A 45-year-old female with a history of opioid use disorder p…
A 45-year-old female with a history of opioid use disorder presents with concerns for cravings and urges to use opioids. She has recently transitioned from the prison environment and is facing challenges with transitioning to the community. She has not used opioids for over a year. Which of the following medications would be the most appropriate for this patient to start?
Read DetailsA 50-year old physician presents with complaints of anhedoni…
A 50-year old physician presents with complaints of anhedonia, fatigue, headache, abdominal distress, and weight loss. His husband reports increasing irritability, inattentiveness and low libido over the last month. He was seen by his primary care provider who just notified him he had pre-diabetes, hypercholesterolemia and hypertension despite weight loss. These findings are most consistent with
Read DetailsA 10-year-old boy is referred by the school nurse because of…
A 10-year-old boy is referred by the school nurse because of persistent stomachaches every morning in school. In evaluating the boy, the PMHNP learned that he does not like to go to school and insists on coming home immediately, and that he sleeps in his parent’s bed at night. His clinical description is most characteristic of which of the following conditions?
Read DetailsA 25-year-old female presents to the emergency department, h…
A 25-year-old female presents to the emergency department, having just witnessed an accident. Her speech is pressured. She states, “There were a lot of people in need of care at the scene, and I should know because I have traveled to many Third World countries. I know how bad needs can get. The people were injured, and I was hit by a car before but I did not suffer any injuries. There were a lot of police cars and ambulances.” The patient was triaged to psychiatry. The PMHNP describes her thought process as:
Read DetailsThe psychiatric-mental health nurse practitioner uses a cogn…
The psychiatric-mental health nurse practitioner uses a cognitive-behavioral approach to help a patient address self-defeating behaviors. After identifying the stressor that causes the inappropriate behavior, the initial strategy is to explore:
Read DetailsA 42-year-old man presents with recurrent episodes of major…
A 42-year-old man presents with recurrent episodes of major depressive disorder. He generally experiences remissions at therapeutic doses of serotonin reuptake inhibitors but has subsequently required dosage escalations to control symptoms. He was eventually changed to a new medication due to resistance to adequate trials at maximum dosages. His only current medication is sertraline 200 mg per day. His adult children brought him to the emergency department due to concerns that he is behaving differently than during past episodes of depression. They report he has withdrawn from them and refuses to speak to anyone. He sits in his recliner all day and stares straight ahead. They have been unable to get him to eat for two days. They even tried to put a glass of juice in his hand and lift it to his mouth, at which time he kept his hand up by his mouth but did not take a drink. They ended up removing the glass from his hand so that he did not accidentally break it. His mental status exam is significant for lack of speech and lack of movement except for purposelessly keeping his right arm up in the air. When the examiner attempts to lower the patient’s arm, he demonstrates slight, even resistance. Which of the following is the best initial step?
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