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 statements is most accurate regarding alcohol use in the United States?
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Alcohol use has increased among males but not among females
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Females consume more alcohol and cause more alcohol-related injuries than males
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Females are more susceptible to alcohol-induced liver inflammation and cardiovascular disease than males
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Rates of alcohol-related deaths have decreased among males and females
Explanation
Research has shown that females are more susceptible to the adverse effects of alcohol, including alcohol-induced liver inflammation and cardiovascular disease, compared to males. This is partly due to physiological differences, such as lower levels of alcohol dehydrogenase (an enzyme that helps metabolize alcohol), smaller body size, and differences in how alcohol is processed by the liver. These factors make women more vulnerable to liver damage and cardiovascular issues even with lower levels of alcohol consumption.
Correct Answer Is:
C. Females are more susceptible to alcohol-induced liver inflammation and cardiovascular disease than males
How does the diagnosis of persistent depressive disorder differ from major depressive disorder?
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The onset of persistent depressive disorder is usually late in life
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Hypomanic episodes are present in persistent depressive disorder
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Persistent depressive disorder has a high-grade chronicity
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Persistent depressive disorder is subjective in nature
Explanation
Persistent depressive disorder (PDD), also known as dysthymia, is characterized by chronic, low-grade depression lasting for at least two years (one year in children and adolescents). Unlike major depressive disorder (MDD), which is episodic and may last for weeks to months, PDD is considered a long-term condition with high-grade chronicity, meaning it persists over a longer duration and is less likely to remit without treatment.
Correct Answer Is:
C. Persistent depressive disorder has a high-grade chronicity
The PMHNP is seeing patients at an inpatient substance abuse facility. She is called to assist a 42-year-old patient suspected of benzodiazepine overdose who has not responded to 3 mg of flumazenil (Romazicon) administered intravenously (IV). The most appropriate intervention at this time would be to:
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Wait 5 minutes and administer a 1-mg dose of flumazenil IV.
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Wait 20 minutes and administer another 3 mg of flumazenil.
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Do not administer another dose of flumazenil.
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Immediately administer another 3-mg dose of flumazenil IV.
Explanation
Flumazenil is a benzodiazepine antagonist used to reverse the effects of benzodiazepine overdose. However, after an initial dose of 3 mg flumazenil may be ineffective if there is a significant overdose, as the effects may not be reversed completely or rapidly. Moreover, repeated doses of flumazenil are not recommended due to the risk of seizures, especially in patients with chronic benzodiazepine use, as flumazenil can precipitate withdrawal symptoms, including seizures. After administering a dose, the clinician should wait and observe, as the effects of the overdose may not be fully reversed by flumazenil. If the patient does not respond, it is generally more appropriate to supportively manage the overdose with other measures such as airway support, oxygenation, and monitoring, rather than administering more flumazenil.
Correct Answer Is:
C. Do not administer another dose of flumazenil.
A 71-year-old man on the geriatric behavioral inpatient unit displays ataxia, vestibular dysfunction, and a variety of ocular motility abnormalities such as horizontal nystagmus and a sluggish reaction to light. He has a 40-year history of alcohol abuse. What is his most likely diagnosis?
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Creutzfeldt-Jacob disease
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Lewy body dementia
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Wernicke's encephalopathy
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Delirium
Explanation
Wernicke's encephalopathy is a neurologic emergency caused by thiamine (vitamin B1) deficiency, most commonly seen in individuals with long-term alcohol use disorder. The classic triad includes ataxia, ophthalmoplegia or ocular abnormalities (such as nystagmus and sluggish pupillary responses), and confusion. Although not every patient presents with all three symptoms, this man’s long alcohol history combined with his ataxia and ocular findings makes Wernicke's encephalopathy the most likely diagnosis.
Correct Answer Is:
C. Wernicke's encephalopathy
An adult is being evaluated in a psychiatry clinic. At the end of the evaluation, the clinician explains that their presentation is consistent with a diagnosis of obsessive-compulsive disorder. The diagnosis and treatment options are reviewed. The clinician recommends the initiation of fluoxetine (Prozac) and explains the typical dosing and side effects of the medication. Which of the following can ensure the patient understands the diagnosis and treatment plan?
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Ask the patient if they have any questions
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Ask the patient to summarize the information
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Repeat the information, pausing to permit the patient to ask questions
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Call the patient in 2 weeks to ensure they are taking the medicine correctly
Explanation
Asking the patient to summarize the information is the best way to ensure they understand the diagnosis and treatment plan. This approach actively engages the patient and helps the clinician assess whether the key points were clearly communicated and understood. Summarizing allows the clinician to identify any misunderstandings or gaps in the patient's knowledge, which can then be addressed in real-time.
