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PURPLE BOOK PMHNP
100 MULTIPLE CHOICE
QUESTIONS WITH
ANSWERS ANCC
1.vThevpurposevofvthevAmericanvNursesvAssociation'svPsychiatric- MentalvHealthvNursing:vScopevandvStandardsvofvPracticevisvto A.vDefinevthevrolevandvactionsvforvthevNP Establishvthevlegalvauthorityvforvthevprescriptionvofvpsychotropicv B.vmedications C.vDefinevthevlegalvstatutesvofvthevrolevofvthevPMHNP D.vDefinevthevdifferencesvbetweenvthevphysicianvrolevandvthevNPvrolev- vcorrectvanswer-CorrectvAnswer:vA.vThevANA'svPsychiatric- MentalvHealthvNursing:vScopevandvStandardsvofvPracticevdefinesvthevrolevandvactio nsvofvthevnursevpractitioner. 2)vPrimaryvpreventionvcarevpracticesvarevanvessentialvaspectvofvthevPMHNPvrole.vW hichvofvthevfollowingvisvthevbestvexamplevofvavprimaryvpreventionvcarevstrategyvforvc ommunityvbehavioralvhealth? a)vAftercarevprogramvforvchronicallyvmentallyvillvclientsvrecentlyvdischargedvfromvthev hospital b)vCourt-orderedvcounselingvforvabusivevparents c)v24-hourvcrisisvhotlines
d)vParentingvskillsvclassesvforvpregnantvadolescentsv-vcorrectvanswer- CorrectvAnswer:vD.vInformationvreducesvincidencevofvdisease. 3 Thevtrendvinvlegalvrulingsvonvcasesvinvolvingvmentalvillnessvovervthevpastv 25 vyearsvh asvbeenvto a)vEncouragevjuriesvtovfindvdefendantsvnotvguiltyvbyvreasonvofvinsanity b)vProtectvthevperson'svfreedomsvorvrightsvwhenvhevorvshevisvcommittedvtovavmental vhospital c)vPlacevincreasingvtrustvinvmentalvhealthvprofessionalsvtovmakevgoodvandvethicalvd ecisions d)vDecreasevthev"redvtape"vassociatedvwithvcommitmentsvsovthatvcommitmentsvarevf astervandveasierv-vcorrectvanswer- B.vIdentifiesvthevtrendvofvensuringvthevprotectionvofvindividualvcivilvlibertiesvforvpsychi atricvclients. 4 vMr.vSmithers,vanvinvoluntarilyvhospitalizedvpatientvexperiencingvpsychoticvsymptom s,vrefusesvtovtakevanyvofvhisvorderedvmedicationvbecausevhevbelievesv"JesusvChristv toldvmevIvamvthevprophetvandvmustvfastvforvavyear."vYourvactionsvshouldvbevbasedvo nvyourvknowledgevofvwhichvofvthevfollowing? a)vPsychiatricvclientsvcannotvrefusevtreatment b)vPsychiatricvclientsvdovnotvalwaysvknowvwhatvisvgoodvforvthem c)vPsychiatricvclientsvcanvrefusevtreatment d)vPsychiatricvclientsvcannotvbevtrustedvtovmakevgoodvhealthcarevdecisionsvand,vthe refore,vthevnurse'svbestvclinicalvjudgmentvshouldvguidevactionsv-vcorrectvanswer- C.vAsvwithvanyvclient,vpsychiatricvclientsvcanvrefusevtreatmentvun- vlessvavlegalvprocessvresultingvinvinvoluntaryvcommitmentvorvmandatoryvcourtvordervf orvtreatmentvhasvbeenvobtained. 5.vWhichvofvthevfollowingvstatementsvbestvreflectsvthevdifferencevbetweenvthevnurse- clientv(N-C)vrelationshipvandvavsocialvrelationship? a)vInvthevN-Cvrelationship,vthevprimaryvfocusvisvonvthevclientvandvthevclient'svneeds. b)vGoalsvinvthevN- Cvrelationshipvarevdeliberatelyvleftvvaguevandvunspokenvsovthatvthevclientvcanvworkv onvanyvissue. c)vInvthevN- Cvrelationship,vthevnursevisvsolelyvresponsiblevforvmakingvthevrelationshipvwork. d)vInvthevN-Cvrelationship,vtherevisvnovplacevforvsocialvinteraction.v-vcorrectvanswer- A.vSocialvrelationshipsvarevmutualvinterpersonalvrelationshipsvinvwhichvthevneedsvofv bothvpartiesvarevaddressed.vThevN-Cvrelationshipvisvmostvcon- vcernedvwithvmeetingvthevneedsvofvthevclient. 6.vAvcommunityvhasvanvunusuallyvhighvincidencevofvdepressionvandvdrugvusevamon gvthevteen- vagevpopulation.vThevpublicvhealthvnursesvdecidevtovaddressvthisvproblem,vinvpart,vb yvmodifyingvthevenvironmentvandvstrengtheningvthevcapacitiesvofvfamiliesvtovprevent vthevdevelopmentvofvnewvcasesvofvdepressionvandvdrugvuse.vWhatvisvthisvisvanvexa mplevof? a)vPrimaryvprevention
