NR547 PMHNP Pre-clinical Diagnostic Exam Chamberlain University.
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Free NR547 PMHNP Pre-clinical Diagnostic Exam Chamberlain University. Questions
A patient with acute symptoms of Crohn's disease would most likely be started on which of the following medications to manage the acute flare?
- Methotrexate (Trexall).
- Ibuprofen (Advil).
- Prednisone (Deltasone).
- Adalimumab (Humira).
Explanation
Explanation:
Correct Answer: (C) Prednisone (Deltasone)
Corticosteroids such as prednisone are the first-line treatment for inducing remission during acute flares of Crohn's disease. They rapidly suppress the inflammatory response, providing quick symptom relief. However, they are not used for long-term maintenance due to significant side effects with prolonged use.
Why Other Options are Incorrect:
A. Methotrexate is an immunomodulator used for maintenance therapy in Crohn's disease to sustain remission, not for managing acute flares due to its slower onset of action.
B. Ibuprofen is an NSAID that can actually worsen inflammatory bowel disease symptoms and increase the risk of gastrointestinal complications. It is generally avoided in Crohn's disease patients.
D. Adalimumab (Humira) is a biologic TNF-alpha inhibitor used for moderate to severe Crohn's disease maintenance therapy. While it can induce remission, it is not typically the first agent initiated for an acute flare compared to the faster-acting corticosteroids.
When screening for melanoma, which one of the following findings would be considered a suspicious feature of a mole characteristic of a possible melanoma?
- Brown color
- Regular border.
- Symmetry of the lesion, mirror-like image when divided in half.
- Diameter of 1 cm.
Explanation
Explanation:
Correct Answer: (D) Diameter of 1 cm.
The ABCDE criteria for melanoma screening include Asymmetry, Border irregularity, Color variation, Diameter greater than 6 mm, and Evolution. A diameter of 1 cm (10 mm) significantly exceeds the 6 mm warning threshold and is therefore a suspicious feature warranting further evaluation for possible melanoma.
Why Other Options are Incorrect:
A. Brown color alone is not a suspicious feature. Most benign moles are uniformly brown. It is the variation in color (multiple shades of brown, black, red, white, or blue within the same lesion) that raises concern for melanoma.
B. A regular, well-defined border is actually a reassuring feature of a benign mole. Melanoma is characterized by irregular, notched, or poorly defined borders, not regular ones.
C. Symmetry (where one half mirrors the other) is a benign characteristic of normal moles. Melanoma is characterized by asymmetry, where the two halves of the lesion do not match when divided in half.
Your patient states they have a diagnosis of hyperthyroidism. On assessment, which of the following represent typical findings of hyperthyroidism?
- Hypersomnia.
- Bradycardia.
- Tremor
- Recent unplanned weight gain.
Explanation
Explanation:
Correct Answer: (C) Tremor
Tremor is a classic manifestation of hyperthyroidism caused by the excess thyroid hormone overstimulating the nervous system and increasing adrenergic activity. Fine hand tremors are a hallmark sign consistently associated with hyperthyroid states such as Graves' disease.
Why Other Options are Incorrect:
A. Hypersomnia (excessive sleepiness) is associated with hypothyroidism, where metabolic processes are slowed. Hyperthyroidism causes the opposite effect, resulting in insomnia, restlessness, and hyperactivity.
B. Bradycardia (slow heart rate) is a classic sign of hypothyroidism. Hyperthyroidism characteristically causes tachycardia and palpitations due to increased metabolic rate and excess thyroid hormone stimulation of the heart.
D. Unplanned weight gain is a hallmark of hypothyroidism due to slowed metabolism. Hyperthyroidism causes unintentional weight loss despite increased appetite due to an accelerated metabolic rate.
Which of the following are considered essential features of sexual dysfunction?
