NKU 26SUM2 MSN 665L PMHNP Pre Predictor Exam
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Free NKU 26SUM2 MSN 665L PMHNP Pre Predictor Exam Questions
The parent of an 8-year-old boy presents to the emergency department stating that her child took some pills he found in his grandmother's purse. The grandmother reports taking medication for reflux, hypertension, hyperlipidemia, and depression. The child exhibits vomiting, anuria, and dry mouth. Assessment of vital signs and an ECG determine that the boy has tachycardia and a widened QRS syndrome. Which type of medication did the child likely take?
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An angiotensin-converting enzyme inhibitor
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A serotonin-norepinephrine reuptake inhibitor
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A tricyclic antidepressant
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A proton pump inhibitor
Explanation
Explanation:
Correct Answer: (C) A tricyclic antidepressant
Tricyclic antidepressant toxicity classically presents with anticholinergic symptoms such as dry mouth and urinary retention (anuria), along with cardiotoxic effects including tachycardia and a widened QRS complex due to sodium channel blockade. This combination of anticholinergic and cardiac conduction findings is a hallmark of TCA overdose, particularly dangerous in pediatric ingestions.
Why Other Options are Incorrect:
A. An angiotensin-converting enzyme inhibitor — Overdose typically causes hypotension and possible angioedema, not anticholinergic symptoms or QRS widening.
B. A serotonin-norepinephrine reuptake inhibitor — While overdose can cause tachycardia and serotonergic symptoms, it does not typically produce the pronounced anticholinergic effects and widened QRS complex seen here.
D. A proton pump inhibitor — These medications are generally very safe in overdose and are not associated with cardiotoxicity, anticholinergic symptoms, or ECG changes.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for depression must include either a depressed mood or which of the following?
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Anhedonia
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Recurrent thoughts of death
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Diminished cognitive ability
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Consistent waking throughout the night
Explanation
Explanation: Correct Answer: (A) Anhedonia The DSM-5 requires that at least one of the two core symptoms—depressed mood or anhedonia (markedly diminished interest or pleasure in almost all activities)—be present for a diagnosis of major depressive disorder.
Why Other Options are Incorrect:
B. Recurrent thoughts of death — A possible symptom of depression but not one of the two required core criteria.
C. Diminished cognitive ability — Can be a symptom but is not one of the two essential gateway criteria.
D. Consistent waking throughout the night — A form of sleep disturbance that can be a symptom, but it is not one of the two required core criteria.
A patient diagnosed with borderline personality disorder is most likely to benefit from:
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Milieu therapy
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Psychoanalysis
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Cognitive behavioral therapy
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Dialectical behavioral therapy
Explanation
Explanation:
Correct Answer: (D) Dialectical behavioral therapy Dialectical behavioral therapy was specifically developed for the treatment of borderline personality disorder, focusing on emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness skills, making it the most evidence-based and effective treatment approach for this population.
Why Other Options are Incorrect:
A. Milieu therapy — Involves creating a therapeutic environment but is not the primary evidence-based treatment specifically indicated for borderline personality disorder.
B. Psychoanalysis — A traditional therapeutic approach that is less structured and less evidence-based for the specific symptom management needed in borderline personality disorder.
C. Cognitive behavioral therapy — While beneficial for many conditions, DBT (a specialized form of CBT) has stronger evidence specifically for borderline personality disorder due to its focus on emotional dysregulation.
The PMHNP is considering mental health treatment for a 17-year-old patient. The Health Insurance Portability and Accountability Act (HIPAA) specifies that the minor:
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Must have consent from parents for all treatment decisions, regardless of state regulations.
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Has the right to consent to their own treatment, if permitted by state law.
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Must consent for the release of private health information, even to parents.
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Can be treated if the provider determines that parental consent is not needed.
Explanation
Explanation: Correct Answer: (B) Has the right to consent to their own treatment, if permitted by state law.
