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1. An 8-year-old boy diagnosed with leukemia Provide toys and allow the child to play
is referred to child psychiatry because he is
consistently displaying a flat affect, irritabil-
ity, angry acting out, and occasional physi-
cal aggression toward his 6-year-old broth-
er. What approach should the PMHNP take
when interviewing this child?

2. Which eating disorder is considered ego syn- Anorexia Nervosa (Anorexia Nervosa is
tonic? challenging to treat because it is ego
syntonic. In other words, one's behav-
iors, feelings and values are in line with
the needs of the ego and reliable to
one's self image.)

3. A 30-year-old G1P0,1 has become increasing- Sertraline

ly oddly related, neglecting self-care, sleep-
ing much of the day, eating minimally, cry-
ing easily, and despite reassurance that her
pregnancy is progressing normally, worries
that she will lose the pregnancy. Which of
the following medications is considered least
harmful in pregnancy?

4. A 10-year-old boy who had been prescribed Psychomotor agitation

fluoxetine for major depressive disorder pre-
sents to the psychiatric emergency depart-
ment for running into the street in front of
a car on the way home from school. In the
emergency department, he has been selec-
tively mute, but the nurse practitioner stu-
dent was able to elicit his desire to be dead.
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He has been medically cleared pending a psy-

chiatric evaluation. What is the most com-
mon sign of major depressive disorder in chil-
dren?

5. A 6-year-old boy is referred by the child Expressive language disorder

study team for speech difficulty. On exam-
ination the boy is friendly and cooperative,
his speech is clear, and he uses simple sen-
tences with a limited vocabulary. Most no-
tably he confuses verb tenses consistently.
The parents report he met most of his devel-
opmental milestones except speech, which
was delayed. His clinical presentation is most
consistent with which of the following?

6. The school psychologist refers a 7-year-old Vision and hearing

girl with difficulty reading, distractibility, and
writing avoidance behaviors. The child has no
diagnosed conditions, takes no medications,
and met all of her developmental milestones.
She loves arts and crafts and physical educa-
tion. Prior to diagnosing a learning disorder,
which of the following screening tests must
be performed?

7. Which disorder is associated with higher Fragile X (Fragile X is associated with a

rates of ADHD, enlarges testes, a long narrow higher rate of ADHD, impaired intellec-
face, hypotonia and short stature? tual ability, learning d/o's, autism spec-
trum d/o. Physical attributes include
hypotonia, flat feet, enlarges testes,

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long narrow face, flexible fingers and

short stature.)

8. A 10-year-old girl is referred for evaluation Attention deficit disorder

of behavioral difficulties. Her teachers report
that she is easily distracted and fails to com-
plete any class work, and often stares off
into space or tries to chat with her neighbor.
Her mother reports that mornings are the
most difficult because of her general disorga-
nization and forgetfulness. Otherwise she is
socially engaged and enjoys many activities.
Which of the following is the most likely diag-
nosis?

9. A pregnant woman with depression is re- The actual course of depression cannot
luctant to take medication for fear of caus- be predicted
ing her baby neonatal abstinence syndrome
due to selective serotonin reuptake inhibitor
(SSRI) medication. Her husband states they
would like to use a faith healer instead. Which
of the following is most accurate regarding
the prognosis of depression during pregnan-
cy?

10. Which of the following statements regarding IQ test scores remain the gold stan-
intellectual developmental disorder is false? dard for determining intellectual dis-
ability (IQ test scores are not the gold
standard for determining intellectual
disability. Furthermore, IQ tests fail to
asses reasoning in real life scenarios
and fail to measure mastery of practi-

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cal tasks despite measuring conceptual

capacity.)

11. An 8-year-old boy presents with nocturnal Imipramine

enuresis, which persists despite behavioral
interventions including eliminating fluid in-
take in the evening, scheduled awakening at
night to use the bathroom, and a urine alarm.
Which of the following medications is most
appropriate?

12. Sam is 11 years old without past psychiatric Streptococcus

history. He was born by normal spontaneous
vaginal delivery with normal APGAR scores.
He has met all of his developmental mile-
stones. He began sixth grade this year and
has had increased trouble falling asleep. He
has always had bedtime rituals but lately they
are extending in complexity and length. Most
of his time in the evening is spent checking
that the lights are turned off and that the
windows are locked. As a result, he is only
getting 5 hours of sleep at night and now has
excessive daytime sleepiness with decreased
interest in socialization and failing grades.
Which of the following infectious diseases
may contribute to this clinical presentation?

13. The PMHNP is providing psychoeducation Stage 3 to 4

and anticipatory guidance to the concerned
parent regarding night terrors. At which
stage of sleep is this most likely to occur?

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14. Early onset Schizophrenia is considered All of the statements listed are true.
what? (Early onset schizophrenia is rare. It is
8X more prevalent amongst 1st degree
relatives (Sadock, Sadock & Ruiz, 2014).

15. Child protective services is requested for an A foster home

evaluation of a 9-month-old girl in foster care
whose mother was on a methadone main-
tenance program and using cocaine while
pregnant. The child is HIV negative and dur-
ing the assessment you learn of a 3-year-old
brother who is HIV positive. You are asked
to recommend placement for both these chil-
dren. Which of the following is best?

16. In regards to Insecure Attachment: Am- Be bullied (Insecure attachment: Am-

bivalent type children are more likely to bivalent children are uncertain of a
________________. caregiver's response regardless of a sit-
uation. These children are more likely
to be bullied and do worse with sepa-
rations. The caregiver sometimes uses
threats of abandonment as a form of
punishment.)

17. An 8-year-old boy is referred to you for eval- Tourette's syndrome

uation for disruptive behavior in school. The
teachers report that without warning the boy
will make disruptive sounds or shout out in
class. Other than these instances the boy is
described as polite and well kempt, but rest-
less. This clinical presentation is most consis-
tent with which of the following disorders?

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18. Ella is trying to help her 3-year-old son sleep Create and maintain bedtime routine
through the night but reports recently he and reduce stimuli
has had three episodes of waking up within
3 hours of falling asleep with inconsolable
screaming and crying. He then falls back
asleep on his own and has no memory of
what happened. What would be the best in-
tervention?

19. A father brings his 6-year-old son to you be- "I can see this is upsetting for you."
cause he is worried about him. He states that
the son sits up in bed shortly after falling
asleep and screams. He says he is incon-
solable and unable to be awakened during
these episodes but eventually he falls back
asleep. The father states he is not able to fall
back asleep after those episodes and is ex-
hausted and falling asleep at work during the
day. The child is energetic and playful during
the day and has no memory of the episodes.
What is the most appropriate response?

20. The certified nurse midwife is evaluating a Admit the patient to the hospital
29-year-old woman 2 weeks postpartum and
finds her neglecting her self-care and mini-
mally attentive to the baby and will not allow
anyone else to care for the baby. During the
visit a PMHNP is able to provide webcam con-
sultation and liaison services. Based on the
information provided, what is the priority in
the management of this patient?

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21. Which of the following is a potential risk fac- All of the statements listed are poten-
tor for Anorexia Nervosa? tial risk factors. (A gay male orientation,
Ballet school, & a male on a high school
wrestling team

22. A mother 4 months postpartum is referred Rumination disorder

to infant psychiatry as the baby has failed to
gain weight over the last 2 months. He has
dropped from the 75th percentile to the 50th
percentile. The mother states that up until
8 weeks of age he was gaining weight and
growing just fine. The baby is generally hap-
py and continues to meet his developmental
milestones. Of note, the mother has returned
to work after her postpartum leave 2 months
ago and the baby is in daycare 5 days a week.
The mother notes that he has been increas-
ingly spitting up for the last month soon after
receiving breast milk via the bottle. She has
also started to supplement with formula out
of concern for his poor weight gain. This clin-
ical description is most consistent with which
type of disorder?

23. Which of the following statements regarding Mild - moderate intellectual disabili-
intellectual developmental disorder is false? ty may not be apparent until adult-
hood (Moderate intellectual disabili-
ty may not be apparent until adult-
hood is false. Academic learning diffi-
culty would be apparent in school age
children with a mild level of disability

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and markedly apparent in those with

moderate disability.)

24. In terms of the management of Bipolar disor- First (Lithium, Valproic acid and Car-
der in pregnancy, one should avoid Lithium, bamazepine have been associated with
Valproic acid and Carbamazepine, especially fetal harm, with the greatest risk occur-
in which trimester? ring in the first trimester)

25. A 32-year-old woman who is 6-months post- Tension building phase

partum requests a psychiatric house call
while her husband is at work. Upon entering
the home, the PMHNP notices a well-cared
for infant playing in a crib, and the patient
sitting in her breakfast nook overlooking the
nearby park. She is requesting a medication
to help her relax because she feels as if she is
walking on eggshells around her husband for
fear of him "getting physical with me" if the
baby cries too much. Which of the following
best describes this woman's circumstance?

26. Which of the following statements regarding Asperger's disorder is a separate diag-
Autism Spectrum Disorder is false? nosis from Autsim Spectrum Disorder
in the DSM-5. (Autism spectrum dis-
order encompasses the disorder pre-
viously referred to as Asperger's disor-
der. Previously, Asperger's disorder was
used to describe symptoms consistent
with high functioning autistic disorder.
Asperger's disorder is no longer rec-
ognized as an official diagnosis of the
DSM-5.)

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27. Shawna is a 3 year old female who, at times, No treatment is required (No treatment
bites her own hand. She has no other con- is required for stereotypic movement
cerning behaviors or developmental delays. disorder when not associated with oth-
Which of the following would be the best in- er symptoms. This behavior should fade
tervention? by 4 years of age.)

28. A 4-year-old boy is brought to the pediatric Urine toxicology

emergency department kicking and scream-
ing while trying to run away from the sharks
he fears are going to eat him. Which of the
following diagnostic tests would be most ap-
propriate?

29. Children with this disorder "annoy others". Oppositional defiant disorder. (These
This disorder is associated with defiance, children tend to upset others around
blaming others and arguing with adults or them. They can be vindictive and nega-
authority figures. tive, but not usually physically harmful.
They often blame others for their mis-
takes and argue with authority.)

30. The PMHNP is performing primary preven- Suicidal behavior

tion in the high school regarding mental ill-
ness. The most common psychiatric emer-
gency in children and adolescents is:

31. When evaluating a new 40-year-old, 4-week Thyroid-stimulating hormone (TSH)

postpartum woman complaining of fatigue, and free T4
irritability, dry skin, and poor sleep quality
for mood disorder, which of the following di-
agnostic tests should be ordered to aid in
formulating a diagnosis?

32.
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Which of the following is true regarding Bradycardia, Hypotension and Hy-

Anorexia Nervosa? pothermia are potential consequences
(Major mood disorders are common in
family members of clients with Anorexia
Nervosa. Bradycardia, hypotension and
hypothermia may occur. The serum sali-
vary amylase levels are often elevated,
not decreased in the presence of vom-
iting associated with anorexia nervosa.)

33. Luanne is a 19-year-old single mother of a Report the mother to child protective
3-year-old boy. She works during the day and services
attends classes for her high school equivalen-
cy exam several evenings per week. Her son
is in daycare and an after-school program
from 8 a.m. to 7 p.m. 5 days per week. She
reports feeling so tired that she sometimes
loses her patience with her son and gives him
Benadryl to help calm him down and sleep
through the night. Which of the following ac-
tions should the PMHNP take?

34. A 35-year-old woman 7 days postpartum is Depression with psychosis

brought by the mobile crisis team to the ED
at the request of the husband. The patient
has no past psychiatric history and takes only
prenatal vitamins. He reports that his wife
has not been sleeping and has noticed her
walking around their apartment in the mid-
dle of the night crying and talking to nobody.
In addition, she has been ignoring the baby,
but last night she told him that it was "Lu-
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cifer's seed and it must be destroyed." Which

of the following is the most likely diagnosis?

35. Which of the following regarding Rett syn- Rett syndrome is a rare disorder that
drome is false? mostly occurs in males. (Rett syndrome
is a rare disorder that mostly occurs in
males is false. This neurodevelopmental
disorder affects girls almost exclusive-
ly.)

36. Jamal is an 12-year-old boy who has been Conduct disorder (Early patterns of ag-
skipping the last several hours of school to gression and the violation of the ba-
sneak out and play video games, bullying sic rights of family and peers. Running
younger students on the bus, and recently away from home, truant before age 13,
spray painted his neighbor's garage and cat. destruction of property, animal cruelty,
Which of the following choices most accu- bullying, forced sexual activity or rob-
rately describes William's behavior? bery are consistent with conduct disor-
der. The key here is the lack of remorse,
guilt or empathy with shallow affect.)

37. The PMHNP is evaluating a 22-month-old girl Each day, schedule some time for you
whose mother is concerned about aggres- and your daughter to spend together
sive behavior toward her 4-month-old broth- without the baby
er. The mother states that her daughter is
often angry and irritable with directed hos-
tility toward the baby. Which of the following
responses is best?

