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BUNDLE OF PMHNP QUESTION WITH CORRECT ANSWERS 2023
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PMHNP board set Question with complete solution 2023
increase prolactin - Stop prolactin (stop the agent that cause increase prolactin) 3-year-old masturbates, play with self, says naughty things Nor... [Show More] mal for Piaget 5-year-old tells you his brother sodomized him - Tell mom don't leave him alone with patient and call CPS implement crisis 13-year-old want to smoke - Ask him of his plan to stop smoking 14-year-old girl clenching her teeth - Cranial nerve V-Trigeminal nerve 16-year-old falls with the wrong crowd - Conduct disorder 16-year-old refuse treatment - Send to psych specialist for acting out kids 16-year-old shows up with mother for first therapy - Confidential (mom sits in lobby) ACE inhibitors - HTN ACE inhibitors are the drug of choice for what? - Heart failure/HTN Acute stress disorder (ASD) - Can be 2 to 4 weeks ( less than a month) ADPIE • Assessment: 1st step, subjective and objective data • Diagnosis: analysis, formulation of nursing diagnosis • Planning: prioritizing problems, determining goals, plan of care • Implementation: nursing action (rather than medical action) • Evaluating: comparing outcomes, communicate and document findings Adult panic disorder - Buspar Lithium level 1.2 what are you concerned with - 4+ Ketones Labs for Kidney compromised it is wrong Urine kidney problem 1. NSAID, dehydration and Thiazides increases risk of Lithium toxicity Lithium toxicity Ibuprofen and lithium INCREASES the serum level up to double Lab Values concerning for patient on Lithium: o Leukocytosis o Creatinine o BUN o NA+ o 4 + PORTEIN in Urine o + Pregnancy Test Lithium toxicity o Slurred speech, confusion, severe GI effect - diarrhea/nausea/vomiting, metallic taste and SEVERE tremor. . Aggressive patient to give - IM Geodon agoraphobia fear of open spaces Agoraphobia treatment BZDs - short term symptom relief SSRIs - long-term maintenance fluoxetine (Prozac) paroxetine (Paxil) sertraline (Zoloft) SNRIs - long-term maintenance venlafaxine (Effexor) TCAs - long-term maintenance imipramine Alprostadil (PGE1) • Ductal-dependent Congenital Heart Disease (all forms) • 0.05-0.1 µg/kg/min IV/IO infusion initially, then 0.01-0.05 µg/kg/min IV/IO In babies with congenital heart defects, it is used by slow injection into a vein to open the ductus arteriosus until the surgery can be carried out. By injection into the penis or placement in the urethra, it is used to treat erectile dysfunction . Amygdala: - Fear, anxiety, and aggression Amygdala - A limbic system structure involved in memory and emotion, anxiety, particularly fear and aggression Anorexia (SAFETY = KEY) - Set up family therapy (especially adolescent pts since they have no control over food choices) Anorexia admission criteria for hospitalization - Weight loss over 30 % over 6 months, severe hypothermia (temp lower than 36 C or 96.8 F), heart rate less than 40 beats per minute, systolic blood pressure less than 70 mm hg, and hypokalemia (less than 3 mEq/L). anorexia nervosa - BMI less than 18.5 - BMI < 16 = AUTOMATIC ADMISSION - An eating disorder in which an irrational fear of weight gain leads people to starve themselves ANOVA (analysis of variance) an inferential statistical test for comparing the means of three or more groups Antidepressant takes 4 to 6 weeks Prozac causes what? increase anxiety in elderly Apoptosis programmed cell death in aging/elderly Appreciative Inquiry - Dream (wishes or dreams of organization) - Design (decide what you want to change) - Destiny (make it happen, implanting change) Appreciative Inquiry an organizational change strategy that directs the group's attention away from its own problems and focuses participants on the group's potential and positive elements Appreciative Inquiry an organizational change philosophy and process building organizations around what works, rather than focusing on and trying to fix what doesn't work [Show Less]
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ANCC® PMHNP Psych-Mental Health NP_Test 1 Question 100% solved
Your patient, whose wife died a few months ago, appears to be very unkempt and apathetic. Although several months have passed since his wife's death he has... [Show More] not progressed at all through his grieving. You assess this condition as which of the following? disenfranchised grief panic disorder complicated grief physiologic grief Correct Answer: complicated grief A person has uncomplicated grief when he or she has normal physical, psychological, cognitive and spiritual responses to the death of a significant other. But when the person shows persistent maladaptive behaviors such as not taking care of personal hygiene and/or appearance and does not progress through the mourning process, this is complicated grief. If a patient has had a myocardial infarction, which of the following atypical antidepressants should not be prescribed within the recovery phase? Trazodone Duloxetine Bupropion Desvenlafaxine Correct Answer: Trazodone If a patient has had a myocardial infarction, during the recovery phase, the patient should not be prescribed this medication. Trazodone (Desyrel) can cause the patient to develop orthostatic hypotension and priapism. To get your teaching ideas and concepts across to a poor reader which of the following would be most appropriate? Use longer sentences. Use abstract concepts. Discourage questioning. Use examples and review. Correct Answer: Use examples and review. To get the idea across to a poor reader use examples and review. The other choices are not helpful. You should use short sentences and easy to read layouts; be concrete rather than abstract; and teach them how to ask questions about their health. Also, tell context first and use visual, use common words and examples, and explain meaning. A 21-year old woman presents with complaints of milky discharge from her breasts. She doesn't have any other symptoms and is not pregnant, nor has been before. She tells the nurse about each medication that she takes. Which of these drugs may be implicated as the cause of the symptom? aspirin Lamotrigine Risperidone sertraline Correct Answer: Risperidone Risperidone can cause the greatest prolactin elevation among atypical psychotics. A milky white discharge known as galactorrhea could be a sign of an underlying condition. The fact that the woman takes Risperidone, an atypical antipsychotic, would likely point to the cause and should be switched with one less likely to have that same side effect. Which of the following would be considered one of the main things that is responsible for about 2/3 of psychiatric hospital readmissions? Not sufficient care. Medication noncompliance Biophysical assessments None of the above Correct Answer: Medication noncompliance Medication noncompliance is a major problem with the psychiatric mental health patients. The home health nurses assists by helping the patients to see the relationship between their compliance with their medication regimen and control of their symptoms. Which of the following would be considered an important form of communication that can help to promote consistency in the care of the patient at the same time that it justifies their stay in the hospital? Review of care. Documentation Verbal reporting None of the above Correct Answer: Documentation The other 3 options above are incorrect. One of the most important aspects of nursing is documentation. Documentation can promote consistency in the care of the patient and is also used to help justify the patient remaining in the hospital. Effects of an overdose of LSD (Lysergic acid diethylamide) can include all of the following except? Vomiting Respiratory failure Hypertensive crisis Seizures Correct Answer: Hypertensive crisis Hypertensive crisis would be considered a symptom of PCP overdose. Vomiting, respiratory failure and seizures would be considered an effect of LSD overdose. Symptoms of serotonin syndrome include all of the following EXCEPT: insomnia nausea loss of coordination sweating or shivering with goose bumps Correct Answer: nausea Symptoms of serotonin syndrome can present in patients that have drug combinations that are contraindicated. They can vary from restlessness and agitation to tremors, chills, headaches, and insomnia as well as loss of coordination. Nausea has not been implicated in serotonin syndrome. What is the rate of suicide attempts for patients having dissociative identity disorder? 30% 45% 70% 60% Correct Answer: 70% People with dissociative identity disorder have one of the highest risks for suicide. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5),more than 70% of outpatients with DID have attempted suicide, and multiple suicide attempts are common. Of the following, which would not be considered a phase of schizophrenia treatment? Maintenance Acute Cognitive Stabilization Correct Answer: Cognitive Cognitive is not one of the three phases of schizophrenia treatment. The three phases are: Phase 1: acute Phase 2: stabilization Phase 3: maintenance The patient should be monitored for effects of psychotropic medications which can impact cardiac rhythms. Which of the following could be a potential cardiac side effect? A prolonged QT interval Narrowing of the QRS Both A and B None of the above Correct Answer: A prolonged QT interval With antipsychotic drugs, the triclyclic action can cause problems. These medications can cause a widening of the QRS or a prolonged QT interval. This is a measure of the ventricular repolarization. Sullivan described three developmental cognitive modes of experience and believed that mental disorders are related to the persistence of one of the early modes. The mode that begins in early childhood as the child begins to connect experiences in sequence is which of the following? prototaxic mode parataxic mode syntaxic mode composite mode Correct Answer: parataxic mode The parataxic mode begins in early childhood. The child may not make logical sense of the experiences and may see them as coincidence or chance events. The child seeks to relieve anxiety by repeating familiar experiences, although he or she may not understand what he or she is doing. Which of the following acts have provided the greatest protection for the individual not to lose or be denied health insurance coverage? Patient Protection and Affordable Care Act OSHA ISPN None of the above