PMHNP Certification Q & A

The PMHNP is performing a follow-up visit on a 41-year-old female who is being treated for obsessive-compulsive disorder. She has been seeing an exposure-response therapist for over six months, and approximately two months ago both patient and the therapist felt that pharmacotherapy should be considered. The patient was started on fluoxetine and was rapidly titrated up to 40 mg day two months ago. Today in follow-up the patient’s Y-BOCS score is 23, as compared to a 24 when she started her medication 2 months ago. Subjectively she feels distinct improvement. She still loses time to both her obsessive thoughts and occasionally her husband has to pick her up and carry her from bed to living room because of her obsession about touching the floor. But, she feels encouraged and genuinely feels as though things are better.

The appropriate course of action today would be to do which of the following?

A. Increase her fluoxetine to 60 mg day

B. Change her SSRI to fluvoxamine rapidly tapering to 300 mg/day

C. Continue the current plan of care and follow-up in one month

D. Discuss with her a change of therapeutic modality to EMDR.

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YouTube: https://www.youtube.com/watch?v=UIuwwA5N63I&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=144

The PMHNP is reviewing the results of a comprehensive new patient assessment and notes that the result of the patient health questionnaire (PHQ)-9 is a 7. Knowing that the sensitivity of this screening tool is 90% for a score of 8 or more, the PMHNP recognizes that the likelihood that the patient is having a major depressive episode is:

A. 10%

B. 15%

C. 85%

D. 90%

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YouTube: https://www.youtube.com/watch?v=iK87yMniCNY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=143

J.T. is a 38-year-old male patient who presents for assessment and treatment of substance use disorder. He has a long history of chronic alcohol use, typically drinking a 6-pack of beer every evening. According to his primary care provider his physical examination and laboratory studies are all within normal limits and there are no documented medical conditions.

He admits that he personally does not truly believe he has substance use problem, but his wife does like the fact that he drinks, and they argue about it often. He loves his wife and does not want to argue, but he enjoys his beer and feels strongly that it is not hurting anything when he drinks. He thinks she is being unreasonable.

The PMHNP recognizes that he is at what point in the change process?

A. Precontemplative

B. Focusing

C. Unfreezing

D. Planning

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YouTube: https://www.youtube.com/watch?v=vY9f7ZTdt4M&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=142

The PMHNP is seeing a 11-year-old patient who is being managed for obsessive-compulsive disorder. The patient has been in exposure response therapy for almost one year and has been taking fluoxetine 40 mg daily. For the last six months the patient was in an acceptable remission, but today he reports that his obsessive thought processes and compulsive hygiene behaviors have started to become intrusive and are making it difficult for him to manage his day appropriately. Additional assessment today must include which of the following?

Select all that apply

A. Subjective information from the patient

B. Subjective information from the parent

C. Subjective information from the teacher

D. Subjective information from the therapist

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YouTube: https://www.youtube.com/watch?v=q2r-w3LoANQ&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=141

An initial psychiatric evaluation should include a comprehensive risk assessment across the lifespan. Which of the following should be part of the initial intake for all patients aged 8 to 24 as part of that risk evaluation?

A. The CAGE questionnaire

B. The ASQ tool

C. The SCARED tool

D. The MCHAT-R questionnaire

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YouTube: https://www.youtube.com/watch?v=jB53p074Ze0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=140

The PMHNP is performing a follow-up visit on a 32-year-old male. He is being treated with sertraline 100 mg daily for a major depressive episode that began when he started having serious marital problems. His depressive symptoms have much improved, and he currently denies depressed mood, anhedonia, hopelessness, worthlessness, guilt or irritability. Even sleep has improved, and he is currently satisfied with his response to pharmacotherapy. During the visit, the PMHNP notes that the patient repeatedly voices his opinion that his wife will not consider reconciliation, that she does not understand he has improved and wants to work on the marriage. Despite several attempts to redirect the conversation, the patient repeatedly returns to the topic of his wife not doing her part.

The NP documents which finding with respect to mental status examination?

A. Rumination

B. Echolalia

C. Tangential thought

D. Perseveration

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YouTube: https://www.youtube.com/watch?v=p_3AhDQt5og&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=139

A 5-year-old child presents for evaluation with her mother. The mother is concerned that the child might have autism spectrum disorder and asks for a comprehensive evaluation. As part of a developmentally appropriate assessment, the PMHNP recognizes that which of the following is the appropriate approach to assessing the child’s affect, coordination and motor skills, speech, attention span, capacity for complex thinking and interaction?

