NKU APEA PSYCH
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Free NKU APEA PSYCH Questions
The PMHNP has just diagnosed a 28-year-old woman with generalized anxiety disorder and prescribed the selective serotonin reuptake inhibitor escitalopram (Lexapro). Which of the following tools will he administer to measure the client's response to the medication over time?
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Patient Health Questionnaire-9
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Brief psychiatric rating scale (BPRS)
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State-trait anxiety inventory (STAI)
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Hamilton Anxiety Rating Scale (HAM-A)
Explanation
Explanation:
Correct Answer: (D) Hamilton Anxiety Rating Scale (HAM-A) The HAM-A is a clinician-administered scale specifically designed to measure the severity of anxiety symptoms and track treatment response over time, making it the appropriate tool for monitoring this client's progress.
Why Other Options are Incorrect:
A. The PHQ-9 measures depressive symptoms, not anxiety.
B. The BPRS is used to assess psychotic symptoms, not anxiety.
C. The STAI is a self-report tool rather than the standard clinician-administered scale used to track anxiety treatment response in this context.
The area of the brain that is responsible for speech, cognition, judgment, perception, and motor function is:
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the cerebellum.
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the medulla oblongata.
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the cerebral cortex.
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the hypothalamus.
Explanation
Explanation:
Correct Answer: (C) the cerebral cortex. The cerebral cortex is the brain region responsible for higher-order functions including speech, cognition, judgment, perception, and voluntary motor function, making it the correct structure described.
Why Other Options are Incorrect:
A. The cerebellum primarily coordinates balance and fine motor coordination, not speech, cognition, and judgment.
B. The medulla oblongata regulates basic autonomic functions like breathing and heart rate, not the functions described.
D. The hypothalamus regulates homeostatic functions such as temperature, hunger, and hormone release, not the functions described.
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.
The PMHNP has diagnosed a 9-year-old boy with attention deficit hyperactivity disorder (ADHD) and is prescribing medication. As she discusses the medication with the mother, she can see the mother is becoming visibly anxious. What does the PMHNP do next?
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Do not prescribe the medication.
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Stop and address the mother's anxiety.
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Continue her discussion and then ask if the mother has any questions.
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Tell the mother not to worry, because this medication is going to work for her son.
Explanation
Explanation:
Correct Answer: (B) Stop and address the mother's anxiety. Effective patient and family education requires the recipient to be in a receptive state; pausing to acknowledge and address the mother's visible anxiety ensures she can actually absorb the information being provided, rather than continuing to teach into a barrier to learning.
Why Other Options are Incorrect:
A. Withholding a clinically indicated medication is not warranted simply because the mother appears anxious; her anxiety should be addressed, not treated as a reason to change the treatment plan.
C. Continuing to talk without addressing the visible anxiety risks the mother not retaining any of the education being given.
D. Offering false reassurance dismisses the mother's concerns rather than exploring and addressing them.
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 who has been on long-term treatment for anxiety has noticed a steady decline in the effectiveness of the drug while on the maximum dose for the last 6 months. Which of the following statements explains their tolerance?
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The dose is not potent enough and should be increased to provide relief.
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The route of administration is not effective and should be switched to intramuscular administration.
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The maximum effect level of the drug has been reached, likely because of saturated binding sites.
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The patient is taking the drug on a full stomach, preventing the full absorption of the medication.
Explanation
Explanation:
Correct Answer: (C) The maximum effect level of the drug has been reached, likely because of saturated binding sites. Pharmacologic tolerance develops when receptor binding sites become saturated or downregulated over time, reducing the drug's effect despite consistent dosing — this is the mechanism underlying the declining effectiveness described.
Why Other Options are Incorrect:
A. The patient is already on the maximum dose, so further increasing it is not a viable or safe option.
B. There is no indication that route of administration is the issue; this scenario describes a pharmacodynamic tolerance issue, not an absorption problem.
D. Taking the medication with food is not the described mechanism of declining effectiveness after 6 months at a stable maximum dose.
A 43-year-old man with a BMI of 33 presents to the PMHNP with complaints of being depressed, difficulty falling asleep, loss of motivation, diminished concentration, and decreased sexual desire. Based on this scenario, which of the following medications would be most appropriate as an initial treatment?
