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PHNP - Purple Book 4th Edition Exam
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PHNP - Purple Book 4th Edition Exam
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PHNP - Purple Book 4th Edition ExamA 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 - ANS-Correct Answer: C.
Ideas of reference are misinterpretations of incidents and events that one believes have
a direct personal reference to oneself.
REF: Pg. 318
A 23-year-old woman is brought into the ER after attempting suicide by cutting her
wrists. Which nursing action by the PMHNP would be of highest priority initially?
a. Assess her coping behaviors
b. Assess her current level of suicidality
c. Take her vital signs
d. Assess her health history - ANS-Correct Answer: C.
The PMHNP needs to ensure that her suicide attempt has not led to medical instability.
REF: Pg. ??
A 74-year-old married white woman was referred to you by her primary care provider for
a psychiatric evaluation. She had a normal medical and neurological examination in the
last 2 months. The client presents with her husband of 45 years who states, "My wife is
just not the same anymore, she is irritable and asks the same question several times,
even though I've answered it many times." The client responds, "Oh, Henry, you do the
same thing, it's just a normal part of getting older, and the kids think everything is fine."
During the assessment you compete the mini mental status examination (MMSE) and
the client scores 18. As the PMHNP treating the client, you know the results of her
MMSE indicate which level of cognitive impairment?
a. No cognitive impairment
b. Mild cognitive impairment
c. Moderate cognitive impairment
d. Severe cognitive impairment - ANS-Correct Answer: C.
Cut points on the MMSE are as follows: total score 30, 25-30 questionable significance,
20-25 mild impairment, 10-20 moderate impairment, and 10 or lower severe impairment.
,REF: Pg. 281 - *mentions MMSE only but not the score ranges.
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 time is
a. Increase his dose of antidepressant medication to better capture symptoms
b. Change him to another antidepressant for better symptom control
c. Augment his antidepressant with an atypical antipsychotic medication
d. Order a comprehensive metabolic panel - ANS-Correct Answer: D.
Client symptoms are consistent with electrolyte imbalance and a physical cause of his
symptoms must be ruled out first.
REF: Pg. 149, 150
A client is displaying low self-esteem, poor self-control, self-doubt, and a high level of
de-pendency. These behaviors indicate developmental failure of which of the following
stages of development:
a. Infancy
b. Early childhood
c. Late childhood
d. School age - ANS-Correct Answer: B.
These signs indicate developmental failure of early childhood.
REF: Pg. 40 - Table 3-2
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 - ANS-Correct Answer: B.
Appetite, sleep, and libido are regulated by the hypothalamus
REF: Pg. 66
A client returns for a follow-up appointment 3 weeks after starting on fluoxetine 20 mg.
During this appointment you notice that her speech is a little rapid, in marked contrast to
the psychomotor retardation and paucity of spontaneous speech she displayed on her
first visit. Instead of looking at the floor, she now makes normal eye contact. Her affect
has gone from constricted to expansive. She continues to have difficulty sleeping, but
,her energy has improved and she states she feels "so much better!" What should you
conclude about the shift in the client's presentation?
a. She is experiencing the activating side effects of fluoxetine.
b. She is becoming euthymic.
c. She is becoming hypomanic.
d. She is in a mixed state. - ANS-Correct Answer: C.
In this case, you see a shifting set of symptoms, the most important being her
expansive mood and statement "so much better" that indicates she has gone beyond
euthymia.
REF: Pg. 176, 177, 178 - *look for 'expansive' on page 178
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 any-more." 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?"
d. Remain silent - ANS-Correct Answer: B.
This response is the most therapeutic, allowing the client to further clarify and express
feelings.
REF: Pg. ??
A client who has been addicted to opioids has not used in 15 days. During your
medication management visit, the client states, "I'm going to die from not having my
Opanas. You need to give me something now." The PMHNP's best response is:
a. "I know you are feeling very uncomfortable and we need to get you to the emergency
room immediately to prevent a seizure."
b. "I know you are feeling very uncomfortable, let's take your vital signs and talk about a
trial on Catapres to treat your withdrawal symptoms."
c. "You have been using Opana for a long time and it is going to take several months for
the withdrawal to end. In the meantime, I will see you weekly."
d. "There is no treatment for opioid withdrawal; you will have to wait it out." - ANS-
Correct Answer: B.
Opioid withdrawal symptoms can be treated with central alpha agonists.
REF: Pg. 305 - Table 13-1
A client who 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 lobe
d. Occipital lobe - ANS-Correct Answer: A.
Problems with working memory, planning and prioritizing, insight into problems, and
impulse control indicate a problem in the frontal lobe.
REF: Pg. 65
A client with bipolar I disorder presents to your PMHNP office for a follow-up visit.
During the visit the client informs you that he no longer wants to be treated with
medication, and he does not have bipolar disorder, that was a misdiagnosis. He further
informs you he stopped all his medication 2 months ago and is here to thank you for
your care and tell you that he no longer needs follow-up appointments. Understanding
the ethical conflict, you use which of the following ethical principles in working with this
client?
a. Autonomy
b. Nonmaleficence
c. Justice
d. Beneficence - ANS-Correct Answer: A.
Clients who are legally competent have the ability to make medical decisions and
maintain individual autonomy.
REF: Pg. 18, 19
A community has an unusually high incidence of depression and drug use among the
teen-age population. The public health nurses decide to address this problem, in part,
by modifying the environment and strengthening the capacities of families to prevent the
development of new cases of depression and drug use. What is this is an example of?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Protective factorial prevention - ANS-Correct Answer: A.
This action focuses on interventions designed to reduce the incidence of new cases of
disease
REF: Pg. 103
A mother brings in her 7-year-old son for a psychiatric follow-up visit with the PMHNP.
This is the fourth visit the PMHNP has had with the client, his mother, and his younger
sister, Renee, now 7 months old. You notice that she has a decrease in head growth,
along with stereotypic motions of the hands, often licking and slapping. Renee has also
lost her language skills. What medical condition do you suspect Renee has developed?
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