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 ...

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...

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 ---YouTube: https://www.youtube.com/watch?v=1vG6aYVNno8&list=PLf0PFEPBXfq5...

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 gett...

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 there...

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? A. Concentration B. Orientation C. Visuospatial function D. Recall ---YouTube: https://www.youtube.com/watch?v=p3x-HNGaWXY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=38

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? A. Circumstantiality B. Tangentiality C. Perseveration D. Flight of ideas ---YouTube: https://www.youtube.com/w...

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? A. Guanfacine may be used as adjunct therapy to psychostimulants. B. Clonidine is available in a long-acting formulation. C. Clonidine is selective for alpha-2a adrenergic receptors. D. Guanfacine is appreciably less sedating. ---YouTube: https://www.youtube.com/watch?v=8jYx5O0eEOQ&list=PLf...

Which of the following is not a validated tool used to evaluate attention deficit disorder? A. The Vanderbilt Assessment Scale B. The Connors Comprehensive Scale C. The Early Childhood Screening Assessment D. The Child Behavior Checklist ---YouTube: https://www.youtube.com/watch?v=pmuMEFrjBLg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=35

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? A. Lecanemab B. DonepezilC. Memantine D. Namzaric® ---YouTube: https://www.youtube.com/watch?v=-z2D99MLGuM&list=PLf0PFEPBXfq...

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? A. Her fluctuations in mood have caused problems with interpersonal relationships at work. B. Both parents have expressed significant concern over the depths of her ...

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? A. Resume desvenlafaxine ER 150 mg daily B. Add va...

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? A. A calcium channel blockerB. An antiepileptic C. A diureticD. A ...

Piaget’s sensorimotor stage of development is characterized by all of the following except: A. Object permanenceB. Magical thinking C. ExploringD. Manipulating environment ---YouTube: https://www.youtube.com/watch?v=Z3amwp7QVzY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=30

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? A. Escitalopram (Lexapro)B. Venlafaxine (Effexor) C. Fluvoxamine (Luvox)D. Sertraline (Zoloft) ---YouTube:...

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? A. Fluoxetine (Prozac)B. Paroxetine (Paxil) C. Clomipramine (Anafranil)D. Escitalopram (Lexapro) ---Youtube:h...

Which of the following organisms are associated with an increased risk of neurodevelopmental disorders? A. Group B StreptococcusB. Escherichia coli C. Herpes simplex virusD. Proteus sp. ---YouTube: https://www.youtube.com/watch?v=FMg1bZE4o00&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=27

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 is...

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 dur...

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 re...

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 boyfr...

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 p...

Patients on lithium carbonate for management of bipolar disorder should be subject to routine assessment of: A. CBC and BMP B. TSH and serum Na+ C. CMP and ECG D. LFTs and EEG ---YouTube: https://www.youtube.com/watch?v=nZY82DoTVCw&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=21

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 dif...