Upon auscultation at the apex, the APRN hears a grade 3 systolic heart murmur that is soft and blowing in character. What does this finding suggest?

A mother presents to the nurse practitioner with her 10-year-old son for a routine well check and a flu shot. She asks the NP if there are any vaccines he is not up-to-date on. The NP explains that the HPV vaccine (Gardasil 9) is indicated for which of the following groups?

Two weeks ago, the PMHNP prescribed the antidepressant escitalopram (Lexapro) for a 28-year-old female client with generalized anxiety disorder. At her initial appointment, she scored 28 on the Hamilton Anxiety Rating Scale (HAM-A). At today’s follow-up visit, she scored 26. She reports no side effects from the Lexapro. Which of the following is the next step for the PMHNP?

A 10-year-old boy displays deficits in intellectual functions that involve his ability to reason, solve problems, and learn from instruction or experience. He has been slow to develop skills in school and is behind his peers in reading, writing, and mathematical abilities. As a result, he has significant impairments in his ability to develop socially appropriate interpersonal communication skills and has developed no real friendships. He is dependent on others for assistance with his basic needs, such as dressing and feeding. Which of the following diagnoses most accurately represents this presentation?

A 4-year-old child is preoccupied with her mother's breasts and frequently wants to gently pat them with her hands. Her mother does not visibly react to this; instead, she redirects the child to another activity. The mother is worried that if she shames her daughter about the breast patting, it might "mess her up somehow." According to Erikson, the child's behavior is considered:

The PMHNP is evaluating a new patient, a 33-year-old woman. She reports feeling "keyed up" most of the time, having constant muscle tension, and excessively worrying about "every little thing." These symptoms have been occurring for about 9 months, and they are causing her significant distress at home and at work. She takes no medications, and her lab work and physical exam are negative for an underlying medical cause for these symptoms. What diagnosis is most likely?

The father of an 18-year-old girl who is being treated for generalized anxiety disorder with panic attacks calls the PMHNP with questions about the medications she was prescribed. He demands the information because the patient lives in his home and is on his health insurance plan. What should the nurse practitioner do?

A PMHNP would like to monitor a client's progress in anxiety symptom reduction over time using a clinician-administered anxiety rating scale. Which of the following is the most commonly used clinician-administered anxiety rating scale?

The parents of a 14-year-old female high school freshman bring her to the PMHNP for an evaluation. They believe she should be doing better in high school due to her "gifted" status. They state that she has a formal IQ score of 125 and that her grades were mostly As through 5th grade. Now, she hands in her papers late and her grades are dropping to mostly Bs and Cs. During her psychiatric evaluation, the girl reports that high school is different from elementary school and junior high because now she has to write papers. She says she often turns them in late due to procrastination and forgetfulness. She reports a long history of inability to sustain attention while in class or doing homework, failure to pay attention to details or finish chores or tasks, significant difficulties with time management, planning, and organization. She is forgetful, often loses things, and is easily distracted. She has no history of restlessness or impulsivity, and she is popular with her peers. What is the most likely 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?

A 6-year-old boy has difficulty making friends and problems with initiating and sustaining back-and-forth conversation. He also has trouble reading social cues and sharing his feelings with others. He has a range of affect that generally seems appropriate to the situation, makes good eye contact, displays appropriate facial gestures, and has normal speech intonation. He demonstrates an interest in space ships that seems abnormally excessive in intensity and focus. He engages in little imaginative play. Which of the following diagnostic requirements for autism spectrum disorder are NOT met in this case?