NRNP 6675 Midterm Exam Answers

NRNP 6675 Midterm Exam Answers

 

Discrepancy between anatomical sex and gender is known as?

 

1. B) Gender Discordance

 

Which of the following are risk factors for neuroleptic malignant syndrome? Select all that apply

 

Rapid dose escalation; parental route of administration; higher potency typical antipsychotics

 

Antipsychotic medication provides D2 blockage in the meso-coritcal pathway causing which of the following effects?

 

1. B) Increases EPS

Incorrect: reduces negative s/s, causes prolactinemia, reduces positive symptoms

 

 

 

Phencyclidine (PCP) and ketamine exert their unique behavioral effects by blocking which of the following receptors?

 

1. D) NMDA type receptors

Incorrect: GABA, serotonin, dopamine “receptors”

 

The diagnosis used to describe a syndrome characterized by specific s/s resulting from recent ingestion or exposure to a substance is known as which of the following?

 

1. C) Substance use disorder

 

Abnormal involuntary movements in a rhythmic pattern affecting the face, mouth, tongue jaw is known as which of the following?

 

1. C) Tardive dyskinesia

 

A deeply held belief despite evidence to the contrary, lasting at least 1 month, without prominent hallucinations, with functional impairment that relates to the delusional system disorder called?

 

Delusional disorder

 

Which of the following is true about preoccupation with castration?

 

1. A) This can be serious and life threatening if castration is carried out without medical supervision

 

Which of the following is a system that provides a uniform language for describing medical and surgical procedures and diagnostics services rendered by clinicians?

 

CPT

 

A patient on Chlorpromazine states his orgasm is dry and afterwards he will commonly have milky urine. The APRN realizes this is which of the following?

 

1. A) This is likely a harmless response to the Chlorpromazine

 

A condition which results from absence of second female sex chromosome (XO) and is associated with web neck, dwarfism, cubitus valgus and infertility is known as which of the following?

 

1. B) Turners Syndrome

Turners syndrome:

tx involves hormone therapy; fertility treatments for women when they decide to have a baby

 

Which of the following would be characterized as a negative s/s of schizophrenia?

 

B & C only

1. B) impaired social and occupational functioning
   C) isolation and impaired self-care

 

Which of the following are keys to distinguishing OCD from psychosis?

 

Patients with OCD can almost always acknowledge the unreasonable nature of their symptoms

 

 

A federal program administered nationally and locally which covers enrolled individuals 65+ who pays premiums and disabled individuals

 

Both A& B (Medicare and Medicaid)

 

 

Having an adequate legal description of nurse practitioner (NP) scope of practice according to state law is important for which of the following reasons?

 

All of the above (to avoid any charges of practicing medicine without a license, to place accountability for both benefits and harm to patients squarely on the NP, to get reimbursed for physician services when provided by a NP

 

Which of the following is the most widely consumed psychoactive substance?

 

1. B) Caffeine

Incorrect: alcohol, heroin, cannabis

 

 

Which of the following is used to tx TD?

 

None of the above

(cogentin, artane, catapress)

 

 

The APRN consensus model did which of the following?

 

B & C

1. B) adult and gerontology were merged and identified as PCP or acute care
   C) psychiatric mental health foci were stipulated as across the lifespan

 

Which of the following behaviors are associated with an alcohol blood level of 0.05%?

 

1. B) Thought judgement and restraints are impaired

 

 

According to HIPPA, which of the following must the NP share their NPI with? Check all the above

 

1. A) Health Plans
   B) Other providers
   C) Any entity that may need it for a billing purpose

 

A patient presents with delusions, disorganized thoughts, and speech with poor self care all of which has persisted for the past 7 months. The APRN knowns this presentation means what diagnosis?

 

Schizophrenia

 

 

Major neurotransmitters possibly involved in developing substance abuse and substance dependence are which of the following?

 

1. A) Dopamine

Incorrect: GABA, serotonin, A& B only

 

The dopamine hypothesis of schizophrenia, which of the following?

 

1. A) Schizophrenia results from too much dopaminergic activity

incorrect: results from a deprivation of dopamine

 

 

A patient reports a panic attack several years ago in an elevator and since then has avoided elevators. The pt meets the criteria for:

 

1. B) Specific phobia

 

 

A patient with a substance use disorder who does not meet clinical criteria for hospitalization but lacks sufficient social and vocational skills and lack substance-free social supports is to

 

1. D) All of the above

(Residential tx, partial hospitalization, outpt tx)

 

 

Obscene phone calling to an unsuspecting partner for sexual arousal is known as?

 

1. C) Telephone Scatologia

(not telephillia, partialism, normal adolescent prank)

 

 

The main psychological difference between fear and anxiety is best described by which of these statements?

 

1. B) Anxiety is insidious, fear is sudden

 

A diffuse, unpleasant, vague sense of apprehension often accompanied by autonomic symptoms varies upon persons is commonly known as which of the following?

 

1. C) Normal anxiety

(incorrect- fear, stress, pathological anxiety

 

 

If a pregnancy begins while the woman is taking high doses of methadone and withdrawal is desired during which trimester is the least hazardous?

 

1. D) Withdrawal from methadone should never be done while the woman is pregnant

 

 

Neurochemical or neurophysiological changes in the body that results from the repeated administration of a drug is known as which of the following?

 

1. C) Neuroadaption

incorrect: cross-tolerance, neurotransformation, neurocognitive adjustment

 

 

The recurrent and intense sexual arousal from the physical and psychological suffering of another person is known as which of the following?

 

1. C) Sexual sadism

 

Which of the following is not consistent with the onset of OCD?

 

1. D) The onset of OCD is typically preceded by OCD personality traits

True answers about OCD:
-more than 1/2 of pts with OCD have a sudden onset of symptoms
-the onset of symptoms for about 50-70% of patients occurs after a stressful event
-most patients keep their symptoms secret initially

 

The recurrent urge to expose one’s genitals to a stranger is known ass which of the following?

 

1. C) Exhibitionism

 

 

Which of the following patients would be appropriate for hospitalization for substance use disorder? Select all that apply

 

1. D) A&B only

(Patients who have a substance overdose who cannot be safely tx in an outpt setting & pts who are at risk for severe or medically complicated withdrawal symptoms

 

 

The nursing practice model recommendation for NPs by the NAtional Academy of Medicine and the National Council of State Boards of Nursing is which of the following?

 

1. A) Full practice

 

Which of the following groups does medicare cover? Select all the above

 

1. A) Individuals 65+ years and older who have enrolled and pay premiums
   B) Disabled individuals who quality for social security disability payments and benefits

 

 

Which of the following neurotransmitters increases libidio?

 

1. D) Dopamine

Incorrect: GABA, serotonin, oxytocin

 

 

Which of the following factors are associated with poor prognosis for patients with OCD?

 

1. D) A & C

(Childhood onset & Co-existing major depressive disorder)

 

 

Which of the following is inconsistent with current knowledge about schizophrenia?

 

1. C) Dopamine level is a laboratory tests that assists in the diagnosis of schizophrenia

 

 

A chronic disorder characterized by repetitive hair pulling leading to variable hair loss that may be..to others known as?

 

1. C) Trichotillomania

 

 

Which of the following are risk factors for neuroleptic malignant syndrome?

 

1. B) Rapid dose escalation
   C) Parental route of admin
   D) High potency typical antipsychotics

 

A method of therapy used to tx individuals with substance use based on the fundamental principle of

 

a psychology that reinforced behaviors are likely to be..is known as the following?

1. B) Contingency Management

 

The conditions in which people are born, grow, work, live and age are known as?

 

Social determinants of health

 

 

All of the following is consistent with the ANCCs rules regarding recertification EXCEPT:

 

1. A) You are required to have a maximum of 25 credit hours during each certification period

Correct:
B) you can start the recert process 1 year before your expiration date, but no later than 3 months before
C) You must have 1000 clinical practice hours in a clinical speciality within the preceding 5 years
D)you must have at least 25 contact hours in pharmacotherapy

 

Risks factors for school violence include which of the following? Select all that apply

 

1. A) Bullying
   B) Being bullied
   C) Isolation

 

 

Persons who subordinate their own needs to those of others, get others to assume responsibility for major areas in the lives, lack of self-confidence, and may experience intense discomfort when alone for more than a brief period of time are demonstrating characteristics with which of the following personality disorders?

