A 22-year-old woman diagnosed with bipolar disorder missed her last two appointments with the PMHNP after she was started on lithium (Eskalith). Her mother brought her to a third appointment. The patient was excited to see the PMHNP, as evidenced by her rapid rate of speech and discussion about the book she was writing. The patient went on to say that God had spoken directly to her and given her a message that only she could give to the world. She said she hadn’t been able to sleep for at least 1 week because she had been so busy working on this book, but she felt “absolutely incredible” despite her lack of sleep. Both the patient and the mother insist she has not stopped taking her medication. The PMHNP orders laboratory studies, including a lithium level. Which level of lithium will be subtherapeutic and indicate a need for an increased dose?

A 63-year-old man was recently placed on warfarin (Coumadin) by his nurse practitioner. Which of the following supplements will he need to discontinue?

A 26-year-old female patient reports 1 week of an elevated and expansive mood. Along with other symptoms, evidence of which of the following would suggest she is experiencing a hypomanic, not a manic, episode?

A 35-year-old man with bipolar I disorder presents with a new-onset manic episode and is successfully treated with medication adjustment. He notes chronic depressive symptoms that, on reflection, long preceded his manic episodes. He describes these symptoms as "feeling down," having decreased energy, and more often than not, having no motivation. He denies other depressive symptoms but feels that these alone have been sufficient to negatively affect his marriage. Which diagnosis best fits his presentation?

A 19-year-old girl sustained multiple long bone fractures as a result of a motor vehicle crash and now is at risk for fat embolism. Which of the following signs and symptoms strongly suggest fat embolism?

A 24-year-old woman presents to the PMHNP for a psychiatric evaluation with a chief complaint of depression. Upon questioning, the client states that during certain periods of time, she has needed little sleep but still felt energetic. She has had "creative spurts” during these periods, during which she has started new projects, such as home decorating and writing a book. Which of the following assessment tools will the PMHNP use to assist in diagnosis?

The major characteristic that differentiates between delirium and dementia of Alzheimer’s type (DAT) is:

A 49-year-old female patient has been taking gabapentin for 6 months. It has produced some relief for her neuropathic pain, but she still rates her average daily pain at about a 5. What would be the next most appropriate treatment?

A 42-year-old woman recently diagnosed with rheumatoid arthritis asks the nurse practitioner about disease-modifying antirheumatic drugs (DMARDs). Which of the following statements about DMARDs is INCORRECT?

During an initial psychiatric evaluation on a 65-year-old man who is new to the practice, the patient expresses concern about his left foot "shaking." One of the differential diagnoses for dementia of Alzheimer’s type is Parkinson's disease. Which physical exam finding would be expected?

The PMHNP primarily works with older adult patients who frequently present with cognitive issues. He knows many people with Lewy body dementia are misdiagnosed or do not receive diagnosis for 18 months or more. Which of the following assessment tools does the PMHNP use to discriminate between Lewy body dementia (LBD), Parkinson's disease dementia (PDD), and mild cognitive impairment (MCI) due to Lewy body disease from other forms of cognitive impairment?