NURS 751 Midterm
1) Whate are the questions for the CAGE alcohol use screening?
Have you felt the need to CUT down on your drinking?
Do you feel ANNOYED by people complaining about your
drinking?
Do you feel GUILTY about your drinking?
Do you ever drink an EYE-OPENER in the morning to steady your
nerves or get rid of a hangover?
2) Where is Dopamine produced? In the substantia nigra of the brain
3) Which neurotransmitter is decreased in individuals with depression?
Serotonin
4) What should the PMHNP assess for if a patient reports frequent
nightmares? A history of trauma
5) What is the prevalence rates for schizophrenia in specific populations?
6) Which disorder is not a psychotic prone personality disorder? Paranoid
personality disorder
7) If a patient has positive signs of schizophrenia and is scheduled for a
brain scan, What part of the brain will the brain scan focus on?
Temporal lobe
8) A client comes to the nursing unit with a BP of 180/110, HR 102, and
RR of 20. Hand tremors are present, along with diaphoresis and
complains of anxiety, nervousness. There is a long-standing history of
alcohol and cocaine abuse. What is the client most likely experiencing?
Alcohol withdrawal
9) The psychiatric mental health nurse practitioner working in a crisis
stabilization unit evaluates a patient verbalizing suicidal thoughts after
being sexually assaulted. Before processing through the traumatic
event, What should the nurse practitioner first attempt to do? Provide
an environment of safety
10) Ms. Thomas has been diagnosed with major depressive disorder
(MDD) and is placed on antidepressant medication for depression. For
PMHNP to effectively monitor her use of the medication, which of the
following actions should be part of ongoing care? Use of a standardized
rating scale for depression (PHQ9)
11) A healthcare professional is seeing a patient with suspected
schizophrenia. For which prenatal occurrence should the professional
assess? Viral infection
12) Which best describes beliefs that most people would describe as
a misrepresentation of reality, or a disorder of thought content?
Delusions
13) A patient has been diagnosed with lithium toxicity. Which
electrolyte imbalance does the healthcare professional correlate with
this condition? Hyponatremia
14) What happens when clients that are addicted to one substance
are also addicted to another substance within the same category?
Cross tolerance
15) A client presents with complaints of change in appetite, feeling
fatigued, problems with sleep-rest cycle and changes in libido. What is
the neuroanatomical area of the brain that is responsible for the
normal regulation of these functions? Hypothalmus
16) What is the link between depression major depression and
cortisol secretion? Individuals with depression show persistently
elevated plasma cortisol levels can result in inflammation that is
believed to trigger depression
17) What is the common property among the three types of
medications used to treat depression? They increase neurotransmitter
levels within the synapse
18) A new client reveals to the PMHNP that her boyfriend screams at
her and has repeatedly slapped and pushed her in front of her 3 year
old son. She goes on to say that the boyfriend has thrown things at her
and on one occasion threw a glass of water at her that hit her son in
the back. Should the PMHNP reports this to CPS? Yes, as a PMHNP you
have a duty to report
19) Where is serotonin produced? In the Raphe nuclei
20) Which neurotransmitter is reduced in individuals with
schizophrenia? Gamma-aminobutyric acid
21) What are the physiological effects of prolonged, severe stress on
the body? Enlargement of the adrenal cortex and lymphatic structures
22) Mr. Johnson is a client newly admitted to an inpatient psychiatric
hospital. The PMHNP on call at the facility plans to perform the initial
intake assessment and diagnostic process. Mr. Johnson asks to please
talk in his room because he says, “people make me nervous.” His room
is at the end of the hallway and is the farthest away from the nursing
station. Where is the best location for the PMHNP to do the
assessment? The assessment should be completed in a quiet place,
but public enough to get assistance with client care, should it be
required during the assessment
23) What is true about the risk of suicide? Suicide risk is elevated by
a history of suicide in a first-degree relative, especially in the same-sex
parent
24) A client is experiencing difficulties with working memory,
planning, and prioritizing, insight into problems, and impulse control
presents for assessment. This represents problems with which
part/lobe of the brain? The frontal lobe
25) A client says to PMHNP, “some days life is just not worth it. All
my wife and I ever do is fight and scream. Things at home would be
calmer and simpler if I just wasn’t there anymore.” What is the most
therapeutic response for the PMHNP to make? Tell me what you mean
by “it would be simpler if you just weren’t there anymore”.
26) Hypothalamic-pituitary-adrenal (HPA) system abnormalities exist
in a large percentage of individuals with what disorder? Major
depression
27) A client was admitted into substance abuse treatment facility
with symptoms of hypotension, tachycardia, clammy skin, slow/shallow
breathing, depressed levels of consciousness. What is this client most
likely experiencing? Opiod overdose/toxicity
28) Mrs. Shea has come to the mental health center seeking
treatment for depression. She has a history of suicide attempt by
overdose 1 month ago. She was started on tricyclic antidepressant
(TCA) after that event but stopped taking the medication 1 week later
because it “did no good.” The PMHNP meet with Mrs. Shea to plan care
for her. What is the most appropriate initial action? Ask Mrs. Shea how
to help her
29) Which is not a poorly empathetic personality disorder? Histrionic
30) Sarah presents for her initial intake appointment with complaints
of depression. She is being treated for hypertension and asthma by her
primary care provider. Knowing that certain medications can cause or
exacerbate depression, you obtain a complete medication history.
Which medication is known to exacerbate or cause depression?
Propanolol (Levothyroxine DOES NOT exacerbate or cause depression)
31) What is a notable complication of panic disorder? Agoraphobia
32) In assessing a client, you ask him the meaning of the proverb
“people who live in glass houses shouldn’t throw stones. He replies,
“Because it will break the windows.” What is the correct interpretation
of this finding? Unable to interpret the finding without knowing the
client’s age
33) A 68 year old woman presents with confusion and history of
chronic alcohol abuse in the Emergency Department. On examination,
she is tachycardic and hypothermic and has an ataxic gait with foot
weakness and footdrop. What is the most likely diagnosis? Werneke’s
encephalopathy
34) What is a positive symptom of schizophrenia? Auditory
hallucinations
35) What is the role of the neurotransmitters in the central nervous
system? A communication medium
36) A patient who has borderline personality disorder experiences
intense anxiety when the psychiatric mental health nurse practitioner
goes on vacation. What is the most appropriate explanation for this
reaction? Has not developed object constancy
37) What is the usual age of onset of symptoms for patients with
bipolar disorder? Between 15-30
38) What is the most common type of hallucinations in
schizophrenia? Auditory hallucinations
39) In considering whether to order an MRI of the head for a client,
which of the following would be a contraindication to this diagnostic
test? Pacemaker
40) Tommy is an 8 year old who presents to the PMHNP for
evaluation of attention deficit hyperactivity disorder. His mother
completed the Vanderbilt ADHD rating scale and brough in the
Vanderbilt teaching rating scale. Both our clinical interview and the
rating scales indicate Tommy has ADHD. What assessment indicator(s)
need to be completed prior to starting a stimulant medication? Assess
for family history of cardiovascular disease and if positive for
conduction problems, order an ECG before prescribing medication
41) A client comes into the clinic with a longstanding history of
depression and chronic renal failure. He is on an antidepressant and a
diuretic and complains of increased depression, mild confusion,
irritability, and overall apathy for being too tired to do anything. What
is the best initial action for the PMHNP to take? Order a CMP
42) A criterion for a diagnosis of generalized anxiety disorder (GAD)
is a period of excessive worry that lasts for at least how many months?
6 months
43) What would laboratory findings for a patient with alcohol use
disorder show? Increased MCV and elevated triglycerides
44) What is the best explanation of target symptom identification?
Identification of specific, precise, and individualized symptoms
reasonably expected to improve with medication
45) According to established clinical guidelines, suicidality is
decreased by treating patient who have borderline personality disorder
with what? Dialectical behavioral therapy
46) What is the primary excitatory neurotransmitter? Glutamate
47) What situation does not correlate with an increased risk of
vulnerability to unhealthy levels of stress? Having a network of friends
and acquaintances
48) What is the goal of the psychiatric assessment process
performed by the PMHNP? Identify the mental health needs of the
client
49) A patient presents to your clinic numerous times with vague
complaints. She seems to respond poorly to medical treatment that is
given to her. What should be considered when obtaining a history from
her? Physical abuse or depression
50) You are treating a 14 year old female for attention deficit
hyperactivity disorder (ADHD) who has a family history of bipolar
disorder. What should the PMHNP know about the symptoms of both
ADHD and pediatric bipolar disorder? Excessive talking, irritability and
sleep problems
51) What is a disorder that is associated with developmental inappropriate and excessive
distress with separation from a major attachment figure after age 4? separation anxiety
52) Which of psychiatric patient is at the least risk of suicide? Dementia
53) What is not an indication for electroconvulsive therapy? Acute suicide behavior
54) What impairment is not characterized by Rett syndrome? Poor social skills
55) Which factor does not apply to antisocial personality disorder? No substance abuse co-
morbidity
56) During psychiatric consultation in palliative care, what aspect of spirituality should the
PMHNP examine?
57) Which disorder is characterized by chronic feeling of emptiness, impulsivity, suicide
behavior, threats, self-mutilation, and unstable interpersonal relationships? Borderline
personality disorder
58) What is NOT a DSM-5 criteria for gender dysphoria? Preoccupation and interest in
physical characteristics of biological sex
59) Talking or writing about death is not an imminent danger of suicide. FALSE
60) Which neurotransmitter dysfunction is NOT responsible in personality disorders?
