PMHNP Certification Q & A

A 32-year-old female is diagnosed with bipolar I disorder. While discussing with her information about her diagnosis, medications, and anticipated course of illness, the patient asks if she will need to be on medication forever of if this is something that will get better as she ages. The PMHNP advised the patient that: A. With good medication adherence, exacerbations will fade as she ages B. Depr...

The PMHNP is evaluating a 4-year-old male patient who is presented to care by his new adoptive parents. The patient has been in a variety of foster homes since birth but is now finally in a stable adoptive home. The adoptive mother is concerned that he might have attention deficit hyperactivity disorder because he literally cannot sit still. He is constantly moving, and seems to shift attention fr...

A 4-year-old child presents for care with his new adoptive mother. The child has had a difficult first years of life, having been separated from his mother at birth because she was incarcerated. He was placed in foster care, but his experiences were inconsistent and he was moved around frequently as a result of various relatives trying to get custody. His adoptive mother initially served as a fost...

The PMHNP is conducting a new patient intake for a 6-year-old male. The patient’s mother made the appointment because she is afraid that her son has ADD. She reports that for the last few years he has been increasingly difficult at home. He is constantly difficult, seems to be purposefully disobeying her rules, and is always “getting into things.”  He does not get along well with other children in...

The PMHNP is called to the emergency room for a stat consult on a patient who reportedly was transferred in by ambulance after “acting weird at a party.” Upon arrival to the ED the NP finds the patient unresponsive. His respiratory rate is 7 bpm, his blood pressure is 70/48 mm Hg and pulse is 40 bpm. The skin is pale and clammy and his pupils are 1 mm. The most appropriate initial action is: A. A...

The PMHNP is evaluating a 14-year-old girl who is encouraged to care by her parents because they are concerned that she has an eating disorder. Physical examination reveals a cachectic female who, at 5’4” tall weighs 96 lbs for a BMI of 16.4. She appears clinically dehydrated, with poor skin turgor. Her vital signs reveal a temperature of 96.0o F, pulse of 48 bpm, respiratory rate of 20 bpm, and a...

A 51-year-old female is referred from her primary care provider. The patient had a 27-year-old son who died two years ago after inadvertently running in front of a car while intoxicated on hallucinogens. The patient continues to struggle with the loss of her son, and even two years later is preoccupied with thoughts of him on a daily basis. She is persistently talking about him, posting old pictur...

An 82-year-old man with a long history of depression has been treated over the years with various pharmacologic agents with little improvement. Last week the PMHNP decided to try vortioxetine as the patient is clearly despondent, has not responded to several SSRI options, and is not interested in discussing ECT. At this visit the patient appears markedly brighter. He engages in conversation, has b...

The PMHNP on call gets a call from the assisted living facility to advise that his 78-year-old patient is acutely confused. The patient, who is treated with mirtazapine for anxiety, insomnia, and decreased appetite, is normally oriented x 3. Today however, she does not recognize the staff at the facility and insists that she has to go home right now as her husband is waiting for her to cook dinner...

A 25-year-old female patient is being evaluated to rule out bipolar disorder. The PMHNP knows that all of the following are risk factors for bipolar disorder except:  A. A history of depressive disorder in adolescence  B. Low self-esteem  C. Childhood adversity  D. A first-degree relative with the disorder  --- Youtube: https://www.youtube.com/watch?v=vMQrrPDb1t8&list=PLf0PFEPBXfq5HGfNV-GbOlYH...

A 29-year-old pregnant woman is referred to the PMHNP for management of anxiety and depression. She has been taking paroxetine 40 mg daily as an outpatient for several years prescribed by her primary care provider. Upon learning that the patient was pregnant, the primary care provider insisted that the patient consult with mental health for continued management. The patient is clear that she needs...

A 42-year-old male presents for treatment of opioid use disorder. He has been taking 30 mg oxycodone tablets 4-6 times a day for over a year and both his personal and professional life are deteriorating. He has received several formal warnings at work about his absences and productivity, and his wife has been clear that she will need to move out with their children until he can get treatment. He s...

