PMHNP Certification Q & A

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

The PMHNP is managing a patient with bipolar disorder. While the patient has had manic episodes historically, the dominant pole of his disorder is depression. He is currently being treated with valproic acid and olanzapine. Today his depressive symptoms have exacerbated and he admits to increasing suicidal ideation. He is not acutely suicidal, but his ideation is more frequent, and twice in the last month he has called the suicide and crisis hotline at 988. Which of the following medications would be most appropriate to add to his regimen? A. Lithium B. Sertraline C. Lamotrigine D. Lurasidone --- YouTube: https://www.youtube.com/watch?v=gIOu23bxyOQ&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=133

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 --- 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 --- 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 --- 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. --- 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. --- 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 --- 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 --- 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 --- YouTube: https://www.youtube.com/watch?v=HBgF3KS6jjg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=125

A 39-year-old male patient presents asking for pharmacotherapy to help with difficulty falling asleep. He denies any psychiatric history and is in good health. He is currently struggling with sleep because he is going through a difficult divorce and while he acknowledges that he has to work through it, the difficulty sleeping is so profound right now that it is making it difficult for him to be effective at work. The patient agrees to have an evaluation with a therapist, and the PMHNP agrees to short-term pharmacotherapy with trazodone. What is the most important aspect of patient education for this patient? A. He must be advised of the risk of priapism and what to do if it occurs B. He must be advised that this is only a time-limited intervention and he cannot rely on medication-induced sleep indefinitely. C. He must be advised that this should be taken on an empty stomach; if taken with food absorption is markedly delayed. D. He must be advised that there may be some early morning fatigue that would also contribute to not feeling well rested. --- YouTube: https://www.youtube.com/watch?v=qnmaXQVuEfg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=124

The PMHNP has assumed care of a 32-year-old patient who is being managed for opioid use disorder with buprenorphine-naloxone 8.2 mg films t.i.d. The patient’s previous provider has moved out of state and no records are immediately available, the only information available is from the prescription monitoring program. The patient request to be treated with a buprenorphine-only formulation because he says that the he is allergic to naloxone. The NP considers which of the following? Choose all that apply. A. Naloxone allergy is extremely rare and more likely any adverse reaction was due to precipitated opioid withdrawal B. It is never appropriate to use buprenorphine without naloxone when it is being used for OUD. C. Because the PMP shows that he has been prescribed a buprenorphine-naloxone combination for the last year is not possible that he is allergic. D. It is easier to misuse buprenorphine without the naloxone component and the NP should evaluate for misuse.

A 27-year-old female patient presents for a follow-up appointment for generalized anxiety disorder. She has a complex history including polysubstance use disorder and borderline personality disorder, but she had been doing well. She achieved remission of her symptoms over one year ago and has been well managed on escitalopram 10 mg daily. She has been substance free for over one year, and is in therapy for her personality disorder. Today she is not feeling well. She reports some major psychosocial stressors and a brief substance relapse, but she stopped using all substances 2 days ago. The PMHNP notes a pronounced postural and intention tremor and suspects this is due to withdrawal from which of the following substances? A. Kratom B. Opioids C. Marijuana D. Alcohol --- YouTube: https://www.youtube.com/watch?v=16Vg_4HFG1A&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=122

The PMHNP is managing a patient of Chinese ancestry with a diagnosis of bipolar disorder. The patient is currently experiencing some symptoms consistent with an early manic episode. When considering prescribing carbamazepine, the NP considers that this patient is at particular risk for which of the following adverse effects? A. Drug-induced hepatitis B. Pancreatitis C. Hypothyroidism D. Toxic epidermal necrolysis --- YouTube: https://www.youtube.com/watch?v=5MaExNnaFDM&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=121

The PMHNP is called to the emergency department to evaluate a patient with an acute onset mental status change. The patient has a long history of schizophrenia and has been managed on a variety of antipsychotic therapies that have had some success, but the patient has not ever really achieved goal remission. Most recently he was started on a first generation antipsychotic along with benztropine (Cogentin). Today the patient is in the ED with confusion and muscle stiffness. Which of the following represents anticipated vital signs? A. T 103.5o F, P 54 bpm, RR 24 bpm, BP 150/100 mm Hg B. T 102.5o F, P 129 bpm, RR 22 bpm, BP 170/110 mm Hg C. T 96.4o F, P 60 bpm, RR 24 bpm, BP 190/120 mm Hg D. T 98.6o F, P 102 bpm, RR 18 bpm, BP 147/99 mm Hg --- YouTube: https://www.youtube.com/watch?v=9emyKQQhmYc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=120

The PMHNP is evaluating a 73-year-old patient who has just been discharged from the hospital after being treated for a urinary tract infection with associated delirium. She has a baseline major neurocognitive disorder and the spouse has been told in the past that the patient cannot take antipsychotics. However, while she was hospitalized she was given an antipsychotic for delirium and it seemed to help a lot. The spouse wants to know why the patient cannot take an antipsychotic for her chronic behavioral symptoms. The PMHNP knows that the patient most likely has which underlying cause of major neurocognitive disorder? A. Pick’s disease (FTD) B. Alzheimer’s disease (AD) C. Vascular disease (VaD) D. Parkinson’s disease (PD)

A 3-year-old child is being seen because the daycare facility staff have suggested to the parents that the child is having difficulty interacting with other children. Additionally, the staff have observed that when the child seems to become anxious or upset, he always becomes fixated on stacking building blocks one on top of the other to the extent that he will not acknowledge anyone or anything else. When the parents ask if their child has autism spectrum disorder (ASD), the PMHNP advises the parents that: A. The repetitive and predictable nature of stacking blocks is calming in children with ASD B. Stacking blocks is a very typical activity in children at this developmental stage and is not suggestive of ASD. C. The child should be tested for ASD, but in any event he should be discouraged from using building blocks as a coping mechanism. D. While the social dysfunction at this age may suggest ASD, the building block activity is not an abnormal finding in a 3-year-old. --- YouTube: https://www.youtube.com/watch?v=rf3inZzulEg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=118