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 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 an example of a complex reflection by the PMHNP?
- A. It must have been really hard to admit that to me today. I appreciate your strength and commitment to sobriety.
- B. What I am hearing is that you are having a hard time quitting even though you know your wife will leave you if you don't quit.
- C. What is the hardest part about quitting for you?
- D. It sounds like you are trying to make up your own mind regarding what you think about using marijuana. If you decide you aren't going to smoke it, it won't be because other people are pressuring you to stop.
Explanation
A complex reflection goes beyond repeating or rephrasing what the patient said—it adds deeper meaning, introduces insight, or highlights ambivalence. This statement reflects the patient’s internal conflict, acknowledges autonomy, and reframes the situation in a way that enhances self-awareness and motivation. It helps the patient explore their own motivations rather than external pressures, which is central to motivational interviewing.
Correct Answer Is:
D. It sounds like you are trying to make up your own mind regarding what you think about using marijuana. If you decide you aren't going to smoke it, it won't be because other people are pressuring you to stop.
Which of the following features is most likely to be demonstrated in a person with antisocial personality disorder (ASPD)?
- A. Repeated discussions, attempts, or contemplations of suicide or intentional self-harm
- B. Onset of conduct disorder after age 16
- C. An inability to feel guilty or personally responsible following the harm, deception, or abuse of another person
- D. 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
The PMHNP is working with a patient who says he is anxious today. Which of the following is an example of a scaling question?
- A. "Was there a time when you didn't have anxiety?"
- B. "On a scale of 1-10, with 10 being the most anxious and 1 being the least, how would you rate your anxiety today?"
- C. "Is this the most anxiety you have ever felt in your life?"
- D. "If you woke up tomorrow and your anxiety was completely gone, what would that look like?"
Explanation
A scaling question is a technique used to assess the intensity or severity of a particular symptom or experience by asking the individual to rate it on a numerical scale. In this case, the question "On a scale of 1-10, with 10 being the most anxious and 1 being the least, how would you rate your anxiety today?" is an example of a scaling question because it directly asks the patient to assess their level of anxiety on a numerical scale. This helps the provider understand the intensity of the anxiety and track changes over time. The other options do not use a scale to measure the patient's anxiety.
Correct Answer Is:
B. "On a scale of 1-10, with 10 being the most anxious and 1 being the least, how would you rate your anxiety today?"
A 36-year-old female client presents to the psychiatric-mental health nurse practitioner. She has been stable for 1 year but says her buprenorphine regimen has not been working since she started a new medication prescribed by her primary care provider. Which medication most likely contributed to the decrease in buprenorphine efficacy?
- A. Carbamazepine (Tegretol)
- B. Amitriptyline (Elavil)
- C. Fluoxetine (Prozac)
- D. Erythromycin
Explanation
Carbamazepine is a strong CYP3A4 inducer, meaning it increases the metabolism of drugs processed by this enzyme—including buprenorphine. Enhanced metabolism leads to lower plasma levels of buprenorphine, reducing its effectiveness and causing the patient to feel as though the medication "is not working." The other listed medications do not significantly decrease buprenorphine levels.
Correct Answer Is:
A. Carbamazepine (Tegretol)
Which of the following statements regarding the risk of death from suicide is most accurate?
- A. People with insomnia have an equivalent risk of death by suicide compared with the general population.
- B. People with ADHD have a lower risk of death by suicide than the general population.
- C. The rate of death by suicide in people with bipolar disorder is the highest for any disorder.
- D. The rate of death by suicide in people with bipolar disorder is higher than that of people with major depression.
Explanation
Research indicates that people with bipolar disorder have a higher risk of suicide than those with major depressive disorder. Bipolar disorder has a particularly high rate of suicide, particularly during manic or depressive episodes, as the mood fluctuations and impulsivity associated with the disorder increase the likelihood of suicidal behavior. Studies show that individuals with bipolar disorder are at a higher risk of suicide than individuals with major depressive disorder due to the severity of mood swings, impulsivity, and higher rates of comorbid psychiatric conditions, such as substance abuse.
Correct Answer Is:
D. The rate of death by suicide in people with bipolar disorder is higher than that of people with major depression.
The father of an 18-year-old girl who is being treated for generalized anxiety disorder with panic attacks calls the PMHNP with questions about the medications she was prescribed. He demands the information because the patient lives in his home and is on his health insurance plan. What should the nurse practitioner do?
- A. Give the father limited information in order to appease him.
- B. Do not give the father any information without the patient's consent.
- C. Answer all of the father's questions because she is on his health insurance plan.
- D. Tell the father to make an appointment for an evaluation.
