PMHNP Practice SET4 Psychotherapy Theory
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Free PMHNP Practice SET4 Psychotherapy Theory Questions
According to Freudian theory, a patient who has alcohol use disorder and smokes to excess became fixated at which stage?
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Anal
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Oral
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Phallic
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Latent
Explanation
Explanation: Correct Answer: (B) Oral In Freudian psychosexual theory, fixation at the oral stage is classically associated with behaviors centered on the mouth for gratification, including excessive smoking, drinking, and other oral-seeking behaviors in adulthood.
Why Other Options are Incorrect:
A. Fixation at the anal stage is classically associated with traits like excessive orderliness, control, or messiness, not oral behaviors like smoking and drinking.
C. Fixation at the phallic stage is classically associated with issues related to authority and identity, not oral-seeking behaviors.
D. The latent stage is not classically associated with fixation-driven adult behaviors in the same way as the oral stage.
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.
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.
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.
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.
The PMHNP is treating a 69-year-old man with ziprasidone (Geodon) for schizophrenia and orders an electrocardiogram. Which QTc interval places the patient at greatest risk for torsades de pointes?
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100-200 milliseconds
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300-400 milliseconds
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500-700 milliseconds
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260-460 milliseconds
Explanation
Explanation:
Correct Answer: (C) 500-700 milliseconds A QTc interval in the range of 500-700 milliseconds represents significant prolongation, which is well above the threshold generally considered dangerous (typically over 500 ms) and places the patient at the greatest risk for the potentially fatal arrhythmia torsades de pointes.
Why Other Options are Incorrect:
A. A QTc of 100-200 milliseconds is far below even the normal range and is not a physiologically realistic or dangerous QTc value.
B. A QTc of 300-400 milliseconds falls within or near the normal range and does not represent a significant risk for torsades de pointes.
D. A QTc of 260-460 milliseconds largely overlaps with the normal reference range and does not represent the level of prolongation associated with the greatest arrhythmia risk.
Which theorist developed interpersonal theory and the stages of interpersonal development?
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Jean Piaget
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Erik Erikson
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Abraham Maslow
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Harry Stack Sullivan
Explanation
Explanation:
Correct Answer: (D) Harry Stack Sullivan Harry Stack Sullivan developed interpersonal theory, which describes personality development through a series of interpersonal stages and emphasizes the central role of relationships in psychological development.
Why Other Options are Incorrect:
A. Jean Piaget developed cognitive developmental theory, not interpersonal theory.
B. Erik Erikson developed psychosocial developmental theory with its eight stages, which is distinct from Sullivan's interpersonal theory.
C. Abraham Maslow developed the hierarchy of needs, not interpersonal developmental theory.
A 19-year-old man presents to the PMHNP for a psychiatric evaluation. He is diagnosed with schizophrenia. His body mass index is 30, his fasting blood glucose is 121 mg/dL, and his fasting triglycerides are 230 mg/dL. Based on this clinical scenario, which of the following medications is most appropriate?
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Olanzapine (Zyprexa)
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Ziprasidone (Geodon)
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Risperidone (Risperdal)
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Quetiapine (Seroquel)
Explanation
Explanation:
Correct Answer: (B) Ziprasidone (Geodon) This patient already shows evidence of significant metabolic dysfunction (obesity, elevated fasting glucose consistent with prediabetes, and elevated triglycerides), so an antipsychotic with the lowest metabolic risk profile among the options — ziprasidone — is the most appropriate choice to avoid worsening these parameters.
Why Other Options are Incorrect:
A. Olanzapine carries the highest risk of weight gain and metabolic disturbance among the options, making it inappropriate for this patient.
C. Risperidone carries a moderate metabolic risk, higher than ziprasidone, making it a less appropriate choice given this patient's existing metabolic abnormalities.
D. Quetiapine carries a moderate-to-significant metabolic risk, higher than ziprasidone, making it a less appropriate choice given this patient's existing metabolic abnormalities.
Faye Abdellah developed the 21 nursing problems theory. Which of the following statements best describes how Abdellah's theory helped form the nurse's view of their role?
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The role of a nurse as the provider of fresh air, light, cleanliness, warmth, quiet, and nutrition.
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How to provide care that aligns with the cultural context of the individual.
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Described the individual as an energy field existing within the universe.
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Nursing care should encompass the physical, emotional, intellectual, social, and spiritual needs of the client and family.
Explanation
Explanation:
Correct Answer: (D) Nursing care should encompass the physical, emotional, intellectual, social, and spiritual needs of the client and family. Faye Abdellah's 21 nursing problems theory reframed nursing practice around a holistic, problem-solving approach that addresses the full range of physical, emotional, intellectual, social, and spiritual needs of clients and their families.
Why Other Options are Incorrect:
A. This description reflects Florence Nightingale's environmental theory of nursing, not Abdellah's theory.
B. Culturally-aligned care is more closely associated with theorists such as Madeleine Leininger's transcultural nursing theory.
C. Describing the individual as an energy field is characteristic of Martha Rogers' Science of Unitary Human Beings, not Abdellah's theory.
The PMHNP is rounding at the local ED when he is asked to consult on a 29-year-old man who is in a psychiatric crisis. The ED physician believes the patient is in psychosis due to methamphetamine, because his urine drug screen is positive for this substance. When speaking with the patient's mother, the PMHNP learns that he was diagnosed with schizoaffective disorder at age 19. He was previously stabilized on risperidone (Risperdal) for psychosis and another medication for depression. The mother says he will no longer take his Risperdal because he believes he is "cured" of the psychotic symptoms. He does continue to take the antidepressant. Based on this information, the PMHNP does not believe the patient is taking methamphetamine and instead is displaying psychosis due to discontinuation of Risperdal. Which of the following is supportive of this conclusion?
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His mother says her son eats poppy seed muffins for breakfast every day.
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His mother says he takes ibuprofen daily for an old sports injury.
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His mother says he takes fluoxetine (Prozac) for depression.
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His mother says he takes sertraline (Zoloft) for depression.
Explanation
Explanation:
Correct Answer: (D) His mother says he takes sertraline (Zoloft) for depression. Sertraline has documented cross-reactivity that can cause a false-positive urine drug screen result for amphetamines/methamphetamine on standard immunoassay testing. This supports the PMHNP's conclusion that the positive methamphetamine screen may be a false positive related to the sertraline he continues taking, rather than actual methamphetamine use, and that his psychosis is instead due to stopping his antipsychotic.
Why Other Options are Incorrect:
A. Poppy seed consumption is classically associated with false-positive opiate results, not amphetamine/methamphetamine results.
B. Ibuprofen is not a well-documented cause of false-positive amphetamine/methamphetamine urine drug screen results.
C. While some antidepressants have been reported with amphetamine cross-reactivity, sertraline has the more specifically documented association relevant to supporting this conclusion.
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