38. A 35-year-old woman is being evaluated 7 Sertraline

months postpartum for recurrent thoughts
about wanting to harm her baby by stab-
bing with a knife. She continues to breastfeed
and care for the baby. Since having these
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thoughts, she has removed all sharp objects

from the home and has started ordering take
out food to feed her family. She is reluctant
to share these thoughts with her husband.
Which of the following medications would be
most appropriate to prescribe?

39. A 10-year-old boy is referred by the school Separation anxiety

nurse because of persistent stomachache
every morning in school. In evaluating the
boy, the PMHNP learned that he does not like
to go to school and insists on coming home
immediately, and that he sleeps in his par-
ent's bed at night. His clinical description is
most characteristic of which of the following
conditions?

40. Eleanor is 16 months old. She has been eat- Normal Behavior (At 16 months old,
ing dirt and other nonfood substances. As a eating nonfood substances is consid-
PMHNP, you recognize this as which of the ered normal behavior. To be diagnosed
following? with PICA, Eleanor must be at least 2
years old.)

41. Which of the following statements is true? Insecure attachment disorganized type
is associated with abused children.(In-
secure attachment: Disorganized type.
These are abused children. They are
frightened of the caregiver. They are
more likely to have conduct disorder
(Green & Goldwyn, 2002)

42. A 6 year old boy with no known medical con- Persistant Motor or Vocal Tic Disorder
ditions shrugs his shoulders many times a (The diagnostic criteria for Persistent
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day for a very short duration. His parents first Motor or Vocal Tic Disorder include the
noticed this when he was 4.5 years old. Ac- age of onset before 18, the tic(s) have
cording to his parents, he is unaware of this. persisted for more than one year and
On exam, he has no other symptoms, other motor or vocal tics are present but not
than a sudden, rapid, recurrent, non-rhyth- both. In Tourette's disorder both multi-
mic shoulder shrug that persists for less than ple motor tics and vocal tics are present
one second. What is the best diagnosis given at some point. With provisional Tic Dis-
the information provided? order, the symptoms are less than one
year from onset. Tardive Dyskinesia is a
hyperkinetic movement disorder asso-
ciated with dopamine receptor blocking
agents)

43. A 4 year old adopted child with unknown Global Developmental Delay (The diag-
medical and social history has struggled to nosis of Global Developmental Delay is
meet several expected developmental mile- utilized for children under 5 years of
stones in areas of intellectual functioning. age and clinical severity cannot be re-
This child has no deficits in reciprocal social liably assessed. This is especially true
communication or social interaction. Which for children too young to participate in
of the following is the most accurate diagno- standardized testing, yet fail to meet ex-
sis? pected developmental milestones. One
would expect children with ASD to have
impairments in social-emotional reci-
procity and social interaction.)

44. A 19-year-old female is being seen at a cri- Financial independence

sis pregnancy center for an unplanned preg-
nancy. She feels compelled by her boyfriend
to get an abortion, but it goes against her
deeply held religious beliefs. Which of the
following reduces her risk of being the victim
of domestic violence?
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45. When evaluating a 7-year-old girl diagnosed IQ test

with expressive language disorder, which of
the following assessments would be most
helpful in confirming the diagnosis?

46. Which of the following best describes All of the statements listed are true.
Child-Onset Fluency disorder? (Child-Onset fluency disorder or stut-
tering: Early intervention crucial. Most
develop before age 8. Parent praises
child when the child does not stutter
and asks child to correct word when
stuttering present. This is operant con-
ditioning.)

47. A 60-year-old man with alcohol use disorder "How have you been able to maintain
in remission presents to the psychiatric ED your sobriety for so long?"
and is very distraught. He tells the PMHNP
that he was at his daughter's wedding and
called upon to make a toast. The waiter had
handed him the champagne glass, and he
took a sip of alcohol for the first time in 10
years. He tells the PMHNP that he is con-
cerned he may relapse and go back to his
old ways. What is the best response by the
PMHNP?

48. A woman in her 20th week of pregnancy has Increased blood volume
been resumed on lithium for bipolar disor-
der. The PMHNP knows that the patient may
become subtherapeutic despite taking the
medication as prescribed due to:

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49. Which of the following developmental mile- Copy a circle

stones should a 2-year-old child be able to
accomplish?

50. Which of the following agents could cause Amphetemines

a patient to behave restlessly, agitated,
grandiose, aggressive, and emotionally la-
bile?

51. The clinical management of patients differs Acute intoxication

depending on the substance-related syn-
drome exhibited. A patient with a history
of alcohol use disorder who presents for a
monthly injection of naltrexone is disinhib-
ited, emotionally labile, inattentive, and im-
pulsive and is likely in which of the following
phases?

52. A 38-year-old male presents for follow up Evaluate for Opioid use disorder, rec-
chronic back pain and spasm. Four years ear- ommend a slow taper off full opioid
lier, he sustained a motorcycle accident. He agonists and then start buprenorphine.
has been taking morphine extended release (This patient has signs of OUD. This is
40mg PO BID and Hydrocodone 10mg IR Qd little evidence supporting opioids for
PRN. Today he complains that the medication chronic pain syndromes. The patient re-
is no longer effective. He notes diarrhea and mains functional at work so no need for
restlessness when he skips a dose. He con- acute hospitalization. Benzodiazepines
tinues to be employed and has not missed and opioids should not be combined
any work days. He has been filling the pre- given the increase risk of death when
scription 1 day early each month and visited used together.)
an urgent care twice this summer requesting
additional pain control. The are no changes
on exam today and no focal deficits. Which

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of the following do you recommend for this

patient?

53. Which of the following is NOT a symptom of Hypothermia (The signs and symptoms
Alcohol Withdrawal as listed in the Criterion of alcohol withdrawal as noted in crite-
B of the DSM-5? rion B of the DSM-5 include autonom-
ic hyperactivity, increased hand tremor,
insomnia, nausea or vomiting, halluci-
nations, psychomotor agitation, anxiety
and generalized tonic clonic seizures.)

54. A patient presents for a follow-up visit and Lapse

has a dual diagnosis of substance use dis-
order and major depressive disorder. He re-
ports that he has been feeling increasingly
anxious, having difficulty sleeping. He con-
tinues to attend his Alcoholics Anonymous
meetings regularly, but reports he had two
beers 3 days ago and feels very guilty. Which
of the following best describes this patient's
situation?

55. A patient who has been drinking a six-pack Alcohol use disorder
of beer each night to relax after work has
been having trouble staying asleep through
the night. When she wakes up at 2 a.m. she
takes diphenhydramine 25 mg to help her
fall back asleep, but this makes her sleep
through the alarm clock and late for work.
She also reports having a headache through
midmorning until she gets her second cup
of coffee. She thinks this is related to her

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alcohol use and has unsuccessfully tried to

cut down several times in the past year. Which
of the following disorders best describes this
patient's condition?

56. Which of the following best represents the Adapting and accepting something you
theory of resilience as it applies to psychiatric cannot change
advanced practice nursing?

57. A phenomenon in which a markedly in- Tolerance (Tolerance is a phenomenon

creased dose of a substance is required to in which after repeated administration,
achieve the desired effect or a markedly re- a given dose of a substance produces
duced effect is experienced when the usual a decreased effect or larger doses are
(original) dose is consumed is better known required to achieve the same effect as
as what? the original dose.)

58. A 29-year-old man presents to the emer- Cocaine-induced mood disorder

gency department stating he is very anxious
and feels his heart is going to beat out of
his chest. He is diaphoretic, with pressured
speech and unable to be calmed. A psychi-
atric consult was called because the patient
seems uncooperative and a proper history
cannot be obtained. Which of the following
conditions must be excluded first?

59. A patient who has been sober for 20 years is Assess this coping strategies
anticipating some major life changes in the
next 3 months and is very worried about re-
lapse. Which of the following actions should
the PMHNP do first?

60.
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Marjorie decided to cancel her upcoming ap- Label avoidance (Label avoidance oc-
pointment with her PMHNP and avoid po- curs when one avoids treatment out of
tential treatment out of fear that her peers fear of the future negative label or view
may find out and think she is "crazy". This associated with having a mental illness.
behavior is best described as what? Public stigma occurs AFTER individuals
are stereotyped because of their mental
illness. Beneficence and Persona non
grata do not apply to the provided sce-
nario here.)

61. A 49-year-old female is on Fentanyl patch at All of these contributed to this episode.
25 mcg/hr. In the last week the patient's val- (The patient was on Fentanyl and re-
proate was increased from 750mg po BID to cently started a strong CYP3A4 in-
1000mg po BID. In the last 4 days the patient hibitor (Macrolide antibiotics include
was placed on clarithromycin for strep throat clarithromycin). This led to a REDUC-
and started cepacol lozenges. This morning TION in the clearance of the opioid
she was resuscitated with Naloxone and she resulting in sedation.Cepacol lozenges,
returned to baseline mantation. Which med- Valproate & Clarithromycin)
ication likely contributed to her unresponsive
episode?

62. Mr. Peters is a 45-year-old man who has been Has she ever gotten so angry that she
married for 12 years when his wife tells him hit you?
she cannot take it anymore and wants a di-
vorce. He has sought therapy to deal with his
new circumstance and reports feeling bewil-
dered and fearful, is having difficulty sleeping
and concentrating, and states, "I thought I
did everything right. I even told her I forgive
her for the affair, and that I was proud of
her for going to Alcoholics Anonymous for

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the last 6 months." Which of the following

questions should the PMHNP ask?

63. Individuals with a history of prenatal alcohol The risk for all of these disorders is
exposure are at increased risk for what disor- increased. (Individuals with a history
der? of prenatal alcohol exposure are at in-
creased risk for ADHD, bipolar, depres-
sive disorders, ODD, conduct disorders,
alcohol use disorder and substance use
disorders.)

64. Which pupillary changes would one expect to Dilated pupils (Stimulant intoxication
observe with acute stimulant intoxication? is associated with pupillary dilation.
Narcotic drugs are associated with
pupil constriction. Unequal pupil sizes
(anisocoria) are associated with both
benign and life threatening emergen-
cies.)

65. A 61-year-old married woman who has been Alcohol withdrawal

sober from alcohol use disorder for 25 years
relapsed 3 weeks ago. She reports drinking
1.5 L of vodka and half a liter of scotch daily.
On exam she is emotionally labile ranging
from irritable to crying, slurring her words,
and exhibits a bilateral upper extremity fine
tremor. Vitals: blood pressure 150/100, heart
rate 110, respiratory rate 18, SpO2 98% room
air. She reports feeling nauseous, sweating,
and moderately anxious. What is the primary
concern for this patient?

66. Fluoxetine 20 mg PO daily

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A 16-year-old male with a history of smoking

cigarettes and marijuana is being evaluated
at the request of the school and parents. The
child states that the reason he smokes is it
"helps calm me down" as he is anxious all
the time. Which of the following medications
would be the best choice?

67. Which of the following is a therapeutic tech- Motivational interviewing

nique to facilitate a health behavior change
in a 28-year-old male with substance use dis-
order who is in denial regarding the severity
of his habit?

68. A patient who has been sober for 7 days Citalopram

struggles with cravings and is fearful of re-
lapse. He reports taking naltrexone daily.
What agent should the PMHNP prescribe to
help reduce his cravings?

69. Jade is a 44 year old female who works sec- Withdrawal headaches may last 3
ond shift as an ICU nurse. She decided to skip months (Caffeine withdrawal does in-
her daily 3 cups of coffee. She is complaining clude Flu-like symptoms as listed in
of headache, fatigue, depressed mood, diffi- criterion B of the DSM-5, along with
culty concentrating and muscle pain. Which headache, fatigue, depressed or irri-
of the following is not true regarding caffeine table mood and difficulty concentrat-
withdrawal? ing. Withdrawal headaches beyond 3-4
weeks of caffeine abstinence would
raise concern that the headaches have
other etiology.)

70. Abrupt cessation of daily diazepam 40 mg Seizure (Abrupt cessation of a benzodi-

use after 2 years may present with what? azepine after chronic use may result in
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a withdrawal seizure, delirium or other

withdrawal reaction which may be life
threatening.)

71. Which of the following symptoms would like- Depressed mood and decreased ap-
ly emerge after abrupt cessation of daily petite (Cannabis withdrawal is com-
cannabis use for 2 years? mon with abrupt cessation. The symp-
toms typically emerge within 1 week af-
ter a period of heavy and prolonged
use. The symptoms may include; ir-
ritability, anger, aggression, nervous-
ness, anxiety, sleep difficulty, decreased
appetite, weight loss, restlessness, de-
pressed mood and physical symptoms
such as fever, chills, sweating, abdomi-
nal pain and headache.)

72. Which of the following medications is pre- Naltrexone 380 mg IM monthly

ferred for a 21-year-old male with a history
of polysubstance use disorder and difficulty
with medication adherence?

73. A patient who has been stable on his "Let us make an appointment as your
long-acting injectable medication tells the medication dose may need to be low-
PMHNP that he would like to quit smoking. ered."
What is the best response?

