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