Focused Learning for ANCC Domain 3 | Case-
Based Exercises with Explanatory Notes
A patient presents for a clinic appointment and tells the psychiatric mental health nurse practitioner
(PMHNP), "My depression is a little better, but I read about acupuncture, and I want to add this to my
treatment." What is the PMHNPs best response to this patient?
a. Integrative therapies have no effectiveness in improving depressive symptoms and if your depression
has not improved and you have not achieved remission of your symptoms, I recommend that we
increase your antidepressant
b. Integrative therapies such as acupuncture are not well studied, and I cannot recommend that you add
this to your current treatment
c. Acupuncture is one of many integrative therapies, but it has the least effectiveness in improving
depression
d. Acupuncture has been found to help some individuals with depression. While the data is limited, if
this is something you would like to consider, let's talk about where you might find a reputable
practitioner for acupuncture treatments. - ✔✔d. Acupuncture has been found to help some individuals
with depression. While the data is limited, if this is something you would like to consider, let's talk about
where you might find a reputable practitioner for acupuncture treatments.
You are seeing a female patient who is morbidly obese. She also suffers from major depression, anxiety,
and antidepressant-induced decreased libido. She has been stabilized on Desvenlafaxine (Pristiq) 50 mg
1 PO QAM and Bupropion (Wellbutrin) 50 mg. She also take Mononessa (Ortho-Cyclen) 1 PO QAM and
Vitamin D 1000 IU PO QAM. She has had trouble maintaining weight loss on diet support programs, diet
medications, and self-directed food reduction plans. She asks you about using Phentermine to help her
lose weight. You discuss options with her and decide to:
A. Prescribe a one month course of Phentermine and Topiramate (Qsymia) 7.5/46 for 30 days. Have her
return to the clinic in 1 month for a checkup.
B. Prescribe a one month course of Phentermine (Adipex-P) 37.5 mg PO QAM. Have her come back in
one month for a check-up
C. Prescribe a 1 month course of Topiramate (Topamax) 50 mg 1 PO QHS. Have the patient come back in
1 month for a checkup. Let the patient know that you may have to increase the dosage at one-month
intervals.
D. Discontinue her current Bupropion. Prescribe Bupropion and Naloxone (Contrave) 90mg/8mg for one
week. Have her come back in one week for a check-up. You may have to increase the dosage at one-
week intervals. - ✔✔D. Discontinue her current Bupropion. Prescribe Bupropion and Naloxone
, (Contrave) 90mg/8mg for one week. Have her come back in one week for a check-up. You may have to
increase the dosage at one-week intervals.
Which is the only medication that is approved by the U.S. Food and Drug Administration (FDA) to treat
depression in children?
A. Fluoxetine (Prozac)
B. Citalopram (Celexa)
C. Paroxetine (Paxil)
D. Sertraline (Zoloft) - ✔✔A. Fluoxetine (Prozac)
Mr. Ready is a 58 y/o new patient at a community mental health center. He's seen by the psychiatric
mental health nurse practitioner for depression, anxiety, and co-morbid substance use disorder, which
the patient describes as effective in treatment of his symptoms. He does not have a primary care
provider and does not know when he last had laboratory values drawn. Ready takes Tylenol PRN for his
knee pain, Prilosec OTC 20 mg BID and has been on his current psychotropic medications for over 2
years: Buspirone 20 mg BID, Sertraline 200 mg PO daily, and Aripiprazole 2 mg daily. What screening
labs are appropriate for this patient?
A. CBC, CMP, Lipid Profile, and Vitamin B12
B. BMP, LFT, and Vitamin D
C. Lipid Profile, CMP, CBC, Thyroid Profile, and Vitamins B12 and D
D. CBC and CMP - ✔✔C. Lipid Profile, CMP, CBC, Thyroid Profile, and Vitamins B12 and D
Which laboratory test should be ordered to rule out a medical cause of dementia symptoms?
