Psychiatric-Mental Health Nurse Practitioner (PMHNP) Purple Book Practice Test

These questions are part of the practice quiz. Start practicing

• In family therapy, a paradoxical directive is used to have a client intensely worry about everything for one hour each day. This technique belongs to which type of therapy?
• What is a common strategy to manage benzodiazepine withdrawal safely?
• During termination, which pattern is commonly observed?
• What is the gold-standard psychotherapy for OCD and what does it entail?
• Which statement accurately describes the manic episode duration criterion?
• What are the core diagnostic features of Obsessive-Compulsive Disorder?
• What are common red flags indicating a high risk for suicide that require urgent assessment and intervention?
• Which psychotherapy is particularly effective for PTSD and often includes exposure components?
• A patient on clonazepam 0.5 mg nightly for 2 years reports needing 4 pills to achieve the same effect as 1 pill previously. This pattern most likely represents which pharmacologic process?
• When a paranoid client asks if I am recording the session, what is the best PMHNP response?
• A patient presents with mania and psychotic symptoms. What is the standard initial treatment approach?
• In the consult liaison service, a note asks to evaluate competency to make independent medical decisions and consent for a surgical procedure. What is the most appropriate action?
• Divalproex exposure in pregnancy is associated with which fetal malformation, while lithium exposure is associated with Epstein's anomaly?
• Delusional Disorder requires delusions for at least how long, with functioning not obviously impaired otherwise?
• Which of the following is the best example of a primary prevention strategy for community behavioral health?
• What factors guide the choice between an SSRI and SNRI as initial pharmacotherapy for non-psychotic depression?
• Health care economics is concerned with making decisions so the benefits outweigh the cost of resource utilization. Which two concepts relate to fair distribution of resources and allocation?
• Older adults are more sensitive to drug toxicity because of which of the following reasons?
• When a mother asks about the HPV vaccine for her 10-year-old son, what is the best approach for the PMHNP?
• Mr. Johnson, a 54-year-old, lies on the floor and assumes the fetal position during discussion of marital stress. This is most likely an example of
• You are treating a client with schizophrenia who takes clozapine. What laboratory value will indicate the client needs to discontinue treatment?
• During the first session, a client describes repeatedly grounding her son, taking away his bike, and confining him to his room, asking what to do next. What is the most therapeutic response for the PMHNP to make?
• During a session, a client says, 'Some days life is just not worth it. All my wife and I fight and scream. Things would be calmer if I wasn't there anymore.' What is the most therapeutic response?
• Brief Psychotic Disorder is characterized by psychotic symptoms lasting up to what maximum duration?
• Miracle questions are a technique associated with which type of therapy?
• Which set of symptoms is overlapping between ADHD and pediatric bipolar disorder?
• A client displays low self-esteem, poor self-control, self-doubt, and high dependency. These behaviors indicate developmental failure of which stage?
• A 20-year-old man with schizophrenia describes that the television is sending him messages through news anchors. Which symptom is this?
• Defense mechanisms are best viewed as a function of the ego to
• In paranoid personality disorder, which treatment strategy is best?
• In pediatric depression, which SSRI has FDA approval for pediatric major depressive disorder and requires monitoring for suicidality?
• What is the purpose of the miracle question in solution-focused therapy?
• Which statement describes the duration criterion for generalized anxiety disorder?
• A hospitalized patient with alcohol withdrawal has a CIWA score of 17. Which withdrawal phase does this indicate?
• In malpractice analysis, which four elements must be present?
• In crisis assessment, which item is NOT typically a primary focus?
• Does the DSM-5-TR include a bereavement exclusion for diagnosing major depressive disorder?
• Which neurotransmitter is the primary excitatory neurotransmitter?
• Valproate carries a high risk of what in pregnancy, and what is the key counseling point?
• Which of the following is a primary function of the psychiatric interview?
• Following the 2008 LACE model, which statement about DNP grandfathering is correct?
