1. In the aftermath of a tornado that - What is your biggest concern right destroyed over 100 homes in a rur- now? I will help you as much as you can.
... [Show More] al Midwest community, the PMH- NP draws on principles of crisis intervention while working with an elderly couple who lost every- Rationale: Principles of crisis interven- tion guide the PMHNP to focus on one of the individual's primary concerns at a time offering direct, realistic informa- thing in the storm during the night. tion, and emotional support. Do not give Which of the following statements is most appropriate at the initial encounter? - What is your biggest concern right now? I will help you as much as you can. - Tell me everything that hap- pened. We'll sort through the next steps. - You will be able to stay in the shelter until the FEMA trailers ar- rive. It's going to be OK. - What medications were you tak- ing? Let me work on that first. 2. 1. During an initial assessment, the PMHNP asks the patient to perform the serial 7's. What aspect of the mental status exam would the nurse practitioner be assess- ing? - Concentration - Affect - Memory - Speech 3. A 31-year old married woman with a history of anorexia nervosa, binging-purging type, during her teens and early 20's, is pregnant. She has had two prior sponta- neous abortions in late 20's. She false reassurance which blocks commu- nication; you don't know whether every- thing will be resolved, and in this sce- nario, nothing can replace a lifetime of treasures and memories lost in their home. Do not focus on all implications at once or ask the individual to describe all of the losses or implications; this will be too overwhelming. While concerns about medication is important, first the PMHNP needs to assess what the pri- mary concern is for this couple before addressing the medication issue. - Concentration Rationale: Subtracting serial 7's from 100 is a simple task that requires intact concentration and cognitive capabilities. - Increase daily caloric intake by 500 calories, reduce running to 2-4 miles daily, alternate with stretching and yoga in second and third trimesters, add pre-natal vitamin and vitamin b-12 sup- plement, plan a 28-40# gradual weight is worried whether this pregnancy may trigger recurrence of her pri- or eating disorder, adversely im- pact fetal development, or affect the likelihood of full-term deliv- ery. At 5'7" she maintains a weight of 120 pounds by running 6-10 miles daily as conditioning for marathons and a 2,000 calorie dai- ly vegan diet. What lifestyle modi- fications would reduce risks of ex- acerbating an eating disorder and increasing likelihood of normal fe- tal development and full-term de- livery? - Increase daily caloric intake by 250 calories, reduce running to 4-8 miles daily with reduction in sec- ond or third trimester, add pre-na- tal vitamin, Calcium supplement, and plan a 20-30# gradual weight gain over the course of pregnan- cy. - Increase daily caloric intake by 1,000 calories, continue running as tolerated with reduction in sec- ond or third trimester, add pre-na- gain over the course of pregnancy. Rationale: At 120 pounds for 5'7" her Body Mass Index is 18.8 (low). BMI normal range for adults is 19.8 - 26.0. BMI = 703 x weight (lbs) = 703 x 120 = 18.8 [Height (in)]2 672 Or Weight (kg)/ Stature (cm)/ Stature (cm) x 10,000 = BMI. BMI = weight (kg) [height (m)]2 Low pre-pregnancy BMI and failure to gain recommended weight dur- ing pregnancy are associated with in- creased risk for spontaneous abortions, pre-term delivery, and low birth weight infants. Recommended caloric intake for pregnant women during pregnan- cy varies from additional 150 calo- ries in first trimester, 300 calories in second trimester, and 500 calories in third trimester before accounting for strenuous daily exercise. Recommend- ed weight gain for pregnant women of normal BMI is 25-35# and 28-40# for women with low BMI as in this patient. tal vitamin, vitamin E supplement, The vegan diet lacks animal fat the only and B-complex supplement, plan a 20-30# gradual weight gain over the course of pregnancy. - Increase daily caloric intake by 500 calories, reduce running to 2-4 miles daily, alternate with stretch- ing and yoga in second and third trimesters, add pre-natal vitamin and vitamin b-12 supplement, plan a 28-40# gradual weight gain over the course of pregnancy. dietary source of Vitamin B-12. Addition of pre-natal vitamin and supplement of Vitamin B-12 is indicated for vegan diet. - Increase daily caloric intake by 700 calories, continue running as tolerat- ed with reduction in second or third trimester, add pre-natal vitamin, vitamin E supplement, and B-complex supple- ment, plan a 25-35# gradual weight gain over the course of the pregnancy. 4. Which of the following illustrates the role of the PMHNP in reduc- ing the stigma of mental illness through community education as primary intervention? - Expert witness for standard of acre regarding psychiatric nurs- ing staff in wrongful death lawsuit - Professional speaker inter- viewed by morning television talk show anchor on depression - Teaching high school class about depression and teen sui- cide - Volunteering to help with depres- sion screenings at a community health fair 5. A patient comes into your office in a full manic episode. This patient has a diagnosis of Bipolar and Al- cohol Use disorder, moderate. You have a report from the patient's chemical dependency counselor indicating that inpatient chemical dependency counseling is need- ed. Your patient has been on the fence about inpatient chemical de- pendency treatment in the past. You assess the patient and find a strong odor of alcohol, auditory and visual hallucinations, flight of ideas, lack of sleep for 3 days, sui- cidal ideations without a firm plan, and plans to drive to another state to gamble. The patient's