The PMHNP is performing a new patient assessment on a 41-year-old patient referred from primary care for depressive disorder refractory to SSRIs. During the mental status examination, the patient is unable to successfully perform a serial 7’s backward count. The NP documents an abnormal finding in the area of:

A. Speech

B. Thought process

C. Judgment

D. Cognition

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YouTube: https://www.youtube.com/watch?v=uQYdcEqFBLc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=117

Patients with a deficit in one of six neurocognitive domains to the extent that it represents a deterioration of function from their baseline and makes it impossible for them to live independently are diagnosed with major neurocognitive disorder.

Which of the following is not one of the six neurocognitive domains?

A. Learning and memory

B. Language

C. Perceptual motor

D. Cognition and emotion

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YouTube:https://www.youtube.com/watch?v=b9166JUmJLg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=116

The PMHNP is evaluating a new patient who has been referred by his employer for evaluation. His supervisor is concerned about his mental health and his safety. The NP evaluates the patient and does not find criteria consistent with major depressive disorder, but identifies which of the following as particularly concerning for risk of suicide?

A. Anhedonia

B. Hopelessness

C. Depressed mood

D. Weight loss

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YouTube: https://www.youtube.com/watch?v=sNlBelJr92M&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=115

The PMHNP is called to consult on a patient in the emergency department who has been admitted following a traumatic motor vehicle/pedestrian accident. He was walking across the street when a speeding driver crashed into him at high speed. The patient remarkably does not have serious injuries, the staff noted that he seemed a bit “odd” and decided to call for a mental health consult. The patient lives alone, has no close friends or family members to call, and appears disinterested in any discussion of interpersonal relationships.

The PMHNP recognizes that the most appropriate approach to this patient requires which of the following?

A. A warm, straightforward approach with particular attention to being non-judgmental.

B. A firm, professional approach with firm limit setting at the beginning of the encounter.

C. Particular attention to the need for insight-oriented therapy with the goal od increasing independence.

D. Referral to dialectical behavior therapy as a mechanism for promoting acceptance and change.

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YouTube: https://www.youtube.com/watch?v=CXMZcHbje1s&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=114

Which of the following laboratory abnormalities is not consistent with a female patient who drinks more than 3 alcoholic drinks daily?

A. Elevated high density lipoprotein

B. Elevated macrocytosis

C. Elevated transaminases

D. Elevated triglycerides

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YouTube: https://www.youtube.com/watch?v=XL6auWRfup8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=113

The PMHNP is counseling a patient who wants to enter treatment for a substance use disorder. The patient has been using methamphetamine for over one year and freely acknowledges how much he likes the way it makes him feel. However, he is realizing that it is destroying his marriage, his professional reputation, and his health. He genuinely wants to stop using it, and is willing to do whatever he has to do, but admit that he has tried twice before and relapsed. Both he and his significant other do not understand why the desire to use is so powerful since there is not a true physical withdrawal phenomenon.

The PMHNP explains that there is a very strong physiological drive due to the influence of which reward neurotransmitter?

A. Serotonin
B. Glutamae
C. Norepinephrine
D. Dopamine

When managing a patient in the stabilization phase of schizophrenia primary goals and process include which of the following?

A. Self-management skills

B. Supported employment

C. Assertive community treatment

D. Minimizing stress and supporting recovery

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YouTube: https://www.youtube.com/watch?v=3CM5_CTX69U&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=111

A 50 -year-old female patient has been followed by the PMHNP for over 6 years for a diagnosis of major depressive disorder, recurrent. The patient has achieved a successful remission on sertraline, 75 mg daily. Today presents complaining of an acute onset depressed mood, tearful days, and difficulty concentrating for the last month. It has become a problem at work, and her boss has suggested that she might need to take some time off to “take care of her problem.” Further discussion reveals that the patient learned last month that her husband is having an affair with a coworker. She is so distraught and consumed that she cannot fulfill her work responsibilities and she has completely cut herself off socially from friends and family.

The PMHNP suggests that the next best step in her care should include which of the following?

A. Increasing her sertraline to 100 mg daily

B. A referral to psychotherapy

C. A referral to couples counseling

D. Changing her pharmacotherapy to an SNRI

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YouTube: https://www.youtube.com/watch?v=I1kYlCdi7cg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=110