Which of the following is characteristic of the leadership competency for the psychiatric-mental health nurse?
A.
Amid the COVID-19 pandemic, the psychiatric-mental health nurse is providing follow-up psychoeducation regarding medication therapeutic and adverse effects. The patient wants to have a video visit through their non-HIPAA (Health Information Portability and Accountability Act) secure video chat. Which of the following can be discussed during the visit?
B.
According to the Health Information Portability and Accountability Act (HIPAA), which of the following entities can receive personal health identifiers without express consent from the patient?
A.
Actions judged based on their inherent value regardless of their consequence is based on which ethical decision-making approach?
A.
3. Which of the following may govern the practice of the psychiatric-mental health nurse?
C.
A member attending a teen addiction treatment group for the first time expresses gratitude for being court ordered to attend the recovery group instead of serving prison time, and he realizes how out of control he was while using. Which Health Belief Model concept is demonstrated?
B.
A 30-year-old man with three past psychiatric hospitalizations for schizoaffective disorder presents for follow-up in the partial hospital program. Before discharge, the patient received court-ordered Zyprexa Relprev 300 mg IM X 1. The patient tells the psychiatric-mental health nurse that he is aware that smoking can “make him need more medication.” In which stage of change is the patient?
D.
A patient was prescribed naltrexone and bupropion for binge eating disorder by her primary care provider. The patient has lost 4 pounds since her last visit 1 month ago. The patient states that sometimes she finds it very difficult not to binge eat when her emotions are intense and expresses doubt in her ability to make a lasting change. The best response is:
A.
The psychiatric-mental health nurse is evaluating a 68-year-old man for symptoms of major depression. While assessing the appearance of the patient, an obvious left-sided ptosis is noted. Which cranial nerve is directly linked to this condition?
C.
A patient with chronic pain disorder takes oxycontin extended-release 30 mg every 12 hours and is recently admitted to acute psychiatry for depression with suicidal ideations. The psychiatrist prescribes clonazepam 0.5 mg at bedtime, and citalopram 10 mg for depression and anxiety. The psychiatric-mental health nurse should monitor for which of the following conditions with respect to the current use of medications?
D.
5. A 19-year-old male is in an alcohol recovery group facilitated by a psychiatric-mental health nurse. The patient states that on one occasion he passed out much sooner than he usually would with far less than he would usually drink. The patient reveals the time he passed out was during a fraternity hazing in which he was butt-chugging (receiving a beer and vodka enema). What pharmacokinetic process was bypassed by this rectal administration route?
C.
A patient has been taking valproic acid for mood stabilization from a manic episode but is still not sleeping through the night. His last drug level was 50 mcg/mL. The psychiatric-mental health nurse notices the patient seems disoriented to time and is flapping his wrists. Which of the following orders would be expected after notifying the psychiatrist on call?
A.
A 61-year-old married woman who has been sober from alcohol use disorder for 25 years relapsed 3 weeks ago. She reports drinking 1.5 L of vodka and half a liter of scotch daily. On exam, she is emotionally labile, ranging from irritable to crying, slurring her words, and exhibits a bilateral upper extremity fine tremor. Vitals: blood pressure 150/100, heart rate 110, respiratory rate 18, SpO2 98% room air. She reports feeling nauseous, sweating, and moderately anxious. What is the primary concern for this patient?
C.
A patient who has required increasing amounts of medication to achieve the desired effect and develops withdrawal symptoms when dosing is delayed is said to be:
A.
A 43-year-old man was involved in a motor vehicle collision in which he was found to have a blood alcohol concentration of 0.200. He was observed wandering around the crash site, slurring his words, and unable to provide a clear history. Emergency Medical Services brought him to the emergency department. The nurse triaged him to psychiatry for acute alcohol intoxication. What is the first priority for the patient?
D.
A patient presents for a follow-up visit and has a dual diagnosis of substance use disorder and major depressive disorder. He reports that he has been feeling increasingly anxious, having difficulty sleeping. He continues to attend his Alcoholics Anonymous meetings regularly but reports he had two beers 3 days ago and feels very guilty. Which of the following best describes this patient’s situation?
