Explore every episode of the podcast PMHNP Certification Q & A

The PMHNP is performing a follow-up visit on a 32-year-old male. He is being treated with sertraline 100 mg daily for a major depressive episode that began when he started having serious marital problems. His depressive symptoms have much improved, and he currently denies depressed mood, anhedonia, hopelessness, worthlessness, guilt or irritability. Even sleep has improved, and he is currently satisfied with his response to pharmacotherapy. During the visit, the PMHNP notes that the patient repeatedly voices his opinion that his wife will not consider reconciliation, that she does not understand he has improved and wants to work on the marriage. Despite several attempts to redirect the conversation, the patient repeatedly returns to the topic of his wife not doing her part. 

The NP documents which finding with respect to mental status examination? 

A. Rumination

B. Echolalia

C. Tangential thought 

D. Perseveration

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YouTube: https://www.youtube.com/watch?v=p_3AhDQt5og&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=139

A 5-year-old child presents for evaluation with her mother. The mother is concerned that the child might have autism spectrum disorder and asks for a comprehensive evaluation. As part of a developmentally appropriate assessment, the PMHNP recognizes that which of the following is the appropriate approach to assessing the child’s affect, coordination and motor skills, speech, attention span, capacity for complex thinking and interaction? 

A. Playing with the child on the floor

B. Administering the Sally/Anne test 

C. A complete neuropsychiatric assessment 

D. Evaluate responses to a CRAFFT questionnaire 

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YouTube: https://www.youtube.com/watch?v=QpiaTE0r7bo&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=138

The PMHNP is seeing a 22-year-old male patient for his initial evaluation.  The appointment is court ordered and the patient seems very uncomfortable being there and answers direct questions with one-word responses. According to information provided by the court, the patient comes from a very dysfunctional upbringing, has been homeless for an indeterminate time period, and did not adapt well during his brief period of incarceration. The PMHNP is very open about all information that she has from the referral, is clear about her role, what has to be reported to the court, and what remains confidential, and offers to answer any questions the patient has before they begin their discussion. 

The PMHNP is employing which key component of developing a therapeutic alliance? 

A. Empathy and active listening 

B. Trust and safety 

C. Goal alignment 

D. Collaborative tasks 

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YouTube: https://www.youtube.com/watch?v=BOxvSEiUqe0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=137

The PMHNP is evaluating a patient new to the practice. He is a 27-year-old male with a long history of bipolar depression, generalized anxiety disorder, and a remote history of substance use disorder for which he has been in remission for over 6 years. While discussing his medication history the patient reports that over the years he has been treated with a number of different medication to help with his symptoms. He denies any medication allergies but reports that one of the medications made him have an erection that would not go down for several hours and he finally had to go to the emergency room and took “a lot of procedures” to make things normal again. He was told never to take that medication again, but he cannot remember the name. 

Which of the following was most likely cause of his symptoms? 

A. Venlafaxine 

B. Buspirone 

C. Mirtazapine 

D. Trazodone

Social determinants of health (SDOH) are recognized by the World Health Organization as non-medical conditions that can often outweigh genetic or clinical medical access in determining overall health. Addressing SDOH is endorsed as a priority  with respect to improving population health. They are categorized in five major domains. 

Discrimination or systemic bias is an example of which domain?

A. Economic stability 

B. Social and community context

C. Neighborhood and built environment 

D. Education access and quality 

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YouTube: https://www.youtube.com/watch?v=MFyq0om1tNw&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=135

The PMHNP is working with a patient who is struggling with significant depressive symptoms. The patient is a 34-year-old female who is lives alone and works in a job that “pays the bills” but not much else. The patient has no close connections, she remains friendly with a few friends from college, but she feels “alone in the world.” At present her options are limited. She is not financially able to make major life changes, but she feels as if she is spiraling down and wants to feel better. In an effort to engage the PMHNP asks the patient, “if you woke up tomorrow and this problem was solved, how would you know? What would your day be like?” 

The PMHNP is initiating which type of therapeutic modality? 

A. Solution-focused therapy

B. Motivational interviewing. 

C. Interpersonal psychotherapy. 

D. Cognitive behavioral therapy. 

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YouTube: https://www.youtube.com/watch?v=hS3di8KqNnY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=134

The PMHNP is managing a patient with bipolar disorder. While the patient has had manic episodes historically, the dominant pole of his disorder is depression. He is currently being treated with valproic acid and olanzapine. Today his depressive symptoms have exacerbated and he admits to increasing suicidal ideation. He is not acutely suicidal, but his ideation is more frequent, and twice in the last month he has called the suicide and crisis hotline at 988. 

Which of the following medications would be most appropriate to add to his regimen? 