n,vshevsuddenlyvbeginsvtovdemonstratevthevoriginalvsymptomsvthatvhadvbroughtvherv tovtreatmentvinitially.vShevisvnowvhesitantvtovdischarge,vwantsvtovcontinuevservices,v andvisvdisplayingvanvincreasevinvregressivevdefensevmechanisms.vWhatvisvthevbestv explanationvforvMs.vFrench'svbehavior? a)vAnvexacerbationvofvhervsymptomsvrelatedvtovstress b)vThevnormalvcyclicvnaturevofvchronicvmentalvhealthvsymptoms c)vAvsignvofvnormalvresistancevtovterminationvseenvinvthevterminationvphasevofvthera py d)vAvsignvofvpathologicalvattachmentvtovthevtherapistvthatvmustvbevaddressedv- vcorrectvanswer- C.vClientsvfrequentlyvdisplayvresistancevandvregressionvatvthevterminationvofvavmean ingfulvtherapeuticvprocess.vThevPMHNPvisvresponsiblevforvplanningvanveffectivevter minationvandvmonitoringvclientsvduringvthevterminationvperiod. 11 v Avclientvisvdisplayingvlowvself-esteem,vpoorvself-control,vself- doubt,vandvavhighvlevelvofvde- vpendency.vThesevbehaviorsvindicatevdevelopmentalvfailurevofvwhichvofvthevfollowing vstagesvofvdevelopment: a)vInfancy b)vEarlyvchildhood c)vLatevchildhood d)vSchoolvagev-vcorrectvanswer- CorrectvAnswer:vB.vThesevsignsvindicatevdevelopmentalvfailurevofvearlyvchildhood. 12 vMr.vThompsonvhasvbeenvforgetfulvlately,vforvexample,vforgettingvwherevhevhasvplac edvhisvkeysvorvwhatvtimevappointmentsvarevscheduled,vandvhevhasvstatedvthatvhevthi nksvthesevarevjustvrandomvbehaviorsvthatvhavevnovparticularvmeaning.vWhichvFreudi an- basedvpsychodynamicvprinciplevassumesvthatvallvbehaviorvandvactionsvarevpurposef ul? a)vPleasurevprinciple b)vPsychicvdeterminismvprinciple c)vRealityvprinciple d)vUnconsciousnessvprinciplev-vcorrectvanswer- B.vThevpsychicvdeterminismvprinciplevstatesvthatvallvbehaviorvhasvpurposevandvmea ning,voftenvunconsciousvinvnature,vandvthatvnovbehaviorsvoccurvrandomlyvorvbyvcoin cidence. 13 1)vAnvexamplevofvavmature,vhealthyvdefensevmechanismvis a)vDenial b)vb.vRationalization c)vRepression d)vSuppressionv-vcorrectvanswer- CorrectvAnswer:vD.vSuppressionvisvthevonlyvdefensevmechanismvlistedvinvwhichvthev clientvchannelsvconflictingvenergiesvintovgrowth-promotingvactivities. 14
Mr.vJohnsonvisvav54-year- oldvclientvyouvhavevbeenvseeingvforvseveralvweeksvinvtherapy.vWhilevdiscussingvhisv currentvconcernsvofvmaritalvstress,vhevliesvonvthevfloorvandvassumesvthevfetalvpositio n.vThisvisvmostvlikelyvanvexamplevof a)vImmaturevregressivevdefensevmechanism b)vDenialvofvreality c)vImmaturevfantasyvdefensevmechanism d)vRepressivevbehaviorv-vcorrectvanswer- CorrectvAnswer:vA.vImmaturevregressivevdefensevmechanismvisvavreturnvtovavbehav
- viorvcommonvtovanvearliervstagevofvdevelopment. 15 vDefensevmechanismsvarevbestvviewedvasvavfunctionvofvthevego a)vTovalertvusvtovharmvandvdanger b)vTovalertvusvtovproblems c)vUsedvtovresolvevavconflict d)vUsedvtovprotectvthevidv-vcorrectvanswer- CorrectvAnswer:vC.vDefensevmechanismsvarevavfunctionvofvthevegovusedvtovresolvev avconflict. 16 Onevofvthevhealthvcarevchangesvthatvhasvoccurredvasvavresultvofvthevaffordablevcare vactv(ACA)visvthatvdoctors/hospitals/ clinicvgroupsvorvhealthvsystemsvarevcomingvtogethervandvassum- vingvthevresponsibilityvforvqualityvcarevtovlargevgroupsvofvindividualsvinsuredvbyvMedi care.vThevhealthvcarevclinics/ systemsvdoctorsvorvhospitalsvthatvjoinvtogethervarevcalledvwhichvofvthevfollowing? a)vHealthvMaintenancevOrganizationv(HMO) b)vPreferredvProvidervNetworkv(PPO) c)vAccountablevCarevOrganizationv(ACO) d)vIndividualvHealthvPlanv(IHP)v-vcorrectvanswer- CorrectvAnswer:vC.vACO'svarevgroupsvofvdoctorsvorvothervhealthvcarevprovidersvwho vvoluntarilyvcomevtogethervandvassumevthevcarevprovidedvtovMedicarevpatients. 17 Healthvcareveconomicsvisvconcernedvwithvmakingvdecisionsvsovthevbenefitsvoutweig hvthevcostvofvresourcevutilization.vWhatvarevtwovconceptsvthatvhealthcareveconomics visvconcernedvwithvinvregardvtovfairvdistributionvofvresourcesvandvallocation? a)vEquityvandvefficiency b)vCostvandvbenefits c)vOpportunityvandvwaste d)vAffordablevandvqualityv-vcorrectvanswer- CorrectvAnswer:vA.vHealthvcarevefficiencyvisvmakingvriskvandvbenefitvdecisionvaboutv howvcarevresourcesvarevallocatedvandvequityvisvensuringvthatvtherevisvavfairvdistribu- vtionvofvthevresources. 18 Whatvfourvelementsvneedvtovbevpresentvforvavmalpracticevlawsuitvtovbevfiled? a)vBeneficence,vNon-Maleficence,vTruthfulness,vandvJustice
