A 64-year-old patient presents with new onset anxiety. She denies any history of anxiety disorder or any psychiatric disorder previously in her life, but for the last 9 months she has been having episodes that she describes as “attacks.” Out of the blue she will develop a sense of racing heart, hyperventilation, numbness and tingling in her arms, and feeling lightheaded. She worries about this a lot, and now worries virtually all the time about why this is happening. It is causing difficulty with sleeping, and she finds herself being very irritable at home and at work.

These episodes last for “a few minutes” and then subsides on its own. She takes medication for high blood pressure and high cholesterol, but otherwise reports being very healthy.

What aspect of this scenario is suggestive that there might be an underlying organic cause of her symptoms?

A. Age of onset

B. Character of episodes

C. Medical history

D. Duration of episodes

The dopamine hypothesis of schizophrenia postulates an abnormality in which of the following dopamine pathway as the etiology of symptoms? Select all that apply.

A. The mesolimbic pathway

B. The mesocortical pathway

C. The nigrostriatal pathway

D. The tuberoinfundibular pathway

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YouTube: https://www.youtube.com/watch?v=oQ42kYfwJU4&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=103

The PMHNP is seeing a patient who presents with a chief complaint of feeling depressed. Further exploration reveals that while the patient does have several symptoms of a depressive episode, he does not quite meet criteria for any of the commonly encountered depressive disorders. The primary issue seems to center around the fact that the client feels as if his life has no meaning. He says he gets up, he gets dressed, goes to work, pays the bills, does all of the things he is supposed to do in life, but he struggles with the question, “what is the point? Why does any of it matter?

The PMHNP recognizes that the patient might benefit from which of the following types of therapy?

A. Cognitive behavioral therapy

B. Behavioral therapy

C. Psychodynamic therapy

D. Existential therapy

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YouTube: https://www.youtube.com/watch?v=5CwRoe9maZQ&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=102

The PMHNP is evaluating a 69-year-old patient who has self-referred for evaluation. The patient retired from his professional role as a CEO from a major fortune 500 company 8 months ago and admits that he feels himself sinking into an uncharacteristic depression. For most of his life he has been a high-achiever, and he retired 8 months ago with the intention of enjoying the wealth he worked so hard to build. While he did take some big trips and had a lot of fun at first, now he feels oddly empty and for no good reason feels himself sinking into depression.

According to Erikson’s stages of psychosocial development this patient may be having maladaptive resolution of which stage?

A. Identity versus role confusion

B. Initiative versus guilt

C. Generativity versus stagnation

D. Ego integrity versus despair

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YouTube: https://www.youtube.com/watch?v=8OBGbzW1HDc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=101

Which of the following medical conditions should be considered when a patient presents complaining of new onset episodes of anxiety-like symptoms including hypervigilance, tremulousness, tachycardia, and palpitations?

A. Hypothyroidism

B. Insulinoma

C. Anemia

D. Hepatitis

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YouTube: https://www.youtube.com/watch?v=PgcoKYwUNMo&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=100

A PMHNP partners with a local women’s health practice to develop a program to screen pregnant women for depression in an effort to identify patients at high risk for post-partum depression and institute treatment as appropriate. This is an example of which level of prevention?

A. Primary prevention

B. Secondary prevention

C. Tertiary prevention

D. Collaborative prevention

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YouTube: https://www.youtube.com/watch?v=QtlF5hZ5e0U&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=100

The PMHNP is evaluating a patient who has presented for care repeatedly reporting that she is bipolar and has manic episodes. She has been medicated in the past with a number of mood stabilizers without any meaningful improvement. Today a more detailed history reports that what she is calling manic episodes are actually periods of dramatic responses to stressors. When she argues with her significant other, her mother, and even people at work she becomes very animated. In response to stressors she is very dramatic and defensive, will react in an erratic fashion, but then often within hours goes to extremes to try and explain her behavior and make amends. She clearly struggles with being alone.

Which of the following diagnoses should be explored for this patient?

A. Bipolar disorder with mixed episodes

B. Schizoaffective disorder

C. Adjustment disorder with anxiety features

D. Borderline personality disorder

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YouTube: https://www.youtube.com/watch?v=dKMlovMXyVM&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=98

A 67-year-old female is being evaluated for complaints of depression. She has always struggled with times where she was down but never liked taking medication and has tried to treat herself with nutraceuticals. Her symptoms have gotten much worse lately because her husband died and she is struggling with that. She has been seeing a therapist for the last few months but is not feeling any real improvement.

When considering pharmacotherapy for her, which of the following medications should be avoided?

A. Sertraline (Zoloft)

B. Bupropion (Wellbutrin)

C. Escitalopram (Lexapro)

D. Citalopram (Celexa)