PMHNP Certification Q & A

The PMHNP is called to the emergency department to evaluate a patient with an acute onset mental status change. The patient has a long history of schizophrenia and has been managed on a variety of antipsychotic therapies that have had some success, but the patient has not ever really achieved goal remission.  Most recently he was started on a first generation antipsychotic along with benztropine (Cogentin). Today the patient is in the ED with confusion and muscle stiffness. Which of the following represents anticipated vital signs?A. T 103.5o F, P 54 bpm, RR 24 bpm, BP 150/100 mm Hg B. T 102.5o F, P 129 bpm, RR 22 bpm, BP 170/110 mm Hg C. T 96.4o F, P 60 bpm, RR 24 bpm, BP 190/120 mm Hg D. T 98.6o F, P 102 bpm, RR 18 bpm, BP 147/99 mm Hg ---YouTube: https://www.youtube.com/watch?v=9emyKQQhmYc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=120

The PMHNP is evaluating a 73-year-old patient who has just been discharged from the hospital after being treated for a urinary tract infection with associated delirium. She has a baseline major neurocognitive disorder and the spouse has been told in the past that the patient cannot take antipsychotics. However, while she was hospitalized she was given an antipsychotic for delirium and it seemed to help a lot. The spouse wants to know why the patient cannot take an antipsychotic for her chronic behavioral symptoms. The PMHNP knows that the patient most likely has which underlying cause of major neurocognitive disorder? A. Pick’s disease (FTD)B. Alzheimer’s disease (AD) C. Vascular disease (VaD) D. Parkinson’s disease (PD) 

A 3-year-old child is being seen because the daycare facility staff have suggested to the parents that the child is having difficulty interacting with other children. Additionally, the staff have observed that when the child seems to become anxious or upset, he always becomes fixated on stacking building blocks one on top of the other to the extent that he will not acknowledge anyone or anything else. When the parents ask if their child has autism spectrum disorder (ASD), the PMHNP advises the parents that: A. The repetitive and predictable nature of stacking blocks is calming in children with ASDB. Stacking blocks is a very typical activity in children at this developmental stage and is not suggestive of ASD. C. The child should be tested for ASD, but in any event  he should be discouraged from using building blocks as a coping mechanism. D. While the social dysfunction at this age may suggest ASD, the building block activity is not an abnormal finding in a 3-year-old. ---YouTube: https://www.youtube.com/watch?v=rf3inZzulEg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=118

The PMHNP is performing a new patient assessment on a 41-year-old patient referred from primary care for depressive disorder refractory to SSRIs. During the mental status examination, the patient is unable to successfully perform a serial 7’s backward count. The NP documents an abnormal finding in the area of: A. Speech B. Thought process C. Judgment D. Cognition---YouTube: https://www.youtube.com/watch?v=uQYdcEqFBLc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=117

Patients with a deficit in one of six neurocognitive domains to the extent that it represents a deterioration of function from their baseline and makes it impossible for them to live independently are diagnosed with major neurocognitive disorder. Which of the following is not one of the six neurocognitive domains? A. Learning and memory B. Language C. Perceptual motor D. Cognition and emotion---YouTube:https://www.youtube.com/watch?v=b9166JUmJLg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=116

The PMHNP is evaluating a new patient who has been referred by his employer for evaluation.  His supervisor is concerned about his mental health and his safety. The NP evaluates the patient and does not find criteria consistent with major depressive disorder, but identifies which of the following as particularly concerning for risk of suicide? A. Anhedonia B. HopelessnessC. Depressed mood D. Weight loss ---YouTube: https://www.youtube.com/watch?v=sNlBelJr92M&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=115

