Psychiatric-Mental Health Nurse Practitioner Exam Mental Health and Psychiatric Nursing 3 — Questions and Answers
Question 1: A PMHNP evaluates a 70-year-old patient with new-onset paranoid delusions and visual hallucinations. Which assessment finding would most strongly suggest a medical etiology rather than a primary psychiatric disorder?
- Family history of schizophrenia
- Auditory hallucinations with command features
- Acute onset with fluctuating consciousness and disorientation (Correct answer)
- Social withdrawal over the past year
Correct answer: Acute onset with fluctuating consciousness and disorientation
Acute onset, fluctuating consciousness, and disorientation are hallmarks of delirium—a medical emergency—rather than a primary psychiatric illness like schizophrenia.
Question 2: Under Tarasoff duty-to-warn statutes, a PMHNP is legally obligated to take protective action when a patient:
- Expresses general anger toward a public figure
- Makes a specific, credible threat against an identifiable third party (Correct answer)
- Has a history of past violence but denies current intent
- Reports passive suicidal ideation without a plan
Correct answer: Makes a specific, credible threat against an identifiable third party
The Tarasoff ruling established the duty to protect identifiable third parties when a patient makes a specific, serious, credible threat of harm toward them.
Question 3: A patient on a stable dose of an SSRI reports decreased libido and inability to achieve orgasm. The PMHNP's BEST initial intervention is:
- Switch the patient to a tricyclic antidepressant
- Add bupropion to address sexual side effects (Correct answer)
- Increase the SSRI dose to achieve faster remission
- Discontinue all antidepressants immediately
Correct answer: Add bupropion to address sexual side effects
Augmenting with bupropion (which has pro-dopaminergic/noradrenergic activity) is a common evidence-based strategy to counteract SSRI-induced sexual dysfunction.
Question 4: Which of the following is a cardinal feature that differentiates borderline personality disorder (BPD) from bipolar II disorder?
- Mood episodes lasting less than one hour triggered by interpersonal events (Correct answer)
- Recurrent depressive episodes
- Impulsive behavior during mood shifts
- Sleep disturbance during mood episodes
Correct answer: Mood episodes lasting less than one hour triggered by interpersonal events
In BPD, dysphoric mood episodes are typically brief (hours), reactive to interpersonal stressors, and return to baseline, unlike the days-long episodes seen in bipolar disorder.
Question 5: A nurse practitioner is using the Columbia Suicide Severity Rating Scale (C-SSRS). Which item would place a patient at the HIGHEST level of suicide ideation on this scale?
- Passive death wish ('I wish I were dead')
- Active ideation without plan or intent
- Active ideation with intent but no specific plan
- Active ideation with a specific plan and intent to act (Correct answer)
Correct answer: Active ideation with a specific plan and intent to act
The C-SSRS categorizes ideation from passive wish to die up to active ideation with a specific plan and intent, with the latter representing the highest and most critical risk level.
Question 6: A PMHNP conducting a mental status exam notes that a patient's speech jumps from one topic to another based on the sound of words rather than logical meaning. This is documented as:
- Tangentiality
- Flight of ideas
- Clang associations (Correct answer)
- Circumstantiality
Correct answer: Clang associations
Clang associations occur when the patient's speech is driven by the rhyme or sound of words rather than their semantic meaning, commonly seen in mania.
Question 7: A PMHNP is treating a 10-year-old with ADHD whose parents prefer to avoid stimulants. Which non-stimulant medication is FDA-approved for ADHD in children and has the most evidence base?
- Bupropion
- Atomoxetine (Strattera) (Correct answer)
- Clonidine only
- Modafinil
Correct answer: Atomoxetine (Strattera)
Atomoxetine is a selective norepinephrine reuptake inhibitor FDA-approved for ADHD in children aged 6 and older and is the most studied non-stimulant option.
Psychiatric-Mental Health Nurse Practitioner Exam Mental Health and Psychiatric Nursing 3
A PMHNP evaluates a 70-year-old patient with new-onset paranoid delusions and visual hallucinations.
Which assessment finding would most strongly suggest a medical etiology rather than a primary psychiatric disorder?