Psychiatric-Mental Health Nurse Practitioner Exam Special Populations in Psychiatric Care 2 — Questions and Answers
Question 1: A PMHNP assessing an older adult for dementia versus depression should recognize that pseudodementia (depression presenting as cognitive decline) most commonly presents with:
- Insidious onset and no subjective complaints
- Acute onset, awareness of deficits, and mood symptoms preceding cognitive changes (Correct answer)
- Normal mood and sleep patterns
- Confabulation as a primary feature
Correct answer: Acute onset, awareness of deficits, and mood symptoms preceding cognitive changes
Pseudodementia (depressive cognitive syndrome) typically has a more acute onset, and patients are often distressed about and aware of their memory problems.
Question 2: When treating an autistic patient with psychiatric comorbidities, which communication strategy is most appropriate?
- Use metaphors and abstract language for better engagement
- Use clear, literal, concrete language and provide structure (Correct answer)
- Avoid written instructions to prevent overwhelm
- Focus sessions on emotional expression only
Correct answer: Use clear, literal, concrete language and provide structure
Concrete, literal language with clear structure accommodates common communication and cognitive processing differences in autistic patients.
Question 3: A PMHNP treating a transgender patient should understand that gender dysphoria refers to:
- A mental illness caused by gender identity
- Clinically significant distress resulting from incongruence between assigned sex and gender identity (Correct answer)
- Refusal to accept biological sex
- A personality disorder variant
Correct answer: Clinically significant distress resulting from incongruence between assigned sex and gender identity
Gender dysphoria describes the distress caused by the incongruence between an individual's experienced gender and their assigned sex at birth, not the gender identity itself.
Question 4: Which eating disorder is characterized by recurrent binge eating without compensatory behaviors and is the most prevalent eating disorder in the US?
- Anorexia nervosa
- Bulimia nervosa
- Binge-eating disorder (BED) (Correct answer)
- Avoidant/restrictive food intake disorder
Correct answer: Binge-eating disorder (BED)
Binge-eating disorder is the most prevalent eating disorder in the US and is distinguished from bulimia nervosa by the absence of compensatory behaviors.
Question 5: A PMHNP working with veterans notes that moral injury differs from PTSD in that moral injury primarily involves:
- Intrusive flashbacks and nightmares
- Hyperarousal and startle response
- Guilt, shame, and spiritual distress from actions violating personal moral code (Correct answer)
- Avoidance of trauma reminders
Correct answer: Guilt, shame, and spiritual distress from actions violating personal moral code
Moral injury results from witnessing or participating in events that transgress deeply held moral beliefs, leading to guilt, shame, and loss of meaning rather than fear-based PTSD responses.
Question 6: When prescribing psychotropics to elderly patients, the PMHNP should follow the Beers Criteria, which primarily warns against using:
- SSRIs for all elderly patients
- Benzodiazepines, anticholinergics, and first-generation antipsychotics due to fall and cognitive risks (Correct answer)
- All antipsychotics regardless of indication
- Lithium in any patient over 65
Correct answer: Benzodiazepines, anticholinergics, and first-generation antipsychotics due to fall and cognitive risks
The Beers Criteria specifically flags benzodiazepines, anticholinergic medications, and first-generation antipsychotics as potentially inappropriate for older adults due to risks of falls, delirium, and cognitive impairment.
Psychiatric-Mental Health Nurse Practitioner Exam Special Populations in Psychiatric Care 2
A PMHNP assessing an older adult for dementia versus depression should recognize that pseudodementia (depression presenting as cognitive decline) most commonly presents with: