Explorez tous les épisodes du podcast PMHNP Certification Q & A
| Titre | Date | Durée | |
|---|---|---|---|
| Medication Change | 28 Aug 2024 | 00:07:34 | |
A 32-year-old female patient with diagnoses of bipolar I disorder and borderline personality disorder was recently transferred to your care. She was managed on desvenlafaxine ER 150 mg daily and olanzapine 10 mg daily but experiencing increasingly elevated mood. In an attempt to wean off desvenlafaxine you reduce her from 150 mg to 100 mg daily. She experiences profound discontinuation syndrome symptoms. What is the most appropriate approach? | |||
| Treatment Contraindications | 21 Aug 2024 | 00:06:26 | |
You are evaluating a 71-year-old female patient and have made a diagnosis of major depressive episode, moderate. The patient is agreeable to pharmacotherapy. When considering pharmacologic treatment options, you review her existing medication list for potential interactions and contraindications. Which of the following classes of medication might increase the patient’s risk of cognitive impairment with the addition of an SSRI? | |||
| Initial Medication Therapy | 19 Jun 2024 | 00:05:21 | |
Anthony is a 41-year-old male patient who presents for evaluation. His wife made the appointment because she is worried about him, and she says he would never seek care on his own. Reportedly, Anthony has become progressively withdrawn over the last few months, and actually is in danger of losing his job because he misses so many days. He has been evaluated by his primary care provider and has no apparent medical conditions. His wife reports that he has been diagnosed with depression in the past and has even taken medication that seemed to help. This time he just refused to pursue care. After a comprehensive assessment the PMHNP diagnoses the patient with major depressive episode with psychotic features. Which of the following options would be the best choice of initial medication therapy for Anthony? | |||
| Lithium Carbonate Monitoring | 12 Jun 2024 | 00:07:26 | |
Patients on lithium carbonate for management of bipolar disorder should be subject to routine assessment of: | |||
| New Symptom Onset | 05 Jun 2024 | 00:06:22 | |
A 22-year-old male patient is started on sertraline 50 mg p.o. daily after presenting with a major depressive episode. After tolerating it without difficulty for two weeks his dose was increased to 100 mg p.o. daily. Approximately 4 weeks later he reported an unusual set of new symptoms for the last week and a half. He says he feels “amped up” and just very generally agitated and nervous. He was short-tempered at work and home and was snapping at people for no good reason. He also reports difficulty concentrating at work. Last week he expressed disproportionate anger at his work and his boss told him that he was bipolar and should be put on medication. The PMHNP discusses with the patient that: | |||
| DUI findings | 29 May 2024 | 00:06:00 | |
Jeffrey T. is a 27-year-old man who has presented for care after being required to do so by the county court. He was involved in a car accident, and while he was not at fault for the accident, routine blood alcohol screening revealed that he was driving while intoxicated. He is a bit resentful at being required to attend therapy; he is vocal that his driving was not impaired and that he can function normally even after drinking what others might consider excess amounts of alcohol. His wife confirms this; they both admit what began as one or two beers after work a few years ago has evolved to where he now drinks at least a 12 pack of beer nightly. Regardless, they both confirm that he never “seems drunk” and this does not interfere with his job or fulfilling his family functions. Jeffrey’s ability to function normally despite high blood alcohol is likely a result of: | |||
| Court Ordered Counseling | 22 May 2024 | 00:05:28 | |
Fletcher is a 29-year-old male referred for court-ordered counseling. He has a long history of repeated offenses including DUI, domestic violence, battery, and other violent acts that fortunately have not yet caused any serious injury or death to the victims. An interview with his wife reveals that for the last few years he has lied about almost everything; he is able to get hired for jobs because he is very engaging and likeable, and then invariably he gets fired because he misses work and doesn’t do his job properly when he is there. According to the wife, they have known each other since high school where Fletcher was very happy and well-adjusted. He was on the soccer team, liked by teachers, and never demonstrated the tendencies he does now. Apparently in college he got involved with a fraternity that was notorious for alcohol and drug abuse, and he started drinking heavily; it was “all downhill from there.” The PMHNP considers that: | |||
