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    Exam Review

    1. A client diagnosed with generalized anxiety disorder reports no relief of symptoms after taking paroxetine 20 mg daily for a month. What is the most appropriate next step?
      A)
      add a PRN benzodiazepine
      B)
      change medication to venlafaxine
      C)
      add daily buspirone
      D)
      increase the daily dose of paroxetine to 40 mg daily
    2. Which statement is true regarding sleep-wake disorders?
      A)
      coexisting clinical comorbidities are the rule, not the exception
      B)
      they share clinical features of nocturnal distress and circadian rhythm disruption
      C)
      they all share common sleep stage dysfunctions
      D)
      pharmacologic interventions are the primary treatment for all sleep-wake disorders
    3. A client presents with symptoms of depression. Which laboratory test result indicates a possible medical cause for symptoms?
      A)
      hematocrit of 29%
      B)
      urinalysis positive for nitrites
      C)
      serum creatinine of 1.4 mg/dL
      D)
      thyroid stimulating hormone of 2.2 mIU/L
    4. The psychiatric mental health nurse practitioner is reviewing the medication list for a client who presents with complaints of difficulty falling asleep. The client takes all their medications at night. Which medication should the client take in the morning instead if possible?
      A)
      hydroxyzine
      B)
      fluoxetine
      C)
      omeprazole
      D)
      topiramate
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    Exam Review

    1. A client presents with symptoms of chest pain, irritability, and restlessness. Which listed medication's adverse effects present similarly?
      A)
      bupropion
      B)
      zolpidem
      C)
      sertraline
      D)
      glargine insulin
    2. The psychiatric mental health nurse practitioner is seeing a client for an initial diagnostic assessment. Which factor is most critical in determining whether a physical exam is necessary as part of the assessment?
      A)
      the nature of the client's complaints
      B)
      the number of medications the client takes
      C)
      the amount of time that has elapsed since the client's last complete physical exam
      D)
      the complexity of the client’s past medical history
    3. A client presents with symptoms of fatigue. Which laboratory test result indicates a possible medical cause of symptoms?
      A)
      hematocrit of 42%
      B)
      serum glucose of 128 mg/dL
      C)
      thyroid stimulating hormone of 7.1 mlU/L
      D)
      serum creatinine of 0.9 mg/dL
    4. The psychiatric mental health nurse practitioner is performing an initial interview with a client. Which client endorsement is considered a social determinant of health?
      A)
      The client describes growing up in a household where there was abuse and neglect.
      B)
      The client reports being noncompliant with medications because he did not like the side effects.
      C)
      The client states that he has a family history of depression and schizophrenia.
      D)
      The client states that she has been hospitalized for a psychiatric diagnosis in the past.
    Page 2 of 19

    Exam Review

    1. What is the most common breathing related sleep disorder?
      A)
      obstructive sleep apnea hypopnea
      B)
      central sleep apnea
      C)
      primary snoring
      D)
      sleep-related hypoventilation
    2. Which psychological comorbidity is most commonly seen with generalized anxiety disorder?
      A)
      unipolar major depressive disorder
      B)
      neurodevelopmental disorder
      C)
      acute stress disorder
      D)
      obsessive compulsive disorder
    3. Which physiological response commonly occurs in clients with anxiety disorders?
      A)
      decreased autonomic and sympathetic activation
      B)
      excessive activation of postsynaptic 5-HT1A receptors in the substantia nigra
      C)
      exaggerated noradrenergic system output
      D)
      exaggerated noradrenergic system input
    4. Which diagnosis presents with minimal spontaneous sexual thinking or minimal desire for sex ahead of sexual experiences?
      A)
      male hypoactive sexual desire disorder
      B)
      male sexual interest/arousal disorder
      C)
      female orgasmic disorder
      D)
      female sexual interest/arousal disorder
    Page 3 of 19

