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. This may be an inaccurate characterization as depressed patients tend to overemphasize negatives

C. In some circumstances patients will purposefully mischaracterize the efficacy of medications they feel were ineffective

D. Some forms of recurrent depression are best managed with nonpharmacologic strategies
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YouTube: https://www.youtube.com/watch?v=tkuR-oLi0S8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=17

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 anger and reached up to swipe all the food off of the shelves. She has been fired from jobs because of her uncontrollable temper; she sometimes “just can’t be around certain people.” Chantel also reports that at times she will go two full days and nights without sleep, and that her mind keeps racing and she can’t “shut it down.” When this happens she gets up and does things around the house. Finally, Chantel reports that she cannot hold onto money at all. Whenever she gets a paycheck she immediately spends it on things that she acknowledges she doesn’t even need. When considering a diagnosis of bipolar disorder the PMHNP specifically assesses for:

A. Any history of suicidal attempts of suicidal ideation
B. History and current patterns of substance abuse
C. Concomitant psychotic features such as hallucination or delusion
D. Manic symptoms are sustained most of the day for at least two weeks
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YouTube: https://www.youtube.com/watch?v=X-x8g9wflPg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=16

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 person in the world, but she can’t help because her boss fired her for no reason. Alexa has a history of arrests for buying illegal drugs and for prostitution. The last time she was in jail her sentence was extended for 30 days because she got into a fight with another inmate and beat her up so badly she had to be admitted to the hospital for 6 days. The PMHNP considers which of the following personality disorders?

A. Histrionic
B. Narcissistic
C. Borderline
D. Schizoid
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YouTube: https://www.youtube.com/watch?v=qDhZKym5gn8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=15

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 in mental status

B. Angry verbal outbursts that seem unwarranted

C. Death of her best friend

D. An unplanned weight loss despite consistent oral intake
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YouTube: https://www.youtube.com/watch?v=ZDngVJdU_YA&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=14

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 says “she has nothing to be depressed about.” In trying to help M.T.’s husband understand the disease process, the PMHNP discusses with him that:

A. The physiologic stress accompanying her first episode of depression may have produced changes in brain biology that makes her susceptible to subsequent episodes without an external trigger.

B. The pharmacotherapy required to achieve remission with her first episode resulted in neuroplastic changes that increased her likelihood of experiencing additional depressive episodes

C. The scientific literature suggests that the loss of a sibling is the life event most closely associated with recurrent episodes of major depressive disorder throughout adulthood

D. Response to pharmacotherapy often takes a minimum of 8 weeks and M.T. is much more likely to achieve remission if her husband can continue to provide the necessary support throughout her remission period.
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YouTube: https://www.youtube.com/watch?v=TWL9C9qKr84&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=12

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 history of childhood sexual abuse, loss of interest in both his professional and personal life, an unplanned 10 lb weight loss in the last 3 months, and perceptual disturbances

C. A 65-year-old male whose wife died 6 months ago who reports a 3-week history of generally depressed mood, extreme guilt about his wife’s death, insomnia, difficulty focusing on daily tasks, with increasing thoughts of dying

D. A 72-year-old female who just relocated across country to live with her adult son and daughter-in-law who is despondent about leaving her home and reports forgetfulness, loss of appetite, new onset bowel problems, and extreme loss of energy
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YouTube: https://www.youtube.com/watch?v=XXXVZAj2Ncs&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=13

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
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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

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YouTube: https://www.youtube.com/watch?v=hWAtkhja2TI&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=10