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

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