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.