The PMHNP is evaluating a 4-year-old boy who is brought in by his foster mother. The child has been living with her for 1 week, and she is concerned about this behavior. Staff at the day care center he attends report that he displays fear unrelated to particular activities. Even when distressed, he does not seek comfort in, nor respond to, any staff members. What additional information about this child would be important in determining whether his symptoms represent reactive attachment disorder (RAD) or autism spectrum disorder (ASD)?

A 29-year-old female client with posttraumatic stress disorder (PTSD) is resistant to eye movement desensitization and reprocessing therapy (EMDR) because she has heard that past traumas must be re-experienced. She said she avoids thinking about the trauma and does not want to re-live it. What is the most appropriate response?

A 27-year-old married woman reports to the PMHNP that she is experiencing significant distress in her marriage because she "hates" going to social events, and her husband's job requires attending regular social gatherings. She avoids these activities because she is "terrified" she will do or say something embarrassing, and she has started pretending she has headaches to get out of going to them. Her husband doesn't understand why she doesn't want to go to these parties, which are typically small gatherings of less than 15 people. She admits that when she does go, they end up being "no big deal." The PMHNP will diagnose this woman with which of the following?

A 21-year-old unmarried man has near-daily intrusive thoughts that his neighbors knock on his door at night. He tells the PMHNP he knows this knocking is just his "imagination" because the neighbors work nights and are not home. However, he feels compelled to get out of bed and open the door, no matter what time it is. He opens and closes the door repeatedly for at least an hour, sometimes longer. He says he has had this problem "in the past" and did not seek help for it. This time it has been going on at least 6 months and is becoming "problematic." It is interfering with his ability to get a good night's sleep and he is having problems at work. His roommate is also very troubled by it. The PMHNP will diagnose him with which of the following?

A 25-year-old female pharmaceutical sales representative presents to the PMHNP for an evaluation due to what she calls an increasing level of anxiety about her job, which she has had for approximately 1 year. She works from a home office, and it has become unorganized and cluttered. She frequently forgets deadlines for submitting reports, and as a result she turns them in at the last minute. She has been chastised more than once by her boss for not paying attention to details on these necessary reports. Because she does not report to anyone on a day-to-day basis, she often gets completely overwhelmed by the autonomy of the job, and as a result she completely "shuts down." She knows she should be planning her time better, but she has never been good at time management or planning. During her evaluation, she reports making excellent grades until she got to college. She says she can remember not being able to pay attention to teachers as early as first grade, and her report cards frequently said she talked too much. She often got in trouble at home for not finishing chores because she was easily distracted and forgetful. Today, she says she is getting so overwhelmed and anxious about her job performance that she is thinking about quitting. She says her friends are tired of her complaining and tell her she has it "so good." She wishes someone would just tell her exactly what to do every day so she didn't have to think about anything.

A parent previously agreed that the psychiatric-mental health nurse practitioner (PMHNP) and her 17-year-old son could discuss his treatment in confidentiality. Now, the mother is calling the PMHNP asking about his most recent diagnosis of gender dysphoria. What should the PMHNP do?

A 13-year-old boy has developed concentration problems in school, accompanied by a significant decline in grades. When evaluated, he explains that he has been worrying about his grandfather, with whom he is extremely close. His grandfather was recently diagnosed with Alzheimer's disease, and the boy has been helping his mother take care of him. As his grades decline, he becomes increasingly sad and his energy level drops, which further hinders his ability to pay attention in school. He also complains of being restless and unable to sleep. What is the most likely diagnosis?

The parents of a 16-year-old adolescent girl come to the PMHNP requesting treatment for her "so-called gender issues." The mother cries while the father says, "She says she has wanted to be a boy ever since she was 4 years old. This is all just nonsense. It's a phase, and the sooner she gets over it, the better." The daughter acknowledges "feeling like a boy" since the age of 4, and she currently binds her breasts. She also wants to be called by a male name. Her father wants to send her to conversion therapy offered by their church. The mother wants to know the PMHNP's opinion. Which of the following is the most appropriate response?

A 19-year-old man presents to the PMHNP for a psychiatric evaluation with a chief complaint of intrusive thoughts and compulsive behaviors. Of the following, which is considered the gold standard assessment tool for obsessive-compulsive disorder (OCD) severity?

The PMHNP working on an inpatient eating disorders unit is evaluating a 17-year-old girl with suspected anorexia nervosa. Her laboratory results reveal elevated serum cholesterol levels, elevated serum salivary amylase concentrations, and decreased fasting glucose concentrations. Which electrocardiography (ECG) changes will help confirm the diagnosis?

A 54-year-old Latino man receives a phone call that his mother has had a stroke and is in ICU at his local hospital. Soon after, he begins trembling, then shouting and screaming. The impression is that he is completely out of control. Which culture-bound syndrome should the PMHNP include in the differential diagnosis?