1. During a suicide intervention with your 28yo male patient, to which agreement should you ask for his consent, verbally or in writing?
a. -“No
... [Show More] Harm” contract- health care professionals are obligated to ask suicidal patients to agree to a no harm contract, verbally or in writing, detailing specifically that the patient will restrain from harming themselves
b. “No Suicide” contract- typical contracts used in the prevention of suicide
c. “Prevention” Contract- typical contracts used in the prevention of suicide
d. “Affirming Life” contract- typical contracts used in the prevention of suicide
2. Courtney 35 is a rape victim. You note that she has an expressed style of coping in her acute rape trauma syndrome. Which of the following would most lead you to this conclusion?
a. Patients Masked face
b. Patients Distractibiity c. Patient Smiling
d. Patient having difficulty making decisions
3. Which of the following patients would not require hospitalization?
a. A 29yo self-admitted bulimic male with bradycardia
b. A 27yo female with repeated use of laxatives and diuretics at least two times a week for 3 months
c. A 20yo male suffering from persistent hypothermia
d. A 18yo young woman who is 5’4” and weighs 92 pounds
4. Terry, 35yo, visits your office with the assumption that he is experiencing depression. Terry explains that he has a history of substance abuse and a family history of mood disorders. He claims that he has recently been incredibly fatigued, possessing no energy to even perform day to day activities. Even with the sudden onset of fatigue. Terry explains that he is still experiencing insomnia. He also complains about recurring confusion and loss of weight, and confesses that he has been experiencing more recurrent suicidal thoughts. Of the following which is the best medication to prescribe Terry for his situation?
a. Sympathomimetics- thought to be most effective pharmacological treatment for depression, however they have a potential for abuse
b. Bupropion- better choice due to history of substance abuse
c. Olanzapine- mood stabilizer more effective for bipolar
d. Risperidone- for mania
5. You are attending to a 30yo male after he was shot at and almost killed. By showing empathy, confrontation, and immediacy, you are exhibiting which of the following?
a. Identifying the hazard and precipitating event- involves differentiating the precipitating event from long term psychological problems.
b. Counseling keystones relevant to assessment of a crisis- Three of the counseling keystones relevant to assessment of a crisis are empathy, confrontation, and immediacy.
c. Identifying coping mechanisms- does not involve wide-ranging keystones such as empathy, but rather specific actions such as questioning and increasing adaptive coping by recommending the patient seek information.
d. Situational support
6. A patient with which of the following findings should be referred to primary care for cardiovascular problems? a. A patient with a blood pressure of 130/85- considered prehypertension and should be referred to
primary care.
b. Systole
c. Diastole
d. Low density lipoprotein level (LDL) of 69 mg/dl- is the desired LDL for patients, anything over 100 mg/dl should warrant a referral to primary care for evaluation of cholesterol.
7. Patients with severe and persistent mental illness (SPMI) exhibit symptoms which interfere with occupational, academic, and social functioning. Which of the following illnesses eventually touches 100% of patients affected with SPMI?
a. Unipolar depression- affects 20-30% of SPMI patients
b. Schizophrenia- affects 90% of SPMI patients
c. Dementia- 100% of patients with SPMI are eventually affected by varying degrees of dementia which interfere with occupational, academic and social functioning
d. Bipolar Depression- affects 40-50% of SPMI patients
8. Before patients enter a hospice they are advised of their right to refuse care, but only if they have which of the following?
a. Decisional capability
b. A living will
c. A healthcare directive
d. Informed consent
9. Which of the following statements is not a correct association with the Bronfenbrenner’s ecological system model?
a. Children are dynamic entities and develop the skills necessary to that setting
b. The child may be established as by the parents relationships
c. Objective reality influences behaviors and development more than ones perception of environment
d. Changes in family structure such as the birth of a sibling affect a child’s development
10. A 34yo man who recently had a major car accident comes to your office. He reports that his car hit the car in front of him. The man says he has a relative with intermittent explosive disorder and worries, that he may also have it. He is worried that if he has this disorder, it could lead to further problems in the future. When asked if he hit the car on purpose, he initially denies it, but then indicates that he was particularly annoyed with the driver in front of him. Which of the following would not be a typical characteristic of this disorder?
a. The degree of aggression was out of proportion to the precipitating psychological stressor b. He had been drinking alcohol extensively earlier in the night
c. He felt immediately guilty after the episode
d. He experienced tingling and chest tightness shortly before episode.
