Psychiatric-Mental Health Nurse Practitioner Exam Special Populations in Psychiatric Care 1 — Questions and Answers
Question 1: When prescribing SSRIs for children and adolescents, the FDA black box warning requires informing families about increased risk of:
- Tardive dyskinesia
- Suicidal ideation and behavior in patients under 25 (Correct answer)
- Serotonin syndrome in all pediatric patients
- QTc prolongation
Correct answer: Suicidal ideation and behavior in patients under 25
The FDA black box warning on antidepressants requires clinicians to monitor for increased suicidal ideation and behavior in children, adolescents, and young adults.
Question 2: Which condition is characterized by at least 6 months of inattention and/or hyperactivity-impulsivity before age 12 with impairment in two or more settings?
- Bipolar disorder
- Attention-deficit/hyperactivity disorder (ADHD) (Correct answer)
- Conduct disorder
- Autism spectrum disorder
Correct answer: Attention-deficit/hyperactivity disorder (ADHD)
DSM-5 ADHD criteria require symptom onset before age 12 and impairment across multiple settings, such as home and school.
Question 3: A PMHNP is assessing an elderly patient for depression. Which instrument is specifically validated for detecting depression in older adults?
- PHQ-9
- Geriatric Depression Scale (GDS) (Correct answer)
- Beck Depression Inventory (BDI)
- Hamilton Depression Rating Scale (HAM-D)
Correct answer: Geriatric Depression Scale (GDS)
The GDS was specifically designed and validated for use with older adults, omitting somatic items that confound depression screening in the elderly.
Question 4: Which medication for ADHD is a non-stimulant and is preferred when there is comorbid anxiety or substance use disorder?
- Methylphenidate
- Amphetamine salts
- Atomoxetine (Correct answer)
- Lisdexamfetamine
Correct answer: Atomoxetine
Atomoxetine (Strattera) is a non-stimulant SNRI approved for ADHD that does not carry abuse potential, making it preferred in patients with comorbid anxiety or SUD.
Question 5: A PMHNP caring for a pregnant patient with bipolar disorder should avoid which mood stabilizer in the first trimester due to risk of Ebstein's anomaly?
- Lamotrigine
- Lithium (Correct answer)
- Valproate
- Quetiapine
Correct answer: Lithium
Lithium use in the first trimester is associated with an increased risk of Ebstein's anomaly, a cardiac malformation of the tricuspid valve.
Question 6: Which psychiatric disorder is most prevalent among incarcerated individuals in the US, highlighting a major gap in mental health care access?
- Autism spectrum disorder
- Specific phobia
- Substance use disorder comorbid with serious mental illness (Correct answer)
- Eating disorders
Correct answer: Substance use disorder comorbid with serious mental illness
The US prison system has become a de facto psychiatric care setting, with very high prevalence of co-occurring substance use and serious mental illness.
Psychiatric-Mental Health Nurse Practitioner Exam Special Populations in Psychiatric Care 1
When prescribing SSRIs for children and adolescents, the FDA black box warning requires informing families about increased risk of: