Adult Psychiatric & Mental Health NP Practice
The Adult Psychiatric & Mental Health NP exam is a comprehensive and detailed assessment for men and women hoping to enter this challenging field of healthcare. The content of the assessment can be broken down into the following domains of practice: health promotion and disease prevention (24 questions, 16% of the exam); assessment of acute and chronic disease states (35 questions, 23%); nurse practitioner and patient relationship (13 questions, 9%); clinical management (51 questions, 34%); professional role and policy (18 questions, 12%); and research (9 questions, 6%).
CNS Adult Health Practice Questions
1. A 17-year-old adolescent girl is brought to you by her parents, who complain that she doesn’t eat and is very thin. On examination it is determined that her body weight is less than 85% of normal, she has not had a menstrual period in 6 months, she worries about being overweight and becoming fat, and she complains that she is “too fat.” Which of the following additional features allows you to confidently diagnose Anorexia Nervosa, Binge-Eating/Purging Type as a single diagnosis rather than Bulimia Nervosa additionally?
A. Binging and purging occur only during episodes of anorexia nervosa
B. Episodes of binge eating are recurrent
C. Inappropriate compensatory behavior to prevent weight gain—such as self-induced vomiting, use of diuretics or laxatives, fasting, or excessive exercise—is recurrent
D. Binge eating and inappropriate compensatory behaviors have both been occurring, on average, at least twice per week for 3 months
2. Which of the following features supports the diagnosis of Malingering, as opposed to Factitious Disorder?
A. Medical history, physical examination, and laboratory evaluations do not identify specific abnormalities
B. The patient’s symptoms have necessitated his being kept in the hospital rather than returning to prison to continue serving his sentence
C. The patient’s symptoms are vague, ill-defined, at times overdramatized, and not in accordance with known clinical conditions
D. The patient has a long history of previous hospitalizations, during which his symptoms have been severe but little pathologic evidence has been identified
3. A married Italian man in his 60s has a history of treatment-resistant depression. You consult with the patient’s psychiatrist, and the recommendation is to initiate treatment with an MAO inhibitor antidepressant. What is the most important reason to meet with the patient’s family when you prescribe this medication?
A. MAO inhibitors can cause orthostatic hypotension, which may be worse on arising; therefore, family members need to be watchful
B. MAO inhibitors can cause sexual dysfunction; therefore, the patient’s spouse should be informed so as to anticipate this possibility
C. MAO inhibitors can interact with certain foods and over-the-counter medications and cause an abrupt increase in blood pressure, which can be harmful
D. MAO inhibitors can disrupt the sleep-wake cycle, which can result in daytime somnolence and nighttime insomnia
4. The family of an elderly patient with a recent diagnosis of terminal cancer takes you aside and requests that you not inform the patient of the diagnosis because it would be too upsetting for them. You conduct an assessment and find that the patient is competent and rational. The patient asks you to discuss the doctor’s findings, and you focus on the patient’s mild chronic history of asthmatic bronchitis. Which ethical principle have you violated?
5. The following are 4 of the criteria used to evaluate qualitative research. Which of them is incorrectly defined?
A. Descriptive Vividness – The researcher describes the data gathering process in sufficient detail that the reader can personally experience it. The data collected, often in the form of personal statements, should be quoted directly and extensively, because this is the raw data from the study
B. Methodological Congruence – The researcher presents the philosophical and methodological approach used and cites references to support their approach. The subjects, sampling method, data-gathering and data-analysis strategies, and processes for informed consent are clearly and concisely described
C. Analytical Precision – The methods used to determine statistical significance, study size, the number of subjects needed, and the precision and accuracy of the instruments used to measure the data are described in detail
D. Theoretical Connectedness – Any theory developed from the study is clearly stated, logically consistent, reflective of the data, and in accord with other available knowledge
Answers & Explanations
1. A: If a patient binges and purges only during periods of time when other signs and symptoms qualify the patient for a diagnosis of Anorexia Nervosa, Bulimia Nervosa will not be diagnosed additionally. The correct diagnosis in this situation is Anorexia Nervosa, Binge Eating-Purging Type.
2. B: In both Factitious Disorder and Malingering, false or grossly exaggerated physical or psychological symptoms are intentionally reported. Careful assessment both excludes other causes and often allows documentation of direct evidence of fabrication based on the non-physiological or non-anatomical nature of the symptoms, changes in symptoms, or observations (e.g., witnessing a patient deliberately contaminate a wound that mysteriously refuses to heal). There may be a pattern of such “illnesses” in both cases. Malingering is associated with a clear external incentive or secondary gain from assuming a sick role, such as avoiding military service or incarceration, avoiding work, obtaining financial rewards such as disability payments or other financial compensation, obtaining drugs, or evading criminal prosecution. Factitious Disorder is associated with a more internal motive, that is, to assume the sick role.
3. C: Any member of the family who prepares meals should be educated about the potential tyramine reaction that can occur with the ingestion of aged cheeses, certain sausages and other fermented protein products, and some alcoholic beverages (beer and wine). The presence of these products in food may be masked during preparation; therefore, both the food preparer and the patient should be aware of the risk.
4. C: Veracity is the duty to tell the truth and not intentionally deceive or mislead clients. Occasions when the truth would produce harm or interfere with the recovery process are rare. The principle of autonomy holds that the patient is presumed rational and responsible, retaining the right to determine their own destiny and to be fully informed about their condition. Withholding the truth would violate this principle as well. In this case, the nurse is attempting to act under the principles of nonmaleficence (to do no intentional harm to the client), beneficence (to benefit or promote the good of others), and justice (to treat all individuals, including the family, equally and fairly); however, the primary duty is to the patient.
5. C: Analytical Precision is not concerned with statistics and instruments. It refers to the decision-making process by which researchers synthesize concrete data (words of the subjects) into an abstract that clarifies the meaning and the importance of the study. The last of the 5 criteria is Heuristic Relevance – The researcher clarifies the significance of the study, its applicability to public health or community nursing, and its likely influence on future research.