11. Of the following antidepressant medications, which is a tetracyclic antidepressant?
a. Maprotiline- a tetracyclic antidepressant, chemical compound consists of primarily 4 rings of atoms.
b. Amitriptyline- tricyclic antidepressant
c. Amoxapine- tricyclic antidepressant
d. Phenetzine sulfate- MAOI
12. The sexually transmitted disease that causes superficial, painful ulcers surrounded by an erythematous halo in men but is usually asymptomatic in women is which of the following?
b. Herpes Simplex virus type I- painful ulcers on face no halo
c. Human Papillomavirus- single or multiple soft, fleshy, papillary, or sessile, painless keratinized growth around anus, vulvovaginal area, penis urethra, or perineum.
d. Lymphogranuloma venereum- painless and involves bubo
13. The medical profession categories the various levels of prevention that caregivers practice on their patients. A pap smear screening corresponds to which of these types of prevention?
a. Primary prevention
b. Secondary prevention
c. Quaternary Preventioin
d. Tertiary Prevention
14. Schizophrenia is a complex illness with certain accepted phases; and often lifelong movement between phases, which of the following is not a phase of schizophrenia?
a. Prodromal
b. Premorbid c. Relapsable
d. Acute
15. Eric, a 34yo male, diagnosed as schizophrenic 5yrs ago. Among his characteristics and features is an apparent emotional detachment from his action and surroundings. During interviews with him, you note his persistently confused speech and behavior. You are also informing Eric’s family members of his diagnosis, you should tell them that Eric displays characteristics of which type of schizophrenia?
a. Disorganized
b. Catatonic
c. Residual
d. Paranoid
16. In the treatment of GAD, benzos are advisable typically for short term use. Which of the following is not a risk associated with this treatment?
a. Tolerance b. Blood clots
c. Dependency
d. Withdrawal symptoms when discontinued
17. Vitamin B12 deficiency can lead to clinical symptoms of dementia. In patients with dementia, which of the following findings would you also expect to see as a result of this deficiency?
a. Markedly increased neuritic plaques and neurofibrillary tangles- hallmark of Alzheimers as is decreased availability of acetylcholine.
b. Demyelination and axon loss in the brain and spinal cord- dementia due to B12 is caused by demyelination and axon loss in brain and spinal cord.
c. Decreased availability of acetylcholine
d. Substantial reduction in neurons in the substantia nigra -aka atrophy of the substantia nigra is a clinical feature of Parkinson’s disease and not related to B12.
18. You are treating SergeI, who speaks limited English, and you do not know enough Russian to treat him. According to the standards of Culturally and Linguistically Appropriate Services, you must provide all of the following for Sergei, except:
a, b, and c all are part of (CLAS)- One of the standards of Culturally and Linguistically Appropriate Services (CLAS) is the requirement that health organizations must provide language assistance Services. This includes bilingual staff or interpreter services at no cost to the patient. Their right to this service must be made known to the patient in their preferred language, both verbally and in written notices. Additionally, the patient’s family or friends may be used as translators unless specifically requested by the patient.
a. Bilingual staff and interpreter services at no cost to the patient
b. An English-Russian translator application on your computer- does not meet the stadards of CLAS
c. Verbal and written notices in the patient’s native language
d. A trusted family member or friend who can translate, if requested
19. Matthias, 8yo male, is having difficulty in school. His mother is concerned about his social withdrawal and isolation. His mother tells you that she is worried that it may be schizophrenia because her older brother has the condition. You tell her that Matthias may be in the premorbid phase of schizophrenia, which requires early intervention. The premorbid phase contains all of the following characteristics except:
a. Echopraxia- the involuntary repetition of another individual’s observed actions. This is a feature of the acute or psychotic phase of schizophrenia, not the premorbid phase.
b. Enuresis- premorbid phase can also include involuntary urination or enuresis
c. Irritability and or anger- major characteristics of premorbid phase
d. Depression- major characteristics of premorbid phase
20. A physical therapist helps Chris who was paralyzed below his waist after falling off a horse. He is now post spinal cord surgery and he is able to feel his legs and feet again. What level of prevention is occurring here?