brother who accompanies him corrobo- rates this information. In order to best treat this patient, you: - Professional speaker interviewed by morning television talk show anchor on depression Rationale: While all responses have an element of education, primary preven- tion through community education is best illustrated by reaching the broadest general audience with information about depression through television, radio, or newspaper media. - Admit him to the local psychiatric unit, with an order for the collection of labo- ratory values. Rationale: While he is both manic and of danger to himself, he should be hos- pitalized. The patient will not be able to participate in any programming until he is out of his acute manic state. Going home is not an option unless the patient has someone who can be with him 24 hours and monitor his withdrawal from alcohol, his manic condition, and his suicidal issues and desire to leave the state. - Admit him to the inpatient chem- ical dependency program. - Admit him to the local psychi- atric unit, with an order for the col- lection of laboratory values. - Send the patient home with his brother and a prescription for a new antipsychotic medication. - Admit him to the dual diagnosis chemical dependency unit with an order for the collection of labora- tory values. 6. When assessing a client, what is the most important predictor of potential for violence? - History of aggressive rage - History of substance abuse - History of head injury - History of seizures 7. 1. Which of the following state- ments would be most likely to be effective in changing sexual be- havior when counseling a sexu- ally active 15-year-old adolescent girl? - Require your partner to use a condom. - Use this sample condom. - Always use condoms when hav- ing sex. - Always carry condoms in your purse. - History of aggressive rage Rationale: History of previous episodes of rage and violent behavior, escalat- ing irritability, intruding angry thoughts, and fear of losing control are the most important predictors of potential for vi- olence. Head injury, substance use or abuse, and temporal lobe epilepsy have been discussed as possible predictors, but not conclusively. - Use this sample condom. Rationale: Use specific risk-reduction steps rather than global statements. Providing an actual condom to try con- fers direct responsibility for condom use rather than relying on partner to use condom. An adolescent girl is less likely to purchase condoms than initially using a sample condom from a provider. 8. 1. In evaluating the functional sta- tus of a 68-year-old woman who has depression, the Instrumental Activities of Daily Living Scale in- cludes which of the following ac- tivities? - Using telephone - Filing taxes - Toileting bathing 9. 1. 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? - Edinburgh Postnatal Depression Scale (EPDS) - Montgomery-Asberg Depression Rating Scale (MADRS) - Hamilton Rating Scale for De- pression (HRSD) - Major Depression Inventory (MDI) 10. 1. When child, adult partner, or el- der abuse is suspected, the PMH- NP needs to conduct an abuse as- sessment screen in privacy, away from the partner, the child's par- ents or guardians, or the elder person's relative or companion. - Using telephone Rationale: Instrumental activities of dai- ly living (IADLs) include those that fa- cilitate or enhance the performance of ADLs (i.e. shopping, using the tele- phone, and using transportation). Func- tional activities or activities of daily living (ADLs) are the activities necessary for self-care (i.e., bathing, toileting, dress- ing, and transferring). Cognitive execu- tive function includes higher-order activ- ities such as balancing a check book, assembling tax records, filing taxes, and driving. - Edinburgh Postnatal Depression Scale (EPDS) Rationale: The EPDS is most frequently used in the research setting and clinical practice for several reasons. The scale consists of 10 self-reported questions that are health literacy appropriate and take less than 5 minutes to complete. - Within the past year, have you been hit, slapped, kicked or otherwise physically hurt by someone? Rationale: This response is one of four items on a standardized abuse assess- ment screen, The other items are part of a danger assessment that may be used Simple, direct questions in a non- judgmental interview are indicat- ed. Which of the following would be an appropriate abuse screen- ing question? - Within the past year, has anyone ever forced you to do something by threatening you with a gun? - Within the past year, have you ever threatened or tried to commit suicide to escape the abuse? - Within the past year, have you been hit, slapped, kicked or other- wise physically hurt by someone? - Within the past year, has anyone ever threatened to kill you? 11. Which of the following would not be advised to divorced parents to facilitate recovery for their chil- dren? - The divorced couple must pro- vide an age-appropriate truthful explanation why they divorced - The divorced couple must avoid arguing with one another - The divorced couple must show consistent behavior toward the child - The divorced couple must contin- ue to relate to the child despite the child's anger 12. In advising parents how to re- duce the risk for teen substance abuse when there is positive fam- following a positive response to one of the abuse screening questions. - The divorced couple must provide an age-appropriate truthful explanation why they divorced Rationale: Divorce recovery for children does not necessarily require an expla- nation of why the parents divorced, par- ticularly if circumstances are damag- ing or affix blame to one parent over the other (e.g., infidelity, sexual orienta- tion, illicit drug use, etc.) despite fram- ing in age-appropriate context. Avoid- ing parental arguments, demonstrating