APEA Psychiatry Exam at at Northern Kentucky University
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Free APEA Psychiatry Exam at at Northern Kentucky University Questions
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?
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Post-traumatic stress disorder (PTSD)
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Acute stress disorder
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Adjustment disorder
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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 44-year-old woman presents to the psychiatric nurse practitioner at the urging of, and accompanied by, her older sister. The patient identifies her sister as her "best friend." Her chief complaint, according to the sister, is "lifelong social anxiety." The client has a constricted affect and speaks in mostly one- or two-word answers. Her clothes are mismatched and are too large for her. The sister says, "All she wants to do is sit at home and watch Ancient Aliens." The PMHNP asks the woman if she has ever seen a UFO, and she suspiciously says "Yes, but my sister doesn't believe me. I have had ESP ever since I saw the UFO when I was 6 years old." Of the following, which most closely represents this clinical scenario?
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Schizoid personality disorder
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Schizotypal personality disorder
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Paranoid personality disorder
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Antisocial personality disorder
Explanation
The patient's eccentric behavior, odd beliefs (such as having ESP after seeing a UFO), and social anxiety are characteristic features of schizotypal personality disorder. This disorder is marked by social withdrawal, odd thinking, and magical thinking—traits that the patient exhibits, such as believing in ESP. The constricted affect, odd clothing, and longstanding social anxiety further align with schizotypal personality disorder. It is a disorder involving eccentric behaviors and cognitive or perceptual distortions, which is a good fit for this patient's symptoms.
Correct Answer Is:
B. Schizotypal personality disorder
The PMHNP is conducting an evaluation on a 45-year-old divorced man who has a history of depression and substance use disorder. He wants to know if the substance use disorder caused the depression, or if the depression caused the substance use disorder. What is the most appropriate response?
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"It doesn't really matter. We'll treat both conditions."
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"Many clients experience both, and it was most likely a combination of many factors that led to the development of each condition."
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"It was most likely the depression that caused the substance use disorder."
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"It was most likely the substance use disorder that caused the depression."
Explanation
The most appropriate response acknowledges that both depression and substance use disorder often have complex, bidirectional relationships. In many cases, it is not possible to determine which condition came first, as substance use can both contribute to the development of depression, and depression can increase the risk of substance use as individuals may self-medicate. Thus, it is important to recognize that the development of each condition is likely influenced by a combination of genetic, environmental, and psychological factors. This response also reflects the importance of treating both conditions simultaneously, which is key to improving the patient's overall mental health and functioning.
Correct Answer Is:
B. "Many clients experience both, and it was most likely a combination of many factors that led to the development of each condition."
A 22-year-old female patient was diagnosed with major depressive disorder by her primary care provider, who referred her to the PMHNP for treatment and further evaluation. Which of the following tools helps gauge the intensity of depression in patients who have been diagnosed with a depressive syndrome?
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Beck Hopelessness Scale
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St. Louis University Mental Status Exam (SLUMS)
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Patient Health Questionnaire-9 (PHQ-9)
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Beck Depression Inventory (BDI)
Explanation
The PHQ-9 is a widely used, validated tool for assessing the severity of depression in individuals diagnosed with major depressive disorder (MDD). It consists of 9 questions that correspond to the diagnostic criteria for MDD and help gauge the intensity of depressive symptoms. It is commonly used in clinical settings to assess both the presence and severity of depression and is useful for monitoring treatment response.
Correct Answer Is:
C. Patient Health Questionnaire-9 (PHQ-9)
An adult patient is being evaluated for excessive worrying and is diagnosed with generalized anxiety disorder. The nurse practitioner prescribes paroxetine (Paxil) 10 mg daily. On a follow-up visit two months later, the patient tells the NP that they no longer have anxiety, so they stopped taking the medication. What is the best course of action for the NP?
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The NP should advise the patient to restart the medication at a reduced dose of 5 mg daily.
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The NP should educate the patient regarding discontinuation symptoms and the risk of disease occurrence.
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The NP should suggest electroconvulsive therapy (ECT) to avoid pharmacotherapy.
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The NP should transition the patient to clonazepam (Klonopin) 1 mg three times daily as needed.
Explanation
When a patient with generalized anxiety disorder (GAD) stops taking an SSRI like paroxetine (Paxil), it’s important for the nurse practitioner (NP) to educate the patient about the potential for discontinuation symptoms, which can include dizziness, nausea, irritability, and sensory disturbances. Additionally, the NP should emphasize that cessation of medication without proper management increases the risk of symptom recurrence and may result in a relapse of anxiety symptoms. In this case, restarting paroxetine at the previous dose of 10 mg daily is typically appropriate, but the NP should also reassess the patient's need for continued medication and consider a gradual tapering schedule if discontinuation is desired in the future.
