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

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 from one thing to another without an ability to spend any meaningful time on one task, even if he is enjoying it. On physical examination the NP notes that the patient has short palpebral fissures, a thin upper lip, and a long, smooth philtrum.

Suspecting a diagnosis of fetal alcohol syndrome, the NP expects to find which additional physical findings?

A. Underdeveloped ears

B. Bradycardia

C. Polydactyl

D. Macrocephaly
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YouTube: https://www.youtube.com/watch?v=Uxvt3PB78us&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=52

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 foster mother when he was 3-years-old, and she was the first consistent, stable, and loving caregiver in his experience. The adoptive mother is concerned because the patient is very withdrawn, does no respond well to his new siblings or peers, and demonstrates disproportionate fearfulness in normal circumstances. The PMHNP anticipates additional findings to include:

A. A concomitant diagnosis of autism spectrum disorder.

B. Social skills markedly below what is expected at his age.

C. Crying when his adoptive mother leaves

D. Being purposefully annoying to siblings and peers
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YouTube: https://www.youtube.com/watch?v=E-brrC6HA4g&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=51

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 his kindergarten class, and the teacher says that he seems consistently test boundaries and seems to intentionally annoy his classmates. The NP expects that the mother:

A. Appears defeated and does not make any effort to correct the problematic behaviors.

B. Overbearing and constantly correcting or stopping the child any time he displays initiative.

C. Has a personal history of successfully managed ADD in childhood and adolescence.

D. Is very resistant to the idea of medication and is more interested in pursuing family therapy as a treatment modality.
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YouTube: https://www.youtube.com/watch?v=rZftfx76O0o&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=50

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 CT scan of the head

B. Immediate administration of naloxone

C. Rapid infusion of IV crystalloids

D. Determination of medical history
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YouTube: https://www.youtube.com/watch?v=A8GD3jfcUHg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=49

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 blood pressure of 90/58 mm Hg. Suspecting a diagnosis of anorexia nervosa, the PMHNP orders a relevant laboratory assessment. Which of the follow abnormalities are most consistent with anorexia nervosa?

A. Hypernatremia, hypokalemia, decreased BUN and creatinine

B. Polycythemia, leukocytosis, and metabolic acidosis

C. Elevated liver enzymes, hypoalbuminemia, and decreased LDL

D. Hypercholesterolemia, low TSH, Low T3, and anemia
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YouTube: https://www.youtube.com/watch?v=4aBsBqFjJ8E&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=48