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PMHNP Psychopharm Exam 8 2024
- Scientific Foundation You are treating a patient for his first episode of major depression. You decide to initiate citalopram (Celexa). How much time should you allow for the medication to provide its initial therapeutic effect and the patient to see improvement of symptoms? 8 months 4 to 6 weeks 2 weeksterm- 2 2 months - Correct answer: 4 to 6 weeks The initial time frame for this medication to have a therapeutic effect is 4 to 6 weeks. Once the patient begins treatment on an SSRI, and the nurse practitioner and patient agree on the regimen, patients are expected to continue this treatment for 6 to 12 months. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 151.
- Scientific Foundation What is the primary purpose of the corpus callosum? To connect the right and left hemispheres and facilitate sensorimotor information exchange To allow for multimodal sensory input and trigger memories To coordinate movement of multiple muscles To control voluntary motor movement, working memory, and behavioral cueing - Correct answer: To connect the right and left hemispheres and facilitate sensorimotor information exchange The corpus callosum is a large bundle of white matter that connects the right and left hemispheres and provides an area of sensorimotor information exchange. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 65.
- Scientific Foundation When assessing for genetic influences, the PHMNP understands which of the following about single nucleotide polymorphisms (SNPs)? Single-gene disorders are common SNPs detect single-base changes during the DNA-sequencing process To be classified as an SNP, the variant must be found in 10% of the population SNPs are the rarest type of genetic variation among humans - Correct answer: SNPs detect single-base changes during the DNA-sequencing process Single nucleotide polymorphisms detect single-base changes during DNA sequencing. SNPs are the most common gene variant in the population and must occur in 1% of the population to be considered an SNP. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 75.
- Scientific Foundation Systemic effects of hypernatremia include which of the following? Restlessness
Confusion Apprehension Lethargy - Correct answer: Restlessness Systemic effects of hyponatremia include confusion, apprehension, and lethargy. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 91.
- Scientific Foundation Which of the following amino acids is implicated in bipolar disorder, seizures, and schizophrenia? Aspartate Glycine Glutamate GABA - Correct answer: Glutamate Glutamate is also known as the universal excitatory neurotransmitter and has been connected to bipolar disorder, seizures, mood imbalance, and schizophrenia. Aspartate is another excitatory neurotransmitter and works in conjunction with glutamate. GABA and glycine are inhibitory neurotransmitters. Reference: Psychiatric-Mental Health Nurse Practitioner Review and Resource Manual, 4th Edition. Pg
- Scientific Foundation A 29-year-old African American female was diagnosed with schizophrenia approximately three years ago. After many trials of antipsychotics, she was finally stabilized on haloperidol during the past six months. Three weeks ago she began exhibiting mild pseudo-Parkinson's symptoms. Which class of medications would be most appropriate for treating these side effects? Muscarinic 1 antagonist Histamine 1 antagonist Alpha 1 adrenergic agonist Cholinesterase inhibitor - Correct answer: Muscarinic 1 antagonist Extrapyramidal symptoms are drug-induced side effects that affect motor functioning and muscle movement. Extrapyramidal symptoms are associated with a deficiency of dopamine and an excess of acetylcholine in the nigrostriatal pathway. A common type of extrapyramidal symptom is called pseudo-Parkinson's, which presents with a shuffling gait, motor slowing, mask-like facial expression, tremors, and muscle rigidity. Muscarinic 1 antagonist medications reduce the effects of excess acetylcholine and relieve extrapyramidal symptoms. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-Mental Health Nurse Practitioner Review Manual, Fourth Edition. Pg 251-252.