• Advanced signs of lithium toxicity?
• In crisis evaluation, what is the initial focus of the assessment?
• Clozapine is reserved for which patients, and what crucial lab monitoring is required?
• A CIWA score of 12 indicates which withdrawal category?
• Which statement best describes capacity versus competence?
• Based on DSM-5 criteria, does the student meet criteria for a mental disorder?
• In addressing ataque de nervios, which intervention demonstrates culturally informed care?
• What is generally considered first-line pharmacotherapy for non-psychotic depression?
• As a PMHNP, which family history factor is associated with higher risk for antisocial personality disorder?
• A voluntarily admitted patient requests discharge after 24 hours; what is the best nursing action reflecting the patient's legal rights?
• Which brain structure regulates appetite, sleep, and libido?
• In suspected neuroleptic malignant syndrome, what is a key pharmacologic step in management beyond stopping the offending medication?
• Which statement is true about pharmacologic treatment of anxiety in older adults?
• Which statement best explains why group therapy is beneficial for clients?
• Which of the following is NOT a typical negative symptom of schizophrenia?
• How do you differentiate a Substance/Medication-Induced mood disorder from a primary mood disorder?
• During the PMHNP assessment for Mrs. Shea, which laboratory test is most appropriate to order initially?
• Divalproex exposure in pregnancy is linked to which neural tube defect?
• What is the primary purpose of the American Nurses Association's Psychiatric-Mental Health Nursing: Scope and Standards of Practice?
• When prescribing an SSRI for a child or young adult up to age 24, what education must be included?
• Three weeks after starting an antidepressant, a patient reports rapid speech and an expansive mood. This finding most likely indicates which state?
• According to DSM-5, which statement is true about diagnosing mental disorders and culture?
• In the following exchange, which communication technique is demonstrated when addressing a client's repeated lateness?
• What is the maximum duration of symptoms after trauma for Acute Stress Disorder?
• Which statement about obsessive-compulsive disorder is NOT a core diagnostic feature?
• Which statement about bipolar disorders is true?
• In augmentation strategies for treatment-resistant MDD, which of the following is an example besides second-generation antipsychotics?
• How long must worry persist for a diagnosis of Generalized Anxiety Disorder?
• What is the therapeutic trough range for lithium?
• Antidepressants can precipitate mania in susceptible individuals. This is particularly a concern in which population?
• Which of the following values indicates severe neutropenia requiring immediate discontinuation of clozapine due to risk of infection?
• A 54-year-old man with a long history of schizophrenia presents with avolition and anhedonia. This presentation is best explained by which type of symptoms?
• DSM-5-TR criteria for Substance Use Disorder involve how many criteria within what time frame, and what are general domains?
• In the ED after a suicide attempt by wrist-cutting, which nursing action should be the highest priority initially?
• A new client reports her boyfriend has violently assaulted her in front of their 3-year-old child and asks whether the PMHNP should report to child protective services. Which statement best reflects the clinician's duty?
• Which statement best reflects patient autonomy in psychiatric care?
• For adult ADHD, when must symptoms have appeared to meet diagnostic criteria?
• Which structure contains neurons that produce serotonin?
• What are the main pharmacologic treatment options for Opioid Use Disorder?
• Dopamine is produced in which location?
• Panic Disorder diagnosis requires recurrent unexpected panic attacks and persistent concern or behavioral change for at least how long?
• Clozapine is reserved for which patient population?
• When developing a suicide safety plan, what are three essential components?
• Which defense mechanisms are commonly used by persons with obsessive-compulsive personality disorder?
• Damage to which brain lobe is most likely to cause deficits in planning and impulse control?
• Baseline assessments before starting stimulant therapy in a child with ADHD should include which measurements?
• Serotonin syndrome features?
• When applying DSM-5 diagnostic assessments, what must clinicians consider regarding culture?
• Serotonin is produced in which location?