The PMHNP is called to consult on a patient in the emergency department who has been admitted following a traumatic motor vehicle/pedestrian accident. He was walking across the street when a speeding driver crashed into him at high speed. The patient remarkably does not have serious injuries, the staff noted that he seemed a bit “odd” and decided to call for a mental health consult.  The patient lives alone, has no close friends or family members to call, and appears disinterested in any discussion of interpersonal relationships. The PMHNP recognizes that the most appropriate approach to this patient requires which of the following? A. A warm, straightforward approach with particular attention to being non-judgmental.B. A firm, professional approach with firm limit setting at the beginning of the encounter.C. Particular attention to the need for insight-oriented therapy  with the goal od increasing independence.D. Referral to dialectical behavior therapy as a mechanism for promoting acceptance and change. ---YouTube: https://www.youtube.com/watch?v=CXMZcHbje1s&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=114

Which of the following laboratory abnormalities is not consistent with a female patient who drinks more than 3 alcoholic drinks daily? A. Elevated high density lipoproteinB. Elevated macrocytosis C. Elevated transaminasesD. Elevated triglycerides---YouTube: https://www.youtube.com/watch?v=XL6auWRfup8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=113

The PMHNP is counseling a patient who wants to enter treatment for a substance use disorder. The patient has been using methamphetamine for over one year and freely acknowledges how much he likes the way it makes him feel. However, he is realizing that it is destroying his marriage, his professional reputation, and his health. He genuinely wants to stop using it, and is willing to do whatever he has to do, but admit that he has tried twice before and relapsed. Both he and his significant other do not understand why the desire to use is so powerful since there is not a true physical withdrawal phenomenon. The PMHNP explains that there is a very strong physiological drive due to the influence of which reward neurotransmitter? A. Serotonin B. Glutamae C. NorepinephrineD. Dopamine

When managing a patient in the stabilization phase of schizophrenia primary goals and process include which of the following? A. Self-management skills B. Supported employment C. Assertive community treatment D. Minimizing stress and supporting recovery---YouTube: https://www.youtube.com/watch?v=3CM5_CTX69U&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=111

A 50 -year-old female patient has been followed by the PMHNP for over 6 years for a diagnosis of major depressive disorder, recurrent. The patient has achieved a successful remission on sertraline, 75 mg daily.  Today presents complaining of an acute onset depressed mood, tearful days, and difficulty concentrating for the last month. It has become a problem at work, and her boss has suggested that she might need to take some time off to “take care of her problem.”  Further discussion reveals that the patient learned last month that her husband is having an affair with a coworker.  She is so distraught and consumed that she cannot fulfill her work responsibilities and she has completely cut herself off socially from friends and family. The PMHNP suggests that the next best step in her care should include which of the following? A. Increasing her sertraline to 100 mg daily B. A referral to psychotherapyC. A referral to couples counseling D. Changing her pharmacotherapy to an SNRI ---YouTube: https://www.youtube.com/watch?v=I1kYlCdi7cg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=110

A 48-year-old patient who reports a diagnosis of obsessive-compulsive disorder has transferred to your care after moving from out of state. You are unable to obtain medical records and must rely on the patient for information. During the initial appointment the patient says reports a very stressful home life. She has a school-aged daughter with severe chronic illness who requires 24-7 total care, as well as some other stressors related to her other children and finances. The patient says that for several years she has been in exposure-response therapy with intermittent, inconsistent improvement, and took fluvoxamine 300 mg daily which seemed to help for a while but then stopped. Her primary symptom presentation is related to obsessive thoughts, although there is a strong chronic anxiety and depressive component. The obsessive thought patterns are markedly worse when there is a stressful life event, and she has had periods of relief when things are calmer at home. Which of the following aspects of her history is a favorable prognostic indicator? A. Precipitating triggersB. Reported history of treatment C. Presence of children in the home D. Lack of comorbid compulsions ---YouTube: https://www.youtube.com/watch?v=5ovzvLVpBrc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=109

