A number of mood stabilizers and antipsychotics are indicated for the patient with bipolar disorder. Which of the following is a true statement with regard to lithium?

A. It is considered highly teratogenic in the second and third trimesters of pregnancy

B. It is the only mood stabilizer that has a demonstrated decrease in suicidal ideation

C. Lithium is indicated for acute states but not for prevention of cycling

D. Most consequences of lithium toxicity are reversible when levels normalize

Which of the following scenarios should prompt a PMHNP to self-reflect on the potential impact of countertransference on the patient/provider relationship? The PMHNP:

A. Gives gifts to a patient after several appointments

B. Shares several attributes with the patient’s spouse

C. Is very firm with respect to boundary setting

D. Refuses to prescribe controlled substances

A 34-year-old female patient presents for treatment. She has been on and off medication for schizophrenia for years but has historically been non-adherent to pharmacotherapy because of the adverse effects. When considering olanzapine therapy for this patient, the PMHNP advises that she will need to be monitored for:

A. Absolute neutrophil count (ANC)

B. Hypertension, hyponatremia and hypertriglyceridemia

C. Extrapyramidal symptoms and irregular menses

D. Weight gain, hyperglycemia and dyslipidemia

A PMHNP student is beginning his clinical practicum in a child and adolescent psychiatry practice and quickly realizes that performing patient interviews in school-aged children is very different than performing interviews with adults.

Which of the following techniques is recommended for developing a therapeutic bond with a 10-year-old child?

A. Separating the child from the parents for the initial interview

B. Offering to play a game that the child enjoys

C. Reassuring the child that anything said is confidential

D. Offering snacks popular among children

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YouTube: https://www.youtube.com/watch?v=U9P5NLsyd1Q&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=57

A 77-year-old male is admitted to the emergency department from a long-term care facility where he has lived for over 3 years. He has been maintained on antipsychotic medications for years but recently required a change to a first-generation agent as his symptoms were breaking through on even high doses of olanzapine. Last evening staff reported that he was increasingly confused, and this morning he developed a fever of 102.6o F. Initial laboratory assessment must include a:

A. Urinalysis

B. Complete blood count

C. Creatine kinase

D. Complete metabolic panel

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YouTube: https://www.youtube.com/watch?v=hnhEx773lJw&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=56

The PMHNP is performing an initial history and physical examination on a new patient who has just transferred to his care from out of state. The patient has a complex psychiatric history including schizoaffective disorder, generalized anxiety disorder, prolonged grief reaction, and adjustment disorder. His medication list indicates that he has been taking clozapine 300 mg daily for 15 months.

The PMHNP recognizes that:

A. This dose is subtherapeutic and should be increased in increments of 25 mg daily to a goal dose of 600 mg/day

B. The patient must be routinely monitored for absolute neutrophil count

C. Lithium is contraindicated in patients taking clozapine

D. Clozapine is absolutely contraindicated in patients < 18 years of age

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YouTube: https://www.youtube.com/watch?v=G8vWlcwj1BY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=55

A 14-year-old patient is being managed for social anxiety by a therapist and is doing well. However, she reports having difficulty falling asleep most nights and is asking for medication to help her sleep. Her mother acknowledges the problem and is open to the option of sleeping medication as this has been a long-term problem.

The PMHNP knows that the approach to an adolescent patient with insomnia includes all of the following except:

A. Stopping daytime napping

B. Considering a melatonin agonis

C. Eliminating screen time one hour before bedtime

D. Considering a tricyclic antidepressant
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YouTube: https://www.youtube.com/watch?v=KmmQSG7kkR0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=54

A 32-year-old female is diagnosed with bipolar I disorder. While discussing with her information about her diagnosis, medications, and anticipated course of illness, the patient asks if she will need to be on medication forever of if this is something that will get better as she ages.

The PMHNP advised the patient that:

A. With good medication adherence, exacerbations will fade as she ages

B. Depressive episodes tend to be less severe but manic episodes tend to worsen

C. Depressive episodes tend to worsen but manic episodes tend to improve

D. The general trajectory of bipolar disorder typically worsens with age
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YouTube: https://www.youtube.com/watch?v=fwUe2Vsz-u8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=53