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 seeing a 34-year-old male patient who recently decided to stop smoking marijuana after smoking it for 15 years. He is having trouble abstaining from marijuana, even though his wife has threatened to divorce him if he continues to smoke. Using the principles of motivational interviewing, which of the following would be the most appropriate response from the PMHNP to enhance his motivation to change?
- A. I hear you saying you want to save your marriage, and I also hear you saying you want to keep smoking marijuana.
- B. I thought you said you don't want to get divorced.
- C. Think about what you were willing to do for your addiction. Think about all the time, effort, and money you put into getting high. You'd do anything to get your drugs. Why are you not willing to do anything for your recovery?
- D. I really think you need to tell your family that you used again. You won't be able to stay clean and sober if you are not honest with the people closest to you in your life.
Explanation
In motivational interviewing (MI), the goal is to engage the patient in a non-judgmental and empathetic way to explore their own motivations and resolve ambivalence about change. Response A is an example of reflective listening, which helps the patient acknowledge the ambivalence they are feeling (wanting to save the marriage versus wanting to continue smoking marijuana) and encourages them to explore their conflicting desires without feeling judged. This approach promotes a collaborative environment and enhances the patient's intrinsic motivation to change.
Correct Answer Is:
A. I hear you saying you want to save your marriage, and I also hear you saying you want to keep smoking marijuana.
A 32-year-old single man has a childhood history of repeated instances of torturing animals, setting fires, stealing, running away from home, and skipping school. These behaviors started at age 9 years. As an adult, he has a history of lying and engaging in check forgery. He has multiple felony convictions for physical assault. He also has fathered several children with several women, none of whom he married. He has used aliases to avoid paying child support. There is no history of manic, depressive, or psychotic symptoms. What is the appropriate diagnosis?
- A. Avoidant personality disorder
- B. Antisocial personality disorder
- C. Narcissistic personality disorder
- D. Schizoid personality disorder
Explanation
The patient’s history of persistent antisocial behaviors—such as animal abuse, stealing, lying, physical assault, and legal trouble—starting in childhood and continuing into adulthood is characteristic of antisocial personality disorder (ASPD). ASPD is defined by a pattern of disregard for and violation of the rights of others and often includes deceitfulness, impulsivity, aggression, and irresponsibility. The fact that the patient meets the criteria for conduct disorder before age 15 (e.g., torturing animals, stealing, and running away) further supports the diagnosis of ASPD, as the disorder requires evidence of conduct disorder in childhood. There are no signs of manic, depressive, or psychotic symptoms, ruling out other psychiatric disorders.
Correct Answer Is:
B. Antisocial personality disorder
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?
- A. Levothyroxine (Synthroid)
- B. Metformin (Glucophage)
- C. Lisinopril (Prinivil)
- D. 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)
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?
- A. Obsessive-compulsive disorder (OCD)
- B. Generalized anxiety disorder
- C. Schizophrenia
- D. 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)
Two weeks ago, the PMHNP prescribed the antidepressant escitalopram (Lexapro) for a 28-year-old female client with generalized anxiety disorder. At her initial appointment, she scored 28 on the Hamilton Anxiety Rating Scale (HAM-A). At today's follow-up visit, she scored 26. She reports no side effects from the Lexapro. Which of the following is the next step for the PMHNP?
- A. Discontinue treatment with Lexapro
- B. Make no changes
- C. Add an augmenting agent
- D. Switch to a different antidepressant
Explanation
The patient has shown a slight improvement in her symptoms, with her HAM-A score decreasing from 28 to 26. Although this is not a large reduction, it indicates that the current treatment with escitalopram (Lexapro) is having some effect. For patients with generalized anxiety disorder (GAD), it can take several weeks to see a more significant response to SSRIs like escitalopram. Since the patient is tolerating the medication without side effects, and there is some improvement, no changes are needed at this time.
Correct Answer Is:
B. Make no changes
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), how long must symptoms be present to justify a diagnosis of a specific phobia?