Suicide assessment should include an assessment of both risk factors and protective factors. Which of the following is a true statement with respect to suicide assessment? A. Each protective factor mitigates a risk factor B. Bonding with a pet is an internal protective factor C. Strong sense of cultural identity is an external protective factor D. There is no clear increase in suicidal rates with...

A 19-year-old male is in your office for evaluation of profound anxiety. He is in his first year of college and last week there was an active shooter on campus. Three people were killed. Although he didn’t know any of them, it was in the building where he has one of his classes and he is having severe anxiety and nightmares. He gets profoundly distressed when discussing this with anyone, he feels...

The PMHNP is asked to evaluate a 5-year-old child who has been having difficulty adjusting to kindergarten and has been disruptive in the classroom. The child is pleasant in the office, responds to questions, and seems to understand that she is having this appointment because she does not seem happy in kindergarten. Via role play and discussion the PMHNP learns that the child is sad and frightened...

While performing a mental status exam, the PMHNP asks the patient to count backwards, beginning with 100 and subtracting 7. This is an effort to assess which element of the mental status exam? A. Concentration B. Orientation C. Visuospatial function D. Recall --- YouTube: https://www.youtube.com/watch?v=p3x-HNGaWXY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=38

A new patient is being evaluated at the request of her primary care provider. While conducting the interview the PMHNP has a very difficult time getting direct answers to questions. The patient will try to answer but often drifts off topic, talking about things that appear related, but she never actually answers the question. The PMHNP documents which abnormality of thought process? A. Circumstant...

When counseling the parents of a 7-year-old patient regarding pharmacotherapy for attention deficit disorder, the PMHNP identifies which clinically relevant difference between clonidine and guanfacine? A. Guanfacine may be used as adjunct therapy to psychostimulants. B. Clonidine is available in a long-acting formulation. C. Clonidine is selective for alpha-2a adrenergic receptors. D. Guanfacine i...

Which of the following is not a validated tool used to evaluate attention deficit disorder? A. The Vanderbilt Assessment Scale B. The Connors Comprehensive Scale C. The Early Childhood Screening Assessment D. The Child Behavior Checklist --- YouTube: https://www.youtube.com/watch?v=pmuMEFrjBLg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=35

Alzheimer’s disease is the most common cause of major neurocognitive disorder and and while largely managed with non-pharmacologic interventions, there are also a variety of pharmacotherapeutics available for use when appropriate. Which of the following is considered a first-line pharmacologic intervention for symptom control in the patient with Alzheimer’s disease? A. Lecanemab B. Donepezil C. Me...

A new patient presents for evaluation of self-diagnosed bipolar disorder. An assessment of her history of interpersonal relationships increases your index of suspicion for borderline personality disorder as opposed to bipolar disorder. Which of the following circumstances is most characteristic of borderline personality disorder? A. Her fluctuations in mood have caused problems with interpersonal...

A 32-year-old female patient with diagnoses of bipolar I disorder and borderline personality disorder was recently transferred to your care. She was managed on desvenlafaxine ER 150 mg daily and olanzapine 10 mg daily but experiencing increasingly elevated mood. In an attempt to wean off desvenlafaxine you reduce her from 150 mg to 100 mg daily. She experiences profound discontinuation syndrome sy...

You are evaluating a 71-year-old female patient and have made a diagnosis of major depressive episode, moderate. The patient is agreeable to pharmacotherapy. When considering pharmacologic treatment options, you review her existing medication list for potential interactions and contraindications. Which of the following classes of medication might increase the patient’s risk of cognitive impairment...

Piaget’s sensorimotor stage of development is characterized by all of the following except: A. Object permanence B. Magical thinking C. Exploring D. Manipulating environment --- YouTube: https://www.youtube.com/watch?v=Z3amwp7QVzY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=30

You are evaluating a 17-year-old patient who presents for care reporting panic attacks. A comprehensive assessment suggests that the patient is experiencing post-traumatic stress disorder related to a very serious motor vehicle accident a few months ago. Which of the following medications is the best augment to trauma therapy for this patient? A. Escitalopram (Lexapro) B. Venlafaxine (Effexor) C....