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NRNP 6665 / NRNP-6665N Midterm
Exam 2025 | Verified Questions
and Answers | Latest 2025
UPLOAD | Scored(A+) 100% |
Psychiatric Mental Health
Nurse Practitioner (PMHNP)
Program| PASS AT YOUR
COMFORT
An 80-year-old man with hypertension and hyperlipidemia presents with complaints of the rapid onset of severe low- back pain accompanied by abdominal pain that is gradually worsening. The patient appears pale and complains that he does not feel well. During the abdominal exam, the nurse practitioner detects a soft pulsatile mass just above the umbilicus as she palpates this area with her hand. Which of the following conditions is most likely? - << ANSWER IS>> --Abdominal aortic aneurysm
Which of the following laboratory test is sensitive for evaluating the renal function - << ANSWER IS>> -- Estimated glomerular filtration rate (eGFR) Which of the following groups has been recommended to be screened for thyroid disease? - << ANSWER IS>> -- Women aged 50 years or older All of the following patients should be screened for diabetes mellitus except: - << ANSWER IS>> --A 30-year- old White man with hypertension A 40-year-old White woman with a body mass index (BMI) of 32 complains of colicky pain in the right upper quadrant of her abdomen that gets worse if she eats fried food. During the physical exam, the nurse practitioner presses deeply on the left lower quadrant of the abdomen and the patient complains of pain on the right side of the lower abdomen. What is the name of this finding? - << ANSWER IS>> --Rovsing's sign Which of the following symptoms characterize this disorder? - << ANSWER IS>> --1.Ritualistic behaviors that the patient feels compelled to repeat.
- increased axiety when attempting to ignore or suppress the repetitive behaviors. 3.frequent intrusive and repetive thoughts and impluses All the above
A new mother is planning to breastfeed her newborn infant for at least 6 months. She wants to know whether she should give the infant vitamins. Which of the following vitamin supplements is recommended by the American Academy of Pediatrics (APA) during the first few days of life? - << ANSWER IS>> --Vit D drops An asthmatic exacerbation is characterized by all of the following symptoms except: - << ANSWER IS>> --Chronic coughing A 76-year-old woman reports that for the previous 4 months, she has noticed severe stiffness and aching in her neck and both shoulders and hips that is worsened by movement. She reports having a difficult time getting out of bed because of the severe stiffness and pain. It is difficult for her to put on a jacket or blouse or to fasten her bra. Along with these symptoms, she also has a low-grade fever, fatigue, loss of appetite, and weight loss. Starting yesterday, the vision in her right eye has progressively worsened. She has annual eye exams and denies that she has glaucoma. Which of the following conditions is most likely? - << ANSWER IS>> --Polymyalogia rheumatic (PMR) Hematoma - << ANSWER IS>> --epidural: m/c in the temporal/parietal region Subdural hematoma: m/c caused by tearing of the bridging veins
acute subdural hematoma sxs - << ANSWER IS>> -- drowsiness, agitation, and confusion HA unilateral or bilateral pupil dilatation hemiparesis noncontrast CT sx indications: >10mm thickness with >5mm midline shift regardless of GCS chronic subdural hematoma sxs - << ANSWER IS>> --HA memory loss personality changes incontinence ataxia obtain CT scan sx usually required, burr holes or craniotomy traumatic subarachnoid hemorrhage - << ANSWER IS>> -- HA reduced LOC nuchal rigidity hemiplegia ipsilateral pupillary abnormalities delayed vasospasm diffuse axonal injury - << ANSWER IS>> --type of brain injury characterized by shearing, stretching, or tearing of nerve fibers with subsequent axonal damage.
and alogia). - << ANSWER IS>> --signs and symptoms of schizophrenia a decline in both cognitive and social functioning that often precedes the development of florid psychosis. - << ANSWER IS>> --Schizophrenia is associated with The exact etiology of schizophrenia is unknown, although it is thought to be linked to an increase in dopaminergic activity. No single etiological factor is responsible for schizophrenia. - << ANSWER IS>> --Etiology of Schizophrenia Treatment includes antipsychotics in conjunction with behavioral therapy. - << ANSWER IS>> --Treatment of Schizophrenia Schizophrenia is a chronic serious mental disorder characterized by loss of contact with reality and manifested by two main symptoms: hallucinations and delusions. - << ANSWER IS>> --Schizophrenia definition Men and women are equally affected, but with a slight difference in the age of onsetMen: average age of onset = 23 years Women: average age of onset = 26 years - << ANSWER IS>> --onset of schizophrenia The disorder manifests when a person with a genetic predisposition is exposed to one of many environmental stressors.
- genetic predisposition
- environmental stressors - << ANSWER IS>> --Etiological factors of schizophrenia Environmental stressors are believed to be triggers of schizophrenia rather than true causes of the disorder.