74. A 30-year-old male who was started on ser- Tolerance

traline for generalized anxiety disorder was
also started on lorazepam 1 mg for sleep dur-
ing the first 2 weeks as he was adjusting to
the medication. At the 2-week follow-up visit
his psychiatrist increased the sertraline, but
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the dose of lorazepam does not seem to be

helping with sleep and the patient is request-
ing a higher dose. Which of the following best
describes the patient's condition?

75. What would a COWS score of 16 indicate? Moderate Withdrawal (The COWS or
Clinical Opiate Withdrawal Scale can
range from 0 - 36+. A Score of 5 - 12
would be considered mild. A score of
13 - 24 would be considered moder-
ate. A score of 25 - 36 would be con-
sidered moderately severe and a score
of more than 36 would indicate severe
withdrawal.)

76. Which of the following substances would be Alprazolam

most likely to cause withdrawal symptoms?

77. A patient is complaining of chronic back pain Addiction

and requests a refill of his oxycodone pre-
scription because the pain is so bad he be-
comes suicidal. As a result, his primary care
provider referred him to the PMHNP. The pa-
tient states he can tell if he is late taking his
next dose by even 1 hour as he becomes very
anxious, restless, irritable, and begins sweat-
ing. He states that he is so worried about hav-
ing pain attacks that much of his day is spent
waiting to take the next dose. When he runs
out of his medication between visits he buys
some from his friend. Which of the following
best describes the patient's condition?

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78. A 32-year-old man presents on referral from Cognitive behavioral therapy

his primary care provider. He reports a
6-month history of recurrent bouts of anxi-
ety associated with chest pain, tachycardia,
tremors, nausea, diaphoresis, and an im-
pending sense of doom. The episodes last
approximately 20 minutes and he is unable to
identify a precipitating event. The patient has
become increasingly isolated for fear of not
wanting to have this sort of episode in public.
The primary care provider started him on a
selective serotonin reuptake inhibitor (SSRI)
6 months ago but he continues to have the
symptoms. Which adjunctive psychotherapy
would be most appropriate for this patient?

79. Delirium and dementia may at times have sudden onset (Delirium is associated
overlapping characteristics. However, which with a sudden onset, fluctuating course
of the following are readily associated with over a 24-hour period, with reduced
delirium? consciousness, slow or rapid incoher-
ent speech and decreased attention
span.)

80. Alex experienced repeated sexual abuse as Dissociative Identity disorder

a child. Years later, during therapy, several
distinct personality states emerged. This is
best describes as?

81. Which of the following expressed suicidal "I am planning to take all of my med-
ideations has the highest lethality? ications at once, I just want this pain to
stop."

82.
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Soledad is a 32 year old female who for the Illness anxiety disorder (Soledad meets
last 8 months has been overly concerned the DSM-5 criteria for illness anxiety
that she has been infected with the Covid-19 disorder. No somatic symptoms are
virus. Her mother had the virus 6 months present. Repeated and excessive reas-
ago. Soledad is anxious that she is now ill. She surance and medical care visits are pre-
checks her temperature 4 times a day. She sent. The preoccupation with having a
has tested negative for Covid -19 10 times serious illness has been present for at
in the last 3 months. Soledad has no overt least 6 months. There is a high level of
symptoms of the virus. She frequently visits anxiety about personal health status.)
her PCP and drug store clinic asking for re-
peated testing. Two years ago, she had fears
of the Zika virus and displayed similar behav-
ior and repeated medical care visits. What is
the most likely diagnosis here?

83. A couple presents with their 18-year-old Schizophrenia prodrome

son who was referred by his primary care
provider for evaluation of symptoms related
to perceptual disturbances, oddly related in-
terpersonal communication, neglect of basic
hygiene, and increasing isolative behaviors.
These symptoms are most consistent with:

84. Which of the following medications may con- All of these contribute to REM sleep
tribute to REM sleep behavior disorder? behavior disorder. (SSRI's, SNRI's, TCA's
and Beta Blockers use may all result in
REM sleep behavior disorder.)

85. Jeanne received a Christmas card from a fam- Paranoid Personality Disorder
ily that she has not connected with for several
years. Jeanne felt she only received this card
"because they want a card returned from her,

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to see if she gained weight". Jeanne has of-

ten worried that her husband of 18 years
is cheating on her despite any evidence to
support infidelity. Jeanne is quick to counter-
attack with anger with any perceived insults.
Jeanne does not like to confide in others be-
cause she fears the information will be used
against her in the future. Jeanne does not
have a psychotic disorder or medical condi-
tion to better explain her personality disor-
der. Which of the following disorders would
best explain Jeanne's behavior?

86. Shirley is a 20-year-old female on oral contra- All of these could interact with the con-
ceptives. Which of the following is most likely traceptive. (Grapefruit juice, St. John's
to interact with her oral contraceptive? wart & Phenytoin

87. Your client suffers from PTSD. Which of the Eye Movement Desensitization and Re-
following is the best option for your client? processing therapy (EMDR) (Eye Move-
ment Desensitization and Reprocessing
therapy (EMDR) is supported in the lit-
erature in reducing hyperarousal and
treating PTSD.)

88. A 25 year old male reported a sudden chok- Panic disorder

ing sensation at work which caused some
difficulty breathing. He retreated to the bath-
room out of fear that others would see
him struggling as he couldn't comprehend if
these symptoms were life threatening or he
was going crazy. He felt dizzy, sweaty, sick to
his stomach and could not swallow. He had a

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fear at first that he was dying. He attributed

his symptoms to an undiagnosed illness or a
recent infection that he wasn't over. He never
sought medical treatment. He struggled for
the next 3 weeks out of concern these symp-
toms might come back. The symptoms re-
curred 4 weeks later, while sitting alone in his
car after leaving a supermarket. He drove to
the nearest emergency room and no immedi-
ate cause was identified. He was instructed to
follow up with an ENT provider as an outpa-
tient. What disorder the most likely diagnosis
based on his symptoms?

89. Which neurocognitive disorder has an in- Lewy Body disease (The core diagnostic
sidious onset, recurrent hallucinations, pro- features of Lewy Body disease include
nounced variation in attention and a dramat- Fluctuating cognition, well-formed re-
ic sensitivity to antipsychotic medications? current visual hallucinations, parkin-
sonism onset subsequent to the cog-
nitive decline. Suggestive features in-
clude rapid eye movement sleep be-
havior disorder and severe antipsychot-
ic sensitivity.)

90. The experience of depersonalization is Ego-dystonic and reality testing is in-

ego_________ and reality testing is ___________? tact (Ego-dystonic and reality testing is
intact. Clients are disturbed by deper-
sonalization and reality testing remains
intact.)

91. Which of the following symptoms supports All of these support the diagnosis. (Lo-
the diagnosis of Conversion disorder? calized anesthesia, The presence of dis-

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sociative symptoms & Tunnel Vision. The

diagnostic criteria for Conversion dis-
order include one or more symptoms
of altered voluntary motor or senso-
ry function. The clinical finding are in-
compatible with neurological or med-
ical conditions. The symptoms are not
better explained by another mental or
medical disorder. The symptoms cause
great distress or impairment in function
for the individual.)

92. A 36-year-old victim of domestic violence has Provide information about support re-
three young children at home. She presents sources
to the PMHNP for depression, and requests
something to calm her nerves because she
is not sure how much more she can tolerate.
What should the PMHNP do next?

93. Charlie picks at his skin after feeling tension Excoriation disorder (Skin picking (Ex-
and anxiety. He also picks his skin when he coriation) disorder maybe related to a
is bored. Which disorder does Charlie most variety of emotional states. Boredom
likely have? and anxiety are often reported as trig-
gers to skin picking,)

94. A 28-year-old female is referred from her em- Psychosis

ployee assistance program from a tech com-
pany for poor hygiene and erratic behaviors
interfering with her work. The patient states
her company is spying on her and setting
her up to fail for the last 9 months. While
speaking she stops herself and begins to talk

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back to someone who is not present. These

symptoms are most consistent with:

95. A 68-year-old man presents with his wife for Trazodone

evaluation of sleep disorder. The wife reports
he does not sleep well at night and wanders
around the house. He then sleeps much of
the day. Which of the following medications
is preferred to control this behavior?

96. A 45-year-old man is reporting chest pres- Tangential

sure, difficulty breathing, numbness, and tin-
gling in his hands and lips. He has been seen
in the emergency department in which he un-
derwent a negative cardiac workup. He was
subsequently triaged to psychiatry for evalu-
ation. The PMHNP asks how he came to the
hospital. He states, "I felt awful, my heart was
pounding, I was sweating so much, I thought
I was going to die. My father had a similar
problem, but he died 10 years ago." Which
of the following best describes the thought
pattern?

97. A 6 year old boy is struggling to fall asleep Separation anxiety disorder
and returns into his parents bedroom after
attempting to sleep for 3 minutes on his own.
He is often scared of something under his
bed or in the closet. He falls asleep easily
when with his parents. Hee occasionally has
nightmares that he cannot find his parents

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in a large gathering. What is the most likely

diagnosis?

98. Children with this disorder have frequent Disruptive mood dysregulation disor-
temper outbursts and irritability between der
ages 6-18. The outbursts which occur 2 or 3
times per week are inconsistent with devel-
opmental level. The core feature of this dis-
order includes verbal rages and/or physical
aggression out of proportion to the situation.
The irritability and anger last most of the day
and is observable to others (teachers, peers,
parents, coaches). In this disorder, there are
no symptoms of mania or hypomania and the
core symptoms are present for at least 12
months. Which disorder bests describes the
above diagnostic criteria?

99. A 72-year-old man with a history of hyper- Frontotemporal dementia

tension, and type 2 diabetes mellitus has be-
come increasingly disinhibited and flirts with
his home health aide. He demands she kiss
him or he will pee on himself. She is some-
times able to distract him with cookies but his
children often object because it will worsen
his blood sugar control. Which of the follow-
ing is the most likely diagnosis?

100. Erin is a 19 year old female who displays 2 Dissociative identity disorder
distinct personality states. She experiences
gaps in memory beyond ordinary forgetting.
These symptoms have negatively impacted

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her career. She has no other medical condi-

tions and does not use any substances or
alcohol. What is the most likely diagnosis?

101. Which of the following case examples best A 21 year old male who was arrested
fits antisocial personality disorder? at age 14 for burning down a garage
and repeatedly engaging in violence
towards animals without any remorse.
(A 21 year old male who was arrested
at age 14 for burning down a garage
and repeatedly engaging in violence
towards animals without any remorse.)

102. A 61-year-old female is referred to the psychi- Somatic delusion

atric emergency department with complaints
of abdominal pain, nausea, and bloody
stools. Despite an extensive evaluation, no
underlying cause for her symptoms can be
identified and her hemoglobin is normal. The
patient insists there is something physically
wrong with her. Which of the following best
describes her condition?

103. A 36-year-old man has been readmitted five Court ordered assertive community
times in the past year for medication nonad- treatment
herence despite the use of a long-acting in-
jectable antipsychotic for schizophrenia. The
patient is often brought in by police when
bystanders report reckless behavior. Which
of the following would provide him with the
best chance of reduced morbidity and au-
tonomous living?

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104. Which of the following is true with insomnia Complaint of dissatisfaction of sleep
disorder? quality or quantity (Individuals with In-
somnia disorder are dissatisfied with
sleep quality or quantity. Insomnia is
a more prevalent complaint amongst
females than males. The first episode
is more common in young adulthood
compared to childhood.)

105. A key difference between non pathological Non pathological worry is in proportion
worry and general anxiety disorder (GAD) is to the impact of the anticipated event
what?

106. Which of the following conditions frequently Depression

occurs in patients with dementia but may im-
prove as the condition declines?

107. A 55-year-old female recently accepted a sev- Speak in a clam reassuring voice and
erance package for early retirement from her evaluate for comorbid conditions
job as a fashion buyer for a major retail store.
Over the past 6 months she has increasing-
ly become isolated, neglecting her self-care,
and collecting various things of no real value.
Her appearance is unkempt, and her affect
is flat. Before being called back to the con-
sultation room the PMHNP notices that the
patient seems to be talking to herself audibly.
During the consultation the patient makes
poor eye contact and wants frequent reas-
surance that no one is listening in. Which of
the following would be the best action for the
PMHNP to take?

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108. A 55-year-old man with poorly controlled Amitriptyline

type 2 diabetes was referred for evaluation
of medication noncompliance. Upon evalua-
tion you realize that the patient has increased
sleep latency, anhedonia, poor appetite, and
persistent depressed mood. In addition, he
reports chronic neuropathic pain in the feet
unrelieved by analgesics. Which of the follow-
ing medications may address the patient's
symptoms of poor sleep, depressed mood,
poor appetite, and neuropathic pain?