A patient with bipolar I disorder is currently being managed with lithium, 60 mg q.h.s. along with quetiapine 300 mg daily. The patient presents today for follow-up and reports that her mood has been very stable. Her work as a pastry chef has been really stressful around the holiday season, but she has handled it well and has no concerns about any mood deviations, either manic or depressive. She is sleeping approximately 7 hours nightly. Her last blood work was 7 months ago, and at the time there were no alarm findings in her lithium level, renal function tests, TSH, or liver function tests. On physical examination the PMHNP appreciates a fine, symmetrical tremor of the hands that gets worse when the NP asks her to write her name. This finding was not present on previous examinations. The NP should take which of the following actions? A. Draw a TSH, lithium level, and metabolic panel with eGFR in the office today B. Instruct the patient to proceed to the emergency room immediately   C. Hold the lithium and order a lithium level to be drawn in one week. D. Hold the quetiapine and order a metabolic panel with eGFR in one week. ---YouTube: https://www.youtube.com/watch?v=EpZHxV2hSn4&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=108

A 27-year-old patient presents for evaluation at the suggestion of his intimate partner who thinks he might have depression. During the initial evaluation the patient admits that he is often “down,” has a really hard time feeling happy even when really good things happen. He denies any particular precipitating factor and in retrospect thinks he has been like this for “years.” He denies any difficulty sleeping, although says he never really wakes up feeling “well-rested and ready to go.” His appetite is fine, he denies any thoughts of death, suicide or self-harm, and denies a sense of hopelessness about life. He likes his job with a property management company, although he says it’s not especially exciting. He admits to generally having no mental or physical energy. Sometimes he wants to do things, but cannot get himself to do it. It is beginning to be a problem with his relationship, which is why he made the appointment. He has not medical conditions, takes no medications, and the rest of his history and ROS is within normal limits. What is the most likely diagnosis? A. Depressive mood due to substance use disorder B. Adjustment disorder with depressed mood C. Major depressive disorder, recurrent D. Persistent depressive disorder ---YouTube: https://www.youtube.com/watch?v=WCrL3cdK4dM&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=107

The PMHNP is seeing a patient who has been struggling with a collection of anxiety and depressive symptoms. She is resistant to pharmacotherapy and prefers to begin with a psychotherapy approach. As it turns out, the primary source of her symptoms is that she is married to a spouse in the military and has had to move thousands of miles from home, friends and family. An attempt to implement solution-focused therapy would include which of the following techniques? A. Motivational interviewing B. Cognitive restructuring C. Social skills training D. The miracle question ---YouTube: https://www.youtube.com/watch?v=60cxLyWFU4E&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=106

The PMHNP is interviewing a new patient, a 32-year-old single female who is presenting for evaluation of underlying anxiety. While collecting a social history the PMNP asks the patient if she has a boyfriend. The patient is uncomfortable with the question as she is lesbian and is now afraid that the PMHNP will not treat her fairly and with dignity. The PMHNP is most likely demonstrating which of the following? A. An appropriate approach to collecting social historyB.  A manifestation of implicit biasC. An overt implementation of her value system D. A conscious disregard for alternative lifestyles ---YouTube: https://www.youtube.com/watch?v=6kyWMh95t18&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=105

A 64-year-old patient presents with new onset anxiety. She denies any history of anxiety disorder or any psychiatric disorder previously in her life, but for the last 9 months she has been having episodes that she describes as “attacks.” Out of the blue she will develop a sense of racing heart, hyperventilation, numbness and tingling in her arms, and feeling lightheaded. She worries about this a lot, and now worries virtually all the time about why this is happening. It is causing difficulty with sleeping, and she finds herself being very irritable at home and at work. These episodes last for “a few minutes” and then subsides on its own. She takes medication for high blood pressure and high cholesterol, but otherwise reports being very healthy.  What aspect of this scenario is suggestive that there might be an underlying organic cause of her symptoms? A. Age of onsetB. Character of episodes C. Medical history D. Duration of episodes ---YouTube: https://www.youtube.com/watch?v=frd2lx7bb7o&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=104

The dopamine hypothesis of schizophrenia postulates an abnormality in which of the following dopamine pathway as the etiology of symptoms?  Select all that apply. A. The mesolimbic pathwayB. The mesocortical pathwayC. The nigrostriatal pathway D. The tuberoinfundibular pathway ---YouTube: https://www.youtube.com/watch?v=oQ42kYfwJU4&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=103

