Is Becoming an FNP Worth It?

The patient has been on an optimized dose of fluoxetine for 8 weeks with virtually no change in his PHQ-9 score, indicating a non-response. When a patient shows no clinical improvement after an adequate trial of 6 to 8 weeks, the recommended strategy is to switch to a different antidepressant, often from a different pharmacological class like an SNRI or NDRI. Increasing the fluoxetine dose to 60 mg is unlikely to be effective given the complete lack of initial response. Augmenting with an atypical antipsychotic is generally reserved for partial responders or treatment-resistant depression after multiple failed trials. Continuing the current dose for four more weeks delays necessary treatment, as 8 weeks is already a sufficient trial period.

The M-CHAT-R is validated specifically for toddlers between 16 and 30 months of age. Administering it to a 14-month-old infant yields unreliable results and high false-positive rates. The correct action is to defer the specific screening tool until the child reaches the appropriate age, while continuing developmental surveillance. Option B is incorrect because using an unvalidated tool provides inaccurate clinical data. Option C is incorrect as the follow-up interview cannot be used without a valid initial screen. Option D is incorrect because an immediate formal diagnostic referral based solely on family history without valid screening or clear clinical deficits is premature.

The patient's presentation of symmetrical wrist pain, prolonged duration, and spongy swelling is highly suspicious for rheumatoid arthritis. The standard initial diagnostic workup includes rheumatoid factor and anti-CCP to assess for autoantibodies, along with ESR and CRP to quantify systemic inflammation, making option A correct. Option B is incorrect because uric acid and Lyme serology are better suited for monoarticular or episodic arthritis, not symmetrical polyarthritis. Option C is incorrect because while radiographs are helpful for baseline damage, joint aspiration is rarely needed for classic symmetrical presentation unless infection or crystals are suspected. Option D is incorrect because HLA-B27 is used to evaluate axial spondyloarthritis, not peripheral polyarthritis, and blood cultures are unnecessary without signs of systemic infection.