A 27-year-old female presents for therapy because she and her new husband are having difficulty adjusting to their new roles as spouses sharing a household who both work full time. There have been some struggles with regard to household tasks, communicating expectations, and other adjustments. After identifying the patient’s primary concerns the therapist determines that Interpersonal Therapy is the most appropriate approach to the patient. Therapeutic techniques are likely to include any of the following except: 

A. Role playing 

B. Communication analyses 

C. Clarifying incidents 

D. Examining motivation 

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YouTube: https://www.youtube.com/watch?v=ruwc_xl8EL4&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=68

The PMHNP is evaluating a patient in follow-up and despite appropriate pharmacotherapy and psychotherapy the patient has not achieved a successful remission. The patient states that his therapist is very nice, but that therapy is not really helping. The patient relates that the therapist keeps talking about “phases of change” and steps like engagement, focusing, evoking, and planning.  The PMHNP recognizes that the therapist is using which of the following? 

A. Lewin’s Change Theory 

B. Motivational Interviewing 

C. Interpersonal Therapy 

D. Cognitive Behavioral Therapy

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YouTube: https://www.youtube.com/watch?v=i_Ijalm5sNg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=67

Patient in mental health care may be at increased risk for demonstrating unhealthy coping mechanisms or inappropriate responses to distress. When your patient is angry with you for not making a medication change she requested, which of the following would be characterized as a passive-aggressive response? 

A. Glaring at you for the rest of the visit and responding to every question with, “you don’t listen to me so why do you ask?” 

B. Loudly complaining to you and other people in the waiting room that you don’t know what you are doing. 

C. Purposefully missing her next appointment without calling to change or cancel 

D. Telling you that she refuses to take any medication if you will not consider her input. 

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YouTube: https://www.youtube.com/watch?v=qZRWPZFL0Eg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=66

An 18-year-old male patient has been treated successfully for bipolar II disorder as an outpatient with Risperdal, however now that he has symptom control he frequently forgets to takes his medication. The best approach to this patient would include: 

A. Exploring reasons why he might not want to take it 

B. Convert to IM administration 

C. Change to another second generation antipsychotic 

D. Add a mood stabilizer to his regimen 

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YouTube: https://www.youtube.com/watch?v=EENe4WNB5W0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=65

A 28-year-old male presents for follow-up of his medication management for schizophrenia. Which of the following assessment findings represents an improvement in negative symptoms? 

A. An appropriate range of affect during the office visit 

B. A marked decrease in auditory hallucinations 

C. Resolution of akathisia 

D. Ending an intimate partner relationship 

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YouTube: https://www.youtube.com/watch?v=LFCzZ3KZCNc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=64

When managing the patient with schizophrenia, the PMHNP recognizes that which of the following interventions is most closely associated with good long-term outcomes? 

A. Maintenance of antipsychotic therapy 

B. Compliance with necessary laboratory follow-up 

C. Documentation of AIMS score with each visit 

D. Implementation of Assertive Community Treatment (ACT) 

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YouTube: https://www.youtube.com/watch?v=RClYxx2-8y4&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=63

While performing an initial comprehensive assessment on a new patient the PMHNP is particularly attentive to social determinants of mental health. Which of the following patient factors is should be identified? 

A. Race

B. Poverty 

C. Divorce 

D. Substance use 

A 41-year-old female patient is being treated for obsessive-compulsive disorder (OCD). She is in exposure-response therapy (ERT) and is frustrated by the time it is taking for her to develop any meaningful improvement. She is now being started on fluoxetine as an augment to her therapy. It is important to advise her that: 

A. It is critical that she not stop taking fluoxetine abruptly due to concerns about discontinuation syndrome 

B. Success rates are very low but there may be some minimal improvement in combination with ERT therapy 

C. She will likely need a higher dose and longer duration than patients taking fluoxetine for depression 

D. The primary advantage of fluoxetine over other SSRIs for OCD is the low risk of drug interactions. 

A number of mood stabilizers and antipsychotics are indicated for the patient with bipolar disorder. Which of the following is a true statement with regard to lithium? 

A. It is considered highly teratogenic in the second and third trimesters of pregnancy 

B. It is the only mood stabilizer that has a demonstrated decrease in suicidal ideation 

C. Lithium is indicated for acute states but not for prevention of cycling 

D. Most consequences of lithium toxicity are reversible when levels normalize 

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YouTube: https://www.youtube.com/watch?v=gecVHaY_Ix8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=60

Which of the following scenarios should prompt a PMHNP to self-reflect on the potential impact of countertransference on the patient/provider relationship? The PMHNP: 

A. Gives gifts to a patient after several appointments 

B. Shares several attributes with the patient’s spouse 

C. Is very firm with respect to boundary setting 

D. Refuses to prescribe controlled substances 

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YouTube: https://www.youtube.com/watch?v=srDkSa2tDCs&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=59