a. Secondary Prevention b. Tertiary Prevention
c. Primary Prevention
d. Quaternary prevention
21. The following choices represent the predisposing factors for enuresis except:
a. African American
b. Male
c. Small bladder capacity d. Poor nutrition
22. You are meeting Ginger, a 10yo, who was brought to you by a social worker. You notice that Ginger is wary of adult contact, withdrawn and responds to your questions in monosyllabic answers. You also gather that she is frightened of her parents, yet she makes constant efforts to please them. The patient’s behavior is most indicative of which of the following?
a. Neglect y caretakers
b. Emotional abuse by caretakers
c. Sexual abuse by caretakers d. Physical abuse by caretakers
23. Despite the fact that she claims she “forgot” to pay for the items. Cynthia was recently arrested for shoplifting at a clothing store. Looking at this 32yo, female’s history, you realize she has a history of shoplifting often by herself and with no apparent need or want for the items. Which of the following would you expect to see in Cynthia’s family history?
a. Her sister was addicted to pain killers b. Her mother has OCD
c. Her father was an alcoholic
d. Her aunt suffered from panic attacks
24. You are performing a comprehensive health history of 20yo Ricky. He has been in and out of juvenile detention centers because of his violent history over the last 3 years. You are trying to delineate whether his propensity for violence is associated with internal or external factors. Yu should pay special attention to the following possible issues except:
a. GI problems
b. History of substance abuse
c. High fevers
d. Head injury
25. Jameson, 47, is a self-described “neurotic overachiever” who is obsessed with growing his small business. During your interview, you note that he appears arrogant and grandiose. He is convinced that his largest business competitor is intent on sabotaging his company. He appears unable to empathize with the feelings and needs of others and has few friends or interests outside of work as a result. Which of the following personality disorders best explains Jameson’s behavior?
a. Obsessive-Compulsive
b. Histrionic
c. Borderline d. Narcissistic
26. You see an Alzheimer’s patient you treat regularly, 77yo Jane. In your last checkup you have noticed bruises on her, and Jane is in no state to recall what occurred. In most states, which of the following would you be legally required to report to social services?
a. Neither incident
b. The incident of domestic abuse c. Both incidents
d. The incident of elder abuse
27. When treating a patient with hyperactive delirium, you must help the patient in managing his or her symptoms until the delirium has resolved. Which of the following would be least appropriate for this type of patient?
a. Schedule treatments and medications at times that will not interrupt nighttime sleep
b. Clearly identify staff and their function
c. Allow the patient to sit up partially
d. Provide the patient with a semi-darkened room
28. Even though many types of dementia are permanent and become progressively worse, there is a potentially eversible form of dementia. This type of dementia impairs the return of cerebral spinal fluid to brain from the spinal column because of enlarged ventricles. Which of the following matches this description?
a. Dementia due to Picks disease
b. Dementia due to normal-pressure hydrocephalus
c. Dementia due to HIV
d. Dementia due to Creutzfeld-Jacob disease
29. Which of the following are two risk factors for the recurrence of major depressive disorder?
a. Prior history of multiple major depressive episode and a later age of onset—earlier age of onset not later
b. Negative Cognitive style and persistent sleep disturbance- along with a prior history of major depressive episodes, ongoing psychosocial stress, negative cognitive style, and earlier age of onset, and persistent sleep disturbances are some of the risk factors for the recurrence of major depressive disorder.
c. Sociopathic behavior and paranoid behavior- suggests less of a risk for mood disorders.
d. Ongoing psychosocial stress and family history of major depressive disorder- family history of MDD not a risk factor for its recurrence
30. Which of the following statements about elder abuse is false?
a. Elderly women are at higher risk of being abused than elderly men- elderly men at higher risk of being abused than women, especially if the elderly men were abusive in the past.
b. About one in ten elders in the community are mistreated- true
c. Elder abuse increases with increase in “caretaker burden”- true
d. More than half of abused dependent elders are abused by their spouse- true
31. Abnormalities in neurotransmitters such as serotonin and dopamine may be a neurological predisposing factor for bipolar disorders. An abnormality of which of the following may also be a neurological predisposing factor? Neurological predisposing factors for bipolar disorders include, but are not limited to, abnormalities of cortisol, norepinephrine, glutamate, and acetylcholine.