- Childhood trauma
- Residence in an urban area
- Social isolation
- Frequent cannabis use in early adolescence
- Migration
- Poverty
- Stress and psychosocial factors
- Birth in late winter or early spring
- Advanced paternal age at conception - << ANSWER IS>> --Environmental Stressors of Schizophrenia Genetic and environmental risk factors appear to act via a common pathway of disrupting the function of 1 or more neurotransmitter components. Dopaminergic theory: Almost all drugs with antipsychotic properties block the dopaminergic D2 receptor. However, antipsychotics are only 70% effective and clozapine, the most effective antipsychotic for treating schizophrenia, is a weak D2 antagonist. Hyperactivity of dopamine D2 receptor neurotransmission in subcortical, and limbic brain regions contribute to the positive symptoms of schizophrenia. Hypo functionality of dopamine D1 receptor neurotransmission in the prefrontal cortex contributes to both negative and cognitive
Symptoms can be classified into premorbid, positive, negative, and cognitive. - << ANSWER IS>> --Clinical Presentation of schizophrenia Easy to recognize. Delusions:
- False, fixed beliefs maintained by the patient despite being contradicted by reality or logical arguments.
- Can include grandiosity, ideas of reference, paranoia, persecutory, erotomania, jealousy, and somatic delusions. Hallucinations:
- Perceptual abnormalities in which sensory experiences occur in the absence of external stimuli.
- Can be auditory (most common), visual, somatic, gustatory, and olfactory. Illusions:
- distinguished from hallucinations by the presence of real external stimuli that is simply misinterpreted by the patient. Disorganized speech and/or behavior:
- can include neologisms, echolalia, flight of ideas, pressured speech, and loose associations, among others.
- << ANSWER IS>> --Positive (psychotic phase)
- Potentially difficult to recognize because of similarities to depression.
- Flat affect (diminished emotional expression).
- Avolition (lack of initiative).
- Alogia (poverty of speech).
- Poor attention.
- Anhedonia. - << ANSWER IS>> --Negative (residual phase)
- Usually nonspecific; related to the impact on the patient's quality of life.
- Poor executive functioning, represented by disorganized speech and/or thought that results in impaired communication.
- Inattention
- Impaired memory - << ANSWER IS>> --Cognitive Diagnosis is made by clinical observations based on the type of symptoms presented, their severity and duration, and how the patient's life is affected by their presence. A total duration of symptoms of at least 6 months, including a period of positive symptoms lasting at least 1 month. The presence of a mix of positive and/or negative symptoms, especially delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior. The presence of these symptoms must disturb the patient's daily functioning, including the social, personal, and professional areas of life. - << ANSWER IS>> -- Diagnosis of Schizophrenia Other conditions must be ruled out to make a definitive diagnosis:
- Schizoaffective, brief psychotic, and schizoaffective disorders.
increased risk of mortality in older adult patients with dementia. Examples include haloperidol, fluphenazine, and chlorpromazine. - << ANSWER IS>> --1st-generation antipsychotics Newer medications, starting with clozapine (approved in 1989). Associated with a lower risk for EPS compared with FGAs and therefore the 1st-line drugs to use (although the risk of metabolic syndrome is increased with SGAs). The decreased risk for EPS is the most important distinction from FGAs, as the pharmacologic properties, therapeutic effects, and adverse effects are not distinct between the 2 groups. Serotonin and dopamine antagonists. Common side effects include metabolic syndrome, hypotension, sedation, anticholinergic symptoms, hyperprolactinemia, EPS, cardiac effects, cardiomyopathies, cataracts, and sexual dysfunction. Examples are risperidone, aripiprazole, quetiapine, olanzapine, ziprasidone, clozapine. - << ANSWER IS>> -- 2nd-generation (atypical) antipsychotics Requires immediate attention.
Use oral antipsychotic and benzodiazepine (may require intramuscular due to noncompliance or for more rapid effect). Usually lasts 4-6 weeks. - << ANSWER IS>> --treatment of acute psychosis in schizophrenia
- Obtain laboratory tests: CBC (including differential if clozapine used), electrolytes, fasting glucose, lipid profile, liver, renal, and thyroid function tests, and a pregnancy test in females of fertile age.
- ECG if history of heart disease or if using drugs that may prolong the QT interval (clozapine, thioridazine, iloperidone, ziprasidone).
- Monitor for the 1st few weeks and then regularly for involuntary movement disorders/EPS, since they may become irreversible.
- The goal is to minimize symptoms, avoid relapses, and promote recovery that allows integration into society.
- Minimize side effect profile.
- Recommended maintenance treatment is > 5 years.
- May use long-acting injectable antipsychotics for non- compliant patients after checking for tolerability/efficacy with an oral agent. - << ANSWER IS>> --treatment of Maintenance phase in schizophrenia
- Roughly 40% of treated patients will demonstrate positive symptoms that are resistant to treatment.