Avclientvpresentsvwithvcomplaintsvofvchangesvinvappetite,vfeelingvfatigued,vproblemsv withvsleep- restvcycle,vandvchangesvinvlibido.vWhatvisvthevneuroanatomicalvareavofvthevbrainvtha tvisvresponsiblevforvthevnormalvregulationvofvthesevfunctions? a)vThalamus b)vHypothalamus c)vLimbicvsystem d)vHippocampusv-vcorrectvanswer- B.vAppetite,vsleep,vandvlibidovarevregulatedvbyvthevhypothalamus. 24 vInvconsideringvwhethervtovordervanvMRIvofvthevheadvforvavclient,vwhichvofvthevfollow ingvwouldvbevavcontraindicationvtovthisvdiagnosticvtest? a)vProstheticvlimb b)vHistoryvofvheadvtrauma c)vPacemaker d)vPregnancyv-vcorrectvanswer- C.vAvclientvwithvavpacemakervshouldvnotvreceivevanvMRIvofvthevhead. 25 vThevprimaryvexcitatoryvneurotransmittervis a)va.vGABA b)vb.vSerotonin c)vc.vDopamine d)vd.vGlutamatev-vcorrectvanswer- D.vGlutamatevisvthevprimaryvexcitatoryvneurotransmitter. 26 vAvclientvwhovisvexperiencingvdifficultiesvwithvworkingvmemory,vplanningvandvprioritiz ing,vinsightvintovhisvproblems,vandvimpulsevcontrolvpresentsvforvassessment.vInvplan ningvhisvcare,vthevPMHNPvshouldvapplyvhisvorvhervknowledgevthatvthesevsymptomsv representvproblemsvwithvthe a)vFrontalvlobe b)vTemporalvlobe c)vParietalvlobe d)vOccipitalvlobev-vcorrectvanswer- A.vProblemsvwithvworkingvmemory,vplanningvandvprioritizing,vinsightvintovproblems,v andvimpulsevcontrolvindicatevavproblemvinvthevfrontalvlobe. 27 1)vThevconceptvofvtargetvsymptomvidentificationvisvbestvexplainedvas a)vIdentificationvofvthevmajorvclinicalvpresentationvofvthevclient b)vIdentificationvofvspecific,vprecise,vandvindividualizedvsymptomsvreasonablyvexpect edvtovimprovevwithvmedication c)vIdentificationvofvthevsecondaryvmessengervsystemvsyndrome d)vIntentionalvmodulationvofvsynapticvpathwaysv-vcorrectvanswer- B.vTargetvsymptomvidentificationvisvthevidentificationvofvspecific,vprecise,vandvindivid ualizedvsymptomsvreasonablyvexpectedvtovimprovevwithvavgivenvmedication. 28
ThevgoalvofvthevpsychiatricvassessmentvprocessvperformedvbyvthevPMHNPvisvto a)vGainvanvunderstandingvofvthevlifevexperiencesvofvthevclient b)vCorrectlyvdiagnosevthevclient c)vIdentifyvthevmentalvhealthvneedsvofvthevclient d)vBevablevtovcommunicatevwithvothervstaffvaboutvthevclient'svhealthvneedsv- vcorrectvanswer- CorrectvAnswer:vC.vAlthoughvdiagnosisvisvanvimportantvaspectvofvthevassessmentvpr ocess,vthevassessmentvultimatelyvshouldvidentifyvthevneedsvofvthevclient. 29 Mr.vJohnsonvisvavclientvnewlyvadmittedvtovanvinpatientvpsychiatricvhospital.vThevPM HNPvonvcallvatvthevfacilityvplansvtovperformvthevinitialvintakevassessmentvandvdiagno sticvprocess.vMr.vJohnsonvasksvtovpleasevtalkvinvhisvroomvbecause,vhevsays,v"Peopl evmakevmevnervous."vHisvroomvisvatvthevendvofvthevhallwayvandvisvthevfarthestvaway vfromvthevnursingvstation.vThevPMHNP'svactionvshouldvbevbasedvonvawarenessvthat vthevbestvlocationvtovdovthevassessmentvis a)vInvMr.vJohnson'svroom,vbecausevitvisvleastvnoisyvandvmostvcomfortablevforvhim,vth usvfacilitatingvdatavcollection b)vInvthevdayroom,vwhichvisvfullvofvpeople,vtovobservevhisvinteractionsvwithvothervpeo ple c)vInvavquietvplace,vbutvpublicvenoughvtovgetvassistancevwithvclientvcarevshouldvitvbe vre-vquiredvduringvthevassessment d)vInvthevtreatmentvroomvwithvthevdoorvclosed,vavneutralvlocationv-vcorrectvanswer- C.vOnevPMHNPvrolevisvtovcontrolvthevmilieuvasvanvaspectvofvas- vsessment,vsovthevPMHNPvshouldvchoosevavquietvplacevthatvisvpublicvenoughvtovget vassistancevwithvclientvcarevshouldvitvbevrequiredvduringvthevassessment. 30 WhichvcommunicationvtechniquevisvthevPMHNPvusingvinvthevfollowingvsituation? vClient:v"SorryvIvwasvlate.vIvdidn'tvrealizevwhatvtimevitvwas."vPMHNP:v"Thisvisvthevthir dvtimevnowvthatvyouvhavevbeenvlatevforvourvsessions.vIvamvwonderingvhowvcommitte dvyouvarevtovourvworkingvonvyourvproblems." a)vTheming b)vRecognizing c)vValidating d)vSequencingv-vcorrectvanswer- B.vThisvexchangevisvanvillustrationvofvthevtechniquevofvrecognizing. 