Chapter review

Fitzgerald PMHNP board review. ch01. Preparing for Exam and Test-Taking Strategies. This is drive 10 of 10. When I say Pause. Answer. wait, then I will give the answer. New section. Safety Alerts and Board Traps. Topic. Open-Ended Questions vs Closed-Ended Questions. - Think Open-Ended Questions when: Initiating the psychiatric interview, exploring subjective emotional experiences, building rapport, or asking the patient to describe their chief complaint in their own words. - Think Closed-Ended Questions when: Pinpointing specific clinical timelines, confirming **DSM-5-TR** symptom criteria, quantifying drug or alcohol use, or screening for immediate suicide risk. - Priority difference: Open-ended questions yield comprehensive narrative context, whereas closed-ended questions deliver precise, structured clinical facts. - What boards are testing: Your ability to choose the appropriate questioning technique based on the patient's immediate clinical needs and the phase of the interview. Live Board Practice Items. Question 1. Assessment of the optic disc is a component of the evaluation of cranial nerve: - A. Cranial nerve I - B. Cranial nerve II - C. Cranial nerve III - D. Cranial nerve IV Pause. Answer. B. Why it is correct: Direct fundoscopic evaluation of the optic disc assesses cranial nerve II, the optic nerve. Why each distractor fails: - A. Cranial nerve I is the olfactory nerve, which evaluates sense of smell. - C. Cranial nerve III is the oculomotor nerve, which evaluates eye movements and pupillary constriction. - D. Cranial nerve IV is the trochlear nerve, which evaluates downward and inward eye movement. Test-taking pearl: Physical examination maneuvers evaluating cranial nerves test direct recall of core assessment skills. Question 2. Of the following, which should be performed initially in assessing a 48-year-old woman with suicidal ideation? - A. Does she have someone at home to stay with her? - B. What is the content of her thoughts? - C. Does she have access to a firearm? - D. Has she attempted suicide in the past? Pause. Answer. B. Why it is correct: Evaluating active thought content determines suicidal intent, plan specificity, and immediate lethality risk during initial mental status assessment before arranging disposition or reviewing past history. Why each distractor fails: - A. Inquiring about home supervision relates to disposition planning, which is premature before assessing active thought content and intent. - C. Assessing firearm access evaluates suicide means, but establishing current active thought content takes immediate priority. - D. Reviewing past suicide attempts gathers historical risk data, but active thought content dictates immediate clinical safety. Test-taking pearl: Evaluate active suicidal thought content and intent initially to establish immediate patient safety before planning disposition. Question 3. An 8-year-old boy presents for an evaluation for possible attention-deficit/hyperactivity disorder (ADHD). His parents report him to be a healthy 3rd-grader with "plenty of good friends." They are concerned he could have ADHD because he is "hyperactive" and because his father had ADHD. The Vanderbilt screening tools completed by his parents strongly indicate inattention, with moderate hyperactivity symptoms. Your next best action is to: - A. Prescribe a low dose of methylphenidate and return to clinic in four weeks to evaluate both response and adverse drug effects. - B. Arrange for parents to obtain Vanderbilt screening tool or other written feedback from his teacher and return in 2 weeks. - C. Order a screening head computed tomography (CT), complete blood count (CBC) and thyroid-stimulating hormone (TSH). - D. Refer to a pediatric neurologist. Pause. Answer. B. Why it is correct: Diagnostic criteria for **ADHD** require documented impairment in two or more settings. Obtaining teacher rating scales confirms multi-setting impairment before establishing a diagnosis or initiating medication. Why each distractor fails: - A. Prescribing **methylphenidate** before confirming multi-setting impairment is premature care planning. - C. Ordering a head CT, CBC, and TSH is unindicated in a healthy child without focal physical or neurological findings. - D. Referring to a specialist is unnecessary when evaluating routine outpatient **ADHD** falls within the independent scope of the PMHNP. Test-taking pearl: Confirm symptoms across multiple settings before establishing a diagnosis or initiating controlled pharmacotherapy. Question 4. You have been asked by the director of a large primary care clinic to serve as a consultant. Specifically, you are asked to propose strategies to improve access to mental healthcare services for their patients. Which of the following actions by the PMHNP is recognized as an innovative, best practice model? - A. Schedule lunch and learn sessions to advise the providers about how to improve treatment of mental health disorders with their patients. - B. Provide the nursing staff with a list of referral agencies including direct access contact information. - C. Collaborate with the director to plan for implementation of on-site behavioral health specialists embedded into the primary care clinic. - D. Arrange your psychiatric clinic to have 2 appointments per week available for the primary care patients. Pause. Answer. C. Why it is correct: Embedding behavioral health specialists directly within primary care settings represents the national gold-standard integrated care model, expanding access and improving clinical outcomes. Why each distractor fails: - A. Lunch and learn sessions offer informal provider education, but do not create an integrated behavioral health model. - B. Providing external referral lists maintains fragmented care rather than delivering an integrated on-site service model. - D. Reserving two appointment slots per week in an off-site clinic is an inadequate schedule modification that fails to establish a sustainable best-practice model. Test-taking pearl: Select integrated on-site collaborative models to fulfill national best-practice standards. Question 5. A 60-year-old female who is being treated for stable major depressive disorder and generalized anxiety disorder presents for a routine follow-up visit. She reports that her mood is stable on her current medication regimen, but she occasionally misplaces her keys and forgets where she parked her car. Which of the following choices represents the best initial PMHNP action to take at this time? - A. Refer the patient immediately to a neurologist for a comprehensive dementia workup - B. Administer a standardized cognitive screening tool such as the Montreal Cognitive Assessment (MoCA) - C. Increase the daily dosage of her selective serotonin reuptake inhibitor - D. Schedule laboratory testing for TSH and CBC Pause. Answer. B. Why it is correct: Evaluating a new subjective memory complaint requires gathering objective baseline assessment data using a bedside tool like the MoCA before taking diagnostic or therapeutic action. Why each distractor fails: - A. Referring to a neurologist is premature before completing a brief bedside cognitive assessment. - C. Increasing the antidepressant dosage assumes worsening depression without objective evidence of depression relapse or cognitive decline. - D. Scheduling laboratory testing may follow, but administering a cognitive screening tool represents the best immediate bedside action. Test-taking pearl: Gather objective assessment data using standardized bedside tools before adjusting stable medications or referring away. Question 6. During an initial diagnostic evaluation, a 28-year-old male with generalized anxiety disorder appears guarded and reluctant to share details about his distress. Which of the following statements by the PMHNP represents the most effective open-ended question to encourage the patient to elaborate freely? - A. Do you experience panic attacks when you leave your home? - B. Tell me what brings you in for an evaluation today. - C. Have you taken any antianxiety medications in the past? - D. Is your anxiety worse in the morning or in the evening? Pause. Answer. B. Why it is correct: "Tell me what brings you in for an evaluation today" is an open-ended gentle command that invites the patient to share his story in his own words, building rapport and reducing guardedness. Why each distractor fails: - A. Asking if he experiences panic attacks is a closed-ended question that limits the answer to yes or no. - C. Inquiring about past medication use is a closed-ended fact-finding question. - D. Asking if anxiety is worse in the morning or evening is a structured, forced-choice closed question. Test-taking pearl: Use open-ended statements and gentle commands during the opening phase of an interview to build rapport and encourage free discussion. Best Next Step. Best next step. Move to the next leaf under Clinical Review Skills covering Case formulation to master synthesizing biopsychosocial data for board certification. Next. End of this drive.