Elevated levels of norepinephrine
61) Which is NOT an early warning sign of homicide? Limited stress from personal problems
or a life crisis
62) The neurotransmitters influences a neuron in all of the following: excitatory, inhibitory,
modulatory
63) Eighty percent of children who receive mental health services access care through the
school system. TRUE
64) A rare and potential life-threatening reaction to a foreign antigen that can occur with
exposure to anticonvulsant mood stabilizer is: Steven Johnson’s Syndrome
65) Physical assault is the most common form of abuse: FALSE
66) Wernicke-Korsakoff’s Syndrome is one of the most commonly found conditions in
chronic alcoholics. Fatty liver is NOT a symptom of Wernicke-Korsakoff’s Syndrome
67) Delusions
a. Delusions of erotomania – delusional content focuses on false belief that
someone is in love with him/her
b. Delusions of grandiose – delusional content focuses on having extraordinary
great talent, skill, or knowledge, special connection to God
c. Delusions of jealousy – delusional content focuses on false believe that spouse is
being unfaithful with someone else
d. Delusions of persecution – delusional content focuses on belief that others are
out to harm, spy on him/her
e. Somatic delusions – delusional content focuses on bodily functions and sensations
68) What is NOT a characteristic of an abuser? Financial difficulties
69) White males over 85 have a higher suicide rates: FALSE
70) Healthy personality structures do not allow for realistic, happy, and satisfying self-
perceptions and interpersonal interactions. FALSE
71) Risk factors for suicide DOES NOT INCLUDE: Impulsive aggressive tendencies
72) Hereditary cause of intellectual disability DOES NOT include: single-gene abnormalities
such as Tuberous sclerosis
73) Males are how many times more likely to commit suicide? 5 times
74) What is NOT a goal of an abuser? Render power to the other person
75) Brief psychotic disorder is characterized by sudden onset of symptoms lasting how long?
At least one day but less than one month
76) Cultural assessment is not relevant in conducting complete psychiatric assessment:
FALSE
77) Positive symptoms of schizophrenia – symptoms that respond to antipsychotic
medications and reflects excesses or distortions of normal brain functioning; caused by
increase in dopamine in mesolimbic pathway
a. Negative symptoms of schizophrenia – symptoms that are less responsive to
antipsychotic medications but respond better to atypical antipsychotic
medications; caused by decreased dopamine in mesolimbic pathway
b. Associated symptoms of schizophrenia - symptoms not required to be present to
diagnose the disorder but present and a focus of treatment
78) What is NOT a differential diagnosis for oppositional defiant disorder per DSM-5? Rett
Syndrome
79) A patient with eating disorder may exhibit evidence of: anxiety disorder
80) Hypothalamic pituitary adrenal (HPA) system abnormalities exist in a large percentage
of individuals with: Major depression
81) Which of the following would NOT be part of the differential diagnosis of an 84 year old
patient with dementia symptoms? Normal aging process
82) Match each of the collaboration levels with appropriate description:
a. Level 1 – minimal collaboration, mental health and other health care professionals
function in silos without communication and services are provided in different locations.
b. Level 2 – basic collaboration at a distance, function in different locations, communicate
by telephone or letters to address patient issues
c. Level 3 – basic collaboration on site, different providers and separate systems, share
same facility, communication may be face to face due to co-location of service, and no
shared decision making
d. Level 4 – close collaboration in a partly integrated system, mental health and other
providers share the same space and part of their system, more face to face meeting with
team, and degree of shared decision making is influenced by logistics
e. Level 5 – close collaboration in a fully integrated system, mental health and other
professionals share same location, same vision and seamless system of care
83) The following prevalence rates for schizophrenia specific populations are accurate
EXCEPT: Non-twin sibling of a schizophrenic parent 16%
84) Which findings suggest that a patient may be abusing alcohol? Macrocytosis,
tremulousness, and hypertension
85) Which is not associated with Rett Syndrome? Associated with psychosis
86) Alcohol is involved in 34% of rapes. True
87) An adolescent with diagnosis of intermittent explosive disorder are often faced with the
following functional consequences EXCEPT: early onset of sexual behavior
88) Ethical principles that PMHNP need to consider in their work includes the following
EXCEPT: beneficial
89) All of the following characteristics may be found in an older adult with dementia. Which
one is common in a patient with Alzheimer’s disease, but uncommon in a patient with
another type of dementia? Indifference
90) Mental status examination findings that are suggestive of a person being abused
includes all EXCEPT: elated
91) A patient with diagnosis of Rett Syndrome will show the following on a mental status
examination EXCEPT: vocal tics