| History Of Mood Disorders | 15 May 2024 | 00:06:20 | |
Mrs. Bowen is a 33-year-old female who presents as a new patient requesting medication for depression. She reports a long history of mood disorders on and off going back to adolescence. She is very articulate in describing her history and reports that neither sertraline nor fluoxetine “worked for her.” With respect to considering Mrs. Bowen’s medication history, the PMHNP knows that: | |||
| Bipolar Diagnosis | 08 May 2024 | 00:06:18 | |
Chantel is a 19-year-old female who presents for care because she thinks she is bipolar. During her initial interview, she admits that she has a long history of feeling like she was the person in the family of whom there were always high expectations, and she was never able to express her feelings of inadequacy. When asked why she thinks she is bipolar, she says she gets very moody. She was at the grocery store last week and slipped and fell; while waiting for help she could not control her anger and reached up to swipe all the food off of the shelves. She has been fired from jobs because of her uncontrollable temper; she sometimes “just can’t be around certain people.” Chantel also reports that at times she will go two full days and nights without sleep, and that her mind keeps racing and she can’t “shut it down.” When this happens she gets up and does things around the house. Finally, Chantel reports that she cannot hold onto money at all. Whenever she gets a paycheck she immediately spends it on things that she acknowledges she doesn’t even need. When considering a diagnosis of bipolar disorder the PMHNP specifically assesses for: | |||
| Personality Disorder Findings | 01 May 2024 | 00:06:16 | |
Renee is a 27-year-old female who has come to group therapy while incarcerated in the city jail. She was arrested for vagrancy because she was sleeping in her car. She could not post bail and was sentenced to 14 days in jail. During group she contributes that none of this is her fault. Her mother is totally evil because she would not let Alexa stay in the family home. She has some other family but they are all jerks because they won’t help her. Alexa’s friend Melanie is the absolute best person in the world, but she can’t help because her boss fired her for no reason. Alexa has a history of arrests for buying illegal drugs and for prostitution. The last time she was in jail her sentence was extended for 30 days because she got into a fight with another inmate and beat her up so badly she had to be admitted to the hospital for 6 days. The PMHNP considers which of the following personality disorders? | |||
| Alzheimer's + Behavior Changes | 24 Apr 2024 | 00:08:52 | |
Mrs. Maxwell is a 75-year-old patient with neurocognitive disorder due to Alzheimer’s disease. She lives with her son and his wife and generally does very well with her day-to-day activities. The family understand the importance of routine and Mrs. Maxwell maintains a regular schedule of activities including her meals, timed toileting, and recreational activities. Which of the following behaviors should prompt an immediate depression screening for Mrs. Maxwell? | |||
| Anticipated Outcomes | 17 Apr 2024 | 00:07:35 | |
M.T. is a 39-year-old female being seen by the PMHNP for a major depressive disorder. She is being managed with SNRI therapy in combination with cognitive behavioral therapy, but is having difficulty achieving remission. Her husband is becoming very frustrated. He wants to be supportive, but does not understand why she is so depressed. Two years ago she had an episode of depression when her sister died in an accident, but after 6 month of treatment she seemed to return to normal. Her husband says “she has nothing to be depressed about.” In trying to help M.T.’s husband understand the disease process, the PMHNP discusses with him that: | |||
| Piaget's | 14 Aug 2024 | 00:06:47 | |
Piaget’s sensorimotor stage of development is characterized by all of the following except: | |||
| DSM-V Criteria | 10 Apr 2024 | 00:05:23 | |
A PMHNP student is reviewing his notes from his clinical experience over the past week to prepare his first required case presentation on a patient suffering a major depressive episode. Which of the following patients best represents the DSM-V criteria for major depressive episode? | |||
| Chronic Alcohol Use Labs | 03 Apr 2024 | 00:06:25 | |
When evaluating the laboratory assessment of a patient with alcohol use disorder, the PMHNP may reasonably expect to find all of the following abnormalities due to chronic alcohol use except: | |||
| Narcissistic Personality Disorder | 27 Mar 2024 | 00:05:23 | |
