APEA Psychiatry Exam
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Free APEA Psychiatry Exam Questions
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
A 37-year-old man presents to the PMHNP based on a referral from his primary care physician, who suspects rapid cycling bipolar I disorder. Which of the following should be ordered to rule out an underlying medical etiology?
- A. Liver function test
- B. CSF 5-HIAA level
- C. Thyroid function tests
- D. Dexamethasone suppression test
Explanation
Thyroid dysfunction, particularly hyperthyroidism or hypothyroidism, can present with symptoms similar to mood disorders, including bipolar disorder. In cases of rapid cycling bipolar disorder, it is important to rule out thyroid dysfunction as a possible underlying cause, as thyroid imbalances can affect mood and cause symptoms similar to those of bipolar disorder. Thyroid function tests (T3, T4, and TSH) should be ordered to assess the thyroid's role in the patient's mood instability.
Correct Answer Is:
C. Thyroid function tests
A 31-year-old woman presents to the PMHNP for an evaluation. Her chief complaint is "depression." The nurse practitioner asks her to complete a Zung Depression Scale, and the client's score is a 51. What does this score represent?
- A. Normal mental state
- B. Mild depression
- C. Moderate depression
- D. Severe depression
Explanation
On the Zung Self-Rating Depression Scale, a score of 50–59 corresponds to mild depression. The scale ranges as follows:
• 20–49 = normal
• 50–59 = mild depression
• 60–69 = moderate to marked depression
• 70+ = severe depression
A score of 51 therefore indicates mild depressive symptoms.
Correct Answer Is:
B. Mild depression
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?
- A. Feeling of detachment or estrangement from others
- B. Affect lability often associated with fear
- C. Efforts to avoid real or imagined abandonment
- D. 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 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?
- A. Tourette's syndrome
- B. Pediatric autoimmune neuropsychiatric disorders associated with Streptococcal infection (PANDAS)
- C. Obsessive-compulsive disorder
- D. 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)
A 51-year-old woman with a history of generalized anxiety disorder (GAD) has been treated with 20 mg of paroxetine (Paxil) for 6 months. The dose was increased to 40 mg at her last visit 2 weeks ago due to increased symptoms of anxiety. Now she reports "hot flashes" and significant hyperhidrosis to her psychiatric mental health nurse practitioner. Which of the following statements is NOT correct about this clinical scenario?
- A. The client is experiencing a dose-dependent antidepressant-related hyperhidrosis.
- B. Selective serotonin reuptake inhibitors (SSRIs) may be less effective in women over 50, especially if they are not taking estrogen.
- C. The PMHNP should switch the client to escitalopram (Lexapro), which has a lower potential for dose-dependent hyperhidrosis.
- D. An appropriate next step would be to reduce the dose of paroxetine back to 20 mg, add a short-term adjunctive treatment for acute anxiety, and draw labs to check her hormone levels prior to making further medication changes.
Explanation
This statement is NOT correct. While escitalopram (Lexapro) is an SSRI that is often considered to have a more favorable side-effect profile than paroxetine (Paxil), it does not necessarily have a lower potential for dose-dependent hyperhidrosis. Hyperhidrosis (excessive sweating) can be a dose-dependent side effect of SSRIs, including paroxetine and escitalopram. Switching to escitalopram may not resolve the issue of hyperhidrosis, as both medications are in the same class and can cause similar side effects.
Correct Answer Is:
C. The PMHNP should switch the client to escitalopram (Lexapro), which has a lower potential for dose-dependent hyperhidrosis.
During a psychiatric evaluation, the psychiatric-mental health nurse practitioner conducts a psychiatric review of systems (ROS) in which she reviews common psychiatric symptoms that may not have been elicited in the history of present illness (HPI). Which of the following questions is most likely designed to elicit a response for the system "mood"?
- A. What do you think of your appearance?
- B. Do you worry about your physical health more than other people?
- C. Is it hard for you to control or stop your worrying?
- D. Have there ever been periods of time when you needed much less sleep but still felt very energized, happy, or outgoing?
Explanation
This question is specifically designed to assess mood by asking about hypomanic or manic episodes, which are characterized by a decreased need for sleep, elevated mood, and increased energy levels. This kind of questioning helps the clinician evaluate the patient's mood symptoms, specifically looking for signs of bipolar disorder or mood elevation that could indicate mood instability. The other questions are more related to anxiety, self-image, or health concerns, and do not directly assess mood in the same way.
Correct Answer Is:
D. Have there ever been periods of time when you needed much less sleep but still felt very energized, happy, or outgoing?
A patient who has bipolar disorder and is prescribed carbamazepine (Tegretol) is experiencing manifestations of dizziness, headache, lethargy, and changes in mental status. Which of the following conditions can the PMHNP anticipate for this patient?
- A. Hepatotoxicity
- B. Thrombocytopenia
- C. Hyponatremia
- D. Toxic epidermal necrolysis
Explanation
Carbamazepine (Tegretol) is an anticonvulsant and mood stabilizer commonly used in the treatment of bipolar disorder. One of the known adverse effects of carbamazepine is hyponatremia (low sodium levels), which can cause symptoms like dizziness, headache, lethargy, and changes in mental status, as seen in this patient. This side effect occurs due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH), which leads to water retention and dilution of sodium levels in the blood.
Correct Answer Is:
C. Hyponatremia
Of the following, which disorder is more common in higher-income countries than lower-income countries?
- A. Avoidant personality disorder
- B. Posttraumatic stress disorder
- C. Bipolar disorder
- D. Delusional disorder
Explanation
Bipolar disorder is more commonly diagnosed in higher-income countries compared to lower-income countries. This may be due to several factors, including greater access to healthcare, better diagnostic tools, and more widespread awareness of mental health disorders. In contrast, disorders like posttraumatic stress disorder (PTSD) are more prevalent in lower-income countries due to higher rates of trauma and conflict. Avoidant personality disorder and delusional disorder are not typically linked to income levels in the same way.
Correct Answer Is:
C. Bipolar disorder
A 42-year-old married man presents for a psychiatric evaluation as part of an ongoing divorce proceeding and resulting custody dispute. He displays contempt and a lack of empathy for his ex-wife, and he is angry that he is being "forced" to do this by the court. He seems to believe he is above the law and expresses feelings of entitlement and specialness. He wears expensive suits and always makes a point of remarking on the brand names of the clothing and watches he wears. He appears disappointed if the PMHNP does not seem impressed by his labels. He displays no signs of depression, mania, or psychosis. What is the most likely diagnosis?
- A. Histrionic personality disorder
- B. Antisocial personality disorder
- C. Narcissistic personality disorder
- D. Borderline personality disorder
Explanation
The patient's behavior aligns most closely with narcissistic personality disorder (NPD). Individuals with NPD typically have an inflated sense of their own importance, a deep need for admiration, and a lack of empathy for others. The man’s contempt for his ex-wife, his feelings of entitlement, and his preoccupation with his appearance (expensive suits, brand names, and expecting others to be impressed) are all characteristic of narcissism. This disorder is marked by a pervasive pattern of grandiosity, need for admiration, and lack of empathy, which is evident in his interactions.
Correct Answer Is:
C. Narcissistic personality disorder
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