The PMHNP is seeing a patient who presents with a chief complaint of feeling depressed. Further exploration reveals that while the patient does have several symptoms of a depressive episode, he does not quite meet criteria for any of the commonly encountered depressive disorders. The primary issue seems to center around the fact that the client feels as if his life has no meaning. He says he gets up, he gets dressed, goes to work, pays the bills, does all of the things he is supposed to do in life, but he struggles with the question, “what is the point? Why does any of it matter? The PMHNP recognizes that the patient might benefit from which of the following types of therapy? A. Cognitive behavioral therapy B. Behavioral therapy C. Psychodynamic therapy D. Existential therapy ---YouTube: https://www.youtube.com/watch?v=5CwRoe9maZQ&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=102

The PMHNP is evaluating a 69-year-old patient who has self-referred for evaluation. The patient retired from his professional role as a CEO from a major fortune 500 company 8 months ago and admits that he feels himself sinking into an uncharacteristic depression. For most of his life he has been a high-achiever, and he retired 8 months ago with the intention of enjoying the wealth he worked so hard to build. While he did take some big trips and had a lot of fun at first, now he feels oddly empty and for no good reason feels himself sinking into depression. According to Erikson’s stages of psychosocial development this patient may be having maladaptive resolution of which stage? A. Identity versus role confusion B. Initiative versus guilt C. Generativity versus stagnationD. Ego integrity versus despair---YouTube: https://www.youtube.com/watch?v=8OBGbzW1HDc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=101

Which of the following medical conditions should be considered when a patient presents complaining of new onset  episodes of anxiety-like symptoms including hypervigilance, tremulousness, tachycardia, and palpitations? A. HypothyroidismB. InsulinomaC. Anemia D. Hepatitis ---YouTube: https://www.youtube.com/watch?v=PgcoKYwUNMo&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=100

A PMHNP partners with a local women’s health practice to develop a program to screen pregnant women for depression in an effort to identify patients at high risk for post-partum depression and institute treatment as appropriate. This is an example of which level of prevention? A. Primary prevention B. Secondary preventionC. Tertiary prevention D. Collaborative prevention---YouTube: https://www.youtube.com/watch?v=QtlF5hZ5e0U&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=100

The PMHNP is evaluating a patient who has presented for care repeatedly reporting that she is bipolar and has manic episodes. She has been medicated in the past with a number of mood stabilizers without any meaningful improvement. Today a more detailed history reports that what she is calling manic episodes are actually periods of dramatic responses to stressors. When she argues with her significant other, her mother, and even people at work she becomes very animated. In response to stressors she is very dramatic and defensive, will react in an erratic fashion, but then often within hours goes to extremes to try and explain her behavior and make amends. She clearly struggles with being alone. Which of the following diagnoses should be explored for this patient?  A. Bipolar disorder with mixed episodes B. Schizoaffective disorder C. Adjustment disorder with anxiety features D. Borderline personality disorder---YouTube: https://www.youtube.com/watch?v=dKMlovMXyVM&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=98

A 67-year-old female is being evaluated for complaints of depression. She has always struggled with times where she was down but never liked taking medication and has tried to treat herself with nutraceuticals. Her symptoms have gotten much worse lately because her husband died and she is struggling with that. She has been seeing a therapist for the last few months but is not feeling any real improvement.When considering pharmacotherapy for her, which of the following medications should be avoided? A. Sertraline (Zoloft) B. Bupropion (Wellbutrin) C. Escitalopram (Lexapro) D. Citalopram (Celexa) ---YouTube: https://www.youtube.com/watch?v=3R_9ZEV9B24&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=97

The PMHNP is evaluating a family at the request of county social services. A mother, father, 8-year-old and 2-year-old are present for the evaluation. The NP notes that the 2-year-old clings excessively to the parents, despite the fact that the parents do not seem to be particularly responsive to the child’s caution.  The 2-year-old does not exhibit typical curiosity about his new environment and does not express any curiosity about the PMHNP. These behaviors are consistent with:A. Separation anxiety disorder B. Normal behaviorC. Autism spectrum disorder. D. Insecure-ambivalent attachment---YouTube: https://www.youtube.com/watch?v=Q53ltO03TKU&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=96

