NP Mental Health & Psychiatric NP 2 — Questions and Answers
Question 1: A veteran reports recurrent nightmares about combat, avoidance of crowded places, hypervigilance, and emotional numbing for 6 months. Which diagnosis best fits?
- Acute stress disorder
- Generalized anxiety disorder
- Post-traumatic stress disorder (Correct answer)
- Adjustment disorder with anxious mood
Correct answer: Post-traumatic stress disorder
PTSD requires symptoms from 4 clusters (intrusion, avoidance, negative cognitions/mood, hyperarousal) lasting more than 1 month after a traumatic event.
Question 2: A patient on lithium presents with coarse tremor, confusion, ataxia, and a lithium level of 2.4 mEq/L. What is the priority intervention?
- Reduce the lithium dose by half and recheck level in 48 hours
- Administer activated charcoal and monitor
- Discontinue lithium and initiate hemodialysis if severe (Correct answer)
- Switch to valproate immediately
Correct answer: Discontinue lithium and initiate hemodialysis if severe
Lithium levels >2.0 mEq/L with neurological symptoms indicate severe toxicity requiring lithium discontinuation and hemodialysis to rapidly clear the drug.
Question 3: Which type of psychotherapy has the strongest evidence base for treating major depressive disorder and is considered a first-line non-pharmacological treatment?
- Psychodynamic therapy
- Cognitive behavioral therapy (CBT) (Correct answer)
- Supportive therapy
- Dialectical behavior therapy (DBT)
Correct answer: Cognitive behavioral therapy (CBT)
CBT has robust randomized controlled trial evidence supporting its efficacy for MDD and is recommended as a first-line treatment by major clinical guidelines.
Question 4: An adult patient presents with inattention, impulsivity, and hyperactivity that have been present since childhood and impair occupational functioning. What is the first-line pharmacological treatment for ADHD in adults?
- Atomoxetine (Strattera)
- Stimulant medications such as methylphenidate or amphetamine salts (Correct answer)
- Bupropion (Wellbutrin)
- Guanfacine (Intuniv)
Correct answer: Stimulant medications such as methylphenidate or amphetamine salts
Stimulant medications (methylphenidate and amphetamine-based agents) are the most effective and first-line pharmacological treatment for adult ADHD.
Question 5: A 17-year-old female presents with restrictive eating, BMI of 16, lanugo, amenorrhea, and denial of low body weight. Which eating disorder is most consistent with this presentation?
- Bulimia nervosa
- Binge eating disorder
- Avoidant/restrictive food intake disorder
- Anorexia nervosa, restricting type (Correct answer)
Correct answer: Anorexia nervosa, restricting type
Anorexia nervosa restricting type is characterized by severe caloric restriction, low body weight, body image disturbance, and fear of gaining weight, with physical findings like lanugo and amenorrhea.
Question 6: When performing a suicide risk assessment, which factor is considered the strongest predictor of future suicide attempt?
- Family history of depression
- Current substance use disorder
- Previous suicide attempt (Correct answer)
- Social isolation
Correct answer: Previous suicide attempt
A prior suicide attempt is the single strongest risk factor for future suicide; it indicates both intent and access to methods.
Question 7: A patient who has been taking lorazepam 4 mg daily for 3 years abruptly stops the medication. Which life-threatening complication must the NP anticipate?
- Opioid withdrawal syndrome
- Serotonin syndrome
- Benzodiazepine withdrawal seizures (Correct answer)
- Neuroleptic malignant syndrome
Correct answer: Benzodiazepine withdrawal seizures
Abrupt benzodiazepine discontinuation after long-term high-dose use can cause severe withdrawal including tonic-clonic seizures, which can be fatal.
NP Mental Health & Psychiatric NP 2
A veteran reports recurrent nightmares about combat, avoidance of crowded places, hypervigilance, and emotional numbing for 6 months.
Which diagnosis best fits?