- A. At least 2 months
- B. At least 6 months
- C. At least 12 months
- D. At least 2 years
Explanation
According to the DSM-5-TR, for a diagnosis of specific phobia, the symptoms must be present for at least 6 months. This duration helps differentiate persistent fears from more transient or situational fears. The phobia must cause significant distress or impairment in daily functioning, and the individual must experience excessive fear or anxiety when exposed to the object or situation, which is out of proportion to the actual danger.
Correct Answer Is:
B. At least 6 months
The PMHNP is assessing an adolescent patient with adjustment disorder. Which of the following findings indicate a worse prognosis for this patient?
- A. Prognosis is worse if coping skills are ineffective or overwhelmed
- B. Prognosis is worse if there is a therapeutic alliance with the care team
- C. Prognosis is worse if additional stressors in the patient’s environment are limited or removed
- D. Prognosis is worse if comorbid conditions are well managed
Explanation
In adjustment disorder, the prognosis is typically influenced by how well a patient can cope with the stressors they are experiencing. If coping skills are ineffective or overwhelmed, the patient is less able to manage stress, which can lead to chronic symptoms and long-term difficulties. A patient with poor coping mechanisms or who struggles to adapt to stressors is at a higher risk for developing persistent psychological symptoms or transitioning into more severe mental health conditions, such as anxiety, depression, or other mood disorders.
Correct Answer Is:
A. Prognosis is worse if coping skills are ineffective or overwhelmed
A 29-year-old nurse presents to the PMHNP for evaluation after a traumatic event. Two weeks ago, she was attacked by a patient on the behavioral unit where she works. She says she is having flashbacks about the event and keeps wondering "what could I have done to prevent it?" She has had several panic attacks since the incident, and she is to the point now where she is considering quitting nursing. She says, "I guess I am too weak to be a nurse if I can't handle one attack." What is her most likely diagnosis?
- A. Post-traumatic stress disorder (PTSD)
- B. Acute stress disorder
- C. Adjustment disorder
- D. Dissociative identity disorder
Explanation
The most likely diagnosis for this patient is acute stress disorder (ASD). ASD occurs when an individual experiences trauma and develops symptoms such as intrusive memories, flashbacks, anxiety, and panic attacks within 3 days to 4 weeks of the event. This patient’s symptoms, including flashbacks, panic attacks, and feelings of helplessness following the traumatic event (the attack), are consistent with ASD. Since the symptoms have been present for only two weeks, acute stress disorder is the most appropriate diagnosis. If symptoms persist beyond one month, the diagnosis would be reconsidered as post-traumatic stress disorder (PTSD).
Correct Answer Is:
B. Acute stress disorder
A 29-year-old single woman presents to the PMHNP for evaluation of a chief complaint of fatigue. She states she has been feeling "tired" and "empty" for the past 4 years. She sleeps up to 11 hours a day and is still tired. She has trouble concentrating and has difficulty making decisions. She has gained 10 pounds over the past 2 years due to overeating and little physical activity. She reports no suicidal ideation or manic symptoms, and no delusions or hallucinations. What is the most likely diagnosis?
- A. Major depressive disorder
- B. Generalized anxiety disorder
- C. Persistent depressive disorder (Dysthymia)
- D. Cyclothymic disorder
Explanation
Persistent depressive disorder is characterized by chronic depressive symptoms lasting at least 2 years in adults. This patient reports a 4-year history of low mood, fatigue, hypersomnia, overeating, low energy, and poor concentration—all symptoms consistent with dysthymia. Her symptoms are continuous rather than episodic, and there is no evidence of mania, hypomania, or psychosis. These long-standing, lower-grade depressive symptoms fit the diagnostic criteria for persistent depressive disorder rather than major depressive disorder, which requires discrete episodes lasting at least 2 weeks.
Correct Answer Is:
C. Persistent depressive disorder (Dysthymia)
Which of the following aspects of bipolar disorder predicts a favorable response to lithium treatment?
- A. Rapid cycling
- B. Euthymic intervals
- C. Psychotic symptoms
- D. Mixed episodes
Explanation
Euthymic intervals (periods of stable mood) are generally associated with a better response to lithium treatment. Lithium is most effective for preventing mood episodes in individuals who experience long periods of mood stability between episodes of mania and depression, which is characteristic of those with euthymic intervals.
Correct Answer Is:
B. Euthymic intervals
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