- Inability to respond to sexual stimulation or the experience of pain during the sexual act
- Abnormal heightened arousal to sexual stimulation and abnormal timing in orgasm in relationship to sexual stimuli
- Lack of sexual desire and the experience of pain during the sexual act
- Aversion to sexual stimuli and the experience of painful orgasm
Explanation
Explanation:
Correct Answer: (A) Inability to respond to sexual stimulation or the experience of pain during the sexual act
According to the DSM-5, the essential features of sexual dysfunction include a clinically significant disturbance in a person's ability to respond sexually or to experience sexual pleasure, encompassing inability to respond to sexual stimulation or pain during the sexual act. These features must cause significant distress and are not better explained by another condition.
Why Other Options are Incorrect:
B. Abnormal heightened arousal is not an essential feature of sexual dysfunction. Sexual dysfunctions are defined by deficits or disturbances in the sexual response, not by excessive arousal.
C. While lack of sexual desire is a feature of specific sexual dysfunctions such as female sexual interest/arousal disorder, it alone combined with pain does not capture the full breadth of the essential features that define sexual dysfunction as a category.
D. Aversion to sexual stimuli was a concept used in older diagnostic systems but is no longer listed as a recognized sexual dysfunction category in the DSM-5, making this an outdated and inaccurate description of essential features.
Which symptoms describe female orgasmic disorder?
- Recurrent delay in or absence of orgasm after normal sexual excitement phase during masturbation and coitus
- Recurrent delay in or absence of orgasm and lack of pleasure after normal sexual excitement phase during masturbation
- Recurrent delay in or absence of orgasm after normal sexual excitement phase during masturbation
- Recurrent delay in or absence of orgasm after normal sexual excitement phase during coitus
Explanation
Explanation:
Correct Answer: (A) Recurrent delay in or absence of orgasm after normal sexual excitement phase during masturbation and coitus
Female orgasmic disorder is defined as a persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase across a wide range of sexual stimulation, including both masturbation and coitus.
Why Other Options are Incorrect:
B. The addition of "lack of pleasure" is not part of the diagnostic criteria for female orgasmic disorder. Lack of pleasure is more characteristic of other sexual dysfunctions.
C. Limiting the diagnosis only to masturbation is incomplete. The disorder must be present across multiple types of stimulation including coitus to meet full diagnostic criteria.
D. Limiting the diagnosis only to coitus is also incomplete. The disorder must be identified across various forms of sexual stimulation, not just one.
Which one of the following would you expect to occur if a patient has narrow (closed) angle glaucoma?
- Decrease in intraocular pressure only if glaucoma is bilateral (affecting both eyes).
- Severe eye pain and headache.
- Decrease in intracranial pressure.
- Gastroparesis or stool impaction.
Explanation
Explanation:
Correct Answer: (B) Severe eye pain and headache.
Narrow (closed) angle glaucoma is an acute ophthalmic emergency characterized by a sudden and dramatic rise in intraocular pressure due to obstruction of the trabecular meshwork by the peripheral iris. This rapid pressure increase causes severe eye pain, headache, nausea, vomiting, blurred vision, halos around lights, and a fixed mid-dilated pupil. Immediate treatment is required to prevent permanent vision loss.
Why Other Options are Incorrect:
A. Acute angle-closure glaucoma causes a sudden increase in intraocular pressure, not a decrease. The pressure elevation is what produces the painful and sight-threatening emergency, and its occurrence is not dependent on bilateral involvement.
C. Narrow angle glaucoma affects intraocular pressure within the eye, not intracranial pressure. These are separate compartments and the condition does not cause a decrease in intracranial pressure.
D. Gastroparesis and stool impaction are gastrointestinal conditions with no pathophysiological relationship to narrow angle glaucoma or intraocular pressure changes.
Urticaria can commonly be managed with which of the following class of medications?
- NSAIDs.
- First generation antihistamines.
- H1 receptor antagonists.
- Proton pump inhibitors.
Explanation
Explanation:
Correct Answer: (C) H1 receptor antagonists
Urticaria (hives) is primarily mediated by histamine released from mast cells binding to H1 receptors in the skin, causing the characteristic wheals, flares, and pruritus. H1 receptor antagonists (antihistamines) block these receptors, preventing histamine from exerting its effects and providing effective relief of urticarial symptoms. Both first and second generation antihistamines fall under this category.
Why Other Options are Incorrect:
A. NSAIDs can actually worsen or trigger urticaria in some patients, particularly those with aspirin-sensitive urticaria. They are not used to treat urticaria and may exacerbate the condition.