D.
A patient with familial fatty liver disease and elevated liver enzymes secondary to alcohol use disorder is admitted for detox. Which of the following benzodiazepines should not be used?
C.
A 70-year-old retired male with a history of hypertension controlled with amlodipine, metoprolol, valsartan, and furosemide has been referred from his primary care provider for depression. Formerly an avid reader, the patient has lost interest in reading and has become increasingly isolative as he has been spilling things during his lunch club meetings and finds this embarrassing, which makes him feel self-conscious and anxious. In which portion of the mental status exam would the psychiatric-mental health nurse expect to find a deficit?
C.
A 50-year-old man with a diagnosis of Parkinson’s disease is admitted to the hospital after tripping and falling and breaking his hip while on a business trip, where he was inspecting a slaughterhouse. The third day after surgery, the patient is having tremors, intermittent slurred speech, dysarthria, and dysgraphia. The orthopedist is attributing his symptoms to slow postoperative progression complicated by having not taken his antiparkinsonian medications for 2 days and the effects of narcotics. Psychiatry was asked to see the patient for mood disorder and possible delirium to aid in planning discharge to subacute rehab. On exam, the patient is unable to name the day, month, or year; he has poor three-object registration and recall, scoring 12 of 30 on a mental state exam; his speech fluency and attention span are incongruent with his baseline; he has no decline in his level of consciousness. What support services might the patient and/or family require?
A.
A 68-year-old man with no past psychiatric history but with a history of polysubstance use disorder is admitted for psychosis (disorganized thoughts, rapid pressured speech, persistent rumination, paranoid delusions, and apathy). Which of the following tests would be most important in determining the etiology of his new-onset symptoms?
D.
When evaluating a 78-year-old man, the psychiatric-mental health nurse 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 psychiatric-mental health nurse do first?
A.
When providing anticipatory guidance to the loved ones of a 68-year-old woman who has been diagnosed with dementia, what is the most important information to convey?
B.
Jose is a 48-year-old veteran of Operation Iraqi Freedom, during which he sustained a traumatic brain injury that left him unconscious for 7 days. He has progressively regained function and is able to perform his instrumental activities of daily living most days. His wife is worried because he has periods where she does not recognize him as he becomes irritable, fails to remember important dates and events, and gets headaches so bad that he says he wishes he had died in the war. What is the priority action for the psychiatric-mental health nurse to take during this office visit? A. Provide anticipatory guidance and coping mechanisms to the patient and his wife
B. Refer the patient to the emergency department for suicidal ideation
C. Prescribe antipsychotic medications to be used when the patient becomes irritable
D. Refer the patient to a neurologist
A.
The primary distinguishing feature between dementia and delirium is:
A.
A 28-year-old female is referred from her employee assistance program from a tech company for poor hygiene and erratic behaviors interfering with her work. The client states her company is spying on her and setting her up to fail for the last 9 months. While speaking she stops herself and begins to talk back to someone who is not present. These symptoms are most consistent with:
C.
A 33-year-old female with history of schizoaffective disorder was brought to the emergency department by police for disruptive behavior, auditory hallucinations, and self-neglect. The client screams that she had stopped taking her medication. The psychiatrist orders Haldol 5 mg PO, which the client willingly accepts. An hour later, the client demonstrates an involuntary upward deviation of the eyes and hiccoughs. Which of the following
interventions should the psychiatric-mental health nurse do first?
D.
A 45-year-old female reports that she has difficulty falling back asleep after she wakes up at 4 a.m. for the last month. She understands that it is better to get out of bed rather than lay in bed awake. She uses this time to catch up on her reading but as a result is very sleepy during the day. What intervention should the psychiatric-mental health nurse recommend?
B.
Ella is trying to help her 3-year-old son sleep through the night but reports recently he has had three episodes of waking up within 3 hours of falling asleep with inconsolable screaming and crying. He then falls back asleep on his own and has no memory of what happened. What would be the best intervention?
D.
A 30-year-old man has been started on sertraline 50 mg daily for major depression 1 week ago. He presents for follow-up. Which of the following sleep patterns is he expected to report?
C.