Correct Answer: Patient Protection and Affordable Care Act The other 3 options above are incorrect. For several decades now, the ANA (American Nurses Association) has been working and advocating for reforms that will help to guarantee the access of high-quality health care. This act has helped millions of people, but ANA recognizes the fact that this debate is far from being over. The ANA is dedicated to educating the nursing public about the changing systems and their impacts on people's lives and the nursing profession. Which of the following is an example of Western alternative medical systems? TCM (traditional Chinese medicine) naturopathy ayurveda acupuncture Correct answer: naturopathy Naturopathy and homeopathy are examples of Western alternative medical systems. Naturopathy emphasizes health restoration rather than disease treatment and combines nutrition, homeopathy, therapeutic counseling and other therapies. The underlying belief is that the individual assumes responsibility for his or her recovery. What is NOT a sign of alcohol intoxication? Nystagmus Mood lability The face has pale skin. Aggressive impulses Correct Answer: The face has pale skin. A flushed face is a sign of alcohol intoxication. Other signs include disinhibition of sexual impulses, impaired judgment, and impaired occupational functioning. In terms of styles of leadership in therapeutic groups, which type of leader encourages individual creativity and group cohesiveness? autocratic democratic laissez-faire psychotherapeutic Correct Answer: democratic There are three main styles of group leadership: autocratic, democratic, and laissez-faire. A democratic leadership style focuses on the members of the group. Members are encouraged to participate fully in problem-solving of issues that relate to the group. This type of leader encourages individual creativity and group cohesiveness. All of the following are considered to be types of family structures except? Nuclear family Behavioral family Blended family Extended family Correct Answer: Behavioral family The major types of family structures are: Nuclear family Blended family Extended family Single-parent family Other familial systems [Show Less]
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ANCC PMHNP review Question and answer rated A+
Piaget's Cognitive Theory Stages: sensorimotor (object permanence), preoperational (magical thinking/language), concrete operations (logic, reversibility)... [Show More] , formal operations (formal, logical) Henry Stack Sullivan's Interpersonal Theory behavior is in respond to interpersonal dynamics. Stages: oral gratification/first anxiety, delayed gratification, formation of peer relationships, same sex friendships, opposite sex relationships, self-identity development Maslow's Hierarchy of Needs survival, safety/security, love, self-esteem, self-actualization Health Belief Model barriers to health promotion: perception of susceptibility, seriousness of illness, perceived benefits of treatment, barriers to change, expectations of efficacy Bandura's Self-Efficacy/Social Learning Theory behavior is a result of cognitive and environmental factors, learned through observation/role-modeling, efficacy predicts change/maintenance Watson's Caring Theory Caring is essential component of nursing Frontal lobe Frontal lobe: motor function, premotor area, association cortex (decision-making), executive functions (memory, reasoning, planning, prioritizing, insight, flexibility, judgment, impulse control, intelligence, abstraction), language (expressive), personality Temporal lobe receptive language, memory, emotion, integration of vision/sensory info (damage results in A/V hallucination, aphasia, amnesia) Occipital lobe visual cortex, integration of sensory info (damage results in visual hallucinations, blindness) Parietal lobe primary sensory data, taste, reading/writing (damage results in sensory disturbances, agnosia) Cerebellum processing of sensory info from thalamus, including speech/cognition, judgment, perception, motor function, equilibrium (if damaged, atataxia, negative Rhomberg) Limbic system emotions, memory (hypothalamus, thalamus, hippocampus, amygdala) Hypothalamus regulates appetite, thirst, libido, circadian rhythm, hormones Thalamus relays sensory info and affects emotions, memory, affective behaviors Hippocampus memory Amygdala regulates mood, fear, emotion, aggression Basal ganglia/corpus striatum stabilizes motor activity, movement initiation, learning/automatic motions, EPS, involuntary motor activities (if damaged, bradykinesia, hyperkinesis, dystonia) Brainstem where NTs are produced (midbrain, pons, medulla, cerebellum) Midbrain ventral tegmental and substantia nigra (where DA is produced) Pons locus ceruleus (where NE is produced) Medulla autonomic control center for internal body functions Reticular formation system primitive brain controls involuntary movement, reflex, blood pressure, respiratory rate, vital signs, muscle tone (if damaged, LOC) Structural imaging CT (3D view of brain, nonspecific), MRI (superior but expensive) Functional imaging EEG (evoked potentials, least expensive, shows electrical function of CNS), MEG (often used with EEG, detects electrical activity in the brain), SPECT (cerebral blood flow, expensive), PET (very expensive) Structural/functional diagnostic tests fMRI, 3fEMRI, DA receptor binding Fever can indicate agranulocytosis in these meds carbamazepine, clozapine [Show Less]