B. First generation antihistamines such as diphenhydramine are indeed H1 receptor antagonists and can treat urticaria, but this answer is less complete than option C. H1 receptor antagonists as a class encompasses both first and second generation agents, making C the more comprehensive and accurate answer.
D. Proton pump inhibitors reduce gastric acid production and are used for gastrointestinal conditions such as GERD and peptic ulcer disease. They have no direct role in managing urticaria or histamine-mediated skin reactions.
Which health indicators are important to monitor for clients who are prescribed second-generation antipsychotic medications?
- Insulin levels, prolactin levels, lipid profile
- Complete metabolic profile, liver function studies, kidney function studies
- Electrocardiogram, complete blood count, thyroid function studies
- Body mass index, fasting blood glucose, lipid profile
Explanation
Explanation:
Correct Answer: (D) Body mass index, fasting blood glucose, lipid profile
Second-generation antipsychotics are well known to cause metabolic side effects including weight gain, hyperglycemia, and dyslipidemia. Monitoring body mass index, fasting blood glucose, and lipid profile is essential to detect and manage metabolic syndrome, which is one of the most significant health risks associated with long-term use of second-generation antipsychotics.
Why Other Options are Incorrect:
A. While prolactin levels can be elevated with some antipsychotics such as risperidone, prolactin and insulin monitoring are not the primary standard metabolic monitoring parameters for the entire class of second-generation antipsychotics.
B. A complete metabolic profile, liver function studies, and kidney function studies are important baseline assessments but are not the most specifically targeted monitoring parameters for the metabolic side effects uniquely associated with second-generation antipsychotics.
C. Electrocardiogram monitoring is particularly important for first-generation antipsychotics and specific agents such as ziprasidone due to QTc prolongation risk, but it is not the primary monitoring indicator for the metabolic effects of second-generation antipsychotics as a class.
A client presents to the provider with symptoms of obsessive-compulsive disorder. In determining whether the client's symptoms are subclinical or clinical, which factor should the psychiatric mental health nurse practitioner consider?
- Whether the client has a comorbid tic disorder
- Whether others in the client's life find the behaviors problematic
- The patient's level of distress and impairment in function
- Whether the client has an awareness of their behaviors
Explanation
Explanation:
Correct Answer: (C) The patient's level of distress and impairment in function
The key factor distinguishing subclinical OCD symptoms from a clinical diagnosis is the degree to which the obsessions and compulsions cause significant distress and functional impairment in the person's daily life, relationships, or work. This is a core diagnostic criterion according to the DSM-5.
Why Other Options are Incorrect:
A. The presence of a comorbid tic disorder is relevant to OCD specifiers but does not determine whether symptoms cross the threshold from subclinical to clinical.
B. Whether others find the behaviors problematic is not a valid clinical criterion. The distress must be experienced by the client themselves, not judged by those around them.
D. Awareness of behaviors relates to insight specifiers in OCD but does not determine whether the disorder is subclinical or clinical in severity.
Having the patient cover their right eye and you covering your left eye, then bringing a set number of fingers or wiggling fingers into each quadrant of the patient's visual field having them identify when they see your fingers/movement is known as which?
- Refractory reflex.
- Confrontation.
- Visual acuity.
- Convergence.
Explanation
Explanation:
Correct Answer: (B) Confrontation.
Confrontation visual field testing is a bedside technique used to screen for peripheral visual field defects. The examiner and patient face each other, cover opposite eyes, and the examiner introduces fingers or movement into the peripheral visual fields, comparing the patient's field of vision to their own as a reference standard.
Why Other Options are Incorrect:
A. The refractory reflex is not a standard clinical examination technique for visual field assessment. Refraction refers to the bending of light by the eye's optical components and is assessed differently using lenses and charts.
C. Visual acuity testing measures the clarity and sharpness of central vision, typically using a Snellen chart, not through finger movement in visual quadrants.
D. Convergence testing assesses the ability of both eyes to turn inward simultaneously to focus on a near object. It does not involve covering one eye or testing peripheral visual fields.
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