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 36-year-old man is evaluated by the PMHNP for a recent incident in which he stayed up for several nights in a row, had much more energy than usual, and believed he was talking to God. He was diagnosed with bipolar disorder. In reviewing his medications, the PMHNP finds he is taking acetaminophen 500 mg BID, bupropion XL (Wellbutrin) 150 mg once daily, Sam-E for pain from an old football injury, and alprazolam 0.5 mg pm for agitation. Which of these should be discontinued immediately?

The clock-drawing test (CDT) has become a standard cognitive screening tool around the world. Like all cognitive screening tests, it is designed to detect early brain changes to determine if a person may be experiencing dementia. Which of the following statements most accurately depicts the usefulness of this test?

The nurse practitioner (NP) is working in an urgent care clinic which advertises treatment for "broken bones." Which is not a correct definition of each classification of fracture?

An urgent care nurse practitioner comes in to examine his patient, a 77-year-old woman who was brought in by her family for altered mental status. He notes that the patient appears restless and does not know where she is. Upon further assessment, he notes that her pupils are sluggish to react to light and are unequal in size. She is unable to sit up at the side of the bed and her blood pressure is 190/88 mm Hg. Which of the following does the NP suspect?

The factors that raise the risk for heart disease, diabetes, and stroke are collectively known as:

The PMHNP works on an inpatient geriatric psychiatric unit. She knows that which of the following features is commonly present in Lewy body dementia?

In addition to the physical exam and functional assessment, which of the following is used to assess response to treatment for rheumatoid arthritis?

A 62-year-old woman presents to the PMHNP for an evaluation. She is concerned she is developing dementia due to her significant family history. Which of the following would help the PMHNP make a diagnosis of pseudodementia rather than dementia?

The PMHNP is evaluating a 7-year-old boy who is brought in by his grandmother. The child has epicanthal skin folds, a short nose, a small head circumference, and a smooth, indistinct philtrum. What is the most likely diagnosis?

A mom brings her 13-year-old daughter to the PMHNP for an evaluation of suspected attention-deficit hyperactivity disorder (ADHD). For an adolescent who presents with distractibility, which of the following additional features would suggest an association with bipolar II disorder rather than ADHD?