    Exam Review

    1. Anxiety disorders can be differentiated by which diagnostic criteria?
      A)
      the types of objects/situations that induce fear, anxiety, and avoidance
      B)
      the presence of autonomic arousal
      C)
      the presence of nervousness or edginess
      D)
      the presence of worry
    2. A client with mild symptoms of generalized anxiety disorder would prefer to try a nonpharmacologic intervention rather than daily medication. What alternative suggestions might the psychiatric mental health nurse practitioner offer?
      A)
      PRN clonazepam
      B)
      electroconvulsive therapy
      C)
      exposure therapy
      D)
      a meditation app for the phone
    3. Which of the following are common comorbidities in clients who present with sleepwalking?
      A)
      major depressive disorder and obsessive-compulsive disorder
      B)
      neurodegenerative disorders and personality disorders
      C)
      bipolar disorder and anxiety disorder
      D)
      narcolepsy and coronary artery disease
    4. Select the appropriate treatment modalities for a client with circadian rhythm sleep-wake disorder.
      A)
      melatonin and chronotherapy
      B)
      alprazolam and cognitive therapy
      C)
      valerian root and sleep diary
      D)
      doxepin and paradoxical intention
    Page 4 of 19

    Exam Review

    1. Which factor would rule out a diagnosis of schizophreniform disorder?
      A)
      The client displays echolalia
      B)
      The client is dressed in dirty, disheveled clothes that are inappropriate for the season
      C)
      The client is experiencing disturbing command hallucinations
      D)
      The client has experienced symptoms intermittently for 18 months
    2. Which statement is true regarding enuresis?
      A)
      clients typically sleep through episodes
      B)
      episodes awaken clients after a deep sleep
      C)
      more common in females
      D)
      typically caused by a physiologic abnormality
    3. A 17-year-old boy is brought to the mental health clinic by his parents due to their concerns about his lack of motivation, odd behaviors, verbal aggression, and social isolation. The parents report the client has had few friends since middle school. Over the last 9 months, he has gradually withdrawn from family and refuses to eat meals with them. He is experiencing increased academic difficulties. His parents are concerned about drug use, but the client reports he has only used alcohol a few times and tried marijuana one time. The client has no previous medical history and is not on any prescribed medications. The client has no past psychiatric history. While meeting privately with the psychiatric mental health nurse practitioner, the client reports that his family is out to get him, and they have been poisoning his food with a chemical substance his father obtained from a terrorist organization. His mental status exam is significant for a clear sensorium, restricted affect, tangential speech, and poor insight. Laboratory testing is normal, and urine drug screen is negative. Which is the most likely diagnosis?
      A)
      schizoid personality disorder
      B)
      schizoaffective disorder
      C)
      schizophreniform disorder
      D)
      schizophrenia
    4. In which situation would the use of a brief screening tool be least appropriate?
      A)
      completing a psychiatric history for a new counseling client
      B)
      evaluating the efficacy of a client's antipsychotic medication
      C)
      assessing a client's suicide risk in the emergency department
      D)
      assessing the severity of a client's anxiety
    Page 5 of 19

    Exam Review

    1. Which factor has the strongest evidence as the cause of schizophrenia?
      A)
      genetics
      B)
      neuroendocrine system abnormalities
      C)
      prenatal nutritional deficiencies, birth complications, and trauma after delivery
      D)
      prenatal exposure to viral infection
    2. A client presents to the clinic with anxiety symptoms. A GAD 7 was completed, the score is 10. How does the psychiatric mental health nurse practitioner interpret this score?
      A)
      moderate anxiety
      B)
      mild anxiety
      C)
      minimal anxiety
      D)
      severe anxiety
    3. A 43-year-old client presents with complaints of excessive daytime sleepiness. She sometimes falls asleep without warning during meetings at work and while driving. She sometimes loses muscle tone suddenly if she laughs too hard or gets excited. Prior to prescribing medication, which diagnostic test should be completed?
      A)
      cerebrospinal fluid analysis
      B)
      complete blood count
      C)
      thyroid stimulating hormone (TSH)
      D)
      magnetic resonance imaging (MRI)
    4. For which conditions are persistent insomnia and excessive sleepiness comorbid?
      A)
      major depressive disorder, substance use disorder
      B)
      anxiety, obstructive sleep apnea hypopnea
      C)
      parasomnias, major depressive disorder
      D)
      obstructive sleep apnea hypopnea, substance use disorder
    Page 6 of 19