PMHNP Practice SET4 Psychotherapy Theory
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Free PMHNP Practice SET4 Psychotherapy Theory Questions
James is a 46-year-old man with schizophrenia. His disease has been stable on olanzapine (Zyprexa) for several years. Recently, James stopped smoking in an effort to reduce his risk of developing heart disease or lung cancer. What dose adjustment should the PMHNP make, if any?
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Increase the olanzapine or James may become acutely psychotic
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Reduce the olanzapine or James may experience increased lethargy
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No dose adjustment is needed
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Reduce the dose of olanzapine or James may become hyperglycemic
Explanation
Explanation:
Correct Answer: (B) Reduce the olanzapine or James may experience increased lethargy Cigarette smoke induces the CYP1A2 enzyme responsible for metabolizing olanzapine. When James stops smoking, this enzyme induction is lost, causing olanzapine levels to rise, which can lead to increased sedation and lethargy unless the dose is proactively reduced.
Why Other Options are Incorrect:
A. Stopping smoking raises, not lowers, olanzapine levels, so there is no pharmacologic reason to expect worsening psychosis requiring a dose increase.
C. A dose adjustment is needed because smoking cessation removes CYP1A2 induction, causing a clinically meaningful rise in olanzapine levels.
D. While metabolic effects are a general olanzapine concern, the specific and immediate pharmacokinetic consequence of smoking cessation is increased sedation from higher drug levels, not hyperglycemia as the primary concern prompting dose adjustment.
During a psychiatric evaluation, the psychiatric-mental health nurse practitioner conducts a psychiatric review of systems (ROS) in which she 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 "psychosis"?
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Do you ever lose time, forget important details about yourself, or find evidence that you took part in events you cannot remember?
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Are there specific objects, places, or social situations that make you feel very anxious or tearful?
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Do you frequently experience unwanted images, thoughts, or urges?
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Do you ever feel like people are following you or trying to hurt you in some way?
Explanation
Explanation:
Correct Answer: (D) Do you ever feel like people are following you or trying to hurt you in some way? This question directly screens for paranoid or persecutory delusional content, a core psychotic symptom, making it the most appropriate item for eliciting the "psychosis" system on a psychiatric ROS.
Why Other Options are Incorrect:
A. This question screens for dissociative symptoms (such as dissociative amnesia), not psychosis.
B. This question screens for specific phobia-type anxiety symptoms, not psychosis.
C. This question screens for obsessive-compulsive symptoms (intrusive thoughts/urges), not psychosis.
An adult patient presents to the psychiatry clinic wearing a wig. They have no eyelashes or eyebrows. Which behavioral therapy has been shown efficacious for this patient's suspected hair-pulling disorder?
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Habit reversal training
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Negative practice
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Psychodynamic therapy
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Psychoanalytic therapy
Explanation
Explanation:
Correct Answer: (A) Habit reversal training Habit reversal training is the behavioral therapy with the strongest evidence base for treating trichotillomania (hair-pulling disorder), teaching patients to recognize urges to pull hair and substitute an incompatible competing response.
Why Other Options are Incorrect:
B. Negative practice is not the evidence-based behavioral therapy recognized for treating trichotillomania.
C. Psychodynamic therapy is not the first-line, evidence-based treatment approach for trichotillomania.
D. Psychoanalytic therapy is not the first-line, evidence-based treatment approach for trichotillomania.
Which of the following is the correct term for the level at which one's sense of self-worth is not dependent on external relationships, circumstances, or occurrences?
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Emotional cutoffs
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Transactional patterns
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Differentiation
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Enmeshment
Explanation
Explanation: Correct Answer: (C) Differentiation Differentiation, a core concept in Bowen family systems theory, describes the degree to which an individual can maintain a stable sense of self and self-worth independent of external relationships, emotional reactivity, or circumstances.
Why Other Options are Incorrect:
A. Emotional cutoffs describe individuals distancing themselves from family members to manage unresolved emotional issues, not the stability of self-worth.