- Scientific Foundation As a nurse practitioner, you are responsible for assessing cranial nerves as a part of the neurological exam. What cranial nerve assessment tests hearing? Oculomotor nerve (CN III) Trochlear nerve (CN IV) Vestibulocochlear nerve (CN VIII)
- Scientific Foundation Bipolar disorder is believed to be related to an increase in what neurotransmitter? Dopamine Glutamate GABA Norepinephrine - Correct answer: Glutamate Bipolar disorder is believed to be related to an increase in glutamate. Glutamate is an excitatory amino acid neurotransmitter. While the exact connection between glutamate and bipolar disorder remains unclear, proton magnetic resonance spectroscopy studies have found increased glutamate in those with bipolar disorder compared with healthy controls. Glutamate is also implicated in seizure disorders and schizophrenia. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 69.
- Scientific Foundation Which of the following is an example of combined structural and functional imaging currently mainly used in research? Fluorine magnetic spectroscopy Functional imaging Computed tomography Magnetic resonance imaging - Correct answer: Fluorine magnetic spectroscopy Fluorine magnetic spectroscopy is one of the newest imaging attempts to examine structure in connection with function and is mainly used in research. CT, MRI, and functional imaging tests such as EEG and PET scans are currently used to examine either structure or function but not both. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 72-73.
- Scientific Foundation Which of the following is a biological factor influencing gender identity? Family and religious views on transsexuality Cultural attitudes toward sexual orientation Pre- and postnatal hormone levels Messages spread by the mass media related to sexual identity - Correct answer: Pre- and postnatal hormone levels Gender identity is a person's sense of identity along a continuum between normative constructs of masculinity and femininity. Both biological and social factors influence gender identity. Biological factors include pre- and postnatal hormone levels and gene expression. Social factors include gender messages from a person's culture, family, and the mass media. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 23-28.
- Scientific Foundation The definition of primary care is: The production of integrated, accessible health care tests by clinicians who are accountable for addressing all populations and their personal health care needs by developing a sustained
partnership with patients, and practicing in the context of family and community with the financial backing of the insurance companies The provision of integrated, accessible health care services by clinicians who operate only under the umbrella of federal law, apply science to their practices, and seek to establish a practice devoted to only specialized areas of medicine The provision of integrated, accessible health care products by clinicians who are accountable for addressing minority populations and their persoterm-55nal health care needs by developing a sustained partnership with patients, and practicing in the context of family and community The provision of integrate - Correct answer: The provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community Reference: Buppert, Carolyn. Nurse Practitioner's Business Practice and Legal Guide, 5th Edition. Pg 7.
- Scientific Foundation Where does variable expression of a gene for a disorder occur? Cellular level RNA DNA Nucleotide bases - Correct answer: Cellular level Variable expression of a gene for a disorder occurs at the cellular level. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 75.term- 0
- Scientific Foundation Decreased levels of calcium in the bloodstream is indicative of what type of disease process? Addison's disease Acidosis Renal failure Hyperthyroidism - Correct answer: Renal failure In acute renal failure, calcium levels decrease. On the other hand, in disease processes such as acidosis, Addison's Disease, and hyperthyroidism, calcium levels are known to be increased. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 89.
- Scientific Foundation Which strategy is an option for the NP when dealing with a treatment-resistant patient? Refer to genetic testing to assess glutamine transmitters Reevaluate the diagnosis since the patient is not responding to conventional treatment Consider ECT for drug-resistant patients Implement a combination of medications - Correct answer: Implement a combination of medications Sometimes patients do not respond typically to medications normally used for their diagnosis. In these situations, the NP can implement different strategies, such as drug combinations, unconventional drugs, or high doses.
Typical antipsychotics (also known as first-generation antipsychotics) are more likely to cause these side effects than atypical antipsychotics (also known as second-generation antipsychotics). Benzodiazepines do not cause extrapyramidal symptoms. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 248-249.
- Scientific Foundation Which of the following interfering factors can result in decreased serum calcium levels? Alkaline antacids Vitamin D Oral contraceptives Lithium - Correct answer: Oral contraceptives Serum calcium values can be decreased during treatment with oral contraceptives. Vitamin D, lithium, and alkaline antacids are all examples of interfering factors that increase serum calcium levels. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 90.