fair and consistent behavior toward the child, and continuing respectful commu- nication despite a child's anger are rec- ognized principles of divorce recovery. - Random urine testing using home drug testing kits Rationale: Parental presence, support, ily history of alcohol dependence, and fostering a sense of connectedness a PMHNP encourages all of the fol- with teens are primary strategies for re- lowing recommendations except: - Acknowledgement of family risk factor and open discussion with teen - Parental presence and involve- ment in child's school and sports activities - Parental networking and supervi- sion of any teen parties - Random urine testing using home drug testing kits 13. A PMHNP realizes she is frustrat- ed and easily angered with one of her patients for no apparent rea- son. When discussing the situa- tion with a colleague, she states the patient reminds her of her abu- sive stepfather. Which of the fol- lowing best describes the nurse practitioner's reaction? - Countertransference - Displacement - Transference - Projection 14. An example of a screening tool ducing risk for teen substance abuse. Fostering communication among other parents, endorsing parental supervision of all parties, and knowing the extent of parental supervision at parties is anoth- er important strategy. Home urine test- ing for alcohol and drugs by parents may be advised for monitoring teens that al- ready have a demonstrated alcohol or drug problem as part of a rehabilitation contract, but it is not considered a risk strategy. Countertransference Rationale: Countertransference is the nurse practitioner's emotional reaction to the patient based on his/her past ex- periences. Countertransference is essentially the reverse of transference. In contrast to transference (which is about the client's emotional reaction to the therapist), countertransference can be defined as the therapist's emotional reaction to the client. - The Mini-Mental Status Examination that measures severity and tracks (MMSE) change in specific symptoms is - The Mini-Mental Status Examina- tion (MMSE) - The Behavior and Symptom Iden- tification Scale (BASIS) - The Short Form 36 (SF-36) - The CAGE Rationale: The MMSE is an example of a screening tool that measures the severity and tracking change in specific symptoms. It is used to provide an as- sessment of a broad array of cognitive function, including orientation, attention, memory, construction, and language. It is commonly used to screen for demen- tia and in following the progression of dementia over time. 15. 1. A 67-year-old Vietnamese immi- grant, who has been a resident in the U.S. for 3 years, comes to your clinic for an evaluation. Her first language is Vietnamese, but she does speak, some English. She has problems with reading and writing, as she did not finish high school, or earn a GED (General Educational Department) equiva- lency. As the PMHNP, what is your priority disparity to address with this patient? - Health literacy - Reading level - Race - age 16. A patient was started on a an- tipsychotic medication two weeks ago and is now experiencing the following symptoms: inability to sit still, pacing, and feelings of inner restlessness. He does not complain of any anxiety or being worried about anything in partic- ular. Which of the following rating scales would be the most appro- - Health literacy Rationale: Adults meeting the following criteria are most likely to have limited health literacy, which has been related to health outcomes; one, over age 65 from racial and ethnic groups other than white; two, recent refugees and immi- grants; three, less than a high school GED; four, low income; and five, non-na- tive speaker of English. - Barnes Akathisia Rating Scale Rationale: The patient is experienc- ing symptoms consistent with akathisia. The BARS can be very useful in identi- fying akathisia, assess its severity, and monitor change in symptoms. Akathisia - restlessness Dyskinesia - abnormality or impairment of voluntary movement EPS - The extrapyramidal symptoms priate to assess these symptoms? include acute dyskinesias and dyston- - Simpson Angus EPS Scale - Dyskinesia Identification System Condensed User Scale (DISCUS) - Abnormal Involuntary Movement Scale (AIMS) - Barnes Akathisia Rating Scale 17. A 32-year-old Caucasian Catholic female patient presents for her therapy session. She is upset ic reactions, tardive dyskinesia, Parkin- sonism, akinesia, akathisia, and neu- roleptic malignant syndrome. - Previous suicide attempt Rationale: Severity and risk factors are usually rated as low, moderate, or high. 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 thought of hurting herself. She has a past history of overdosing with Tylenol sever- al years ago. Which of the follow- ing places her at high-risk for sui- cide? - Marital status - Previous suicide attempt - Age - gender 18. 1. When questioning a patient re- garding alcohol use during an in- take, the patient tells you he only drinks socially. Which initial re- sponse is most appropriate? - I am glad you are a responsible drinker. - Many people with alcohol issues say they are social drinkers. - What amount and what kind of alcohol do you drink in a week? - Do other people in your house- hold drink alcohol? 