HIPAA defers to state law regarding a minor's ability to consent to their own mental health treatment. In states that grant minors the right to consent to certain types of care without parental involvement, HIPAA respects that autonomy and the minor's associated privacy rights over related health information.
Why Other Options are Incorrect:
A. Must have consent from parents for all treatment decisions, regardless of state regulations — This is incorrect because HIPAA explicitly defers to state law, which may allow minors to consent to their own treatment in certain circumstances.
C. Must consent for the release of private health information, even to parents — This is not universally true; the rules governing disclosure to parents depend on state law and the specific circumstances under which the minor consented to treatment.
D. Can be treated if the provider determines that parental consent is not needed — Provider discretion alone does not override state legal requirements regarding minor consent for treatment.
A 25-year-old female referred to the PMHNP by their gynecologist describes their symptoms as a feeling of "going insane," feeling emotionally out of control, and having racing negative thoughts. These episodes occur a week or two before the patient's monthly menstrual cycle. The patient has no other physical or mental health disorders, but other female relatives have had similar complaints. The most likely treatment choice for these symptoms is:
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A selective serotonin reuptake inhibitor (SSRI)
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A mood stabilizer
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An anxiolytic
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A serotonin-norepinephrine reuptake inhibitor (SNRI)
Explanation
Explanation:
Correct Answer: (A) A selective serotonin reuptake inhibitor (SSRI) This presentation is consistent with premenstrual dysphoric disorder (PMDD), and SSRIs are considered first-line pharmacologic treatment, effectively reducing the emotional and cognitive symptoms associated with the luteal phase of the menstrual cycle.
Why Other Options are Incorrect:
B. A mood stabilizer — Not first-line for PMDD; typically reserved for bipolar disorder or other mood disorders with distinct presentations.
C. An anxiolytic — May provide symptomatic relief but is not the first-line or most effective treatment for PMDD.
D. A serotonin-norepinephrine reuptake inhibitor (SNRI) — Not the first-line treatment choice for PMDD compared to SSRIs.
Jay, age 36, uses cocaine on a regular basis. When discussing this with the patient, the PMHNP determines that he is in the precontemplation stage of the Transtheoretical Model (also known as the Stages of Change Model). With this awareness and considering the stages of the Transtheoretical Model, the next step for the PMHNP is to:
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Allow the patient to come to his own realization that this is an abhorrent behavior
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Encourage the patient to enroll in a self-help program immediately
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Help the patient develop a detailed plan to quit using cocaine
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Build Jay's awareness until he sees that the pros of quitting cocaine outweigh the cons
Explanation
Explanation:
Correct Answer: (D) Build Jay's awareness until he sees that the pros of quitting cocaine outweigh the cons In the precontemplation stage, patients are not yet considering change, so the appropriate next step is to gently raise awareness about the consequences of the behavior, helping the patient begin to recognize that the benefits of quitting may outweigh the costs of continuing, moving them toward the contemplation stage.
Why Other Options are Incorrect:
A. Allow the patient to come to his own realization that this is an abhorrent behavior — Passive waiting is not an active therapeutic strategy; the PMHNP should actively engage the patient in raising awareness.
B. Encourage the patient to enroll in a self-help program immediately — This action corresponds to the preparation or action stages, not precontemplation, and would be premature for this patient.
C. Help the patient develop a detailed plan to quit using cocaine — Developing a detailed plan is appropriate for the preparation stage, not precontemplation, where the patient has not yet acknowledged a need for change.
The PMHNP knows that research demonstrates specific risk factors for development of gout. With that information, the PMHNP understands that the patient with the highest risk for gout is:
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A 30-year-old female with a BMI of 28 who takes oral contraceptives
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A 30-year-old male who golfs and drinks 1-2 beers per week
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A 50-year-old male with metabolic syndrome who takes hydrochlorothiazide
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A 50-year-old female who lifts weights and has a uric acid level of 7.3
Explanation
Explanation:
Correct Answer: (C) A 50-year-old male with metabolic syndrome who takes hydrochlorothiazide This patient has multiple compounding risk factors for gout: male sex, metabolic syndrome (which is strongly associated with hyperuricemia), and use of hydrochlorothiazide, a diuretic well-known to increase uric acid levels and precipitate gout attacks, making this the highest-risk profile among the options.