• Four elements must be present for a malpractice lawsuit to be filed. Which set correctly lists these elements?
• Which of the following are signs and symptoms of cannabis intoxication?
• Target symptom identification is best explained as which of the following?
• In group therapy with peer-led meetings like AA/NA, which therapeutic factor is instilled by hearing others' recovery stories?
• Which defense mechanism involves returning to an earlier developmental pattern under stress?
• Ziprasidone carries a notable risk in what cardiac parameter?
• Which statement describes major benzodiazepine withdrawal complications?
• How long must symptoms be present to diagnose Schizophreniform Disorder?
• Dialectical thinking in DBT emphasizes the central pattern of tension between which concepts?
• An example of a mature, healthy defense mechanism is
• Delirium prevention is crucial because delirium after hospitalization is associated with which outcome?
• Which physiology change increases free drug concentration in older adults due to reduced protein binding?
• What is the best therapist response when Cody makes a comment about the therapist’s car?
• Which healthcare concept emphasizes creating an open and fair environment that acknowledges human error to promote safety?
• What best describes homeostasis in a family system?
• In a motivational interviewing session with a client, which two techniques are demonstrated in the described interaction?
• In group therapy, which term describes elements like universality, hope, and sharing information that contribute to client change?
• Early signs of lithium toxicity?
• Which medication class is known to exacerbate or cause depression and should be reviewed in patients with depressive symptoms?
• Which defense mechanism is described as mature and channels energies into growth-promoting activities?
• Which of the following is a contraindication to MRI of the head?
• What differentiates atypical antipsychotic medications from first-generation or typical antipsychotic medications?
• Among second-generation antipsychotics, which have relatively lower metabolic risk?
• What are common indications for electroconvulsive therapy (ECT) in mood disorders?
• As a PMHNP trained in transactional analysis (TA), which statement best reflects trauma affecting Samantha’s happiness?
• What is the primary goal of the psychiatric assessment process performed by the PMHNP?
• What is a key consideration when treating late-life depression to minimize cognitive adverse effects?
• Rett syndrome primarily affects which gender?
• When Tim's HPV vaccine question arises, the PMHNP's best response includes which of the following?
• Which statement best differentiates Acute Stress Disorder from Posttraumatic Stress Disorder?
• Which therapy uses paradoxical directives, such as asking a resistant client to worry extensively for a set period, to provoke change?
• Stimulant-induced psychosis typically resolves after what action?
• Which statement best differentiates the nurse-client relationship from a social relationship?
• During a neurological exam, a patient is asked to hold out her arms and stick out her tongue to assess for tremors. Which cranial nerve is being tested?
• Which term describes the movement of drugs through the body (absorption, distribution, metabolism, excretion)?
• Mary, a PMHNP working in a hospitalist role, has encountered repeated demeaning behavior toward nursing staff and delays in calls. The concept she is employing is
• Which statement best describes adult brain neurogenesis?
• The study of what the body does to drugs is called
• Which medication class is known to potentially exacerbate depression and should be reviewed in a depressed patient?
• Which statement best describes capacity to consent in a medical setting?
• Which ethical principle best applies when a legally competent patient with bipolar I disorder states they no longer want to be treated with medication and refuses follow-up?
• Tim's action in the case of a bipolar I patient with uncontrolled hypertension and diabetes who is out of medications: what is most appropriate?
• During the initial intake in an inpatient setting, which location is most appropriate for the assessment to balance comfort and safety?
• Generalized anxiety disorder requires excessive anxiety and worry about various events for at least how long?
• Which of the following is NOT an indication for electroconvulsive therapy in mood disorders?
• Which lobe is associated with working memory, planning, insight, and impulse control?
• Three weeks after starting fluoxetine 20 mg, which conclusion best explains the shift in presentation?
• In PMHNP practice, which of the following is an assessment action?
• Which psychotherapeutic approach is most associated with therapeutic factors such as universality and instillation of hope?