The PMHNP is considering a diagnosis of narcissistic personality disorder in a new patient. When reviewing the history and physical examination, which of the following findings would be most consistent with this diagnosis? | |||
| Psych Assessment + Alzheimers | 20 Mar 2024 | 00:05:07 | |
When performing a psychiatric assessment of an elderly patient with Alzheimer’s disease, the PMHNP recognizes that: a. The most important part of the history will come from the caregiver | |||
| Depressive Disorders | 13 Mar 2024 | 00:05:48 | |
Jen is a 31-year-old female who presents for care complaining of depressed mood. During the interview it becomes apparent that she has a long history of depressive symptoms, as well as a long history of being socially isolated and feeling generally inadequate. When considering a diagnosis of persistent depressive disorder, the PMHNP considers that the core concept of persistent depressive disorder refers to subaffective or subclinical depressive disorder with all of the following except: | |||
| Clinical Assessment Tools | 06 Mar 2024 | 00:09:11 | |
Validated and reliable instruments are an important part of assessment for both clinical practice and research in mental health. Which of the following tools is currently considered the standard for assessing clinical outcomes in treatment studies of schizophrenia? | |||
| Priority Assessment | 28 Feb 2024 | 00:05:42 | |
Laura is a 27-year-old female who is being seen today for psychiatric evaluation. She has no significant psychiatric or medical history and denies any history of substance abuse. She is being seen today because she is persistently having olfactory hallucinations. For the last three months she has been having a progressive sense of smelling particularly foul odors – feces, rotting food, and trash, with no obvious cause. She made the appointment because she had an uncle who had schizophrenia and he used to have hallucinations, although he was mostly hearing voices. The PMHNP knows that a priority of assessment includes a : | |||
| Evaluation Findings | 21 Feb 2024 | 00:05:28 | |
C.J. is a 23-year-old male being seen today by the PMHNP today for an initial evaluation. He says that he does not think anything is wrong but his family, specifically his mother, grandmother, and aunt, have all told him that he must be “mentally ill.” He cannot hold a job. He has worked as a cook at more than 5 chain restaurants in the last 6 months. He has no real friends – he says his friends only call him when they need something. He is currently staying with his grandmother but will soon be homeless “unless things change.” While he is telling his story the PMHNP appreciates that he repeatedly includes details that make it hard to understand his point. When asked why he thinks he will be homeless, he responds by talking about how many hours he has worked, and how everything was going well until his car broke down and he couldn’t afford to fix it because his tax return was held by the IRS. The PMHNP recognizes that this represents an abnormal: | |||
| Confused Older Adult | 14 Feb 2024 | 00:07:14 | |
The PMHNP is asked to evaluate the parent of one of her existing patients. The patient reports that her father, a 78-year-old man who lives alone, has always been in good health. However, last Sunday during breakfast with him he was overtly confused and at first he did not even seem to recognize his daughter. This patient is concerned that her father has Alzheimer’s disease and is amazed because two days prior he was “completely fine.” The PMHNP knows that the most likely cause of this presentation is: | |||
| Therapeutic Interventions | 07 Feb 2024 | 00:08:42 | |
The PMHNP is conducting an office visit with a 42-year-old male who is in treatment for the management of symptoms related to problems in his marriage. During the visit he begins to cry and the PMHNP responds to his tears by gently moving a box of tissues toward him. This is a facilitating intervention known as: | |||
| PTSD Medication Treatment | 07 Aug 2024 | 00:06:31 | |
You are evaluating a 17-year-old patient who presents for care reporting panic attacks. A comprehensive assessment suggests that the patient is experiencing post-traumatic stress disorder related to a very serious motor vehicle accident a few months ago. Which of the following medications is the best augment to trauma therapy for this patient? | |||
| Elements of Physical Exam | 31 Jan 2024 | 00:05:54 | |
In documenting a mental status exam (MSE) for Janet, a 54-year-old female, the PMHNP notes that she is bradykinesic, has poverty of speech, is depressed, and has flat affect. This includes all of the following elements of physical examination except: | |||