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Mirtazapine
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Fluoxetine
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Bupropion
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Nortriptyline
Explanation
Explanation:
Correct Answer: (C) Bupropion Bupropion is an appropriate choice for this client because it does not cause the sexual dysfunction associated with SSRIs (relevant given his already decreased libido) and does not carry the significant weight gain risk seen with mirtazapine, which would be particularly undesirable given his elevated BMI.
Why Other Options are Incorrect:
A. Mirtazapine is strongly associated with weight gain and increased appetite, which would be counterproductive for a patient who is already obese.
B. Fluoxetine, an SSRI, commonly causes sexual side effects, which could worsen this client's already decreased sexual desire.
D. Nortriptyline, a TCA, is associated with weight gain and has a less favorable side effect profile for this patient's presentation.
A PMHNP is managing a patient who has schizophrenia. When providing education about clozapine (Clozaril) therapy, which of the following substances, once stopped, has the most potential to double serum clozapine (Clozaril) levels?
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Cocaine
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Cigarettes
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Marijuana
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Heroin
Explanation
Explanation:
Correct Answer: (B) Cigarettes Smoking induces the CYP1A2 enzyme responsible for metabolizing clozapine, so when a patient who smokes suddenly stops, this enzyme induction is lost, causing clozapine levels to rise significantly — potentially doubling serum levels and increasing toxicity risk.
Why Other Options are Incorrect:
A. Cocaine use does not have this well-documented CYP1A2 induction effect on clozapine metabolism.
C. Marijuana does not have the same well-documented CYP1A2 induction effect on clozapine metabolism as tobacco smoke.
D. Heroin does not have this well-documented effect on clozapine metabolism.
An older adult with a history of bipolar disorder and chronic kidney disease is admitted for worsening renal function secondary to dehydration. The police found them wandering the streets, claiming to be an Apostle of God. The assessment reveals a patient who is pacing around the room and furiously writing on a notepad. Their tangentiality, rapid speech, and looseness of association make it difficult to communicate. The patient reports they took lithium (Lithobid) at one time in the past but is unable to provide any further details about their treatment history. Given this current assessment data, which of the following is the best medication to initiate as treatment?
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Sertraline (Zoloft)
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Bupropion (Wellbutrin)
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Lithium (Lithobid)
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Valproate (Depakote)
Explanation
Explanation:
Correct Answer: (D) Valproate (Depakote) Given this patient's chronic kidney disease and current dehydration/worsening renal function, lithium would be a poor and potentially dangerous choice due to its renal clearance and narrow therapeutic index; valproate is a safer mood stabilizer option for treating this acute manic presentation in the setting of renal impairment.
Why Other Options are Incorrect:
A. Sertraline is an antidepressant and is not appropriate or sufficient to treat this patient's acute manic/psychotic presentation, and antidepressants can risk inducing further mania.
B. Bupropion is an antidepressant with stimulating properties and is not appropriate for treating acute mania; it could worsen manic symptoms.
C. Lithium is relatively contraindicated in this patient given the chronic kidney disease and acute dehydration, which significantly increase the risk of lithium toxicity.
The psychiatric-mental health nurse practitioner is treating a 26-year-old woman diagnosed with bipolar I disorder who has exhibited a partial response to Lamictal 200 mg PO BID. The PMHNP wants to augment the Lamictal with valproate (Depakote). To do so, how must she change the dose of Lamictal?
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She does not need to change the dose of Lamictal.
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She must double the dose.
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She must decrease the dose by half.
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She must discontinue the dose of Lamictal because the two medications are contraindicated.
Explanation
Explanation:
Correct Answer: (C) She must decrease the dose by half. Valproate inhibits the metabolism of lamotrigine, roughly doubling its serum concentration, so the lamotrigine dose must be reduced by half when valproate is added to avoid toxicity, including an increased risk of serious rash.
Why Other Options are Incorrect:
A. Leaving the dose unchanged risks lamotrigine toxicity due to the significant drug interaction with valproate.
B. Doubling the dose would dangerously increase lamotrigine levels given the interaction with valproate.
D. These medications are not contraindicated together; they can be used in combination with appropriate dose adjustment.
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