- Scientific Foundation A patient with a diagnosis of Prader-Willi syndrome has been admitted to the children's inpatient psychiatric unit. For this neurodevelopmental disorder, which of the following dietary considerations are an important part of treatment? A gluten-free diet A high-protein diet due to low muscle tone A high-fiber diet A restricted-calorie diet - Correct answer: A restricted-calorie diet Prader-Willi syndrome is a neurodevelopmental and genetic disease characterized by compulsive eating, intellectual disability, hypogonadism, small stature, low muscle, and low muscle tone. Due to their hypotonic and compulsive eating, these patients are prone to obesity and must maintain a low-calorie diet. Reference: Kaplan & Sadock's Synopsis of Psychiatry, 12th Edition. Pg 102.
- Scientific Foundation Understanding pharmacokinetics and the distribution of medication in the bloodstream, the PMH-NP monitors which of the following patients for possible toxicity and a need for lowered dosing? A 20-year-old patient with a high fever A malnourished patient A patient with Crohn's disease An athletic patient - Correct answer: A malnourished patient The principle of distribution requires that the medication binds to a protein for movement through the body. The chemicals are not active when they are protein-bound. The active form of medication is the unbound chemicals in the bloodstream. When a person is malnourished, they may be protein-deficient and have less protein for the medications to bind. This leaves more active medication in the bloodstream and increases the risk of toxicity. Extremely thin, malnourished, protein-deficient, or elderly patients are at risk for toxicity due to decreased muscle mass.
Crohn's disease impacts absorption. A young person with a high fever is not routinely monitored for drug toxicity. An athletic body does not indicate malnourishment or protein deficiency. Reference: Psychiatric-Mental Health Nurse (PMH-BC™) Certification Review 1st Edition. Pg 84.
- Scientific Foundation Which of the following is considered an environmental risk factor? Vaccination Infection Medication management Exercise regimen - Correct answer: Infection Environmental risk factors include prenatal insults, stress, infections, poor nutrition, exposure to toxins, and physical or sexual abuse. Vaccinations are not considered environmental risk factors, as they are meant to provide supportive prevention of a disease process. Medication management is not considered an environmental risk factor, as they are meant to provide supportive treatment of illnesses and diseases. Exercise regimens are not considered environmental risk factors, because exercise improves health. Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 75.
- Scientific Foundation Problems with the frontal lobe could lead to which of the following? Visual field defects Sensory-perceptual disturbances Personality changes Aphasia and amnesia - Correct answer: Personality changes Problems with the frontal lobe can lead to personality, emotional, and intellectual changes. Problems with the temporal lobe can lead to aphasia and amnesia. Problems with the occipital lobe can lead to visual field defects. Problems with the parietal lobe can lead to sensory- perceptual disturbances and agnosia. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 65.
- Scientific Foundation The measles, mumps and rubella vaccine should not be given to those in which of the following situations: Children aged 6- 12 Those who have received a blood transfusion in the past two weeks Postmenopausal women Men over the age of 25 - Correct answer: Those who have received a blood transfusion in the past two weeks Those who have received a blood transfusion in the past two weeks, pregnant women, people with cancer, those with weakened immune systems, and those who have HIV or AIDS with T-cell counts below 200 should not receive the MMR vaccine.
Memory issues and mistrustful and manic behaviors are part of dementia and mental health issues, so they would not be ruled out by a differential screening tool as an etiology as they are a symptom. Reference: Psychiatric-Mental Health Nurse Practitioner Review and Resource Manual, 4th Edition. Pg
Advanced Practice Skills During the initial assessment and follow-up appointments with mental health patients at a community health clinic, a PMHNP uses mental health screening tools such as the PHQ-9, MOCA, and mental status exam. The implementation of screening tools in a mental health clinic is an example of which type of prevention strategy? Primary prevention Secondary prevention Tertiary prevention Sentinel event prevention - Correct answer: Secondary prevention Primary prevention is primarily healthy advice and education for the general public, such as instructing on seat belts and exercise. Secondary prevention is screening for disease in an at- risk group. Tertiary prevention is reducing disease progression in someone who has already been diagnosed, such as in rehabilitation and support groups. A sentinel event triggers a root- cause analysis for unexpected outcomes that are reportable to public health agencies. Reference: Psychiatric-Mental Health Nurse (PMH-BC™) Certification Review 1st Edition. Pg 25.