109. Leo is a 32-year-old male with MDD who All of these are associated with in-
has been treated with Citalopram for the last creased risk. Triptans, Oxycodone and
5 years. Which of the following is associat- Tramadol, Yohimbe, Panax ginseng and
ed with and increased risk of serotonin syn- St. John's wart, 5-HTP, Valproate and
drome? Trypophan. All of these drugs and herbs
may contribute to serotonin syndrome.)

110. When providing anticipatory guidance for Medications are most effective for hal-
the parents of a 23-year-old male with schiz- lucinations, disorganization, and delu-
ophrenia, which of the following statements sions
is most accurate?

111. A 22-year-old male has been referred by the Narcolepsy

employee assistance program at his job for
poor work performance. The patient reports
that no matter how much coffee he drinks
he remains sleepy throughout the day and
will doze off at meetings. He notes that he
will often awake when his head hits the back
of his chair when at a meeting. On occasion

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he has dropped his cup of coffee in front of

everyone and now he feels he is under con-
stant scrutiny and thinks people are speculat-
ing he is using drugs. What is the most likely
diagnosis?

112. Which of the following are true regarding dis- The amnesia is selective for specific
sociative amnesia? events which should be successfully re-
called in stored memory and readi-
ly remembered. (Dissociative amnesia
involves the inability to recall impor-
tant autobiographical information, usu-
ally of a traumatic or stressful nature,
that is inconsistent with ordinary forget-
ting. It is potentially reversible and not
associated with neurobiological dam-
age. Loss of one's personality identity
and procedural knowledge is associat-
ed with generalized amnesia.)

113. A 40-year-old veteran is being evaluated in Do you have access to firearms?

the mental health clinic and states that he
has had trouble sleeping, feels on edge, and,
whenever he is in a crowd, has flashbacks
to a time when he had to drive his Humvee
through a crowd of civilians to escape ene-
my fire. He feels guilty for possibly having
killed innocent people. Which of the following
questions should the PMHNP ask him?

114. A 50-year-old man with a diagnosis of Parkin- Creutzfeldt-Jakob disease

son's disease is admitted to the hospital af-

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ter tripping and falling and breaking his hip

while on a business trip, where he was in-
specting a slaughterhouse. The third day af-
ter surgery the patient is having tremors,
intermittent slurred speech, dysarthria, and
dysgraphia. The orthopedist is attributing
his symptoms to slow postoperative progres-
sion complicated by having not taken his an-
tiparkinsonian medications for 2 days and
the effects of narcotics. Psychiatry was asked
to see the patient for mood disorder and pos-
sible delirium to aid in planning discharge
to subacute rehab. On exam the patient is
unable to name the day, month, or year;
has poor three-object registration and recall,
scoring 12 of 30 on a mental state exam;
his speech fluency and attention span are
incongruent with his baseline; and he has no
decline in his level of consciousness. Which of
the following

115. A 62-year-old billionaire was recently ar- Malingering

rested on charges of pedophilia and child
pornography. He was denied bail at his hear-
ing and is waiting in jail pending his trial. The
next morning the patient was found passed
out on the ground and transferred to the
emergency department. He was evaluated,
and the work up was negative. Upon dis-
charge, he tells the emergency department
attending he is suicidal and wants to hang
himself. The patient is referred to psychiatry
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for evaluation of suicidal ideation. Which of

the following conditions must be considered
in the differential diagnosis?

116. The PMHNP is covering for the vacationing Early morning awakening
psychiatrist and is conducting a follow-up vis-
it for a 24-year-old man diagnosed with ma-
jor depressive disorder. Which type of sleep
disturbance is most consistent with this diag-
nosis?

117. Jerry, a 37 year old male presents to you after Hoarding disorder, excessive acquisi-
agreeing with his partner's request to obtain tion type (Hoarding disorder, excessive
help. He notes that he collects comic books acquisition type. The comic book col-
and feels strongly that this growing collection lecting becomes pathological hoarding
is an investment in the future. He offers that once the diagnostic criteria are met. In
he never sells the comic books and "cannot this case, the patient has difficulty dis-
part with them". He admits that the condo- carding the comic books, feels he needs
minium is running out of walkable hallway to save them (not selling any), has accu-
space to store all of the comics. Despite this, mulated comic books that congest the
he continues to purchase more comic books living space and yet continues to pur-
each week. His partner is concerned about chase more despite third party opin-
both the cost of the comic books and the ion.)
remaining space left in their home to store
these items. What is the best diagnosis?

118. A patient is requesting the PMHNP to com- Auditory hallucinations coincide with a
plete his disability application for schizophre- delusion
nia because he got fired for disruptive be-
havior. He states the constant voices ask him
questions and interfere with his sleep, so he
has started smoking marijuana to help him

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relax. Which of the following statements is

true regarding auditory hallucinations?

119. A 44-year-old male with type 2 diabetes is Order a sleep study

becoming increasingly irritable, inattentive,
and forgetful, and frequently falls asleep in
front of his computer at work. He is worried
he will get fired and lose his benefits, which
he needs to cover his diabetic supplies. He
says, "I am so worried that my blood sugars
are as high as 300 and on occasion have wet
the bed." What should the PMHNP do during
this visit?

120. Jose is a 48-year-old veteran of Operation Provide anticipatory guidance and cop-
Iraqi Freedom, during which he sustained a ing mechanisms to the patient and his
traumatic brain injury that left him uncon- wife
scious for 7 days. He has progressively re-
gained function and is able to perform his in-
strumental activities of daily living most days.
His wife is worried because he has periods
where she does not recognize him as he be-
comes irritable, fails to remember important
dates and events, and gets headaches so bad
that he says he wishes he had died in the war.
What is the priority action for the PMHNP to
take during this office visit?

121. Which of the following highlights the core A pervasive pattern consisting of atten-
feature of Histrionic Personality disorder? tion seeking and excessive emotionality
(A pervasive pattern beginning in early

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adulthood consisting of attention seek-

ing and excessive emotionality.)

122. The husband of a 68-year-old woman with The cognitive decline is reversible once
major depressive episodes is concerned the depression is treated
about cognitive decline in his wife. Which of
the following statements best addresses his
concern regarding this symptom?

123. A 25-year-old female presents with symp- Inquire as to the most bothersome
toms of nausea, headache, and back- symptom and when it occurs
ache. Despite consultation with her prima-
ry care provider, gastroenterologist, neurol-
ogist, and ED visit no identifiable cause has
been found for her symptoms. She has been
referred to psychiatry but insists she should
go to rheumatology. What should the PMH-
NP do?

124. A 22-year-old man is referred to the psy- Grandiose delusion

chiatric emergency department for suicidal
ideation. Upon interview the patient states
that he is not trying to kill himself, and he
really can fly if only people would let him.
The patient is emphatic that he is not manic
because he is "the best sleeper in the world."
The patient has a bright reactive affect and
is pressured at times. Which of the following
best describes his condition?

125. A 33-year-old female with history of schizoaf- Benadryl 25 mg IV push

fective disorder was brought to the emer-
gency department by police for disruptive be-
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havior, auditory hallucinations, and self-ne-

glect. The patient screams that she had
stopped taking her medication. The PMHNP
orders Haldol 5 mg PO, which the patient
willingly accepts. An hour later the patient
demonstrates an involuntary upward devia-
tion of the eyes, and hiccoughs. Which of the
following should the PMHNP do first?

126. A 25-year-old female is referred by her Premenstrual dysphoric disorder

women's health nurse practitioner for evalu-
ation. The patient reports that the week be-
fore her period every month she feels angrier
and is increasingly irritable, and has difficulty
concentrating, low energy, and a desire to
sleep more and eat more ice cream. These
symptoms all seem to stop the week after her
period. What is the most likely diagnosis?

127. A 50-year-old woman referred from the sur- Somatization disorder

gical service is described as a "frequent flyer."
She reports vague complaints that have no
apparent cause or objective clinical findings.
Most recently, she complains of vaginal pain,
headache, and stomachache. Upon interview
she is tearful, guarded, and withdrawn. What
is the most likely psychiatric diagnosis?

128. Delirium characterized by apathy, psychomo- Hypoactive delirium

tor retardation, and inattentiveness is known
as:

129.
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Jesse is a 72 year old male with major neu- Rapid Eye Movement Sleep Behavior
rocognitive disorder with Lewy bodies. His Disorder (Over 50% of individuals with
family noted that Jesse had a sleep wake dis- REM sleep behavior will go on to devel-
order which became prominent in his late op a neurodegenerative disease.)
60's. Which sleep wake disorder did Jesse like-
ly have?

130. A 38-year-old Middle Eastern male veteran of Sertraline

Operation Iraqi Freedom is evaluated at the
mental health clinic. He reports that he saw
many of his battle buddies get killed in action.
He has been stateside for 2 years, but since
that time he has had trouble sleeping and
as such he is very irritable to be around. He
reports ongoing nightmares and flashbacks
to an explosion and he feels on edge most
of the time. He avoids large crowds and loud
noises. He finds that having a few beers helps
calm him and makes him more pleasant to
be around and allows him to socialize rather
than isolate himself. Which of the following
medications should the PMHNP prescribe?

131. A 26 year old male with a former history of Somatic symptom disorder (Somatic
testicular cancer developed low back pain af- symptom disorder. The patient's somat-
ter a flag football game. Over the next year, ic symptoms are distressing enough to
he focuses continuously on sensations in his disrupt his daily life. The symptoms are
back and groin area and repeatedly seeks persistent for more than 6 months. He
multiple health care providers for his ongo- is not concerned with his appearance of
ing symptoms. He checks himself daily for his physical features, but rather abnor-
changes in lymph nodes or skin changes. He mal focus and appraisal regarding the
continues to call on more physicians despite seriousness of the symptoms. Addition-
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a negative work up for testicular cancer or ally, his persistent high level of anxiety
injury to his spine. Which diagnosis best fits regarding the symptoms and excessive
this clinical scenario? time and energy devoted to the symp-
toms help support the diagnosis.)

132. Upon awakening, a period of reduced alert- Sleep inertia (Sleep inertia refers to
ness, impaired performance and reduced a groggy period lasting minutes to
vigilance associated with Hypersomnolence hours, which includes impaired alert-
disorder is better known as what? ness upon awakening and is specific to
hypersomnolence disorder.)

133. Which of the following would meet the diag- Being in the close vicinity of a drive
nostic criterion A for the diagnosis of Acute by shooting while walking to work (The
Stress disorder? Criterion A for Acute Stress Disorder in-
clude traumatic events that are expe-
rienced directly such as exposure to
war, threatened or actual violent assault,
natural or manmade disasters and se-
vere accidents.)

134. A 38-year-old male reports excessive daytime Request the patient complete a sleep
sleepiness for the last 2 weeks in the setting log
of restructuring at his job. He is unable to tell
if he is having more trouble falling asleep or
staying asleep. Sometimes he wakes up at 4
a.m. and is unable to fall back asleep. What
should the PMHNP do first?

135. A 15-year-old boy has refused to go to school Separation anxiety

for the past month. Every morning he has a
new symptom or develops one and has to
be picked up from school. When he is home,
the symptoms disappear. On weekends the
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symptoms never present. What is the most

likely diagnosis?

136. Which mental illness accounts for the highest Major depressive disorder
rate of mental illness?

137. Mabel is a 85 year old female with moder- Supervise Mabel and allow her to wan-
ate-advanced stage of Alzheimer's dementia. der (The greatest concern of wandering
She has been wandering inside of the locked in patients with cognitive impairment is
ward within the nursing home in which she elopement. Mabel is safe considering
resides. The PMHNP is consulted to address she resides in a locked ward. Person
the wandering behavior of Mabel. What is centered care may help meet the needs
the most appropriate treatment option for of residents who wander. Wandering
wandering in the case scenario? itself can be thought of as a desire to
fulfill a need.)

138. Jaime is a 22 year old male who is accompa- Schizotypal personality disorder (Jaime
nied by his brother. His brother is concerned meets the criteria for Schizotypal per-
that Jaime "needs mental help". Jaime has sonality disorder. He has no true delu-
no close relationships other than his brother. sions or hallucinations. The "weirdness"
He has been described as "weird" and "odd" and eccentricity are unique to Schizo-
since high school. Jaime is superstitious, but typal vs Schizoid personality disorder.)
does not have any true delusions or halluci-
nations. He feels that he can "sense things"
and describes himself similar to "a seer". He
remains employed at a video game store for
the last 5 years, but has no friends at work.
On exam, Jaime has old clothes on that do
not match, and sports a "reverse mohawk"
haircut. His speech at times is metaphorical
and his affect is constricted. Jaime has ex-
cessive social anxiety that does not diminish

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with familiarity. Which of the following best

explains Jaime's behavior?

139. Kevin is a 69 year old retired contractor who Mild Cognitive impairment (Kevin likely
dropped out of high school in the 10th grade. has MCI. The MOCA or Montreal Cogni-
Kevin is concerned with his self reported tive Assessment is considered superior
"memory difficulty" the past 2 years. He has to the MMSE especially in the context
no reported changes in activities of daily liv- of screening for Mild Cognitive Impair-
ing or functional ability. He scored a 24 on ment. A cut off score of <25 for pa-
the Montreal Cognitive Assessment and a 26 tients with less than or equal to 12 years
on the Mini Mental State Examination. He is of formal education indicates cognitive
accompanied by his daughter who acknowl- impairment. Frank remains functioning
edges that her father is having some memo- stable and has no difficulties with ADLs
ry issues. Which is the most likely diagnosis which eliminates major neurocognitive
given the information provided? disorder. There was no mention of de-
pression related cognitive dysfunction
or pseudodementia in this case.)

140. A 25-year-old female presents to the emer- Circumstantial

gency department, having just witnessed an
accident. Her speech is pressured. She states,
"There were a lot of people in need of care
at the scene, and I should know because I
have traveled to many Third World countries.
I know how bad needs can get. The people
were injured, and she was hit by a car before
but did not suffer any injuries. There were a
lot of police cars and ambulances." The pa-
tient was triaged to psychiatry. The PMHNP
describes her thought process as:

141.

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A 24-year-old man has been stable on lithium Repeat the lithium level and ensure it is
1,800 mg daily for 2 years. His most recent a trough
serum lithium level is 2.0. The patient has no
signs or symptoms of toxicity. Which of the
following is the best action by the PMHNP?

142. A 57-year-old man was evaluated in the ED Order 1 L normal saline at 100 mL/hr
for altered mental status. His head CT scan
is negative, white blood cells are 6,000, uri-
nalysis negative for infection with positive ke-
tones, serum glucose is 120 mg/dL, sodium
is 148, blood urea nitrogen 22, creatinine 1.8,
and cardiac enzymes are negative. Neurolo-
gy has cleared him for an acute event, and
the ED physician has cleared him for psychia-
try. The PMHNP evaluating him obtained col-
lateral information that the patient has been
in bed for 3 days, and not eating or drinking
because the voices tell him the food is bad
and the water is contaminated. What should
the nurse practitioner do first?

143. A patient presents to the emergency depart- Conversion disorder

ment reporting sudden onset blindness. Her
physical exam is unremarkable. The patient is
referred to psychiatry for disposition because
the patient insists she cannot care for herself.
What is the most likely diagnosis?

144. The PMHNP is consulting on a 79-year-old Delirium workup

female in a long-term care facility with histo-
ry of hypertension, coronary artery disease,

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and atrial fibrillation. The patient is having

difficulty sleeping and was started on lo-
razepam 2 mg at bedtime. The patient has
become increasingly agitated and wandering
and has been further prescribed lorazepam
2 mg every 6 hours. The patient is also
prescribed hydrochlorothiazide 25 mg daily,
digoxin 0.125 mg every other day, diltiazem
sustained release 360 mg daily, and isosor-
bide 30 mg daily. What should the PMHNP do
first?

145. A 30-year-old man has been started on ser- Increased sleep latency
traline 50 mg daily for major depression 1
week ago. He presents for follow-up. Which
of the following sleep patterns is he expected
to report?

146. The primary distinguishing feature between Disturbance in consciousness

dementia and delirium is:

147. Which of the following is false regarding De- Reality testing is impaired (During the
personalization/Derealization disorder? depersonalization or derealization ex-
periences, reality testing remain intact.)

148. A 32-year-old man presents to the emer- Brief psychotic disorder

gency department with acute onset disorga-
nization, paranoid delusions, and visual hal-
lucinations of flying bugs, which he tries to
crush because he thinks they contain listen-
ing devices. The patient is accompanied by
the police, who were called because the man
was smashing things in a store. Which of the
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following can the PMHNP diagnose during

the initial encounter?

149. A 45-year-old man reports difficulty falling Administer Patient Health Question-
asleep and early morning awakening. He re- naire (PHQ)-9
ports excessive daytime sleepiness as a result
of his unrestful sleep. What should the PMH-
NP do first?

150. In the wake of school shootings, adminis- Bullying or being bullied

trators have requested education for early
warning signs of potential school violence.
Which of the following risk factors are specific
to increased threats of violence?

151. The most common complaint and reason the Gastrointestinal side effects (The
acetylcholinsterase inhibitors are sometimes most common side effects of the
discontinued is what? cholinesterase inhibitor medications
are gastrointestinal. This includes
weight loss, nausea, vomiting and diar-
rhea.)

152. Which of the following about major depres- Suicide attempts are higher for men
sive disorder and suicide is false? (The risk of suicide is higher in women
and suicide completion risk is higher
in men. Others risks for a completed
suicide include being single or living
alone)

153. A 40-year-old man who has been on olan- Statin therapy

zapine for schizophrenia has a lipid pro-
file indicating total cholesterol 240 mg/dL,

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and low-density lipoprotein (LDL) 200 mg/dL.

Which of the following is recommended?

154. The discharge paperwork from the in-pa- Significant weight loss, early morning
tient psychiatric hospital notes "melancho- awakening, lack of reaction to usually
lia". Which of the following group of symp- pleasurable activities (Loss of pleasure
toms best describe the melancholic features in all activities, lack of reactivity to usu-
that maybe experienced in the setting of a ally pleasurable stimuli, empty mood,
major depressive disorder? symptoms worse in the AM, early morn-
ing awakening, marked psychomotor
agitation or retardation, anorexia and
excessive guilt are all melancholic fea-
tures of depression.)

155. John is a 55 year old male who was recently Adjustment disorder ( The criteria for
diagnosed with Parkinson's Disease. He has general anxiety disorder and major de-
delayed his appointment with a neurologist pressive disorder with psychotic fea-
after he has convinced himself that he will die tures are not met. Parkinson's disease
soon. He has been avoiding work despite his is not considered a traumatic event de-
ability to perform his occupation as a sales spite the burden of the disease and
manager. He describes nightmares since his thus the criteria for acute stress disor-
diagnosis 1 month ago. He has being expe- der are not met. The symptoms above
riencing guilt that his former boxing career are consistent with adjustment disor-
must have brought on the disease. What di- der.)
agnosis best describes the this clinical sce-
nario?

156. Delirium characterized by periods of agita- Hyperactive delirium

tion and restlessness is known as:

157. Regardless of any accompanying symptoms, 15 (A diagnosis of Obstructive Sleep

how many obstructive apneas or hypoap- Apnea Hypopnea can be made when
neas found on polysomnography per hour, polysomnography shows 15 or more
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would qualify one for a diagnosis of Obstruc- obstructive apneas or hypoapneas in

tive Sleep Apnea Hypopnea? an hour regardless of accompanying
symptoms.)

158. Which description best corresponds to a per- Severe memory impairment and disori-
son with a MOCA score of 3? entation (A MOCA of < 6 is associated
with profound impairment in cognition,
memory and function.)

159. A 55 year old female resident residing in a A 21 year old male who was arrested
nursing home after breaking her femur. She at age 14 for burning down a garage
became angered and felt abandoned after and repeatedly engaging in violence
the nursing staff changed her roommate. towards animals without any remorse.(
She in turn, retaliated by recording staff un- A 21 year old male who was arrested
knowingly in the hallway having a private at age 14 for burning down a garage
conversation with her cell phone. She then and repeatedly engaging in violence
sent the video to the nursing board claiming towards animals without any remorse.)
poor treatment.

160. Which of the following highlights the core A pattern of instability in interperson-
feature of Borderline Personality disorder? al relationships, self image, affect and
impulsivity (A pattern of instability in
interpersonal relationships, self image,
affect and impulsivity)

161. Mikey complains of a new tingling sensation Conversation disorder (Conversion dis-
in both of his hands and feels his hands order (Functional Neurological Symp-
are now "weak". This occurred 4 days after tom Disorder). One or more symptoms
his partner abruptly ended their 5 year rela- of altered voluntary motor or senso-
tionship. Mikey became very distressed and ry function, incompatibility between the
booked an urgent appointment with his pri- symptoms and the exam, not better ex-
mary care provider. He has no other com- plained by another medical condition
plaints, rarely calls his primary care provider
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and denies any recent injury. Upon exam, and the deficit causes significant dis-
Mikey has no evidence of a medical condition tress.)
other than his new sensory function com-
plaint. Given the limited information in this
scenario, this is likely an example of what?

162. Which of the following is NOT a diagnostic cri- Nightmares (Nightmares do not con-
teria for meeting the diagnosis of Obstructive tribute to the diagnostic criteria for Ob-
Sleep Apnea Hypoapnea? structive Sleep Apnea Hypoapnea.)

163. A 60-year-old man has been treated for de- Doxepin

pression for the last 2 years with a medica-
tion he cannot remember. He reports that
he has had increasing urinary hesitancy, xe-
rostomia, and intermittent lightheadedness.
Which of the following medications is this pa-
tient most likely prescribed?

164. A 42 year old factory worker complains of Circadian rhythm sleep-wake disorder,
excessive daytime sleepiness. Three months shift work type (Circadian Rhythm Sleep
prior, she moved from the 3-11PM evening Wake Disorder includes insomnia dur-
shift to a 6PM - 6AM shift after receiving a ing the major sleep period and / or
financial incentive. She has little energy on excessive sleepiness during the major
her days off and this has impacted her social awake period related to a shift work
life and friendships. What is the most likely schedule. The disruption causes signif-
diagnosis? icant distress or impairment in social,
occupational and other important areas
of functioning.)

165. A patient with major depression and early Elevated cortisol

morning awakening is likely to have which of
the following hormonal states accounting for
his symptoms?
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166. The PMHNP is evaluating a 32-year-old male Past history of abuse

who reports social anxiety and depression
over his dating prospects. The mental state
exam reveals a flat affect, avoidant individual
with poor eye contact, and psychomotor ag-
itation. He describes his last relationship in
college as one where he just tried to keep the
peace. Which of the following areas should
the interview focus on to address his con-
cerns?

167. Roberto is a 26 year old male who intention- Factitious disorder (The best answer is
ally punctured his foot with a rusty nail and factitious disorder. In this case scenario
smothered the wound with dirt. Several days there was induction of injury, deceptive
later he sought medical care. He verbalized to behavior in the absence of obvious ex-
his PCP that he must have stepped on some- ternal rewards.)
thing while walking his dog. In the absence of
secondary gain, this example best represents
which diagnosis?

168. The spouse of your patient asks you to de- Donepezil helps prevent the breakdown
scribe how Donepezil helps her husband who of acetylcholine (Donepezil is a re-
has mild Alzheimer's disease. Which of the versible inhibitor of the enzyme acetyl-
following is the best response? cholinersterase. Acetylcholinersterase is
the enzyme which breaks down acetyl-
choline. Increased concentrations of
acetylcholine may help with the cogni-
tive deficits secondary to the cholinergic
deficiency associated with Alzheimer's
dementia. Donepezil does not cure
Alzeimer's dementia.)

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169. The PMHNP is evaluating a 30-year-old fe- "How long have you been experiencing
male who reports intermittent auditory hal- the voices?"
lucinations in which a familiar female voice is
commenting on her as she eats. In an effort
to deal with the voices she has been using
headphones and listens to podcasts and mu-
sic all the time, but it is interfering with her
ability to do her work. Which of the following
questions would help in formulating a diag-
nosis?

170. A 30-year-old man was recently terminated Bipolar disorder

from his job for impulsive corporate spend-
ing. He was brought to the ED by the po-
lice for public nudity. The urine toxicology is
negative, and all labs are normal. The patient
is pressured and difficult to interrupt. He is
demanding to leave and wants to speak to
his lawyer, and he states that "the found-
ing fathers declare that all men are created
with the inalienable right to life and liberty,
and President Trump has caused the Federal
Bureau of Investigation (FBI) to trample my
rights, which is a high crime and he should
be impeached." Which of the following is the
most likely diagnosis?

171. The recurrent pulling out of one's own hair is Trichotillomania (Trichotillomania is the
know as what disorder? recurrent pulling out of one's hair re-
sulting in hair loss.)

172.

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Marcus, a 73 year old male, presents to his Educate Marcus that his total sleep time
PCP office for his annual check up. He men- is adequate and he is experiencing an
tions he goes to sleep at 9:30 PM and wakes age-dependent shift in the timing of
up at 4:45 AM every morning. Marcus wishes the sleep period. (Marcus is sleeping
he could sleep later into the morning, as he greater than 6.5 hours a night with no
previously did earlier in his youth. He denies reported daytime impairments in func-
daytime sleepiness or changes in function tion. There is no mention of increased
related to his sleep complaint. Which of the sleep latency or sleep maintenance is-
following would the clinician consider when sues.)
addressing Marcus' concern?

173. The cognitive processes that allows us to or- Executive functions (Executive functions
ganize, plan, sequence and initiate tasks are allow us to pay attention, organize, plan,
collectively know as what? prioritize, sequence, begin tasks, reg-
ulate emotions, self-monitor and com-
prehend different viewpoints. Executive
functions are sometimes referred to as
the the CEO of the brain.)

174. A 50-year-old woman with no past psychiatric Capgras syndrome

history is evaluated for anhedonia, fatigue,
apathy, and psychomotor agitation. She tells
you that she has been refusing care from her
husband because he has been replaced by
an alien from outer space and only appears
like her husband. Which of the following de-
scribes this psychotic depression?

175. Which of the following is considered a protec- Sense of purpose

tive factor for suicide in a patient with schiz-
ophrenia?

176.
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Memantine has FDA approval for which of the Moderate to Severe Alzheimer's dis-
following in Alzheimer's disease? ease (Memantine is approved for use
in moderate to severe Alzheimer's dis-
ease.)

177. A 50-year-old woman reports that she is tired Are you planning to harm or kill your
of her abusive husband of 20 years and today husband?
was the day she is going to do something
about it. Which of the following questions
should the PMHNP ask?

178. What is Schizophrenia associated with? High hereditability (Schizophrenia is

associated with high hereditability. In
identical twins, the concordance rate of
schizophrenia is close to 50%.)

179. In treating personality disorders the role of Alleviate comorbid mood symptoms
psychopharmacology is to:

180. A patient who has required increasing Dependent

amounts of medication to achieve the de-
sired effect and develops withdrawal symp-
toms when dosing is delayed is said to be:

181. Karina has been of paroxetine for sever- 5 weeks after discontinuing the paroxe-
al years with marginal effect. Her psychi- tine (At least 5 weeks should pass from
atrist would like to start phenelzine. How the discontinuation of the SSRI before
may weeks should pass from the discontin- beginning a MOAI.)
uation of paroxetine before the initiation of
phenelzine?

182. When providing psychoeducation to the par- Substance induced

ents of a 20-year-old male with psychosis,
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which of the following is considered a good

prognostic indicator?

183. Sunny is a 50-year -old female who presents Do nothing (A QTC of 388 ms is consid-
to the clinic with a recent ECG tracing. Her ered normal. Persons over 60 are limit-
QTC is recorded at 327 ms. Mary is on Citalo- ed to a daily dose of Citaloprma 20mg
pram 40 mg daily x 3 years secondary to gen- given the potential risk of prolonged
eralized anxiety disorder. Given this informa- QTC.)
tion, you decide to do what?

184. A 16-year-old boy with a history of substance Nausea

use disorder reports fatigue, apathy, and an-
hedonia almost every day and his mother re-
ports increasing irritability and raging behav-
ior. The boy says he smokes marijuana daily
just to feel good and is unwilling to give it
up. The mother wants some sort of medica-
tion to help him feel better so that he stops
smoking marijuana. The PMHNP agrees to
prescribe fluoxetine 20 mg daily. What is the
most common side effect associated with this
medication?

185. A condition characterized by abnormal invol- Tardive dyskinesia

untary movements in a rhythmic pattern of-
ten affecting the mouth, tongue, and jaw that
is potentially irreversible is known as?

186. Codeine is converted to morphine via Prodrug (A prodrug is a medication that

CYP2D6 in the liver. This is an example of is converted into a pharmacological ac-
what? tive drug via metabolism.)

187. Stevens-Johnson syndrome

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A patient is started on lamotrigine for bipolar

depression. The patient complained of a rash
comprised of blistering skin and mouth sores
after a dose increase. The blood work reveals
normal renal and liver function. Which type
of drug rash is most likely?

188. After a drug is absorbed the substrate binds Unbound

to protein for transport. Which portion of the
drug is available for therapeutic effects?

189. The PMHNP is monitoring a serum drug level 120 hours

for a medication with a 24-hour half-life. How
many hours will it take to reach steady state?

190. Jena is a 32-year-old female who presented Kava (Kava has the potential for severe
to the emergency room with severe weak- liver injury.)
ness, lethargy and an AST/ALT of 660/776
U/L. Which of the following could have con-
tributed to this laboratory result?

191. Which of the following is not related to the Acute dystonia (Acute dystonia is not an
Black Box warning for Valproate? adverse effect of Valproate. The Black
box warning for Depakote includes He-
patotoxicity, Pancreatitis, Teratogenicity
and Thrombocytopenia.)

192. Which of the following is true regarding Be- BEN is more common in non-Cau-
nign Ethnic Neutropenia (BEN) in regards to casian ethnic groups with darker skin.
Clozapine treatment? (BEN is more commonly observed in
African descent, middle eastern and
other non-Caucasian groups with dark-
er skin. It is more common in men and
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patients with BEN are not at an in-

creased risk of clozapine related neu-
tropenia.)

193. The PMHNP prescribes fluoxetine to treat Serotonin

depression. Which neurotransmitter will be
made readily available in the synapse?

194. Robert presented to the emergency room af- Sertraline (SSRI's are considered safer
ter ingesting an unknown amount of pills. than TCA's or MAOI's in overdose situ-
Which of the following medications has a re- ations. Acetaminophen overdose leads
duced risk of mortality in overdose? to hepatic failure and possibly death.)

195. Which of the following antipsychotics pose Ziprasidone (Ziprasidone and Aripra-
the least cardiometabolic risk? zole are two examples of antipsychotics
associated with lower cardiometabolic
risk.)

196. A patient with schizophrenia was discharged Increase his olanzapine, and schedule a
from the hospital on olanzapine 5 mg twice follow-up visit in 2 days
a day. He immediately resumed smoking cig-
arettes and escalated to one pack per day.
Upon presenting for his 1-week follow-up ap-
pointment, the patient reports he is having
trouble sleeping and the voices have start-
ed to return. Which of the following actions
should the PMHNP take?

197. A patient who has been taking paroxetine Prescribe the patient fluoxetine for 1
for 3 years wants to come off due to sexual week (Have the patient resume the
side effects. He had gradually tried to wean paroxetine and prescribe the patient a
the dose on his own but noticed a feelings PD5- inhibitor)
of dizziness, fatigue, headaches, anxiety, and
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electric-like shocks in his head. These find-

ings are most consistent with SSRI discontin-
uation. What would be a reasonable action
for the PMHNP to take?

198. All of the following help manage bruxism sec- Low dose Haloperidol (Medication
ondary to SSRI's except which? risk factors for sleep related bruxism
include Haloperidol (antipsychotics),
SSRI's, SNRI's, NDRI's.)

199. Which of the following medications are ap- Aripiprazole and Risperidone (Aripipra-
proved by the US Food and Drug Adminis- zole and Risperidone have FDA approval
tration specifically targeting irritability in chil- for treating irritability secondary to ASD.
dren with Autism Spectrum d/o (ASD)? There are many other medications uti-
lized for irritability related to ASD that
are designated as "off-label" use.)

200. Which of the following is considered a low Chlorpromazine (Chlorpromazine (Tho-

potency 1st generation antipsychotic? razine) is a 1st generation low potency
antipsychotic.)

201. A 45-year-old man who takes olanzapine 5 Akathisia

mg twice daily for psychosis reports a perpet-
ual sense of restlessness and an inability to
sit still. He says, "sometimes it gets so bad I
want to jump out of my own skin." Which of
the following is the most likely explanation?

202. Which is the key laboratory parameter for ANC (The ANC or Absolute Neutrophil
monitoring patients for clozapine-induced count is the key laboratory parame-
neutropenia? ter for monitoring patients for clozap-
ine-induced neutropenia.)

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203. An uninsured patient who was discharged Call 911 for transfer to the emergency
from the hospital on haloperidol 10 mg twice department
daily presents to the PMHNP for a 2-week
follow-up medication check visit. On exam
the patient has tachypnea, tachycardia, and
tremors, the skin is hot to the touch, and is
overall very rigid. What should the PMHNP do
first?

204. A patient who has been stable on quetiapine "Stop drinking the grapefruit juice, and
(Seroquel XR) for 3 months has decided to schedule an appointment to discuss the
start to drink grapefruit juice twice daily be- matter further."
cause she has heard it helps with weight loss.
She calls to report that since her new diet she
has been feeling fatigue and difficulty waking
up in the morning. What is the best response
by the PMHNP?

205. A patient has been taking valproic acid for Draw an ammonia level
mood stabilization from a manic episode but
is still not sleeping through the night. His
last drug level was 50 mcg/mL. The PMHNP
notices the patient seems disoriented to time
and is flapping his wrists. What should the
PMHNP do next?

206. A patient has had a pharmacogenomic test, The usual dose

which reveals he is an extensive metabolizer
on CYP450, 1A2, 2D6, and 3A4. The PMHNP
should prescribe:

207. A patient was recently started on a dopamine Dopamine transmission in the

antagonist, and complains of breast tender- tuberoinfundibular pathway
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ness and milky discharge. What is the most

likely explanation for the symptoms?

208. Layne, a client of yours, has started a "Juice Grapefruit juice may increase the serum
cleanse diet". Layne is taking Sertraline for concentration of Sertraline. (Grapefruit
depression. Layne reports that his diet in- juice is a well known CYP 3A4 in-
cludes several glasses of grapefruit juice a hibitor and therefore would potential-
day. As a PMHNP you know which of the fol- ly increase the serum concentration of
lowing? Sertraline (a CYP 3A4 substrate).)

209. Which of the following psychoactive medica- Valproate (Valproate may produce con-
tions is most likely to be associated with fetal genital malformations, lower IQ and
risk? greater risk for autism spectrum disor-
der in children.)

210. The PMHNP is evaluating a 37-year-old man Psuedo-Parkinson's

who takes a long-acting injectable paliperi-
done palmitate, who reports that he is glad
to not have to take a pill every day. He re-
ports that often, for the first few days after
he gets his injection, he notices that he walks
slower than usual and with a shuffling gait,
feels stiffness in his joints, and people think
he is depressed but the symptoms dissipate
as the month progresses. Which of the fol-
lowing best describes this condition?

211. Clozapine has been associated with what? It is associated with all of these. (Cloza-
pine has been associated with a range
of neutropenia from mild, moderate to
severe, which can lead to serious infec-
tions, up to and including death.

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212. Before a trial of Clozaril, a patient with- 1500 mcgL (Before the start of Cloza-
out Benign Ethnic Neutropenia must have a pine treatment, a patients must have
baseline ANC (Absolute Neutrophil Count) of a baseline ANC of 1500/mcgL or
greater than what threshold? 1000/mcgL with a diagnosis of BEN
(Benign Ethnic Neutropenia).

213. Gabe receives psychotherapy for perfor- Eszopiclone (Eszopiclone (Lunesta) may
mance anxiety. He has a rare request for a help with short term insomnia related
medication to help with sleep. He is required to sleep maintenance issues.)
to travel for work and is requesting help. He
has no trouble with sleep latency but wants
6 hours of sleep. Which of the following best
fits Gabe's needs?

214. A 60-year-old male recently underwent re- Hanging a clock and calendar in view
pair of a right fractured hip. He developed a of the patient (One would want to
post-operative delirium. He has been awake avoid benzodiazepines in the elder-
for 52 hours and ripped off his surgical dress- ly and especially benzodiazepines with
ing. Treatment for delirium in this scenario long half-lives when treating delirium.
may include what? Tramadol use has been associated with
delirium. H1 Antagonisets contribute to
anticholinergice burden, which is con-
sidered a risk factor for delirium.)

215. VMAT2 inhibitors are best described as a Decrease the motor symptoms associ-
class of medications associated with which of ated with TD (Tardive Dyskinesia)
the following? VMAT2 inhibitors have FDA approval for
treatment of the motor symptoms of TD
in adults.

216. A drug that binds to a receptor but does not Partial agonist
fully activate it, producing a muted biological
response, is a(n):
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217. The PMHNP knows that the study of how the Pharmacokinetics
body absorbs, distributes, metabolizes, and
excretes a medication is known as:

218. Pharmacogenetic testing shows that a 26 Citalopram (Venlafaxine, Vortioxetine

year old female with MDD is a CYP450 2D6 and Paroxetine are primarily substrates
slow metabolizer. This may require reduced for CYP2D6. Citalopram is metabolized
dosing or awareness of drug-drug interac- by CYP3A4 and CYP2C19. A CYP2D6 slow
tions to minimize potential drug toxicity. metabolizer phenotype would not affect
Which of the following medications is the the- the metabolism of Citalopram.)
oretical safest choice for treating MDD in this
patient given the test results?

219. Which of the following medications have a Vortioxetine (Vortioxetine is associat-

lower rate of undesired sexual side effects? ed with lesser sexual dysfunction com-
pared to SSRI's when utilized at low
dosing.)

220. When is the risk of neutropenia associated The first 18 weeks of treatment (The risk
with Clozapine use the greatest? of neutropenia associated with clozap-
ine is greatest during the first 18 weeks
of the clozapine treatment.)

221. A patient who had previously reported feel- Tachyphylaxis

ing much better on her antidepressant sud-
denly says the "drug seems to have stopped
working. This is known as:

222. Which of the following would help the PMH- Clonus ( A febrile patient with muscle
NP differentiate between NMS and serotonin rigidity may have either NMS or sero-
syndrome? tonin syndrome. Clonus is associated
with serotonin syndrome. Low Vitamin
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B12 does not help narrow the differen-

tial diagnosis in this clinical scenario.)

