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 to continue pharmacotherapy. She had a baby 3 years ago and tried to stop taking medication and her condition deteriorated rapidly.

The most appropriate approach for the PMHNP would be to:

A. Advise the patient that psychodynamic psychotherapy is her safest option

B. Continue the paroxetine as ordered

C. Reduce the paroxetine gradually to 20 mg daily for the duration of pregnancy

D. Stop the paroxetine and begin sertraline
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YouTube: https://www.youtube.com/watch?v=5g--quPOme0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=43

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 seems sincere but is very concerned about whether or not he can do it. He has tried unsuccessfully to stop on his own and finally realized that he needs professional help so he made the appointment today. He is in which stage of the Transtheoretical Model of Change?

A. Precontemplative

B. Contemplative

C. Preparation

D. Action
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YouTube: https://www.youtube.com/watch?v=ICORO90EO6o&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=42

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 antidepressant use
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YouTube: https://www.youtube.com/watch?v=1vG6aYVNno8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=41