A 79-year-old female is in a long-term care facility with history of hypertension, coronary artery disease, and atrial fibrillation. The patient is having difficulty sleeping and was started on lorazepam 2 mg at bedtime. The patient has become increasingly agitated and wandering and has been further prescribed lorazepam 2 mg every 6 hours. The patient is also prescribed hydrochlorothiazide 25 mg daily, digoxin 0.125 mg every other day, diltiazem sustained release 360 mg daily, and isosorbide 30 mg daily. What should the psychiatric-mental health nurse do first?
B.
A patient who is considering electroconvulsive therapy (ECT) for resistant depression inquires as to the number of sessions she would likely require. Based on the best evidence currently available, what is the best response from the psychiatric-mental health nurse?
B.
A 30-year-old man was recently terminated from his job for impulsive corporate spending. He was brought to the emergency department by the police for public nudity. The urine toxicology is negative, and all labs are normal. The patient is pressured and difficult to interrupt. He is demanding to leave and wants to speak to his lawyer, and he states that “the founding fathers declare that all men are created with the inalienable right to life and liberty, and President Trump has caused the Federal Bureau of Investigation (FBI) to trample my rights, which is a high crime and he should be impeached.” What action should the psychiatric-mental health nurse take first?
D.
A 25-year-old female presents to the emergency department, having just witnessed an accident. Her speech is pressured. She states, “There were a lot of people in need of care at the scene, and I should know because I have traveled to many Third World countries. I know how bad needs can get. The people were injured, and she was hit by a car before but did not suffer any injuries. There were a lot of police cars and ambulances.” The patient was triaged to Psychiatry. Which of the following best describes the patient’s thought process?
A.
A 45-year-old man is reporting chest pressure, difficulty breathing, numbness, and tingling in his hands and lips. He has been seen in the emergency department, where he underwent a negative cardiac workup. He was subsequently triaged to Psychiatry for evaluation. The psychiatric-mental health nurse asks how he came to the hospital. He states, “I felt awful, my heart was pounding, I was sweating so much, I thought I was going to die. My father had a similar problem, but he died 10 years ago.” Which of the following best describes the patient’s thought process?
A.
A 32-year-old male was referred from the urologist for erectile dysfunction. He has been prescribed a phosphodiesterase-5 inhibitor (PD5-I) with variable success despite a negative physiological workup. Which form of therapy is indicated for this sexual dysfunction?
D.
A 29-year-old woman has been diagnosed with panic disorder and is requesting a psychiatric home visit because she continues to experience feelings that her environment is not real despite the fluoxetine she had been prescribed. She states that this is very unsettling and, as a result, has stopped going out of her home. Which of the following best describes the symptoms reported?
B.
A 34-year-old Korean male pediatric dentist is referred to Psychiatry for persistent anxiety. Upon further assessment, he reveals that his penis is shrinking into his abdomen. Despite the reassurance he has received from numerous health care providers in the past he remains convinced of this belief. This culture-bound delusion is known as:
D.
A 30-year-old female is referred by her women’s health nurse practitioner for vaginismus. The woman is distraught and embarrassed because she has not been able to consummate her marriage. Which therapeutic technique would be most helpful?
C.
A 10-year-old boy who had been prescribed fluoxetine for major depressive disorder presents to the psychiatric emergency department (ED) for running into the street in front of a car on the way home from school. In the ED, he has been selectively mute, but the nurse practitioner student was able to elicit his desire to be dead. He has been medically cleared pending a psychiatric evaluation. What is the most common sign of major depressive disorder in children?
B.
A 16-year-old boy with a history of substance use disorder reports fatigue, apathy, and anhedonia almost every day, and his mother reports increasing irritability and raging behavior. The boy says he smokes marijuana daily just to feel good and is unwilling to give it up. The mother wants some sort of medication to help him feel better so that he stops smoking marijuana. The psychiatric-mental health advanced practice nurse (PMH-NP) agrees to prescribe fluoxetine 20 mg daily. What psychoeducation should the psychiatric-mental health nurse reinforce as the most common side effect associated with this medication?
D.
