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PMHNP ANCC Exam Review Questions And
Answers A+ Verified
1. The purpose of the American Nurses Association's Psychiatric-Mental
Health Nursing: Scope and Standards of Practice is to
a. Define the role and actions for the NP
b. Establish the legal authority for the prescription of psychotropic medica-
tions
c. Define the legal statutes of the role of the PMHNP
d. Define the differences between the physician role and the NP role: A. The
ANAs Psych-Mental Health Nursing Scope and Standards of Practice defines the role and actions of the nurse practitioner.
2. D. Information reduces incidence of disease.: Primary prevention care prac- tices
are an essential aspect of the PMHNP role. Which of the following is the best example of a primary prevention care strategy for community behavioral health?
a. Aftercare program for chronically mentally ill clients recently discharged from the
hospital
b. Court-ordered counseling for abusive parents
c. 24-hour crisis hotlines
d. Parenting skills classes for pregnant adolescents
3. The trend in legal rulings on cases involving mental illness over the past 25
2 / years has been to
a. Encourage juries to find defendants not guilty by reason of insanity
b. Protect the person's freedoms or rights when he or she is committed to a
mental hospital
c. Place increasing trust in mental health professionals to make good and
ethical decisions
d. Decrease the "red tape" associated with commitments so that commitments are
faster and easier: B. Identifies the trend of ensuring the protection of individual civil liberties for psychiatric clients.
4. Mr. Smithers, an involuntarily hospitalized patient experiencing psychotic
symptoms, refuses to take any of his ordered medication because he believes "Jesus Christ told me I am the prophet and must fast for a year." Your actions should be based on your knowledge of which of the following?
a. Psychiatric clients cannot refuse treatment
b. Psychiatric clients do not always know what is good for them
c. Psychiatric clients can refuse treatment
d. Psychiatric clients cannot be trusted to make good healthcare decisions
and, therefore, the nurse's best clinical judgment should guide actions: C. As with any client, psychiatric clients can refuse treatment unless a legal process
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a. Discharge the client
b. Explain that the client cannot leave until you can complete further assess-
ment
c. Allow the client to leave but have her sign forms stating she is leaving
against medical advice
d. Immediately start the paperwork to commit the client and to allow you to
treat her against her wishes: B. Almost every state allows for a brief for a period detainment to assess a client for dangerousness to self or others before allowing the client to leave a hospital setting, even if the admission was voluntary.
8. In forming a therapeutic relationship with clients, the PMHNP must con-
sider developing many characteristics that are known to be helpful in rela- tionship-building. Which of the following is an essential part of building a
5 / therapeutic relationship?
a. Collecting a family history
b. Like-mindedness
c. Authenticity
d. Accuracy in assessment: C. Authenticity. Being genuine, honest, and respect- ful are
essential elements in establishing a working relationship with any client. Like- mindedness is not a part of the therapeutic relationship. Although an important aspect of the PMHNP role, collecting a family history and accuracy in assessment does not in and of itself facilitate relationship building.
9. According to the DSM-5, which of the following is true? (Ch. 3)
a. A mental disorder is equivalent to the need for treatment.
b. Diagnostic criteria are used to inform clinical judgment.
c. Socially deviant behavior is considered a mental disorder.
d. A culturally expected response to a stressor is not a mental disorder.: D. All
DSM-5 disorders need to be made taking a person's culture into account. A cultural expression of a response to grief, loss, or stress is not considered a DSM-5 diagnosis.
10. Mrs. French has been in individual therapy for 3 months. She has shown
much growth and improvement in her functioning and insight and is to dis- continue services within the next few weeks. In the next session, after you discuss service termination, she suddenly begins to demonstrate the original symptoms that had brought her to treatment initially. She is now hesitant to discharge, wants to continue services, and is displaying an increase in regressive defense mechanisms. What is the best explanation for Ms. French's behavior?
a. An exacerbation of her symptoms related to stress
b. The normal cyclic nature of chronic mental health symptoms
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c. Late childhood
d. School age: B. These signs indicate developmental failure of early childhood.
12. Mr. Thompson has been forgetful lately, for example, forgetting where he
has placed his keys or what time appointments are scheduled, and he has stated that he thinks these are just random behaviors that have no particular meaning. Which Freudian-based psychodynamic principle assumes that all behavior and actions are purposeful?
a. Pleasure principle
b. Psychic determinism principle
c. Reality principle
d. Unconsciousness principle: B. The psychic determinism principle states that all
behavior has purpose and meaning, often unconscious in nature, and that no behaviors occur randomly or by coincidence.
13. An example of a mature, healthy defense mechanism is
a. Denial
b. Rationalization
c. Repression
d. Suppression: D. Suppression is the only defense mechanism listed in which the client
channels conflicting energies into growth-promoting activities.
14. Mr. Johnson is a 54-year-old client you have been seeing for several weeks in
therapy. While discussing his current concerns of marital stress, he lies on the floor and assumes the fetal position. This is most likely an example of
a. Immature regressive defense mechanism
b. Denial of reality
c. Immature fantasy defense mechanism
d. Repressive behavior: A. Immature regressive defense mechanism is a return to a
8 / behavior common to an earlier stage of development.
15. Defense mechanisms are best viewed as a function of the ego
a. To alert us to harm and danger
b. To alert us to problems
c. Used to resolve a conflict
d. Used to protect the id: C. Defense mechanisms are a function of the ego used to
resolve a conflict.
16. One of the health care changes that has occurred as a result of the afford-
able care act (ACA) is that doctors/hospitals/clinic groups or health systems are coming together and assuming the responsibility for quality care to large groups of individuals insured by Medicare. The health care clinics/systems doctors or hospitals that join together are called which of the following?
a. Health Maintenance Organization (HMO)
10 / working in a hospitalist role. Mary has encountered over five incidences in which attending psychiatrists and medical residents have been demeaning to nursing staff and not answering calls in the middle of the night or telling the nursing staff to write orders and the MD would sign off in the a.m. Mary is concerned about errors and wants to improve quality, reduce errors to promote safety. What concept is Mary employing?
a. Bullying
b. Abuse
c. Civil Disobedience
d. Just Culture: D. The ANA has a position statement that nurses are responsible for
developing health care settings that include just culture initiatives understanding that human error can cause error and harm by creating an open and fair environment.
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20. The role of neurotransmitters in the central nervous system is to function
as
a. A communication medium
b. A gatekeeper for transmissions
c. A building block for amino acids
d. An agent to break down enzymes: A. Neurotransmitters in the central nervous
system function as a communication medium.
21. Serotonin is produced in which of the following locations:
a. Locus ceruleus
b. Nucleus basalis
c. Raphe nuclei
d. Substantia nigra: C. Serotonin is produced in the raphe nuclei.
22. Dopamine is produced in which of the following locations:
a. Locus ceruleus
b. Nucleus basalis
c. Raphe nuclei
d. Substantia nigra: D. Dopamine is produced in the substantia nigra.
23. A client presents with complaints of changes in appetite, feeling fatigued,
problems with sleep-rest cycle, and changes in libido. What is the neu- roanatomical area of the brain that is responsible for the normal regulation of these functions?
a. Thalamus
b. Hypothalamus
c. Limbic system
d. Hippocampus: B. Appetite, sleep, and libido are regulated by the hypothalamus.
13 / assessment. In planning his care, the PMHNP should apply his or her knowl- edge that these symptoms represent problems with the
a. Frontal lobe
b. Temporal lobe
c. Parietal lobe
d. Occipital lobe: A. Problems with working memory, planning and prioritizing,
insight into problems, and impulse control indicate a problem in the frontal lobe.
27. The concept of target symptom identification is best explained as
a. Identification of the major clinical presentation of the client
b. Identification of specific, precise, and individualized symptoms reasonably
expected to improve with medication
c. Identification of the secondary messenger system syndrome
d. Intentional modulation of synaptic pathways: B. Target symptom identification is
the identification of specific, precise, and individualized symptoms reasonably expected to improve with a given medication.
28. The goal of the psychiatric assessment process performed by the PMHNP is
to
a. Gain an understanding of the life experiences of the client
b. Correctly diagnose the client
c. Identify the mental health needs of the client
d. Be able to communicate with other staff about the client's health needs: C.
Although diagnosis is an important aspect of the assessment process, the assess- ment ultimately should identify the needs of the client.
