Mixed Deck — All Psychiatric-Mental Health Nurse Practitioner Exam Topics Flashcards

The Montreal Cognitive Assessment (MoCA) differs from the MMSE in that it:

Answer: Is more sensitive to mild cognitive impairment (MCI)

The MoCA has greater sensitivity than the MMSE for detecting mild cognitive impairment, particularly in executive functioning and attention.

The following is the best method for separating delirium from other types of confusion:

Answer: Confusion Assessment Method

The Confusion Assessment Method, which may be used by persons without psychiatric training, is the most suitable method for distinguishing delirium from other types of confusion. The tool addresses nine different aspects of abnormal behavior, including onset, attention, level of consciousness, reasoning, orientation, memory, perceptual disturbances, psychomotor abnormalities, and sleep-wake cycle. Delirium is characterized by an abrupt onset of disorientation, fluctuating levels of attention, disordered thought, or an altered state of consciousness.

Efraim was brought to the emergency room after receiving an amphetamine psychosis diagnosis. Which of the following medications would Nurse Philippe most likely get ready to administer?

Answer: Haldol

To lessen agitation and psychotic symptoms, such as delusions, hallucinations, and cognitive impairment, the nurse would get ready to give an amphetamine psychosis patient an antipsychotic drug like Haldol. A first-generation (typical) antipsychotic drug with widespread usage is haloperidol. Haloperidol has been approved by the Food and Drug Administration (FDA) for the treatment of schizophrenia, Tourette syndrome (control of tics and vocal utterances in adults and children), hyperactivity (which may present as impulsivity, difficulty focusing, severe aggression, mood instability, and frustration intolerance), severe childhood behavioral issues (such as combative, explosive hyperexcitability), and intractable hiccups. It treats positive symptoms of schizophrenia such hallucinations and delusions, making it a typical antipsychotic.

A PMHNP evaluating a patient in crisis should first prioritize which action?

Answer: Establish safety and assess risk of harm to self or others

Safety assessment is always the first priority in any psychiatric crisis situation.

A nurse is applying motivational interviewing (MI) techniques. Which response best exemplifies a reflective listening statement?

Answer: 'It sounds like you feel torn between wanting to change and enjoying alcohol.'

Reflective listening in MI involves mirroring the patient's expressed ambivalence without judging or directing, which builds rapport and fosters change talk.

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?

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.

A patient with treatment-resistant depression is started on ketamine infusions. Which mechanism best explains its rapid antidepressant effect?

Answer: NMDA receptor antagonism followed by AMPA receptor upregulation and BDNF release

Ketamine blocks NMDA receptors, causing a glutamate surge that activates AMPA receptors, releasing BDNF and promoting rapid synaptogenesis in the prefrontal cortex and hippocampus.

Eye Movement Desensitization and Reprocessing (EMDR) is the first-line evidence-based treatment for which condition?

Answer: Post-traumatic stress disorder (PTSD)

EMDR is a well-established, evidence-based treatment specifically validated for PTSD.

An anxiety attack is plaguing a patient. What should the best nursing intervention contain?

Answer: Staying with the client and speaking in short sentences.

Short sentences, staying with the client, reducing stimulation, maintaining cool, and administering medication as needed are all appropriate nursing actions for an anxiety attack. Since anxiety is contagious and can be passed from staff to client or vice versa, maintain a calm, non-threatening demeanor while working with the client. Speak slowly and clearly while using basic language to describe hospital experiences to the client; in a highly worried state, the client is unable to understand anything except the most basic communication.

Which of the following liquids would nurse Kate give to a female patient who is high on phencyclidine (PCP) in order to speed up the drug's excretion?

