Psychiatric-Mental Health Nurse Practitioner Exam Mental Health and Psychiatric Nursing 4 — Questions and Answers
Question 1: A patient taking an MAOI for treatment-resistant depression asks about dietary restrictions. Which food poses the GREATEST risk for a hypertensive crisis?
- Fresh chicken breast
- Aged cheddar cheese (Correct answer)
- White rice
- Fresh vegetables
Correct answer: Aged cheddar cheese
Aged cheeses are high in tyramine, which MAOIs prevent from being metabolized, leading to a dangerous accumulation and potential hypertensive crisis.
Question 2: A PMHNP is applying Dialectical Behavior Therapy (DBT). Which skill module teaches patients to tolerate distress without making a crisis worse?
- Interpersonal effectiveness
- Emotion regulation
- Distress tolerance (Correct answer)
- Mindfulness
Correct answer: Distress tolerance
Distress tolerance skills in DBT teach patients to survive crisis moments without engaging in behaviors that worsen the situation, using techniques like TIPP and ACCEPTS.
Question 3: A patient with a long history of alcohol use disorder abruptly stops drinking after heavy daily use. Which vital sign pattern should alert the PMHNP to a risk of severe alcohol withdrawal (AWS)?
- Bradycardia and hypothermia
- Tachycardia, hypertension, and fever (Correct answer)
- Hypotension and bradypnea
- Orthostatic hypotension alone
Correct answer: Tachycardia, hypertension, and fever
Tachycardia, hypertension, diaphoresis, and fever during alcohol withdrawal reflect autonomic hyperactivity and can progress to seizures and delirium tremens.
Question 4: A patient with bipolar I disorder who is stabilized on lithium becomes pregnant. The PMHNP knows that lithium carries a risk for which fetal cardiac defect?
- Tetralogy of Fallot
- Ebstein's anomaly (Correct answer)
- Ventricular septal defect
- Patent ductus arteriosus
Correct answer: Ebstein's anomaly
Lithium exposure in the first trimester has been associated with Ebstein's anomaly, a rare tricuspid valve malformation, though the absolute risk is low.
Question 5: A PMHNP treating a patient with anorexia nervosa should monitor MOST closely for which life-threatening electrolyte complication?
- Hypernatremia
- Hypercalcemia
- Hypokalemia and hypophosphatemia (Correct answer)
- Hypermagnesemia
Correct answer: Hypokalemia and hypophosphatemia
Hypokalemia and hypophosphatemia (especially refeeding syndrome) in anorexia nervosa can cause fatal cardiac arrhythmias and require vigilant electrolyte monitoring.
Question 6: Which psychotherapy is considered the gold standard first-line treatment for bulimia nervosa based on the strongest evidence base?
- Psychodynamic therapy
- Cognitive Behavioral Therapy (CBT) (Correct answer)
- Acceptance and Commitment Therapy (ACT)
- Interpersonal psychotherapy as the sole treatment
Correct answer: Cognitive Behavioral Therapy (CBT)
CBT is the most extensively studied and recommended first-line treatment for bulimia nervosa, targeting the cognitive distortions and behavioral patterns maintaining the disorder.
Question 7: A patient is brought to the ED agitated and confused after ingesting an unknown substance. The nurse notes hyperthermia, diaphoresis, muscular rigidity, clonus, and hyperreflexia. The PMHNP suspects:
- Neuroleptic malignant syndrome (NMS)
- Anticholinergic toxidrome
- Serotonin syndrome (Correct answer)
- Malignant hyperthermia
Correct answer: Serotonin syndrome
Serotonin syndrome presents with the triad of mental status changes, autonomic instability, and neuromuscular abnormalities including clonus and hyperreflexia, distinguishing it from NMS.
Psychiatric-Mental Health Nurse Practitioner Exam Mental Health and Psychiatric Nursing 4
A patient taking an MAOI for treatment-resistant depression asks about dietary restrictions.
Which food poses the GREATEST risk for a hypertensive crisis?