A 62-year-old woman formerly employed as a receptionist reports progressive word-
finding difficulty over the past 6 months that caused her so much anxiety she quit her
job. Her daughter has become increasingly impatient waiting for her to finish her
sentences but she has now become depressed due to the relational strain. She denies
any other behavioral problems. Which of the following diagnostic tests would be most
appropriate?
Bilateral carotid Doppler study
Transthoracic echocardiogram
EEG
Brain MRI with and without contrast - CORRECT ANSWER-Brain MRI with and without
contrast
A 26-year-old female is diagnosed with psychosis not otherwise specified (NOS) and
substance use disorder. Which of the following lab tests should be ordered prior to
starting antipsychotic medications?
Amylase, lipase, liver function test
Urinalysis, urine pregnancy test
Cardiac enzymes, brain naturetic peptide
Hemoglobin A1C, lipid profile, EKG - CORRECT ANSWER-Hemoglobin A1C, lipid
profile, EKG
In observing the appearance of the patient with depression and a history of systemic
lupus erythematosus, the PMHNP notices a lesion on the neck of the patient about the
size of a pencil eraser, flush with the skin, uniformly colored, with discrete borders, and
consistent texture. The PMHNP should:
Refer the patient to oncology
Watch and wait
Refer the patient to rheumatology
Refer the patient to dermatology - CORRECT ANSWER-Watch and wait
Which of the following best represent the physical exam maneuver known as Murphy's
sign?
While supine, ask the patient to grasp her knee while tucking 1 leg up to the chest. A
positive test occurs when pain prohibits elevation of the ipsilateral leg.
, The examiner palpates in the right upper abdominal quadrant below the costal margin
while the patient breathes in. The test is positive if the examiner observes pain during
inhalation.
Press and palpate deeply into the abdomen and release quickly observing for pain.
Ask the patient to bend at the knees while holding onto a rail, observe for a loss of
balance. - CORRECT ANSWER-The examiner palpates in the right upper abdominal
quadrant below the costal margin while the patient breathes in. The test is positive if the
examiner observes pain during inhalation.
Acute cholecystitis
What does the Murphy sign assess for - CORRECT ANSWER-Cholecystitis
When evaluating a 78-year-old man, the PMHNP notices the patient frequently leans in
with the right side of his head and frequently asks for things to be repeated. His
daughter is very worried that he has dementia or depression because he has also
become increasingly isolated, as well as increasingly irritable as he believes people are
yelling at him out of frustration of not being heard. The daughter is tearful, anxious, and
frustrated. What should the PMHNP do first?
Order a CT scan of the head
Separate the patient from the daughter and interview him alone
Examine the patient's ear canals
Provide anticipatory guidance regarding aging parents to the daughter - CORRECT
ANSWER-Examine the patient's ear canals
A 35-year-old man diagnosed with bipolar disorder mentions to his PMHNP that he had
felt a lump on his left testicle. He is concerned he has not had a physical exam in 10
years. What is the best action by the PMHNP?
Explore the reason for not having had a physical in so long
Refer him to his primary care provider
Perform a urogenital exam and order an ultrasound
Refer him to urology - CORRECT ANSWER-Explore the reason for not having had a
physical in so long
A 26-year-old man has been on an antipsychotic. He requires further titration for control
of symptoms. Which of the following tests should be repeated?
EKG
Head CT scan
Liver function test
Urinalysis - CORRECT ANSWER-EKG