A. Vitamin B12
B. Thiamine
C. Vitamin D3
D. Albumin - ✔✔A. Vitamin B12
Lorazepam is the preferred benzodiazepine when managing alcohol withdrawal symptoms in a patient
with co-morbid:
A. OxyContin abuse
B. Seizure disorder
Based Exercises with Explanatory Notes
A patient presents for a clinic appointment and tells the psychiatric mental health nurse practitioner
(PMHNP), "My depression is a little better, but I read about acupuncture, and I want to add this to my
treatment." What is the PMHNPs best response to this patient?
a. Integrative therapies have no effectiveness in improving depressive symptoms and if your depression
has not improved and you have not achieved remission of your symptoms, I recommend that we
increase your antidepressant
b. Integrative therapies such as acupuncture are not well studied, and I cannot recommend that you add
this to your current treatment
c. Acupuncture is one of many integrative therapies, but it has the least effectiveness in improving
depression
d. Acupuncture has been found to help some individuals with depression. While the data is limited, if
this is something you would like to consider, let's talk about where you might find a reputable
practitioner for acupuncture treatments. - ✔✔d. Acupuncture has been found to help some individuals
with depression. While the data is limited, if this is something you would like to consider, let's talk about
where you might find a reputable practitioner for acupuncture treatments.
You are seeing a female patient who is morbidly obese. She also suffers from major depression, anxiety,
and antidepressant-induced decreased libido. She has been stabilized on Desvenlafaxine (Pristiq) 50 mg
1 PO QAM and Bupropion (Wellbutrin) 50 mg. She also take Mononessa (Ortho-Cyclen) 1 PO QAM and
Vitamin D 1000 IU PO QAM. She has had trouble maintaining weight loss on diet support programs, diet
medications, and self-directed food reduction plans. She asks you about using Phentermine to help her
lose weight. You discuss options with her and decide to:
A. Prescribe a one month course of Phentermine and Topiramate (Qsymia) 7.5/46 for 30 days. Have her
return to the clinic in 1 month for a checkup.
B. Prescribe a one month course of Phentermine (Adipex-P) 37.5 mg PO QAM. Have her come back in
one month for a check-up
C. Prescribe a 1 month course of Topiramate (Topamax) 50 mg 1 PO QHS. Have the patient come back in
1 month for a checkup. Let the patient know that you may have to increase the dosage at one-month
intervals.
D. Discontinue her current Bupropion. Prescribe Bupropion and Naloxone (Contrave) 90mg/8mg for one
week. Have her come back in one week for a check-up. You may have to increase the dosage at one-
week intervals. - ✔✔D. Discontinue her current Bupropion. Prescribe Bupropion and Naloxone
, (Contrave) 90mg/8mg for one week. Have her come back in one week for a check-up. You may have to
increase the dosage at one-week intervals.
Which is the only medication that is approved by the U.S. Food and Drug Administration (FDA) to treat
depression in children?
A. Fluoxetine (Prozac)
B. Citalopram (Celexa)
C. Paroxetine (Paxil)
D. Sertraline (Zoloft) - ✔✔A. Fluoxetine (Prozac)
Mr. Ready is a 58 y/o new patient at a community mental health center. He's seen by the psychiatric
mental health nurse practitioner for depression, anxiety, and co-morbid substance use disorder, which
the patient describes as effective in treatment of his symptoms. He does not have a primary care
provider and does not know when he last had laboratory values drawn. Ready takes Tylenol PRN for his
knee pain, Prilosec OTC 20 mg BID and has been on his current psychotropic medications for over 2
years: Buspirone 20 mg BID, Sertraline 200 mg PO daily, and Aripiprazole 2 mg daily. What screening
labs are appropriate for this patient?
A. CBC, CMP, Lipid Profile, and Vitamin B12
B. BMP, LFT, and Vitamin D
C. Lipid Profile, CMP, CBC, Thyroid Profile, and Vitamins B12 and D
D. CBC and CMP - ✔✔C. Lipid Profile, CMP, CBC, Thyroid Profile, and Vitamins B12 and D
Which laboratory test should be ordered to rule out a medical cause of dementia symptoms?
A. Vitamin B12
B. Thiamine
C. Vitamin D3
D. Albumin - ✔✔A. Vitamin B12
Lorazepam is the preferred benzodiazepine when managing alcohol withdrawal symptoms in a patient
with co-morbid:
A. OxyContin abuse
B. Seizure disorder