a. Somatostatin
b. Epinephrine c. Cortisol
d. dimethyltryptamine
32. Which of the following findings is not among the list of necessary symptoms for a diagnosis of dementia?
a. Agnosia
b. Aphasia
c. Anosognosia
d. Apraxia
33. Samuel is under your care for depression. Your medication of choice in his case is a prescription for a serotonin norepinephrine reuptake inhibitor (SNRI). This type of medication blocks the reuptake of neurotransmitters after their release from the presynaptic terminal. Which of the following medications did you prescribe?
a. Venlafaxine
b. Thioridazine
c. Perphenazine
d. Chlorpromazine
34. Of the following, which is not a goal of the “Healthy People 2020” program?
a. Help Americans attain lives free of preventable conditions
b. Promote accessibility to health care
c. Provide healthcare for the uninsured- goal to promote not provide
d. Provide measurable data and goals to guide policy decisions- the program collects and provides information to help healthcare providers, consumers, and policy makers make better informed decisions concerning healthcare.
35. A 47yo male presents with slurred speech, an unsteady gait, and overall drowsiness, as well as a sense of “wellbeing”. Which of the following substances is he most likely abusing?
a. Alcohol- blackouts and headaches
b. Amphetamines- autonomic hyperactivity and pupil changes
c. Opioids- indicated by constricted pupils, and diarrhea
d. Benzodiazepines
36. A 19yo female comes to your office with her parents. She recently finished her first year of college, and her parents mention she has lost a significant amount of weight, even though she was not heavy when she began college. When discussing the issue with you, the patient clarifies that she is not preoccupied with losing weight, rather she has increased her workouts to avoid the unhealthy behavior of many other freshmen around her. Upon further delving into the issue, she mentions that she is not sexually active and that exercise and her weight help her feel better about herself. If the patient’s signs and symptoms are indicative of an eating disorder, which of the following would be most expected in this patient?
a. Broken fingernails b. Amenorrhea
c. Pale skin tone
d. Binging followed by purging
37. You are practicing in a rural community hospital. You visit with Aaron, a 29yo male who has just received a diagnosis of schizophrenia. During and after college he lived in a large city, but he has returned to the rural community to get support for his illness. His 22yo sister, who has always lived in the rural community, pulls you aside and says she is worried that her Fiancés family will think her family is prone to mental illness. You inform her about her brother’s condition by using all of the following statements except:
a. There is seemingly multigenic genetic vulnerability to schizophrenia that is not completely expressed- Schizophrenia is associated with an imbalance of neurotransmitters, it would be incorrect to say the imbalance is the definitive cause, since no single cause can currently account for Schizophrenia. Rather, it appears to be the result of multiple causes, such as genetic factors, environmental and psychological assaults, and possible hormonal changes that alter the brain’s chemistry. Second, the neurotransmitter imbalance is not thought to be related to brain shrinkage, rather, the disease may arise from unrelated structural changes.
c. Schizophrenia undoubtedly has a genetic component. The risk for inheriting schizophrenia is 15% in those who have one immediate family member with the disease and about 35% if the disease affect an identical twin or both parents.- explains genetic predisposition to Schizophrenia
d. Over-involved, critical, and hostile families with high levels of expressed emotion often have more difficulty assisting the schizophrenic member with maintaining stability.- stress must be also taken into account for patients, including the types of families described here.
38. Which of the following predisposing factors in the occurrence of mental retardation? a. Prenatal factors
b. Perinatal factors
c. Postnatal factors
d. Hereditary factors
39. After her parent was murdered, you suspect your 32yo patient may be exhibiting distortions in her cognitive thinking. You recall Beck’s cognitive triad, which describes individual behaviors that indicates cognitive distortions. Which of the following is not an example of that behavior?
Beck’s triad is concerned with a patient’s outlook on events, and does not touch on actions such as a patient willfully disrupting coping systems. Holding a negative view of self and assuming a future holds no hope are aspects to Beck’s triad, and evaluating ongoing events in a negative way is counted as the same part as misinterpreting available data.
a. Assuming the future holds no hope
b. Willfully disrupting coping systems- an aspect of the patient’s assimilation
c. Misinterpreting available data
d. Evaluating ongoing events in a negative way
40. Alex’s husband is in his final days of life with terminal cancer. Over the past six months that her husband has been in the hospital. Alex has been progressively losing weight, almost 60 pounds. She is also having difficulty with persistent insomnia. Which model and stage of grief is Alex experiencing?
a. 5th stage of Elizabeth Kubler-Ross’ model- acceptance, resignation, and peace
b. 1st stage of Edward John Mostyn Bowlby’s model—disbelief with the loss that occurred
c. 4th stage of Edward John Mostyn Bowlby’s model- reorganization and demonstrating a readiness to move forward.
d. 4th stage of Elizabeth Kubler-Ross’ model- is depression with symptoms including sleep disturbances and weight changes.
