chloride levels. increased MCV and elevated triglyceride levels. increased urine and serum creatinine levels. - ANS decreased mean corpuscular volume (MCV) and normal triglyceride levels. A new patient arrives at the office for treatment for depression. The patient reports taking simvastatin (Zocor) and lisinopril (Zestril). When selecting an antidepressant, the psychiatric-mental health nurse practitioner eliminates fluoxetine hydrochloride (Prozac), based on the knowledge that the combination can lead to increased plasma levels of the statin, resulting in an increased risk of muscle damage and rhabdomyolysis. What is the nurse practitioner's rationale? Both medications are CYP450 3A4 inhibitors. Both medications are CYP450 3A4 substrates. One medication is a CYP450 3A4 substrate and one is a CYP450 3A4 inducer. One medication is a CYP450 3A4 substrate and one is a CYP450 3A4 inhibitor. - ANS One medication is a CYP450 3A4 substrate and one is a CYP450 3A4 inhibitor. During a mental status examination, an 18-year-old patient reports feeling bugs crawling under their skin. The psychiatric-mental health nurse practitioner documents this statement as a: developmental disorder, and suspects cocaine use. hypnagogic hallucination, and suspects schizophrenia. hypnopompic hallucination, and suspects schizophrenia. perceptual disturbance, and suspects the use of cocaine. - ANS perceptual disturbance, and suspects the use of cocaine. The psychiatric-mental health nurse practitioner is responsible for initiating quality improvement at a community mental health clinic. The effective strategy for evaluating the clinic's services is to: analyze the data from epidemiological studies. conduct a root cause analysis. interview patient families. use a survey to elicit patient satisfaction responses. - ANS use a survey to elicit patient satisfaction responses. The psychiatric-mental health nurse practitioner evaluates a new adult patient via telemedicine. The patient has questions about a new medication that they recently started. The nurse practitioner decides to provide psychoeducation and to: email drug information and resources. encourage the patient to seek information on the internet. have a phone conference with the patient's family member. refer the patient to a local primary care provider. - ANS email drug information and resources. Any court of law that evaluates the standards of care provided by the psychiatric-mental health nurse practitioner: compares the actions to the standard of care provided by a psychiatrist. considers what a reasonably prudent health care provider would do. evaluates patient satisfaction data. reviews the nurse practitioner's charts for similar patients. - ANS considers what a reasonably prudent health care provider would do. The psychiatric-mental health nurse practitioner and a team of local mental health professionals are asked to provide crisis counseling service after an assailant recently took a class hostage at a local elementary school, wounded several students, and then shot themself. In preparing for this assignment, the nurse practitioner recognizes that: a child's developmental stage will influence their response to catastrophic stress. a child's lack of an emotional response to a catastrophic event is a predictor of negative long-term consequences. it is necessary for the child's guardian to be present. the event is more important to the child than whether they suffered physical harm. - ANS a child's developmental stage will influence their response to catastrophic stress. A 32-year-old female patient informs the psychiatric-mental health nurse practitioner that she is three months pregnant. She has been stable on fluoxetine hydrochloride (Prozac) for the last two years. The patient asks whether she may safely continue this medication during her pregnancy. The nurse practitioner responds,: "At this time, Prozac is safe for you to continue during your pregnancy." "Cognitive behavior therapy has proven to be successful during pregnancy with no risk to the fetus, so let's discontinue your Prozac." "Let's review the risks and benefits of continuing or discontinuing Prozac for you and the fetus." "Prozac is unsafe for the fetus, so we'll wean you off this medication during your pregnancy." - ANS Let's review the risks and benefits of continuing or discontinuing Prozac for you and the fetus. Established clinical guidelines suggest that suicidality is decreased by treating patients who have borderline personality disorder with: cognitive behavior therapy. dialectical behavioral therapy. eye movement desensitization reprocessing. interpersonal therapy. - ANS dialectical behavioral therapy. A six-year-old patient with autism spectrum disorder has not responded to six months of psychosocial interventions and continues to demonstrate aggressive tendencies toward a younger sibling. The psychiatric-mental health nurse practitioner prescribes: carbamazepine (Tegretol) 200 mg/d. haloperidol lactate (Haldol) 2 mg/d. dialectical behavioral therapy. venlafaxine hydrochloride (Effexor XR) 37.5 mg/d. - ANS dialectical behavioral therapy. The psychiatric-mental health nurse practitioner working in a crisis stabilization unit evaluates a patient verbalizing suicidal thoughts after being sexually assaulted. Before processing through the traumatic event, the nurse practitioner first attempts to: incorporate psychoeducation to address emotional dysregulation. promote cultivation of coping strategies to enhance distress tolerance. provide an environment of safety. provide intense psychotherapy. - ANS provide an environment of safety. The psychiatric-mental health nurse practitioner uses a cognitive behavior therapy approach to help a patient address self-defeating behaviors. After identifying the stressor that causes the inappropriate behavior, the initial strategy is to explore: alternative positive responses to the stressor. negative consequences of the responses to the stressor. possible outcomes of alternative responses. rational and irrational beliefs about the stressor. - ANS rational and irrational beliefs about the stressor. A patient who has borderline