19. A patient who works the night shift presents for a follow-up ap- pointment to see the PMHNP and states, "I can't sleep when I get home form work." Upon assess- ment, the PMHNP learns the pa- tient recently started an exercise regimen and is now exercising af- ter work. Which response about Factors that increase severity include: previous suicide attempts - What amount and what kind of alcohol do you drink in a week? Rationale: This answer clarifies the pa- tient's own answer while eliciting more information. - 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. Rationale: Measures to promote or in- duce sleep, known as sleep hygiene, are to establish an exercise routine early during the day and avoid evening stimu- lation such as TV. sleep hygiene should the PMHNP provide to the patient? - Regular exercise can help pro- mote sleep but should not be per- formed too close to your bedtime or it can interfere with sleep; try exercising before work. - Exercise does not promote or help deepen your sleep, so you should consider making changes in your daily routine. - Regular exercise helps with sleep, so continue to exercise, and when you get home, watch televi- sion to help promote sleep. - Exercising is a good way to help you get sleep, so keep up your schedule and your body will ad- just to your new routine. 20. 1. Which of the following inter- ventions has greatest relevance when counseling parents of a 20-year-old male patient who has recently been diagnosed with schizophrenia? - Patient and family education about the disease course, treat- ment regimens, support systems, and life management skills. - Supportive psychotherapy group for the parents to facili- tate their grief and build coping skills to help manage their son's life-changing mental illness. - Multi-system family therapy that includes in-home therapy as well as multiple family group therapy to facilitate shared learning from - Patient and family education about the disease course, treatment regimens, support systems, and life management skills. Rationale: Because having a fami- ly member with schizophrenia is a life-changing event for the family and friends who provide care and support, educating patients and their families is crucial. It is a primary concern for the PMHNP. While the other interventions may be helpful over time, initially patient and family education is the priority. other families with members of schizophrenia. - Family therapy to facilitate grad- ual independence for the patient while addressing parental desire to protect their son. 21. Which of the following risk of fac- tors is not amenable to lifestyle changes in reducing lifetime risk of depressive disorders? - Alcohol use - Personality - Work-related stress - Stressful family life 22. 1. An adult female patient has been prescribed an SSRI for an initial episode of major depres- sion. She is fearful of side effects and of becoming suicidal. Which of the following initial responses is most appropriate? - 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. - Have you ever had feelings of hurting yourself? If you took the medication and had thought like that, what would you do? - SSRI's are the safest antidepres- sant medications and rarely cause suicidal thoughts. Try the medica- tion and we can watch closely for any side effects? - Have you ever had feelings of hurting yourself? If you took the - Personality Rationale: Modifiable risk factors are those that can be changed through lifestyle choices and habits. Personality change is not a risk factor amenable to lifestyle change and not ordinarily con- sidered a risk factor. - Have you ever had feelings of hurting yourself? If you took the medication and had thought like that, what would you do? Rationale: It is important to explore prior or current suicidal thoughts and how the patient would respond if she did have such thoughts. Only suggesting contact with crisis hotline without some contact with provider does not facilitate empathy or rapport. Statements offering reassur- ance only may or may not be true. medication and had thoughts like that, would you be willing to call the crisis hotline? 23. 1. A 36-year-old woman was fired from her job as a paralegal at a law firm. She had worked for the same attorney for 10 years. As soon she came in the door from work, her husband noticed she appeared upset and asked her if she was alright. She immediate- ly started yelling at her husband because he had not given their 5-year-old daughter a bath and had not cleaned the house. Which of the following defense mecha- nisms is being demonstrated by this woman? - Rationalization - Displacement - Dissociation - Conversion 24. 1. What opening question or statement by a Psychiatric-Men- tal-Health Nurse Practitioner facil- itates communication at an initial visit? - Tell me what you think the prob- lem is. - What seems to be the problem today? - Tell me your concerns and how I may be of help. - What problem does your primary care physician want us to evalu- ate? - Displacement Rationale: Displacement is a defense mechanism in which a person transfers their emotions from the person or situa- tion that is the target of their frustration to someone or something else. - Tell me your concerns and how I may be of help. Rationale: This statement asks the pa- tient's perspective and conveys the offer to help, which conveys empathy, pro- vides hope, and facilitates communica- tion. While the open-ended questions promote patient-centered counseling as opposed to closed-ended questions, the questioning options above lack empa- thy. 25. 1. During a follow-up medication visit with a 13-year-old male, his mother stayed longer to ask the PMHNP a question. Specifically, his mother states, "The school sent home information about the human papillomavirus and sug- gested my son see his primary care provider to get an immuniza- tion. 