The PMHNP has ordered a comprehensive metabolic panel, CBC, TSH, and HgbA1c as part of a new patient screening panel to evaluate very generic complaints of fatigue, decreased motivation, and unplanned weight gain of 15 lbs in the last 6 months, insomnia and increased irritability. The patient believes he is depressed and is asking for an antidepressant, but the NP has concerns that the history provided is not complete and wants to ensure there is not an underlying organic etiology.

Which of the following abnormal results offers the best explanation for all reported symptoms?

A. A HgbA1c of 6.8%

B. An eGFR of 58 mL/min/1.73 m²

C. A Hgb of 13.1 g/dL

D. A GGT of 85 IU/L

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YouTube: https://www.youtube.com/watch?v=VXLFFzW6XyY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=72

The PMHNP is seeing a patient who has been in Exposure-Response Therapy for obsessive-compulsive disorder for the last four months with suboptimal clinical improvement. After consulting with the therapist the PMHNP is discussing the addition of pharmacotherapy with the patient. The patient is advised that SSRIs may be helpful, and the most appropriate treatment expectations include:

A. Allowing at least 12 weeks for onset of action then maintenance for at least one year.

B. Realizing that SSRIs are not as efficacious for OCD as they are for depression and anxiety disorders and that remission is unlikely.

C. The likelihood that change in therapeutic technique will probably be necessary as an adjunct to medication.

D. Some degree of gastrointestinal side effects likely due to the higher doses of SSRIs needed for OCD.

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YouTube: https://www.youtube.com/watch?v=Y36NRk-2Oic&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=71

Developmental theorists often assert that dysfunction of some sort during growth and development may result in psychopathological traits in adulthood.

According to Erikson’s Developmental Theory, which of the following maladaptive developmental conflicts increases the risk of obsessive-compulsive disorder in adulthood?

A. Trust versus mistrust

B. Autonomy versus shame and doubt

C. Initiative versus guilt

D. Industry versus inferiority

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YouTube: https://www.youtube.com/watch?v=bQPxhPvMuPA&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=70

A 15-year-old male patient reveals that he does not feel comfortable in his body.

When considering a diagnosis of gender dysphoria the PMHNP recognizes that which of the following must be present to constitute this diagnosis?

A. A strong desire to be of a gender other than assigned at birth

B. Feelings associated with clinically significant distress

C. A need to be treated as the gender not assigned by birth

D. Plans for gender reassignment treatment

A 27-year-old female presents for therapy because she and her new husband are having difficulty adjusting to their new roles as spouses sharing a household who both work full time. There have been some struggles with regard to household tasks, communicating expectations, and other adjustments. After identifying the patient’s primary concerns the therapist determines that Interpersonal Therapy is the most appropriate approach to the patient. Therapeutic techniques are likely to include any of the following except:

A. Role playing

B. Communication analyses

C. Clarifying incidents

D. Examining motivation

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YouTube: https://www.youtube.com/watch?v=ruwc_xl8EL4&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=68

The PMHNP is evaluating a patient in follow-up and despite appropriate pharmacotherapy and psychotherapy the patient has not achieved a successful remission. The patient states that his therapist is very nice, but that therapy is not really helping. The patient relates that the therapist keeps talking about “phases of change” and steps like engagement, focusing, evoking, and planning. The PMHNP recognizes that the therapist is using which of the following?

A. Lewin’s Change Theory

B. Motivational Interviewing

C. Interpersonal Therapy

D. Cognitive Behavioral Therapy

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YouTube: https://www.youtube.com/watch?v=i_Ijalm5sNg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=67

Patient in mental health care may be at increased risk for demonstrating unhealthy coping mechanisms or inappropriate responses to distress. When your patient is angry with you for not making a medication change she requested, which of the following would be characterized as a passive-aggressive response?

A. Glaring at you for the rest of the visit and responding to every question with, “you don’t listen to me so why do you ask?”

B. Loudly complaining to you and other people in the waiting room that you don’t know what you are doing.

C. Purposefully missing her next appointment without calling to change or cancel

D. Telling you that she refuses to take any medication if you will not consider her input.

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YouTube: https://www.youtube.com/watch?v=qZRWPZFL0Eg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=66

An 18-year-old male patient has been treated successfully for bipolar II disorder as an outpatient with Risperdal, however now that he has symptom control he frequently forgets to takes his medication. The best approach to this patient would include:

A. Exploring reasons why he might not want to take it

B. Convert to IM administration

C. Change to another second generation antipsychotic

D. Add a mood stabilizer to his regimen

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YouTube: https://www.youtube.com/watch?v=EENe4WNB5W0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=65