PMHNP-C sample questions

Question 1

A 74-year-old retired accountant is accompanied to the psychiatric clinic by his daughter. The daughter reports that over the past six months, her father has become increasingly withdrawn, stopped managing his investment portfolio, lost 12 pounds, and frequently forgets scheduled appointments. The patient states, "There is nothing wrong with me; I am just tired of feeling useless since my spouse died last year." His medical history includes type 2 diabetes mellitus, hypertension, and osteoarthritis.

On targeted examination, the patient appears unkempt and speaks with a delayed response latency. When asked questions testing recall, he frequently answers, "I don't know," without attempting to elaborate. His fasting blood glucose is 128 mg/dL and hemoglobin A1c is 7.1%.

Which initial clinical evaluation strategy is most critical for the psychiatric mental health nurse practitioner to differentiate pseudodementia (major depressive disorder) from an early primary neurocognitive disorder?

Accepted Answer

Administering a validated cognitive screening tool alongside a depression rating scale and obtaining functional collateral from family

Answer

Initiating donepezil 5 mg daily and deferring formal psychiatric assessment for twelve weeks

Answer

Attributing all symptoms to microvascular complications of diabetes and transferring care to neurology

Answer

Immediately ordering an amyloid PET scan and discontinuing all antihypertensive medications

Question 2

During a mental status examination, a 28-year-old patient experiencing acute mania continuously digresses into lengthy, unnecessary details and parenthetical explanations when answering questions, but eventually reaches the point and answers the original inquiry. Which thought process abnormality does the PMHNP document?

```mermaid
flowchart LR
Start[Clinical Question] --> D1[Irrelevant Detail 1]
D1 --> D2[Irrelevant Detail 2]
D2 --> D3[Excessive Anecdote]
D3 --> Goal[Reaches Original Point]
```

Accepted Answer

Circumstantiality

Answer

Loose associations

Answer

Flight of ideas

Answer

Tangentiality

Question 3

A 34-year-old patient with major depressive disorder reports feeling "hopeless" and states, "Everyone would be better off if I weren't around." When the PMHNP conducts a comprehensive risk assessment, which finding indicates the highest imminent risk of suicide requiring immediate acute crisis intervention?

Accepted Answer

Reporting an explicit plan to ingest accumulated prescription sedatives tonight, with current possession of the pills and a written note

Answer

Expressing passive wishes to fall asleep and not awaken, without specific intent or action plan

Answer

Having a remote family history of depression in a first-degree relative without personal history of self-harm

Answer

Describing chronic passive emptiness and nihilism that has remained unchanged for over four years

Question 4

A PMHNP in an outpatient community behavioral clinic conducts a violence risk assessment on a 42-year-old client diagnosed with paranoid schizophrenia. Which TWO clinical features represent the strongest dynamic risk factors for imminent violence toward others? (Select TWO)

Accepted Answer

Concurrent acute intoxication with methamphetamine and alcohol

Accepted Answer

Persecutory delusions focusing on a specific named individual coupled with command auditory hallucinations to assault

Answer

Full cognitive insight into psychiatric illness and voluntary adherence to oral atypical antipsychotics

Answer

Documented static demographic factors such as male biological sex and age over 40

Answer

A remote history of uncomplicated somnambulism during early childhood

Question 5

Which validated, evidence-based instrument is specifically designed as a 9-item self-administered scale to evaluate the presence and severity of depressive symptoms and monitor clinical response over time?

Accepted Answer

Patient Health Questionnaire-9 (PHQ-9)

Answer

Abnormal Involuntary Movement Scale (AIMS)

Answer

Generalized Anxiety Disorder 7-item scale (GAD-7)

Answer

Alcohol Use Disorders Identification Test-Concise (AUDIT-C)

Question 6

Prior to initiating lithium carbonate maintenance therapy for an adult female presenting with acute mania in bipolar I disorder, which baseline laboratory tests must the PMHNP order to assess organ function and safety?

Accepted Answer

Serum creatinine, blood urea nitrogen, estimated glomerular filtration rate, thyroid-stimulating hormone, and human chorionic gonadotropin

Answer

Serum troponin, creatine kinase-MB, and 24-hour urinary copper clearance

Answer

Serum amylase, lipase, total bilirubin, and international normalized ratio (INR)

Answer

Glycosylated hemoglobin (HbA1c), fasting lipid panel, and serum prolactin level

Free PMHNP-C sample questions

A PMHNP in an outpatient community behavioral clinic conducts a violence risk assessment on a 42-year-old client diagnosed with paranoid schizophrenia. Which TWO clinical features represent the strongest dynamic risk factors for imminent violence toward others? (Select TWO)

Which validated, evidence-based instrument is specifically designed as a 9-item self-administered scale to evaluate the presence and severity of depressive symptoms and monitor clinical response over time?

Prior to initiating lithium carbonate maintenance therapy for an adult female presenting with acute mania in bipolar I disorder, which baseline laboratory tests must the PMHNP order to assess organ function and safety?

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