Answer: Cranberry Juice

PCP is more easily excreted when the environment is acidic. Cranberry juice will undoubtedly be administered by the nurse to the PCP-impaired client in order to hasten excretion and acidify the urine to a pH of 5.5. PCP starts to show symptoms at 0.05 mg/kg, and a dose of 20 mg or more can result in coma, death, and seizures. 10% of it is eliminated in the urine and 90% is processed primarily by the liver. The most common mode of administration, inhalation, and intravenous both cause effects in 2 to 5 minutes. Symptoms from oral ingestion appear within 30 to 60 minutes.

A PMHNP in private practice begins dating a former patient who terminated therapy 6 months ago. This behavior is best described as:

Answer: A boundary violation that is ethically prohibited

Sexual or romantic relationships with former patients are considered boundary violations and are prohibited by professional ethics codes due to the power differential inherent in the therapeutic relationship, which persists after termination.

The psychiatric and mental health nurse should recognize that when a patient with substance addiction disorder says he has been using "beanies," he is referring to:

Answer: Methamphetamine

The psychiatric and mental health nurse should recognize that if a patient with substance abuse disorder says they have been using "beanies," they are referring to methamphetamine, also known as "blue devils," "crank," and "crystal" as well as a variety of other local names. Heroin is also known as "horse," "H," "Aunt Hazel," "smack," and "charley," among other less popular names, while marijuana is known as "weed," "Aunt Mary," "Mary Jane," and "pot." Cocaine is also known as "coke," "blow,", "snow," and "sugar."

A patient reports racing thoughts, decreased need for sleep, grandiosity, and increased goal-directed activity for 5 days without hospitalization. The PMHNP should document this episode as:

Answer: Manic episode

A manic episode requires at least 7 days (or any duration if hospitalization is needed) of elevated/expansive/irritable mood with 3+ symptoms; 5 days with functional impairment severe enough to describe meets manic criteria.

The best way to promote participation in an outreach program to evaluate homeless people for mental health and/or substance misuse disorders is to:

Answer: Offer free food, water, and hygiene products.

Free food, water, and hygiene supplies are arguably the best incentives to utilize because homeless persons are more likely to be driven by self-interest due to their ongoing need. The psychiatric and mental health nurse may need to think about collaborating with or working with other community resources, such as homeless shelters and food kitchens, as these organizations can refer the homeless, even though funding may be limited. However, occasionally community members or organizations, like the Salvation Army®, will contribute.

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:

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.

A patient who has been diagnosed with a thinking disorder and is taking clozapine (Clozaril) 25 mg QD is having his or her lab results reviewed by the nurse. RBC 4.7 million/mcL, WBC 2000/mcL, and TSH 1.3 mc-IU levels are recorded. Considering these values, which would the nurse anticipate the doctor to prescribe?

Answer: “Discontinue clozapine (Clozaril).”

White blood cell (WBC) counts in adults should range between 4500 to 10,000/mcL. The WBC count for this patient is 2000/mcL, which denotes agranulocytosis, a potentially lethal blood condition. Therapy with the antipsychotic drug clozapine (Clozaril) carries a substantial risk for agranulocytosis. The nurse would anticipate that the doctor will stop prescribing clozapine (Clozaril).

A patient presents with pressured speech, decreased need for sleep, grandiosity, and hypersexuality for 5 days without significant functional impairment. What is the MOST likely diagnosis?

Answer: Bipolar II disorder, hypomanic episode

A hypomanic episode in bipolar II disorder lasts at least 4 days, causes elevated/irritable mood and increased energy, but does NOT cause marked functional impairment or require hospitalization.

Which element is NOT required to establish malpractice in psychiatric nursing practice?

Answer: The PMHNP intended to harm the patient

Malpractice (negligence) requires duty, breach of duty, causation, and damages — intent to harm is not an element, distinguishing negligence from intentional torts.

The concept of 'least restrictive environment' in psychiatric care means:

Answer: Treatment should be provided in the setting that meets clinical needs while maximizing patient freedom

The least restrictive environment principle requires that psychiatric treatment occur in the setting that addresses the patient's clinical needs while preserving the greatest degree of personal freedom and autonomy.

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:

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.