223. A new client has a diagnosis of Bipolar I with 50-100mcg/ml (The antimanic re-
most recent episode manic. He is managed sponse for Valproate is usually achieved
on a second generation antipsychotic in ad- above 50mcg/ml, but caution above
dition to Valproate. What is the valproate 100mcg/ml to minimize toxic side ef-
serum concentration therapeutic range? fects. Therefore, the therapeutic range
is 50-100 mcg/ml.)

224. A 65 year old male has a history of MDD, CAD, Sertraline (Given this patient's health
CKD IV, CVA, HTN and arrhythmia. Which of history, Sertraline is the most appropri-
the following is the safest medication to treat ate choice for MDD in this situation.)
MDD?

225. Kyle is a 36-year-old male who has schizo- He may become increasingly tired. (To-
phrenia and recently stopped smoking. Kyle bacco smoking induces the metabolism
previously smoked 2.5 packs per day for sev- of Haldol. Without the tobacco inducer
eral years. Kyle has been clinically stable on onboard, Luke may experience lethargy
Haloperidol for last 10 years. Given the above secondary to the reduction of Haldol
scenario, what is likely to happen to Kyle? metabolism.)

226. A drug that blocks receptors, inhibiting a bi- Antagonist

ological response, is known as a(n):

227. A 79-year-old female with no past psychiatric Olanzapine 2.5 mg PO

history is admitted with new onset auditory
hallucinations. The patient states her most
bothersome symptom is the voices, which
have kept her from sleeping through the
night for the last 3 weeks, and as a result,
she is tired and irritable. Which medication

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should the PMHNP order for bedtime for

sleep?

228. The PMHNP in the ED is evaluating a Acetylcholine

68-year-old woman who was recently diag-
nosed with mild cognitive impairment and
cannot remember the name of the medica-
tion that she has recently started 1 week ago.
The patient is complaining of increased heart
rate, sweating, and muscle spasms progres-
sively worsening for the last 3 days. Which
neurotransmitter is associated with this ad-
verse effect?

229. A patient who was recently started on Dopamine transmission in the nigros-
haloperidol for psychosis begins to manifest triatal pathway
hand tremor, and a shuffling gait. What is the
most likely explanation for these symptoms?

230. Keenan is an 72-year-old male admitted to Diphenhydramine (Diphenhydramine

the hospital with a diagnosis of delirium. and similar medications are contraindi-
Medications with anticholinergic side effects cated in persons over 65 given their
are known to cause delirium. Which of the elevated anticholinergic activity.)
following medications are most suspect in
contributing to delirium?

231. Kerry is a 19-year-old female with Bipolar dis- Pregnancy test (Pregnancy test. Lithium
order about to start on Lithium. Several lab is a known teratogen.)
values are recommended prior to the initia-
tion of Lithium. Which of the following listed
below are part of the lab panel the PMHNP
would order?

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232. A medication that works by receptor activa- Agonist

tion to produce a biological response is an:

233. Which of the following is true about a drug The plasma concentration required for
with a narrow therapeutic index? a therapeutic effect is near the con-
centration that results in toxic effects.
(The plasma concentration required for
a therapeutic effect is near the concen-
tration that results in toxic effects.)

234. A drug that binds to the same receptor as an Inverse agonist

agonist, but induces an opposite biological
response, is a(n):

235. A 19-year-old male is referred to the PMHNP First-pass effect

by the student health office for alcohol use
disorder. The patient states that on one occa-
sion he passed out much sooner than he usu-
ally would with far less than he would usual-
ly drink. Upon further interview, the patient
reveals the time he passed out was during a
fraternity hazing in which he was butt-chug-
ging (receiving a beer and vodka enema).
What pharmacokinetic process was bypassed
by this rectal administration route?

236. Which of the following is an example of a Tobacco smoking (Tobacco smoking is a

drug inducer? well known CYP1A2 inducer.)

237. The PMHNP knows the relationship between Pharmacodynamics

drug concentration and effect on the body is
known as:

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238. Helen is a 59 female who presents with oc- Statin induced myositis (Helen's labo-
casional panic attacks and new onset "leg ratory results are relatively normal ex-
aches". She is on ASA 81mg/day, Sertraline cept for an elevated CK. Statins are well
150mg/day, Aripiprazole 2mg/day, Atorvas- known to cause myalgias. There is no
tatin 20mg/day and Magnesium OTC Daily evidence of acute blood loss, hypona-
PRN. Laboratory results are as follows: BUN tremia or renal disease present here)
17, Creatinine 1.0, Sodium 139, CK 244 IU/L
and Hemoglobin of 13.1. Blood pressure of
130/80. Which medication could explain He-
len's current chief complaint and related lab-
oratory abnormality?

239. Which of the following statements is true? Tardive Dyskinesia may result from pro-
longed metoclopramide use (TD may
result from metocloprmaide use. Lip
smacking is a symptom of TD that re-
sults from blocking D2 receptors in the
Nigrostriatal pathway. EPS can occur
immediately after starting an antipsy-
chotic or any time there after.)

240. One of the most common electrolyte ab- Hyponatremia

normalities associated with the use of psy-
chotropic medication is:

241. Joelle is a 19-year-old college student who Buspirone (Buspirone (Buspar) is the
desires pharmacologic treatment for GAD. best choice given the list provided was
Which of the following is the best choice for devoid of SSRI's, SNRI's or Benzodi-
Joelle? azepines as needed.)

242. Pharmacodynamics describe which of the fol- How the drug effects the body (Phar-
lowing? macodynamics describe how the drug
effects the body.)
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243. Which region of the brain is associated with Parietal lobe

sensory integration, spatial awareness, and
conscious awareness of the opposite side of
the body?

244. Neurons that only travel from the body to the Sensory neurons
brain are called:

245. Damage to the temporal lobe can affect the Recognizing faces (Damage to the tem-
storage of long term memories. Additionally, poral lobe can cause anterograde am-
temporal lobe damage may cause prosopag- nesia, long term memory storage prob-
nosia. With prosopagnosia one may struggle lems and prosopagnosia, which is bet-
with what? ter known as face recognition deficit.)

246. Your patient Abigail has suffered an infarct Contralateral weakness (Contralateral
in the right hemisphere of her brain. What refers to the opposite side of the body.
would the APRN expect to find on physical An infarct in the right hemisphere of the
exam? brain may produce weakness on the left
side of the body.)

247. What is the fatty layer that prevents inter- Myelin sheath
ference and increases the speed of impulse
transmission along the axon?

248. Which of the following neurotransmitters ex- Gamma-aminobenzoic acid (GABA)

ert inhibition over neuronal function?

249. Theodore is a 44 year old male with a histo- Right hemisphere (Damage to the right
ry of traumatic brain injury (TBI). Today, he hemisphere may impair the ability to
presents to you with his caregiver, Beverly. He interpret when a speaker is angry, sad,
has difficulty determining whether you are happy or other.)

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happy or angry. Which area of the brain is

most likely impacted secondary to his TBI?

250. Which of the following best represents the A white matter bundle of axons con-
function of the Corpus Callosum? necting the brain hemispheres (The
Corpus Callosum is a white matter bun-
dle of axons connecting the 2 brain
hemispheres.)

251. PTSD is thought to cause which part of the Hippocampus (A smaller hippocampus
brain to shrink? is associated with PTSD vulnerability.
Trauma shrinks the hippocampus.)

252. A 55-year-old woman has been referred for a Frontal lobe

psychiatric evaluation for a change in person-
ality, lack of impulse control, and increasingly
reckless decision-making. Which area of the
brain would be responsible for these symp-
toms?

253. The junction between two neurons is known Synapse

as the:

254. Penelope is a 27-year old female with schiz- Tuberoinfundibular pathway (When the
ophrenia. She has been treated with Ripseri- D2 receptors are blocked in the
done. She is experiencing galactorrhea. You Tuberoinundibular pathway, hyperpro-
recognize that this side effect of Risperidone lactinemia may result.)
is a result of D2 blockade in the what?

255. The physiological process in which structural Neuroadaptation

changes occur in the brain, increasing the
likelihood of addiction over time and increas-

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ing the risk of relapse after a period of sobri-

ety, is called:

256. The PMHNP is evaluating a 68-year-old man III

for symptoms of major depression. While as-
sessing the appearance of the patient, an ob-
vious left-sided ptosis is noted. Which cranial
nerve is directly linked to this condition?

257. A patient appears internally preoccupied and Temporal lobe

responding to auditory hallucination. This pa-
tient may have a pathology affecting which
lobe of the brain?

258. The part of the neuron that takes in and re- Dendrite
ceives messages is called:

259. Which type of brain matter contains myelin White matter (White matter allows elec-
and allows electrical signals to travel fast? trical signals to travel very fast. This mat-
ter appears white due to its myelin con-
tent.)

260. Which system is involved in stimulating di- The parasympathetic nervous system
gestion and pupil constriction? (The Parasympathetic nervous system is
involved with stimulating digestion and
pupil constriction.)

261. The patient presents with a recent diagnosis The inability to carry out a skilled move-
of apraxia. What is apraxia? ment despite having the physical ability
to do so (With apraxia, one cannot carry
out a skilled movement despite the fact
that one retains the physical ability to do

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so. This is may occur with damage to the

Parietal lobe.)

262. The central nervous system is composed of Brain and spinal cord (The CNS is com-
this which of the following elements? posed of the Brain and Spinal cord.)

263. What neurotransmitter is released in the Serotonin (The Raphe nuclei are the
Raphe nuclei in the brain? chief source of serotonin release in the
brain. In the body, 90% of the serotonin
can be found in the GI tract.)

264. A patient is diagnosed with major depressive Dopamine

disorder with the most prominent feature of
apathy, anhedonia, and isolation. Which neu-
rotransmitter is associated with the symp-
toms?

265. Layla checks on her curling iron to ensure it Caudate Nucleus (The Caudate Nucleus
has been shut off upwards of 8 times per day. is thought to be dysfunctional in per-
Layla suffers from obsessive thinking. Layla sons with OCD.)
likely has an overly active what?

266. When explaining the means by which neuro- A chemical messenger

transmitters relate to mental illness, a patient
asks, "What is a neurotransmitter?" The best
answer is:

267. Which part of the limbic system has a role in Hippocampus (The Hippocampus has a
long term memory? role in long term memory.)

268. Anxiety can arise from intrapsychic conflict Ego

among the structures of the mind. Which

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structure of the mind deals with reality test-

ing and the thinking process?

269. Which of the following receives messages Dendrite

and conducts impulses to the soma?

270. This lobe of the brain empowers one to know Frontal (The Frontal lobe is involved
the difference in how one should act at a with personality and modifying emo-
church service vs. at a football game? tions to fit what is considered socially
acceptable.)

271. With respect to nervous system conduction, The afferent nerve fibers carry nerve im-
which of the following statements is true? pulses into the CNS.(The Afferent nerve
fibers carry nerve impulses from the
sensory into the CNS. Think afferent
equals arrive at the CNS.)

272. Which cerebral lobe houses the receptive Parietal Lobe (The Parietal lobe houses
area for touch and spatial orientation? the receptive area for touch and spatial
orientation.)

273. A 72-year-old man with a comorbid history of Broca's area

uncontrolled hypertension is referred to the
PMHNP for dementia secondary to depres-
sion. The mental status exam reveals difficul-
ty speaking fluently, inappropriate and con-
fabulated responses, incongruent affect, and
poor judgment. A cerebrovascular accident in
which region of the brain would better ex-
plain these symptoms?

274. Expressive aphasia may occur with damage

in which brain location?
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Broca's area (Damage to Broca's area

located within the frontal lobe may re-
sult in expressive aphasia.)

275. A 70-year-old retired male with a history Intersecting pentagon

of hypertension controlled with amlodipine,
metoprolol, valsartan, and furosemide has
been referred from his primary care provider
for depression. Formerly an avid reader, the
patient has lost interest in reading and has
become increasingly isolative as he has been
spilling things during his lunch club meetings
and finds this embarrassing, which makes
him feel self-conscious and anxious. In which
portion of the mental status exam would the
PMHNP expect to find a deficit?

276. The PMHNP is treating a client for gen- Termination

eralized anxiety disorder with depressive
symptoms. Treatment has included both
psychopharmacology and interpersonal psy-
chotherapy. The patient abruptly reports a
reemergence of the symptoms that have
been in remission. In what phase of therapy
is this an expected finding?

277. An 9 year old child is given 2 peaches. 1 of Concrete Operations (This time period
the peaches is cut into 3 pieces. The child rec- between 7 -11, the child develops oper-
ognizes that the chopped peach contains the ational thought - understanding of re-
same amount of peach as the intact peach. versibility and conservation - while be-
This is known as conservation. Which stage coming less ego centric.)

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in Piaget's theory of cognitive development

does a child develop conservation?