31)vInvassessingvavclient,vyouvaskvhimvthevmeaningvofvthevproverbv"Peoplevwhovlive vinvglassvhousesvshouldn'tvthrowvstones."vHevreplies,v"Becausevitvwillvbreakvthevwind ows."vThevcorrectvinterpretationvofvthisvfindingsvis a)vClientvhasvavprobablevmoodvdisorder b)vClientvhasvavprobablevanxietyvdisorder c)vClientvhasvlimitedvintellectualvability d)vUnablevtovinterpretvthevfindingvwithoutvknowingvthevclient'svagev-vcorrectvanswer- D.vThevanswervdemonstratesvconcretevthoughtvprocesses,vwhichvarevnormalvinvpers onsvyoungervthanvagev 12 vbutvarevabnormalvaftervagev12.vTovinter- vpretvthevfinding,vthevPMHNPvmustvknowvthevagevofvthevclient. 32
d)vElectrolytevpanelv-vcorrectvanswer- C.vClientvoverdosedvandvthenvwasvplacedvonvavmedicationvthatvaffectsvthevliver.vThe vPMHNPvneedsvtovassessvthevclient'svlivervfunctionvasvanvaspectvofvcarevplanningvfo rvher. 36 Avclientvcomesvintovthevclinicvwithvavlongstandingvhistoryvofvdepressionvandvchronicv renalvfail- vure.vHevisvonvanvantidepressantvandvavdiureticvandvcomplainsvofvincreasedvdepress ion,vmildvconfusion,virritability,vandvoverallvapathyvfromvbeingvtoovtiredvtovdovanythin g.vThevbestvinitialvPMHNPvactionvtovtakevatvthisvtimevis a)vIncreasevhisvdosevofvantidepressantvmedicationvtovbettervcapturevsymptoms b)vChangevhimvtovanothervantidepressantvforvbettervsymptomvcontrol c)vAugmentvhisvantidepressantvwithvanvatypicalvantipsychoticvmedication d)vOrdervavcomprehensivevmetabolicvpanelv-vcorrectvanswer- D.vClientvsymptomsvarevconsistentvwithvelectrolytevimbalancevandvavphysicalvcausev ofvhisvsymptomsvmustvbevruledvoutvfirst. 37 vSarahvpresentsvforvhervinitialvintakevappointmentvwithvcomplaintsvofvdepression.vSh evisvbe- vingvtreatedvforvhypertensionvandvasthmavbyvhervprimaryvcarevprovider.vKnowingvtha tvcertainvmedicationsvcanvcausevorvexacerbatevdepression,vyouvobtainvavcompletev medicationvhistory.vWhichvofvthevfollowingvmedicationsvisvknownvtovexacerbatevorvc ausevdepression? a)vOmeprazole b)vPropranolol c)vLevothyroxine d)vClarithromycinv-vcorrectvanswer- B.vBetavblockersvcanvcausevorvexacerbatevdepression. 38 Whenvtreatingvoldervadults,vyouvshouldvkeepvinvmindvthatvtheyvarevmorevsensitivevto vissuesvofvdrugvtoxicityvbecausevofvwhichvofvthevfollowingvreasons? a)vDecreasedvbodyvfat b)vIncreasedvlivervcapacity c)vDecreasedvproteinvbinding d)vIncreasedvmusclevconcentrationv-vcorrectvanswer- C.vOldervadultsvusuallyvhavevdecreasedvproteinvlevels.vMostvpsycho- vtropicvmedicationsvarevhighlyvprotein- bound.vItvisvthevunboundv(free)vconcentrationofvthevdrugvthatvisvactive;vthevboundvco ncentrationvofvthevdrugvisvinert.vThus,vwithvdecreasedvproteinvavailablevforvbinding,v morevfreev(active)vdrugvremainsvinvthevbody,vwhichvthenvpredisposesvoldervadultsvto vtoxicity. 39 vWhichvknownvteratogenicveffectsvcanvbevcausedvbyvthevcommonvpsychotropicvmedi cationsvdivalproexvandvlithium? a)vDivalproex—Epsteinvanomaly;vlithium—cleftvpalate b)vDivalproex—spinavbifida;vlithium—Epsteinvanomaly
c)vDivalproex—limbvmalformations;vlithium—seizurevdisorder d)vDivalproex—mentalvretardation;vlithium—spinavbifidav-vcorrectvanswer- B.vDivalproexvcanvcausevspinavbifidavandvlithiumvcanvcausevEpstein'svanomaly. 1)vThevstudyvofvwhatvthevbodyvdoesvtovdrugsvisvcalled a)vPharmacodynamics b)vPharmacology c)vPharmacokinetics d)vDistributionv-vcorrectvanswer- C.vPharmacokineticsvisvthevstudyvofvwhatvthevbodyvdoesvtovdrugs. 41 1)vYourvclientvSamvisvbeingvtreatedvforvpanicvdisordervwithvagoraphobia.vHevcurrentl yvisvbeingvprescribedvparoxetinev(PaxilvCR,v37.5vmgvq.d.)vandvclonazepamv(Klonopi n,v0.5vmgvq.d.,vp.r.n.).vHevhasvbeenvonvclonazepamvforv 2 vyearsvandvadmitsvtovneedi ngv 4 vpillsvtovachievevthevsameveffectvthatv 1 vpillvinitiallyvproduced.vThisvisvpossiblyvan vexamplevofvwhichvprocess? a)vKindling b)vAddiction c)vTolerance d)vPotencyv-vcorrectvanswer- C.vTolerancevmeansvneedingvmorevtovachievevthevsameveffect. 