Child Protective Services is requested for an evaluation of a 9-month-old girl in foster care whose mother was on a methadone maintenance program and using cocaine while pregnant. The child is HIV negative and during the assessment the psychiatric-mental health nurse learns of a 3-year-old brother who is HIV positive. The psychiatric-mental health nurse is asked to recommend placement for both of these children. Which of the following is the best recommendation?
D.
An 8-year-old boy diagnosed with leukemia is referred to child psychiatry because he is consistently displaying a flat affect, irritability, angry acting out, and occasional physical aggression toward his 6-year-old brother. What approach should the psychiatric-mental health nurse take when interviewing this child?
C.
The psychiatric-mental health nurse is evaluating a 22-month-old girl whose mother is concerned about aggressive behavior toward her 4-month-old brother. The mother states that her daughter is often angry and irritable with directed hostility toward the baby. Which of the following responses is best?
C.
A 12-year-old child is seen for follow up after starting on a stimulant for attention-deficit hyperactivity disorder. Which of the following parameters should the psychiatric-mental health nurse assess?
D.
A 40-year-old man with a history of oppositional defiant behavior as a child has recently been released on parole for possession of marijuana and theft. He tells the probation officer to send him to the psychiatrist so he can get some disability. The psychiatric-mental health nurse should plan care according to which of the following personality traits?
A.
An 18-year-old high school senior with a history of substance use disorder and school refusal brags to her peers about her shoplifting exploits. To which personality disorder group should the psychiatric-mental health nurse assign the patient when admitting her to the partial hospital program?
C.
A 30-year-old female is admitted to the emergency department after slashing her arms when her boyfriend left for a weeklong business trip. She states she did not want to kill herself but rather wanted him to come back home. Which intervention would be most helpful for this patient’s emotional distress?
B.
Mr. Smith is complaining about another failed romantic relationship. He says his girlfriend described him as needy all the time, avoidant of confrontation at all costs, agreeable to all her requests, and never disagreeable with her. She told him she was done with his passive ways and was going to find a real man. These traits are most consistent with which of the following disorders?
A.
Which of the following characteristics distinguishes schizotypal personality disorder from autism spectrum disorder?
B.
The purpose of a professional organization’s scope and standards of practice is to:
C.
Which Freudian psychodynamic principle assumes all behavior conveys purpose?
B.
A married couple of 7 years presents for therapy because the wife perceives her husband to be a constant nag. He believes that he is correct and only trying to help. The psychiatric-mental health nurse assigns him a paradoxical directive to schedule 1 hour per day in which he nags her, and once that hour is over, to keep a list and save it until the next day. The therapeutic intervention is a type of which therapy?
C.
The following statement is reflective of which type of therapy: “If a miracle were to happen the problem that brought you into therapy no longer existed, what would be different?”
A.
A 36-year-old pharmacist has a history of depression and a suicide attempt 1 month ago by hanging. She had been started on a tricyclic antidepressant but abruptly stopped taking the medication a week after she started, saying it was “ineffective.” The psychiatric-mental health nurse meets with this patient to plan care. Which of the following is the most appropriate initial action?
B.
The psychiatric-mental health nurse is providing psychoeducation on the relationship between neurophysiology and mental illness. Which area of the brain regulates appetite, the sleep–wake cycle, and libido?
D.
A patient who is not willing to discuss his involvement in a psychological trauma is using which of the following defense mechanisms?
C.
Which of the following is a defense mechanism purpose?
A.
Which of the following is the best intervention for a client experiencing ataque de nervios?
A.
The psychiatric-mental health nurse is reviewing charts for an insurance company. According to the DSM-5, personality disorders are categorized according to which of the following?
A.
When providing psychotherapy to a 50-year-old man with a Cluster A personality disorder, what would be the best strategy?
D.
The psychiatric-mental health nurse is providing psychotherapy for a patient with a personality disorder. Which of the following defense mechanisms are most commonly used in patients with Cluster C personality disorders?
D.
A 23-year-old male with schizoaffective disorder and a history of four past hospitalizations for manic episodes has been started on clozapine. During the weekly complete blood count with differential, which of the following results would necessitate discontinuing treatment?
B.