278. Ruby is a 79 year old female who lives in Discontinue to Omperazole and docu-
a nursing home. Her past medical histo- ment in the record( Patients have the
ry includes mild cognitive impairment and right to refuse care and medication as
GI bleed 6 years prior to admission. Ruby long as they are considered competent
is competent and makes her own health and understand the risks and benefits
care decisions. The Nurse Practitioner or- of a treatment. In this case, we learned
dered Omeprazole 20mg PO QAM. Ruby re- Ruby has MCI and remains compe-
fused the medication after reading about tent to make her own decisions. Hiding
proton pump inhibitors. She does not feel the medications or misleading a resident
risks are "worth it". A PMHNP was consulted. about a medication would not only be
Which of the following is the best next step of considered unethical - it is a direct vio-
the PMHNP? lation of Ruby's rights.)

279. What is the name of the thought process Tangential

where a client calmly begins with one state-
ment, makes another related statement in a
different direction, another statement in yet
another direction and never returns to the
original question?

280. The PMHNP is explaining the risks and ben- Consciousness raising
efits of long-acting injectable antipsychotics
to a patient with a history of medication non-
adherence. The patient is asking logical ques-
tions that demonstrate he can understand
the facts. Which process of changing repre-
sents the patient's position?

281. The PMHNP is facilitating a closed support "What plans have you implemented?"
group for victims of domestic violence and
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a member shares she is ready to leave her

abuser. What would be the best response?

282. The PMHNP is facilitating a support group She just will not listen to me.
for perpetrators of domestic violence. Which
of the following is an example of a cognitive
distortion expressed by a group member?

283. A 44 year old female presents with a heart TSH (Hyperthyroidism can present with
rate of 101, nervousness, insomnia and nervousness, irritability, increased heart
weight loss, brittle hair. Which test would be rate, palpitations, sweating, tremors,
most helpful given the findings? weight loss, exophthalmos and insom-
nia.)

284. Blake has been focusing on himself lately. Generativity vs. self - absorption (A Mid
He bought an exotic sports car he could life crisis, increased self absorption and
not afford and has spent little time with his the inability to care for others are all
teenage daughter. Which Erikson stage of signs of failing generativity vs. self ab-
psychosocial development is Blake potential- sorption in mid adulthood (35 - 65).
ly failing?

285. Montel lost his family during a Tsunami while Adventitious Crisis
on vacation. This is an example of a what?

286. The PMHNP is conducting a neurological ex- Dysdiadochokinesia

amination on a patient with altered mental
status. The inability to perform rapidly alter-
nating hand movements is known as:

287. Which one of the following scenarios is most Adolescents are able to seek STD as-
accurate in terms of the care of minors? sessment without parental consent.
(Adolescents are able to seek STD as-
sessment without parental consent.)
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288. A 30-year-old female is referred by her Systematic desensitization

women's health nurse practitioner for vagin-
ismus. The woman is distraught and embar-
rassed because she has not been able to con-
summate her marriage. Which therapeutic
technique would be most helpful?

289. According to the DSM-5, an incongruence be- Gender Dysphoria (Gender Dyspho-
tween one's natal gender and one's experi- ria describes the marked incongru-
enced or expressed gender is better know as ence between an individual's gender
what? assigned at birth and thier expressed or
experienced gender.)

290. The PMHNP was asked to lead a new project Work with the patient to identify situ-
at the hospital and implement a recovery ori- ations that may lead to a relapse (The
ented care philosophy. The best intervention recovery model embraces empowering
most consistent with recovery oriented nurs- the patient, self directed and patient
ing would include which of the following? centered care (Seed & Torkelson, 2012)
i.e. more "work with" and less "do for".)

291. What level of prevention would include Screening for pancreatic cancer is
screening for pancreatic cancer in a asymp- not recommended.(The USPSTF rec-
tomatic 49 year old female with no family ommends against screening for pan-
history of pancreatic cancer? creatic cancer in asymptomatic adults.)

292. A 43-year-old man is requesting medica- Assess his current level and history of
tion-assisted treatment for addiction with use
Suboxone and wants to begin immediately to
"get his life back." What should the PMHNP
do first?

293. Kyle is a 33-year-old wheelchair-bound man Emotional abuse

with a history of spina bifida and is being
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seen in a follow-up visit for depression and

anxiety. He reports that he is tired of feeling
like he is a burden and is very grateful to have
the home health aide, who helps with his
grooming, hygiene, and meal prep. During
his bed bath, the aide will make comments
about his disability and his inability to be-
come aroused and have children. This is an
example of which of the following?

294. The PMHNP finds herself sad when her client Concordant Identification (In Concor-
expresses sorrow. This is best described as dant Identification, the therapist takes
what? on part of the client's personality or em-
pathizes with the client's experience.)

295. Mr. Yoon is a 46-year-old male who was re- Inquire about access to weapons
ferred from the employee assistance pro-
gram for interpersonal difficulties in the
workplace. His boss states that he is very
committed to his job, often working late, but
he is unable to tolerate any criticism of his
work and becomes argumentative and fre-
quently irritable with his coworkers. He never
seems to socialize at company events and
seems to not speak of any family or friends
outside of work. He has become so difficult
to work with that termination is possible,
but fear persists of a homicidal threat. What
should the PMHNP do when seeing this pa-
tient?

296. Cranial nerves and reflexes

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The mental status exam includes all of the

following except:

297. A 19-year-old male is attending his post hos- Establish therapeutic alliance
pital discharge appointment where he was
diagnosed with psychosis. He has been tak-
ing risperidone 4 mg by mouth twice daily.
Which of the following is the top priority dur-
ing this first encounter with the PMHNP?

298. The PMHNP is supervising a nurse practition- Agraphesthesia

er student. When presenting the case, the
student notes that the patient has an inability
to recognize letters or numbers drawn on the
palm with a pointed object. This sign is called:

299. A 45-year-old man presents for a follow-up Quick Inventory of Depressive Sympto-
visit after starting on an SSRI 2 weeks ago matology
for major depressive disorder. Which assess-
ment tool would be the best indicator of
progress?

300. Which of the following immediate determi- Negative emotional state

nants related to relapse prevention is the
biggest predictor of relapse?

301. A 55-year-old woman reports to the PMH- Perform a Mini-Mental State Exam and
NP that since she accepted early retirement Confusion Assessment Methods Instru-
last year she finds that her memory has ment
gotten worse and she has trouble sleeping
at night. She denies any medical problems.
What should the PMHNP do first?

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302. A 36-year-old Korean male who has recently Conversion

started attending graduate school complains
of persistent abdominal pain despite an ex-
tensive gastrointestinal work-up including an
upper and lower gastroscopy. Which of the
following defense mechanisms is employed?

303. When conducting a community outreach ed- The most dangerous time for victims is
ucational session regarding domestic vio- when they try to leave the abuser.
lence, which of the following points should
the PMHNP emphasize?

304. A 16 year old client Jamie presents to your Identifies as non-binary (Some people
office and begins with "I might be transgen- do not identify with a specific gender.
der". You respond, My name is James, and Persons whose gender is not female or
my pronouns are he/him. How do you Jamie, male may use several terms to describe
describe your gender identity? What are your themselves including "non-binary" as
preferred pronouns? Jamie answers, "My pro- one of them.)
nouns are "They". As a PMHNP you recognize
that Jamie...

305. A 26-year-old female with a 6-year history of Educate the patient on the benefit
Opioid use disorder presents for follow up. of continuing buprenorphine for 1-2
She has been on buprenorphine for 4 months more years. (Educate the patient on the
and is considered in early remission accord- benefit of continuing buprenorphine
ing to the DSM-5 definition. She continues for at least 1-2 more years, as the ben-
to work full time as a medical assistant and efit of the medication outweigh the risk
can provide for her child. She is confused as of relapse in OUD.)
to the benefit of continuing buprenorphine
given her ability to "remain clean". What is
the best course of action for this patient?

306.
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According to Maslow's hierarchy of needs, Basic needs (Maslow postulated that

one can only achieve their full potential after the most basic needs such as food, wa-
first meeting which of the following needs? ter and shelter are necessary before
climbing the pyramid towards self actu-
alization.)

307. Jake described his brother's death stemming Restricted (Restricted Affect - Jake dis-
from a horrific car accident with minimal dis- played little emotion describing the ac-
comfort in his expression. Jake's affect would cident which would be considered a re-
best be described as? stricted or constricted affect. The next
best answer would be flat affect. How-
ever, a flat affect describes a complete
lack of emotional expression.)

308. After a motor vehicle accident, Nancy was Informed consent (In a life saving situ-
unresponsive and required surgery for mul- ation with a patient who lacks decision
tiple leg fractures. In an emergency situation making capacity and no patient surro-
where one cannot weigh the risks and bene- gate is available, the healthcare team
fits of a procedure, what is assumed? may initiate treatment. This is known as
assuming informed consent.)

309. A 16-year-old girl with no past medical history Cognitive behavioral therapy
was referred by her primary care provider
who saw her for a sports physical because
she said she was depressed. During the in-
terview the girl revealed that she has been
feeling tired, sad, is crying easily, and has
difficulty falling asleep. She reports that she
has also been eating a lot more and to keep
from gaining weight she has been taking lax-
atives and on occasion makes herself vomit.
She has dropped out of the yearbook com-

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mittee and she is not sure she wants to go to

college anymore. Which nonpharmacologic
intervention is most appropriate?

310. Which section of the Mental Status exam Motor activity

would one document gait, tics and hand
wringing?

311. The PMHNP is caring for a 20-year-old man Precontemplation

with bipolar I disorder. The patient indicates
that he does not have a problem because
he can accomplish so much during his manic
episodes. Which stage of change is the pa-
tient in?

312. Actions judged based on their inherent value Deontological theory

regardless of their consequence is based on
which ethical decision-making approach?

313. Which of the following may govern the pro- Statutory law
fession of the PMHNP?

314. Which of the following ethical principles Beneficence

deals with promoting the well-being of a pa-
tient?

315. Which of the following allows the PMHNP to Licensure

practice in a state?

316. What does force field analysis prepare the Becoming aware of the pressures for
nursing leader for? and against a proposed change (Force
field analysis recognizes that change
occurs regularly. Becoming aware of

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the pressure for and against change

can help an organization predict resis-
tance to change. The force with a mo-
tive to change must outweigh the force
maintaining the status quo.)

317. Use the following scenario to answer ques- Cues to action and perceived severity
tion regarding the Health Belief Model
(HBM).
A PMHNP is leading a recovery group for
at-risk teens who have been mandated to
attend meetings as part of their addiction
treatment.
A member of the group expresses how diffi-
cult it has been to maintain her sobriety and
as a result does not feel she will be successful
this time. Which concept of the Health Belief
Model would be the most significant risk fac-
tor for relapse?

318. A 34-year-old Korean male pediatric dentist Koro

is referred to psychiatry for persistent anxi-
ety. Upon further assessment, he reveals that
his penis is shrinking into his abdomen. De-
spite the reassurance he has received from
numerous health care providers in the past
he remains convinced of this belief. This cul-
ture-bound delusion is known as:

319. A cultural explanation of distress includ- India and Pakistan (Dhat syndrome is
ing fatigue, weakness, weight loss, somatic a syndrome of distress thought relat-
complaints, depressed mood and impotence ed to a loss of semen. Related symp-

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thought to be related to semen loss is oth- toms thought caused from dhat include
erwise known as dhat in this region of the depressed mood, fatigue, weight loss,
world. Where is a client most likely from given anxiety, somatic complaints and impo-
the specific complaint of dhat? tence.)

320. A specific behavior related to a person's cul- Culture-bound syndrome

ture and not leading to a psychiatric disorder
is classified as:

321. Andika, a 26 year old male from Indonesia Amok (Amok is mostly found amongst
swung a sword at a doctor shortly after the males in Malaysia and Indonesia. Sud-
sudden death of his father. He lost conscious- den violent behavior that is often fol-
ness, collapsing to the floor after the vio- lowed by amnesia best describes this
lent attempt to hurt the doctor. Which culture dissociative episode.)
bound syndrome best describes Andika's be-
havior?

322. A patient who is refusing psychiatric treat- Autonomy

ment has their case adjudicated. The judge
orders treatment over objection for the good
of the patient. Which ethical principle is
trumped?

323. The level of significance describing the prob- p-value

ability of a particular result occurring by
chance alone is represented by which of the
following?

324. What concept is defined by an independent Internal validity

variable causing a change in the dependent
variable?

325. External validity

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What concept is defined by a sample that is

representative of the population, and where
the results can be generalized?

326. Which of the following roles of the PMHNP Mentoring

requires mutual respect and an interactive
learning process to facilitate role develop-
ment, competencies, and skill acquisition?

327. The learned beliefs and behaviors common Culture

among all members of a group defines:

328. During a psychiatric evaluation, the client re- Female

veals to the PMHNP a transgender identity.
The client indicates a preference for personal
pronouns like he and him. What is the biolog-
ical sex of the client?

329. All of the following are attributes of cultural Urban setting

care that may influence the therapeutic al-
liance except?

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