NKU 26SUM2 MSN 665L PMHNP Pre Predictor Exam
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Free NKU 26SUM2 MSN 665L PMHNP Pre Predictor Exam Questions
When including a patient in a clinical trial, which of the following is NOT true?
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The PMHNP should assure the patient they can withdraw from the study at any time
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The PMHNP should assure the patient that they will be informed of new information as it develops in the study
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The PMHNP should assure the patient that the benefits of the study will outweigh the risks
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The PMHNP should assure the patient that selection to participate is fair based on the scientific goals of the study
Explanation
Explanation:
Correct Answer: (C) The PMHNP should assure the patient that the benefits of the study will outweigh the risks
This statement is NOT true because researchers cannot ethically guarantee or assure a patient that the benefits of a clinical trial will outweigh the risks, as this is often unknown (especially in early-phase trials) and would violate principles of informed consent, which require that patients be given balanced, honest information about both potential risks and benefits without overstating expected benefits.
Why Other Options are Incorrect (meaning these ARE true and appropriate):
A. The PMHNP should assure the patient they can withdraw from the study at any time — This is a fundamental and true ethical principle of informed consent in clinical trials; participants must always have the right to withdraw at any time without penalty.
B. The PMHNP should assure the patient that they will be informed of new information as it develops in the study — This is also a true and required ethical obligation, ensuring ongoing informed consent as new relevant information emerges during the study.
D. The PMHNP should assure the patient that selection to participate is fair based on the scientific goals of the study — This reflects the true ethical principle of justice in research, ensuring fair and equitable selection of participants based on the scientific aims of the study, not arbitrary or discriminatory factors.
According to the Beers Criteria, which SSRI should be avoided in older adults due to its strong anticholinergic properties causing the most risk in patients over 65?
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Citalopram (Celexa)
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Paroxetine (Paxil)
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Sertraline (Zoloft)
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Desvenlafaxine (Pristiq)
Explanation
Explanation:
Correct Answer: (B) Paroxetine (Paxil) Paroxetine has the strongest anticholinergic properties among SSRIs, which increases the risk of confusion, falls, and cognitive impairment in older adults. The Beers Criteria specifically identifies it as a medication to avoid in this population due to these risks.
Why Other Options are Incorrect:
A. Citalopram (Celexa) — Has minimal anticholinergic activity compared to paroxetine, though it carries its own cardiac (QT prolongation) considerations.
C. Sertraline (Zoloft) — Generally considered one of the safer SSRIs for older adults with low anticholinergic burden.
D. Desvenlafaxine (Pristiq) — An SNRI, not an SSRI, and does not carry the same strong anticholinergic risk profile.
Tricyclic antidepressants (TCAs) are considered second-line drugs for treating major depressive disorder (MDD). The PMHNP knows that this is most likely because:
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TCAs are associated with more side effects and, potentially, poor adherence as a result
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TCAs are expensive medications and many patients have poor adherence due to cost
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TCAs can produce elevated heart rate and high blood pressure due to their vasopressor side effects
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TCAs are poor choices for patients who are at risk for suicide due to the general inability of this class of medications to produce adequate symptom relief
Explanation
Explanation:
Correct Answer: (A) TCAs are associated with more side effects and, potentially, poor adherence as a result
TCAs are considered second-line agents primarily because of their extensive side effect profile, including anticholinergic effects, cardiac conduction issues, sedation, and weight gain, which often lead to poor patient adherence and tolerability compared to newer antidepressant classes like SSRIs, which have become first-line treatments due to their more favorable side effect profiles.
Why Other Options are Incorrect:
B. TCAs are expensive medications and many patients have poor adherence due to cost — TCAs are actually generally inexpensive, older generation medications; cost is not the primary reason they are considered second-line.
C. TCAs can produce elevated heart rate and high blood pressure due to their vasopressor side effects — While TCAs do have cardiac side effects, this is not accurately described as a "vasopressor" effect, and this is not the primary comprehensive reason for their second-line status.