| Manic Hypomanic Findings | 24 Jan 2024 | 00:07:05 | |
The psychiatric mental health nurse practitioner on call is asked to evaluate a 21-year-old male who was just arrested following an altercation at a local bar. The patient has never been incarcerated before and there is no psychiatric or medical history available. His toxicology screen was negative for alcohol or any drugs of abuse. His mother is available, and she reports that in the past he has had some episodes of agitation. But this is the first time it's been a problem. Reportedly, he and some coworkers were at the bar celebrating a birthday, and before anyone knew what happened, an argument appeared to escalate. The patient became very loud, was yelling and acting crazy, began breaking bottles and finally punched a coworker. When considering a manic or hypomanic episode, the psychiatric mental health nurse practitioner expects that his speech would most likely be characterized as: A. Stuttered B. Increased C. Childlike D. Confused | |||
| OCD Pharm Options | 31 Jul 2024 | 00:06:03 | |
A 14-year-old female is diagnosed with obsessive-compulsive disorder and has been in exposure and response prevention (ERP) therapy for the last three months. While there has been some improvement of symptoms, the patient, patient’s Mom, and therapist would all like to discuss augmenting therapy with medication management. Which of the following would be a likely pharmacologic option? | |||
| Suspected Organism | 24 Jul 2024 | 00:05:03 | |
Which of the following organisms are associated with an increased risk of neurodevelopmental disorders? | |||
| Evaluation Recommendation | 17 Jul 2024 | 00:05:22 | |
The PMHNP is evaluating Jared, a 47-year-old male who is brought to care by his wife because “he’s not the man I married 20 years ago.” He denies any significant medical history. He takes no medication and his remaining histories are unremarkable. According to his wife, she and Jared have been married for 20 years, have two children, and have lived a “normal” life. Jared owns a local construction company and their marriage has been a solid one, characterized by the typical day-to-day issues that occur in most marriages, but otherwise happy. For the last two to three months, she says Jared has completely changed. He will get angry for no apparent reason and even broke a lamp once. He tells stupid and offensive jokes that no one else thinks are funny, and someone even called the police when he continued to make inappropriate remarks to a woman in a restaurant. Jared seems unsure what to say, but his wife is adamant that this is a totally different man from the one she has known. The PMHNP knows that Jared should be evaluated for: | |||
| Appropriate Intervention | 10 Jul 2024 | 00:05:24 | |
Janel is a 37-year-old woman who is being interviewed as part of a family assessment. Her 10-year-old son is having some behavioral issues in school and has been referred for evaluation. While interviewing Janel the PMHNP appreciates that she appears very emotional. She expresses extreme distress at her son’s behavior and says she will do anything to help him; they are “best friends.” She is very demonstrative during the assessment and seems unhappy when she is not the center of attention during the evaluation process. She repeatedly talks about her own medical problems such as recurrent headache and abdominal pain which her doctors cannot diagnose. Her appearance is very flamboyant, and her dress is more appropriate to nightclub than a family assessment. In addition to managing her son’s needs, Janel would likely benefit from: | |||
| Evidence Based Findings | 03 Jul 2024 | 00:05:06 | |
Cory is a 23-year-old male recently incarcerated in the county correction facility for a 9-month sentence following his third conviction for battery. As part of an early release program he is required to participate in therapy. During his initial interview he is very pleasant and engaged, expressing no anxiety or distress with his current circumstances. His psychiatric history is significant for numerous adolescent episodes of running away, truancy, and substance abuse. As a young adult he reportedly has not held a steady job, but rather is constantly coming up with money making schemes that typically take advantage of someone vulnerable or unsuspecting. Given the likely diagnosis, evidence-based practice suggests that Cory may: | |||
| Non-Pharm Interventions | 26 Jun 2024 | 00:05:06 | |