Advanced Practice Skills The federal government offered financial awards to encourage hospitals to implement meaningful use. The incentive program required hospitals to demonstrate all of the following except: Effective data capturing and sharing Improved patient outcomes Adoption of a government-designed electronic health record Technologically advanced clinical processes - Correct answer: Adoption of a government- designed electronic health record The federal government offered financial awards to encourage hospitals to implement meaningful use. The incentive program required hospitals to demonstrate: Effective data capturing and sharing Technologically advanced clinical processes Improved patient outcomes Reference: Zaccagnini, M. E., & White, K. W. (2017). The doctor of nursing practice essentials: A new model for advanced practice nursing. Burlington: Jones & Bartlett Learning. Pg 150.
Advanced Practice Skills Which phase of therapy involves health monitoring and symptom management as prominent goals? Orientation Termination Follow-up Working/treatment - Correct answer: Working/treatment There are three phases of therapy: orientation, working/treatment, and termination.
The working phase includes prioritizing goals, health monitoring, symptom management, and learning coping skills. Orientation involves identifying goals, establishing boundaries, and setting expectations. Termination consists of summarizing progress and care, identifying signs of relapse, and referrals for follow-up care. Reference: Psychiatric-Mental Health Nurse (PMH-BC™) Certification Review 1st Edition. Pg 51.
- Advanced Practice Skills A PMHNP completes a mental status exam on a patient that demonstrates findings consistent with anxiety. Some psychotic findings are noted when the patient is remembering certain events. These findings are most consistent with which of the following diagnoses? Obsessive-compulsive disorder Panic disorder Posttraumatic stress disorder Adjustment disorder - Correct answer: Posttraumatic stress disorder Mental status findings for PTSD are often similar to the presentation of anxiety, but there may be brief psychotic features during flashbacks of the trauma. Reference: Psychiatric-Mental Health Nurse Practitioner Review and Resource Manual, 4th Edition. Pg
- Advanced Practice Skills Which inferential statistic tests the relationship between two variables? Pearson's r correlation t-test p-value Analysis of variance - Correct answer: Pearson's r correlation Inferential statistics are numerical values that enable one to reach conclusions that extend beyond the immediate data alone. Examples include: t-test: assesses whether the means of two groups are statistically different from each other Analysis of variance (ANOVA): tests the difference among three or more groups Pearson's r correlation: tests the relationship between two variables Probability: the likelihood of an event occurring p-value (level of significance): describes the probability of a particular result occurring by chance alone. For example, if p = 0.01, there is a 1% probability of obtaining the result by chance alone. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 54.
- Advanced Practice Skills When involuntarily admitted to an inpatient psychiatric unit, the client has his or her civil liberties withdrawn for a period of time for purposes of assessment. Which of the following is an example of a civil liberty that is withheld for a period of time? Having visitors within the first 24 hours Maintaining the right to refuse medication Leaving the facility after being seen and screened by a psychiatric provider Making phone calls to family members - Correct answer: Leaving the facility after being seen and screened by a psychiatric provider
Poor nutritional status - Correct answer: A first-degree relative with MDD Risk factors for PTSD include having a first-degree relative with MDD. Symptoms of PTSD cannot precede the traumatic event associated with the diagnosis. Although poor nutritional status and low educational levels may impact overall coping, they do not indicate the potential for PTSD. Reference: Psychiatric-Mental Health Nurse Practitioner Review and Resource Manual, 4th Edition. Pg
Advanced Practice Skills What is the preferred treatment for anxiety? Electroconvulsive therapy (ECT) Nonpharmacological treatments Anxiolytics Vagal nerve stimulation (VNS) - Correct answer: Nonpharmacological treatment Nonpharmacological treatments for anxiety offer the longest relief from symptoms. Options include CBT, mindfulness, and meditation. Anxiolytics are short-term and sometimes result in rebound anxiety when the medication wears off. ECT and VNS are treatments for catatonia and depression. Reference: Psychiatric-Mental Health Nurse (PMH-BC™) Certification Review 1st Edition. Pg 227.
