PMHNP Certification Q & A

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 distrau...

A 48-year-old patient who reports a diagnosis of obsessive-compulsive disorder has transferred to your care after moving from out of state. You are unable to obtain medical records and must rely on the patient for information. During the initial appointment the patient says reports a very stressful home life. She has a school-aged daughter with severe chronic illness who requires 24-7 total care, as well as some other stressors related to her other children and finances. The patient says that for several years she has been in exposure-response therapy with intermittent, inconsistent improvement, and took fluvoxamine 300 mg daily which...

A patient with bipolar I disorder is currently being managed with lithium, 60 mg q.h.s. along with quetiapine 300 mg daily. The patient presents today for follow-up and reports that her mood has been very stable. Her work as a pastry chef has been really stressful around the holiday season, but she has handled it well and has no concerns about any mood deviations, either manic or depressive. She is sleeping approximately 7 hours nightly. Her last blood work was 7 months ago, and at the time there were no alarm findings in her lithium level, renal function tests, TSH, or...

A 27-year-old patient presents for evaluation at the suggestion of his intimate partner who thinks he might have depression. During the initial evaluation the patient admits that he is often “down,” has a really hard time feeling happy even when really good things happen. He denies any particular precipitating factor and in retrospect thinks he has been like this for “years.” He denies any difficulty sleeping, although says he never really wakes up feeling “well-rested and ready to go.” His appetite is fine, he denies any thoughts of death, suicide or self-harm, and denies a sense of hopelessness about life. 

The PMHNP is seeing a patient who has been struggling with a collection of anxiety and depressive symptoms. She is resistant to pharmacotherapy and prefers to begin with a psychotherapy approach. As it turns out, the primary source of her symptoms is that she is married to a spouse in the military and has had to move thousands of miles from home, friends and family. 

An attempt to implement solution-focused therapy would include which of the following techniques? 

A. Motivational interviewing 

B. Cognitive restructuring 

C. Social skills training 

D. The m...

The PMHNP is interviewing a new patient, a 32-year-old single female who is presenting for evaluation of underlying anxiety. While collecting a social history the PMNP asks the patient if she has a boyfriend. The patient is uncomfortable with the question as she is lesbian and is now afraid that the PMHNP will not treat her fairly and with dignity. 

The PMHNP is most likely demonstrating which of the following? 

A. An appropriate approach to collecting social history

B.  A manifestation of implicit bias

C. An overt implementation of her value sys...

A 64-year-old patient presents with new onset anxiety. She denies any history of anxiety disorder or any psychiatric disorder previously in her life, but for the last 9 months she has been having episodes that she describes as “attacks.” Out of the blue she will develop a sense of racing heart, hyperventilation, numbness and tingling in her arms, and feeling lightheaded. She worries about this a lot, and now worries virtually all the time about why this is happening. It is causing difficulty with sleeping, and she finds herself being very irritable at home and at work. 

These episo...

The dopamine hypothesis of schizophrenia postulates an abnormality in which of the following dopamine pathway as the etiology of symptoms?  Select all that apply. 

A. The mesolimbic pathway

B. The mesocortical pathway

C. The nigrostriatal pathway 

D. The tuberoinfundibular pathway 

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YouTube: https://www.youtube.com/watch?v=oQ42kYfwJU4&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=103

The PMHNP is seeing a patient who presents with a chief complaint of feeling depressed. Further exploration reveals that while the patient does have several symptoms of a depressive episode, he does not quite meet criteria for any of the commonly encountered depressive disorders. The primary issue seems to center around the fact that the client feels as if his life has no meaning. He says he gets up, he gets dressed, goes to work, pays the bills, does all of the things he is supposed to do in life, but he struggles with the question, “what is the po...

The PMHNP is evaluating a 69-year-old patient who has self-referred for evaluation. The patient retired from his professional role as a CEO from a major fortune 500 company 8 months ago and admits that he feels himself sinking into an uncharacteristic depression. For most of his life he has been a high-achiever, and he retired 8 months ago with the intention of enjoying the wealth he worked so hard to build. While he did take some big trips and had a lot of fun at first, now he feels oddly empty and for no good reason feels himself sinking into depression. 

Which of the following medical conditions should be considered when a patient presents complaining of new onset  episodes of anxiety-like symptoms including hypervigilance, tremulousness, tachycardia, and palpitations? 