Correct Answer Is:
B. The NP should educate the patient regarding discontinuation symptoms and the risk of disease occurrence.
A 36-year-old man presents to the psychiatric-mental health nurse practitioner with lethargy, confusion, and impaired judgment. He has been stable on 8 mg of buprenorphine for 2 years. Recently his primary care provider prescribed a new medication for him. Which of the following medications most likely contributed to his current condition?
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Gabapentin (Neurontin)
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Naltrexone
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Naloxone
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Carbamazepine (Tegretol)
Explanation
Gabapentin has a CNS depressant effect, and when combined with buprenorphine, the sedative effects can potentiate, leading to lethargy, confusion, impaired judgment, and even respiratory depression. This drug combination is well known for increasing risk of overdose-level sedation. Naltrexone and naloxone would cause withdrawal, not sedation, and carbamazepine does not typically cause acute CNS depression when combined with buprenorphine.
Correct Answer Is:
A. Gabapentin (Neurontin)
A 35-year-old man with bipolar I disorder presents with a new-onset manic episode and is successfully treated with medication adjustment. He notes chronic depressive symptoms that, on reflection, long preceded his manic episodes. He describes these symptoms as "feeling down," having decreased energy, and more often than not, having no motivation. He denies other depressive symptoms but feels that these alone have been sufficient to negatively affect his marriage. Which diagnosis best fits his presentation?
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Bipolar II disorder
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Bipolar I disorder, current or most recent episode depressed
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Cyclothymic disorder
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Bipolar I disorder and persistent depressive disorder
Explanation
The patient’s chronic depressive symptoms (feeling down, decreased energy, lack of motivation) that preceded his manic episodes, without meeting the full criteria for a major depressive episode, align most closely with persistent depressive disorder (PDD) (also known as dysthymia). This diagnosis is given when the person has chronic low-grade depressive symptoms lasting for two years or more, but without the severity or duration of a major depressive episode. In this case, the patient's bipolar I disorder is already diagnosed, and his chronic depressive symptoms meet the criteria for persistent depressive disorder rather than a current major depressive episode, because they have been long-standing and not severe enough to meet the full criteria for a major depressive episode.
Correct Answer Is:
D. Bipolar I disorder and persistent depressive disorder
A 32-year-old woman is diagnosed with major depressive disorder (MDD). The PMHNP educates the patient that treatment with an antidepressant should be maintained for a minimum of:
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until symptoms remit
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for 12 weeks
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indefinitely
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6 to 12 months
Explanation
For patients diagnosed with major depressive disorder (MDD), antidepressant treatment should typically be continued for a minimum of 6 to 12 months after symptom remission to reduce the risk of relapse. This guideline is based on clinical evidence suggesting that a longer duration of treatment can help maintain remission and prevent recurrence of depressive episodes. If a patient has had multiple episodes of MDD, treatment may be extended longer or even maintained indefinitely to prevent future relapses.
Correct Answer Is:
D. 6 to 12 months
The PMHNP is managing a patient with a personality disorder and is considering assertiveness training. Which of the following personality disorders is most likely to benefit from this training?
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Dependent personality disorder
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Narcissistic personality disorder
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Schizoid personality disorder
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Histrionic personality disorder
Explanation
Patients with dependent personality disorder struggle with excessive reliance on others, difficulty making decisions independently, and fear of abandonment. Assertiveness training directly targets these difficulties by helping the patient develop confidence, set boundaries, express their needs, and function more autonomously. Among the listed disorders, individuals with dependent personality disorder gain the clearest and most direct benefit from assertiveness training.
Correct Answer Is:
A. Dependent personality disorder
The use of medication during pregnancy can carry risks to the fetus. Which of the following is the most likely potential neonatal risk associated with the use of duloxetine (Cymbalta), a serotonin norepinephrine reuptake inhibitor (SNRI) during the third trimester of pregnancy?
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Pregnancy loss or miscarriage
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Organ malformation or teratogenesis
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Gestational diabetes
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Poor neonatal adaptation syndrome
Explanation
Duloxetine (Cymbalta), an SNRI, has been associated with poor neonatal adaptation syndrome when used during the third trimester of pregnancy. This syndrome can include symptoms such as respiratory distress, jitteriness, feeding difficulties, and hypoglycemia in the newborn. These symptoms occur due to the impact of the medication on serotonin and norepinephrine systems, which are involved in various aspects of neonatal development and adaptation after birth.
Correct Answer Is:
D. Poor neonatal adaptation syndrome
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