Advanced Practice Skills Which statement accurately defines internal validity? How the values are dispersed around the mean When the sample is representative of the population and the results can be generalized The likelihood of an event occurring When the independent variable causes a change in the dependent variable - Correct answer: When the independent variable causes a change in the dependent variable Internal validity occurs when the independent variable causes a change in the dependent variable. External validity occurs when the sample is representative of the population and the results can be generalized. Probability is the likelihood of an event occurring. Variance describes how the values are dispersed around the mean. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-Mental Health Nurse Practitioner Review Manual, Fourth Edition. Pg 54.
Advanced Practice Skills Which of the following examples represents a tertiary prevention strategy in public health? Prompt and effective treatment Early case finding Rehabilitation services Screening - Explanation Details Correct answer: Rehabilitation services Tertiary prevention strategies are aimed at reducing the disability and severity of a disorder. Early case finding, screening, and prompt treatment are all examples of secondary prevention strategies. Reference:
Psychiatric-Mental Health Nurse Practitioner Review and Resource Manual, 4th Edition. Pg
Advanced Practice Skills If a patient has a first-degree relative who developed a panic disorder before age 20, they are how much more likely to develop a panic disorder? 8 times more likely 5 times more likely 20 times more likely - Correct answer: 20 times more likely There is a genetic-loading component to panic disorder. If a patient has a first-degree relative with a panic disorder, they are 8 times more likely to develop a panic disorder. If that relative developed a panic disorder before age 20, the patient is 20 times more likely to develop a panic disorder. Reference: Psychiatric-Mental Health Nurse Practitioner Review and Resource Manual, 4th Edition. Pg
Advanced Practice Skills As part of a health and wellness initiative at a clinic for underserved populations, the PMH- NP advocates which developmental delay screening tool as part of wellness checks for toddlers? PHQ- 9 BSTAD S2BI M-CHAT - Correct answer: M-CHAT The M-CHAT, or Modified Checklist for Autism in Toddlers, is a CDC-approved screening tool for developmental delays in toddlers. The S2BI and BSTAD are adolescent screening tools for tobacco, alcohol, and other drugs. The 9-Question Patient Health Questionnaire is a diagnostic tool to screen adult patients for depression. Reference: Psychiatric-Mental Health Nurse Practitioner Review and Resource Manual, 4th Edition. Pg
Advanced Practice Skills The use of expanding interventions can expand the focus of the interview once trust has been established. Which of the following expanding interventions can lead to unrecognized issues or possible psychopathology? Silence "Why" questions Reflection Clarifying - Correct answer: Clarifying Clarifying involves the summarization of what the patient said and seeking clarification for accuracy. It is an expanded psychiatric interview technique. Silence and reflection are facilitating techniques. "Why" questions are considered an obstructive intervention. Reference: Kaplan & Sadock's Synopsis of Psychiatry, 12th Edition. Pg 14.
Advanced Practice Skills
Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 21.
- Advanced Practice Skills Which inferential statistic determines whether the means of two groups are statistically different from each other? Analysis of variance (ANOVA) Pearson's r correlation t-test p-value - Correct answer: t-test Inferential statistics are numerical values that enable one to reach conclusions that extend beyond the immediate data alone. Examples include: t-test: assesses whether the means of two groups are statistically different from each other Analysis of variance (ANOVA): tests the difference among three or more groups Pearson's r correlation: tests the relationship between two variables Probability: the likelihood of an event occurring p-value (level of significance): describes the probability of a particular result occurring by chance alone. For example, if p = 0.01, there is a 1% probability of obtaining the result by chance alone. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 54.