29. Mr. Johnson is a client newly admitted to an inpatient psychiatric hospital.
The PMHNP on call at the facility plans to perform the initial intake assessment and diagnostic process. Mr. Johnson asks to please talk in his room because, he
14 / says, "People make me nervous." His room is at the end of the hallway and is the farthest away from the nursing station. The PMHNP's action should be based on awareness that the best location to do the assessment is
a. In Mr. Johnson's room, because it is least noisy and most comfortable for
him, thus facilitating data collection
b. In the dayroom, which is full of people, to observe his interactions with other
people
c. In a quiet place, but public enough to get assistance with client care should it
be required during the assessment
d. In the treatment room with the door closed, a neutral location: C. One PMHNP
role is to control the milieu as an aspect of assessment, so the PMHNP should choose a quiet place that is public enough to get assistance with client care should it be required during the assessment.
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b. "Maybe that depends on what you are trying to accomplish."
c. "Perhaps talking to his friends and teachers would help."
d. Remain silent: B. This response will be the most therapeutic in moving forward with
the client.
33. A client says to the PMHNP, "Some days life is just not worth it. All my wife
and I ever do is fight and scream.Things at home would be calmer and simpler if I just wasn't there anymore." The most therapeutic response for the PMHNP to make is
a. "Do you mean that you are thinking about leaving your wife and moving
out?"
b. "Tell me what you mean by 'it would be simpler if you just weren't there
anymore.'"
c. "So you are thinking suicide might be an option for you?"
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d. Remain silent: B. This response is the most therapeutic, allowing the client to
further clarify and express feelings.
34. Mrs. Shea has come to the mental health center seeking treatment for
depression. She has a history of a suicide attempt by overdose 1 month ago. She was started on imipramine (tricyclic antidepressant [TCA]) after that event but stopped taking the medication 1 week later because it "did no good." The PMHNP meets with Mrs. Shea to plan care with her. Which of the following is the most appropriate initial action?
a. Asking Mrs. Shea how to help her
b. Providing client teaching about the long time frame for TCAs to work
c. Contracting with Mrs. Shea for 6 sessions of individual therapy
d. Providing Mrs. Shea with feedback about how suicide might affect her
family: A. Asking the client how to help is an aspect of assessment—all other answers are aspects of interventions, which are not initial actions of the PMHNP.
35. In completing the PMHNP assessment for the Mrs. Shea, the most appro-
priate lab test for the PMHNP to order at this time is
a. CBC
b. TSH
c. Liver function tests
d. Electrolyte panel: C. Client overdosed and then was placed on a medication that affects
the liver. The PMHNP needs to assess the client's liver function as an aspect of care planning for her.
36. A client comes into the clinic with a longstanding history of depression and
chronic renal failure. He is on an antidepressant and a diuretic and complains of increased depression, mild confusion, irritability, and overall apathy from being too tired to do anything. The best initial PMHNP action to take at this
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a. Omeprazole
b. Propranolol
c. Levothyroxine
d. Clarithromycin: B. Beta blockers can cause or exacerbate depression.
38. When treating older adults, you should keep in mind that they are more
sensitive to issues of drug toxicity because of which of the following reasons?
a. Decreased body fat
b. Increased liver capacity
c. Decreased protein binding
d. Increased muscle concentration: C. Older adults usually have decreased protein
levels. Most psychotropic medications are highly protein-bound. It is the unbound (free) concentration of the drug that is active; the bound concentration of the drug is inert. Thus, with decreased protein available for binding, more free (active) drug remains in the body, which then predisposes older adults to toxicity.
39. Which known teratogenic effects can be caused by the common psy-
chotropic medications divalproex and lithium?
a. Divalproex—Epstein anomaly; lithium—cleft palate
b. Divalproex—spina bifida; lithium—Epstein anomaly
c. Divalproex—limb malformations; lithium—seizure disorder
d. Divalproex—mental retardation; lithium—spina bifida: B. Divalproex can
cause spina bifida and lithium can cause Epstein's anomaly.
40. The study of what the body does to drugs is called
a. Pharmacodynamics
b. Pharmacology
c. Pharmacokinetics
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d. Distribution: C. Pharmacokinetics is the study of what the body does to drugs.
41. Your client Sam is being treated for panic disorder with agoraphobia. He
currently is being prescribed paroxetine (Paxil CR, 37.5 mg q.d.) and clon- azepam (Klonopin, 0.5 mg q.d., p.r.n.). He has been on clonazepam for 2 years and admits to needing 4 pills to achieve the same effect that 1 pill initially produced. This is possibly an example of which process?
a. Kindling
b. Addiction
c. Tolerance
d. Potency: C. Tolerance means needing more to achieve the same effect.
42. Why is group therapy beneficial?
a. It assists the client to focus on self
b. It lacks theoretical frameworks
