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

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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. 

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YouTube: https://www.youtube.com/watch?v=QQ-KgQYOuSg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=92

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

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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 patient

B. Dreaming about the patient

C. 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.

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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

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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 communicate

B. 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

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

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 disorder

C. A positive CAGE questionnaire mandates intervention for use disorder 

D. Volume of alcohol or drug use is not a factor in a positive result

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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 

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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. 

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YouTube: https://www.youtube.com/watch?v=Y36NRk-2Oic&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=71

Developmental theorists often assert that dysfunction of some sort during growth and development may result in psychopathological traits in adulthood. 

According to Erikson’s Developmental Theory, which of the following maladaptive developmental conflicts increases the risk of obsessive-compulsive disorder in adulthood? 

A. Trust versus mistrust 

B. Autonomy versus shame and doubt 

C. Initiative versus guilt 

D. Industry versus inferiority 

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YouTube: https://www.youtube.com/watch?v=bQPxhPvMuPA&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=70

A 15-year-old male patient reveals that he does not feel comfortable in his body. 

When considering a diagnosis of gender dysphoria the PMHNP recognizes that which of the following must be present to constitute this diagnosis?

A. A strong desire to be of a gender other than assigned at birth 

B. Feelings associated with clinically significant distress 

C. A need to be treated as the gender not assigned by birth 

D. Plans for gender reassignment treatment 

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YouTube: https://www.youtube.com/watch?v=qwlAnOL5o38&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=69

A 27-year-old female presents for therapy because she and her new husband are having difficulty adjusting to their new roles as spouses sharing a household who both work full time. There have been some struggles with regard to household tasks, communicating expectations, and other adjustments. After identifying the patient’s primary concerns the therapist determines that Interpersonal Therapy is the most appropriate approach to the patient. Therapeutic techniques are likely to include any of the following except: 

A. Role playing 

B. Communication analyses 

C. Clarifying incidents 

D. Examining motivation 

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YouTube: https://www.youtube.com/watch?v=ruwc_xl8EL4&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=68

The PMHNP is evaluating a patient in follow-up and despite appropriate pharmacotherapy and psychotherapy the patient has not achieved a successful remission. The patient states that his therapist is very nice, but that therapy is not really helping. The patient relates that the therapist keeps talking about “phases of change” and steps like engagement, focusing, evoking, and planning.  The PMHNP recognizes that the therapist is using which of the following? 

A. Lewin’s Change Theory 

B. Motivational Interviewing 

C. Interpersonal Therapy 

D. Cognitive Behavioral Therapy

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YouTube: https://www.youtube.com/watch?v=i_Ijalm5sNg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=67

Patient in mental health care may be at increased risk for demonstrating unhealthy coping mechanisms or inappropriate responses to distress. When your patient is angry with you for not making a medication change she requested, which of the following would be characterized as a passive-aggressive response? 

A. Glaring at you for the rest of the visit and responding to every question with, “you don’t listen to me so why do you ask?” 

B. Loudly complaining to you and other people in the waiting room that you don’t know what you are doing. 

C. Purposefully missing her next appointment without calling to change or cancel 

D. Telling you that she refuses to take any medication if you will not consider her input. 

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YouTube: https://www.youtube.com/watch?v=qZRWPZFL0Eg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=66

An 18-year-old male patient has been treated successfully for bipolar II disorder as an outpatient with Risperdal, however now that he has symptom control he frequently forgets to takes his medication. The best approach to this patient would include: 

A. Exploring reasons why he might not want to take it 

B. Convert to IM administration 

C. Change to another second generation antipsychotic 

D. Add a mood stabilizer to his regimen 

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YouTube: https://www.youtube.com/watch?v=EENe4WNB5W0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=65

A 28-year-old male presents for follow-up of his medication management for schizophrenia. Which of the following assessment findings represents an improvement in negative symptoms? 

A. An appropriate range of affect during the office visit 

B. A marked decrease in auditory hallucinations 

C. Resolution of akathisia 

D. Ending an intimate partner relationship 

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YouTube: https://www.youtube.com/watch?v=LFCzZ3KZCNc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=64

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.

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YouTube: https://www.youtube.com/watch?v=K-RKNH9QqU0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=90

When managing the patient with schizophrenia, the PMHNP recognizes that which of the following interventions is most closely associated with good long-term outcomes? 

A. Maintenance of antipsychotic therapy 

B. Compliance with necessary laboratory follow-up 

C. Documentation of AIMS score with each visit 

D. Implementation of Assertive Community Treatment (ACT) 

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YouTube: https://www.youtube.com/watch?v=RClYxx2-8y4&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=63

While performing an initial comprehensive assessment on a new patient the PMHNP is particularly attentive to social determinants of mental health. Which of the following patient factors is should be identified? 

