Psychiatric-Mental Health Nurse Practitioner Exam Mental Health and Psychiatric Nursing 5 — Questions and Answers
Question 1: A PMHNP documents that a patient with schizophrenia sits motionless for hours, maintains an unusual posture when repositioned, and does not speak. These symptoms best describe:
- Negative symptom avolition
- Tardive dyskinesia
- Catatonia (Correct answer)
- Akathisia
Correct answer: Catatonia
Catatonia is characterized by motor immobility, posturing (waxy flexibility), mutism, and negativism, which can occur in schizophrenia, mood disorders, and medical conditions.
Question 2: A PMHNP is treating an adolescent with depression and learns the patient disclosed abuse by a family member. The PMHNP's FIRST legal and ethical obligation is to:
- Discuss the disclosure with the patient's parents before acting
- Maintain confidentiality to preserve the therapeutic alliance
- Report the suspected abuse to the appropriate child protective services (Correct answer)
- Consult a colleague before making any report
Correct answer: Report the suspected abuse to the appropriate child protective services
As a mandated reporter, the PMHNP must immediately report suspected child abuse to child protective services regardless of the therapeutic relationship or parental consent.
Question 3: Which pharmacological property of quetiapine at lower doses (25–100 mg) is primarily responsible for its sedating effects used in sleep or anxiety?
- D2 receptor antagonism
- 5-HT2A antagonism
- H1 (histamine) receptor antagonism (Correct answer)
- Alpha-1 adrenergic agonism
Correct answer: H1 (histamine) receptor antagonism
At low doses, quetiapine's sedating effects are primarily driven by potent H1 histamine receptor antagonism before significant D2 or 5-HT2A blockade occurs.
Question 4: A PMHNP applying trauma-informed care (TIC) principles encounters a patient who becomes suddenly fearful and dissociates during an assessment. The priority intervention is:
- Proceed quickly with the assessment to minimize disruption
- Gently reorient the patient using grounding techniques and pause the assessment (Correct answer)
- Administer a PRN benzodiazepine immediately
- Document the behavior and continue when the patient is calmer without acknowledging it
Correct answer: Gently reorient the patient using grounding techniques and pause the assessment
Trauma-informed care prioritizes safety; grounding techniques help restore present-moment awareness and demonstrate respect for the patient's response to trauma cues.
Question 5: A patient with major depressive disorder has failed two adequate SSRI trials. The PMHNP considers augmentation. Which agent is FDA-approved as an augmentation strategy for treatment-resistant depression?
- Gabapentin
- Aripiprazole (Abilify) (Correct answer)
- Clonazepam
- Lamotrigine as monotherapy
Correct answer: Aripiprazole (Abilify)
Aripiprazole is FDA-approved as an adjunctive therapy to antidepressants for major depressive disorder in patients with an inadequate response.
Question 6: A PMHNP is evaluating a patient for autism spectrum disorder (ASD) in adulthood. Which presentation is MOST characteristic of ASD that may have been missed in childhood?
- Episodic mood swings tied to interpersonal conflicts
- Rigid routines, difficulty with social reciprocity, and sensory sensitivities (Correct answer)
- Auditory hallucinations and flat affect
- Fluctuating cognitive performance across domains
Correct answer: Rigid routines, difficulty with social reciprocity, and sensory sensitivities
Core features of ASD include persistent deficits in social communication, restricted/repetitive behaviors, and sensory processing differences that may be 'masked' in high-functioning individuals until adulthood.
Question 7: A PMHNP is considering prescribing naltrexone for alcohol use disorder. Which condition is an ABSOLUTE contraindication?
- Active depression with suicidal ideation
- Concurrent use of ibuprofen
- Current physiological opioid dependence or acute opioid use (Correct answer)
- Mildly elevated liver enzymes (3x ULN)
Correct answer: Current physiological opioid dependence or acute opioid use
Naltrexone is an opioid antagonist and will precipitate severe acute opioid withdrawal in patients who are physiologically dependent on opioids, making current opioid dependence an absolute contraindication.
Psychiatric-Mental Health Nurse Practitioner Exam Mental Health and Psychiatric Nursing 5
A PMHNP documents that a patient with schizophrenia sits motionless for hours, maintains an unusual posture when repositioned, and does not speak.
These symptoms best describe: