Psychiatric-Mental Health Nurse Practitioner Exam Comprehensive Mental Health and Psychiatric Nursing 3 — Questions and Answers
Question 1: A patient presents with pressured speech, decreased need for sleep, grandiosity, and hypersexuality for 5 days without significant functional impairment. What is the MOST likely diagnosis?
- Bipolar I disorder, manic episode
- Bipolar II disorder, hypomanic episode (Correct answer)
- Cyclothymic disorder
- Major depressive disorder with mixed features
Correct answer: Bipolar II disorder, hypomanic episode
A hypomanic episode in bipolar II disorder lasts at least 4 days, causes elevated/irritable mood and increased energy, but does NOT cause marked functional impairment or require hospitalization.
Question 2: Which cognitive distortion does a patient demonstrate when they say, 'I failed one exam, so I'll never pass any test and I'm a total failure'?
- Personalization
- Overgeneralization (Correct answer)
- Mind reading
- Magnification
Correct answer: Overgeneralization
Overgeneralization involves drawing sweeping negative conclusions from a single event and applying them broadly across situations.
Question 3: A patient with PTSD is most likely to benefit from which evidence-based, trauma-focused psychotherapy?
- Supportive therapy
- Prolonged exposure (PE) therapy (Correct answer)
- Interpersonal psychotherapy (IPT)
- Client-centered therapy
Correct answer: Prolonged exposure (PE) therapy
Prolonged exposure therapy is a first-line, evidence-based treatment for PTSD that systematically reduces avoidance and fear through in vivo and imaginal exposure to trauma-related stimuli.
Question 4: A PMHNP is working with a patient under involuntary commitment. Which ethical principle is MOST in tension with this intervention?
- Beneficence
- Nonmaleficence
- Autonomy (Correct answer)
- Justice
Correct answer: Autonomy
Involuntary commitment overrides the patient's right to make their own decisions (autonomy) in order to protect them or others from harm.
Question 5: A patient taking sertraline for 3 weeks reports nausea and insomnia but no improvement in mood. What is the BEST clinical response?
- Switch immediately to a different antidepressant class
- Increase the dose to achieve faster therapeutic effect
- Educate the patient that SSRIs typically require 4–8 weeks for antidepressant effect (Correct answer)
- Add bupropion augmentation for faster response
Correct answer: Educate the patient that SSRIs typically require 4–8 weeks for antidepressant effect
SSRIs typically take 4–8 weeks to produce full antidepressant effects, while side effects such as nausea and insomnia often appear first and tend to resolve within the first 1–2 weeks.
Question 6: Which finding on mental status examination is MOST characteristic of a patient experiencing a major depressive episode?
- Pressured speech and flight of ideas
- Psychomotor retardation and constricted affect (Correct answer)
- Tangentiality and loose associations
- Grandiosity and decreased need for sleep
Correct answer: Psychomotor retardation and constricted affect
Psychomotor retardation (slowed movement and speech) and constricted affect (reduced emotional expression) are hallmark MSE findings in major depressive disorder.
Question 7: A PMHNP prescribes naltrexone for a patient with alcohol use disorder. What must be confirmed BEFORE initiating this medication?
- The patient has no history of depression
- The patient is opioid-free for at least 7–10 days (Correct answer)
- The patient's BMI is within normal limits
- The patient has completed an inpatient detoxification program
Correct answer: The patient is opioid-free for at least 7–10 days
Naltrexone is an opioid antagonist and must not be started until the patient has been opioid-free for 7–10 days to avoid precipitating acute opioid withdrawal.
Psychiatric-Mental Health Nurse Practitioner Exam Comprehensive Mental Health and Psychiatric Nursing 3
A patient presents with pressured speech, decreased need for sleep, grandiosity, and hypersexuality for 5 days without significant functional impairment.
What is the MOST likely diagnosis?