 

1. C) Dependent personality disorder

Incorrect: avoid PD, passive PD, antisocial PD

 

Generalized convulsions, oliguria, and renal failure are symptoms seen with which of the following lithium levels?

 

1. D) >25 mEq/L
   (TOXICITY)

 

 

A form of child abuse in which a patient or character repeatedly fabricates or actually inflicts injury or illness in a child for whom medical intervention is then sought in an ER is known as which of the following?

 

1. D) Munchausen Syndrome by Proxy

 

Self-care strategies for the ARNP in preparing for the certification exam include all of the following EXCEPT?

 

1. D) plan to study for short periods over a longer period of time

 

 

A patient presents with a formal, tense manner. He reluctantly reports a longstanding (since early adulthood) pervasive suspiciousness of others, preoccupied with..trustworthiness of friends, unjustified concerns about others deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP. The ARNP suspects that the pt likely has which of the following PDs?

 

1. B) Paranoid PD

Incorrect: schizoid PD, BDP, Antisocial PD

 

 

A pt will a hx of alcohol use presents to the ED with oculomotor disturbances, cerebellar ataxia, and confusion. Symptoms are consistent with which of the following psychiatric emergencies?

 

1. C) Wernickes Encephalopathy

Incorrect: akathisia, korsakoff’s syndromes, idiosyncratic alcohol intoxication

 

Cluster A personality disorders are more common in biological families of pts with which of the following disorders?

 

1. D) Schizophrenia

Incorrect: depression, OCD, alcohol use disorder

 

NP core competencies for INDEPENDENT practice includes all of the following EXCEPT:

1. B) Demonstrates the highest level of accountability for professional practice

 

NP competencies for independent practice:

 

1. A) Maintain a collaboration agreement with physician
   C) Practices independently managing previously diagnosed and under-diagnosed pts
   D) Practices patient centered care recognizing culture diversity and the pt or designee as a full practice in decision making

 

Cluster A personality traits consists of which of the following?

1. A) Schizotypal, schizoid, and paranoid subtypes

 

 

The misuse of the charge’s funds for personal gain is known as which of the following?

 

1. C) Financial abuse /exploitation

 

 

the ARNP recognizes which of the following as long term effects of sex trafficking on victims?

 

1. D) All of the above
2. A) Severe depression
   B) Spiritual questions
   C) Trauma bonding

 

 

In about half of the cases in which suicides occur while pts are on a psychiatric unit, a lawsuit results; which of the following is NOT consistent with what courts..related to impatient psychiatric unit suicide events?

 

1. B) Courts provide ZERO suicide rates in inpt setting

 

Cultural Dimensions Therapy is a framework for cross-cultural communication that describes the effects of a society’s culture on the values of its members..by which of the following therorists?

 

1. A) Hofstede

 

 

The tx of choice for pts with paranoid PD includes which of the following?

 

1. D) B&C
2. B) Behavioral Therapy and
   C) Psychotherapy

 

 

The differences in quality of healthcare actions across individuals or groups regard to access, tx options and p..following?

 

1. B) Health disparities

 

 

The incidence of suicide is highest for which of the following populations?

 

1. D) Older African American men

 

 

The pt on lithium with a hx of alcohol use disorder presents with dry mouth, ataxia, dizziness, abdominal pain, and slurred speech. The ARNP should do which of the following?

 

1. C) The ARNP recognizes the symptoms of moderate lithium toxicity, discontinues the lithium immediately, orders lithium level, serum electrolytes and renal function tests

 

The ARNP takes a position in which a specific amount is paid according to a set job description. The ARNP should do which of the following?

 

1. C) The ARNP recognizes these are symptoms of mild to moderate lithium toxicity, discontinues the lithium immediately, orders a lithium level, serum electrolytes and renal function tests

 

 

The ARNP takes a position in which a specific amount is paid according to a set job description. This type of pay structure is known as?

 

1. D) Hourly rate

 

 

A PD characterized by emotional constriction, orderliness, perseverance, stubbornness, indecisiveness, a inflexibility as which of the following?

 

Obsessive compulsive PD

 

Which of the following is consistent with what is known about the epidemiology of anxiety?