A. Race

B. Poverty 

C. Divorce 

D. Substance use 

A 41-year-old female patient is being treated for obsessive-compulsive disorder (OCD). She is in exposure-response therapy (ERT) and is frustrated by the time it is taking for her to develop any meaningful improvement. She is now being started on fluoxetine as an augment to her therapy. It is important to advise her that: 

A. It is critical that she not stop taking fluoxetine abruptly due to concerns about discontinuation syndrome 

B. Success rates are very low but there may be some minimal improvement in combination with ERT therapy 

C. She will likely need a higher dose and longer duration than patients taking fluoxetine for depression 

D. The primary advantage of fluoxetine over other SSRIs for OCD is the low risk of drug interactions. 

A number of mood stabilizers and antipsychotics are indicated for the patient with bipolar disorder. Which of the following is a true statement with regard to lithium? 

A. It is considered highly teratogenic in the second and third trimesters of pregnancy 

B. It is the only mood stabilizer that has a demonstrated decrease in suicidal ideation 

C. Lithium is indicated for acute states but not for prevention of cycling 

D. Most consequences of lithium toxicity are reversible when levels normalize 

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YouTube: https://www.youtube.com/watch?v=gecVHaY_Ix8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=60

Which of the following scenarios should prompt a PMHNP to self-reflect on the potential impact of countertransference on the patient/provider relationship? The PMHNP: 

A. Gives gifts to a patient after several appointments 

B. Shares several attributes with the patient’s spouse 

C. Is very firm with respect to boundary setting 

D. Refuses to prescribe controlled substances 

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YouTube: https://www.youtube.com/watch?v=srDkSa2tDCs&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=59

A 34-year-old female patient presents for treatment. She has been on and off medication for schizophrenia for years but has historically been non-adherent to pharmacotherapy because of the adverse effects. When considering olanzapine therapy for this patient, the PMHNP advises that she will need to be monitored for: 

A. Absolute neutrophil count (ANC)

B. Hypertension, hyponatremia and hypertriglyceridemia 

C. Extrapyramidal symptoms and irregular menses 

D. Weight gain, hyperglycemia and dyslipidemia 

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YouTube: https://www.youtube.com/watch?v=IfnGkx6WfrY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=58

A PMHNP student is beginning his clinical practicum in a child and adolescent psychiatry practice and quickly realizes that performing patient interviews in school-aged children is very different than performing interviews with adults. 

Which of the following techniques is recommended for developing a therapeutic bond with a 10-year-old child? 

A. Separating the child from the parents for the initial interview 

B. Offering to play a game that the child enjoys 

C. Reassuring the child that anything said is confidential 

D. Offering snacks popular among children 

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YouTube: https://www.youtube.com/watch?v=U9P5NLsyd1Q&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=57

A 77-year-old male is admitted to the emergency department from a long-term care facility where he has lived for over 3 years. He has been maintained on antipsychotic medications for years but recently required a change to a first-generation agent as his symptoms were breaking through on even high doses of olanzapine. Last evening staff reported that he was increasingly confused, and this morning he developed a fever of 102.6o F. Initial laboratory assessment must include a: 

A. Urinalysis 

B. Complete blood count 

C. Creatine kinase 

D. Complete metabolic panel 

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YouTube: https://www.youtube.com/watch?v=hnhEx773lJw&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=56

The PMHNP is performing an initial history and physical examination on a new patient who has just transferred to his care from out of state. The patient has a complex psychiatric history including schizoaffective disorder, generalized anxiety disorder, prolonged grief reaction, and adjustment disorder. His medication list indicates that he has been taking clozapine 300 mg daily for 15 months. 

The PMHNP recognizes that: 

A. This dose is subtherapeutic and should be increased in increments of 25 mg daily to a goal dose of 600 mg/day 

B. The patient must be routinely monitored for absolute neutrophil count 

C. Lithium is contraindicated in patients taking clozapine 

D. Clozapine is absolutely contraindicated in patients < 18 years of age 

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YouTube: https://www.youtube.com/watch?v=G8vWlcwj1BY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=55

A 14-year-old patient is being managed for social anxiety by a therapist and is doing well. However, she reports having difficulty falling asleep most nights and is asking for medication to help her sleep. Her mother acknowledges the problem and is open to the option of sleeping medication as this has been a long-term problem.

The PMHNP knows that the approach to an adolescent patient with insomnia includes all of the following except:

A. Stopping daytime napping

B. Considering a melatonin agonis

C. Eliminating screen time one hour before bedtime

D. Considering a tricyclic antidepressant
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YouTube: https://www.youtube.com/watch?v=KmmQSG7kkR0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=54

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 summer

B. 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 32-year-old female is diagnosed with bipolar I disorder. While discussing with her information about her diagnosis, medications, and anticipated course of illness, the patient asks if she will need to be on medication forever of if this is something that will get better as she ages.

