Psychiatric-Mental Health Nurse Practitioner Exam Nursing MCQ 4 — Questions and Answers
Question 1: A patient presents with pressured speech, decreased need for sleep, grandiosity, and increased goal-directed activity lasting 4 days without causing marked functional impairment. This presentation is most consistent with:
- Bipolar I disorder, manic episode
- Bipolar II disorder, hypomanic episode (Correct answer)
- Cyclothymic disorder
- Major depressive disorder with mixed features
Correct answer: Bipolar II disorder, hypomanic episode
A hypomanic episode is defined by elevated mood lasting at least 4 days that does not cause marked impairment or require hospitalization, distinguishing it from mania.
Question 2: The PMHNP is initiating bupropion in a patient with a history of anorexia nervosa. What is the primary contraindication?
- Risk of serotonin syndrome
- Lowered seizure threshold in patients with eating disorders (Correct answer)
- QTc prolongation risk
- Increased risk of lithium toxicity
Correct answer: Lowered seizure threshold in patients with eating disorders
Bupropion is contraindicated in eating disorders because electrolyte imbalances and low body weight significantly increase seizure risk.
Question 3: A patient discloses they plan to harm a specific, identifiable third party. According to the Tarasoff duty-to-protect principle, the PMHNP is obligated to:
- Maintain confidentiality as therapeutic alliance takes priority
- Warn the intended victim and notify law enforcement (Correct answer)
- Document the threat in the chart and increase session frequency
- Consult a supervisor but take no external action
Correct answer: Warn the intended victim and notify law enforcement
Tarasoff establishes a legal and ethical duty to protect identifiable potential victims by warning them and/or notifying authorities when a credible threat exists.
Question 4: Which rating scale is used specifically to assess extrapyramidal side effects (EPS) in patients taking antipsychotics?
- Young Mania Rating Scale (YMRS)
- Simpson-Angus Scale (SAS) (Correct answer)
- Columbia Suicide Severity Rating Scale (C-SSRS)
- Positive and Negative Syndrome Scale (PANSS)
Correct answer: Simpson-Angus Scale (SAS)
The Simpson-Angus Scale assesses drug-induced parkinsonism and other extrapyramidal side effects associated with antipsychotic use.
Question 5: A patient with opioid use disorder is being considered for medication-assisted treatment (MAT). Which medication can be prescribed by a PMHNP in an office-based setting without a specialized DEA waiver?
- Methadone for opioid use disorder
- Buprenorphine/naloxone (Suboxone)
- Injectable naltrexone (Vivitrol) (Correct answer)
- Heroin-assisted treatment
Correct answer: Injectable naltrexone (Vivitrol)
Naltrexone (oral or injectable) does not require a DEA waiver and can be prescribed in any outpatient setting by a licensed prescriber for opioid use disorder.
Question 6: A patient with GAD has not responded to two trials of SSRIs. Which medication class is FDA-approved as a second-line option for GAD?
- Benzodiazepines
- SNRIs such as venlafaxine (Correct answer)
- Atypical antipsychotics as monotherapy
- Tricyclic antidepressants
Correct answer: SNRIs such as venlafaxine
SNRIs such as venlafaxine (Effexor XR) and duloxetine are FDA-approved for GAD and represent a first- or second-line alternative to SSRIs.
Question 7: A patient experiencing acute dystonia after receiving haloperidol is best treated with:
- Lorazepam IV
- Diphenhydramine IM or benztropine IM (Correct answer)
- Propranolol PO
- Dantrolene IV
Correct answer: Diphenhydramine IM or benztropine IM
Acute dystonia is treated with anticholinergic agents such as benztropine or antihistamines such as diphenhydramine, which rapidly reverse muscle spasms.
Psychiatric-Mental Health Nurse Practitioner Exam Nursing MCQ 4
A patient presents with pressured speech, decreased need for sleep, grandiosity, and increased goal-directed activity lasting 4 days without causing marked functional impairment.
This presentation is most consistent with: