Hesi Mental Health Assessment
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Free Hesi Mental Health Assessment Questions
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?
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Obsessive-compulsive disorder (OCD)
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Generalized anxiety disorder
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Schizophrenia
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Agoraphobia
Explanation
Explanation:
Correct Answer: (A) Obsessive-compulsive disorder (OCD)
This patient exhibits classic OCD symptoms: intrusive thoughts (obsessions) that he recognizes as irrational, coupled with repetitive behaviors (compulsions, i.e., opening and closing the door) performed to reduce distress, causing significant functional impairment and consuming substantial time, meeting full diagnostic criteria for OCD.
Why Other Options are Incorrect:
B. Generalized anxiety disorder involves excessive worry about multiple life domains, not specific intrusive thoughts paired with compulsive rituals.
C. Schizophrenia involves psychotic symptoms such as hallucinations or delusions with loss of insight; this patient maintains full insight, recognizing his thoughts as irrational, which is inconsistent with a psychotic disorder.
D. Agoraphobia involves fear of situations where escape might be difficult, not intrusive thoughts and compulsive behaviors.
A 29-year-old woman diagnosed with major depressive disorder is brought to the emergency department by her husband; she is possibly in cardiac arrest. After stabilization, she is admitted to the hospital, where she experiences a seizure. The patient's husband says she recently started taking a new antidepressant in addition to her old one. Which of the following medication combinations could cause these symptoms?
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Atomoxetine and fluoxetine
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Clomipramine and fluoxetine
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Alprazolam and fluoxetine
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Clomipramine and diphenhydramine
Explanation
Explanation:
Correct Answer: (B) Clomipramine and fluoxetine
Clomipramine (a TCA) combined with fluoxetine (an SSRI) can lead to serotonin syndrome and increased cardiotoxicity due to fluoxetine inhibiting the metabolism of clomipramine, increasing its plasma levels, which can result in seizures and cardiac arrhythmias/arrest, matching this patient's presentation.
Why Other Options are Incorrect:
A. While atomoxetine and fluoxetine can have interactions, this combination is less classically associated with this severe combination of cardiac arrest and seizure compared to the TCA-SSRI interaction.
C. Alprazolam combined with fluoxetine can increase sedation but is not classically associated with seizures and cardiac arrest in this manner.
D. Clomipramine and diphenhydramine combined would increase anticholinergic burden but is not the classic combination associated with this specific presentation of seizure and cardiac arrest linked to serotonergic/cardiotoxic interaction.
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 symptom "trauma"?
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Do you frequently feel an irrepressible need to sleep or experience sudden lapses into sleep?
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Do you ever feel as if people or places familiar to you are unreal, or that you are so detached from your body that you are standing outside your body watching yourself?
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What is the worst thing that has ever happened to you?
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Are there specific objects, places, or social situations that make you feel very anxious or tearful?
Explanation
Explanation:
Correct Answer: (C) What is the worst thing that has ever happened to you?
This question directly and openly invites the patient to disclose traumatic experiences, making it the most appropriate and effective question for screening the "trauma" system in a psychiatric review of systems.
Why Other Options are Incorrect:
A. This question screens for narcolepsy or sleep disorder symptoms, not trauma history.
B. This question screens for dissociative symptoms, which, while related to trauma, specifically targets depersonalization/derealization rather than trauma history itself.
D. This question targets specific phobias, not trauma history.
A 68-year-old male patient on an inpatient geropsychiatric unit scored 3 on the Lewy Body Composite Risk Score (LBCRS). What does this score indicate?
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Nonprobable Lewy body case
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Probable Lewy body case
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Minimally probable Lewy body case
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Highly probable Lewy body case
Explanation
Explanation:
Correct Answer: (B) Probable Lewy body case
A score of 3 or greater on the Lewy Body Composite Risk Score is generally considered indicative of a probable Lewy body disease case, as this scoring threshold has been validated to reasonably predict the likelihood of underlying Lewy body pathology.
Why Other Options are Incorrect:
A. A nonprobable case would correspond to a lower score, below the established threshold for probable Lewy body disease.
C. "Minimally probable" is not a standard classification category used with this scoring tool.
D. A "highly probable" designation is not the standard terminology used at this score threshold; a score of 3 corresponds to "probable," not a higher category.
A 22-year-old unmarried woman reports to the PMHNP that about 4 days before the onset of menses, she experiences a feeling that she cannot handle her normal responsibilities. She feels more emotionally sensitive and cries easily. Which of the following symptoms must be present for a woman to meet the criteria of premenstrual dysphoric disorder?
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Physical symptoms such as breast tenderness
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Decreased interest in usual activities
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Marked change in appetite
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Marked affective lability
Explanation
Explanation:
Correct Answer: (D) Marked affective lability
Marked affective lability (mood swings, sudden sadness or tearfulness) is one of the core, required diagnostic criteria for premenstrual dysphoric disorder, and at least one of the core emotional symptoms (including affective lability) must be present to meet diagnostic criteria.
Why Other Options are Incorrect:
A. Physical symptoms like breast tenderness are considered additional/supportive symptoms but are not one of the core required affective symptoms needed to meet the primary diagnostic threshold.
B. Decreased interest in activities is one of several possible symptoms but is not the single specifically required core symptom being tested here (affective lability is more central and specifically required).
C. Appetite changes are among the additional possible symptoms but are not the specific core required affective symptom highlighted in this question.
A 27-year-old married woman reports to the PMHNP that she is experiencing significant distress in her marriage because she "hates" going to social events, and her husband's job requires attending regular social gatherings. She avoids these activities because she is "terrified" she will do or say something embarrassing, and she has started pretending she has headaches to get out of going to them. Her husband doesn't understand why she doesn't want to go to these parties, which are typically small gatherings of less than 15 people. She admits that when she does go, they end up being "no big deal." The PMHNP will diagnose this woman with which of the following?
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Generalized anxiety disorder
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Agoraphobia
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Social anxiety disorder
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Panic disorder
Explanation
Explanation:
Correct Answer: (C) Social anxiety disorder
This patient's fear centers specifically on social situations due to fear of embarrassing herself or being negatively judged by others, which is the core diagnostic feature of social anxiety disorder (social phobia), despite the fact that these events tend to go well when she attends.
Why Other Options are Incorrect:
A. Generalized anxiety disorder involves excessive worry across multiple life domains, not a specific fear centered on social scrutiny and embarrassment.
B. Agoraphobia involves fear of situations where escape might be difficult or help unavailable, not specifically the fear of embarrassment in social situations.
D. Panic disorder involves recurrent, unexpected panic attacks, which is not the primary feature described in this scenario.
The PMHNP has just diagnosed a patient with excoriation disorder. To fulfill diagnostic criteria for excoriation disorder, the skin-picking must be severe enough to result in which of the following?
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Permanent deformity
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An infection
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Skin lesions
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Medical attention
Explanation
Explanation:
Correct Answer: (C) Skin lesions
Excoriation (skin-picking) disorder is diagnosed when recurrent skin picking results in skin lesions, along with significant distress or impairment, making this the specific diagnostic criterion required rather than more severe outcomes.
Why Other Options are Incorrect:
A. Permanent deformity is not a required diagnostic criterion; the diagnosis can be made with less severe, though still clinically significant, skin lesions.
B. An infection is not a required diagnostic criterion for excoriation disorder; while infections can occur as a complication, they are not part of the core diagnostic requirement.
D. Medical attention is not the specific diagnostic threshold; the requirement is the presence of skin lesions resulting from the picking behavior, not necessarily that medical attention was sought.
The region of the brain that is responsible for language comprehension is known as:
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the bundle of His.
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Wernicke's area.
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Broca's area.
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the circle of Willis.
Explanation
Explanation:
Correct Answer: (B) Wernicke's area.
Wernicke's area, located in the posterior superior temporal lobe, is responsible for language comprehension, allowing individuals to understand spoken and written language.
Why Other Options are Incorrect:
A. The bundle of His is a cardiac conduction structure, unrelated to brain function or language.
C. Broca's area is responsible for language production and speech articulation, not comprehension.
D. The circle of Willis is a network of arteries at the base of the brain responsible for blood supply, not language processing.
The PMHNP diagnoses a 25-year-old woman with generalized anxiety disorder with panic attacks. Terrified by the panic attacks, she requests medication, saying, "I need something to control them immediately." The patient is otherwise fit and healthy and has no history of substance abuse or dependence. Which of the following strategies would be reasonable?
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Start the patient on alprazolam and refer her to cognitive-behavioral therapy
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Start the patient on a combination of an SSRI for the long term and low-dose clonazepam for the short term
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Start the patient on any SSRI
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Start the patient in individual psychotherapy
Explanation
Explanation:
Correct Answer: (B) Start the patient on a combination of an SSRI for the long term and low-dose clonazepam for the short term
This strategy addresses the patient's immediate need for symptom relief (short-term, low-dose benzodiazepine like clonazepam) while establishing a long-term, sustainable treatment plan (SSRI) for ongoing management of generalized anxiety disorder, bridging the gap until the SSRI reaches full therapeutic effect.
Why Other Options are Incorrect:
A. Alprazolam is a short-acting benzodiazepine with higher abuse potential and more pronounced withdrawal issues compared to longer-acting options, making it a less ideal initial choice compared to combination therapy with a longer-acting benzodiazepine.
C. Starting an SSRI alone does not address the patient's immediate, urgent need for symptom relief, as SSRIs take several weeks to become effective.
D. Psychotherapy alone does not address the patient's urgent request for immediate symptom control and typically takes time to show benefits.
Which neurotransmitter is matched correctly with its function?
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Serotonin: thinking, fine muscle action, and reward-seeking behavior
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Gamma aminobutyric acid (GABA): reduces arousal, aggression, and anxiety
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Norepinephrine: regulates sleep, pain, mood states, and temperature
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Dopamine: alertness, focused attention, learning, and memory
Explanation
Explanation:
Correct Answer: (B) Gamma aminobutyric acid (GABA): reduces arousal, aggression, and anxiety
GABA is the primary inhibitory neurotransmitter in the central nervous system, and its function is to reduce neuronal excitability, which correspondingly reduces arousal, aggression, and anxiety, making this pairing accurate.
Why Other Options are Incorrect:
A. This description (thinking, fine muscle action, reward-seeking) is actually more characteristic of dopamine's functions, not serotonin.
C. This description (sleep, pain, mood, temperature regulation) is actually more characteristic of serotonin's functions, not norepinephrine.
D. This description (alertness, focused attention, learning, memory) is actually more characteristic of norepinephrine's functions, not dopamine.
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