NR547 PMHNP Pre-clinical Diagnostic Exam Chamberlain University.
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Free NR547 PMHNP Pre-clinical Diagnostic Exam Chamberlain University. Questions
Which of the following agents is considered a cardioselective beta blocker?
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Metoprolol (Lopressor).
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Carvedilol (Coreg).
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Propranolol (Inderal).
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Labetalol (Trandate).
Explanation
Explanation:
Correct Answer: (A) Metoprolol (Lopressor)
Metoprolol is a cardioselective (beta-1 selective) beta blocker, meaning it primarily blocks beta-1 receptors found in the heart. This selectivity makes it preferable in patients with reactive airway disease, as it has less effect on beta-2 receptors in the lungs compared to non-selective beta blockers.
Why Other Options are Incorrect:
B. Carvedilol (Coreg) is a non-selective beta blocker that also blocks alpha-1 receptors. It blocks both beta-1 and beta-2 receptors and is not cardioselective.
C. Propranolol (Inderal) is a non-selective beta blocker that blocks both beta-1 and beta-2 receptors equally, making it less preferred in patients with asthma or COPD.
D. Labetalol (Trandate) is a non-selective beta blocker with additional alpha-1 blocking activity, commonly used in hypertensive emergencies. It is not cardioselective.
Which client is the best candidate for electroconvulsive therapy for major depressive disorder?
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A 25-year-old who continues to experience symptoms of depressive disorder 4 months after starting bupropion 100 mg daily.
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A 45-year-old who continues to experience symptoms of major depressive disorder 6 months after switching to isocarboxazid.
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A 32-year-old who continues to experience symptoms of major depressive disorder six months after starting sertraline 50 mg daily.
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A 29-year-old who continues to experience symptoms of major depressive disorder two months after adding amitriptyline to their daily regimen of paroxetine.
Explanation
Explanation:
Correct Answer: (B) A 45-year-old who continues to experience symptoms of major depressive disorder 6 months after switching to isocarboxazid
Electroconvulsive therapy (ECT) is indicated for treatment-resistant major depressive disorder, defined as failure to respond to adequate trials of antidepressant medications. This client has been on isocarboxazid, a monoamine oxidase inhibitor (MAOI), which represents a later-line antidepressant, for 6 months without improvement. This duration and medication class indicate the most extensive and appropriate trial, making this client the best candidate for ECT.
Why Other Options are Incorrect:
A. The 25-year-old has only been on bupropion for 4 months at 100 mg daily, which may not represent an adequate therapeutic trial at an optimal dose. ECT would be premature at this stage.
C. The 32-year-old has been on sertraline 50 mg for six months, but 50 mg is a low starting dose for major depression. Optimization of the dose should be attempted before considering ECT.
D. The 29-year-old has only been on the combination of paroxetine and amitriptyline for two months, which is insufficient time to determine treatment resistance before escalating to ECT.
All of the following are conditions suspicious for renal artery stenosis (secondary hypertension) except which one?
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Hypertension controlled on 2 medications.
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Severe, sudden hypertension or poorly controlled hypertension in a patient 55 years or older.
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Onset of hypertension at an early age (Onset at age 30 or earlier).
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An unexplained small kidney or size discrepancy between the two kidneys.
Explanation
Explanation:
Correct Answer: (A) Hypertension controlled on 2 medications
Hypertension that is well controlled on two medications does not raise suspicion for renal artery stenosis. Renal artery stenosis is suspected when hypertension is resistant, difficult to control, or occurs with other specific clinical clues. Controlled hypertension suggests the cause is manageable with standard treatment.
Why Other Options are Incorrect:
B. Severe or sudden onset hypertension, especially in older patients, is a classic red flag for renal artery stenosis due to atherosclerotic narrowing of the renal artery.
C. Early onset hypertension (at or before age 30) raises suspicion for fibromuscular dysplasia causing renal artery stenosis, particularly in young women.