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? - I understand your concern with talking to your son about becom- ing sexually active. Let's address how to start the conversation. - Decisions about immunizations can be difficult. The Centers for Disease Control and Prevention recommend that all males be- tween the ages of 11-12, or as early as 9 years of age, receive this vaccination. What concerns do you have? - As your son's PMHNP, I can- not provide you with information about immunizations. - You are correct, only females need to receive the human papil- lomavirus vaccination. This letter must have been sent to you by mistake. - Decisions about immunizations can be difficult. The Centers for Disease Con- trol and Prevention recommend that all males between the ages of 11-12, or as early as 9 years of age, receive this vac- cination. What concerns do you have? Rationale: It is within the scope and role of the PMHNP to address health promo- tion and risk reduction, and have an un- derstanding of immunizations. The Cen- ters for Disease Control and Prevention recommend that all males between the ages of 11-12 have the human papillo- mavirus (HPV4) vaccination, or as early as 9 years of age. 26. 1. A 78-year-old cattleman referred - Thoughts of self-harm, plan, intent, ac- for treatment of refractory depres- sion by his primary care provider reports continued thoughts of fail- cess. Rationale: Evaluation for suicide risk and insuring safety is greatest priority, ure, lack of purpose in life, lack of interest in ranching, fishing, hunt- ing, or family since losing his dri- ver's license due to DUI 6 months age. Which of the following areas is an assessment priority? - Extent of alcohol use and moti- vation to reduce to safe levels. - Thoughts of self-harm, plan, in- tent, access. - Sleep patterns (early-middle-late awakening), sleep hygiene. - Prior and current medications, dose, clinical response, side ef- fects. 27. The PMHNP understands which factor to be the most important in the therapeutic communication: - Nonverbal communication - Verbal communication - Clarification - Feedback 28. 1. A PMHNP is working in an inte- grated care clinic and his FNP col- league asks for a consult. The FNP asks the PMHNP what antidepres- sant to start for a patient who has a score of 15 on the patient health questionnaire (PHQ-9). What is the appropriate response? - A score of 15 on the PHQ-9 in- dicates moderate depression, so you can refer the patient to thera- py and start an antidepressant. - A score of 15 on the PHQ-9 in- dicates moderate depression, so the patient should be started on particularly in an elderly man who has multiple risk factors: gender, age, loss, embarrassment to self and family (DUI), access to guns, and alcohol use. Other areas need to be included in assess- ment; however, suicide risk and safety is the priority. - Nonverbal communication Rationale: Gestures, facial expressions, and body language actually communi- cate more than verbal messages. - A score of 15 on the PHQ-9 indicates possible moderate depression, but a fol- low-up interview is required to assess for depression. I can see this patient today and further assess for depression and the appropriate treatment. Rationale: The PHQ-9 is a screening instrument but should only be used in combination with follow-up questions. a selective serotonin norepineph- rine reuptake inhibitor. - A score of 15 on the PHQ-9 in- dicates severe depression, so you should start a selective serotonin reuptake inhibitor and an atypical antipsychotic. - A score of 15 on the PHQ-9 indi- cates possible moderate depres- sion, 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. 29. During an initial psychiatric eval- uation, the patient reports use of alcohol and illicit drugs. This infor- mation would be the most appro- priate in which part of the evalua- tion? - Personal and social history - Mental status exam - Review of systems - Chief complaint 30. When assessing for alcohol use. What does the CAGE question- naire ask? - Have you ever felt you should Cut down on your drinking, do you - Personal and social history Rationale: Habits are included under personal and social history. - Have you ever felt you should Cut down on your drinking, have people Annoyed you by criticizing your drinking, have you felt Guilty about your drinking, have you ever had an Eye Opener in the morning become Avoidant when you drink, to get rid of a hangover? do you feel Guilty about your alco- hol use, have you ever had an Eye Opener in the morning to get rid of a hangover? - Have you ever felt you should Cut down on your drinking, do you get Angry when you drink, do you Rationale: The CAGE questionnaire is used to assess if a further evaluation of alcohol use is warranted by asking the following four questions: 1. Have you ever felt you should Cut down on your drinking? 2. Have people Annoyed you by criticizing your drinking? 3. Have you feel Guilty about your alcohol use, felt Guilty about your drinking? 4. Have have you ever had an Eye Opener in the morning to get rid of a hang- over? - Have you ever felt you should Cut down on your drinking, have people Annoyed you by criticiz- ing your drinking, have you felt Guilty about your drinking, have you ever had an Eye Opener in the morning to get rid of a hangover? - Have you ever felt you should Cut down on your drinking, do people get Angry when you drink, do you feel Good about your alcohol use, have you ever had an Eye Opener in the morning to get rid of a hang- over? 31. 1. Dementia screening for the gen- eral population is not recommend- ed for the following reasons? - The service benefits few people: target condition has high preva- lence in the chosen population - The service causes net harm in the target population: time in- volved in screening detracts from higher priority preventive health measures in general population - The service has unknown bal- ance of benefit and harm: cur- rent treatments have limited effec- tiveness in modifying instrumen- tal activities of daily living - The service is unfocused for target condition: sensitivity and specificity of dementia screening you ever had an Eye Opener in the morning to get rid of a hangover? - The service has unknown balance of benefit and harm: current treatments have limited effectiveness in modifying instrumental activities of daily living Rationale: Dementia screening is not in- dicated for the general population be- cause the target condition is largely prevalent in the elderly. The balance of benefit and harm is unknown and cur- rent treatments have limited effective- ness in modifying instrumental activities of daily living. measures do not currently war- rant widespread use 32. 