• Baseline metabolic monitoring before starting an atypical antipsychotic should include which comprehensive assessment?
• Which medical condition is characterized by normal development followed by regression with decreased head growth and loss of language skills, predominantly affecting females?
• In psychotherapy for personality disorders, the primary treatment goal is to assist the client in changing dysfunctional interpersonal relationships and use of immature defense mechanisms.
• In treatment-resistant major depressive disorder, what augmentation strategy is commonly used?
• Which statement about adult brain neurogenesis is accurate?
• Which statement best reflects a central DBT principle regarding acceptance and change?
• When interacting with a paranoid client who questions confidentiality or recording, which approach is recommended?
• How does Adjustment Disorder differ from Generalized Anxiety Disorder in terms of onset and duration?
• In pediatric major depressive disorder, which SSRI is often used but does not have FDA approval?
• What is the best treatment for AIDS dementia complex?
• Which statement demonstrates a therapeutic response when a patient has missed several appointments?
• Which lab monitoring is required for clozapine due to agranulocytosis risk?
• Which statement best describes bulimia nervosa in terms of body weight at presentation?
• Which medication should be avoided in pregnancy due to teratogenic risk?
• The role of neurotransmitters in the central nervous system is to function as
• In pregnancy, which medication is considered a first-line pharmacologic option for moderate-severe maternal depression?
• For insomnia, what pharmacologic options are generally considered acceptable for short-term use in PMHNP practice, especially in the elderly?
• Beyond antiretroviral therapy, AIDS dementia complex should be managed with which type of interventions?
• A client in therapy begins regressing and expressing the original symptoms during termination; what is the best explanation?
• A 74-year-old woman scores 18 on the MMSE. This score is most consistent with which level of cognitive impairment?
• Which statement best defines autonomy in medical decision-making?
• Which statement best describes frontal lobe function?
• DSM-5-TR criteria for Schizophrenia require two or more of which hallmark symptoms, with at least one of those being delusions, hallucinations, or disorganized speech?
• The health care changes under the ACA led to doctors/hospitals/clinic groups joining together and assuming responsibility for quality care to Medicare patients. These groups are called
• Which brain structure is not primarily involved in regulating appetite, sleep, and libido?
• Define cyclothymic disorder in DSM-5-TR terms.
• In CBT, which statement best represents its primary rationale?
• Which type of hallucination is rare in persons with psychotic illnesses and is often associated with an organic etiology?
• Which of the following statements about the diagnostic criteria for Major Depressive Disorder is correct?
• A client with opioid dependence has not used for 15 days; the PMHNP’s best response is to discuss a trial of which type of medication to treat withdrawal symptoms?
• In peer-led recovery groups, which therapeutic factor is most consistently linked with fostering hope?
• According to the case, if the student does not learn alternative coping skills, what is he at risk of developing?
• Lamotrigine rash risk is heightened when combined with what drug or when titrated too rapidly?
• How many consecutive days of elevated or expansive mood are required for a manic episode, and how many additional symptoms must be present?
• In a community with unusually high teen depression and drug use, the action of modifying the environment and strengthening families to prevent new cases is an example of which level of prevention?
• The chief nursing officer asks the PMHNP to engage in a retrospective chart review of discharge follow-ups within 7 days and 30 days: this is an example of which type of initiative?
• Social Anxiety Disorder requires marked fear or anxiety about social situations lasting at least how long?
• In the DSM-5, how should a personality disorder be coded?
• Over the past 25 years, what has been the trend in legal rulings on cases involving mental illness?
• In voluntary admission, what action is typical if a patient requests discharge after 24 hours?
• Which statement best describes the purpose of the Scope and Standards document for PMHNPs?
• Mrs. Shea has come to the mental health center seeking treatment for depression after a suicide attempt and stopping a TCA. Which is the most appropriate initial action?
• Which statement best reflects the overlapping symptom profile of ADHD and pediatric bipolar disorder?
