A 78 y/o cattleman referred for treatment of refractory depression by his primary care provider reports continued thoughts of failure, lack of purpose in
... [Show More] life, lack of interest in ranching, fishing, hunting, or family since losing his driver's license due to DUI six months ago. Which of the following areas is an assessment priority?
A. Prior and current medications, dose, clinical response, side effects
B. Extent of alcohol use and motivation to reduce to safe levels
C. Thoughts of self-harm, plan, intent, access
D. Sleep patterns (early-middle-late awakening), sleep hygiene
C. Thoughts of self-harm, plan, intent, access
A 32 y/o Caucasian Catholic female patient presents for her therapy session. She is upset because she and her husband have been in an argument over finances. She does not work and stays at home to take care of the children. She reports feeling sad and has had thoughts of hurting herself. She has a past history of overdosing with Tylenol several years ago. Which of the following places her at high-risk for suicide?
A. age
B. gender
C. previous suicide attempt
D. marital status
C. previous suicide attempt
During a follow-up medication visit with a 13 y/o male, his mother stayed longer to ask the psychiatric mental health nurse practitioner (PMHNP) a question. Specifically, his mother states, "the school sent home information about the human papillomavirus and suggested my son see his primary care provider to get an immunization. Why did I get this information for my son? Furthermore, he is not sexually active." Which of the following would be the PMHNP's best response?
A. As your son's PMHNP, I cannot provide you with information about immunizations
B. I understand your concern with talking to your son about becoming sexually active. Let's address how to start the conversation.
C. Decisions about immunizations can be difficult. The Centers for Disease Control and Prevention recommend that all males between the ages of 11-12, or as early as 9 years of age, receive this vaccination. What concerns do you have?
D. You are correct, only females need to receive the human papillomavirus vaccination. The letter must have been sent to you by mistake.
C. Decisions about immunizations can be difficult. The Centers for Disease Control and Prevention recommend that all males between the ages of 11-12, or as early as 9 years of age, receive this vaccination. What concerns do you have?
What opening question or statement by a Psychiatric-Mental Health Nurse Practitioner facilitates communication at an initial visit?
A. Tell me your concerns and how I may be of help.
B. Tell me what you think the problem is.
C. What seems to be the problem today?
D. What problem does your primary care physician want us to evaluate?
A. Tell me your concerns and how I may be of help.
In evaluating the functional status of a 68 y/o woman who has depression, the Instrumental Activities of Daily Living Scale includes which of the following activities?
A. Using telephone
B. Filing taxes
C. Bathing
D. Toileting
A. Using telephone
An adult female patient has been prescribed an SSRI for an initial episode of major depression. She is fearful of side effects and of becoming suicidal. Which of the following initial responses is most appropriate?
A. SSRI's are the safest antidepressant medications and rarely cause suicidal thoughts. Try the medication and we can watch closely for any side effects.
B. SSRI's are generally quite safe and rarely cause suicidal thoughts. I could call you every few days to see if you are having any of these thoughts.
C. Have you ever had feelings of hurting yourself? If you took the medication and had thoughts like that, what would you do?
D. Have you ever had feelings of hurting yourself? If you took the medication and had thoughts like that, would you be willing to call the crisis hotline?
C. Have you ever had feelings of hurting yourself? If you took the medication and had thoughts like that, what would you do?
A psychiatric mental health nurse practitioner (PMHNP) is working in an integrated care clinic and his family nurse practitioner colleague asks for a consult. The family nurse practitioner asks the PMHNP what antidepressant to start for a patient who has a score of 15 on the patient health questionnaire 9 (PHQ9). What is the appropriate response?
A. A score of 15 on the patient health questionnaire indicates moderate depression, so the patient should be started on a selective serotonin norepinephrine reuptake inhibitor.
B. A score of 15 on the patient health questionnaire 9 indicates possible moderate depression, but a follow-up interview is required to assess for depression. I can see this patient today and further assess for depression and the appropriate treatment
C. A score of 15 on the patient health questionnaire 9 indicates severe depression, so you should start a selective serotonin reuptake inhibitor and an atypical antipsychotic.
D. A score of 15 on the patient health questionnaire 9 indicates moderate depression, so you can refer the patient to therapy and start an antidepressant
B. A score of 15 on the patient health questionnaire 9 indicates possible moderate depression, but a follow-up interview is required to assess for depression. I can see this patient today and further assess for depression and the appropriate treatment
An example of a screening tool that measures severity and tracks change in specific symptoms is
A. The mini-mental state examination (MMSE)
B. The behavior and Symptom Identification Scale (BASIS)
C. The Short Form 36 (SF-36)
D. The CAGE
A. The mini-mental state examination (MMSE)
A ten y/o child lost her father to an unexpected heart attack. Normally confident, sociable and an excellent student, her teachers and mother report that she has withdrawn, become disinterested in schoolmates and schoolwork, and easily becomes tearful if anyone mentions her father. What non-pharmacologic intervention would be most helpful at this time to facilitate her grieving and loss?