A 78-year-old man presents for a follow-up visit. Two months ago he was started on sertraline  for major depressive disorder and has been titrated up to 100 mg daily. Today his daughter reports that she cannot really evaluate if his mood has improved because he seems to have become confused. The patient’s daughter reports a distinct new onset confusion and forgetfulness. The PMHNP considers the most likely cause of his confusion to be: A. Urinary tract infection. B. HyponatremiaC. Alzheimer’s disease D. Depression ---YouTube: https://www.youtube.com/watch?v=HGxzaaVSVxk&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=95

Cognitive assessment in children characterizes stages of development consistent with Piaget’s developmental theory. One of the cognitive principles typically developed during the sensorimotor stage is: A. Object permanenceB. Animalistic thinkingC. Phenomenalistic causality D. Learning without reasoning. YouTube: https://www.youtube.com/watch?v=AIZ5H14yUqI&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=94

A 12-year-old patient is being seen today in follow-up after being started on fluoxetine 1 month ago for a diagnosis of generalized anxiety disorder.  The patient and her father both report that while there does appear to be a mild improvement in anxiety, some adverse effects have developed about which they are concerned. Which of the following is not an expected adverse effect and is a cause for concern?  A. Vivid nightmares B. Diaphoresis C. Restless legs D. Impulsivity---YouTube: https://www.youtube.com/watch?v=6onROBl73UE&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=93

The PMHNP is evaluating a patient who presents complaining of panic attacks that occur for no identifiable reason. The patients has been treated for these previously with a variety of pharmacotherapies that did not provide any meaningful improvement. Upon further conversation, the NP learns that the patient experienced a near-fatal bicycle accident  4 years ago after being hit by a car. When considering a diagnosis of PTSD, the NP explores his history for all of the following diagnostic criteria except: A. Intrusion symptoms. B. Angry outbursts. C. Negative cognition D. Avoidance symptoms. ---YouTube: https://www.youtube.com/watch?v=QQ-KgQYOuSg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=92

J.B. is a 41-year-old female patient who is being managed for obsessive compulsive disorder. She has been in exposure response therapy (ERT) for several months with marginal improvement, but she has never approached true remission. At one time she was on fluvoxamine with notable improvement, but after a few months it ceased to produce any notable impact and after conferring with her therapist she was converted to fluoxetine 20 mg qd. After two months she was still struggling with symptoms, so two months ago her dose was increased to 40 mg qd. Today she presents for follow-up, reporting no notable improvement with pharmacotherapy. She continues to engage in psychotherapy but at this point is becoming very frustrated.  The appropriate approach at this point would be to: A. Continue fluoxetine 40 mg daily for one more month and reassess B. Convert the patient to therapy with a tricyclic antidepressant C. Continue fluoxetine at 40 mg daily and consider a change in therapy. D. Increase the fluoxetine to 60 mg daily and reassess in four to eight weeks ---YouTube: https://www.youtube.com/watch?v=GHa21K_Zprc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=91

The PMHNP is evaluating a patient with significant anxiety and depressive symptoms. In the course of the evaluation the NP further appreciates that the patient is having hypnopompic hallucinations, and that the patient is very concerned about this because his uncle has schizophrenia. The PMHNP advises the patient that: A. There are a variety of pharmacologic options that can be helpful. B. The hallucinations are benign and not a cause for concern.C. There is no need for intervention unless they are accompanied by sleep paralysis.D. The sensory systems involved will dictate the need for further evaluation and treatment.---YouTube: https://www.youtube.com/watch?v=K-RKNH9QqU0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=90