42 1)vWhyvisvgroupvtherapyvbeneficial? a)vItvassistsvthevclientvtovfocusvonvself b)vItvlacksvtheoreticalvframeworks c)vItvenablesvparticipantsvtovacquirevtherapeuticvfactors d)vItvisvalwaysvtimevlimitedv-vcorrectvanswer- D.vGroupvtherapyvisvbeneficialvbecausevitvincreasesvsocialvskills,visvcost- effective,vandvenablesvparticipantsvtovacquirevthevcurativevfactors. 43 vWhichvofvthevfollowingvisvthevbestvrationalevforvusingvcognitivevbehavioralvtherapy? a)vRecognizevandvchangevhisvorvhervautomaticvthoughts b)vSeevrealityvasvyouvseevit c)vChangevhisvorvhervrealityvbyvchangingvhisvorvhervenvironment d)vRecognizevandvacceptvthatvautomaticvthoughtsvsuggestvdelusionalvthinkingv- vcorrectvanswer- A.vCognitivevbehavioralvtherapyvhelpsvclientsvrecognizevandvchangevtheirvautomaticv thoughts. 44 vWhenvworkingvwithvavdysfunctionalvfamily,vyouvfindvthatvthevfather,vJim,vworriesvexc essivelyvandvisvresistantvtovchange.vYouvgivevJimvavparadoxicalvdirectivevtovworryve xtremelyvwellvforv 1 vhourvpervday,vknowingvthatvhevwillvlikelyvbevnoncompliant,vandvth usvchangevwillvoccur.vWithvthisvtechnique,vyouvarevusingvwhichvtypevofvtherapy? a)vExperientialvtherapy b)vStructuralvtherapy c)vStrategicvtherapy
a)vAssessvhervcopingvbehaviors b)vAssessvhervcurrentvlevelvofvsuicidality c)vTakevhervvitalvsigns d)vAssessvhervhealthvhistoryv-vcorrectvanswer- C.vThevPMHNPvneedsvtovensurevthatvhervsuicidevattemptvhasvnotvledvtovmedicalvins tability. 50 WhichvofvthevfollowingvinterventionsvbyvthevPMHNPvforvavpersonvexperiencingvataqu evdevnerviosvdemonstratesvculturallyvinformedvcare? a)vOfferingvbriefvsupportivevpsychotherapy b)vOfferingvavbriefvhospitalization c)vRequestingvavfamilyvmembervactvasvanvinterpreter d)vOfferingvlow-dose,vshort-termvanxiolyticv-vcorrectvanswer- A.vThevliteraturevsuggestsvthatvalthoughvshort- termvanxiolyticvmedicationvmayvbevofferedvinvanvemergencyvroomvsetting,vataquevde vnerviosvisvbestvtreatedvbyvbriefvsupportivevtherapyvbyvavSpanish- speakingvLatinovtherapist. 51)v ThevPMHNPvworkingvatvavstudentvmentalvhealthvclinicvhasvnowvbeenvworkingvwithva vfresh- vmanvstudentvforvseveralvweeks.vThevPMHNPvlearnsvthatvthevstudentvconsidersvhim selfvshy.vHevtellsvthevNPvthatvhevhasvalwaysvfeltvuncomfortablevinvsocialvsituationsvo rvwhenvhevhasvtovdovoralvpresentationsvinvclass.vHevhadvfewvfriendsvupvuntilvhisvsen iorvyearvofvhighvschoolvwhenvhevdiscoveredvhevcouldvenjoyvhimselfvifvhev"hadvavcou plevofvdrinksvbeforevgoingvout."vHevhasvcontinuedvthisvpatternvinvcollegevandvnowvoc casionallyvdrinksv"2vtov 3 vbeers"vonvweekendsvasvwell.vAccordingvtovthevDSM- 5,vdoesvthevstudentvhavevavmentalvdisorder? a)vYes,valcoholvusevdisorder,vmild b)vYes,vgeneralizedvanxietyvdisorder c)vNo,vatvthisvpoint,vthevstudentvdoesvnotvmeetvcriteriavforvavmentalvdisorder. d)vYes,vadjustmentvdisordervwithvmixedvfeaturesv-vcorrectvanswer- C.vThevstudentvdoesvnotvmeetvcriteriavforvalcoholvusevorvothervdisordervatvthisvpoint, vbutvifvhevdoesvnotvlearnvalternativevcopingvskillsvtovdealvwithvhisvshyness,vhevisvatvri skvofvdevelopingvanvalcoholvusevdisorder. 52 vJasonvmissesvseveralvappointments.vThevPMHNPvnotesvshevfeelsvresentfulvtoward vJasonvandvisvstrugglingvwithvhowvtovrespondvtovJasonvwhenvhevfinallyvcomesvinvforv hisvappoint-vment.vWhichvofvthevfollowingvdemonstratesvavtherapeuticvresponse? a)v"Jason,vsincevyouvhavevmissedvseveralvappointments,vwevarevclosingvyourvcase." b)v"Jason,vit'svprettyvclearvtovmevthatvyouvdon'tvwantvtovbevhere." c)v"Jason,vyouvarevambivalentvaboutvseekingvtreatment." d)v"Jason,vhelpvmevunderstandvwhat'svgoingvonvsovwevcanvfigurevoutvhowvtovprocee d."v-vcorrectvanswer- D.vAlthoughvthevPMHNP'svresentmentvisvinvresponsevtovactualvbehaviorvbyvJasonv(h isvmissingvseveralvappointments),vclarifiyingvwhatvisvgoingvonvforvhim,vhisvexpectatio nsvforvtreatmentvandvthevPMHNP'sv(andvthevclinic's)vexpectationsvinvavnon- judgementalvmannervwillvhelpvtovdevelopvavtherapeuticvalliance.
