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

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 to short-term pharmacotherapy with trazodone.

What is the most important aspect of patient education for this patient?

A. He must be advised of the risk of priapism and what to do if it occurs

B. He must be advised that this is only a time-limited intervention and he cannot rely on medication-induced sleep indefinitely.

C. He must be advised that this should be taken on an empty stomach; if taken with food absorption is markedly delayed.

D. He must be advised that there may be some early morning fatigue that would also contribute to not feeling well rested.

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YouTube: https://www.youtube.com/watch?v=qnmaXQVuEfg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=124

The PMHNP has assumed care of a 32-year-old patient who is being managed for opioid use disorder with buprenorphine-naloxone 8.2 mg films t.i.d. The patient’s previous provider has moved out of state and no records are immediately available, the only information available is from the prescription monitoring program. The patient request to be treated with a buprenorphine-only formulation because he says that the he is allergic to naloxone. The NP considers which of the following? Choose all that apply.

A. Naloxone allergy is extremely rare and more likely any adverse reaction was due to precipitated opioid withdrawal

B. It is never appropriate to use buprenorphine without naloxone when it is being used for OUD.

C. Because the PMP shows that he has been prescribed a buprenorphine-naloxone combination for the last year is not possible that he is allergic.

D. It is easier to misuse buprenorphine without the naloxone component and the NP should evaluate for misuse.

A 27-year-old female patient presents for a follow-up appointment for generalized anxiety disorder. She has a complex history including polysubstance use disorder and borderline personality disorder, but she had been doing well. She achieved remission of her symptoms over one year ago and has been well managed on escitalopram 10 mg daily. She has been substance free for over one year, and is in therapy for her personality disorder. Today she is not feeling well. She reports some major psychosocial stressors and a brief substance relapse, but she stopped using all substances 2 days ago.

The PMHNP notes a pronounced postural and intention tremor and suspects this is due to withdrawal from which of the following substances?

A. Kratom

B. Opioids

C. Marijuana

D. Alcohol

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YouTube: https://www.youtube.com/watch?v=16Vg_4HFG1A&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=122

The PMHNP is managing a patient of Chinese ancestry with a diagnosis of bipolar disorder. The patient is currently experiencing some symptoms consistent with an early manic episode.

When considering prescribing carbamazepine, the NP considers that this patient is at particular risk for which of the following adverse effects?

A. Drug-induced hepatitis

B. Pancreatitis

C. Hypothyroidism

D. Toxic epidermal necrolysis

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YouTube: https://www.youtube.com/watch?v=5MaExNnaFDM&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=121

The PMHNP is called to the emergency department to evaluate a patient with an acute onset mental status change. The patient has a long history of schizophrenia and has been managed on a variety of antipsychotic therapies that have had some success, but the patient has not ever really achieved goal remission. Most recently he was started on a first generation antipsychotic along with benztropine (Cogentin). Today the patient is in the ED with confusion and muscle stiffness.

Which of the following represents anticipated vital signs?

A. T 103.5o F, P 54 bpm, RR 24 bpm, BP 150/100 mm Hg

B. T 102.5o F, P 129 bpm, RR 22 bpm, BP 170/110 mm Hg

C. T 96.4o F, P 60 bpm, RR 24 bpm, BP 190/120 mm Hg

D. T 98.6o F, P 102 bpm, RR 18 bpm, BP 147/99 mm Hg

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YouTube: https://www.youtube.com/watch?v=9emyKQQhmYc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=120

The PMHNP is evaluating a 73-year-old patient who has just been discharged from the hospital after being treated for a urinary tract infection with associated delirium. She has a baseline major neurocognitive disorder and the spouse has been told in the past that the patient cannot take antipsychotics. However, while she was hospitalized she was given an antipsychotic for delirium and it seemed to help a lot. The spouse wants to know why the patient cannot take an antipsychotic for her chronic behavioral symptoms.

The PMHNP knows that the patient most likely has which underlying cause of major neurocognitive disorder?

A. Pick’s disease (FTD)

B. Alzheimer’s disease (AD)

C. Vascular disease (VaD)

D. Parkinson’s disease (PD)

A 3-year-old child is being seen because the daycare facility staff have suggested to the parents that the child is having difficulty interacting with other children. Additionally, the staff have observed that when the child seems to become anxious or upset, he always becomes fixated on stacking building blocks one on top of the other to the extent that he will not acknowledge anyone or anything else.

When the parents ask if their child has autism spectrum disorder (ASD), the PMHNP advises the parents that:

A. The repetitive and predictable nature of stacking blocks is calming in children with ASD

B. Stacking blocks is a very typical activity in children at this developmental stage and is not suggestive of ASD.

C. The child should be tested for ASD, but in any event he should be discouraged from using building blocks as a coping mechanism.

D. While the social dysfunction at this age may suggest ASD, the building block activity is not an abnormal finding in a 3-year-old.

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YouTube: https://www.youtube.com/watch?v=rf3inZzulEg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=118