APEA Psychiatry Exam at at Northern Kentucky University
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Free APEA Psychiatry Exam at at Northern Kentucky University Questions
The PMHNP is evaluating a 59-year-old female patient on the inpatient geropsychiatric unit. She has urinary incontinence and is semicomatose. Her serum sodium concentration is 110 mmol/L. Which of the following medications is most likely to be the cause for her condition?
- Lamotrigine (Lamictal)
- Oxcarbazepine (Trileptal)
- Olanzapine (Zyprexa)
- Lithium (Eskalith)
Explanation
Oxcarbazepine, an anticonvulsant commonly used to treat epilepsy and mood disorders, is known to cause hyponatremia (low sodium levels) as a significant side effect. The patient's serum sodium concentration of 110 mmol/L is dangerously low, which can lead to symptoms like confusion, lethargy, urinary incontinence, and coma. Oxcarbazepine induces syndrome of inappropriate antidiuretic hormone secretion (SIADH), which leads to water retention and dilutional hyponatremia.
Correct Answer Is:
B. Oxcarbazepine (Trileptal)
Based on understanding of the etiologic risk factors for Parkinson's disease, the PMHNP asks about family history and:
- History of heavy drinking
- History of smoking
- Exposure to environmental toxins
- Early childhood hypoxia
Explanation
In the context of Parkinson's disease, exposure to environmental toxins is a recognized risk factor. Environmental toxins such as pesticides, herbicides, and heavy metals have been shown to increase the likelihood of developing Parkinson's disease, especially when the exposure occurs over extended periods. In addition to genetic factors, these environmental factors are crucial in understanding the etiology of Parkinson's disease.
Correct Answer Is:
C. Exposure to environmental toxins
A 10-year-old boy is brought by his mother to the PMHNP for evaluation of a sudden onset of obsessions, compulsions, and tics. During the history and exam, the PMHNP learns that the child recently had strep throat. What is the most likely diagnosis?
- Tourette's syndrome
- Pediatric autoimmune neuropsychiatric disorders associated with Streptococcal infection (PANDAS)
- Obsessive-compulsive disorder
- Neurodevelopmental disorder
Explanation
PANDAS is a condition that typically presents with the sudden onset of obsessive-compulsive symptoms (such as obsessions, compulsions) and tics, often following a streptococcal throat infection. The rapid development of these symptoms, especially following an infection, is characteristic of PANDAS. The immune response to the strep infection is thought to affect the basal ganglia, leading to the neuropsychiatric symptoms. This condition is different from typical obsessive-compulsive disorder (OCD) or Tourette's syndrome, which do not have a known association with strep infections.
Correct Answer Is:
B. Pediatric autoimmune neuropsychiatric disorders associated with Streptococcal infection (PANDAS)
Which personality disorder's criteria includes magical thinking?
- Schizoaffective
- Paranoid
- Schizotypal
- Schizoid
Explanation
Magical thinking—believing that one’s thoughts, words, or actions can cause or prevent unrelated external events—is a core diagnostic feature of schizotypal personality disorder. Individuals with this disorder often display eccentric behavior, odd beliefs, discomfort in close relationships, and perceptual distortions. Magical thinking specifically distinguishes schizotypal personality disorder from the other listed disorders, which do not include this feature in their diagnostic criteria.
Correct Answer Is:
C. Schizotypal
The PMHNP is evaluating a 19-year-old girl with a history of childhood sexual abuse and victimization. In distinguishing borderline personality disorder from chronic posttraumatic stress disorder, which of the following would be more indicative of borderline personality disorder?
- Feeling of detachment or estrangement from others
- Affect lability often associated with fear
- Efforts to avoid real or imagined abandonment
- Irritability or intense outbursts of anger
Explanation
A persistent fear of abandonment—along with frantic efforts to avoid it—is a hallmark feature of borderline personality disorder and one of the most distinguishing diagnostic criteria. While emotional lability, anger, and detachment can occur in both BPD and chronic PTSD, the intense, pervasive fear of abandonment is uniquely characteristic of BPD and helps differentiate it from trauma-related disorders.
Correct Answer Is:
C. Efforts to avoid real or imagined abandonment
A PMHNP is prescribing a selective serotonin reuptake inhibitor (SSRI) to an adult patient for treatment of major depressive disorder. Which of the following SSRIs has enhanced, faster absorption when taken with food?
- Sertraline (Zoloft)
- Fluoxetine (Prozac)
- Escitalopram (Lexapro)
- Citalopram (Celexa)
Explanation
Sertraline (Zoloft) has enhanced and faster absorption when taken with food. The absorption rate of sertraline is increased by approximately 40% when taken with a meal, which can help with better and more consistent therapeutic effects.
Correct Answer Is:
A. Sertraline (Zoloft)
A 21-year-old unmarried man has near-daily intrusive thoughts that his neighbors knock on his door at night. He tells the PMHNP he knows this knocking is just his "imagination" because the neighbors work nights and are not home. However, he feels compelled to get out of bed and open the door, no matter what time it is. He opens and closes the door repeatedly for at least an hour, sometimes longer. He says he has had this problem "in the past" and did not seek help for it. This time it has been going on at least 6 months and is becoming "problematic." It is interfering with his ability to get a good night's sleep and he is having problems at work. His roommate is also very troubled by it. The PMHNP will diagnose him with which of the following?
- Obsessive-compulsive disorder (OCD)
- Generalized anxiety disorder
- Schizophrenia
- Agoraphobia
Explanation
This patient's symptoms — intrusive thoughts (obsessions) about his neighbors knocking on his door, coupled with the compulsive behavior of repeatedly opening and closing the door to check — are characteristic of obsessive-compulsive disorder (OCD). OCD is diagnosed when a person experiences persistent, intrusive thoughts (obsessions) and engages in repetitive behaviors or mental acts (compulsions) to reduce the anxiety caused by those thoughts. The patient recognizes that the thoughts are not based in reality, but feels compelled to act on them, which fits the criteria for OCD. The impairment in sleep, work, and social relationships further supports this diagnosis. Generalized anxiety disorder typically involves excessive worry about multiple aspects of life, but does not include specific intrusive thoughts and compulsive behaviors. Schizophrenia would involve more severe delusions or hallucinations, and agoraphobia primarily involves fear of being in situations where escape might be difficult, which is not relevant to this case.
Correct Answer Is:
A. Obsessive-compulsive disorder (OCD)
The PMHNP diagnoses a 25-year-old woman with generalized anxiety disorder with panic attacks. Terrified by the panic attacks, she requests medication, saying, "I need something to control them immediately." The patient is otherwise fit and healthy and has no history of substance abuse or dependence. Which of the following strategies would be reasonable?
- Start the patient on alprazolam and refer her to cognitive-behavioral therapy
- Start the patient on a combination of an SSRI for the long term and low-dose clonazepam for the short term
- Start the patient on any SSRI
- Start the patient in individual psychotherapy
Explanation
In this scenario, SSRIs (e.g., sertraline, fluoxetine) are the first-line treatment for generalized anxiety disorder (GAD) and panic attacks, providing long-term relief from symptoms. However, SSRIs take several weeks to become fully effective. Low-dose clonazepam, a benzodiazepine, can be used in the short term to provide immediate relief from panic attacks while the SSRI takes time to work. This combination approach ensures that the patient receives prompt symptom control for her panic attacks and long-term management of both anxiety and panic disorder, making it the most appropriate strategy.
Correct Answer Is:
B. Start the patient on a combination of an SSRI for the long term and low-dose clonazepam for the short term
A 33-year-old Mexican-American woman is diagnosed with depression by the psychiatric-mental health nurse practitioner. Considering the cultural identity of this patient, which of the following is the most appropriate clinical communication prior to beginning treatment?
- "I have worked with many Hispanic patients who have been depressed."
- "Depression is an illness, just like diabetes, and you have to take medicine for the symptoms to go away."
- "How does your family view this illness?"
- "Do you need your daughter to translate anything for you?"
Explanation
Asking “How does your family view this illness?” demonstrates cultural humility, respects the patient’s cultural background, and acknowledges the central role that family often plays in Latino/Mexican-American cultural values. It opens the door for the patient to share beliefs, stigma, or expectations related to mental health within her cultural context. This approach helps the clinician tailor treatment in a culturally sensitive and respectful way, strengthening trust and engagement.
Correct Answer Is:
C. "How does your family view this illness?"
In rare cases, obsessive-compulsive disorder is associated with which of the following infections in pediatric patients?
- Group B streptococci
- Group A streptococci
- Streptococcus pneumoniae
- Neisseria meningitidis
Explanation
In rare cases, obsessive-compulsive disorder (OCD) in pediatric patients can be associated with an infection caused by Group A streptococci (GAS). This association is most often seen in the context of PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections), a condition in which a strep throat infection or other GAS infections (such as scarlet fever) trigger the sudden onset of OCD symptoms or tic disorders. The theory is that the infection triggers an autoimmune response that affects the basal ganglia, leading to the development of these neuropsychiatric symptoms.
Correct Answer Is:
B. Group A streptococci
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