PMHNP I - Exam 1 - Review Book Questions 2026 Complete Questions and Answers Solved 100%

The purpose of the ANA's PMH Nsg: 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 medications

c. Define the legal statutes of the role of the PMHNP

d. Define the differences between the physician role and the NP role

a. Define the role and actions for the NP

The trend in legal rulings on cases involving mental illness over the past 25 years has been to:

A - Encourage juries to find defendants not guilty by reason of insanity

B - Protect the individual'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.

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 that:

A - Psych clients cannot refuse treatment

B - Psych clients don't always know what's good for them

C - Psych clients can refuse treatment

D - Psych 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, psych clients can refuse treatment unless a legal process resulting in a mandatory court order for treatment has been obtained.

Which of the following statements best reflects the difference between the nurse-client (N-C) relationship and a social relationship? In the N-C relationship...

A - the primary focus is on the client and his needs.

B - goals are deliberately left vague and unspoken so that the client can work on any issue.

C - the nurse is solely responsible for making the relationship work.

D - there is no place for social interaction.

A - the primary focus is on the client and his needs.

Social relationships are mutual interpersonal relationships in which the needs of both parties are addressed. The N-C relationship is most concerned with meeting the needs of the client.

In forming a therapeutic relationship with clients, the PMHNP must consider developing many characteristics that are known to be helpful in relationship-building. These characteristics include all of the following EXCEPT:

A - genuineness

B - acceptance

C - authenticity

D - accuracy in assessment

D - accuracy in assessment

Although an important aspect of the PMHNP role, accuracy in assessment does not in and of itself facilitate relationship building

In forming a therapeutic relationship with clients, the PMHNP must consider developing many characteristics that are known to be helpful in relationship building. Which of the following is an essential part of building a therapeutic relationship?

A. Collecting a family history

B. Like-mindedness

C. Authenticity

D. Accuracy in Assessment

C. Authenticity - Being genuine, honest, and respectful 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.

The DSM-IV provides for holistic client assessment by using a multiaxial assessment format. The general medical conditions experienced by a client that may influence treatment of his or her psychiatric disorders are coded on which of the five axes of the DSM?

A - Axis I

B - Axis II

C - Axis III

D - Axis IV

C - Axis III

Medical conditions are coded on Axis III

According to the DSM-5, which of the following is true?

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 dx.

Mrs French has been in individual therapy for 3 months, and is clinically ready to terminate treatment. After discussing termination, she suddenly begins to demonstrate some of her original symptoms; is hesitant to discharge; and displays regressive defense mechanisms. The best explanation is:

A - An exacerbation of her symptoms related to stress

B - The normal cyclic nature of chronic mental health symptoms

C - A sign of normal resistance to termination seen in the termination phase of therapy

D - A sign of pathological attachment to the therapist that must be addressed

C - A sign of normal resistance to termination seen in the termination phase of therapy

Clients frequently display resistance and regression at the termination of a meaningful therapeutic process. The PMHNP is responsible for planning an effective termination and monitoring clients during the termination period.

A client is displaying low self-esteem, poor self-control, self-doubt, and a high level of dependency. These behaviors indicate developmental failure of which of the following stages of development:

A - Infancy

B - Early childhood

C - Late childhood

D - School age

B- Early Childhood

Mr Thompson has been forgetful lately, for example forgetting where he has placed his keys or what time appointments are scheduled, and he 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.

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.

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 behavior common to an earlier stage of development.

Defense mechanisms are best viewed 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.

One of the health care changes that has occurred as a result of the 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. HMO

B. PPO

C. Accountable Care Organization (ACO)

D. Individual Health Plan (IHP)

C. - ACO's are groups of doctors or other HCPs who voluntarily come together and assume the care provided to Medicare patients.

Health care economics is concerned with making decisions so the benefits outweigh the cost of resource utilization. What are two concepts that healthcare economics is concerned with in regard to fair distribution of resources and allocation?

A. Equity and Efficiency

B. Cost and Benefits

C. Opportunity and Waste

D. Affordable and Quality

A. Health care efficiency is making risk and benefit decision about how care resources are allocated and equity is ensuring that there is a fair distribution of the resources.

Serotonin is produced in which of the following locations:

A. Locus ceruleus

B. Nucleus Basalis

C. Raphe Nuclei

D. Substantia Nigra

C. Raphe Nuclei

Dopamine is produced in which of the following locations:

A. Locus Ceruleus

B. Nucleus Bassalis

C. Raphe Nuclei

D. Substantia Nigra

D. Substantia Nigra

A client presents with complaints of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions?