Trudy L. is a 29-year-old female patient who initiated care because she feels like she has no energy. She just had her annual wellness exam and her primary care provider told her that she is in excellent health. Because she complained about this excessive fatigue, her PCP performed a CBC, CMP, UA and thyroid function tests and told her that, along with her physical examination, everything looks normal. Further discussion reveals that Trudy is having some relationship challenges with her boyfriend of two years and this seems to be “spilling over” at work where she is having persistent conflict with her supervisor. Ultimately the PMHNP diagnoses Trudy with major depressive disorder, mild, single episode. The PMHNP and Trudy discuss treatment options, and Trudy would really like to try non-pharmacologic interventions. Which of the following represents the best approach for Trudy? | |||
| Alzheimer's Treatment | 11 Sep 2024 | 00:06:50 | |
Alzheimer’s disease is the most common cause of major neurocognitive disorder and and while largely managed with non-pharmacologic interventions, there are also a variety of pharmacotherapeutics available for use when appropriate. Which of the following is considered a first-line pharmacologic intervention for symptom control in the patient with Alzheimer’s disease? | |||
| Borderline Personality Characteristic | 04 Sep 2024 | 00:08:23 | |
A new patient presents for evaluation of self-diagnosed bipolar disorder. An assessment of her history of interpersonal relationships increases your index of suspicion for borderline personality disorder as opposed to bipolar disorder. Which of the following circumstances is most characteristic of borderline personality disorder? | |||
| ADD Tool | 18 Sep 2024 | 00:06:06 | |
Which of the following is not a validated tool used to evaluate attention deficit disorder? | |||
| Comparing Medicine | 25 Sep 2024 | 00:05:12 | |
When counseling the parents of a 7-year-old patient regarding pharmacotherapy for attention deficit disorder, the PMHNP identifies which clinically relevant difference between clonidine and guanfacine? | |||
| Difficult PMHNP interview | 02 Oct 2024 | 00:07:57 | |
A new patient is being evaluated at the request of her primary care provider. While conducting the interview the PMHNP has a very difficult time getting direct answers to questions. The patient will try to answer but often drifts off topic, talking about things that appear related, but she never actually answers the question. The PMHNP documents which abnormality of thought process? | |||
| Piaget's Developmental Stage | 16 Oct 2024 | 00:06:34 | |
The PMHNP is asked to evaluate a 5-year-old child who has been having difficulty adjusting to kindergarten and has been disruptive in the classroom. The child is pleasant in the office, responds to questions, and seems to understand that she is having this appointment because she does not seem happy in kindergarten. Via role play and discussion the PMHNP learns that the child is sad and frightened because she was angry with her Daddy and wished he didn’t live there anymore. Very shortly thereafter, her parents told her that Daddy would be moving out. Daddy moving out made Mom sad, the 5-year-old thinks it’s all her fault. This is why she is so unhappy. This is characteristic of which of Piaget’s developmental stages? | |||
| Mental Status Exam | 09 Oct 2024 | 00:05:54 | |
While performing a mental status exam, the PMHNP asks the patient to count backwards, beginning with 100 and subtracting 7. This is an effort to assess which element of the mental status exam? | |||
| Suicide Assessment | 30 Oct 2024 | 00:06:20 | |
Suicide assessment should include an assessment of both risk factors and protective factors. Which of the following is a true statement with respect to suicide assessment? | |||
| Profound Anxiety In Teen | 23 Oct 2024 | 00:06:57 | |
A 19-year-old male is in your office for evaluation of profound anxiety. He is in his first year of college and last week there was an active shooter on campus. Three people were killed. Although he didn’t know any of them, it was in the building where he has one of his classes and he is having severe anxiety and nightmares. He gets profoundly distressed when discussing this with anyone, he feels detached from his friends and even his family, is having trouble sleeping, and finds himself getting angry with everyone for no good reason. The PMHNP explores for additional symptoms to support a diagnosis of: | |||
| Transtheoretical Model of Change | 06 Nov 2024 | 00:06:56 | |
A 42-year-old male presents for treatment of opioid use disorder. He has been taking 30 mg oxycodone tablets 4-6 times a day for over a year and both his personal and professional life are deteriorating. He has received several formal warnings at work about his absences and productivity, and his wife has been clear that she will need to move out with their children until he can get treatment. He seems sincere but is very concerned about whether or not he can do it. He has tried unsuccessfully to stop on his own and finally realized that he needs professional help so he made the appointment today. He is in which stage of the Transtheoretical Model of Change? | |||
