NKU APEA PSYCH
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Free NKU APEA PSYCH Questions
An NP is reviewing the potential side effects of carbamazepine (Tegretol) therapy in a patient who has epilepsy. Which of the following laboratory abnormalities is most commonly associated with the use of this medication?
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Elevated liver enzymes
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Elevated thyroid hormones
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Leukocytosis
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Hyponatremia
Explanation
Explanation:
Correct Answer: (D) Hyponatremia Carbamazepine is well known to cause SIADH-related hyponatremia, making this the laboratory abnormality most commonly and characteristically associated with its use.
Why Other Options are Incorrect:
A. Mild elevation in liver enzymes can occur but is not the laboratory abnormality most classically associated with carbamazepine.
B. Carbamazepine is not associated with elevating thyroid hormones.
C. Carbamazepine is more classically associated with leukopenia (decreased white blood cells), not leukocytosis.
A PMHNP would like to monitor a client's progress in anxiety symptom reduction over time using a clinician-administered anxiety rating scale. Which of the following is the most commonly used clinician-administered anxiety rating scale?
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Beck Anxiety Inventory
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GAD-7 Scale
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Hamilton Anxiety Scale
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Liebowitz Social Anxiety Scale
Explanation
Explanation:
Correct Answer: (C) Hamilton Anxiety Scale The Hamilton Anxiety Rating Scale (HAM-A) is the most widely used clinician-administered scale for assessing the severity of anxiety symptoms and tracking response to treatment over time.
Why Other Options are Incorrect:
A. The Beck Anxiety Inventory is a self-report tool, not clinician-administered.
B. The GAD-7 is a brief self-report screening tool, not the standard clinician-administered scale.
D. The Liebowitz Social Anxiety Scale is specific to social anxiety disorder, not general anxiety symptom monitoring.
A 47-year-old man only travels by train despite the necessity of frequently traveling long distances for his job. This causes significant difficulty, since the train trips are much longer than the plane rides and he misses important meetings. He has tried flying on several occasions, only to have a panic attack each time, even when the flight was smooth with no turbulence. Which of the following is the correct diagnosis?
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Panic disorder
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Specific phobia, situational type
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Acute stress disorder
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Social anxiety disorder
Explanation
Explanation:
Correct Answer: (B) Specific phobia, situational type The client's panic attacks are consistently and predictably triggered by one specific situation — flying — rather than occurring unexpectedly, which fits a specific phobia, situational type, rather than panic disorder.
Why Other Options are Incorrect:
A. Panic disorder involves recurrent, unexpected panic attacks not consistently tied to one specific trigger.
C. Acute stress disorder is a time-limited reaction following a traumatic event, which is not described here.
D. Social anxiety disorder involves fear of social or performance situations due to scrutiny by others, not fear of flying itself.
An adult patient presents with a new onset bilateral hand tremor that started one week ago after a minor motor vehicle accident. The patient has a history of medication-controlled bipolar disorder and is taking lithium (Lithobid). On assessment, the patient denies hitting their head, loss of consciousness, or altered mental status after the accident. They also indicate they had minor neck pain that is responding well to over-the-counter nonsteroidal anti-inflammatory drug (NSAID) therapy, which they are taking as directed. The review of systems is negative except for recent nausea and vomiting. Which of the following is the most likely explanation for the patient's presentation?
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The patient is experiencing signs and symptoms of NSAID overdose.
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The patient injured a cervical nerve root in the motor vehicle accident.
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The patient is experiencing localized seizures from a minor brain injury sustained in the accident.
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The patient is experiencing medication toxicity due to decreased drug clearance.
Explanation
Explanation:
Correct Answer: (D) The patient is experiencing medication toxicity due to decreased drug clearance. NSAIDs can reduce renal clearance of lithium, leading to elevated lithium levels; combined with the new tremor, nausea, and vomiting, this presentation is consistent with emerging lithium toxicity precipitated by the NSAID interaction.
Why Other Options are Incorrect:
A. NSAID overdose does not typically present with this specific combination of tremor and GI symptoms in a patient taking the medication as directed.
B. A cervical nerve root injury would not explain the bilateral tremor and GI symptoms described.
C. There is no evidence of head injury or loss of consciousness to support a seizure etiology, and the symptoms described do not fit a localized seizure presentation.
During a psychiatric evaluation, the psychiatric-mental health nurse practitioner conducts a psychiatric review of systems (ROS) in which he 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 system "anxiety"?
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Do you worry about your physical health more than other people?
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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 you are standing outside your body watching yourself?
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During the past several months, have you frequently been worried about a number of things in your life?
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Have there ever been periods of time when you needed much less sleep but still felt very energized, happy, or outgoing?
Explanation
Explanation:
Correct Answer: (C) During the past several months, have you frequently been worried about a number of things in your life? This question directly screens for the excessive, persistent, and diffuse worry characteristic of generalized anxiety, making it the most appropriate item for eliciting the "anxiety" system on a psychiatric ROS.