A. Playing with the child on the floor

B. Administering the Sally/Anne test

C. A complete neuropsychiatric assessment

D. Evaluate responses to a CRAFFT questionnaire

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YouTube: https://www.youtube.com/watch?v=QpiaTE0r7bo&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=138

The PMHNP is seeing a 22-year-old male patient for his initial evaluation. The appointment is court ordered and the patient seems very uncomfortable being there and answers direct questions with one-word responses. According to information provided by the court, the patient comes from a very dysfunctional upbringing, has been homeless for an indeterminate time period, and did not adapt well during his brief period of incarceration. The PMHNP is very open about all information that she has from the referral, is clear about her role, what has to be reported to the court, and what remains confidential, and offers to answer any questions the patient has before they begin their discussion.

The PMHNP is employing which key component of developing a therapeutic alliance?

A. Empathy and active listening

B. Trust and safety

C. Goal alignment

D. Collaborative tasks

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YouTube: https://www.youtube.com/watch?v=BOxvSEiUqe0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=137

The PMHNP is evaluating a patient new to the practice. He is a 27-year-old male with a long history of bipolar depression, generalized anxiety disorder, and a remote history of substance use disorder for which he has been in remission for over 6 years. While discussing his medication history the patient reports that over the years he has been treated with a number of different medication to help with his symptoms. He denies any medication allergies but reports that one of the medications made him have an erection that would not go down for several hours and he finally had to go to the emergency room and took “a lot of procedures” to make things normal again. He was told never to take that medication again, but he cannot remember the name.

Which of the following was most likely cause of his symptoms?

A. Venlafaxine

B. Buspirone

C. Mirtazapine

D. Trazodone

Social determinants of health (SDOH) are recognized by the World Health Organization as non-medical conditions that can often outweigh genetic or clinical medical access in determining overall health. Addressing SDOH is endorsed as a priority with respect to improving population health. They are categorized in five major domains.

Discrimination or systemic bias is an example of which domain?

A. Economic stability

B. Social and community context

C. Neighborhood and built environment

D. Education access and quality

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YouTube: https://www.youtube.com/watch?v=MFyq0om1tNw&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=135

The PMHNP is working with a patient who is struggling with significant depressive symptoms. The patient is a 34-year-old female who is lives alone and works in a job that “pays the bills” but not much else. The patient has no close connections, she remains friendly with a few friends from college, but she feels “alone in the world.” At present her options are limited. She is not financially able to make major life changes, but she feels as if she is spiraling down and wants to feel better. In an effort to engage the PMHNP asks the patient, “if you woke up tomorrow and this problem was solved, how would you know? What would your day be like?”

The PMHNP is initiating which type of therapeutic modality?

A. Solution-focused therapy

B. Motivational interviewing.

C. Interpersonal psychotherapy.

D. Cognitive behavioral therapy.

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YouTube: https://www.youtube.com/watch?v=hS3di8KqNnY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=134

The PMHNP is managing a patient with bipolar disorder. While the patient has had manic episodes historically, the dominant pole of his disorder is depression. He is currently being treated with valproic acid and olanzapine. Today his depressive symptoms have exacerbated and he admits to increasing suicidal ideation. He is not acutely suicidal, but his ideation is more frequent, and twice in the last month he has called the suicide and crisis hotline at 988.

Which of the following medications would be most appropriate to add to his regimen?

A. Lithium

B. Sertraline

C. Lamotrigine

D. Lurasidone

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YouTube: https://www.youtube.com/watch?v=gIOu23bxyOQ&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=133

The PMHNP is seeing a patient in follow-up. The patient has a diagnosis of schizoaffective disorder and has been taking the second-generation antipsychotic olanzapine for 2 months. The patient appears to be experiencing a distinct improvement in both the positive symptoms of schizophrenia as well as depressive symptoms of major depressive disorder. The NP evaluates for which of the following common adverse drug effects of this medication?

A. Weight gain

B. Insomnia

C. Diarrhea

D. Nausea

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YouTube: https://www.youtube.com/watch?v=YbhPr5zUa78&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=132

The PMHNP is considering the case of a patient who is struggling with significant depressive symptoms following a difficult divorce. The symptoms are having a direct impact on her life, and she has even had written warnings at work about excessive lateness and calling in sick. The patient is very resistant to medication. The NP realizes that the patient’s situation is remarkably similar to what she herself experienced during her divorce five years ago. She considers sharing her experience with the patient.

The NP considers which of the following regarding self-disclosure?

