Psychiatric-Mental Health Nurse Practitioner Exam Mental Health and Psychiatric Nursing 2 — Questions and Answers
Question 1: A patient with schizophrenia is prescribed clozapine. Which laboratory monitoring is MOST critical due to the risk of agranulocytosis?
- Liver function tests weekly
- Absolute neutrophil count (ANC) per REMS protocol (Correct answer)
- Serum creatinine monthly
- Thyroid function tests quarterly
Correct answer: Absolute neutrophil count (ANC) per REMS protocol
Clozapine carries a black box warning for agranulocytosis, requiring ANC monitoring through the Clozapine REMS program before dispensing.
Question 2: A PMHNP is assessing a patient using motivational interviewing. Which technique best exemplifies the 'rolling with resistance' strategy?
- Confronting the patient about the consequences of their behavior
- Arguing against the patient's denial of a substance problem
- Reflecting the patient's ambivalence without challenging it directly (Correct answer)
- Providing direct advice about stopping substance use immediately
Correct answer: Reflecting the patient's ambivalence without challenging it directly
Rolling with resistance in motivational interviewing involves acknowledging ambivalence and reflecting it back rather than confronting or arguing, reducing defensiveness.
Question 3: A patient reports racing thoughts, decreased need for sleep, grandiosity, and increased goal-directed activity for 5 days without hospitalization. The PMHNP should document this episode as:
- Major depressive episode with mixed features
- Hypomanic episode
- Manic episode (Correct answer)
- Cyclothymic episode
Correct answer: Manic episode
A manic episode requires at least 7 days (or any duration if hospitalization is needed) of elevated/expansive/irritable mood with 3+ symptoms; 5 days with functional impairment severe enough to describe meets manic criteria.
Question 4: A teenager presents with sudden onset of paralysis in one arm with no neurological findings on MRI. The patient recently witnessed a traumatic accident. The PMHNP suspects which condition?
- Malingering disorder
- Somatic symptom disorder
- Conversion disorder (Functional Neurological Symptom Disorder) (Correct answer)
- Factitious disorder
Correct answer: Conversion disorder (Functional Neurological Symptom Disorder)
Conversion disorder presents with neurological symptoms (paralysis, blindness, seizures) incompatible with neurological disease, often triggered by psychological stress.
Question 5: Which medication is considered first-line pharmacotherapy for PTSD according to current evidence-based guidelines?
- Lorazepam
- Haloperidol
- Sertraline (Correct answer)
- Buspirone
Correct answer: Sertraline
Sertraline (and paroxetine) are FDA-approved SSRIs for PTSD and are recommended as first-line pharmacotherapy by VA/DoD and APA guidelines.
Question 6: A PMHNP prescribes lithium for a patient with bipolar I disorder. Which patient statement indicates a need for additional teaching?
- I will avoid NSAIDs and use acetaminophen for pain.
- I should maintain consistent fluid and sodium intake.
- I can skip blood levels once I feel stable on lithium. (Correct answer)
- I will call if I experience tremor, nausea, or confusion.
Correct answer: I can skip blood levels once I feel stable on lithium.
Lithium has a narrow therapeutic index and requires ongoing serum level monitoring even when the patient feels stable to prevent toxicity.
Question 7: A patient with opioid use disorder is being discharged from the hospital. Which medication has the strongest evidence base for reducing mortality and preventing relapse in outpatient treatment?
- Naltrexone oral tablets daily
- Buprenorphine/naloxone (Suboxone) (Correct answer)
- Clonidine
- Methadone prescribed by a primary care provider
Correct answer: Buprenorphine/naloxone (Suboxone)
Buprenorphine/naloxone is the most accessible evidence-based medication for OUD, shown to reduce overdose mortality, illicit opioid use, and improve retention in treatment.
Psychiatric-Mental Health Nurse Practitioner Exam Mental Health and Psychiatric Nursing 2
A patient with schizophrenia is prescribed clozapine.
Which laboratory monitoring is MOST critical due to the risk of agranulocytosis?