PMHNP Certification Q & A

The PMHNP is conducting a follow-up appointment with a patient who is being treated for generalized anxiety disorder. The patient has a long-standing difficult relationship with her mother and today it is evident that this is being exacerbated by her mother recently being diagnosed with cancer. Her mother does not appear to appreciate the sacrifices that the patient is making to help her, and the...

The mother of a 3-year-old female brings her daughter in for a psychiatric evaluation. The mother is concerned because she sometimes sees her daughter talking to an “imaginary friend” and Mom is worried because she has a cousin with schizophrenia. Further the staff at her daughter’s daycare report that this little girl seems to prefer playing alone, even though there are lots of other children to...

The PMNP is evaluating a patient who is being treated for obsessive compulsive disorder with fluoxetine 60 mg daily. The patient has been on fluoxetine for months without any concerning adverse effects, but today the patient reports that for the past few weeks she has had a distinct sense of agitation, racing heart, nausea, and has been really clumsy. Suspecting serotonin syndrome, the NP assess f...

The PMHNP is on call at the residential treatment facility and is called to urgently see a patient being treated for methamphetamine use disorder. The patient was admitted earlier this day and being and was still being assessed for appropriate psychotherapy and medication needs. Facility staff was performing routine observation rounds and found the patient unresponsive. You arrive at the bedside a...

A 32-year-old female patient tells the PMHNP in the course of an office visit that her toddler’s pediatrician has suggested that the 3-year-old be referred for further assessment because his MCHAT-R score was high. Your patient is upset and does not think that the result was correct. Which of the following findings in the child would support an elevated MCHAT R score?  A. The child is mostly non-v...

Which of the following is a true statement with respect to the CAGE-AID questionnaire?  A. It is a 5-item questionnaire used to screen for alcohol use disorder  B. A “yes” answer to 1 item is considered highly sensitive for use disorder C. A positive CAGE questionnaire mandates intervention for use disorder  D. Volume of alcohol or drug use is not a factor in a positive result --- YouTube: https:/...

The PMHNP has ordered a comprehensive metabolic panel, CBC, TSH, and HgbA1c as part of a new patient screening panel to evaluate very generic complaints of fatigue, decreased motivation, and unplanned weight gain of 15 lbs in the last 6 months, insomnia and increased irritability. The patient believes he is depressed and is asking for an antidepressant, but the NP has concerns that the history pro...

The PMHNP is seeing a patient who has been in Exposure-Response Therapy for obsessive-compulsive disorder for the last four months with suboptimal clinical improvement. After consulting with the therapist the PMHNP is discussing the addition of pharmacotherapy with the patient. The patient is advised that SSRIs may be helpful, and the most appropriate treatment expectations include:  A. Allowing a...

Developmental theorists often assert that dysfunction of some sort during growth and development may result in psychopathological traits in adulthood.  According to Erikson’s Developmental Theory, which of the following maladaptive developmental conflicts increases the risk of obsessive-compulsive disorder in adulthood?  A. Trust versus mistrust  B. Autonomy versus shame and doubt  C. Initiative v...

A 15-year-old male patient reveals that he does not feel comfortable in his body.  When considering a diagnosis of gender dysphoria the PMHNP recognizes that which of the following must be present to constitute this diagnosis? A. A strong desire to be of a gender other than assigned at birth  B. Feelings associated with clinically significant distress  C. A need to be treated as the gender not ass...

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 t...

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 r...

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’...

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 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  --- YouTube: https://www.youtube.com/w...

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)  --- YouTube: https://www.youtube.co...

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 conce...

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 p...

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  --- YouTube: https://ww...

A 34-year-old female patient presents for treatment. She has been on and off medication for schizophrenia for years but has historically been non-adherent to pharmacotherapy because of the adverse effects. When considering olanzapine therapy for this patient, the PMHNP advises that she will need to be monitored for:  A. Absolute neutrophil count (ANC) B. Hypertension, hyponatremia and hypertriglyc...

A PMHNP student is beginning his clinical practicum in a child and adolescent psychiatry practice and quickly realizes that performing patient interviews in school-aged children is very different than performing interviews with adults.  Which of the following techniques is recommended for developing a therapeutic bond with a 10-year-old child?  A. Separating the child from the parents for the init...

A 77-year-old male is admitted to the emergency department from a long-term care facility where he has lived for over 3 years. He has been maintained on antipsychotic medications for years but recently required a change to a first-generation agent as his symptoms were breaking through on even high doses of olanzapine. Last evening staff reported that he was increasingly confused, and this morning...

The PMHNP is performing an initial history and physical examination on a new patient who has just transferred to his care from out of state. The patient has a complex psychiatric history including schizoaffective disorder, generalized anxiety disorder, prolonged grief reaction, and adjustment disorder. His medication list indicates that he has been taking clozapine 300 mg daily for 15 months.  The...

A 14-year-old patient is being managed for social anxiety by a therapist and is doing well. However, she reports having difficulty falling asleep most nights and is asking for medication to help her sleep. Her mother acknowledges the problem and is open to the option of sleeping medication as this has been a long-term problem. The PMHNP knows that the approach to an adolescent patient with insomni...