personality disorder experiences intense anxiety when the psychiatric-mental health nurse practitioner goes on vacation. The most appropriate explanation for this reaction is that the patient: employs primitive idealization. employs projective identification. has not developed clear ego boundaries. has not developed object constancy. - ANS has not developed object constancy. An initial psychiatric evaluation of a patient reveals a normal mental status and appropriate behavior, despite a parent's reports of disobedience, poor grades, and laziness. To further assess the patient's functioning, the psychiatric-mental health nurse practitioner first: asks that the parent complete a Child Behavioral Checklist at home. asks the parent to bring in the patient's educational and medical records. meets with the parent and patient together to explore the discrepant report. screens for signs of emotional, physical, sexual, or verbal abuse of the patient. - ANS meets with the parent and patient together to explore the discrepant report. The psychiatric-mental health nurse practitioner is employed in a newly created attending role on a psychiatric inpatient unit. To promote an interprofessional environment, the nurse practitioner: assigns a role for all staff members in improving patient outcomes. discusses the resistance directly with the physicians. educates staff members on the role of the psychiatric-mental health nurse practitioner. works with the nurse manager to organize all levels of nursing staff. - ANS assigns a role for all staff members in improving patient outcomes. The psychiatric-mental health nurse practitioner sees a 12-year-old patient who takes methylphenidate extended release (Concerta) 18 mg/d for attention-deficit hyperactivity disorder (ADHD). The nurse practitioner observes a tic, which the parents report began after the patient began taking the psychostimulant, and it has been increasing in severity. Both the parents and the school report that the medication is helpful. The nurse practitioner: continues the psychostimulant and has the parents and teachers observe the patient. discontinues the psychostimulant, prescribes guanfacine hydrochloride extended release (Intuniv), and monitors the patient. increases the dose of the psychostimulant and schedules a follow-up appointment in three months. prescribes lisdexamfetamine dimesylate (Vyvanse) at a dose appropriate for the patient's age and monitors the patient. - ANS discontinues the psychostimulant, prescribes guanfacine hydrochloride extended release (Intuniv), and monitors the patient. increases the dose of the psychostimulant and schedules a follow-up appointment in three months. A patient from India emphasizes a strong feeling that they are one with Brahma and connected to life through this being. While developing a treatment plan, the psychiatric-mental health nurse practitioner realizes that this patient's spirituality also guides their: ability to engage in treatment. interpretation of life events. predisposition to illness. response to medication. - ANS interpretation of life events. The psychiatric-mental health nurse practitioner is tasked with continually improving the quality of care on an inpatient unit. The nurse practitioner implements a: chart review analysis. fishbone diagram. plan-do-study-act (PDSA) process. root cause analysis. - ANS plan-do-study-act (PDSA) process. To improve treatment and patient outcomes, the psychiatric-mental health nurse practitioner utilizes evidence-based practice. An acceptable resource for evidence-based meta-analysis is the: Cochrane database. Medscape database. PubMed database. WebMD database. - ANS Cochrane database. The psychiatric-mental health nurse practitioner is concerned about access-to-care issues in the local community and wants to help develop healthcare policy to help patients access care more effectively. The nurse practitioner knows one of the most effective avenues for developing and advocating for policy is: asking the clinic manager to explore options for access. organizing a political protest. working with the local chapter of the nurse's professional association. writing letters to the editor of the local newspaper. - ANS working with the local chapter of the nurse's professional association. A patient is referred to an outpatient psychiatric clinic for evaluation of depressive episodes after bouts of overeating. Assessment reveals a five-year history of episodes of uncontrollable overeating precipitated by feelings of tension. This occurs about two to three times per week and for the past year has been associated with laxative use, self-induced vomiting, and periods of fasting to maintain body weight. The patient reports becoming increasingly depressed and has considered suicide in the past. The treatment plan includes medical evaluation with electrolyte studies and: bupropion hydrochloride (Wellbutrin XL) for depressive symptoms. lisdexamfetamine dimesylate (Vyvanse) for an eating disorder. recommendation for psychological and personality testing. referral for cognitive behavior therapy. - ANS referral for cognitive behavior therapy. The psychiatric-mental health nurse practitioner evaluates a female patient referred with a three-month history of moderate to severe postpartum depression. The patient has been in therapy for three weeks and has not been prescribed medication, despite several interactions with her obstetrician and primary care provider. After researching the healthcare system's organizational factors that contributed to this fragmented care, the nurse practitioner: advocates for including mental health content in nonpsychiatric graduate specialties. discusses the lack of mental health education. files a complaint with the appropriate regulatory boards regarding the patient's prior care. presents at the local American Congress of Obstetricians and Gynecologists meeting. - ANS advocates for including mental health content in nonpsychiatric graduate specialties. The neuroprotective treatment of choice for bipolar disorder is: carbamazepine (Tegretol).divalproex sodium (Depakote).lithium carbonate (Eskalith).risperidone (Risperdal). - ANS