A. Thalamus

B. Hypothalamus

C. Limbic System

D. Hippocampus

B. Hypothalamus - Appetite, sleep, and libido are regulated by the hypothalamus.

In considering whether to order an MRI of the health for a client, which of the following would be a contraindication to this diagnostic test?

A. Prosthetic Limb

B. History of head trauma

C. Pacemaker

D. Pregnancy

C. A client with a pacemaker should not receive an MRI of the head.

The primary excitatory ntm is:

a. GABA

b. Serotonin

c. Dopamine

d. Glutamate

D. Glutamate is the primary excitatory NTM

A client is experiencing difficulties with working memory, planning and prioritizing, insight into his problems, and impulse control presents for assessment. In planning his care, the PMHNP should apply his or her knowledge that these symptoms represent problems with the

a. Frontal Lobe

b. Temporal Lobe

c. Parietal Lob

d. Occipital Lobe

a. Frontal Lobe - Problems with working memory, planning and prioritizing, insight into problems, and impulse control indicate a problem in the frontal lobe.

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.

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 dx is an important aspect of the assessment process, the assessment ultimately should identify the needs of the client.

Mr. Johnson is a a client newly admitted to an IP psych 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 bc the 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

b. In the dayroom, which is full of 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 tx room with the door closed, a neutral location.

c. In a quiet place, but public enough to get assistance with client care should it be required during the assessment.

One PMHNP role is to control the milieu as an aspect of assessment, so the PMHNP should chose a quiet place that is public enough too get assistance with client care should be be required during the assessment.

Which communication technique is the PMHNP using in the following situation?

Client: "Sorry I was late. I didn't realize what time it was."

PMHNP: "This is the third time now that you have been late for our sessions. I am wondering how committed you are to our working on your problems."

A - Theming

B - Recognizing

C - Validating

D - Sequencing

B. This exchange is an illustration of the technique of recognizing.

In assessing a client, you ask him the meaning of the proverb "people who live in glass houses shouldn't throw stones." He replies "because it will break the windows." The correct interpretation of this finding is

A - Client has probable mood disorder

B - Client has probable anxiety disorder

C - Client has limited intellectual ability

D - Unable to interpret the finding without knowing the client's age

D. The answer demonstrates concrete thought processes, which are normal in persons younger than age 12 but are abnormal after age 12. To interpret the finding, the PMHNP must know the age of the client.

Mrs. Shea has come to the MH center seeking tx for depression. She has a history of a suicide attempt by overdose 1 mo ago. She was started on imipramine (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.

In completing the PMHNP assessment for Mrs. Shea, the most appropriate lab test for the PMHNP to order at this time is:

A. CBC

B. TSH

C. LFT

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 LFTs as an aspect of care planning for her.

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 complaints of increased depression, mild confusion, irritability, and overall apathy form being too tired to do anything. The best initial PMHNP action to take at this time is:

a. Increase his dose of antidepressant medication

b. Change him to anther antidepressant

c. Augment his antidepressant with an SDA

d. Order a CMP

d. Order a CMP - clients symptoms are consistent with an electrolyte imbalance and a physical cause must be ruled out first.

Which of the following medications is known to exacerbate or cause depression?

A. Omeprazole

B. Propranolol

C. Levothyroxine

D. Clarithromycin

B. Propranolol - BB are known to cause or exacerbate depression.

Elderly are more sensitive to issues of drug toxicity r/t:

a. Decreased body fat

b. Increased liver capacity

c. Decreased protein binding

d. Increased muscle concentration

C. Decreased protein binding

Which known teratogenic effects can be caused by the common psychotropic medications divalproex and lithium?

a. Divalproex - Epstein anomaly; lithium - Cleft palate

b. Divalproex - spina bifida; lithium- Epistein anomaly

c. Divalproex - limb malformations; lithium - seizure disorder

d. Divalproex - MR; Lithium- spina bifida

B.

The study of what the body does to drugs is called

a. pharmacodynamics

b. pharmacology

c. pharmacokinetics

d. distribution

c. pharmacokinetics

Mr. Thomas has been diagnosed with MDD and is placed on fluoxetine 20 mg for her depression. For the PMHNP to effectively monitor her use of the medication, which of the following actions should be part of ongoing care?

a. Use of a standardized rating scale of depression

b. Monitoring for potential abuse of the medication

c. Monitoring of labs for renal fx

d. Monitoring for potential cardiac side effects

a. The use of a standardized rating scale will allow the PMHNP to monitor the level of client symptoms and to evaluate the efficacy of the medication.

