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

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 

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) 

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YouTube: https://www.youtube.com/watch?v=3R_9ZEV9B24&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=97

The PMHNP is evaluating a family at the request of county social services. A mother, father, 8-year-old and 2-year-old are present for the evaluation. The NP notes that the 2-year-old clings excessively to the parents, despite the fact that the parents do not seem to be particularly responsive to the child’s caution.  The 2-year-old does not exhibit typical curiosity about his new environment and does not express any curiosity about the PMHNP. 

These behaviors are consistent with:

A. Separation anxiety disorder 

B. Normal behavior

C. Autism spectrum disorder. 

D. Insecure-ambivalent attachment

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YouTube: https://www.youtube.com/watch?v=Q53ltO03TKU&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=96

A 78-year-old man presents for a follow-up visit. Two months ago he was started on sertraline  for major depressive disorder and has been titrated up to 100 mg daily. Today his daughter reports that she cannot really evaluate if his mood has improved because he seems to have become confused. The patient’s daughter reports a distinct new onset confusion and forgetfulness. 

The PMHNP considers the most likely cause of his confusion to be: 

A. Urinary tract infection. 

B. Hyponatremia

C. Alzheimer’s disease 

D. Depression 

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YouTube: https://www.youtube.com/watch?v=HGxzaaVSVxk&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=95

Cognitive assessment in children characterizes stages of development consistent with Piaget’s developmental theory. One of the cognitive principles typically developed during the sensorimotor stage is: 

A. Object permanence

B. Animalistic thinking

C. Phenomenalistic causality 

D. Learning without reasoning. 

YouTube: https://www.youtube.com/watch?v=AIZ5H14yUqI&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=94

A 12-year-old patient is being seen today in follow-up after being started on fluoxetine 1 month ago for a diagnosis of generalized anxiety disorder.  The patient and her father both report that while there does appear to be a mild improvement in anxiety, some adverse effects have developed about which they are concerned. 

Which of the following is not an expected adverse effect and is a cause for concern?  

A. Vivid nightmares 

B. Diaphoresis 

C. Restless legs 

D. Impulsivity

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YouTube: https://www.youtube.com/watch?v=6onROBl73UE&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=93

The PMHNP is evaluating a patient who presents complaining of panic attacks that occur for no identifiable reason. The patients has been treated for these previously with a variety of pharmacotherapies that did not provide any meaningful improvement. Upon further conversation, the NP learns that the patient experienced a near-fatal bicycle accident  4 years ago after being hit by a car. 

When considering a diagnosis of PTSD, the NP explores his history for all of the following diagnostic criteria except: 

A. Intrusion symptoms. 

B. Angry outbursts. 

C. Negative cognition 

D. Avoidance symptoms. 

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YouTube: https://www.youtube.com/watch?v=QQ-KgQYOuSg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=92