A. Hypothyroidism

B. Insulinoma

C. Anemia 

D. Hepatitis 

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YouTube: https://www.youtube.com/watch?v=PgcoKYwUNMo&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=100

A PMHNP partners with a local women’s health practice to develop a program to screen pregnant women for depression in an effort to identify patients at high risk for post-partum depression and institute treatment as appropriate. This is an example of which level of prevention? 

A. Primary prevention 

B. Secondary prevention

C. Tertiary prevention 

D. Collaborative prevention

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YouTube: https://www.youtube.com/watch?v=QtlF5hZ5e0U&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=100

The PMHNP is evaluating a patient who has presented for care repeatedly reporting that she is bipolar and has manic episodes. She has been medicated in the past with a number of mood stabilizers without any meaningful improvement. Today a more detailed history reports that what she is calling manic episodes are actually periods of dramatic responses to stressors. When she argues with her significant other, her mother, and even people at work she becomes very animated. In response to stressors she is very dramatic and defensive, will react in an erratic fashion, but then often within hours goes...

A 67-year-old female is being evaluated for complaints of depression. She has always struggled with times where she was down but never liked taking medication and has tried to treat herself with nutraceuticals. Her symptoms have gotten much worse lately because her husband died and she is struggling with that. She has been seeing a therapist for the last few months but is not feeling any real improvement.

When considering pharmacotherapy for her, which of the following medications should be avoided? 

A. Sertraline (Zoloft) 

B. Bupropion (Wellbutrin) 

C. Escitalopram (Lexapro) 

D...

The PMHNP is evaluating a family at the request of county social services. A mother, father, 8-year-old and 2-year-old are present for the evaluation. The NP notes that the 2-year-old clings excessively to the parents, despite the fact that the parents do not seem to be particularly responsive to the child’s caution.  The 2-year-old does not exhibit typical curiosity about his new environment and does not express any curiosity about the PMHNP. 

These behaviors are consistent with:

A. Separation anxiety disorder 

B. Normal behavior

C. Autism spectrum disorder. 

D. Ins...

A 78-year-old man presents for a follow-up visit. Two months ago he was started on sertraline  for major depressive disorder and has been titrated up to 100 mg daily. Today his daughter reports that she cannot really evaluate if his mood has improved because he seems to have become confused. The patient’s daughter reports a distinct new onset confusion and forgetfulness. 

The PMHNP considers the most likely cause of his confusion to be: 

A. Urinary tract infection. 

B. Hyponatremia

C. Alzheimer’s disease 

D. Depression 

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Cognitive assessment in children characterizes stages of development consistent with Piaget’s developmental theory. One of the cognitive principles typically developed during the sensorimotor stage is: 

A. Object permanence

B. Animalistic thinking

C. Phenomenalistic causality 

D. Learning without reasoning. 

YouTube: https://www.youtube.com/watch?v=AIZ5H14yUqI&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=94

A 12-year-old patient is being seen today in follow-up after being started on fluoxetine 1 month ago for a diagnosis of generalized anxiety disorder.  The patient and her father both report that while there does appear to be a mild improvement in anxiety, some adverse effects have developed about which they are concerned. 

Which of the following is not an expected adverse effect and is a cause for concern?  

A. Vivid nightmares 

B. Diaphoresis 

C. Restless legs 

D. Impulsivity

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The PMHNP is evaluating a patient who presents complaining of panic attacks that occur for no identifiable reason. The patients has been treated for these previously with a variety of pharmacotherapies that did not provide any meaningful improvement. Upon further conversation, the NP learns that the patient experienced a near-fatal bicycle accident  4 years ago after being hit by a car. 

When considering a diagnosis of PTSD, the NP explores his history for all of the following diagnostic criteria except: 

A. Intrusion symptoms. 

B. Angry outbursts. 

C. Negative cognition 

D. Avoida...

J.B. is a 41-year-old female patient who is being managed for obsessive compulsive disorder. She has been in exposure response therapy (ERT) for several months with marginal improvement, but she has never approached true remission. At one time she was on fluvoxamine with notable improvement, but after a few months it ceased to produce any notable impact and after conferring with her therapist she was converted to fluoxetine 20 mg qd. After two months she was still struggling with symptoms, so two months ago her dose was increased to 40 mg qd. Today she presents for follow-up, reporting no notable...