1. The Five A's for Health Behavior Change include the following: - Assess, Advise, Act, Access, As- sist - Assess, Appraise, Agree, Ac- cess, Arrange - Assess, Advise, Agree, Assist, Arrange - Assess, Appraise, Advise, Act, Assist 33. 1. Violence directed toward women by an intimate partner is a serious health problem world- wide. Which of the following women has the greatest risk fac- tors for being the victim of vio- lence? - 35 years old pregnant, African-American woman living with her husband in suburb of Dal- las, Texas - 17 years old, single, Native Alaskan woman living with em- ployed boyfriend in Galena, Alas- ka - 42 years old, divorced, Cau- casian woman dating a recently divorced man in Denver, Colorado - 26 years old, recently separated, Asian American woman living in Boston, Massachusetts - Assess, Advise, Agree, Assist, Arrange Rationale: The Five A's for Behav- ioral Counseling and Health Behavior Change are: Assess Advise Agree Assist Arrange. - 17 years old, single, Native Alaskan woman living with employed boyfriend in Galena, Alaska Rationale: Violence directed at women cuts across all ethinc, racial, and so- cioeconomic lines. However, epidemi- ologic studies find that Asian/Pacif- ic Islander women report the lowest rates of intimate partner violence, and African-American and Native Ameri- can/Alaska Native women report the highest rates (National Institute of Jus- tice [NIJ] & Center for Disease Con- trol [CDC], 2000). Evidence suggest that single, divorced, and separated women are at greater risk than married women. Other women at higher risk of abuse include: pregnant women (Sur- geon General's Report, 1999); lower in- come women, less educated women, and women in relationships with in- come, educational & occupational dis- parities (NIJ & CDC, 2000). The young, single, Native Alaskan girl living in rural Alaska where there is age, education, 34. 1. In assessing patient risks for binge drinking, which of the fol- lowing statements is not accu- rate? and occupational disparity has greatest number of risk factors. - Binge drinking is higher in urban, densely populated areas than rural, sparsely populated areas. Rationale: There is little variation seen - Binge drinking is higher in urban, in binge and heavy alcohol use rates densely populated areas than rur- al, sparsely populated areas. - Binge alcohol use rates are sim- ilar across different levels of edu- cation. - Men are much more likely than women to be binge drinkers. Whites have a higher rate of binge drinking than black or Hispanics. 35. 1. Which of the following lifestyle by population density. There are region- al differences in alcohol use, but not specifically binge drinking rates, with highest alcohol use in western states and lowest use in southern states. The other responses are accurate regarding binge drinking. - Anabolic steroid use factors poses the greatest risk for Rationale: Anabolic steroid use poses depression, irritability, liver prob- lems, and hypertension in a col- lege student? - Anabolic steroid use - Cocaine use - Marijuana use - Binge drinking the greatest risk of the four lifestyle drug use patterns. Anabolic steroid use is as- sociated with increased irritability and aggression, euphoria, increased ener- gy, sexual arousal, mood swings, dis- tractibility, forgetfulness, and confusion. With time, anabolic steroid use is as- sociated with increased risk for heart attacks, strokes, blood clotting, choles- terol changes, hypertension, depressed mood, fatigue, restlessness, loss of ap- petite, insomnia, reduced libido, muscle and joint pain, and severe liver prob- lems, including hepatic cancer. Males can have reduced sperm production, shrinking of the testes, and difficulty or pain urinating. There can be breast enlargement in men and masculiniza- tion of women's bodies. Both sexes can 36. 1. A ten-year-old child lost her fa- ther to an unexpected heart at- tack. Normally confident, socia- ble, and an excellent student, her teachers and mother report that she ahs withdrawn, become disinterested in schoolmates and schoolwork, and easily becomes tearful if anyone mentions her fa- ther. What non-pharmacologic in- tervention would be most helpful at this time to facilitate her griev- ing and loss? - Play therapy - Psychoeducation group - Individual therapy - bibliotherapy 37. Which of the following screen- ing tests has high sensitivity and specificity for identifying cogni- tive impairment in older adults while requiring the least amount of time to administer in a clinical setting? - Global Deterioration Scale - Mini-Mental Status Exam - Dementia rating scale - Clock Drawing Test 38. 1. In assessing possible sexual abuse of a 4-year-old child, which of the following would not be indi- cated? experience hair loss and acne. Intra- venous or intramuscular use of the drug and needle sharing puts users at risk for HIV, hepatitis B and C, and endocarditis. - Psychoeducation group Rationale: While any of these modalities could be helpful, normalizing the expe- rience of grief and loss with peers with similar losses in psychoeducation group format builds on the value of peer sup- port, instillation of hope, and universality that she is not alone in this experience. - Clock Drawing Test Rationale: The Clock Drawing Test (CDT) is highly correlated with the Mini-Mental Status Exam (MMSE), the Global Deterioration Scale, and the De- mentia Rating Scale, yet takes minimum amount of time to administer (2-4 min- utes). It is well-suited for clinical practice settings to screen and monitor progres- sion of cognitive decline in older adults. - Has anyone invited you to a birthday pool party? Rationale: Invitation of a 5-year-old to a birthday pool party is not indica- - Has anyone else asked you to take off your clothes? - Has anyone ever taken your pic- ture without your clothes on? - Has anyone invited you to a birth- day pool party? - Has anyone done something you didn't like to your body? 39. 1. The World Health Organization has predicted that depression will be the number one world health problem in the 21st century. Life- time prevalence for major depres- sive episode is 12% (with a 5-17% range). Which of the following in- dividuals has the greatest risk fac- tive of sexual context ad would require parental involvement in the decision process. The other three questions di- rectly explore inappropriate behavior of sexual nature pertinent to assessment for possible sexual abuse. - 43-year-old, divorced woman, school- teacher, raising three children Rationale: Regardless of country or cul- ture, women have a twofold greater prevalence of major depression than men. Hormonal differences, the ef- fects of childbirth, differing psychoso- cial stressors, and behavioral models tors for major depressive disorder of learned helplessness are hypothe- (MDD)? - 16-year-old, high school male, honors student, who runs cross-country track - 43-year-old, divorced woman, schoolteacher, raising three chil- dren - 28-year-old, single woman, work- ing toward partner in a large law firm - 58-year-old, married male, com- puter analyst, whose work re- quires frequent travel. sized reasons for this difference. The mean age of onset for major depressive episode is about 40 years of age, with 50 percent of all patients having an on- set between the ages of 20 and 50. MDD occurs most often in persons without close interpersonal relationships or in those who are divorced or separated. 40. 1. A female client has gradually as- - Patient safety sumed increasing responsibility for the care of her aging parents. Her mother was diagnosed with Alzheimer's type dementia three years ago and is increasingly dis- oriented to her home surround- Rationale: Although all four are impor- tant aspects related to care, patient safety must take priority before the oth- er three responses. In counseling about safety issues regarding risk for wander- ing, leaving stove burner on unattended, ings. Her father insists on keep- ing her mother at home to pro- vide care until she dies. What is the first priority in counseling this couple and their caretaking adult daughter? - Patient safety - Patient and family education - Caregiver strain - Anticipatory guidance 41. 1. There is a growing recogni- tion that adverse life experiences due to a variety of reasons un- derlie a wide range of psychiatric disorders and medical problems. According to a seminal research study on adverse childhood ex- periences (ACE), a positive rela- tionship exists between ACE and which of the following disorders? - Alcoholism, anxiety, heart dis- ease, sleep disorders, and schizo- phrenia - Alcoholism, anxiety, depression, diabetes, and heart disease - Alcoholism, anorexia, depres- sion, diabetes, and schizophrenia - Alcoholism, anxiety, depression, diabetes, and schizophrenia 42. A 53-year-old male with a histo- ry of schizophrenia is being dis- charged from an inpatient admis- sion to a psychiatric hospital and was referred for you to follow up in your private practice. During your initial assessment with the patient, you ask him about his ed- slips, or falls the PMHNP can introduce the other areas of education, anticipato- ry guidance, and community resources. - Alcoholism, anxiety, depression, dia- betes, and heart disease Rationale: Felitti et al. (1988) semi- nal study of the long-term sequelae of ACE found a positive relationship be- tween ACE and significant heart dis- ease, fractures, diabetes, obesity, un- intended pregnancy, sexually transmit- ted diseases, depression, anxiety, sleep disorder, dissociative disorders, eating disorders, and alcoholism. - Circumstantiality Rationale: Circumstantiality is a distur- bance in which a patient digresses into unnecessary details before communi- cating the central idea. ucation level and he talks about where he went to high school, his high school friends, activi- ties he was involved in, and his high school graduation. He then states, "That was the end of my education." Which of the following does the patient's answer demon- strate? - Perseveration - Circumstantiality - Tangentiality - Loosening of associations 43. 1. A 14-year-old girl admitted to a psychiatric unit following an over- dose on alcohol and and benzo- diazepines after the breakup of a relationship has made seduc- tive comments to her roommate, which is upsetting her roommate. In assessing the girl's behavior to- ward her roommate, the PMHNP needs to include the topic of sexu- al orientation. What is the best in- troductory approach to this topic? - Are you sexually active? - What is your experience in sexual relationships? - Did you overdose after breaking up with a girlfriend or boyfriend? - Are you attracted to girls rather than boys? - What is your experience in sexual re- lationships? Rationale: Although the other respons- es can open the topic, they are close-ended and can be answered sim- ply by "yes" or "no" response. The open-ended question introduces the topic in a broad, nonjudgmental way that affords the respondent to provide pri- or history of relationships both hetero- sexual and same-sex, possible history of abuse, and her thoughts and feel- ings about her experience. Changes in sexual activity as well as comfort with sexual orientation are important to as- sess. Issues involving sexual orientation may still be in a formative stage lead- ing to an adolescent's identity confu- sion and self-esteem. Added to this is the relationship between the adolescent and family member (s) who may or may not be aware of the adolescent's sex- ual orientation. This may be a source of anxiety, shame, or discomfort for the adolescent vis-à-vis their family. 