 

1. B) Women have a higher lifetime prevalence of anxiety than men

 

 

Which of the following is consistent with NP practice parameters when prescribing buprenorphine?

 

1. D) the NP is require to complete specific training to prescribe and dispense buprenorphine

 

 

Which of the following are consistent with current data related to the prevalence of drinking alcohol?

 

1. B) Men and women with higher education and income are more likely to drink alcohol

 

 

A pt with hx of hypoglycemia reports feelings of fear, worry and restlessness that has persisted over the past 6 months. The pt states these feelings are worse when glucose is low. the ARNP suspects the pt has which of the following dx?

 

A_) GAD attributable to another medical condition

 

Which of the following is not consistent with benzo withdrawal?

 

1. B) The best way to proceed with benzo withdrawal is to stop it immediately and tx withdrawal s/s

 

 

Which of the following is true about the legal practice of the PMHNP?

 

1. D) A&B only
2. A) all have some degrees of prescriptive privileges in all states and the district of columbia
   B) all are considered primary providers in all states and the district of columbia

 

 

Flashbacks in which the individual may act and feel as if the trauma were reoccurring represent which of the following clinical features of PTSD?

 

1. A) Intrusion Symptom
   B) Symptom of Avoidance

 

 

In which ways are NPs and PAs different?

 

1. D) A&B
2. A) NPs differ from PAs in legal definition, scope of practice, licensure, and independence of practice
   B) NPs practice under their own license and independent of the physician, PAs always work under the supervision of a physician

 

Which of the following initials would a PMHNP use to designate appropriate credentials?

 

PMHNP-BC

 

 

Variations from norms in gender roles such as toy preferences, rough and tumble play, aggression, or playmate gender is known as which of the following?

 

1. B) Gender role behavior

 

 

3 major neurotransmitters associated with anxiety, based on animal studies and response to drug tx include?

 

1. B) GABA, norepinephrine and serotonin

 

 

Which of the following is consistent with the epidemiology of schizophrenia in the US?

 

1. D) Onset of schizophrenia before the age of 25 is extremely rare

 

 

Clinical findings that may indicate abuse include which of the following? Select all that apply

 

1. B) Explanation by the pt which is inconsistent with the type of injury
   C) Psychological distress such as depression, anxiety, SI, and/or sleep disorder
   D) Explanation by the parent that is inconsistent with the type of injury

 

 

According to the APA, which of the following is consistent with the EBP for telepsych?

 

1. B) In populations with severe anxiety, tele psychiatry is preferred

 

Which of the following is consistent with literature regarding the term psychosexual?

1. D) None of the above

-psychosexual is used to describe personality development and functioning
-psychosexual is synonymous with libidio in the Freudian sense
-Psychosexual basically refers only to sexual feelings and behavior

 

 

Bleuler identified 4 fundamental s//s of schizophrenia, known as the 4 A’s, which include which symptoms?

 

1. A) Associations, Affect, Autism, Ambivalence

 

 

The fear/anxiety regarding places from which escape may be difficult is known as which of the following:

 

1. C) Agoraphobia

 

 

All of the following are one of the 5 major categories of third-party payers EXCEPT:

 

1. D) only A & B
2. A) Medicare/medicaid
   B) Managed care organization (MCOs)

 

 

Which of the following are risk factors for sexual assault EXCEPT:

 

1. A) Religion

Incorrect: serious mental illness, substance use disorder, family hx of sexual abuse

 

 

Which of the following is consistent with what is known about PP depression?

 

1. D) All of the above

(feelings of guilt/ and inadequacy are often present and excessive; thoughts of harming the baby are often present; typical onset is within 3-06 months of delivery)

 

Affirmatively acting to benefit another or others, going beyond what is required by law is known as which of the following?>

 

1. C) Beneficence

 

 

Which of the following is used for treating alcohol dependence individuals seeking to continue to remain alcohol free after they have stopped drinking?

 

1. D) Acamprosate

 

 

The NP can impact health policy and healthcare by doing which of the following?

 

1. D) All of the above

-becomes an active member of local, state, and/or national NP
-becomes familiar with the resources available on NP organization websites
-Volunteer to serve on legislature committees within professional NP organizations

 

The tx of others equitably and distribution of benefits/burdens fairly is known as?