Which of the following is the best reason for considering the SSRI among the first-line drug choices for treating Major Depression?

a. Need to stair-step initial dosages

b. Sedating and calming effect of the medication

c. Safe use in suicidal overdose patients

d. Ability to obtain therapeutic serum drug levels.

c. - SSRIs are considered among the first-line medications used to treat depression bc of safety in suicidal overdose patients.

Which is true about pharmacology treatment of anxiety in older adults?

a. Course of tx is generally shorter than for younger adults.

b. Drugs that are highly oxidized are more unpredictable than drugs that are mostly conjugated

c. The therapeutic dose of SSRIs is generally lower than for young adults.

d. Highly lipophilic drugs have a more linear elimination in older adults.

b. Liver enzyme functioning (among other things) diminishes as we age. All of the other statements are false.

When conducting a neurological examination on a client, the PMHNP asks the client to hold out her arms and stick out her tongue while assessing for tremors. Which cranial nerve is being assessed?

a. Glossopharyngeal

b. Vagus

c. Trigeminal

d. Hypoglossal

D - The tongue is controlled by the hypoglossal cranial nerve.

A 20-year-old Asian man who was recently diagnosed with schizophrenia comes to your office for a follow-up appointment. During the assessment, he talks about his experience in the group home, thinking that the television is sending him messages through news anchors during the 10 p.m. evening news. What symptom is the client describing?

a. Paranoia

b. Illusions

c. Ideas of reference

d. Neologisms

C. Ideas of reference are misinterpretations of incidents and events that one believe have a direct personal reference to oneself.

Following EB practice, which laboratory screening tests and assessments should be completed prior to placing a person on SDA AP medication?

A. Serum glucose, lipid profile, wt, BP, waist circumference, and family hx of CVD

B. CMP, BMI, CBC, and thyroid panel

C. Serum glucose or hemoglobin A1c, lipid profile, wt, BMI, BP, Waist circumference, and family hx of CVD

D. Serum glucose, CBC, assessment of family hx of CVD and CA

C. EBP guidelines indicate that all clients should have the following prior to starting AP medication: fasting glucose or A1c, lipid profile, weight, BMI, BP, waist circumference, and family hx of CVD

What differentiates atypical AP medications from first generation or typical AP medications?

a. 5HT2a receptor antagonist properties

b. 5HT2a receptor agonist properties

c. Specific dopamine receptor 3 and 5HT2a blockade

d. Dopamine receptor 2 antagonistic properties

A. Typical AP medications block D2 receptors; atypical AP medications block D2 receptors and have 5HT2a antagonist properties

You are treating a patient with schizophrenia who takes Clozapine. What laboratory values will indicate the client needs to DC treatment?

A. WBC of less than 1800 and absolute neutrophil count less than 1200.

B. Absolute neutrophil count of less than 1000

C. WBC of less that 1200

D. Absolute neutrophil count of less than 2000

B - The recent change in monitoring clozapine clients using the risk evaluation and mitigation strategy (REMS) indicates persons treated on clozapine need to have absolute neutrophil count monitored, and if it drops below 1000, treatment must be interrupted and can be assumed once the absolute neutrophil count normalizes above 1000.

What is the reason for the PMHNP to taper off Clonazepam if diagnosed with a TBI?

A. Benzos cause memory problems and confusion in clients with a hx of TBI

B. Benzos lower the seizure threshold in clients with a history of TBI

C. VA has banned bentos from the medication formulary.

D. Benzos place clients with a TBI at risk for a second head injury.

A - Benzos are CI in clients with a TBI due to increased rates of confusion and memory problems.

Alice is a 68 yo with concerns about her memory. Fam hx of dementia. Socially and physically healthy. She says, "I understand that I am losing brain cells at my age, but I would still like to keep my mind and body active." What is the best response to Alice?

B. Although most brain development occurs early in life, we still form some new brain cells in a couple areas of the brain during adulthood. You should continue with your activities because they offer excellent physical and mental health benefits and are neuroprotective.

While once we thought brain neurons did not regenerate, we now know that that while most brain development occurs early in life, we continue to form some new brain cells throughout life. As we age, we need to engage in activities that keep our brains healthy by encouraging this growth. Examples are diet, exercise, socialization, and cognitive stimulation.

A man thinks to himself that his wife is really ugly as they sit at the breakfast table, but of course he does not verbalize his feelings. Later in the day he gets a sudden unexplainable urge to send her flowers. The best explanation for his unconscious action is

A - Undoing

B - Suppression

C - Denial

D - Repression

A.