- Assess proper dosage and duration of treatment.
- Associated with long-term treatment with 1st-generation antipsychotics Movement phenotypes include: torticollis (involuntary contraction of neck muscle, causing head tilt), dystonia of lips, tongue, oromandibular, or pharynx.
- Treatment includes drugs (valbenazine and deutetrabenazine) that block vesicular monoamine transporter 2 protein, which then prevents presynaptic dopamine release; injection of botulinum toxin is also used. - << ANSWER IS>> --tardive dyskinesia
- Caused by almost all antipsychotics.
- Can result in irregular menses, galactorrhea, and sexual dysfunction.
- Treatment includes dosage reduction/medication changes. - << ANSWER IS>> --Elevated prolactin
- Weight gain, hyperlipidemia, hyperglycemia, and hypertension → increased cardiovascular risk.
- Treatment: Change from high-risk drug (e.g., olanzapine, quetiapine, risperidone) to an antipsychotic with lower metabolic risk (e.g., aripiprazole or ziprasidone) if possible.
- Monitor and treat each cardiovascular risk factor appropriately. - << ANSWER IS>> --Metabolic
- Idiosyncratic reaction to antipsychotics.
- This is a life-threatening emergency.
- Symptoms include at least 2 of the following cardinal symptoms: fever, altered mental status, muscle rigidity, and autonomic dysfunction.
- Treatment includes immediate discontinuation of the antipsychotic medication and aggressive supportive care. - << ANSWER IS>> --Neuroleptic Malignant Syndrome Nonpharmacological treatments are known to be partially effective in treating the negative and cognitive symptoms of the disorder and increase patient adherence to medications.
- Hospitalization: May be required to ensure the safety of patients. In certain cases, isolation may be required for a short period of time.
- Psychosocial therapy:
- Cognitive-behavioral therapy
- Compliance therapy Individual psychotherapy
- Group therapy
- Electroconvulsive therapy: mostly treatment-resistant cases for augmentation to pharmacotherapy. - << ANSWER IS>> --Nonpharmacological treatments for schizophrenia
- brief psychotic disorder
- schizophreniform disorder
- schizoaffective disorder
- delusional disorder
- substance induced psychotic disorder
- psychotic disorder d/t medical condition
- mood disorder with psychotic features - << ANSWER IS>> --Differential Diagnosis (DDx) for schizophrenia
IS>> --Rule out any physiological cause for the crying spells A 22-year-old sexually active woman is complaining of amenorrhea and new-onset bloody vaginal spotting. On examination, her left adnexa is tender and cervical motion tenderness is positive. Which test should the nurse practitioner order initially? - << ANSWER IS>> --Urine pregnancy test A 44-year-old woman who is undergoing treatment for infertility complains of not having had a menstrual period for a few months. The night before, she started spotting and is now having cramp-like pains in her pelvic area. Her blood pressure (BP) is 160/80 mmHg, pulse is 110 beats/min, and she is afebrile. Her labs reveal mild anemia with mild leukocytosis. On pelvic exam, the uterine fundus is noted to be above the symphysis pubis. The cervical os is dilated at 3 cm. Which of the following is most likely? - << ANSWER IS>> --Inevitable abortion The Pap smear result for a 22-year-old sexually active college student whose partner uses condoms inconsistently reveals a large number of white blood cells and blood along with inflammatory changes. During the speculum exam, the cervix bled very easily (friable), and a small amount of purulent discharge was present on the cervical surface. No cervical motion tenderness was noted during the bimanual vaginal exam. What is the next step in the management of this patient? - << ANSWER IS>> -- Advise the patient be tested for chlamydia and gonorrhea
All of the following are infections that affect mostly the labia and vagina except: - << ANSWER IS>> --Chlamydia trachomatis Medicare Part B will pay for all of the following services except: - << ANSWER IS>> --Eyeglasses and routine dental care Which of the following individuals is more likely to be affected by alpha thalassemia anemia? - << ANSWER IS>> -- 25 - year-old Chinese patient A nurse practitioner's right to practice is regulated under: - << ANSWER IS>> --The board of nursing A 25-year-old woman's last menstrual period was 6 weeks ago. She is complaining of nausea with vomiting in the morning and fatigue. Her breasts feel bloated. The nurse practitioner suspects that she is pregnant. Her symptoms would be considered: - << ANSWER IS>> --Presumptive signs of pregnancy A new patient who is a 40-year-old female postal worker is being evaluated for complaints of a new-onset erythematous rash on both cheeks and the bridge of the nose, accompanied by fatigue. She reports a history of Hashimoto's thyroiditis and is currently being treated with Synthroid 1.25 mg daily. Which of the following conditions is most likely? - << ANSWER IS>> --Lupus erythematosus
