Psychiatric-Mental Health Nurse Practitioner Exam Nursing MCQ 5 — Questions and Answers
Question 1: Which of the following best describes the primary goal of dialectical behavior therapy (DBT) as originally developed for borderline personality disorder?
- Uncovering unconscious conflicts driving self-destructive behavior
- Balancing acceptance and change strategies to reduce emotional dysregulation (Correct answer)
- Exposing patients to feared stimuli to reduce avoidance
- Restructuring dysfunctional core schemas through behavioral experiments
Correct answer: Balancing acceptance and change strategies to reduce emotional dysregulation
DBT integrates acceptance-based strategies (drawn from mindfulness) with change-based cognitive-behavioral techniques to treat emotional dysregulation.
Question 2: A 70-year-old patient develops sudden onset confusion, agitation, and disorganized thinking 2 days after hip replacement surgery. The most likely diagnosis is:
- Dementia with Lewy bodies
- Delirium (Correct answer)
- First-episode schizophrenia
- Frontotemporal dementia
Correct answer: Delirium
Delirium is characterized by acute onset, fluctuating course, and disturbed attention/cognition, commonly precipitated by surgery, infection, or medications in older adults.
Question 3: A PMHNP considers prescribing valproate to a woman of childbearing age. Which critical counseling point is mandatory?
- Valproate has no documented teratogenic effects at low doses
- Valproate is a Category X teratogen associated with neural tube defects and requires effective contraception (Correct answer)
- Valproate is safe in the first trimester but must be stopped in the third
- Monthly liver function tests replace the need for contraception counseling
Correct answer: Valproate is a Category X teratogen associated with neural tube defects and requires effective contraception
Valproate is a potent teratogen with a high risk of neural tube defects, spina bifida, and cognitive impairment in the fetus; contraception counseling is mandatory.
Question 4: A patient newly diagnosed with ADHD-combined type is a 28-year-old with a history of stimulant misuse. Which is the most appropriate first-line treatment?
- Amphetamine salts (Adderall)
- Atomoxetine (Strattera) (Correct answer)
- Methylphenidate (Ritalin)
- Modafinil (Provigil)
Correct answer: Atomoxetine (Strattera)
Atomoxetine is a non-stimulant SNRI approved for ADHD and is preferred in patients with substance use history due to its lack of abuse potential.
Question 5: Which cognitive distortion is characterized by a patient concluding they are a 'complete failure' after receiving one negative performance review?
- Personalization
- Overgeneralization (Correct answer)
- Catastrophizing
- Mind reading
Correct answer: Overgeneralization
Overgeneralization involves drawing broad negative conclusions from a single event, such as labeling oneself a total failure based on one setback.
Question 6: A patient taking lithium presents with coarse tremor, ataxia, slurred speech, and confusion. Serum lithium is 2.4 mEq/L. What is the priority nursing action?
- Administer activated charcoal
- Hold the next dose and recheck level in 6 hours
- Prepare the patient for hemodialysis and ensure IV access (Correct answer)
- Administer sodium bicarbonate to alkalinize the urine
Correct answer: Prepare the patient for hemodialysis and ensure IV access
A lithium level above 2.0 mEq/L with neurological symptoms is a life-threatening emergency; hemodialysis is the definitive treatment to rapidly remove lithium.
Question 7: A PMHNP is conducting a risk assessment using the Columbia Suicide Severity Rating Scale (C-SSRS). Which finding indicates the highest level of suicidal ideation?
- Passive ideation without intent to act
- Active ideation with a specific plan and intent to act (Correct answer)
- Ideation that occurs less than once per week
- Ideation present only in response to an interpersonal stressor
Correct answer: Active ideation with a specific plan and intent to act
On the C-SSRS, ideation with a specific plan AND intent to act represents the most severe and clinically urgent category requiring immediate intervention.
Psychiatric-Mental Health Nurse Practitioner Exam Nursing MCQ 5
Which of the following best describes the primary goal of dialectical behavior therapy (DBT) as originally developed for borderline personality disorder?