44. 1. The Mini-Mental Status Exam (MMSE) is a brief, standardized screening tool designed for use: - In adults to quantify cognitive status. Rationale: The MMSE is a brief, quan- titative measure of cognitive status in - In adults e 18 years to document adults that assesses orientation, atten- mental status. - Across the lifespan to document mental status. tion, calculation, recall, language, and motor skills. It can be used to screen for cognitive impairment, to estimate the - In older adults e 65 years to quan-severity of cognitive impairment at a giv- tify cognitive status. - In adults to quantify cognitive status. 45. 1. In a psychiatric emergency, the psychiatric mental health nurse en point in time, to follow the course of cognitive changes in an individual over time, and to document an individual's response to treatment. - Know as much about the person as possible prior to starting the interview. practitioner (PMHNP) is aware that Rationale: Self-protection involves the most important goal of the interview is self-protection. What can the PMHNP do to keep himself or herself safe? - Enter the room alone, in order to build a therapeutic alliance. - Make sure the patient is re- strained before beginning the evaluation. - Inform the patient that violence is not acceptable. - Know as much about the person as possible prior to starting the interview. 46. 1. A 44-year-old man presents to the PMHNP at his wife's insis- tence. The patient was hospital- ized for a mild head injury after a motor vehicle accident four weeks ago. He reports a 3-year histo- ry of drinking alcohol. The patient states he was at the store a week knowing as much about the patient as possible, being alert to pending vio- lence, having others present or outside the room, and developing an alliance with the patient. - Capgras syndrome Rationale: The belief that people have been replaced by imposters is the hall- mark of Capgras syndrome. The syndrome of subjective doubles is a rare delusional misidentification syn- drome in which a person experiences the delusion that they have a double ago when he realized the store clerk was an imposter replacing his wife. The patient's wife insists that her husband is delusional and she intends to file for divorce if he does not get help. Which of the following types of delusions is the patient expressing? - Delusion of doubles - Capgras syndrome - Clerambault syndrome - Fregoli phenomenon 47. 1. The mother presents to the clinic with her 9-year-old daugh- ter because she is worried about her. The mother tells ou that her daughter has been waking up in the middle of the night scream- ing off and on for the past sev- eral months. When she goes into her daughter's room, she is sitting up in bed and is initially incon- solable but eventually will go back to sleep. The mother is crying and tells you she is unable to go back to sleep after her daughter's episodes and feels exhausted all of the time. Which is the most ap- propriate initial response? - A. I can see this is very upsetting or Doppelgänger with the same appear- ance, but usually with different character traits, that is leading a life of its own. De Clerambault in 1885 is reviewed and a case is presented. Popularly called erotomania, the syndrome is charac- terized by the delusional idea, usually in a young woman, that a man whom she considers to be of higher social and/or professional standing is in love with her.Fregoli syndrome is the delu- sional belief that one or more familiar persons, usually persecutors following the patient, repeatedly change their ap- pearance. Fregoli delusion is the mistaken belief that some person currently present in the deluded person's environment (typ- ically a stranger) is a familiar person in disguise - A. I can see this is very upsetting for you. Rationale: A simple, nonjudgmental statement, such as "I can see this is very upsetting for you, " conveys to the moth- er that you are concerned. This form of sentence also acts as an open-ended question that is most likely to elicit the most important information most effi- ciently. Specifically directed statements © or leading questions (D) are less likely to be helpful in gaining information than an open-ended statement or question. Statements such as option B may indi- cate that you do not take her problem seriously. for you. - B. I know you are upset, but it will get better. - C. Tell me why you are unable to fall back asleep after your daugh- ter does. - D. Are you worried that this is your fault? 48. 1. Appraisal of the patient's suici- dal ideation, plan, method, intent, and access to implement plan would be documented in which part of the standard psychiatric evaluation? - Review of Systems - History of Presenting Illness - Diagnosis - Mental Status Exam 49. As the PMHNP working with a young female recently diagnosed with bipolar disorder, and using a recovery model, what will be the focus of your interactions with this patient? - Assisting in gainful employment - Focus on the side effects of her medications - Psychoeducation about her dis- ease process - Focus on her feelings, expe- rience, and what she wants to achieve - Mental Status Exam Rationale: Current suicidal ideation, plan, method, intent, and access to im- plement plan is documented in the Men- tal Status Exam under the section for thought content. - Focus on her feelings, experience, and what she wants to achieve Rationale: The PMHNP's role in recov- ery is to assist a patient to rebuild per- sonal, social, and spiritual needs, along with how the individual is feeling and what she is experiencing, and what she wants. [Show Less]