vWhichvisvtruevaboutvpharmacologicvtreatmentvofvanxietyvinvoldervadults? a)vCoursevofvtreatmentvisvgenerallyvshortervthanvforvyoungervadults. b)vDrugsvthatvarevhighlyvoxidizedvarevmorevunpredictablevthanvdrugsvthatvarevmostly vconjugated. c)vThevtherapeuticvdosevofvSSRIsvisvgenerallyvlowervthanvforvyoungvadults. d)vHighlyvlipophilicvdrugsvhavevavmorevlinearveliminationvinvoldervadults.v- vcorrectvanswer- B.vLivervenzymevfunctioningv(amongvothervthings)vdiminishesvasvwevage.vAllvofvthev othervstatementsvarevfalse. 54 1)vAvclientvreturnsvforvavfollow- upvappointmentv 3 vweeksvaftervstartingvonvfluoxetinev 20 vmg.vDuringvthisvappointment vyouvnoticevthatvhervspeechvisvavlittlevrapid,vinvmarkedvcontrastvtothevpsychomotorvr etardationvandvpaucityvofvspontaneousvspeechvshevdisplayedvonvhervfirstvvisit.vInste advofvlookingvatvthevfloor,vshevnowvmakesvnormalveyevcontact.vHervaffectvhasvgonev fromvconstrictedvtovexpansive.vShevcontinuesvtovhavevdifficultyvsleeping,vbutvherven ergyvhasvimprovedvandvshevstatesvshevfeelsv"sovmuchvbetter!"vWhatvshouldvyouvcon cludevaboutvthevshiftvinvthevclient'svpresentation? a)vShevisvexperiencingvthevactivatingvsideveffectsvofvfluoxetine. b)vShevisvbecomingveuthymic. c)vShevisvbecomingvhypomanic. d)vShevisvinvavmixedvstate.v-vcorrectvanswer- C.vInvthisvcase,vyouvseevavshiftingvsetvofvsymptoms,vthevmostvimpor- vtantvbeingvhervexpansivevmoodvandvstatementv"sovmuchvbetter"vthatvindicatesvshev hasvgonevbeyondveuthymia. 55 vMr.vD.visvav35-year-old,vmarried,vhigh- techvindustryvexecutivevwhovisvreferredvtovthevPMHNPvforv"insomnia."vMr.vD.vreports vthatvhevfallsvasleepvquickly,vbutvhasvdifficultyvstayingvasleep.vHevwakesvupvseveralvt imesvduringvthevnight,vandvbelievesvhevtossesvandvturnsvevenvwhenvhevisvsleeping.v Hevwakesvupvfeelingvexhaustedvandvdrinksv"avpotvofvcoffee"vtovstayvawakevandvcon centratevduringvhisvlongvworkvday.vHevdrinksv 1 vglassvofvwinevmostvevenings.vHevde niesvanyvillicitvsubstancevuse.vHevdeniesvanyvsymptomsvofvavmoodvorvanxietyvdisord er,vbutvisvfeel- vingvincreasinglyvfrustratedvandvconcernedvaboutvhisvsleep.vWhichvofvthevfollowingvis vthevmostvlikelyvcontributingvfactorvtovMr.vD.'svongoingvmiddlevinsomnia? a)vObstructivevsleepvapneav(OSA) b)vCaffeinevdependence c)vAlcoholvwithdrawal d)vAttention-deficitvhyperactivityvdisorderv(ADHD)v-vcorrectvanswer- A.vOSAvisvthevonlyvplausiblevpossibilityvifvthevrestvofvthevinformationvgivenvbyvthevcli entvisvaccurate.vOSAvcausesvclientsvtovhavevfrequentvawakeningsvandvavsensevthatv theyvarevnotvsleepingvdeeplyv("tossingvandvturning")vthatvisvcausedvbyvapnea.vThevcl ientvshouldvbevassessedvfurthervforvsnoringvandvawarenessvofvapnea.vAlthoughvthev clientvstatesvhevdrinksvavlotvofvcoffee,vthisvisvdrivenvbyvhisvsleepvissues.vDrinkingv 1 vg lassvofvwinevinvtheveveningvwouldvnotvcausevthevdegreevofvsleepvpathol-
c)vAvtaskvthatvisvoutsidevofvthevPMHNP'svscopevofvpractice d)vQualityvimprovementvinitiativev-vcorrectvanswer- D.vEngagingvinvavprojectvtovassessvwhethervavstandardvofvcarevwasvmetvisvavqualityv improvementvproject. 59 1)vAvPMHNPvwhovisvworkingvonvthevconsultvliaisonvservicevisvreferredvtovavpatientvin vthevmedicalvintensivevcarevunitvbyvthevattendingvhospitalist.vThevconsultvnotevreadv" Evaluatevthevpatientvforvcompetencyvtovmakevindependentvmedicalvdecisionsvandvc onsentvforvavsurgicalvprocedure."vBasedvonvthevscopevofvpracticevofvavPMHNP,vwhic hvresponsevwouldvbevmostvappropriate? a)vCompletevthevpatientvassessmentvandvwritevupvthevfindingsvinvthevpatient'svmedic alvrecord. b)vCompletevavpatientvassessment,vincludingvthevminivmentalvstatusvexaminationvan dvfamilyvcollateralvdatavtovdeterminevcompetency. c)vCallvthevhospitalistvandvprovideveducationvthatvcompetencyvisvavlegalvconceptvan dvex- vplainvthatvyouvcanvassessvthevpatientvforvthevcapacityvtovmakevmedicalvdecisions. d)vRefusevthevconsultvandvinformvthevhospitalistvthatvthisvisvoutsidevyourvscopevofvpr actice.v-vcorrectvanswer- C.vThevlegalvsystemvmakesvdeterminationvwhethervavpersonvisvcom- vpetent;vpractitionersvcanvassessvandvmakevavdeterminationvaboutvavperson'svcapac ityvtovmakevmedicalvdecisions. 60 vYouvarevaskedvbyvavchurchvorganizationvtovworkvwithvmembersvwithinvyourvhealthvs ystemvtovdevelopvavfluvvaccinationvprogram.vAccordingvtovpublicvhealthvprinciples,vth isvisvanvexamplevofvwhatvlevelvofvprevention? a)vSecondary b)vPreventative c)vTertiary d)vPrimaryv-vcorrectvanswer- D.vPreventionvofvillnessvisvprimaryvpreventionvandvadministrationvofvfluvvaccinationsv invavcommunityvisvintendedvtovpreventvavfluvoutbreak. 61 1)vAvclientvwithvbipolarvIvdisordervpresentsvtovyourvPMHNPvofficevforvavfollow- upvvisit.vDuringvthevvisitvthevclientvinformsvyouvthatvhevnovlongervwantsvtovbevtreated vwithvmedication,andvhevdoesvnotvhavevbipolarvdisorder,vthatvwasvavmisdiagnosis.vH evfurthervinformsvyouvhevstoppedvallvhisvmedicationv 2 vmonthsvagovandvisvherevtovtha nkvyouvforvyourvcarevandvtellvyouvthatvhevnovlongervneedsvfollow- upvappointments.vUnderstandingvthevethicalvconflict,vyouvusevwhichvofvthevfollowingv ethicalvprinciplesvinvworkingvwithvthisvclient? a)vAutonomy b)vNonmaleficence c)vJustice d)vBeneficencev-vcorrectvanswer- A.vClientsvwhovarevlegallyvcompetentvhavevthevabilityvtovmakevmedi- vcalvdecisionsvandvmaintainvindividualvautonomy.