A.J. is an 8-year-old male who is under the care of the PMHNP for ADHD.  His symptoms are profound, and the recommendation is to begin psychostimulant therapy along with behavioral therapy.  The parents are concerned because they have read that psychostimulant therapy can impact growth and final adult height if the child starts taking it before the growth spurt of adolescence.The most appropriate response to the parents is to say that: A. The impact on growth can be minimized by taking breaks from the medication on weekends and over the summerB. This concern is not supported by the evidence and that there is no impact on growth when appropriately prescribed C. The impact on growth can be significant and the best management for this patient is likely a non-stimulant option D. The cardiovascular consequences are  actually the bigger concern. ---YouTube: 

A 14-year-old patient has been managed for the last year with fluoxetine 40 mg daily for a diagnosis of generalized anxiety disorder. She had been doing well, but today her mother reports that ever since returning to school after the summer break she has been distant, sullen, argumentative and defiant. She has been spending time with new friends from school and is always out somewhere with them.The PMHNP recognizes that today’s appointment should include use of which of the following objective tools?  A. The AIMS tool B. The BPRS C. The MDQ D. The CRAFFT tool---YouTube: https://www.youtube.com/watch?v=jQmzYmvXL-o&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=88

PMHNP is asked to evaluate a 71-year-old male patient who is reportedly having visual hallucinations. His adult daughter accompanies him to the appointment and reports that he was diagnosed with Parkinson’s disease approximately 2 years ago. It began with the classic motor symptoms, but over the last year he has developed more and more difficulty with memory loss, difficulty with decision making, and episodes of depression and apathy. Sinemet has helped his motor symptoms, but he has not responded well to medications for cognitive symptoms.  A few months ago he started having visual hallucinations. At first it was a sense of things moving in his peripheral vision, but lately he is seeing people who are not there, or interpreting inanimate objects as people. Which of the following is the most appropriate medication for this patient? A. Bupropion (Wellbutrin)B. Pimavanserin (Nuplazid)C. Quetiapine (Seroquel) D. Sertraline (Zoloft)

A 71-year-old patient with neurocognitive disorder due to Lewy Body disease presents for a routine follow-up.  His wife reveals that he seems to be hallucinating, sometimes at night becoming very agitated as a result of visual hallucinations, and she is afraid for his safety. The patient himself does not really seem to understand that there is a problem, but his wife is very concerned and firm that he seems to have visual hallucinations more and more frequently. Which of the following medications would be most appropriate? A. Risperidone B. Olanzapine C. HaloperidolD. Quetiapine---YouTube: https://www.youtube.com/watch?v=dtthgQAXpes&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=86

A.G. is a 51-year-old female patient who is being managed for a variety of mental health conditions including bipolar disorder, opioid use disorder, generalized anxiety disorder, and adjustment disorder.  Her medication regimen includes a buprenorphine-based medication for OUD, an antipsychotic, an SSRI, and antihistamine. The physical examination documentation for each encounter should include a(n) :A. A PHQ-9 B. An AIMS score C. A GAD-7 D. An ORT ---YouTube: https://www.youtube.com/watch?v=MYOGl9FLV40&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=85

A 31-year-old Middle Eastern female presents to establish care. She recently relocated to the United States with her husband and is struggling with living in an environment so different from that in which she grew up. She shares that her husband seems more comfortable because he is working and integrating outside of the home, but she does not have that experience and feels very isolated from everything she knows. She is in her first trimester of pregnancy with their first child, and clearly struggling with the cultural shift  of living in the United States. The PMHNP recognizes that the best approach to this patient includes: A. Assisting with the integration of her cultural values into her those of her new homeB. Encouraging the patient that maintenance of her native cultural values should remain the mainstay of her life C. Referring the patient to a culturally-similar therapist who can help her maintain her cultural identity D. Facilitating her shift into the cultural mores and folkways most compatible with her new living circumstances ---YouTube: https://www.youtube.com/watch?v=If3UC_jLRhs&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=84