1. B) Justice

 

 

Which of the following is INCONSISTENT with current literature about victims of sexual abuse?

 

1. C) The pre-existing relationship and\ familiarity with the abuser may impeded the victim’s ability to make rational decisions

 

 

Which of the following would constitute negligence? Select all that apply

 

1. A) Failure to give necessary care
   B) Failure to refer when necessary
   C) Failure to follow up with a patient
   D) Failure to disclose necessary info to a patient

 

 

Which of the following developed a biblically-based cultural competence model for healthcare professionals?

 

1. B) Camipinha-Cacote`

 

 

the ARNP recognizes which of the following as long term effects of sex trafficking on victims?

 

1. D) All of the above
   -severe depression
   -spiritual questions
   -trauma bonding

 

 

A patient appears odd, with a pervasive hx of magical thinking, ideas of reference, illusions or derealization. This is consistent with which of the folllowing PDs?

 

1. C) Schizotypal PD

 

Which of the following are criteria for a particular suicide to be considered inevitable?

 

1. D) All of the above

-strong genetic hx of suicide in one or more family members
-a strong genetic loading of mental illness in the family
-the pt may have received the highest standard of tx and that txd failed

 

 

A pt with a hx of alcohol use disorder presents to the ED with oculomotor disturbances, cerebellar ataxia, and confusion. The ARNP recognizes these symptoms as consistent with which of the following psych emergencies?

 

1. C) Wernicke’s encephalopathy

 

 

The emotional burnout and lack of empathy towards clients that healthcare providers experience after treating victims is known as the following?

 

1. B) Primary traumatization

 

The ACE study found that which of the following relationships between child traumatic events and high-risk behaviors exhibited by adults?

 

1. D) The study revealed an indirect relationship between child traumatic events and high risk adult behaviors

 

 

Walking on eggshells and appeasement/avoidance behaviors by the victim is characteristic of which phase of the cycle of DV?

 

1. A) Honeymoon phase

 

A term that defines a person who has distress with clinical symptomology because their gender identity is not consistent with gender assigned at birth is which of the following?

 

Gender Dysphoria

 

Social irresponsibility, diregard for others, deceitfulness, and manipulation of others for personal gain

 

Antisocial

 

Self-grandiosity, need for admiration and lack of empathy

 

Narcissistic PD

 

 

Eccentric ideas and behaviors PD?

 

Schizotypal PD

 

Disinterest in others PD?

 

Schizoid

 

Mistrust and suspicion PD?

 

Paranoid PD

 

Perfectionism, rigidity and obstinacy traits PD?

 

OCD PD

 

Avoidance of interpersonal contact due not rejection sensitivity PD?

 

`Avoidant

 

Submissiveness and a need to be taken care of PD?

 

Dependent PD

 

Which of the following is NOT consistent with recommendations for psychiatric hx taking and the MSE of older adults?

 

1. B) Pt should be seen alone even in cases of clear evidence of impairment to persevere the privacy of a doctor/pt relationship

 

Low health literacy has been linked with which of the following?

 

D_ All of the above

-poor health outcomes
-lower rates of hospitalization
-less frequent use of preventative services

 

A claim of malpractice requires that a patient/plaintiff prove which of the following? Select all that apply

 

1. A) The existence of a client-professional relationship–duty ti care
   C) a causal link b/t the provider’s failure to confirm to tx standards and harm to the pt
   D) Actual injury to the pt

 

Freud’s Psychosexual Theory and 5 Stages of Human Development?

 

1.Oral stage
2. Anal stage
3. Phallic stage
4. Latent stage
5. genital stage

 

The mouth, sucking, swallowin ect

 

Stage 1- oral stage

 

 

EGO develops in which phase?

 

ORAL phase 1

 

 

The penis or vagina-sexual intercourse?

 

Stage 5 genital

 

 

`The anus- withholding or expelling feces

 

2. Anal stage

 

Little to no sexual motivation present?

 

Stage 4. Latent phase

 

 

The penis or clitoris- masturbation

 

Stage 3 Phallic

 

 

the SUPEREGO develops at what phase?