Why Other Options are Incorrect:
A. A 30-year-old female with a BMI of 28 who takes oral contraceptives — Female sex and lack of other major risk factors make this a lower-risk profile compared to option C.
B. A 30-year-old male who golfs and drinks 1-2 beers per week — Minimal alcohol consumption and regular physical activity represent a lower-risk lifestyle profile.
D. A 50-year-old female who lifts weights and has a uric acid level of 7.3 — While elevated uric acid is a risk factor, female sex and an active lifestyle without metabolic syndrome or diuretic use represent a comparatively lower overall risk.
A patient with a history of alcoholism is following up with the PMHNP, who notices the patient was recently started on sitagliptin (Januvia), a DPP-4 inhibitor. The PMHNP knows that this medication is contraindicated in this patient due to their history of:
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Hypothyroidism
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Depression
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Hallucinations
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Pancreatitis
Explanation
Explanation:
Correct Answer: (D) Pancreatitis DPP-4 inhibitors like sitagliptin carry a known risk of causing or worsening pancreatitis, and since chronic alcoholism is a significant risk factor for pancreatitis, this medication should be used with caution or avoided in patients with a history of alcoholism due to the compounded risk.
Why Other Options are Incorrect:
A. Hypothyroidism — Not a known contraindication or significant concern with sitagliptin use.
B. Depression — Not specifically linked to sitagliptin's risk profile or contraindications.
C. Hallucinations — Not associated with sitagliptin use or a relevant contraindication for this medication.
A 32-year-old man presents with complaints of fatigue, decreased libido, poor sleep, and decreased appetite. What area of the brain is responsible for regulation of these functions?
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Hypothalamus
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Hippocampus
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Thalamus
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Locus coeruleus
Explanation
Explanation:
Correct Answer: (A) Hypothalamus The hypothalamus regulates numerous homeostatic functions including sleep, appetite, libido, and energy levels through its control over hormonal and autonomic pathways, making it directly responsible for the constellation of symptoms this patient is experiencing.
Why Other Options are Incorrect:
B. Hippocampus — Primarily involved in memory formation and learning, not regulation of appetite, libido, or sleep.
C. Thalamus — Functions mainly as a relay station for sensory information, not homeostatic regulation of these functions.
D. Locus coeruleus — Involved in arousal and stress response through norepinephrine release, but not the primary regulator of appetite, libido, and sleep as a whole.
In counseling a 28-year-old woman with migraines as part of her treatment plan, which of the following is the least appropriate recommendation?
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Consider a strategy to quit smoking.
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Avoid physical exercise that triggers your headaches.
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Implement strategies to reduce stressful activities.
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Follow strict fluid restriction to prevent exacerbation of migraines.
Explanation
Explanation:
Correct Answer: (D) Follow strict fluid restriction to prevent exacerbation of migraines.
Adequate hydration is actually recommended for migraine prevention, as dehydration is a well-known trigger for migraine headaches. Advising strict fluid restriction is inappropriate and could worsen the patient's condition rather than help manage it.
Why Other Options are Incorrect:
A. Consider a strategy to quit smoking — Smoking cessation is an appropriate recommendation, as smoking is associated with increased frequency and severity of migraines.
B. Avoid physical exercise that triggers your headaches — This is appropriate guidance, as identifying and avoiding specific triggers, including certain types of exertion, is a standard part of migraine management.
C. Implement strategies to reduce stressful activities — Stress reduction is a well-established and appropriate recommendation, since stress is one of the most common migraine triggers.
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