B. Transactional patterns is not the specific Bowen systems term describing independent self-worth.
D. Enmeshment describes the opposite concept — an overly fused, poorly differentiated relationship where self-worth is highly dependent on others.
A 68-year-old woman is referred to the PMHNP 4 months after her husband died. The referral was made by the woman's primary care physician. She reported to the physician that she can hear her deceased husband's voice calling out to her as she is falling asleep. This usually happens after she has been talking about him with friends or looking through old photo albums. The PCP is worried the patient is having a psychotic episode and would like her to have a psychiatric evaluation. Which of the following statements explains why her symptoms are not considered to be psychotic?
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The voice calls her name.
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The voice is that of a close family member.
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The voice does not command her to do anything.
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The voice calls out as she is falling asleep.
Explanation
Explanation:
Correct Answer: (D) The voice calls out as she is falling asleep. Hallucination-like experiences that occur specifically during the transition into sleep (hypnagogic) are a recognized, normal phenomenon, particularly in the context of grief, and are not considered indicative of a true psychotic disorder.
Why Other Options are Incorrect:
A. The voice calling her name is not, by itself, the feature that distinguishes this from a true psychotic symptom.
B. The identity of the voice as a close family member does not by itself explain why this is non-psychotic; grief-related hallucinations of any familiar voice can occur in this context.
C. While the absence of command content is reassuring regarding risk, it is not the specific feature that explains why this experience is considered non-psychotic (a hypnagogic, grief-related experience).
A 40-year-old man employed as a warehouse worker comes to the PMHNP with complaints of mild depressive symptoms for the past few months. He reports no feelings of anxiety, but he wonders if he should try harder to form relationships. He has had no significant romantic relationships at any time in his life, nor has he had the desire for one. He reports having no friends, nor does he desire to have friendships. He feels no distress about his lack of relationships; however, he wonders if he should have some because "everyone else has friends." He works nights, lives alone, and prefers to avoid interactions with others. He exhibits a flat affect and does not meet criteria for major depressive disorder. Which personality disorder best fits this clinical scenario?
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Paranoid personality disorder
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Schizotypal personality disorder
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Avoidant personality disorder
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Schizoid personality disorder
Explanation
Explanation:
Correct Answer: (D) Schizoid personality disorder This man shows a pervasive, lifelong pattern of detachment from social relationships, a genuine lack of desire for close relationships (rather than fear of rejection), restricted emotional expression (flat affect), and general indifference to his social isolation — the core defining features of schizoid personality disorder.
Why Other Options are Incorrect:
A. Paranoid personality disorder is characterized by pervasive distrust and suspicion of others' motives, which is not described in this presentation.
B. Schizotypal personality disorder involves odd beliefs, magical thinking, and eccentric behavior or speech, none of which is described here.
C. Avoidant personality disorder involves a desire for relationships accompanied by significant fear of rejection or criticism, which contrasts with this man's genuine lack of desire for relationships and indifference to being alone.
A 34-year-old man presents to the PMHNP with complaints of auditory hallucinations that have been worsening over the past few months. He explains that he hears Satan telling him he is "a dirty pig," and the messages are coming from the exhaust pipes of vehicles. He also complains of depressive symptoms including sadness and anhedonia, which have been present for at least 2 weeks each month. He says he hears the voices even when his mood is "normal." Which combination of medications would be most appropriate to treat these symptoms?
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Citalopram (Celexa) and mirtazapine (Remeron)
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Divalproex (Depakote) and lorazepam (Ativan)
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Ziprasidone (Geodon) and sertraline (Zoloft)
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Alprazolam (Xanax) and risperidone (Risperdal)
Explanation
Explanation:
Correct Answer: (C) Ziprasidone (Geodon) and sertraline (Zoloft) This presentation — persistent auditory hallucinations occurring even when mood is normal, combined with recurring depressive symptoms — is consistent with schizoaffective disorder, depressive type, which requires combined treatment with an antipsychotic (to address ongoing psychosis) and an antidepressant (to address the depressive episodes).