- Advanced Practice Skills According to the United States Centers for Disease Control and Prevention, who does not need to receive the annual influenza vaccination? A 29-year-old nurse practitioner A nine-month-old female A healthy 25-year-old male A 45-year-old man with diabetes - Correct answer: A healthy 25-year-old male Healthy individuals between the ages of 19 and 49 are not required to receive the annual influenza vaccine unless they meet any of the criteria below. The following people should always receive the influenza vaccine: Children from six months to 18 years of age Anyone aged 50 years and older Anyone who lives in a nursing home or in a long-term care or assisted living facility Anyone with a chronic health condition including asthma, diabetes, renal or hepatic dysfunction, HIV, and neuromuscular disorders Pregnant women Health care personnel Caregivers of children younger than five years Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 97.
- Advanced Practice Skills A PMH-NP is meeting with an adolescent male who was arrested for underage drinking for the second time. His license was suspended due to a DWI, and he subsequently lost his job as a pizza delivery driver. He has an upcoming court hearing. During the initial interview, the patient states, "I don't know what the big deal is! I'm almost 18 years old. My grandpa was
fighting in Vietnam at my age. I had one too many. What's the big deal? Anyway, whatever. My record will be expunged at 18 anyway." Which of the following concepts of the Health Belief Model are being demonstrated? Perceived severity and perceived benefits Perceived susceptibility and perceived barriers Perceived severity and perceived barriers Self-efficacy and perceived barriers - Correct answer: Perceived severity and perceived barriers This patient is expressing a belief that his behaviors and their consequences are minimal and will have little impact ultimately on his life. Self-efficacy is a patient's belief that they can successfully change their behavior. In this instance, the individual appears unwilling or unmotivated to change. Perceived susceptibility is a person's belief that they could develop a problem or condition. Perceived barriers are a person's beliefs about the cost of giving up a behavior. Reference: Psychiatric-Mental Health Nurse (PMH-BC™) Certification Review 1st Edition. Pg 38.
- Advanced Practice Skills What term describes a collection of individuals who coordinate lobbying efforts around a common interest and seek to influence policymakers? Special interest group Grassroots lobby Caucus Legislative assistants - Correct answer: Special interest group A special interest group is a collection of individuals who coordinate lobbying efforts around a common interest and seek to influence policymakers. A legislative assistant is an employee of a senator or representative who keeps the legislator informed, meets with constituents, and drafts reports. A caucus is a group of members of Congress or a political party created to support a defined political ideology. Grassroots lobbying occurs when unpaid individuals contact their legislators to influence policy. Reference: Buppert, Carolyn. Nurse Practitioner's Business Practice and Legal Guide, 5th Edition. Pg
- Advanced Practice Skills A 62-year-old male is being seen by a PMH-NP for suspected progressive memory problems. He reports being increasingly under stress and really forgetful. His co-workers at his law office have been joking about his forgetfulness, but he is beginning to get really concerned. "I forgot to turn off the burner on the stove after I boiled my tea water this morning!" He reports going back and checking things over and over again. Which of the following would be most helpful in distinguishing between stress-induced forgetfulness and cognitive impairment? PHQ- 9 Montreal Cognitive Assessment (MoCA) Brain MRI with and without contrast Hamilton Rating Scale for Depression - Correct answer: Montreal Cognitive Assessment (MoCA) The MoCA was developed to detect mild cognitive impairment and assess a broad swath of domains. It is suitable for those at higher educational levels, and this patient is a lawyer.
A 53-year-old female arrives at your clinic for a psychiatric evaluation. You determine that she meets the diagnostic criteria for major depressive disorder. She is already taking multiple medications, so you want to prescribe an agent that does not induce or inhibit the cytochrome p450 enzymes. Which medication would you choose? Citalopram Mirtazapine Fluvoxamine Fluoxetine - Correct answer: Mirtazapine Mirtazapine does not induce or inhibit any cytochrome p450 enzymes. Citalopram is a weak inhibitor of cytochrome p450 2D6. Fluoxetine inhibits 2D6 and 3A4. Fluvoxamine is an inhibitor of 1A2, 3A4, and 2C9/2C19. Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 111-119.