D. A small kidney or size discrepancy between kidneys on imaging is a direct radiological clue suggesting renal artery stenosis causing ischemic nephropathy on the affected side.
Pain in the left lower quadrant abdomen is most likely suggestive of which of the following diagnoses?
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Appendicitis
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Cholecystitis
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Diverticulitis
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Pancreatitis
Explanation
Explanation:
Correct Answer: (C) Diverticulitis
Diverticulitis classically presents with pain in the left lower quadrant (LLQ) of the abdomen, often described as a "left-sided appendicitis." The pain results from inflammation or infection of diverticula, which most commonly form in the sigmoid colon located in the left lower quadrant.
Why Other Options are Incorrect:
A. Appendicitis classically presents with pain in the right lower quadrant (RLQ), beginning periumbilically and migrating to McBurney's point, not the left lower quadrant.
B. Cholecystitis (inflammation of the gallbladder) presents with pain in the right upper quadrant (RUQ), often radiating to the right shoulder, and is associated with Murphy's sign.
D. Pancreatitis typically presents with epigastric pain that radiates to the back, not left lower quadrant pain.
Which factor is a common cause of circadian sleep disorders?
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Obstruction
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Shift work
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Iron deficiency
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Depression
Explanation
Explanation:
Correct Answer: (B) Shift work
Shift work is one of the most common and well-documented causes of circadian rhythm sleep-wake disorders. Working night shifts or rotating shifts disrupts the alignment between the internal circadian clock and the external light-dark cycle, leading to insomnia, excessive sleepiness, and impaired daytime functioning. Shift Work Sleep Disorder is a recognized DSM-5 diagnosis within the circadian rhythm sleep-wake disorders category.
Why Other Options are Incorrect:
A. Obstruction of the upper airway is the primary cause of obstructive sleep apnea hypopnea, which is a breathing-related sleep disorder, not a circadian rhythm disorder.
C. Iron deficiency is associated with restless legs syndrome, a sleep-related movement disorder characterized by uncomfortable sensations in the legs, not a circadian rhythm disruption.
D. Depression is associated with sleep disturbances including insomnia and hypersomnia and disrupts sleep architecture, but it is classified as a mood disorder rather than a primary cause of circadian rhythm sleep-wake disorders.
The workup for a patient with macrocytic anemia should include which of the following?
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Vitamin D deficiency
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Vitamin B6 deficiency
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Folate deficiency
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Iron and TIBC
Explanation
Explanation:
Correct Answer: (C) Folate deficiency
Folate deficiency is a classic cause of macrocytic (megaloblastic) anemia. Folate is essential for DNA synthesis and red blood cell maturation. Its deficiency leads to the production of abnormally large, immature red blood cells. Along with B12 deficiency, folate deficiency testing is a standard part of the macrocytic anemia workup.
Why Other Options are Incorrect:
A. Vitamin D deficiency is associated with bone disease, immune dysfunction, and muscle weakness but does not cause macrocytic anemia. It is not part of the macrocytic anemia workup.
B. Vitamin B6 deficiency is associated with sideroblastic anemia, which is a microcytic anemia, not macrocytic anemia.
D. Iron and TIBC are evaluated in the workup of microcytic anemia (particularly iron deficiency anemia), not macrocytic anemia.
Which of the following is a correct diagnosis for the patient with platelets of 700,000?
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Thrombocytopenia.
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Thrombastemia.
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Thrombocytosis.
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Pancytopenia.
Explanation
Explanation:
Correct Answer: (C) Thrombocytosis
Thrombocytosis refers to an abnormally high platelet count, typically defined as platelets exceeding 400,000–450,000/μL. A count of 700,000 clearly falls into this category, making thrombocytosis the correct diagnosis.
Why Other Options are Incorrect:
A. Thrombocytopenia refers to a low platelet count (below 150,000/μL), which is the opposite of what is seen in this patient.
B. Thrombasthenia is a disorder of platelet function, not platelet count. Platelet numbers may be normal but they do not work properly.
