PMHNP Certification Q & A

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

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.

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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 

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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 

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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 

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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. 

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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 

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YouTube: https://www.youtube.com/watch?v=16Vg_4HFG1A&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=122