Psychiatric-Mental Health Nurse Practitioner Exam Comprehensive Mental Health and Psychiatric Nursing 5 — Questions and Answers
Question 1: A patient describes feeling detached from their own body and observing themselves from the outside during periods of stress. This symptom is BEST described as:
- Derealization
- Depersonalization (Correct answer)
- Dissociative amnesia
- Déjà vu
Correct answer: Depersonalization
Depersonalization is the subjective experience of feeling detached from or outside of one's own body, thoughts, or feelings.
Question 2: A PMHNP applies the Recovery Model when working with patients with serious mental illness. Which principle is MOST central to this model?
- Symptom elimination as the primary treatment goal
- Self-determination and building a meaningful life despite illness (Correct answer)
- Medication adherence as the only evidence-based intervention
- Clinician-directed care planning to optimize outcomes
Correct answer: Self-determination and building a meaningful life despite illness
The Recovery Model emphasizes self-determination, hope, and building a meaningful, satisfying life even in the presence of ongoing psychiatric symptoms.
Question 3: A patient with major depressive disorder has not responded to two adequate SSRI trials. The PMHNP considers augmentation. Which agent is FDA-approved for adjunctive treatment of MDD?
- Gabapentin
- Aripiprazole (Correct answer)
- Clonazepam
- Hydroxyzine
Correct answer: Aripiprazole
Aripiprazole is FDA-approved as an adjunctive therapy to antidepressants in adults with major depressive disorder who have had an inadequate response.
Question 4: Under the duty to protect (Tarasoff ruling), a PMHNP is legally obligated to act when a patient:
- Expresses generalized anger about society
- Makes a specific, credible threat against an identifiable third party (Correct answer)
- Reports historical violence committed years ago
- Describes violent video game content
Correct answer: Makes a specific, credible threat against an identifiable third party
The Tarasoff duty to protect is triggered when a patient makes a specific, serious, and credible threat against an identifiable victim, requiring the clinician to warn the potential victim and/or notify law enforcement.
Question 5: A patient with ADHD and comorbid bipolar disorder requires pharmacological treatment. Which approach is MOST appropriate?
- Start a stimulant immediately to address ADHD as the primary diagnosis
- Stabilize the bipolar disorder with a mood stabilizer before treating ADHD (Correct answer)
- Use an MAOI to address both conditions simultaneously
- Avoid all pharmacotherapy due to the complexity of comorbidity
Correct answer: Stabilize the bipolar disorder with a mood stabilizer before treating ADHD
In ADHD-bipolar comorbidity, the bipolar disorder must be stabilized first with a mood stabilizer to prevent stimulants from triggering mania or rapid cycling.
Question 6: A patient recently started on lithium complains of a coarse tremor, confusion, and vomiting. Lithium level is 2.4 mEq/L. What is the PRIORITY intervention?
- Administer activated charcoal and hold the next dose
- Administer IV normal saline and arrange urgent hemodialysis consultation (Correct answer)
- Reduce the lithium dose by half and recheck level in 24 hours
- Add propranolol to manage the tremor and observe inpatient
Correct answer: Administer IV normal saline and arrange urgent hemodialysis consultation
A lithium level above 2.0 mEq/L with neurological and GI toxicity signs constitutes severe lithium toxicity; IV hydration restores renal clearance and hemodialysis may be needed to rapidly reduce levels.
Question 7: When conducting a cultural formulation interview (CFI), the PMHNP's PRIMARY goal is to:
- Determine the patient's DSM-5 diagnosis through culturally adapted questions
- Understand the patient's own explanatory model, cultural identity, and psychosocial stressors (Correct answer)
- Identify which cultural group the patient belongs to for treatment matching
- Screen for culturally bound syndromes that replace Western diagnoses
Correct answer: Understand the patient's own explanatory model, cultural identity, and psychosocial stressors
The CFI elicits the patient's own perspective on their illness, cultural identity, and social context to inform a culturally sensitive diagnostic and treatment formulation.
Psychiatric-Mental Health Nurse Practitioner Exam Comprehensive Mental Health and Psychiatric Nursing 5
A patient describes feeling detached from their own body and observing themselves from the outside during periods of stress.
This symptom is BEST described as: