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 PMHNP recognizes that:

A. This dose is subtherapeutic and should be increased in increments of 25 mg daily to a goal dose of 600 mg/day

B. The patient must be routinely monitored for absolute neutrophil count

C. Lithium is contraindicated in patients taking clozapine

D. Clozapine is absolutely contraindicated in patients < 18 years of age

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YouTube: https://www.youtube.com/watch?v=G8vWlcwj1BY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=55

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 insomnia includes all of the following except:

A. Stopping daytime napping

B. Considering a melatonin agonis

C. Eliminating screen time one hour before bedtime

D. Considering a tricyclic antidepressant
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YouTube: https://www.youtube.com/watch?v=KmmQSG7kkR0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=54

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. Depressive episodes tend to be less severe but manic episodes tend to worsen

C. Depressive episodes tend to worsen but manic episodes tend to improve

D. The general trajectory of bipolar disorder typically worsens with age
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YouTube: https://www.youtube.com/watch?v=fwUe2Vsz-u8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=53