D. TCAs are poor choices for patients who are at risk for suicide due to the general inability of this class of medications to produce adequate symptom relief — TCAs are actually effective at relieving depressive symptoms; the specific concern regarding suicide risk with TCAs relates to their lethality in overdose, not to inadequate symptom relief.
The PMHNP is evaluating a patient in the emergency department who presents with symptoms of nausea, vomiting, hypotension, and bradycardia. His laboratory results show hypermagnesemia. Based on the patient's medication list, which medication should the PMHNP suspect as the cause of the increased magnesium level?
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Lamotrigine (Lamictal)
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Lithium (Eskalith)
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Valproic acid (Depakote)
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Carbamazepine (Tegretol)
Explanation
Explanation:
Correct Answer: (B) Lithium (Eskalith)
Lithium is excreted by the kidneys and shares handling pathways with other electrolytes; lithium toxicity and associated renal effects can result in electrolyte disturbances including hypermagnesemia, along with the classic presentation of nausea, vomiting, hypotension, and bradycardia seen with lithium toxicity.
Why Other Options are Incorrect:
A. Lamotrigine is not classically associated with causing hypermagnesemia or this symptom presentation.
C. Valproic acid is not classically associated with causing hypermagnesemia; its more notable adverse effects relate to hepatotoxicity and pancreatitis.
D. Carbamazepine is not classically associated with causing hypermagnesemia; it is more notably associated with hyponatremia (SIADH) as an electrolyte disturbance.
Which of the following is least likely to be included in the treatment regimen for a 79-year-old man with Parkinson's disease?
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Ropinirole
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Pramipexole
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Levodopa
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Chlorpromazine
Explanation
Explanation:
Correct Answer: (D) Chlorpromazine Chlorpromazine is a first-generation antipsychotic that blocks dopamine receptors, directly opposing the goal of Parkinson's treatment, which is to increase dopaminergic activity. Using it would worsen parkinsonian symptoms and is contraindicated.
Why Other Options are Incorrect:
A. Ropinirole — A dopamine agonist commonly used to treat Parkinson's disease.
B. Pramipexole — Another dopamine agonist appropriate for Parkinson's management.
C. Levodopa — The gold-standard precursor therapy that converts to dopamine in the brain, standard for Parkinson's treatment.
When attending a party, a 42-year-old man with a diagnosis of social phobia stayed by his partner's side for the entire event. This is an example of:
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Avoidance
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Catastrophizing
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Adaptive behavior
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Safety behavior
Explanation
Explanation:
Correct Answer: (D) Safety behavior
Safety behaviors are actions a person with anxiety takes to reduce distress in a feared situation without fully avoiding it altogether, such as staying close to a trusted companion for reassurance; while providing temporary relief, these behaviors can reinforce anxiety and prevent the person from learning that the feared situation is manageable on their own.
Why Other Options are Incorrect:
A. Avoidance would involve not attending the party at all, whereas this patient did attend, just with a safety behavior in place.
B. Catastrophizing refers to a cognitive distortion involving assuming the worst possible outcome, not a behavioral action taken during a feared situation.
C. This is not considered an adaptive behavior, since relying on a safety behavior like staying by a partner's side can reinforce anxiety and prevent genuine coping skill development, rather than representing a healthy, adaptive coping strategy.
A patient reports feeling "keyed up" and fears losing control. Symptoms have been present for the past 3 years. The patient reports low energy, insomnia, low self-esteem, and difficulty making decisions. Which of the following is the most likely diagnosis?
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Persistent depressive disorder with anxious distress
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Major depressive disorder with atypical features
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Bipolar 2 disorder with melancholic features
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Bipolar 1 disorder with melancholic features
Explanation
Explanation:
Correct Answer: (A) Persistent depressive disorder with anxious distress
This patient's chronic, longstanding symptoms (present for 3 years) — low energy, insomnia, low self-esteem, and difficulty making decisions — align with persistent depressive disorder's characteristic long duration. The additional symptoms of feeling "keyed up" and fearing loss of control reflect the anxious distress specifier, which describes feelings of tension and apprehension co-occurring with the depressive symptoms.
