A 77-year-old male is admitted to the emergency department from a long-term care facility where he has lived for over 3 years. He has been maintained on antipsychotic medications for years but recently required a change to a first-generation agent as his symptoms were breaking through on even high doses of olanzapine. Last evening staff reported that he was increasingly confused, and this morning he developed a fever of 102.6o F. Initial laboratory assessment must include a:

A. Urinalysis

B. Complete blood count

C. Creatine kinase

D. Complete metabolic panel

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YouTube: https://www.youtube.com/watch?v=hnhEx773lJw&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=56

The PMHNP is performing an initial history and physical examination on a new patient who has just transferred to his care from out of state. The patient has a complex psychiatric history including schizoaffective disorder, generalized anxiety disorder, prolonged grief reaction, and adjustment disorder. His medication list indicates that he has been taking clozapine 300 mg daily for 15 months.

The PMHNP recognizes that:

A. This dose is subtherapeutic and should be increased in increments of 25 mg daily to a goal dose of 600 mg/day

B. The patient must be routinely monitored for absolute neutrophil count

C. Lithium is contraindicated in patients taking clozapine

D. Clozapine is absolutely contraindicated in patients < 18 years of age

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YouTube: https://www.youtube.com/watch?v=G8vWlcwj1BY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=55

A 14-year-old patient is being managed for social anxiety by a therapist and is doing well. However, she reports having difficulty falling asleep most nights and is asking for medication to help her sleep. Her mother acknowledges the problem and is open to the option of sleeping medication as this has been a long-term problem.

The PMHNP knows that the approach to an adolescent patient with insomnia includes all of the following except:

A. Stopping daytime napping

B. Considering a melatonin agonis

C. Eliminating screen time one hour before bedtime

D. Considering a tricyclic antidepressant
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YouTube: https://www.youtube.com/watch?v=KmmQSG7kkR0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=54