A. Lithium

B. Sertraline 

C. Lamotrigine 

D. Lurasidone

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YouTube: https://www.youtube.com/watch?v=gIOu23bxyOQ&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=133

The PMHNP is seeing a patient in follow-up. The patient has a diagnosis of schizoaffective disorder and has been taking the second-generation antipsychotic olanzapine for 2 months. The patient appears to be experiencing a distinct improvement in both the positive symptoms of schizophrenia as well as depressive symptoms of major depressive disorder. The NP evaluates for which of the following common adverse drug effects of this  medication? 

A. Weight gain 

B. Insomnia 

C. Diarrhea 

D. Nausea 

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YouTube: https://www.youtube.com/watch?v=YbhPr5zUa78&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=132

The PMHNP is considering the case of a patient who is struggling with significant depressive symptoms following a difficult divorce. The symptoms are having a direct impact on her life, and she has even had written warnings at work about excessive lateness and calling in sick. The patient is very resistant to medication. The NP realizes that the patient’s situation is remarkably similar to what she herself experienced during her divorce five years ago. She considers sharing her experience with the patient. 

The NP considers which of the following regarding self-disclosure? 

A. The NP is experiencing countertransference 

B. It is an ethical violation and should be avoided 

C. There is a significant risk of dysfunctional attachment 

D. It is appropriate when used to facilitate patient goals

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YouTube: https://www.youtube.com/watch?v=8uewc5hNyJg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=131

The PMHNP is managing a patient with treatment-resistant schizophrenia who continues to have positive symptoms despite appropriate trials with two different antipsychotic regimens. When considering initiation of clozapine, the NP considers that which of the following apply?  

A. The absolute neutrophil count must be > 1000/mm3 to start treatment 

B. The first 2-3 doses should be administered in a closely monitored setting with vital signs monitored regularly

C. The medication must be ministered in accordance with the FDA REMS  safety monitoring 

D. The medication has significantly less medication interaction potential as compared to other antipsychotics 

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YouTube: https://www.youtube.com/watch?v=GH7CZF80ghI&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=130

The PMHNP has just accepted a position at an eating disorders clinic which offers a multi-disciplinary approach to the management of eating disorders, including psychiatric comorbidities and physical health deviations. In preparing for the role, the NP reviews strategies for managing which of the following laboratory abnormalities common in patients with anorexia nervosa? 

A. Hypercholesterolemia, leukopenia, low TSH

B. Anemia, hyperkalemia, low T3. 

C. Hypokalemia, hypocholesterolemia, hypernatremia. 

D. Anemia, low eGFR, hypernatremia. 

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YouTube: https://www.youtube.com/watch?v=Ix9Xaq7uTIM&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=129

A 14-year-old patient is being managed for generalized anxiety disorder and has been responding well to fluoxetine. However, both the patient and his mother report that he has chronic difficulty falling asleep. He denies any racing thoughts at bedtime; he just cannot seem to fall asleep. His mother has been giving him melatonin gummies purchased over the counter from the pharmacy and reports that there is some improvement but would like to know what else can be done. 

The PMHNP advises which of the following interventions that are recommended for adolescent insomnia? Choose all that apply. 

A. The melatonin gummies should be discontinued

B. The adolescent should not be permitted screen time at least one hour before bed.

C. Establish a later bedtime 

D. Eliminate daytime napping.

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YouTube: https://www.youtube.com/watch?v=ZHl59bdwpJM&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=128

A 5-year-old child is accompanied by the foster mother for evaluation of behavioral problems. The foster mother is experienced and has been very successful with children, but this child is very concerning. He has frequent, unexpected episodes of mood and reaction extremes including irritability, sadness, and fearfulness that are disproportionate to the situation. Suspecting reactive attachment disorder, the PMHNP anticipates which of the following to be reported by the foster mother? 

A. Failure to seek or respond to comfort when distressed 

B. Atypical dependency on toys and items that provide comfort 

C. Early toilet training with paradoxical persistent nocturnal enuresis 

D. Tendency toward aggressive behavior and cruelty to animals 

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YouTube: https://www.youtube.com/watch?v=dZOmyrOPIDA&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=127

Jennifer is a 27-year-old female who has been in psychiatric care for several months for a diagnosis of bipolar disorder. She has not responded to three different pharmacotherapeutic approaches and as a result she is now being evaluated by a new PMHNP provider.  She maintains that she has always taken all medications as prescribed but all they do is make her tired. Further she is emphatic that the last provider “did not know what he was doing” but she has heard that the new NP is “really great” and so she is very hopeful. Jennifer further states that she “really needs help right away” because her bipolar disorder is causing lots of problems with her relationship with her significant other. Her behavior during the visit is quite dramatic and virtually all of her descriptions are extreme. 

Exploring a diagnosis of borderline personality disorder, the NP anticipates which of the following in Jennifer’s history? 

A. Depressive episodes characterized by passive SI 

B. Use of recreational substances to help with mood 

C. Difficulty with relationships as home and work 

D. Manic episodes that can last for several hours 

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YouTube: https://www.youtube.com/watch?v=67vx42geUrw&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=126

A patient is mandated to care by court for evaluation and treatment of substance use disorder. He has a history of polysubstance abuse including ETOH, benzodiazepines, and marijuana. He is very resistant to the interview, sits with arms crossed, avoids eye contact, and only offers minimal verbal responses.  The PMHNP asks the patient why he doesn’t want to talk about why he is there. The patient responds, “You are just going judge me and blame me, what’s the point?” 