The PMHNP is conducting a new patient assessment with a patient who has self-referred for treatment of her panic attacks. The patient relates that she has had anxiety for years, and that she has episodes during which she gets very agitated, she can feel her heart pounding, feels as if she cannot breathe, feels very shaky, and has to sit down and wait for it to pass. These episodes can last for more than 15 minutes until she starts to calm down. Which of the following is inconsistent with diagnostic criteria of a panic attack?  A. The duration is too short B. The duration is too long C. There is no report of worrying in between episodes D. There is no report of intense fear---YouTube: https://www.youtube.com/watch?v=Fgx3jTEMvEk&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=83

A 22-year-old female patient is transferred to your care after another provider in the practice retired. She has been managed for bipolar I disorder for 3 years and has had some challenging extremes of exacerbation. She is currently taking a mood stabilizer, an antipsychotic, and an antidepressant. Today she reports a worsening of her depression, admitting to true hopelessness about the future, worsening malaise to the extent that she is not attending to basic hygiene, and for the first time reporting passive suicidal ideation. While her ideation does not rise to the level of hospitalization, it is a new and concerning symptom. Which of the following is the most appropriate adjustment to the plan of care? A. Ensure that the patient is seeing a therapist. B. Adjust the medication regimen to include lithium.C. Increase the dose of the antidepressant.D. Change to a different antidepressant. ---YouTube: https://www.youtube.com/watch?v=FHFskPi8cz8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=82

A patient with a history of rapid-cycling bipolar disorder presents for evaluation of her current, profound depressive symptoms. The patient has been maintained for the last two years on valproic acid and quetiapine, but now a major depressive episode has occurred and the patient is reporting passive suicidal ideation. Concerned that the suicidal ideation may progress, the PMHNP consider which of the following pharmacotherapeutic options? A. Cariprazine B. Lumateperone C. Aripiprazole D. Lithium

The PMHNP is seeing a patient who presents for complaint of depressive symptoms. The patient reports a history of anhedonia, hopelessness, worthlessness, sleep dysfunction, marked decrease in appetite with an unplanned 5 lb wt loss in the last month, and a marked inability to concentrate on necessary tasks. Before diagnosing the patient with major depressive disorder and beginning antidepressive therapy, the PMHNP should: A. Document a Patient Health Questionnaire-9 B. Administer a Mood Disorder Questionnaire C. Refer the patient to cognitive behavioral therapy D. Order a TSH and a CBC to rule out physiologic causes 

The PMHNP has a new patient who reminds her of a former teacher who played an important role in her life and whom she regards as a mentor. The NP is concerned that she may express countertransference and is especially watchful for all of the following except: A. Resistance and strong emotion from the patientB. Dreaming about the patientC. Extending appointments beyond normal time frame D. Offering small, inexpensive gifts occasionally to the patient 

The PMHNP is conducting a follow-up appointment with a patient who is being treated for generalized anxiety disorder. The patient has a long-standing difficult relationship with her mother and today it is evident that this is being exacerbated by her mother recently being diagnosed with cancer. Her mother does not appear to appreciate the sacrifices that the patient is making to help her, and the patient is very upset by this.  At this appointment the patient is agitated and begins to perseverate over the lack of participation by other family members. The NP, in an attempt to refocus the patient on the primary problem, says which of the following?  A. “You said that the family is not helping?” B. “You are close to tears. This is a hard subject for you.” C. “You feel betrayed because the family is not helping.” D. “You were talking about how irritated you were by your mother.---YouTube: https://www.youtube.com/watch?v=xg_1qLCRWQc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=78

The mother of a 3-year-old female brings her daughter in for a psychiatric evaluation. The mother is concerned because she sometimes sees her daughter talking to an “imaginary friend” and Mom is worried because she has a cousin with schizophrenia. Further the staff at her daughter’s daycare report that this little girl seems to prefer playing alone, even though there are lots of other children to play with. The child does not want to share her toys, and does not seem interested in playing with other children. The PMHNP recognizes that it is likely that: A. The child may be demonstrating early indicators of schizophrenia which is possible due to family history. B. These behaviors are consistent with developmental stage and not a cause for concern. C. Play therapy with an early-childhood therapist may help her integrate better with other children D. Autism spectrum disorder is more likely than schizophrenia given the child’s age. ---YouTube: https://www.youtube.com/watch?v=p_bkWpc69Z8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=77