The PMHNP is evaluating a patient with significant anxiety and depressive symptoms. In the course of the evaluation the NP further appreciates that the patient is having hypnopompic hallucinations, and that the patient is very concerned about this because his uncle has schizophrenia. 

The PMHNP advises the patient that: 

A. There are a variety of pharmacologic options that can be helpful. 

B. The hallucinations are benign and not a cause for concern.

C. There is no need for intervention unless they are accompanied by sleep paralysis.

D. The sensory sys...

A.J. is an 8-year-old male who is under the care of the PMHNP for ADHD.  His symptoms are profound, and the recommendation is to begin psychostimulant therapy along with behavioral therapy.  The parents are concerned because they have read that psychostimulant therapy can impact growth and final adult height if the child starts taking it before the growth spurt of adolescence.

The most appropriate response to the parents is to say that: 

A. The impact on growth can be minimized by taking breaks from the medication on weekends and over the summer

B...

A 14-year-old patient has been managed for the last year with fluoxetine 40 mg daily for a diagnosis of generalized anxiety disorder. She had been doing well, but today her mother reports that ever since returning to school after the summer break she has been distant, sullen, argumentative and defiant. She has been spending time with new friends from school and is always out somewhere with them.

The PMHNP recognizes that today’s appointment should include use of which of the following objective tools?  

A. The AIMS tool 

B. The BPRS 

C. The M...

PMHNP is asked to evaluate a 71-year-old male patient who is reportedly having visual hallucinations. His adult daughter accompanies him to the appointment and reports that he was diagnosed with Parkinson’s disease approximately 2 years ago. It began with the classic motor symptoms, but over the last year he has developed more and more difficulty with memory loss, difficulty with decision making, and episodes of depression and apathy. Sinemet has helped his motor symptoms, but he has not responded well to medications for cognitive symptoms.  A few months ago he started having visual hallucinations. At first it was a sen...

A 71-year-old patient with neurocognitive disorder due to Lewy Body disease presents for a routine follow-up.  His wife reveals that he seems to be hallucinating, sometimes at night becoming very agitated as a result of visual hallucinations, and she is afraid for his safety. The patient himself does not really seem to understand that there is a problem, but his wife is very concerned and firm that he seems to have visual hallucinations more and more frequently. 

Which of the following medications would be most appropriate? 

A. Risperidone 

B. Olanzapine 

C. Halop...

A.G. is a 51-year-old female patient who is being managed for a variety of mental health conditions including bipolar disorder, opioid use disorder, generalized anxiety disorder, and adjustment disorder.  Her medication regimen includes a buprenorphine-based medication for OUD, an antipsychotic, an SSRI, and antihistamine. 

The physical examination documentation for each encounter should include a(n) :

A. A PHQ-9 

B. An AIMS score 

C. A GAD-7 

D. An ORT 

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YouTube: https://www.youtube.com/watch?v=MYOGl9FLV40&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=85

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A 31-year-old Middle Eastern female presents to establish care. She recently relocated to the United States with her husband and is struggling with living in an environment so different from that in which she grew up. She shares that her husband seems more comfortable because he is working and integrating outside of the home, but she does not have that experience and feels very isolated from everything she knows. She is in her first trimester of pregnancy with their first child, and clearly struggling with the cultural shift  of living in the United States. 

The PMHNP recognizes th...

The PMHNP is conducting a new patient assessment with a patient who has self-referred for treatment of her panic attacks. The patient relates that she has had anxiety for years, and that she has episodes during which she gets very agitated, she can feel her heart pounding, feels as if she cannot breathe, feels very shaky, and has to sit down and wait for it to pass. These episodes can last for more than 15 minutes until she starts to calm down. 

Which of the following is inconsistent with diagnostic criteria of a panic attack?  

A. Th...

A 22-year-old female patient is transferred to your care after another provider in the practice retired. She has been managed for bipolar I disorder for 3 years and has had some challenging extremes of exacerbation. She is currently taking a mood stabilizer, an antipsychotic, and an antidepressant. Today she reports a worsening of her depression, admitting to true hopelessness about the future, worsening malaise to the extent that she is not attending to basic hygiene, and for the first time reporting passive suicidal ideation. While her ideation does not rise to the level of hospitalization, it is a new and...