• Posttraumatic Stress Disorder requires exposure to a traumatic event plus symptoms in four clusters, with duration of symptoms lasting more than what period?
• Ms. Thomas with major depressive disorder started fluoxetine 20 mg; for ongoing care, which action is appropriate?
• What is the best reason SSRIs are considered among first-line treatments for major depression?
• In treatment-resistant mania with psychotic features, what is the recommended intervention?
• You are asked to help develop a flu vaccination program in a church health ministry. According to public health principles, this is an example of what level of prevention?
• What is a common strategy to manage benzodiazepine withdrawal safely?
• Which statement accurately describes the PTSD symptom clusters?
• Which second-generation antipsychotic is commonly used to augment treatment-resistant depression?
• What best describes the overall goal of psychotherapy for personality disorders?
• Which of the following is an example of a negative symptom in schizophrenia spectrum disorders?
• Prior to starting stimulant medication for ADHD in a child, which assessment is emphasized by guidelines?
• Which statement best describes imitative behavior as a therapeutic factor in group therapy?
• Timothy is an adolescent with a feeding disorder and normal weight who is sociable. These symptoms are most consistent with which eating disorder?
• As a PMHNP on the consult liaison team, you know delirium prevention is important because delirium is associated with which outcome?
• Which statement correctly describes the mechanism distinguishing atypical antipsychotics from typical antipsychotics?
• In Mr. D's insomnia scenario, which statement best describes the relationship between caffeine use and sleep disturbance?
• Sean, a 47-year-old Gulf War veteran with a traumatic brain injury, has a recent taper off clonazepam. What is the primary rationale for tapering benzodiazepines in patients with TBI?
• Which statement best reflects the risk associated with long-term benzodiazepine use such as clonazepam?
• When monitoring depressive symptoms during antidepressant therapy, which assessment tool is most appropriate to quantify changes over time?
• Delusional Disorder is characterized by delusions lasting at least 1 month with what level of overall functioning?
• Which example best illustrates isolation as a defense mechanism in obsessive-compulsive personality disorder?
• Dialectical behavioral therapy (DBT) draws on cognitive theory and behavioral theory. Elements of behavioral theory in DBT include which of the following?
• What is the minimum duration of symptoms required to diagnose schizophrenia, as distinct from schizophreniform disorder?
• In pregnancy, what is a practical approach to treating moderate-severe maternal depression?
• A patient with a longstanding history of depression and chronic renal failure is on an antidepressant and a diuretic, reporting increased depression, mild confusion, irritability, and fatigue. What is the best initial PMHNP action?
• Which class of antipsychotics is most associated with extrapyramidal symptoms, and what is a common management strategy?
• Which is an essential component in building a therapeutic relationship with clients?
• Interpreting the proverb 'People who live in glass houses shouldn't throw stones' in a mental health assessment depends on which factor?
• What are the core diagnostic features of Autism Spectrum Disorder?
• How would you distinguish Borderline Personality Disorder from Bipolar Disorder clinically?
• Following evidence-based practice, which laboratory screening tests and assessments should be completed prior to placing a person on a second-generation (atypical) antipsychotic medication?
• Which Freudian-based principle assumes all behavior and actions are purposeful, often unconscious?
• Name a common medical condition that can mimic anxiety disorders and should be screened for in evaluation?
• If a patient with psychotic symptoms refuses ordered medication, which principle should guide the nurse's actions?
• In the DSM-5-TR framework, tolerance and withdrawal are categorized under which criteria domain for Substance Use Disorder?
• Which structure is a primary site of dopamine production involved in movement?
• Which statement differentiates Bipolar I from Bipolar II disorders?
• An MMSE score of 28 falls into which interpretation category?
• Which Freudian principle posits that not all behavior occurs randomly and has purpose and meaning, often unconscious?
• Mr. D's middle insomnia: which is the most likely contributing factor?
• Neuroleptic Malignant Syndrome presents with what triad and what is a primary acute treatment?