The PMHNP is seeing a 11-year-old patient who is being managed for obsessive-compulsive disorder. The patient has been in exposure response therapy for almost one year and has been taking fluoxetine 40 mg daily. For the last six months the patient was in an acceptable remission, but today he reports that his obsessive thought processes and compulsive hygiene behaviors have started to become intrusive and are making it difficult for him to manage his day appropriately. Additional assessment today must include which of the following?

Select all that apply

A. Subjective information from the patient

B. Subjective information from the parent

C. Subjective information from the teacher

D. Subjective information from the therapist

An initial psychiatric evaluation should include a comprehensive risk assessment across the lifespan. Which of the following should be part of the initial intake for all patients aged 8 to 24 as part of that risk evaluation?

A. The CAGE questionnaire

B. The ASQ tool

C. The SCARED tool

D. The MCHAT-R questionnaire

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YouTube: https://www.youtube.com/watch?v=jB53p074Ze0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=140

The PMHNP is performing a follow-up visit on a 32-year-old male. He is being treated with sertraline 100 mg daily for a major depressive episode that began when he started having serious marital problems. His depressive symptoms have much improved, and he currently denies depressed mood, anhedonia, hopelessness, worthlessness, guilt or irritability. Even sleep has improved, and he is currently satisfied with his response to pharmacotherapy. During the visit, the PMHNP notes that the patient repeatedly voices his opinion that his wife will not consider reconciliation, that she does not understand he has improved and wants to work on the marriage. Despite several attempts to redirect the conversation, the patient repeatedly returns to the topic of his wife not doing her part.

The NP documents which finding with respect to mental status examination?

A. Rumination

B. Echolalia

C. Tangential thought

D. Perseveration

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YouTube: https://www.youtube.com/watch?v=p_3AhDQt5og&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=139

A 5-year-old child presents for evaluation with her mother. The mother is concerned that the child might have autism spectrum disorder and asks for a comprehensive evaluation. As part of a developmentally appropriate assessment, the PMHNP recognizes that which of the following is the appropriate approach to assessing the child’s affect, coordination and motor skills, speech, attention span, capacity for complex thinking and interaction?

A. Playing with the child on the floor

B. Administering the Sally/Anne test

C. A complete neuropsychiatric assessment

D. Evaluate responses to a CRAFFT questionnaire

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YouTube: https://www.youtube.com/watch?v=QpiaTE0r7bo&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=138

The PMHNP is seeing a 22-year-old male patient for his initial evaluation. The appointment is court ordered and the patient seems very uncomfortable being there and answers direct questions with one-word responses. According to information provided by the court, the patient comes from a very dysfunctional upbringing, has been homeless for an indeterminate time period, and did not adapt well during his brief period of incarceration. The PMHNP is very open about all information that she has from the referral, is clear about her role, what has to be reported to the court, and what remains confidential, and offers to answer any questions the patient has before they begin their discussion.

The PMHNP is employing which key component of developing a therapeutic alliance?

A. Empathy and active listening

B. Trust and safety

C. Goal alignment

D. Collaborative tasks

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YouTube: https://www.youtube.com/watch?v=BOxvSEiUqe0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=137

The PMHNP is evaluating a patient new to the practice. He is a 27-year-old male with a long history of bipolar depression, generalized anxiety disorder, and a remote history of substance use disorder for which he has been in remission for over 6 years. While discussing his medication history the patient reports that over the years he has been treated with a number of different medication to help with his symptoms. He denies any medication allergies but reports that one of the medications made him have an erection that would not go down for several hours and he finally had to go to the emergency room and took “a lot of procedures” to make things normal again. He was told never to take that medication again, but he cannot remember the name.

Which of the following was most likely cause of his symptoms?

A. Venlafaxine

B. Buspirone

C. Mirtazapine

D. Trazodone

Social determinants of health (SDOH) are recognized by the World Health Organization as non-medical conditions that can often outweigh genetic or clinical medical access in determining overall health. Addressing SDOH is endorsed as a priority with respect to improving population health. They are categorized in five major domains.

Discrimination or systemic bias is an example of which domain?

A. Economic stability

B. Social and community context

C. Neighborhood and built environment

D. Education access and quality

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YouTube: https://www.youtube.com/watch?v=MFyq0om1tNw&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=135

The PMHNP is working with a patient who is struggling with significant depressive symptoms. The patient is a 34-year-old female who is lives alone and works in a job that “pays the bills” but not much else. The patient has no close connections, she remains friendly with a few friends from college, but she feels “alone in the world.” At present her options are limited. She is not financially able to make major life changes, but she feels as if she is spiraling down and wants to feel better. In an effort to engage the PMHNP asks the patient, “if you woke up tomorrow and this problem was solved, how would you know? What would your day be like?”

The PMHNP is initiating which type of therapeutic modality?

A. Solution-focused therapy

B. Motivational interviewing.

C. Interpersonal psychotherapy.

D. Cognitive behavioral therapy.

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YouTube: https://www.youtube.com/watch?v=hS3di8KqNnY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=134