The PMHNP recognizes that this is likely: 

A. Passive-aggressive behavior 

B. Transference

C. Splitting

D. Catastrophizing 

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YouTube: https://www.youtube.com/watch?v=HBgF3KS6jjg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=125

A 39-year-old male patient presents asking for pharmacotherapy to help with difficulty falling asleep. He denies any psychiatric history and is in good health. He is currently struggling with sleep because he is going through a difficult divorce and while he acknowledges that he has to work through it, the difficulty sleeping is so profound right now that it is making it difficult for him to be effective at work. The patient agrees to have an evaluation with a therapist, and the PMHNP agrees to short-term pharmacotherapy with trazodone. 

What is the most important aspect of patient education for this patient? 

A. He must be advised of the risk of priapism and what to do if it occurs 

B. He must be advised that this is only a time-limited intervention and he cannot rely on medication-induced sleep indefinitely. 

C. He must be advised that this should be taken on an empty stomach; if taken with food absorption is markedly delayed. 

D. He must be advised that there may be some early morning fatigue that would also contribute to not feeling well rested. 

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YouTube: https://www.youtube.com/watch?v=qnmaXQVuEfg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=124

The PMHNP has assumed care of a 32-year-old patient who is being managed for opioid use disorder with buprenorphine-naloxone 8.2 mg films t.i.d.  The patient’s previous provider has moved out of state and no records are immediately available, the only information available is from the prescription monitoring program. The patient request to be treated with a buprenorphine-only formulation because he says that the he is allergic to naloxone. The NP considers which of the following? Choose all that apply. 

A. Naloxone allergy is extremely rare and more likely any adverse reaction was due to precipitated opioid withdrawal

B. It is never appropriate to use buprenorphine without naloxone when it is being used for OUD. 

C. Because the PMP shows that he has been prescribed a buprenorphine-naloxone combination for the last year is not possible that he is allergic.

D. It is easier to misuse buprenorphine without the naloxone component and the NP should evaluate for misuse.

A 27-year-old female patient presents for a follow-up appointment for generalized anxiety disorder. She has a complex history including polysubstance use disorder and borderline personality disorder, but she had been doing well. She achieved remission of her symptoms over one year ago and has been well managed on escitalopram 10 mg daily. She has been substance free for over one year, and is in therapy for her personality disorder. Today she is not feeling well. She reports some major psychosocial stressors and a brief substance relapse, but she stopped using all substances 2 days ago.  

The PMHNP notes a pronounced postural and intention tremor and suspects this is due to withdrawal from which of the following substances? 

A. Kratom 

B. Opioids 

C. Marijuana 

D. Alcohol 

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YouTube: https://www.youtube.com/watch?v=16Vg_4HFG1A&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=122

The PMHNP is managing a patient of Chinese ancestry with a diagnosis of bipolar disorder. The patient is currently experiencing some symptoms consistent with an early manic episode. 

When considering prescribing carbamazepine, the NP considers that this patient is at particular risk for which of the following adverse effects? 

A. Drug-induced hepatitis 

B. Pancreatitis 

C. Hypothyroidism 

D. Toxic epidermal necrolysis

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YouTube: https://www.youtube.com/watch?v=5MaExNnaFDM&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=121

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 

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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 ASD

B. 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. 

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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

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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

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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. Hopelessness

C. Depressed mood 

D. Weight loss 

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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. 

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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 lipoprotein

B. Elevated macrocytosis 

C. Elevated transaminases

D. Elevated triglycerides

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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. Norepinephrine
D. 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

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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 psychotherapy

C. A referral to couples counseling 

D. Changing her pharmacotherapy to an SNRI 

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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 triggers

B. Reported history of treatment 

C. Presence of children in the home 

D. Lack of comorbid compulsions 

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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. 

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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 

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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 

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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 history

B.  A manifestation of implicit bias

C. An overt implementation of her value system 

D. A conscious disregard for alternative lifestyles 

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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 onset

B. Character of episodes 

C. Medical history 

D. Duration of episodes 

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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 pathway

B. The mesocortical pathway

C. The nigrostriatal pathway 

D. The tuberoinfundibular pathway 

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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 

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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 stagnation

D. Ego integrity versus despair

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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. Hypothyroidism

B. Insulinoma

C. Anemia 

D. Hepatitis 

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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 prevention

C. Tertiary prevention 

D. Collaborative prevention

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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

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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) 

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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 behavior

C. Autism spectrum disorder. 

D. Insecure-ambivalent attachment

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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. Hyponatremia

C. Alzheimer’s disease 

D. Depression 

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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 permanence

B. Animalistic thinking

C. 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

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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

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 

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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.

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