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

A 19-year-old male is in your office for evaluation of profound anxiety. He is in his first year of college and last week there was an active shooter on campus. Three people were killed. Although he didn’t know any of them, it was in the building where he has one of his classes and he is having severe anxiety and nightmares. He gets profoundly distressed when discussing this with anyone, he feels detached from his friends and even his family, is having trouble sleeping, and finds himself getting angry with everyone for no good reason. The PMHNP explores for additional symptoms to support a diagnosis of:

A. Post traumatic stress disorder

B. Acute stress response

C. Dissociative disorder

D. Panic disorder
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YouTube: https://www.youtube.com/watch?v=gvM_PjicmQI&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=40

The PMHNP is asked to evaluate a 5-year-old child who has been having difficulty adjusting to kindergarten and has been disruptive in the classroom. The child is pleasant in the office, responds to questions, and seems to understand that she is having this appointment because she does not seem happy in kindergarten. Via role play and discussion the PMHNP learns that the child is sad and frightened because she was angry with her Daddy and wished he didn’t live there anymore. Very shortly thereafter, her parents told her that Daddy would be moving out. Daddy moving out made Mom sad, the 5-year-old thinks it’s all her fault. This is why she is so unhappy. This is characteristic of which of Piaget’s developmental stages?

A. Sensorimotor

B. Preoperational

C. Concrete operational

D. Formal operational
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YouTube: https://www.youtube.com/watch?v=qmn1sXSUmTI&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=39

While performing a mental status exam, the PMHNP asks the patient to count backwards, beginning with 100 and subtracting 7. This is an effort to assess which element of the mental status exam?

A. Concentration

B. Orientation

C. Visuospatial function

D. Recall
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YouTube: https://www.youtube.com/watch?v=p3x-HNGaWXY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=38

A new patient is being evaluated at the request of her primary care provider. While conducting the interview the PMHNP has a very difficult time getting direct answers to questions. The patient will try to answer but often drifts off topic, talking about things that appear related, but she never actually answers the question. The PMHNP documents which abnormality of thought process?

A. Circumstantiality

B. Tangentiality

C. Perseveration

D. Flight of ideas
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YouTube: https://www.youtube.com/watch?v=zjym13JPesM&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=37

When counseling the parents of a 7-year-old patient regarding pharmacotherapy for attention deficit disorder, the PMHNP identifies which clinically relevant difference between clonidine and guanfacine?

A. Guanfacine may be used as adjunct therapy to psychostimulants.

B. Clonidine is available in a long-acting formulation.

C. Clonidine is selective for alpha-2a adrenergic receptors.

D. Guanfacine is appreciably less sedating.
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YouTube: https://www.youtube.com/watch?v=8jYx5O0eEOQ&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=36