ANCC PMHNP-BCFree Psychiatric-Mental Health Nurse Practitioner practice test

Correct answer: D. Recently ended a romantic relationship

A recent romantic breakup is a significant acute stressor for adolescents and can substantially heighten suicide risk, particularly when layered on top of existing risk factors such as prior attempts and substance use disorder. Interpersonal loss can amplify hopelessness and social isolation. Growing up in a single-parent household, while a psychosocial consideration, does not carry as strong an independent correlation with acute suicidal risk. Academic difficulties represent more of a chronic background stressor than an acute precipitant. A biological father's criminal history may hint at familial disruption but is far less immediately impactful than the loss of an intimate relationship.

Correct answer: B. Urine drug screen

Because this patient has no psychiatric history and his symptoms have only been present for six weeks, it is essential to exclude a substance-related etiology before attributing the presentation to a primary psychiatric condition. A urine drug screen is the first priority to rule out substance-induced psychotic disorder. A CT scan may eventually be warranted, but it would be ordered after initial laboratory workup.

Correct answer: D. Substance-induced psychosis

Psychosis that arises from substance use frequently resolves once the offending substance is discontinued. Given that his symptoms began in the context of a party where substances were reportedly used, substance-induced psychosis is the most plausible reversible explanation. A family history of schizophrenia, type 1 diabetes mellitus, or the short duration of symptoms since onset do not support reversibility in the same way.

Correct answer: A. Evaluate current suicidal intent and the lethality of the self-harm behavior

Regardless of the patient's stated intent, a thorough evaluation of current suicidal ideation, intent, and lethality is required. Individuals with borderline personality disorder carry chronic risk for both non-suicidal self-injury and completed suicide. Even superficial wounds can precede escalating self-harm if risk is underestimated. Downplaying risk because the injury was non-lethal could lead to missed intervention opportunities. Probing the patient's theoretical knowledge of lethal methods is inappropriate and potentially distressing at this stage. Exploring cutting history provides useful background but does not take precedence over assessing immediate safety.

Correct answer: B. Drug Abuse Screening Test (DAST)

The DAST is the most appropriate tool for an initial evaluation of suspected stimulant use disorder, as it is comprehensive, validated, and designed to screen for problematic use of a broad range of substances other than alcohol, including stimulants. The CIWA is specific to quantifying alcohol withdrawal severity, not for screening drug use disorders. The AUDIT targets alcohol use exclusively and does not address stimulant or other drug use. The COWS is designed for assessing opioid withdrawal and is unsuitable for stimulant-related concerns.

Correct answer: C. Apply motivational interviewing to explore the patient's readiness for change

Motivational interviewing is the most suitable strategy when a patient is ambivalent about change, as it explores the patient's own reasons for change without judgment, fosters intrinsic motivation, and respects autonomy. It is evidence-based for substance use concerns. Mandating group therapy attendance is unlikely to overcome ambivalence and may provoke resistance. Disulfiram requires the patient to be committed to abstinence; using it before assessing readiness could be ineffective and damage the therapeutic relationship. Providing didactic information about drinking consequences may trigger defensiveness in ambivalent individuals rather than facilitating genuine change.

Correct answer: A. Appearance

Appearance in the mental status examination encompasses the patient's physical presentation, including grooming, hygiene, dress, and general demeanor. Observations such as clothing inappropriate for the weather, disheveled hair, and limited eye contact all fall within the domain of appearance. Mood refers to the patient's subjective internal emotional state, typically gathered through self-report. Affect is the observable expression of emotion evaluated through facial expressions and vocal tone, not physical attire or hygiene. Cognition covers orientation, attention, memory, and related functions assessed through targeted questioning or tasks, not by visual observation of dress or grooming.

Correct answer: B. Clinical Opiate Withdrawal Scale (COWS) and Clinical Institute Withdrawal Assessment (CIWA)

COWS and CIWA are validated instruments designed specifically to quantify the severity of opioid and alcohol withdrawal symptoms, respectively. Using both together provides a comprehensive picture of physiological withdrawal risk from each substance. The DAST screens broadly for drug use problems but does not quantify withdrawal severity, limiting its utility when paired with COWS in an acute withdrawal management context. CIWA paired with AUDIT would address alcohol withdrawal and screening but would leave opioid withdrawal unassessed. Pairing AUDIT with COWS would identify alcohol misuse and opioid withdrawal but would not capture the severity of alcohol withdrawal symptoms needed for immediate risk management.

Correct answer: D. Place the client on continuous one-to-one observation

Continuous one-to-one observation is the most appropriate immediate action when a client presents with both suicidal intent and available means. This level of monitoring is standard in acute settings to reduce the opportunity for self-harm while assessment and further intervention proceed. Initiating supportive psychotherapy, while valuable in an ongoing therapeutic context, does not address the immediate threat to safety and should follow stabilization. Antidepressants require time to reach therapeutic effect and are not an emergency intervention. Removing firearms from the home is an important long-term safety measure but does not mitigate the client's immediate risk within the emergency department.

Correct answer: B. Confirm the patient's immediate safety and begin treatment for depression

A PHQ-9 score of 19 reflects moderately severe depression, which in the postpartum period demands prompt attention because of the elevated risks of self-harm, harm to the infant, or neglect. The nurse practitioner should confirm safety and initiate evidence-based treatment without delay. Watchful waiting is inappropriate for this level of severity in a vulnerable postpartum patient. Substance use evaluation may be relevant if clinically indicated but is not the priority when the depression score signals immediate mental health risk. Waiting until the next visit to observe score changes postpones necessary intervention and increases harm potential.