A. The NP is experiencing countertransference

B. It is an ethical violation and should be avoided

C. There is a significant risk of dysfunctional attachment

D. It is appropriate when used to facilitate patient goals

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YouTube: https://www.youtube.com/watch?v=8uewc5hNyJg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=131

The PMHNP is managing a patient with treatment-resistant schizophrenia who continues to have positive symptoms despite appropriate trials with two different antipsychotic regimens. When considering initiation of clozapine, the NP considers that which of the following apply?

A. The absolute neutrophil count must be > 1000/mm3 to start treatment

B. The first 2-3 doses should be administered in a closely monitored setting with vital signs monitored regularly

C. The medication must be ministered in accordance with the FDA REMS safety monitoring

D. The medication has significantly less medication interaction potential as compared to other antipsychotics

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YouTube: https://www.youtube.com/watch?v=GH7CZF80ghI&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=130

The PMHNP has just accepted a position at an eating disorders clinic which offers a multi-disciplinary approach to the management of eating disorders, including psychiatric comorbidities and physical health deviations. In preparing for the role, the NP reviews strategies for managing which of the following laboratory abnormalities common in patients with anorexia nervosa?

A. Hypercholesterolemia, leukopenia, low TSH

B. Anemia, hyperkalemia, low T3.

C. Hypokalemia, hypocholesterolemia, hypernatremia.

D. Anemia, low eGFR, hypernatremia.

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YouTube: https://www.youtube.com/watch?v=Ix9Xaq7uTIM&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=129

A 14-year-old patient is being managed for generalized anxiety disorder and has been responding well to fluoxetine. However, both the patient and his mother report that he has chronic difficulty falling asleep. He denies any racing thoughts at bedtime; he just cannot seem to fall asleep. His mother has been giving him melatonin gummies purchased over the counter from the pharmacy and reports that there is some improvement but would like to know what else can be done.

The PMHNP advises which of the following interventions that are recommended for adolescent insomnia? Choose all that apply.

A. The melatonin gummies should be discontinued

B. The adolescent should not be permitted screen time at least one hour before bed.

C. Establish a later bedtime

D. Eliminate daytime napping.

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YouTube: https://www.youtube.com/watch?v=ZHl59bdwpJM&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=128

A 5-year-old child is accompanied by the foster mother for evaluation of behavioral problems. The foster mother is experienced and has been very successful with children, but this child is very concerning. He has frequent, unexpected episodes of mood and reaction extremes including irritability, sadness, and fearfulness that are disproportionate to the situation. Suspecting reactive attachment disorder, the PMHNP anticipates which of the following to be reported by the foster mother?

A. Failure to seek or respond to comfort when distressed

B. Atypical dependency on toys and items that provide comfort

C. Early toilet training with paradoxical persistent nocturnal enuresis

D. Tendency toward aggressive behavior and cruelty to animals

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YouTube: https://www.youtube.com/watch?v=dZOmyrOPIDA&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=127

Jennifer is a 27-year-old female who has been in psychiatric care for several months for a diagnosis of bipolar disorder. She has not responded to three different pharmacotherapeutic approaches and as a result she is now being evaluated by a new PMHNP provider. She maintains that she has always taken all medications as prescribed but all they do is make her tired. Further she is emphatic that the last provider “did not know what he was doing” but she has heard that the new NP is “really great” and so she is very hopeful. Jennifer further states that she “really needs help right away” because her bipolar disorder is causing lots of problems with her relationship with her significant other. Her behavior during the visit is quite dramatic and virtually all of her descriptions are extreme.

Exploring a diagnosis of borderline personality disorder, the NP anticipates which of the following in Jennifer’s history?

A. Depressive episodes characterized by passive SI

B. Use of recreational substances to help with mood

C. Difficulty with relationships as home and work

D. Manic episodes that can last for several hours

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YouTube: https://www.youtube.com/watch?v=67vx42geUrw&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=126

A patient is mandated to care by court for evaluation and treatment of substance use disorder. He has a history of polysubstance abuse including ETOH, benzodiazepines, and marijuana. He is very resistant to the interview, sits with arms crossed, avoids eye contact, and only offers minimal verbal responses. The PMHNP asks the patient why he doesn’t want to talk about why he is there. The patient responds, “You are just going judge me and blame me, what’s the point?”

The PMHNP recognizes that this is likely:

A. Passive-aggressive behavior

B. Transference

C. Splitting

D. Catastrophizing

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YouTube: https://www.youtube.com/watch?v=HBgF3KS6jjg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=125