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

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

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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 

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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