Explanation
The Health Insurance Portability and Accountability Act (HIPAA) protects the confidentiality and privacy of patient health information. Adults 18 years and older are considered legal adults and have the right to privacy regarding their medical treatment. Even if the patient is on the father's health insurance plan or lives in his home, the nurse practitioner cannot disclose medical information without the patient's consent, unless there is a legal exception (such as in the case of a medical emergency or if the patient is unable to make decisions for themselves). The patient's privacy rights must be respected, and the PMHNP should explain this to the father, offering to speak with the patient directly to address his concerns.
Correct Answer Is:
B. Do not give the father any information without the patient's consent.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), which of the following is one of the specific criteria for avoidant personality disorder?
- A. Pervasive suspiciousness and distrust of others' motives
- B. Pervasive pattern of social inhibition
- C. Pervasive and excessive desire to be taken care of
- D. Pervasive pattern of preoccupation with control and orderliness
Explanation
Avoidant personality disorder (AVPD) is characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. People with AVPD typically avoid social situations and relationships due to a fear of rejection or criticism, and they are often extremely shy and self-conscious. This differs from other disorders such as paranoid personality disorder (which involves distrust), dependent personality disorder (which involves excessive need for care), and obsessive-compulsive personality disorder (which involves preoccupation with control and orderliness).
Correct Answer Is:
B. Pervasive pattern of social inhibition
A newly licensed and board-certified PMHNP has accepted a position at an inpatient substance use treatment facility. Because opioid withdrawal and benzodiazepine withdrawal can involve similar symptoms, distinguishing between the two can be difficult. Which of the following symptoms would aid the PMHNP in making a correct diagnosis of opioid withdrawal?
- A. Presence of nausea or vomiting
- B. Presence of frequent yawning
- C. Presence of restlessness or agitation
- D. Presence of anxiety
Explanation
Frequent yawning is a classic and distinguishing symptom of opioid withdrawal. While nausea, anxiety, restlessness, sweating, and agitation can occur in both opioid and benzodiazepine withdrawal syndromes, yawning is strongly associated with opioid withdrawal and is not typical of benzodiazepine withdrawal. This makes it a reliable clinical clue when differentiating between the two conditions.
Correct Answer Is:
B. Presence of frequent yawning
A PMHNP is managing care for a patient who has been prescribed Lithium (Lithobid) and asks about management strategies for potential adverse effects. Which of the following management strategies should the PMHNP respond with?
- A. If hypothyroidism develops, proceed with immediate discontinuation of lithium (Lithobid) therapy is indicated.
- B. If polyuria develops, divide the daily dose into four doses every 6 hr.
- C. If tremor develops, prescribe clonidine (Catapres) therapy.
- D. If nausea develops, change to a sustained-release formulation of lithium (Lithobid).
Explanation
Lithium (Lithobid) is associated with several potential side effects, including hypothyroidism, polyuria, tremor, and nausea. The management strategy for each adverse effect can vary:
•Hypothyroidism: Lithium can sometimes cause hypothyroidism, but it doesn't always require discontinuation of therapy. The PMHNP would typically manage hypothyroidism with thyroid hormone replacement rather than stopping lithium. Immediate discontinuation is not generally indicated unless the hypothyroidism is severe and unmanageable.
•Polyuria: Polyuria (increased urination) is a common side effect of lithium. However, adjusting the dosing schedule (e.g., dividing the dose) is not a typical strategy for managing polyuria. Instead, the PMHNP may address polyuria with hydration and possible dose adjustment.
•Tremor: Tremors can be a side effect of lithium, but clonidine (Catapres) is not the first-line treatment for this. A better approach is to adjust the lithium dose or use propranolol if the tremor is significant.
•Nausea: Lithium can cause gastrointestinal side effects, including nausea. A common management strategy for this is to switch to a sustained-release formulation of lithium, as it can reduce the side effects by allowing for a slower absorption rate, which can decrease nausea. This is a standard and effective strategy for minimizing gastrointestinal discomfort.
Therefore, the most appropriate response is to change to a sustained-release formulation if nausea develops.
Correct Answer Is:
D. If nausea develops, change to a sustained-release formulation of lithium (Lithobid).
The PMHNP is managing a patient with histrionic personality disorder. Which of the following therapy types is used to teach patients to focus on their unconscious motivations for being unable to commit to a stable and meaningful relationship instead of seeking out disappointing partners?
- A. Cognitive-behavioral therapy
- B. Problem-solving approach therapy
- C. Interpersonal therapy
- D. Psychoanalytic psychotherapy
Explanation
Psychoanalytic psychotherapy is the most appropriate therapy for exploring unconscious motivations, which is a key component in treating histrionic personality disorder. This therapeutic approach focuses on helping the patient gain insight into their unconscious conflicts and motivations, including the patterns of seeking out unstable or disappointing relationships. It helps them understand how their early life experiences and unconscious drives influence their behavior in relationships.
Correct Answer Is:
D. Psychoanalytic psychotherapy
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