41. Of the following which type of relational orientation is characterized by a value of group goals over individual goals and a tendency toward ordered succession?
a. Individualistic orientation- characterized by more frequent interpersonal relationship with outsiders rather than family
b. Future orientation- deals more with how a patient temporarily views accomplishments and self-value, and is not considered a type of relational orientation
c. Collateral orientation- characterized by a more concentrated focus on group goals and on relationships with others at one’s own level.
d. Lineal orientation- characterized by a higher placed value on group goals over individual goals and a tendency toward ordered succession.
42. In evaluating the health beliefs and practices of a patient which of the following is the first step a nurse practitioner should take in his or her assessment?
a. The NP should ask patients to define and explain how they view health
b. The NP should ask patients to explain their views on death- this is after the patient has disclosed their views on health in general, as well as their own health
c. The NP should tell patients how they can improve their health- only after completion of the cultural assessment, so as to give a more culturally sensitive, relevant, and appropriate recommendation
d. The NP should ask patients about who prepares their food and drink at home- this is asked when evaluating a patient’s family roles
43. Robert’s wife had died after a protracted battle with lymphoma. He is angry at the doctor for not diagnosing her condition sooner or being better able to help her. Robert also feels guilty for not having been kinder towards her while she was alive. Which stage of grief is Robert experiencing according to Bowlby’s model?
a. Stage 4: Reorganization- features an acceptance or resignation regarding the loss, including a readiness to move forward and view the loss as a treasured memory
b. Stage 1: Numbness and Protest- describes those in grief as unable to believe that the loss has occurred
c. Stage 3: Disorganization and Despair- aimless or distracted behavior, isolation, and loneliness are common
d. Stage 2: Disequilibrium- Robert’s somewhat erratic swings between guilt and anger represent a state of disequilibrium and reflect a preoccupation with loss. The inward or outward expression of anger or guilt also define the second stage of Bowlby’s model
44. An 82yo man comes to your office accompanied by his daughter. He works part-time as a janitor. In recent years, he has become increasingly confused and forgetful. At work, he often forgets his daily tasks and either repeats jobs he has already complet4ed or does not correctly perform the job. His daughter states that she spoke to some of his co-workers and learned that her father sometimes speaks in incoherent phases. When performing a cognitive exam, which of the following would you not ask the patient during the mini-mental status exam?
a. Ask the patient about his sleep patterns
b. Ask the patient what is today’s date
c. Ask the patient to name an object to which you pointed
d. Ask the patient to recall three words that he previously registered
45. Which of the following key concepts is not a part of the SLAP assessment for suicidal risk?
a. Lethal
b. Plan and previous
c. Abuse of substances
d. Access
46. Of the following, which is not a special population to be considered by the nurse practitioner in the context of a cultural assessment?
Special populations to be considered by the NP within the context of a cultural assessment include the homeless population, migrant workers, people who are fearful of discrimination based on gender and sexual identity differences, the correctional population, and the forensic population
a. Forensic population
b. LGBT population
c. Physically handicapped population- not considered a special population within the context of a cultural assessment
d. Correctional population
47. Sani, 83 was diagnosed with mild to moderate stage Alzheimer’s 18 months ago. Since his diagnosis, he has experienced progressively worsening depression. You wish to alleviate his depression, sparring his cognitive facilities as much as possible, but do not want significantly increase his risk for seizures. Which of the following medications should you not prescribe?
a. Bupropion
b. Venlafaxine
c. Ducxetine
d. Fluoxetine
48. A patient throws a vase across the room, smashing it. You are treating him for violent outbursts. Of the following, which is the best way to deal with him at this moment?
a. The NP should leave the room until the patient has calmed b. Speak only to give short directions
c. Process the patient’s problems
d. Attempt to give the patient a solution to problems.
49. A 34yo man comes to your office saying that he may be suffering from depression. When taking a Zung depression inventory, which of the following scores indicates an increased risk of depression?
The Zung Depression Inventory is made up of 20 items, a patient who scores above 50 may have increased risk of depression. A normal score would be 34 or less. The other 3 choices are all too low to [Show Less]