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PMHNP Boards - Scientific Foundation and Advance Practice Skills Question and answers 2023
Which of the following is a contraindication to benzodiazepines? a. Acute alcohol intoxication b. Acute narrow angle glaucoma c. Psychosis d. All the a... [Show More] bove a. Acute alcohol intoxication In the pharmacological treatment of psychosis, when antipsychotics are administered, which block dopamine, a secondary effect is blocking in another tract, which causes potential prolactin problems, such as gynecomastia in males. This tract is the: a. mesolimbic b. tuberoinfundibular c. nigrostrial dopamine tract d. mesocortical b. tuberoinfundibular A six-year-old patient with autism spectrum disorder has not responded to six months of psychosocial interventions and continues to demonstrate aggressive tendencies toward a younger sibling. The psychiatric-mental health nurse practitioner prescribes: 1. carbamazepine (Tegretol) 200 mg once a day. 2. haloperidol (Haldol) 2 mg once a day. 3. risperidone (Risperdal) 0.25 mg once a day. 4. venlafaxine ER (Effexor XR) 37.5 mg once a day. 3. risperidone (Risperdal) 0.25 mg once a day. Which drug is likely to produce liver failure and hepatitis? 1. Lamotrigine 2. Gabapentin 3. Carbamazepine 4. Topiramate 3. Carbamazepine EPS arises from: a. D2 blockade in the nigrostriatial tract b. D2 blockade in the tuberoinfundibular tract c. D2 blockade in the alpha-1 adrenergic receptor blockade d. D2 blockade in the HPA axis a. D2 blockade in the nigrostriatial tract Which drug carries a higher risk of metabolic effects than the other second generation antipsychotics: weight gain, diabetes, dyslipidemia ? a. Clozaril b. Zyprexa c. Risperdal d. Geodon b. Zyprexa A patient has not had any relief of symptoms with Fluoxetine, and is going to be started on an MAOI. How long before starting the MAOI should the Fluoxetine be withdrawn? a. 2 weeks b. 3 weeks c. 4 weeks d. 5 weeks a. 2 weeks Which drug can produce serious side effect of rash in some Asians, and the FDA has mandated genetic testing before the administration of this drug? a. Dilantin b. Lamictal c. Depakote d. Tegretol d. Tegretol Which is considered the most sedating SSRI? a. Paroxetine b. Sertraline c. Fluoxetine d. Escitalopram Oxalate a. Paroxetine (Paxil is EVIL) Brain structure responsible for mediating mood, fear, emotion, and aggression; also responsible for connecting sensory smell information with emotions amygdala Regulates memory and converts short-term memory into long-term memory ... Plays key roles in various regulatory functions such as appetite, sensations of hunger and thirst, water balance, circadian rhythms, body temperature, libido, and hormonal regulation ... Patient on lithium and cipro Cipro _____________ lithium level ... Patient on psych meds and dexamethasone will complain of what? ... Patient w/ schizophrenia, structural changes of the brain on CT ... Which lab is checked with clozaril? ANC Lobes of the Brain - Fred Tore his Pants Off Frontal - executive fx, logical thinking Temporal (tempo) sound Occipital (optic) vision Parietal (pat) touch You ask a patient to clench her teeth, which cranial nerve are you testing? Cranial nerve 5 - TRIGEMINAL What does the frontal lobe affect? (LIMP) Executive functions: Language Intelligence (cognitive functoning) Motor Function Personality What does temporal lobe affect? (LAME) Language Affective Component of speech Memory Emotion In which lobe of the brain does the limbic system reside? The temporal lobe What is Wernicke's area responsible for and where does it reside in the brain? Wernicke's area is responsible for receptive speech and it resides in the temporal lobe. What is the first line drug for OCD? SSRIs What is the drug of choice for ADHD for 8 y.o and above? Stimulants (specifically ritalin - methyphenidate) If child develops tics, what do you prescribe? Guanfacine What does parietal lobe affect? (VAST) Visual spatial processing Association cortex Symbolic recognition Topographic sense what is sterognosis? how do you test it? Place objects in hand with closed eyes. Ability to differentiate items comes from parietal lobe What does the occipital lobe affect? (VIP) Visual integration Primary visual cortex Patient was prescribed paroxetine 1 month ago and had since developed ED, he is not a candidate for Wellbutrin because of a history of seizure disorder. What can you prescribe? Cialis (tadalafil) or Viagra (sildenafil) phophodiasterase inhibitors What is mechanism of action of phophodiasterase inhibitors? Rapid absorption. They pull blood to corpus cavernosum. What are the main functions of the limbic system? Regulation of emotion and memory Olfactory sense is combined with memories Hippocampus is located here - memory Where are affective domains (emotions, feelings) originating in the brain? Anterior cingulate gyrus (LIMBIC SYSTEM) If a patient with OCD has failed on SSRIs, what should you switch to? TCA - anafranil [Show Less]