A. Play therapy
B. Individual therapy
C. Psychoeducation group
D. Bibliotherapy
C. Psychoeducation group
Which of the following risk factors is not amenable to lifestyle changes in reducing lifetime risk of depressive disorders?
A. Work-related stress
B. Stressful family life
C. Alcohol use
D. Personality
D. Personality
The Five A's for Health Behavior Change include the following:
A. Assess, Advise, Act, Access, Assist
B. Assess, Appraise, Advise, Act, Assist
C. Assess, Advise, Agree, Assist, Arrange
D. Assess, Appraise, Agree, Access, Arrange
C. Assess, Advise, Agree, Assist, Arrange
A psychiatric mental health nurse practitioner realizes she is frustrated and easily angered with one of her patients for no apparent reason. When discussing the situation with a colleague, she states the patient reminds her of her abusive stepfather. Which of the following best describes the nurse practitioner's reaction?
A. Countertransference
B. Displacement
C. Transference
D. Projection
A. Countertransference
Dementia screening for the general population is not recommended for the following reason:
A. The service has unknown balance of benefit and harm; current treatments have limited effectiveness in modifying instrumental activities of daily living
B. The service benefits few people; target condition has high prevalence in the chosen population
C. The service causes net harm in the target population; time involved in screening detracts from higher priority preventive health measures in general population
D. The service is unfocused for target condition: sensitivity and specificity of dementia screening measures do not currently warrant widespread use
A. The service has unknown balance of benefit and harm; current treatments have limited effectiveness in modifying instrumental activities of daily living
The World health Organization has predicted that depression will be the number one world health problem in the 21st century. Lifetime prevalence for major depressive episode is 12% (with a 5-17% range). Which of the following individuals has the greatest risk factors for major depressive disorder (MDD)?
A. 16 y/o, high school male, honors student, who runs cross-country track
B. 43 y/o, divorced woman, schoolteacher, raising three children
C. 58 y/o, married male, computer analyst, whose work requires frequent travel
D. 28 y/o, single woman, working toward partner in a large law firm
B. 43 y/o, divorced woman, schoolteacher, raising three children
A patient who works the night shift presents for a follow-up appointment to see the psychiatric mental health nurse practitioner (PMHNP) and states, "I can't sleep when I get home from work". Upon assessment, the PMHNP learns the patient recently started an exercise regimen and is now exercising after work. Which response about sleep hygiene should the PMHNP provide to the patient?
A. Exercise does not promote or help deepen your sleep, so you should consider making changes in your daily routine
B. Exercising is a good way to help you get sleep, so keep up your schedule and your body will adjust to your new routine.
C. Regular exercise helps with sleep, so continue to exercise, and when you get home, watch television to help promote sleep
D. Regular exercise can help promote sleep but should not be performed too close to your bedtime or it can interfere with sleep; try exercising before work
D. Regular exercise can help promote sleep but should not be performed too close to your bedtime or it can interfere with sleep; try exercising before work
There is a growing recognition that adverse life experiences due to a variety of reasons underlie a wide range of psychiatric disorders and medical problems. According to a seminal research study on adverse childhood experiences (ACE), a positive relationship exists between ACE and which of the following disorders?
A. Alcoholism, anxiety, depression, diabetes, and heart disease
B. Alcoholism, anxiety, heart disease, sleep disorders, and schizophrenia
C. Alcoholism, anorexia, depression, diabetes, and schizophrenia
D. Alcoholism, anxiety, depression, diabetes, and schizophrenia
A. Alcoholism, anxiety, depression, diabetes, and heart disease
In a psychiatric emergency, the psychiatric mental health nurse practitioner (PMHNP) is aware that the most important goal of the interview is self-protection. What can the PMHNP do to keep himself or herself safe?
A. Know as much about the person as possible prior to starting the interview
B. Inform the patient that violence is not acceptable
C. Enter the room alone, in order to build a therapeutic alliance
D. Make sure the patient is restrained before beginning the evaluation
A. Know as much about the person as possible prior to starting the interview
The American College of Obstetricians and Gynecologists (ACOG) recommends screening for postpartum depression with a validated screening tool. Which of the following is a validated screening tool which has been recommended by ACOG?
A. Edinburgh Postnatal Depression Scale (EPDS)
B. Major Depression Inventory (MDI)
C. Montgomery-Asberg Depression Rating Scale (MADRS)
D. Hamilton Rating Scale for
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