Why Other Options are Incorrect:
A. This question screens for illness anxiety or health-related preoccupation, not general anxiety.
B. This question screens for dissociative symptoms such as derealization and depersonalization.
D. This question screens for manic or hypomanic symptoms, not anxiety.
In most situations, a higher dose of medication produces a greater response. Which of the following can significantly alter this relationship for any given medication?
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Dosage form
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Route of administration
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Dosing schedule
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Affinity for a receptor
Explanation
Explanation:
Correct Answer: (D) Affinity for a receptor A drug's affinity for its receptor determines how effectively it binds and produces an effect at a given concentration, which can significantly alter the typical dose-response relationship independent of the amount of drug administered.
Why Other Options are Incorrect:
A. Dosage form primarily affects how a drug is delivered and absorbed, not the fundamental dose-response relationship at the receptor level.
B. Route of administration affects bioavailability and onset but does not fundamentally alter the receptor-level dose-response relationship.
C. Dosing schedule affects drug levels over time but does not change the fundamental relationship between a given dose and receptor-level response.
A 23-year-old woman of childbearing age has been diagnosed with bipolar disorder. Her most recent episode was manic. Of the following, which medication will the PMHNP avoid due to teratogenic risks?
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Aripiprazole (Abilify)
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Quetiapine (Seroquel)
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Divalproex (Depakote)
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Lurasidone (Latuda)
Explanation
Explanation:
Correct Answer: (C) Divalproex (Depakote) Divalproex carries one of the highest teratogenic risks among mood-stabilizing medications, including significant risk of neural tube defects and other major congenital malformations, making it a medication to avoid in women of childbearing age who may become pregnant.
Why Other Options are Incorrect:
A. Aripiprazole does not carry the same significant teratogenic risk profile as divalproex.
B. Quetiapine does not carry the same significant teratogenic risk profile as divalproex.
D. Lurasidone does not carry the same significant teratogenic risk profile as divalproex.
A patient presents with tachycardia, low-grade fever, nausea/vomiting, and agitation about two days after starting venlafaxine (Effexor) for depression. How should the NP adjust this patient's medication?
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Switch to another SSRI
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Switch to a tricyclic antidepressant (TCA)
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Lower the dose of venlafaxine (Effexor)
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Discontinue the venlafaxine (Effexor)
Explanation
Explanation:
Correct Answer: (D) Discontinue the venlafaxine (Effexor) This presentation — tachycardia, fever, GI upset, and agitation occurring shortly after starting a serotonergic agent — is consistent with serotonin syndrome. The immediate and appropriate action is to discontinue the causative serotonergic medication rather than continue or adjust the dose.
Why Other Options are Incorrect:
A. Switching to another SSRI does not address the acute serotonergic toxicity and risks worsening symptoms if not first discontinuing the offending agent.
B. Switching to a TCA does not address the acute issue and TCAs also carry serotonergic activity that could perpetuate the syndrome.
C. Lowering the dose does not adequately address an acute toxicity reaction; the medication should be stopped.
The NP is assessing an adult patient who has body dysmorphic disorder (BDD). BDD is most often comorbid with which of the following disorders?
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Bipolar disorder
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Generalized anxiety disorder
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Social anxiety disorder
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Specific phobia
Explanation
Explanation:
Correct Answer: (C) Social anxiety disorder BDD and social anxiety disorder share overlapping features of fear of negative evaluation and social avoidance related to appearance concerns, making social anxiety disorder one of the most common comorbid conditions seen with BDD.
Why Other Options are Incorrect:
A. Bipolar disorder is not among the most characteristic comorbidities associated with BDD.
B. Generalized anxiety disorder, while it can co-occur, is not as specifically linked to BDD as social anxiety disorder.
D. Specific phobia is not a typical comorbid condition associated with BDD.
A PMHNP is performing medication reconciliation on their patient. Which of the following drug classes is paired with the correct side effect?
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Monoamine oxidase inhibitors (MAOIs) commonly cause blurred vision.
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Second-generation antipsychotics (SGAs) often cause weight loss.
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First-generation antipsychotics (FGAs) often cause hyperlipidemia.
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Benzodiazepines commonly cause agitation, nervousness, and insomnia.
Explanation
Explanation:
Correct Answer: (D) Benzodiazepines commonly cause agitation, nervousness, and insomnia. Although benzodiazepines are prescribed for their calming and sedative effects, a recognized paradoxical reaction can occur in which patients instead experience agitation, nervousness, restlessness, and insomnia — the opposite of the intended effect.
Why Other Options are Incorrect:
A. MAOIs are more classically associated with hypertensive crisis (with tyramine-containing foods) and orthostatic hypotension rather than blurred vision as a hallmark effect.
B. Second-generation antipsychotics are well known for causing weight gain and metabolic syndrome, not weight loss.
C. Hyperlipidemia and metabolic syndrome are more classically associated with second-generation (atypical), not first-generation, antipsychotics.
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