The PMNP is evaluating a patient who is being treated for obsessive compulsive disorder with fluoxetine 60 mg daily. The patient has been on fluoxetine for months without any concerning adverse effects, but today the patient reports that for the past few weeks she has had a distinct sense of agitation, racing heart, nausea, and has been really clumsy. Suspecting serotonin syndrome, the NP assess for: A. New onset delusional thought B. Constipation C. Irritability D. Recent use of OTC cough medicine---YouTube: https://www.youtube.com/watch?v=VcyTSz7d4M4&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=76

The PMHNP is on call at the residential treatment facility and is called to urgently see a patient being treated for methamphetamine use disorder. The patient was admitted earlier this day and being and was still being assessed for appropriate psychotherapy and medication needs. Facility staff was performing routine observation rounds and found the patient unresponsive. You arrive at the bedside and find the patient to be unresponsive, with a blood pressure of 78/50 mm Hg and a respiratory rate of 7 breaths/minute. The appropriate response is to: A. Immediately review the records for all known substances of abuse B. Administer intranasal naloxone C. Begin CPR D. Place oxygen and IV access ---YouTube: https://www.youtube.com/watch?v=VQTxgzSWDgk&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=75

A 32-year-old female patient tells the PMHNP in the course of an office visit that her toddler’s pediatrician has suggested that the 3-year-old be referred for further assessment because his MCHAT-R score was high. Your patient is upset and does not think that the result was correct. Which of the following findings in the child would support an elevated MCHAT R score? A. The child is mostly non-verbal and uses gestures to communicateB. The child’s growth is not maintaining a consistent pattern C. A 5 day history of painful vesicular lesions over the penile glands, with some lesions now crusting over.D. A one week history of N void dysuria without penile discharge.---YouTube: https://www.youtube.com/watch?v=4xazBfI7jZE&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=74

Which of the following is a true statement with respect to the CAGE-AID questionnaire? A. It is a 5-item questionnaire used to screen for alcohol use disorder B. A “yes” answer to 1 item is considered highly sensitive for use disorderC. A positive CAGE questionnaire mandates intervention for use disorder D. Volume of alcohol or drug use is not a factor in a positive result---YouTube: https://www.youtube.com/watch?v=-HCBrL4iP7o&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=73

The PMHNP has ordered a comprehensive metabolic panel, CBC, TSH, and HgbA1c as part of a new patient screening panel to evaluate very generic complaints of fatigue, decreased motivation, and unplanned weight gain of 15 lbs in the last 6 months, insomnia and increased irritability. The patient believes he is depressed and is asking for an antidepressant, but the NP has concerns that the history provided is not complete and wants to ensure there is not an underlying organic etiology. Which of the following abnormal results offers the best explanation for all reported symptoms? A. A HgbA1c of 6.8% B. An eGFR of 58 mL/min/1.73 m² C. A Hgb of 13.1 g/dL D. A GGT of 85 IU/L ---YouTube: https://www.youtube.com/watch?v=VXLFFzW6XyY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=72

The PMHNP is seeing a patient who has been in Exposure-Response Therapy for obsessive-compulsive disorder for the last four months with suboptimal clinical improvement. After consulting with the therapist the PMHNP is discussing the addition of pharmacotherapy with the patient. The patient is advised that SSRIs may be helpful, and the most appropriate treatment expectations include: A. Allowing at least 12 weeks for onset of action then maintenance for at least one year. B. Realizing that SSRIs are not as efficacious for OCD as they are for depression and anxiety disorders and that remission is unlikely. C. The likelihood that change in therapeutic technique will probably be necessary as an adjunct to medication. D. Some degree of gastrointestinal side effects likely due to the higher doses of SSRIs needed for OCD. ---YouTube: https://www.youtube.com/watch?v=Y36NRk-2Oic&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=71