| Bipolar Disorder Risk Factors | 20 Nov 2024 | 00:06:00 | |
A 25-year-old female patient is being evaluated to rule out bipolar disorder. The PMHNP knows that all of the following are risk factors for bipolar disorder except: | |||
| Pharmacotherapy Option | 13 Nov 2024 | 00:06:40 | |
A 29-year-old pregnant woman is referred to the PMHNP for management of anxiety and depression. She has been taking paroxetine 40 mg daily as an outpatient for several years prescribed by her primary care provider. Upon learning that the patient was pregnant, the primary care provider insisted that the patient consult with mental health for continued management. The patient is clear that she needs to continue pharmacotherapy. She had a baby 3 years ago and tried to stop taking medication and her condition deteriorated rapidly. | |||
| Agitated Elderly Patient | 27 Nov 2024 | 00:06:58 | |
The PMHNP on call gets a call from the assisted living facility to advise that his 78-year-old patient is acutely confused. The patient, who is treated with mirtazapine for anxiety, insomnia, and decreased appetite, is normally oriented x 3. Today however, she does not recognize the staff at the facility and insists that she has to go home right now as her husband is waiting for her to cook dinner. She is agitated and the staff is asking for a sedative to calm her down. The PMHNP recognizes that the patient requires: | |||
| SSRI Response | 04 Dec 2024 | 00:07:02 | |
An 82-year-old man with a long history of depression has been treated over the years with various pharmacologic agents with little improvement. Last week the PMHNP decided to try vortioxetine as the patient is clearly despondent, has not responded to several SSRI options, and is not interested in discussing ECT. At this visit the patient appears markedly brighter. He engages in conversation, has been more active with his peers at the assisted living facility, and overall seems much improved. He has no adverse effects and actually reports improved bowel motility. | |||
| Unexpected Symptoms | 11 Dec 2024 | 00:05:35 | |
A 51-year-old female is referred from her primary care provider. The patient had a 27-year-old son who died two years ago after inadvertently running in front of a car while intoxicated on hallucinogens. The patient continues to struggle with the loss of her son, and even two years later is preoccupied with thoughts of him on a daily basis. She is persistently talking about him, posting old pictures on social media, persists in talking about him at virtually every family gathering, and cannot seem to move on. When considering a diagnosis of prolonged grief disorder, the PMHNP evaluates the patient expecting to see any of the following symptoms except: | |||
| Anticipated Abnormalities | 18 Dec 2024 | 00:05:23 | |
The PMHNP is evaluating a 14-year-old girl who is encouraged to care by her parents because they are concerned that she has an eating disorder. Physical examination reveals a cachectic female who, at 5’4” tall weighs 96 lbs for a BMI of 16.4. She appears clinically dehydrated, with poor skin turgor. Her vital signs reveal a temperature of 96.0o F, pulse of 48 bpm, respiratory rate of 20 bpm, and a blood pressure of 90/58 mm Hg. Suspecting a diagnosis of anorexia nervosa, the PMHNP orders a relevant laboratory assessment. Which of the follow abnormalities are most consistent with anorexia nervosa? | |||
| Unresponsive ED Visit | 25 Dec 2024 | 00:05:44 | |
The PMHNP is called to the emergency room for a stat consult on a patient who reportedly was transferred in by ambulance after “acting weird at a party.” Upon arrival to the ED the NP finds the patient unresponsive. His respiratory rate is 7 bpm, his blood pressure is 70/48 mm Hg and pulse is 40 bpm. The skin is pale and clammy and his pupils are 1 mm. The most appropriate initial action is: | |||
| Suspected ADD | 01 Jan 2025 | 00:06:01 | |
The PMHNP is conducting a new patient intake for a 6-year-old male. The patient’s mother made the appointment because she is afraid that her son has ADD. She reports that for the last few years he has been increasingly difficult at home. He is constantly difficult, seems to be purposefully disobeying her rules, and is always “getting into things.” He does not get along well with other children in his kindergarten class, and the teacher says that he seems consistently test boundaries and seems to intentionally annoy his classmates. The NP expects that the mother: | |||