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 refocus the patient on the primary problem, says which of the following?

A. “You said that the family is not helping?”

B. “You are close to tears. This is a hard subject for you.”

C. “You feel betrayed because the family is not helping.”

D. “You were talking about how irritated you were by your mother.

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YouTube: https://www.youtube.com/watch?v=xg_1qLCRWQc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=78

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 child may be demonstrating early indicators of schizophrenia which is possible due to family history.

B. These behaviors are consistent with developmental stage and not a cause for concern.

C. Play therapy with an early-childhood therapist may help her integrate better with other children

D. Autism spectrum disorder is more likely than schizophrenia given the child’s age.

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YouTube: https://www.youtube.com/watch?v=p_bkWpc69Z8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=77

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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YouTube: https://www.youtube.com/watch?v=VcyTSz7d4M4&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=76