PMHNP Certification Q & A

A 29-year-patient with bipolar disorder is being seen today in follow-up. She has a history of not being well managed, but for the last several months she has been maintained on aripiprazole 15 mg daily and citalopram 20 mg daily with much improvement for the last two months. Today she reports that her mood remains stable, but she feels fatigued all the time. She is sleeping 9-10 hours a night but...

The PMHNP is performing a follow-up visit on a 41-year-old female who is being treated for obsessive-compulsive disorder. She has been seeing an exposure-response therapist for over six months, and approximately two months ago both patient and the therapist felt that pharmacotherapy should be considered. The patient was started on fluoxetine and was rapidly titrated up to 40 mg day two months ago....

The PMHNP is reviewing the results of a comprehensive new patient assessment and notes that the result of the patient health questionnaire (PHQ)-9 is a 7. Knowing that the sensitivity of this screening tool is 90% for a score of 8 or more, the PMHNP recognizes that the likelihood that the patient is having a major depressive episode is:  A. 10% B. 15% C. 85% D. 90% --- YouTube: https://www.youtube...

J.T. is a 38-year-old male patient who presents for assessment and treatment of substance use disorder. He has a long history of chronic alcohol use, typically drinking a 6-pack of beer every evening.  According to his primary care provider his physical examination and laboratory studies are all within normal limits and there are no documented medical conditions.  He admits that he personally does...

The PMHNP is seeing a 11-year-old patient who is being managed for obsessive-compulsive disorder. The patient has been in exposure response therapy for almost one year and has been taking fluoxetine 40 mg daily. For the last six months the patient was in an acceptable remission, but today he reports that his obsessive thought processes and compulsive hygiene behaviors have started to become intrus...

An initial psychiatric evaluation should include a comprehensive risk assessment across the lifespan. Which of the following should be part of the initial intake for all patients aged 8 to 24 as part of that risk evaluation? A. The CAGE questionnaire  B. The ASQ tool C. The SCARED tool  D. The MCHAT-R questionnaire  --- YouTube: https://www.youtube.com/watch?v=jB53p074Ze0&list=PLf0PFEPBXfq5HGf...

The PMHNP is performing a follow-up visit on a 32-year-old male. He is being treated with sertraline 100 mg daily for a major depressive episode that began when he started having serious marital problems. His depressive symptoms have much improved, and he currently denies depressed mood, anhedonia, hopelessness, worthlessness, guilt or irritability. Even sleep has improved, and he is currently sat...

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, capaci...

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 durin...

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 w...

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....

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 t...

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 la...

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 commo...

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 sh...

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...

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,...

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...

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 dis...

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...

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 r...

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 ef...

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 h...

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 th...

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...