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 HgbA1c of 6.8%

B. An eGFR of 58 mL/min/1.73 m²

C. A Hgb of 13.1 g/dL

D. A GGT of 85 IU/L

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YouTube: https://www.youtube.com/watch?v=VXLFFzW6XyY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=72

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.

C. The likelihood that change in therapeutic technique will probably be necessary as an adjunct to medication.

D. Some degree of gastrointestinal side effects likely due to the higher doses of SSRIs needed for OCD.

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YouTube: https://www.youtube.com/watch?v=Y36NRk-2Oic&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=71

Developmental theorists often assert that dysfunction of some sort during growth and development may result in psychopathological traits in adulthood.

According to Erikson’s Developmental Theory, which of the following maladaptive developmental conflicts increases the risk of obsessive-compulsive disorder in adulthood?

A. Trust versus mistrust

B. Autonomy versus shame and doubt

C. Initiative versus guilt

D. Industry versus inferiority

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YouTube: https://www.youtube.com/watch?v=bQPxhPvMuPA&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=70