A 27-year-old female presents via telehealth reporting difficulty maintaining employment, impulsive spending, and “mood swings.” She describes rapid shifts in mood that occur multiple times per day, typically following conflicts with others. She reports a history of unstable relationships, chronic feelings of emptiness, and episodes of self-harm. She recalls being an average student with no significant behavioral issues in childhood. She reports occasional periods of increased productivity lasting several hours but denies decreased need for sleep or sustained elevated mood. Which is the MOST accurate diagnosis?

Which personality disorder is associated with the highest risk of violence when the individual’s ego is threatened?

A 28-year-old female presents via telehealth reporting “mood swings” and difficulty maintaining relationships. During the session, she becomes tearful and states, “Everyone leaves me eventually.” She then shows superficial cuts on her forearm and says, “I wasn’t trying to kill myself—I just needed to feel something.” She denies suicidal intent, has no plan, and agrees to a safety plan. Toward the end of the session, she asks, “Can I message you later tonight if I start to feel this way again?”Which of the following is the MOST appropriate combined response by the PMHNP?

A patient reports believing they can influence events with their thoughts, dresses eccentrically, and experiences ideas of reference. Which diagnosis is most consistent?

A 35-year-old male presents reporting that coworkers “may be trying to undermine him” and that conversations sometimes seem to reference him indirectly. He acknowledges that this “might just be his interpretation.” He has longstanding difficulty forming close relationships, appears socially anxious, and demonstrates eccentric behavior and speech. He denies hallucinations and maintains organized thought processes. Which is the MOST accurate diagnosis?

A patient reports a history of unstable employment and multiple legal issues. He describes himself as “smarter than most people” and frequently manipulates others for financial gain. He denies remorse for his actions. Which diagnosis is MOST consistent?

Which finding would most suggest a psychotic disorder rather than schizotypal personality disorder?

A patient with a history of impulsivity, substance use, and frequent interpersonal conflict becomes verbally aggressive when limits are set during treatment. Which cluster is MOST associated with this pattern of behavior?

A 30-year-old male presents with impulsive decision-making, unstable employment, and frequent interpersonal conflicts. He reports acting “without thinking” in emotionally charged situations but denies childhood history of inattention or academic difficulties. Symptoms began in early adulthood and are most prominent in relationships. Which diagnosis is MOST consistent?

A patient sends the PMHNP a friend request on social media after an initial telehealth visit. What is the MOST appropriate response?