A 5-year-old child is accompanied by the foster mother for evaluation of behavioral problems. The foster mother is experienced and has been very successful with children, but this child is very concerning. He has frequent, unexpected episodes of mood and reaction extremes including irritability, sadness, and fearfulness that are disproportionate to the situation. Suspecting reactive attachment disorder, the PMHNP anticipates which of the following to be reported by the foster mother?

A. Failure to seek or respond to comfort when distressed

B. Atypical dependency on toys and items that provide comfort

C. Early toilet training with paradoxical persistent nocturnal enuresis

D. Tendency toward aggressive behavior and cruelty to animals

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YouTube: https://www.youtube.com/watch?v=dZOmyrOPIDA&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=127

Jennifer is a 27-year-old female who has been in psychiatric care for several months for a diagnosis of bipolar disorder. She has not responded to three different pharmacotherapeutic approaches and as a result she is now being evaluated by a new PMHNP provider. She maintains that she has always taken all medications as prescribed but all they do is make her tired. Further she is emphatic that the last provider “did not know what he was doing” but she has heard that the new NP is “really great” and so she is very hopeful. Jennifer further states that she “really needs help right away” because her bipolar disorder is causing lots of problems with her relationship with her significant other. Her behavior during the visit is quite dramatic and virtually all of her descriptions are extreme.

Exploring a diagnosis of borderline personality disorder, the NP anticipates which of the following in Jennifer’s history?

A. Depressive episodes characterized by passive SI

B. Use of recreational substances to help with mood

C. Difficulty with relationships as home and work

D. Manic episodes that can last for several hours

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YouTube: https://www.youtube.com/watch?v=67vx42geUrw&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=126

A patient is mandated to care by court for evaluation and treatment of substance use disorder. He has a history of polysubstance abuse including ETOH, benzodiazepines, and marijuana. He is very resistant to the interview, sits with arms crossed, avoids eye contact, and only offers minimal verbal responses. The PMHNP asks the patient why he doesn’t want to talk about why he is there. The patient responds, “You are just going judge me and blame me, what’s the point?”

The PMHNP recognizes that this is likely:

A. Passive-aggressive behavior

B. Transference

C. Splitting

D. Catastrophizing

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YouTube: https://www.youtube.com/watch?v=HBgF3KS6jjg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=125