One of the most common problems encountered by a psychiatric-mental health nurse in geriatric psychiatry is delirium. Why must the psychiatric-mental health nurse maintain a high index of suspicion for this condition?
A.
A psychiatric-mental health nurse in private practice is experiencing feelings of resentment toward a patient who missed his last two appointments at the last minute because he forgot. Which of the following is an example of a therapeutic response?
D.
A psychiatric-mental health nurse is contracted to a student health clinic to work with incoming freshman and transfer students for several weeks. The psychiatric-mental health nurse encounters a student who describes himself as shy and uncomfortable in social situations. He reports having few friends in high school and has realized that he needs a few drinks to loosen up before going out to party. Upon further questioning, it is revealed he consistently drinks two to three beers on the weekend to enhance his socialization. According to the DSM-5, does this student have a mental illness?
A.
Dialectical behavioral therapy (DBT) therapy involves reconciling the tension to find the truth between:
B.
A 33-year-old married gay man employed as a corporate attorney wonders aloud to the PMHNP: “Things are going well in our relationship, our 8-year-old boy is about to enter third grade, our 6-year-old girl is entering first grade, my husband is a successful published author, but for some reason I don’t feel happy. I think I have been depressed for much of my life.” Which of the following demonstrates a core concept in transactional analysis (TA)?
D.
A psychiatric-mental health nurse has been appointed to a community board tasked with conducting a risk–benefit analysis regarding healthcare resource utilization in the planning of a psychosocial clubhouse for an at-risk population. What are two economic concepts that must be considered in allocating public funds to demonstrate a return on investment and access to care with the greatest number of people?
B.
Which of the following hallucinations is more common in patients with an organic etiology such as substance-induced altered mental status or delirium rather than in patients with psychosis such as schizophrenia, schizophreniform disorder, and brief psychotic episode?
A.
A middle-aged married man has been attending a psychoeducation group for people with mood disorders. During a session, he reports his symptoms include fatigue throughout the day, leading him to drink five to six cups of coffee daily to stay awake; this leads to him feeling too wired to sleep at night. He drinks one to two drinks every night. He has no trouble falling asleep. However, his wife kicks him due to his snoring and describes him as a restless sleeper, and he also sweats profusely every night. Which of the following suggestions should the psychiatric-mental health nurse offer this client?
B.
When a patient is treated over objection by court order, which ethical principle has been trumped?
D.
In planning for the aftercare of the patient who is treated for schizophrenia, the nurse reads the PPD at 10-mm induration on his tuberculosis skin test. What is the next action for the psychiatric-mental health nurse to take?
A.
A patient who has been diagnosed with microcytic hypochromic anemia for 3 years may have which of the following symptoms?
C.
Which of the following patients is at the lowest risk for suicide?
A.
A 40-year-old man who is HIV positive has a 10-mm induration from his Mantoux test. What should the psychiatric-mental health nurse do next?
C.
A patient with a history of alcohol use disorder tells the psychiatric-mental health nurse during his admission to rehabilitation that the Sinclair method is what he prefers rather than a monthly injection. Which of the following best describes the patient’s preferred method?
C.
A daughter is concerned that her mother may have dementia. Which of the following criteria distinguishes delirium from dementia?
D.
A patient presents to the emergency department with abdominal pain in the epigastric and left upper quadrant. He has history of alcohol use disorder, increasing his risk of pancreatitis. Which of the following would indicate this finding?
B.
The psychiatric-mental health nurse is caring for a patient with paranoid schizophrenia on an inpatient unit. Which of the following actions would help reduce the patient’s distress?
C.
The psychiatric-mental health nurse is facilitating a group for patients with personality disorder traits. A member of the group asks, “Does being diagnosed with schizoid personality disorder mean that I will develop schizophrenia?” Which response would be the most appropriate?
C.
A patient reports symptoms to the triage nurse, including not eating very much lately, increasing irritability, lack of interest, depressed mood, and poor sleep. Which of the following actions should the psychiatric-mental health nurse take first?
A.
A patient reports multiple somatic complaints and feeling hopeless, helpless, and screaming at times. What action should the psychiatric-mental health nurse take?