A patient with a history of rapid-cycling bipolar disorder presents for evaluation of her current, profound depressive symptoms. The patient has been maintained for the last two years on valproic acid and quetiapine, but now a major depressive episode has occurred and the patient is reporting passive suicidal ideation. 

Concerned that the suicidal ideation may progress, the PMHNP consider which of the following pharmacotherapeutic options? 

A. Cariprazine 

B. Lumateperone 

C. Aripiprazole 

D. Lithium

The PMHNP is seeing a patient who presents for complaint of depressive symptoms. The patient reports a history of anhedonia, hopelessness, worthlessness, sleep dysfunction, marked decrease in appetite with an unplanned 5 lb wt loss in the last month, and a marked inability to concentrate on necessary tasks. 

Before diagnosing the patient with major depressive disorder and beginning antidepressive therapy, the PMHNP should: 

A. Document a Patient Health Questionnaire-9 

B. Administer a Mood Disorder Questionnaire 

C. Refer the patient to cognitive behavioral therapy 

D. Order a TSH and a CBC to ru...

The PMHNP has a new patient who reminds her of a former teacher who played an important role in her life and whom she regards as a mentor. The NP is concerned that she may express countertransference and is especially watchful for all of the following except: 

A. Resistance and strong emotion from the patient

B. Dreaming about the patient

C. Extending appointments beyond normal time frame 

D. Offering small, inexpensive gifts occasionally to the patient 

The PMHNP is conducting a follow-up appointment with a patient who is being treated for generalized anxiety disorder. The patient has a long-standing difficult relationship with her mother and today it is evident that this is being exacerbated by her mother recently being diagnosed with cancer. Her mother does not appear to appreciate the sacrifices that the patient is making to help her, and the patient is very upset by this.  At this appointment the patient is agitated and begins to perseverate over the lack of participation by other family members. 

The NP, in an attempt to re...

The mother of a 3-year-old female brings her daughter in for a psychiatric evaluation. The mother is concerned because she sometimes sees her daughter talking to an “imaginary friend” and Mom is worried because she has a cousin with schizophrenia. Further the staff at her daughter’s daycare report that this little girl seems to prefer playing alone, even though there are lots of other children to play with. The child does not want to share her toys, and does not seem interested in playing with other children. 

The PMHNP recognizes that it is likely that: 

A. The...

The PMNP is evaluating a patient who is being treated for obsessive compulsive disorder with fluoxetine 60 mg daily. The patient has been on fluoxetine for months without any concerning adverse effects, but today the patient reports that for the past few weeks she has had a distinct sense of agitation, racing heart, nausea, and has been really clumsy. Suspecting serotonin syndrome, the NP assess for: 

A. New onset delusional thought 

B. Constipation 

C. Irritability 

D. Recent use of OTC cough medicine

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The PMHNP is on call at the residential treatment facility and is called to urgently see a patient being treated for methamphetamine use disorder. The patient was admitted earlier this day and being and was still being assessed for appropriate psychotherapy and medication needs. Facility staff was performing routine observation rounds and found the patient unresponsive. You arrive at the bedside and find the patient to be unresponsive, with a blood pressure of 78/50 mm Hg and a respiratory rate of 7 breaths/minute. 

The appropriate response is to: 

A. Immediately review the records for all known su...

A 32-year-old female patient tells the PMHNP in the course of an office visit that her toddler’s pediatrician has suggested that the 3-year-old be referred for further assessment because his MCHAT-R score was high. Your patient is upset and does not think that the result was correct. Which of the following findings in the child would support an elevated MCHAT R score? 

A. The child is mostly non-verbal and uses gestures to communicate

B. The child’s growth is not maintaining a consistent pattern 

C. A 5 day history of painful vesicular lesions over t...

Which of the following is a true statement with respect to the CAGE-AID questionnaire? 

A. It is a 5-item questionnaire used to screen for alcohol use disorder 

B. A “yes” answer to 1 item is considered highly sensitive for use disorder

C. A positive CAGE questionnaire mandates intervention for use disorder 

D. Volume of alcohol or drug use is not a factor in a positive result

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YouTube: https://www.youtube.com/watch?v=-HCBrL4iP7o&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=73

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 Hg...

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.