APEA Psychiatry Exam at at Northern Kentucky University
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Free APEA Psychiatry Exam at at Northern Kentucky University Questions
Which of the following tools would the PMHNP use to aid in diagnosis of a 69-year-old woman with depressive symptoms?
- St. Louis University Mental Status exam (SLUMS)
- Mini Mental Status Exam (MMSE)
- Geriatric Depression Scale (GDS)
- Montreal Cognitive Assessment (MoCA)
Explanation
The Geriatric Depression Scale (GDS) is specifically designed to assess depressive symptoms in older adults. It minimizes cognitive load and focuses on emotional and functional symptoms relevant to geriatric populations. Because this patient is 69 and presenting with depressive symptoms, the GDS is the most appropriate tool to aid diagnosis. SLUMS, MMSE, and MoCA are cognitive screening tools used primarily to evaluate dementia, not depression.
Correct Answer Is:
C. Geriatric Depression Scale (GDS)
A 17-year-old girl is referred to the PMHNP after pulling her eyebrow hair out to the point of scarring. She says she has a "unibrow" and looks like a "Neanderthal" unless she pulls out the hair. The PMHNP asks to see a photo of the patient before she started pulling out her hair; it was not unusual. What is the most appropriate diagnosis?
- Body dysmorphic disorder
- Delusional disorder, somatic type
- Trichotillomania
- Normal age-appropriate concerns
Explanation
The most appropriate diagnosis is body dysmorphic disorder (BDD). The patient is overly preoccupied with a perceived flaw in her appearance (in this case, a "unibrow"), which leads to excessive grooming and hair-pulling behavior. The photo comparison shows that her eyebrows are not actually abnormal, which suggests that her perception of her appearance is distorted, which is a hallmark feature of BDD. People with BDD have an excessive focus on perceived flaws that others may not see, and they often engage in repetitive behaviors to "correct" these flaws.
Correct Answer Is:
A. Body dysmorphic disorder
A 28-year-old woman with a history of unstable interpersonal relationships, self-harm, suicide attempts, mood lability, substance abuse, and extreme irritability presents to the psychiatric-nurse practitioner for an evaluation. She states, "I just want to know what's wrong with me. I feel like I spend 95% of my time either angry or on the floor crying in the fetal position." The PMHNP suspects this client has borderline personality disorder. In this scenario, how would the discomfort the client experiences as a result of her behaviors best be described?
- Ego-dystonic
- Ego-syntonic
- Maladaptive
- Inflexible
Explanation
In this case, the client describes significant distress and discomfort with her behavior, indicating that her behaviors are in conflict with her self-image and values. This is characteristic of ego-dystonic behaviors, where the individual is aware that their actions and emotions are disruptive or maladaptive and cause personal distress. In contrast, ego-syntonic behaviors are consistent with the person's values and self-image, meaning the individual does not recognize their behaviors as problematic. Maladaptive and inflexible could describe certain traits or behaviors, but they do not specifically address the client's experience of distress in relation to her behaviors, as ego-dystonic does.
Correct Answer Is:
A. Ego-dystonic
A local women's health NP calls the psychiatric-mental health NP to consult on a 27-year-old pregnant patient in her third trimester who just completed the Edinburgh Postnatal Depression Scale (EPDS). The patient responded "yes, quite often" to question 10. How should the PMHNP advise the WHNP?
- Because question 10 asks about suicidal thoughts, the patient should be hospitalized on a psychiatric unit immediately.
- If she has no history of mental health issues, keep a close eye on her. A "yes" answer to question 10 in and of itself is not cause for concern.
- Because question 10 asks about thoughts of self-harm, this client requires particularly close monitoring, a full psychiatric evaluation, and assessment to determine her mental health needs.
- Start her on Wellbutrin and refer her to a therapist.
Explanation
The Edinburgh Postnatal Depression Scale (EPDS) includes a question about thoughts of self-harm or suicide (question 10), which requires careful attention, especially during pregnancy. A response of "yes, quite often" is concerning and indicates a need for immediate follow-up. Although not every "yes" answer necessarily means imminent risk, it warrants close monitoring, a full psychiatric evaluation, and a thorough assessment to determine mental health needs. It is important to assess the degree of suicidal ideation, presence of a plan, and intent, which are critical for appropriate intervention. Starting medication or referring to therapy without a full assessment could miss significant risks to the patient and fetus. Hospitalization may be necessary if there is significant risk of harm to the patient or fetus, but this should be determined after a full evaluation.
Correct Answer Is:
C. Because question 10 asks about thoughts of self-harm, this client requires particularly close monitoring, a full psychiatric evaluation, and assessment to determine her mental health needs.