1)vAvnewvclientvrevealsvtovthevPMHNPvthatvhervboyfriendvscreamsvatvhervandvhasvre peatedlyvslappedvandvpushedvhervinvfrontvofvherv3-year- oldvson.vShevgoesvonvtovsayvthatvthevboyfriendvhasvthrownvthingsvatvhervandvonvone voccasionvthrewvavglassvofvwatervatvhervthatvhitvhervsonvinvthevback.vShouldvthevPM HNPvreportvthisvtovchildvprotectivevservicesv(CPS)? a)vYes,vthevclientvisvissuingvavcryvforvhelpvforvhervson. b)vYes,vthevPMHNPvhasvavdutyvtovreport. c)vNo,vthisvdoesvnotvconstitutevavreportablevoffense. d)vNo,vavreportvtovCPSvwillvescalatevthevviolence.v-vcorrectvanswer- B.vPMHNPsvarevmandatedvreportersvofvchildvabuse.vThev3-year- oldvisvbeingvexposedvtovviolencevandvalthoughvnotvthevtarget,vcouldvhavevbeenvinjur edvwhenvthevboyfriendvthrewvthevglassvofvwater. 63 1)vWhichvofvthevfollowingvisvavfunctionvofvthevpsychiatricvinterview? a)vUnderstandvthevclient'svpsychosocialvneedsvandvcommunicatevthemvtovthevtreatm entvteam b)vIdentifyvthevmentalvhealthvneedsvofvthevclient c)vReviewvpreviousvmedicalvrecords d)vEvaluatevavtreatmentvplanv-vcorrectvanswer- B.vDuringvavpsychiatricvinterview,vthevPMHNPvisvresponsiblevtoviden- vtifyvsymptomsvandvneedsvofvavclientvtovdevelopvanvappropriatevtreatmentvplan. 64 1)vAv74-year- oldvmarriedvwhitevwomanvwasvreferredvtovyouvbyvhervprimaryvcarevprovidervforvavps ychiatricvevaluation.vShevhadvavnormalvmedicalvandvneurologicalvexaminationvinvthe vlastv 2 vmonths.vThevclientvpresentsvwithvhervhusbandvofv 45 vyearsvwhovstates,v"Myvw ifevisvjustvnotvthevsamevanymore,vshevisvirritablevandvasksvthevsamevquestionvsever alvtimes,vevenvthoughvI'vevansweredvitvmanyvtimes."vThevclientvresponds,v"Oh,vHenr y,vyouvdovthevsamevthing,vit'svjustvavnormalvpartvofvgettingvolder,vandvthevkidsvthinkv everythingvisvfine."vDuringvthevassessmentvyouvcompetevthevminivmentalvstatusvexa minationv(MMSE)vandvthevclientvscoresv18.vAsvthevPMHNPvtreatingvthevclient,vyouvk nowvthevresultsvofvhervMMSEvindicatevwhichvlevelvofvcognitivevimpairment? a)vNovcognitivevimpairment b)vMildvcognitivevimpairment c)vModeratevcognitivevimpairment d)vSeverevcognitivevimpairmentv-vcorrectvanswer- C.vCutvpointsvonvthevMMSEvarevasvfollows:vtotalvscorev30,v25- 30 vquestionablevsignificance,v20-25vmildvimpairment,v10- 20 vmoderatevimpairment,vandv 10 vorvlowervseverevimpairment. 65 YouvarevthevPMHNPvtreatingvTim,vav10-year- oldvchild,vforvADHDvandvsocialvanxietyvdisorder.vHisvmothervpresentsvwithvTimvforvhi svscheduledvindividualvtherapyvsession.vAtvthevendvofvthevsessionvhisvmothervsays,v" IvneedvtovtakevTimvtovseevhisvpediatricianvandvatvthevlastvvisitvIvwasvtoldvhevneededv somevHPVvshot.vIvdon'tvknow,vhe'svavboy,vwhyvwouldvhevneedvthat? vWhatvdovyouvthink?"vWhatvisvthevPMHNP'svbestvresponsevtovhervquestion?
