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 medic...

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. ...

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 wit...

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 mus...

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, hypocholesterole...

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 w...

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....

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...

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 recog...

A 39-year-old male patient presents asking for pharmacotherapy to help with difficulty falling asleep. He denies any psychiatric history and is in good health. He is currently struggling with sleep because he is going through a difficult divorce and while he acknowledges that he has to work through it, the difficulty sleeping is so profound right now that it is making it difficult for him to be effective at work. The patient agrees to have an evaluation with a therapist, and the PMHNP agrees ...