Psychiatric-Mental Health Nurse Practitioner Exam Comprehensive Mental Health and Psychiatric Nursing 4 — Questions and Answers
Question 1: A PMHNP is treating a patient with obsessive-compulsive disorder (OCD). Which first-line pharmacological treatment is recommended?
- Buspirone
- Fluvoxamine (an SSRI) (Correct answer)
- Alprazolam
- Mirtazapine
Correct answer: Fluvoxamine (an SSRI)
SSRIs, such as fluvoxamine, are the first-line pharmacological agents for OCD, often at higher doses than used for depression.
Question 2: Which defense mechanism is a patient using when they attribute their own unacceptable angry feelings to someone else, saying 'Everyone here is out to get me'?
- Displacement
- Reaction formation
- Projection (Correct answer)
- Rationalization
Correct answer: Projection
Projection involves attributing one's own unacceptable thoughts, feelings, or impulses to another person.
Question 3: A patient with schizophrenia is prescribed risperidone and develops galactorrhea. What is the mechanism underlying this side effect?
- Muscarinic receptor blockade increasing prolactin indirectly
- Dopamine D2 blockade in the tuberoinfundibular pathway elevating prolactin (Correct answer)
- Serotonin 2A antagonism in the pituitary gland
- Histamine H1 blockade stimulating prolactin release
Correct answer: Dopamine D2 blockade in the tuberoinfundibular pathway elevating prolactin
Dopamine normally inhibits prolactin release; blocking D2 receptors in the tuberoinfundibular pathway removes this inhibition, causing hyperprolactinemia and galactorrhea.
Question 4: According to the DSM-5, how long must symptoms of generalized anxiety disorder (GAD) persist to meet diagnostic criteria?
- At least 2 weeks
- At least 1 month
- At least 6 months (Correct answer)
- At least 1 year
Correct answer: At least 6 months
DSM-5 requires excessive anxiety and worry occurring more days than not for at least 6 months to diagnose GAD.
Question 5: A patient with borderline personality disorder frequently calls the crisis line, threatens self-harm, and then denies having any problems during sessions. This pattern BEST illustrates which concept central to DBT?
- Cognitive restructuring
- Dialectical dilemma: active passivity vs. apparent competence (Correct answer)
- Motivational ambivalence
- Secondary gain from the sick role
Correct answer: Dialectical dilemma: active passivity vs. apparent competence
DBT describes the dialectical dilemma of 'active passivity vs. apparent competence,' where patients appear capable in some contexts but feel unable to cope in others, creating confusion for providers.
Question 6: A PMHNP is seeing a patient who takes bupropion and decides to add an SSRI. Which serious risk must be discussed with the patient?
- Risk of serotonin syndrome
- Risk of QTc prolongation
- Lowered seizure threshold due to bupropion (Correct answer)
- Additive weight gain
Correct answer: Lowered seizure threshold due to bupropion
Bupropion lowers the seizure threshold in a dose-dependent manner, and this risk increases when combined with other serotonergic agents or at higher doses.
Question 7: Which statement about tardive dyskinesia (TD) is MOST accurate?
- TD typically resolves within weeks after discontinuing the offending antipsychotic
- TD is more common with atypical antipsychotics than with first-generation agents
- Valbenazine and deutetrabenazine are FDA-approved treatments for TD (Correct answer)
- TD only occurs in patients who have taken antipsychotics for more than 10 years
Correct answer: Valbenazine and deutetrabenazine are FDA-approved treatments for TD
Valbenazine and deutetrabenazine, vesicular monoamine transporter 2 (VMAT2) inhibitors, are FDA-approved specifically for the treatment of tardive dyskinesia.
Psychiatric-Mental Health Nurse Practitioner Exam Comprehensive Mental Health and Psychiatric Nursing 4
A PMHNP is treating a patient with obsessive-compulsive disorder (OCD).
Which first-line pharmacological treatment is recommended?