Correct Answer Is:
B. Ask the patient to summarize the information
An adult patient presents with a new onset bilateral hand tremor that started one week ago after a minor motor vehicle accident. The patient has a history of medication-controlled bipolar disorder and is taking lithium (Lithobid). On assessment, the patient denies hitting their head, loss of consciousness, or altered mental status after the accident. They also indicate they had minor neck pain that is responding well to over-the-counter nonsteroidal anti-inflammatory drug (NSAID) therapy, which they are taking as directed. The review of systems is negative except for recent nausea and vomiting. Which of the following is the most likely explanation for the patient's presentation?
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The patient is experiencing signs and symptoms of NSAID overdose.
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The patient injured a cervical nerve root in the motor vehicle accident.
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The patient is experiencing localized seizures from a minor brain injury sustained in the accident.
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The patient is experiencing medication toxicity due to decreased drug clearance.
Explanation
The patient's new onset bilateral hand tremor, nausea, and vomiting are concerning for lithium toxicity. Lithium is primarily cleared by the kidneys, and any factors that decrease kidney function or affect renal clearance can lead to increased lithium levels in the body. Since the patient has a history of bipolar disorder and is currently taking lithium, the most likely cause of the tremor is lithium toxicity, which can occur if there is a decrease in drug clearance. The patient’s minor neck pain from the accident, use of NSAIDs, and possible dehydration or altered fluid balance could have contributed to impaired renal function, leading to elevated lithium levels and toxicity.
Correct Answer Is:
D. The patient is experiencing medication toxicity due to decreased drug clearance.
Which of the following features is most likely to be demonstrated in a person with antisocial personality disorder (ASPD)?
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Repeated discussions, attempts, or contemplations of suicide or intentional self-harm
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Onset of conduct disorder after age 16
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An inability to feel guilty or personally responsible following the harm, deception, or abuse of another person
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Short-term thoughts of persecution/victimhood or severe derealization or depersonalization
Explanation
Antisocial Personality Disorder (ASPD) is characterized by a pattern of disregard for and violation of the rights of others. A core feature of ASPD is the lack of remorse or guilt for actions that harm or deceive others. Individuals with ASPD may harm, deceive, or abuse others without any emotional or moral regret. This lack of guilt is a hallmark symptom and is crucial for diagnosing the disorder.
Correct Answer Is:
C. An inability to feel guilty or personally responsible following the harm, deception, or abuse of another person
Clomipramine (Anafranil) is a tricyclic antidepressant (TCA) used to treat obsessive-compulsive disorder, panic disorder, and major depressive disorder. Which of the following symptoms may occur if this medication is taken concurrently with buspirone (Buspar)?
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Hyperthermia
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Tardive dyskinesia
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Hypotonia
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Bradycardia
Explanation
The combination of clomipramine (a tricyclic antidepressant) and buspirone (an anxiolytic) can potentially lead to serotonin syndrome, a condition that occurs when there is an excess of serotonin in the brain. This is more likely when serotonergic medications like clomipramine and buspirone are taken together. Hyperthermia (increased body temperature) is one of the symptoms of serotonin syndrome, along with agitation, increased reflexes, and other autonomic dysfunctions.
Correct Answer Is:
A. Hyperthermia
A PMHNP is honest with an adult patient regarding their new diagnosis of bipolar I disorder. The patient expresses worry about what their future holds. The PMHNP tells the patient that they are committed to helping them achieve remission by advocating for treatment options. Which of the following ethical terms best defines this scenario?
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Beneficence
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Fidelity
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Non-maleficence
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Autonomy
Explanation
Fidelity refers to the commitment to keeping promises and maintaining trust with the patient. In this scenario, the PMHNP demonstrates fidelity by being honest with the patient about their diagnosis and by committing to help the patient achieve remission. The PMHNP also reassures the patient that they are dedicated to advocating for treatment options, which reflects a promise of ongoing care and support.
Correct Answer Is:
B. Fidelity
An adult patient, who has a history of multiple prior depressive episodes and obesity, presents after jejunoileal bypass surgery for weight loss. Which of the following statements regarding the pharmacological treatment of their depression is the most accurate?
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Tricyclic antidepressants (TCAs) are recommended first-line treatments for depression after bariatric surgery.
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Medications should always be given in a solid form to aid in absorption after bariatric surgery.
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Post-surgical changes do not impact absorption, so dosing should remain consistent after bariatric surgery.
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Changing the dose of medication or starting immediate-release medication may be required after bariatric surgery.
Explanation
Bariatric surgery, particularly procedures like jejunoileal bypass, can significantly alter the absorption of medications. The anatomical changes (such as reduced stomach size or altered intestinal length) can affect how medications are absorbed, potentially requiring dose adjustments or switching to immediate-release formulations to ensure adequate therapeutic effects. Medications may need to be given in a form that is better absorbed post-surgery, such as liquids or crushable tablets, depending on the specific surgical procedure. This makes it essential to monitor the patient closely and adjust pharmacological treatments as needed after bariatric surgery.
Correct Answer Is:
D. Changing the dose of medication or starting immediate-release medication may be required after bariatric surgery.
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