Jeffrey T. is a 27-year-old man who has presented for care after being required to do so by the county court. He was involved in a car accident, and while he was not at fault for the accident, routine blood alcohol screening revealed that he was driving while intoxicated. He is a bit resentful at being required to attend therapy; he is vocal that his driving was not impaired and that he can function normally even after drinking what others might consider excess amounts of alcohol. His wife co...

Fletcher is a 29-year-old male referred for court-ordered counseling. He has a long history of repeated offenses including DUI, domestic violence, battery, and other violent acts that fortunately have not yet caused any serious injury or death to the victims. An interview with his wife reveals that for the last few years he has lied about almost everything; he is able to get hired for jobs because he is very engaging and likeable, and then invariably he gets fired because he misses work and d...

Mrs. Bowen is a 33-year-old female who presents as a new patient requesting medication for depression. She reports a long history of mood disorders on and off going back to adolescence. She is very articulate in describing her history and reports that neither sertraline nor fluoxetine “worked for her.” With respect to considering Mrs. Bowen’s medication history, the PMHNP knows that: A. A SNRI will likely be the most appropriate choice if pharmacotherapy is indicated for this episode B....

Chantel is a 19-year-old female who presents for care because she thinks she is bipolar. During her initial interview, she admits that she has a long history of feeling like she was the person in the family of whom there were always high expectations, and she was never able to express her feelings of inadequacy. When asked why she thinks she is bipolar, she says she gets very moody. She was at the grocery store last week and slipped and fell; while waiting for help she could not control her a...

Renee is a 27-year-old female who has come to group therapy while incarcerated in the city jail. She was arrested for vagrancy because she was sleeping in her car. She could not post bail and was sentenced to 14 days in jail. During group she contributes that none of this is her fault. Her mother is totally evil because she would not let Alexa stay in the family home. She has some other family but they are all jerks because they won’t help her. Alexa’s friend Melanie is the absolute best pers...

Mrs. Maxwell is a 75-year-old patient with neurocognitive disorder due to Alzheimer’s disease. She lives with her son and his wife and generally does very well with her day-to-day activities. The family understand the importance of routine and Mrs. Maxwell maintains a regular schedule of activities including her meals, timed toileting, and recreational activities. Which of the following behaviors should prompt an immediate depression screening for Mrs. Maxwell? A. An acute change ...

M.T. is a 39-year-old female being seen by the PMHNP for a major depressive disorder. She is being managed with SNRI therapy in combination with cognitive behavioral therapy, but is having difficulty achieving remission. Her husband is becoming very frustrated. He wants to be supportive, but does not understand why she is so depressed. Two years ago she had an episode of depression when her sister died in an accident, but after 6 month of treatment she seemed to return to normal. Her husband...

A PMHNP student is reviewing his notes from his clinical experience over the past week to prepare his first required case presentation on a patient suffering a major depressive episode. Which of the following patients best represents the DSM-V criteria for major depressive episode?  A. A 27-year-old female with a one-month history of social withdrawal, anorexia, hypersomnia, unprovoked outbursts of anger, and a strong family history of endogenous depression  B. A 41-year-old male with a...

When evaluating the laboratory assessment of a patient with alcohol use disorder, the PMHNP may reasonably expect to find all of the following abnormalities due to chronic alcohol use except:  A. Macrocytosis B. Transaminitis  C. Uremia  D. Hypertriglyceridemia  --- YouTube: https://www.youtube.com/watch?v=8djjQHcSTWI&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=11

The PMHNP is considering a diagnosis of narcissistic personality disorder in a new patient. When reviewing the history and physical examination, which of the following findings would be most consistent with this diagnosis?  A. The presence of fixed delusional thought  B. Disdain for weak or sickly people  C. A history of antisocial behavior  D. Extreme “drama” in most personal relationships  --- YouTube:...

When performing a psychiatric assessment of an elderly patient with Alzheimer’s disease, the PMHNP recognizes that:    a. The most important part of the history will come from the caregiver   b. The patient must be interviewed alone to preserve privacy of the relationship    c.  A sexual history is not necessary in patients who are not sexually active    d. Age often defines the character of transferences in the patient/provider relationship  

Jen is a 31-year-old female who presents for care complaining of depressed mood. During the interview it becomes apparent that she has a long history of depressive symptoms, as well as a long history of being socially isolated and feeling generally inadequate. When considering a diagnosis of persistent depressive disorder, the PMHNP considers that the core concept of persistent depressive disorder refers to subaffective or subclinical depressive disorder with all of the following except: A....

Validated and reliable instruments are an important part of assessment for both clinical practice and research in mental health. Which of the following tools is currently considered the standard for assessing clinical outcomes in treatment studies of schizophrenia? A. SCID B. BPRS  C. PANSS  D. HAM-D --- YouTube: https://www.youtube.com/watch?v=KaCK-iVbQ1U&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=7

Laura is a 27-year-old female who is being seen today for psychiatric evaluation. She has no significant psychiatric or medical history and denies any history of substance abuse. She is being seen today because she is persistently having olfactory hallucinations. For the last three months she has been having a progressive sense of smelling particularly foul odors – feces, rotting food, and trash, with no obvious cause. She made the appointment because she had an uncle who had schizophrenia...

C.J. is a 23-year-old male being seen today by the PMHNP today for an initial evaluation. He says that he does not think anything is wrong but his family, specifically his mother, grandmother, and aunt, have all told him that he must be “mentally ill.” He cannot hold a job. He has worked as a cook at more than 5 chain restaurants in the last 6 months. He has no real friends – he says his friends only call him when they need something. He is currently staying with his grandmother but will soon...

The PMHNP is asked to evaluate the parent of one of her existing patients. The patient reports that her father, a 78-year-old man who lives alone, has always been in good health. However, last Sunday during breakfast with him he was overtly confused and at first he did not even seem to recognize his daughter. This patient is concerned that her father has Alzheimer’s disease and is amazed because two days prior he was “completely fine.” The PMHNP knows that the most likely cause of this...

The PMHNP is conducting an office visit with a 42-year-old male who is in treatment for the management of symptoms related to problems in his marriage. During the visit he begins to cry and the PMHNP responds to his tears by gently moving a box of tissues toward him. This is a facilitating intervention known as:  A. Reinforcement  B. Reassurance C. Encouragement D. Acknowledgement --- YouTube: https://www.youtube.com/watch?v=HYl_lTC5viI&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=3

In documenting a mental status exam (MSE) for Janet, a 54-year-old female, the PMHNP notes that she is bradykinesic, has poverty of speech, is depressed, and has flat affect. This includes all of the following elements of physical examination except: A. Appearance B. Motor Activity  C. Mood D. Affect --- YouTube: https://www.youtube.com/watch?v=1CU-TrnkfDY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=2&t=1s

The psychiatric mental health nurse practitioner on call is asked to evaluate a 21-year-old male who was just arrested following an altercation at a local bar. The patient has never been incarcerated before and there is no psychiatric or medical history available. His toxicology screen was negative for alcohol or any drugs of abuse. His mother is available, and she reports that in the past he has had some episodes of agitation. But this is the first time it's been a problem. Reportedly, he...