Why Other Options are Incorrect:
B. Major depressive disorder is typically characterized by more acute, episodic symptoms rather than this chronic 3-year pattern, and atypical features (such as mood reactivity, increased appetite/weight gain, and leaden paralysis) are not described here.
C. There is no evidence of hypomanic episodes described in this scenario, which would be required for a bipolar 2 diagnosis; melancholic features (such as complete loss of pleasure and worse mood in the morning) are also not specifically described.
D. There is no evidence of manic episodes described, which would be required for bipolar 1 disorder; this presentation is purely depressive/anxious in nature.
A patient states, "My parents love my sister more because she is more successful than I am," and "I'm so stupid." An appropriate response from the PMHNP to address these unfair comparisons is:
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"What evidence do you have to support your thoughts?"
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"I feel that you really believe they love your sister more."
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"Do you blame your parents?"
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"Why do you think you feel stupid?"
Explanation
Explanation:
Correct Answer: (A) "What evidence do you have to support your thoughts?"
This response uses a core cognitive-behavioral technique — examining the evidence — which helps the patient critically evaluate the factual basis for their negative, distorted beliefs, encouraging them to challenge and reconsider unfair comparisons and self-critical thoughts rather than simply accepting them as true.
Why Other Options are Incorrect:
B. This response reflects back the patient's feeling but does not help the patient examine or challenge the distorted thought itself, missing an opportunity for therapeutic cognitive restructuring.
C. This question shifts focus toward blame rather than addressing and examining the unfair, distorted comparisons and self-critical thinking directly.
D. This question reinforces and explores the negative self-label ("stupid") rather than challenging its validity, which could inadvertently validate the distorted belief.
The PMHNP is prescribing lithium to a new client. The PMHNP explains to the patient that they may only be able to use which over-the-counter pain relievers while taking lithium?
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Aspirin
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Both aspirin and acetaminophen (Tylenol)
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None of these
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Acetaminophen (Tylenol)
Explanation
Explanation:
Correct Answer: (D) Acetaminophen (Tylenol)
Acetaminophen is generally considered the safest over-the-counter pain reliever option for patients taking lithium, as NSAIDs (including aspirin, when used regularly at analgesic doses) can significantly increase lithium levels by reducing renal lithium clearance, raising the risk of lithium toxicity.
Why Other Options are Incorrect:
A. Aspirin, particularly with regular use, can interact with lithium by reducing its renal clearance, increasing the risk of elevated lithium levels and toxicity.
B. Since aspirin poses this interaction risk, it should not be recommended together with acetaminophen as a safe option for this patient.
C. Acetaminophen is in fact considered a generally safe option for pain relief in patients taking lithium, making "none of these" an incorrect answer.
A cognitive behavioral therapy (CBT) group that focuses on relapse prevention for substance abusers will most likely:
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Advise patients to serve as mentors for one another
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Stress mindfulness practices and accepting oneself
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Stress the importance of attending a 12-step group like Alcoholics or Narcotics Anonymous
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Assist patients to identify situations that make them vulnerable to relapse
Explanation
Explanation:
Correct Answer: (D) Assist patients to identify situations that make them vulnerable to relapse CBT-based relapse prevention centers on helping patients recognize and understand their personal high-risk situations, triggers, and thought patterns that could lead to relapse, then developing coping strategies to manage them.
Why Other Options are Incorrect:
A. Advise patients to serve as mentors for one another — This is more characteristic of peer support or 12-step models rather than the core focus of CBT.
B. Stress mindfulness practices and accepting oneself — This reflects acceptance-based therapies like ACT or DBT rather than traditional CBT's cognitive-behavioral focus.
C. Stress the importance of attending a 12-step group like Alcoholics or Narcotics Anonymous — This is a separate treatment modality, not a defining feature of CBT relapse prevention groups.
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