- Diagnosis and Treatment What psychiatric condition is characterized by two or more motor tics and at least one vocal tic that occur frequently throughout the day? Stuttering Oppositional defiant disorder Attention-deficit/hyperactivity disorder Tourette's disorder - Correct answer: Tourette's disorder For a person to be diagnosed with Tourette's (TS), they must Have two or more motor tics (for example, blinking or shrugging the shoulders) and at least one vocal tic (for example, humming, clearing the throat, or yelling out a word or phrase), although they might not always happen at the same time. Have had tics for at least a year. The tics can occur many times a day (usually in bouts) nearly every day, or off and on. Have tics that begin before he or she is 18 years of age. Have symptoms that are not due to taking medicine or other drugs or due to having another medical condition (for example, seizures, Huntington disease, or postviral encephalitis). Attention-deficit/hyperactivity disorder is characterized by hyperactivity, impulsivity, and inattentiveness. Stuttering, also called childhood-onset fluency disorder, occurs when the normal fluency of speech is frequently interrupted. Oppositional defiant disorder is characterized by multiple examples of negativistic behavior persistent for at least six months, usually beginning when a child is three or four years old. Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 1197.
- Diagnosis and Treatment Which of the following is not a clinically significant side effect of monoamine oxidase inhibitors? Weight loss Dizziness Sexual dysfunction Hypertensive crisis - Correct answer: Weight loss Clinically significant side effects of monoamine oxidase inhibitors include insomnia, weight gain, sexual dysfunction, dizziness, hypertensive crisis, lightheadedness, and anticholinergic side effects.
Reference: Johnson, K., Vanderhoef, D. (2016). Psychiatric-mental health nurse practitioner, 4th edition. Pg 158.
- Diagnosis and Treatment Which term describes treatments used in addition to traditional medical practices? Complementary therapies Alternative therapies Integrative therapies Biological-based therapies - Correct answer: Complementary therapies The National Institutes of Health (NIH) created the National Center for Complementary and Alternative Medicine (NCCAM) in 1998. The mission of NCCAM is to study therapies outside of traditional medicine. Complementary therapies are defined as treatments used in addition to traditional medical practices. Alternative therapies are used in place of traditional medical practice. Often complementary and alternative are combined to form the term "complementary and alternative medicine" (CAM). Types of CAM: Biological-based therapies: herbal products, vitamins, supplements, and aromatherapy Mind-body interactions: guided imagery, meditation, yoga, and biofeedback Manipulative and body-based therapies: acupressure, acupuncture, massage, reflexology Reference: Johnson, K., & Vanderhoef, D. Psychiatric-mental health nurse practitioner review and resource manual, Fourth Edition. Pg 132-135.
- Diagnosis and Treatment All of the following are considered subtypes of circadian rhythm sleep-wake disorders except: Delayed sleep phase type Shift work type Irregular sleep-wake type Jet lag type - Correct answer: Jet lag type Circadian rhythm sleep-wake disorders are characterized by a mismatch between a person's biological clock and the environment. There are five subtypes: Delayed sleep phase type: falling asleep and waking later than desired Advanced sleep phase type: falling asleep and waking earlier than desired Irregular sleep-wake type: falling asleep and waking at random times Non- 24 - hour sleep-wake type: falling asleep and usually waking progressively later than desired Shift work type: sleepiness associated with changes in work schedule Jet lag refers to feeling sleepy or "hungover" after crossing time zones. It is no longer considered a sleep disorder. Reference: Sadock, Sadock, & Ruiz. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition. Pg 536-537.
- Diagnosis and Treatment Which of the following is an example of a biological theory of bipolar disorder etiology? GABA deregulation Trauma Environmental toxicity