D. Pancytopenia refers to a reduction in all blood cell lines (red blood cells, white blood cells, and platelets), which does not apply here since the platelet count is elevated.
Why are diagnostic instruments and psychiatric rating scales beneficial?
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They independently provide sufficient information to accurately diagnose and treat a client.
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They omit the need for the clinical interview.
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They can help to standardize the information collected across time by various observers.
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They are easy to administer without training.
Explanation
Explanation:
Correct Answer: (C) They can help to standardize the information collected across time by various observers.
Diagnostic instruments and psychiatric rating scales are valuable because they provide a structured, consistent framework for collecting and quantifying clinical information. This standardization allows different clinicians to assess the same client using the same criteria across different time points, improving reliability, enabling tracking of symptom changes, and facilitating communication among providers.
Why Other Options are Incorrect:
A. Diagnostic instruments and rating scales are supplementary tools and cannot independently provide sufficient information to diagnose or treat a client. They must be used in conjunction with a comprehensive clinical interview and assessment.
B. Rating scales complement rather than replace the clinical interview. The therapeutic relationship, clinical judgment, and detailed history obtained through direct conversation remain essential components of psychiatric assessment.
D. Many psychiatric rating scales require specific training to administer correctly and interpret accurately. Assuming they can be administered without training risks misuse, misinterpretation, and inaccurate clinical conclusions.
Which medication is appropriate to prescribe for a 68-year-old client with schizophrenia?
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Olanzapine
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Ziprasidone
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Haloperidol
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Aripiprazole
Explanation
Explanation:
Correct Answer: (D) Aripiprazole
Aripiprazole is the most appropriate antipsychotic for an older adult with schizophrenia because it has a favorable side effect profile with lower risks of metabolic syndrome, weight gain, QTc prolongation, and extrapyramidal symptoms compared to other antipsychotics, making it safer for elderly patients.
Why Other Options are Incorrect:
A. Olanzapine is associated with significant weight gain, metabolic syndrome, and sedation, which carry higher risks in elderly patients and make it a less preferred choice in this population.
B. Ziprasidone carries a risk of QTc prolongation, which is particularly concerning in older adults who may already have underlying cardiac vulnerabilities.
C. Haloperidol is a first-generation antipsychotic associated with high rates of extrapyramidal side effects such as tardive dyskinesia and parkinsonism, which are significantly more problematic and harder to reverse in elderly patients.
Which statement indicates that a client understands education regarding lithium treatment?
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"I will discontinue my medication if I experience increased thirst or headache."
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"I should take all medications as prescribed and get lab work drawn as ordered."
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"I will make an appointment with an endocrinologist to evaluate my blood sugar."
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"I will complete my MRI before my next follow-up appointment."
Explanation
Explanation:
Correct Answer: (B) "I should take all medications as prescribed and get lab work drawn as ordered." Lithium has a narrow therapeutic index (0.6 to 1.2 mEq/L), making medication adherence and regular serum lithium level monitoring essential for safe and effective treatment. Routine lab work also monitors renal function (lithium is renally cleared), thyroid function, and electrolytes. This statement reflects accurate understanding of the key safety requirements for lithium therapy.
Why Other Options are Incorrect:
A. "I will discontinue my medication if I experience increased thirst or headache." — Increased thirst and mild headache are common, expected early side effects of lithium and are not indications to stop the medication. Clients should report symptoms but must never abruptly discontinue lithium without consulting their provider, as this can precipitate mood episodes.
C. "I will make an appointment with an endocrinologist to evaluate my blood sugar." — Lithium is not associated with blood glucose dysregulation. It can affect thyroid function (causing hypothyroidism) and renal function, which are monitored by the prescribing provider — not an endocrinologist for blood sugar evaluation.
D. "I will complete my MRI before my next follow-up appointment." — MRI is not a standard component of lithium monitoring or follow-up care. Regular lab work (serum lithium levels, BMP, thyroid function tests) is the appropriate monitoring strategy.
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