Which of the following statements about antisocial personality disorder is most accurate?
- Antisocial personality disorder cannot be diagnosed before the age of 18.
- Antisocial personality disorder is more common in patients assigned female at birth.
- Antisocial personality disorder occurs most often in those of Latinx ethnicity.
- Autism spectrum disorder commonly leads to the development of antisocial personality disorder.
Explanation
According to the DSM-5, antisocial personality disorder (ASPD) cannot be diagnosed until the age of 18, although the individual must show signs of conduct disorder before the age of 15. Conduct disorder is a childhood precursor to ASPD, characterized by persistent patterns of aggression, deceit, and rule-breaking behaviors. Diagnosing ASPD prior to age 18 would be inappropriate because antisocial behaviors seen in children may be developmental and not necessarily indicative of a personality disorder.
Correct Answer Is:
A. Antisocial personality disorder cannot be diagnosed before the age of 18.
A 32-year-old woman presents to the psychiatric nurse practitioner with a 3-month history of concentration difficulty, irritability, and depression. She has not experienced these symptoms at any other time in her life. During an extensive history inquiry, the woman states that 4 months prior to her visit with the nurse practitioner, she had experienced a short-term flu-like illness and noticed a bull's eye-shaped rash on her calf. She has noted no other symptoms since then, until the mood symptoms began. Her physical examination and laboratory findings are within normal limits. Which of the following is the most likely diagnosis?
- Syphilis
- Chronic fatigue syndrome
- Lyme disease
- Adult attention-deficit hyperactivity disorder
Explanation
The patient's history and symptoms suggest Lyme disease, which is caused by the Borrelia burgdorferi bacteria and transmitted through tick bites. The bull's-eye-shaped rash, known as erythema migrans, is a hallmark sign of early Lyme disease and often appears a few days to weeks after a tick bite. The mood symptoms (irritability, concentration difficulty, and depression) she is experiencing can be a manifestation of neuroborreliosis, a neurological complication of Lyme disease, which can affect the central nervous system and result in cognitive and mood changes.
Correct Answer Is:
C. Lyme disease
A 22-year-old woman recently began treatment with fluoxetine (Prozac) for major depressive disorder. She now exhibits symptoms of mania. She completes the Young Mania Rating Scale (YMRS) and her score is 25. What does this indicate?
- Moderate mania
- Mild mania
- Severe mania
- Minimal mania
Explanation
The Young Mania Rating Scale (YMRS) is a widely used tool to assess the severity of mania symptoms in patients with bipolar disorder or those experiencing medication-induced mania. A score of 25 on the YMRS typically indicates moderate mania. The YMRS scores mania severity as follows:
•0-11: Minimal or no mania
•12-19: Mild mania
•20-39: Moderate mania
•40 or above: Severe mania
In this case, a score of 25 falls within the moderate mania range, indicating significant symptoms that are likely interfering with the patient's functioning. This is especially concerning given that the patient recently started fluoxetine (Prozac), an SSRI, which can induce mania in individuals with a predisposition to bipolar disorder.
Correct Answer Is:
A. Moderate mania
Which of the following cardiac problems mimics anxiety with symptoms of tachycardia, chest pain, dizziness, and panic?
- Cardiomegaly
- Mitral valve prolapse (MVP)
- Pheochromocytoma
- Congestive heart failure
Explanation
Mitral valve prolapse (MVP) is a condition where the mitral valve of the heart doesn't close properly, and it can lead to symptoms that mimic anxiety, such as tachycardia, chest pain, dizziness, and a sense of panic. These symptoms can be distressing and often cause individuals to seek medical attention, believing they are experiencing anxiety or a panic attack. While other conditions, such as pheochromocytoma, can also cause similar symptoms, MVP is the most commonly recognized cardiac condition that presents with symptoms resembling anxiety.
Correct Answer Is:
B. Mitral valve prolapse (MVP)
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?"
An NP is providing patient education about the risks of abruptly stopping a medication. Which of the following medications is associated with the most significant discontinuation/withdrawal syndrome, if stopped abruptly?
- Levothyroxine (Synthroid)
- Metformin (Glucophage)
- Lisinopril (Prinivil)
- Sertraline (Zoloft)
Explanation
Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI), and discontinuing SSRIs abruptly can lead to a significant withdrawal syndrome, known as SSRI discontinuation syndrome. Symptoms can include dizziness, irritability, nausea, headache, electric shock-like sensations, and flu-like symptoms. These symptoms occur due to the rapid change in serotonin levels in the brain. This makes it important to taper off SSRIs slowly under medical supervision.
Correct Answer Is:
D. Sertraline (Zoloft)
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