 

Stage 3 Phallic

 

A patient currently on risperidone presents to the ED with increased agitation, restlessness, muscle discomfort and dysphoria. the ARNP recognizes these symptoms of akathisia and recommends which of the following? Select all that apply

 

1. B) Benztropine IM only

 

Self-care strategies in preparation for the certificate exam includes all of the following EXCEPT:

 

1. C) Drink lots of caffeine and eat high concentrated sugars

 

Pts with this PD are described as excitable, emotional and behave in a colorful, dramatic, extroverted, attention-seeking fashion, often with an inability to maintain deep long-lasting attachments

 

Histrionic PD

 

Non-pharmacologic tx for abuse includes all of the following EXCEPT:

 

Involve the abuser in the tx planning

 

A particular form of psychotherapy based on Otto Kernbeg’s object relations theory is known as which of the following?

 

1. C) Transference-focused psychotherapy

 

Generalized convulsions, oliguria, and renal failure are symptoms seen with which of the following Lithium levels?

 

2. C) > 2.5 mEq/L

 

Nausea, vomiting, anorexia, blurred vision, clonic limb movements, convulsions, oliguria and renal failure

 

Moderate Lithium toxicity: 2.0-2.5

 

Lithium therapeutic window

 

0.6-1.2 mEq/L

 

 

first med approved for bipolar d/o

 

lithium

 

 

Common side effects of Lithium,

 

tremor, nausea., fatigue, increased thirst, slowed thinking

 

Important serious side effects of Lithium:

 

hypothyroidism, weight gain, diabetes insipidus, and lithium toxicity

 

 

How do we decrease the risk of lithium toxicity?

 

Blood level monitoring

therapeutic range: 0.6 – 1.2

 

Lithium levels are known to (increase/decrease) when used concurrently with diuretics, thiazides, ACE inhibitors and NSAIDs?

 

Increase

ACE inhibitors: lisinopril, catopril, enalapril

 

Lithium levels are known to (increase/decrease) when used with drugs including caffeine, acetazolamide and theophylline

 

Decrease

 

 

concurrent use of lithium and antidepressants and/or antipsychotics can cause what?

 

Serotonin syndrome & Neuroleptic malignant syndrome

 

 

The term “suicide survivor” refers to which of the following?

 

1. A) those who have lost a loved one to suicide

 

 

At a minimum, a psychiatric evaluation in an emergency should include which of the following? Select all the above

1. C) is the problem organic, functional or a combination?

 

A pt presents with a formal, tense manner. He reluctantly responds a longstanding (since early adulthood) pervasive suspiciousness of others, preoccupied with trustworthiness of friends, unjustified concerns about others deceiving him, angry about perceived insults and slights, reluctant to confide in the ARNP. The ARNP suspects the pt likely has which of the following PDs?

 

Paranoid PD

 

The obligation to not inflict harm or balancing unavoidable harm with benefits of good achieved is known as which of the following?

 

1. B) Beneficence

 

 

`In about 1/2 the cases in which suicides occur while pts are in a psychiatric unit, a lawsuit occurs. Which of the following is NOT consistent with what court expects related to inpt psych unit suicide events?

 

1. D) Evidence of formulation of a tx plan with a high level of security

 

 

Using the LIAASE: A general cultural competency tool, the ARNP would do which of the following?

 

1. D) all of the above

-agree to disagree on differences in values
-solicit other options or points of view
-acknowledge and validate powerful emotions when expressed

 

Which of the following is NOT consistent with what is known about PP psychosis?

 

1. A) symptoms of PP psychosis can often begin within days of delivery

 

 

Concerns when treating geriatric patients with psychotherapeutic drugs includes all of the following EXCEPT:

 

1. B) Elderly persons may be more susceptible to adverse effects of psychotherapeutic drugs

 

A clause in an employment contract that specifies that an employer and employee may end the working agreement without cause within a specific number of days is known as which?

 

1. C) Termination clause

 

 

Standards of care are now being set, modified, monitored and publicized by certain self-appointed consumer-oriented agencies as well as government agencies, including which of the following?

 

1. D) All of the above

-Medicare
-the Joint Commission
-The agency for healthcare research and quality

 

The differences in the quality of healthcare across individuals and groups in regards to access of care, treatment options, and preventative services is known as?

 

B)Health disparities

incorrect: racism, vulnerable populations, SDOH