thingvhevcanvthinkvofvforv 1 vhourvavday.vUsingvavparadoxicalvdirectivevisvpartvofvwhich vtherapy? a)vExperimental b)vStructural c)vStrategic d)vCognitivev-vcorrectvanswer- C.vParadoxicalvdirectivesvmayvbevusedvinvstrategicvfamilyvtherapy. 70 AsvavPMHNPvworkingvinvanvoutpatientvaddictionvclinic,vyouvoftenvrefervyourvclientsvt ovcommunityvAAvandvNAvmeetings.vUsingvYalom'svtherapeuticvfactors,vyouvarevawa revthatvpeer- vledvgroupsvcanvinspirevandvencouragevothervgroupvparticipants.vWhichvtherapeuticvf actorvisvinstilledvinvAAvandvNAvgroupvmembers? a)vHope b)vAltruism c)vCatharsis d)vExistentialvfactorsv-vcorrectvanswer- A.vWorkingvinvsupportvgroupsvsuchvasvAAvandvNA,vhearingvstoriesvofvothersvwhovha dvsimilarvstruggles,vinstillsvhope. 71 Whichvofvthevfollowingvclientvstatementsvbestvdescribesvimitativevbehaviorvasvavther apeuticvfactorvinvgroupvtherapy? a)vGroupvmembersvtalkvovervonevanothervsovthevloudestvpersonvisvheard b)vGroupvmembersvbeginvtovmodelvaspectsvofvothervmembersvofvthevgroupvandvgro upvleaders c)vGroupvmembersvdiscussvpastvsituationsvwhenvtheyvwerevbulliedvandvfeltvashame d d)vGroupvleadersvtakevchargevofvthevgroupvandvredirectvmembersvwhenvtheyvmonop olizevthevgroupv-vcorrectvanswer- B.vAsvgroupvprogressesvthevleadervisvlessvactivevandvthevmembersvofvthevgroupvtak evovervandvbeginvtovmodelvothervmembersvandvthevleaders. 72 Dialecticalvbehavioralvtherapyv(DBT)vdrawsvonvcognitivevtheoryvandvbehavioralvtheor y,valongvwithvothervtheories.vElementsvofvbehavioralvtheoryvinvDBTvincludevwhichvofv thevfollowing? a)vSkillsvtrainingvandvexposure b)vExaminationvofvfeelingsvandvrelatingvfeelingsvtovvisceralvsensations c)vWorkingvthroughvthevtransferencevwithvthevtherapist d)vCognitivevinterpretationvofvpastvtraumaticvexperiencesv-vcorrectvanswer- A.vDBTvfocusesvonvcognitivevandvbehavioralvtechniques,vmindful- vnessvincludingvmeditation,vandvemotionalvregulation. Dialecticalvbehavioralvtherapyv(DBT)vaffirmsvdialecticalvthinking,vwhichvinvolvesvexa miningvandvdiscussingvopposingvideasvtovfindvthevtruth.vThisvphilosophyvisvavsupport ivevprinciplevofvDBTvtraining.vThevcentralvdialecticalvpatternvemphasizedvinvDBTvinv olvesvthevtensionvbetween:
a)vRadicalvacceptancevandvchange b)vCuevexposurevandvblockvavoidance c)vProblemvavoidancevandvproblem-solving d)vCrisisvsurvivalvandvacceptancev-vcorrectvanswer- A.vDBTvemphasisvacceptancevofvthevcurrentvrealityvofvwhatvisvandvthevabilityvtoveng agevinvpersonalvchange. 74 1)vSamanthavisvav26-year- oldvpartneredvwomanvwhovworksvfullvtimevasvavteacher.vShevisvinvavlong- termvrelationshipvwithvMaryvandvtheyvarevgettingvalongvwell,vandvdoingvwellvfinancial ly.vTheyvhavevtwovchildren,vagesv 2 vandv6.vSamanthavisvseeingvthevPMHNPvtovaddre ssvhervconcernsvthatvshevisvfeelingvdownvandvsadvforvnovreasonvandvstates,v"Ivknow vmyvlifevisvgoingvwellvbutvIvjustvdon'tvfeelvhappy.vIvhavevalwaysvworriedvavlotvandvhav evbeenvsadvmostvofvmyvlife."vAsvavPMHNPvtrainedvinvtransactionalvanalysisv(TA),vyo uvunderstandvthatvpersonalityvisvmultifacetedvandvwondervifvwhichvofvthevfollowingvis vaffectingvhervabilityvtovexperiencevhappiness: a)vShevhadvlongvperiodsvofvseparationvfromvhervprimaryvcaregivervasvavchildvandvno wvhasvavdifficultvtimevacceptingvandvreceivingvlovevandvexperiencingvhappiness b)vShevlikelyvhadvavtraumaticveventvinvhervchildhoodvandvhervthoughtsvandvfeelingsvr elatedvtovtheveventvarevlockedvtogethev-vcorrectvanswer- B.vAccordingvtovTA,vwhenvavpersonvisvtraumatizedvthevthoughtsvandvfeelingsvgetvtie dvtogethervandvthevprocessvofvtherapyvisvtovunlockvthevtwo. 75 Youvhavevbeenvworkingvwithvav54-year- oldvmanvwhovhasvbeenvtreatedvforvschizophreniavsincevagev19.vHevhasvlimitedvsocia lvinteractions,vlikesvtovbevalone,vandvhasvnevervdatedvnorvhadvavdesirevtovdate.vHisv symptomsvarevbestvexplainedvbyvwhichvofvthevfollowing? a)vAntisocialvpersonalityvdisorder b)vLackvofvpersonalvhygiene c)vNegativevsymptoms d)vPositivevsymptomsv-vcorrectvanswer- C.vNegativevsymptomsvincludevflatvaffect,valogia,vavolition,vpoorvattention,vandvanhe donia.vInvthevcasevstudy,vthevsymptomsvarevavolitionvandvanhedonia. 76 Followingvevidence- basedv(EB)vpractice,vwhichvlaboratoryvscreeningvtestsvandvassessmentsvshouldvbev completedvpriorvtovplacingvavpersonvonvavsecond- generationv("atypical")vantipsychoticvmedication? a)vSerumvglucose,vlipidvprofile,vweight,vbloodvpressure,vwaistvcircumference,vandvfa milyvhistoryvofvcardiovascularvdisease b)vComprehensivevmetabolicvpanel,vbodyvmassvindex,vcompletevbloodvcount,vandvth yroidvpanel c)vSerumvglucosevorvhemoglobinvA1c,vlipidvprofile,vweight,vbodyvmassvindex,vbloodv pressure,vwaistvcircumference,vandvfamilyvhistoryvofvcardiovascularvdisease. d)vSerumvglucose,vcompletevbloodvcount,vassessmentvofvfamilyvhistoryvofvcardiovas cularvdiseasevandvcancerv-vcorrectvanswer- C.vEBvpracticevguidelinesvindicatevthatvallvclientsvshouldvhavevthevfol-