The PMHNP advised the patient that:

A. With good medication adherence, exacerbations will fade as she ages

B. Depressive episodes tend to be less severe but manic episodes tend to worsen

C. Depressive episodes tend to worsen but manic episodes tend to improve

D. The general trajectory of bipolar disorder typically worsens with age
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YouTube: https://www.youtube.com/watch?v=fwUe2Vsz-u8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=53

The PMHNP is evaluating a 4-year-old male patient who is presented to care by his new adoptive parents. The patient has been in a variety of foster homes since birth but is now finally in a stable adoptive home. The adoptive mother is concerned that he might have attention deficit hyperactivity disorder because he literally cannot sit still. He is constantly moving, and seems to shift attention from one thing to another without an ability to spend any meaningful time on one task, even if he is enjoying it. On physical examination the NP notes that the patient has short palpebral fissures, a thin upper lip, and a long, smooth philtrum.

Suspecting a diagnosis of fetal alcohol syndrome, the NP expects to find which additional physical findings?

A. Underdeveloped ears

B. Bradycardia

C. Polydactyl

D. Macrocephaly
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YouTube: https://www.youtube.com/watch?v=Uxvt3PB78us&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=52

A 4-year-old child presents for care with his new adoptive mother. The child has had a difficult first years of life, having been separated from his mother at birth because she was incarcerated. He was placed in foster care, but his experiences were inconsistent and he was moved around frequently as a result of various relatives trying to get custody. His adoptive mother initially served as a foster mother when he was 3-years-old, and she was the first consistent, stable, and loving caregiver in his experience. The adoptive mother is concerned because the patient is very withdrawn, does no respond well to his new siblings or peers, and demonstrates disproportionate fearfulness in normal circumstances. The PMHNP anticipates additional findings to include:

A. A concomitant diagnosis of autism spectrum disorder.

B. Social skills markedly below what is expected at his age.

C. Crying when his adoptive mother leaves

D. Being purposefully annoying to siblings and peers
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YouTube: https://www.youtube.com/watch?v=E-brrC6HA4g&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=51

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:

A. Appears defeated and does not make any effort to correct the problematic behaviors.

B. Overbearing and constantly correcting or stopping the child any time he displays initiative.

C. Has a personal history of successfully managed ADD in childhood and adolescence.

D. Is very resistant to the idea of medication and is more interested in pursuing family therapy as a treatment modality.
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YouTube: https://www.youtube.com/watch?v=rZftfx76O0o&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=50

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:

A. A CT scan of the head

B. Immediate administration of naloxone

C. Rapid infusion of IV crystalloids

D. Determination of medical history
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YouTube: https://www.youtube.com/watch?v=A8GD3jfcUHg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=49

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? 

A. Hypernatremia, hypokalemia, decreased BUN and creatinine

B. Polycythemia, leukocytosis, and metabolic acidosis

C. Elevated liver enzymes, hypoalbuminemia, and decreased LDL

D. Hypercholesterolemia, low TSH, Low T3, and anemia
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YouTube: https://www.youtube.com/watch?v=4aBsBqFjJ8E&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=48

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:

A. Identity disruption

B. Avoidance of reminders that the person is dead

C. Feeling that her purpose in life is to keep the memory alive

D. Emotional numbness
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YouTube: https://www.youtube.com/watch?v=WTc2VMSsl2I&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=47

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.

The PMHNP considers that:

A. The SSRI/SPARI combination has improved the patient in a way that the SSRI alone did not.

B.  The patient may be planning suicide and a suicide screening should be implemented

C. It is likely a placebo effect from a new medication as it is unlikely therapeutic after one week

D. It may actually be an impending manic episode that has not been diagnosed previously
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YouTube: https://www.youtube.com/watch?v=apxLdU_UCFA&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=46

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:

A. A non-benzodiazepine sedative for her safety

B. A medical evaluation including a urinalysis

C. Immediate transfer to the emergency department

D. An additional dose of mirtazapine with follow-up tomorrow
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YouTube: https://www.youtube.com/watch?v=pL8ZxcHOu_4&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=45

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: 

A. A history of depressive disorder in adolescence 

B. Low self-esteem 

C. Childhood adversity 

D. A first-degree relative with the disorder 
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Youtube: https://www.youtube.com/watch?v=vMQrrPDb1t8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=44

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

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YouTube: https://www.youtube.com/watch?v=jQmzYmvXL-o&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=88

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.

The most appropriate approach for the PMHNP would be to:

A. Advise the patient that psychodynamic psychotherapy is her safest option

B. Continue the paroxetine as ordered

C. Reduce the paroxetine gradually to 20 mg daily for the duration of pregnancy

D. Stop the paroxetine and begin sertraline
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YouTube: https://www.youtube.com/watch?v=5g--quPOme0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=43

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?

A. Precontemplative

B. Contemplative

C. Preparation

D. Action
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YouTube: https://www.youtube.com/watch?v=ICORO90EO6o&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=42

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?

A. Each protective factor mitigates a risk factor

B. Bonding with a pet is an internal protective factor

C. Strong sense of cultural identity is an external protective factor

D. There is no clear increase in suicidal rates with antidepressant use
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YouTube: https://www.youtube.com/watch?v=1vG6aYVNno8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=41

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:

A. Post traumatic stress disorder

B. Acute stress response

C. Dissociative disorder

D. Panic disorder
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YouTube: https://www.youtube.com/watch?v=gvM_PjicmQI&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=40