A 22-year-old female patient is transferred to your care after another provider in the practice retired. She has been managed for bipolar I disorder for 3 years and has had some challenging extremes of exacerbation. She is currently taking a mood stabilizer, an antipsychotic, and an antidepressant. Today she reports a worsening of her depression, admitting to true hopelessness about the future, worsening malaise to the extent that she is not attending to basic hygiene, and for the first time reporting passive suicidal ideation. While her ideation does not rise to the level of hospitalization, it is a new and concerning symptom.

Which of the following is the most appropriate adjustment to the plan of care?

A. Ensure that the patient is seeing a therapist.

B. Adjust the medication regimen to include lithium.

C. Increase the dose of the antidepressant.

D. Change to a different antidepressant.

A patient with a history of rapid-cycling bipolar disorder presents for evaluation of her current, profound depressive symptoms. The patient has been maintained for the last two years on valproic acid and quetiapine, but now a major depressive episode has occurred and the patient is reporting passive suicidal ideation.

Concerned that the suicidal ideation may progress, the PMHNP consider which of the following pharmacotherapeutic options?

A. Cariprazine

B. Lumateperone

C. Aripiprazole

D. Lithium

The PMHNP is seeing a patient who presents for complaint of depressive symptoms. The patient reports a history of anhedonia, hopelessness, worthlessness, sleep dysfunction, marked decrease in appetite with an unplanned 5 lb wt loss in the last month, and a marked inability to concentrate on necessary tasks.

Before diagnosing the patient with major depressive disorder and beginning antidepressive therapy, the PMHNP should:

A. Document a Patient Health Questionnaire-9

B. Administer a Mood Disorder Questionnaire

C. Refer the patient to cognitive behavioral therapy

D. Order a TSH and a CBC to rule out physiologic causes

The PMHNP has a new patient who reminds her of a former teacher who played an important role in her life and whom she regards as a mentor. The NP is concerned that she may express countertransference and is especially watchful for all of the following except:

A. Resistance and strong emotion from the patient

B. Dreaming about the patient

C. Extending appointments beyond normal time frame

D. Offering small, inexpensive gifts occasionally to the patient

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 patient is very upset by this. At this appointment the patient is agitated and begins to perseverate over the lack of participation by other family members.

The NP, in an attempt to refocus the patient on the primary problem, says which of the following?

A. “You said that the family is not helping?”

B. “You are close to tears. This is a hard subject for you.”

C. “You feel betrayed because the family is not helping.”

D. “You were talking about how irritated you were by your mother.

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YouTube: https://www.youtube.com/watch?v=xg_1qLCRWQc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=78

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 play with. The child does not want to share her toys, and does not seem interested in playing with other children.

The PMHNP recognizes that it is likely that:

A. The child may be demonstrating early indicators of schizophrenia which is possible due to family history.

B. These behaviors are consistent with developmental stage and not a cause for concern.

C. Play therapy with an early-childhood therapist may help her integrate better with other children

D. Autism spectrum disorder is more likely than schizophrenia given the child’s age.

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YouTube: https://www.youtube.com/watch?v=p_bkWpc69Z8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=77

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 for:

A. New onset delusional thought

B. Constipation

C. Irritability

D. Recent use of OTC cough medicine

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YouTube: https://www.youtube.com/watch?v=VcyTSz7d4M4&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=76

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 and find the patient to be unresponsive, with a blood pressure of 78/50 mm Hg and a respiratory rate of 7 breaths/minute.

The appropriate response is to:

A. Immediately review the records for all known substances of abuse

B. Administer intranasal naloxone

C. Begin CPR

D. Place oxygen and IV access

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YouTube: https://www.youtube.com/watch?v=VQTxgzSWDgk&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=75