Why Other Options are Incorrect:
A. This combination of two antidepressants does not address the persistent psychotic symptoms this patient is experiencing.
B. This combination lacks an antipsychotic to target the ongoing hallucinations and lacks a targeted antidepressant for the depressive symptoms.
D. Alprazolam and risperidone lack a dedicated antidepressant to address this patient's recurring depressive episodes.
Which of the following symptom combinations would meet Criterion A of the diagnostic criteria for schizophrenia, if present for 1 month?
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Avolition and diminished emotional expression
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Grossly disorganized behavior and avolition
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Disorganized speech and diminished emotional expression
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Prominent visual and auditory hallucinations
Explanation
Explanation:
Correct Answer: (C) Disorganized speech and diminished emotional expression Criterion A for schizophrenia requires two or more symptoms from five categories (delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior, negative symptoms), and at least one of the two must be delusions, hallucinations, or disorganized speech. Disorganized speech (from the required first three) paired with diminished emotional expression (a negative symptom) satisfies both requirements.
Why Other Options are Incorrect:
A. Avolition and diminished emotional expression are both negative symptoms (the same single category), and neither is a delusion, hallucination, or disorganized speech, so this combination does not meet Criterion A.
B. Grossly disorganized behavior and avolition come from two different categories, but neither is a delusion, hallucination, or disorganized speech, so this combination does not meet Criterion A's requirement that at least one of the required symptoms be present.
D. Visual and auditory hallucinations both fall under the single category of hallucinations; Criterion A requires symptoms from two or more of the five categories, so hallucinations alone, however prominent, are insufficient on their own.
A mother sees her 4-year-old boy masturbating. She expresses concern about this to the PMHNP and says she wants to know if he has been sexually abused. What is the most appropriate response?
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"Yes, this is a clear sign he has been abused. I need to call Child Protective Services."
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"It's possible he has been abused. Bring him in and let me evaluate him."
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"This is part of a normal developmental stage for a child his age."
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"Have you ever left him in a place where he could have been abused?"
Explanation
Explanation:
Correct Answer: (C) This is part of a normal developmental stage for a child his age. Self-stimulatory behavior, including masturbation, is a normal part of childhood development at this age and, in isolation, is not indicative of sexual abuse. Providing accurate developmental education helps reassure the parent without creating unwarranted alarm.
Why Other Options are Incorrect:
A. Declaring this a clear sign of abuse and involving Child Protective Services based on this behavior alone is an inaccurate and premature conclusion not supported by isolated masturbatory behavior in a young child.
B. While a thorough evaluation is reasonable if other concerning signs are present, framing the behavior itself as suspicious of abuse is misleading when it is a normal developmental behavior.
D. This response implies abuse has likely occurred and shifts to an accusatory line of questioning without first providing accurate information about normal development.
The pathophysiology of schizophrenia includes theories about abnormalities in neurotransmission. Which of the following has been suggested as a pathological basis for schizophrenia?
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Excess dopamine in the mesolimbic pathway
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Increased dopamine in the mesocortical pathway
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Increased serotonin
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Decreased glutamate
Explanation
Explanation:
Correct Answer: (A) Excess dopamine in the mesolimbic pathway The dopamine hypothesis of schizophrenia proposes that excess dopaminergic activity in the mesolimbic pathway underlies the positive symptoms of schizophrenia (hallucinations, delusions), which is a foundational and well-supported theory in the pathophysiology of the disorder.
Why Other Options are Incorrect:
B. The mesocortical pathway is more classically associated with decreased, not increased, dopamine activity, which is theorized to underlie negative and cognitive symptoms.
C. While serotonergic dysregulation has been studied in schizophrenia, increased serotonin is not the primary, foundational neurotransmitter hypothesis for the disorder.
D. Glutamate hypofunction (particularly at NMDA receptors) has been theorized as contributing to schizophrenia, but this is typically described as glutamate hypofunction/dysregulation rather than a simple decrease, and it is not as foundational as the mesolimbic dopamine excess theory.
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