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ANCC PMHNP BOARD EXAM Question with complete solution 2023
MOOD D/O: MDD CRITERIA A A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previou... [Show More] s functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly attributable to another medical condition. 1. Depressed mood daily 2. Loss of pleasure of joy in activities/inerests 3. Significant weight loss/gain 4. insomnia/hypersomnia 5. fatigue or loss of energy daily 6. psychomotor retardationagitation 7. feelings of worthlessness or guilt 8. diminished ability to think/concentrate, indecisiveness 9. recurrent thoughts of death, SI, or SI attempt MOOD D/O: MDD CRITERIA B-E B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. C. The episode is not attributable to the physiological effects of a substance or to another medical condition. D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders. E. There has never been a manic episode or a hypomanic episode. Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition. MOOD D/O: MDD PREVALENCE Twelve-month prevalence of major depressive disorder in the United States is approximately 7%, with marked differences by age group such that the prevalence in 18- to 29-year-old individuals is threefold higher than the prevalence in individuals age 60 years or older. Females experience 1.5- to 3-fold higher rates than males beginning in early adolescence. MOOD D/O: MDD DEVELOPMENT AND COURSE -Recovery typically begins within 3 months of onset for two in five individuals with major depression and within 1 year for four in five individuals. -The risk is higher in individuals whose preceding episode was severe, in younger individuals, and in individuals who have already experienced multiple episodes. -The persistence of even mild depressive symptoms during remission is a powerful predictor of recurrence. MOOD D/O: MDD RISK FACTORS -Neuroticism (negative affectivity) is a well-established risk factor for the onset of major depressive disorder -Adverse childhood experiences, particularly when there are multiple experiences of diverse types, constitute a set of potent risk factors for major depressive disorder. -Stressful life events are well recognized as precipitants of major depressive episodes,but the presence or absence of adverse life events near the onset of episodes does not appear to provide a useful guide to prognosis or treatment selection. -First-degree family members of individuals with major depressive disorder have a risk for major depressive disorder two- to fourfold higher than that of the general population. -Relative risks appear to be higher for early-onset and recurrent forms. Heritability is approximately 40%, and the personality trait neuroticism accounts for a substantial portion of this genetic liability. MOOD D/O: PDD (DYSTHYMIA) DSM5 CRITERIA Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year. B. Presence, while depressed, of two (or more) of the following: 1. Poor appetite or overeating. 2. Insomnia or hypersomnia. 3. Low energy or fatigue. 4. Low self-esteem. 5. Poor concentration or difficulty making decisions. 6. Feelings of hopelessness. C. During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time. D. Criteria for a major depressive disorder may be continuously present for 2 years. E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder. F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. G. The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g. hypothyroidism). H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Note: Because the criteria for a major depressive episode include four symptoms that are absent from the symptom list for persistent depressive disorder (dysthymia), a very limited number of individuals will have depressive symptoms that have persisted longer than 2 years but will not meet criteria for persistent depressive disorder. If full criteria for a major depressive episode have been met at some point during the current episode of illness, they should be given a diagnosis of major depressive disorder. Otherwise, a diagnosis of other specified depressive disorder or unspecified depressive disorder is warranted. MOOD D/O: DYSTHYMIA PREVALENCE The 12-month prevalence in the United States is approximately 0.5% for persistent depressive disorder and 1.5% for chronic major depressive disorder. MOOD D/O: DYSTHYMIA DEVELOPMENT COURSE Persistent depressive disorder often has an early and insidious onset (i.e., in childhood, adolescence, or early adult life) and, by definition, a chronic course. Among individuals with both persistent depressive disorder and borderline personality disorder, the covariance of the corresponding features over time suggests the operation of a common mechanism. Early onset (i.e., before age 21 years) is associated with a higher likelihood of comorbid personality disorders and substance use disorders. MOOD D/O: DYSTHYMIA RISK FACTORS -Factors predictive of poorer long-term outcome include higher levels of neuroticism (negative affectivity), greater symptom severity, poorer global functioning, and presence of anxiety disorders or conduct disorder. -It is thus likely that individuals with persistent depressive disorder will have a higher proportion of first-degree relatives with persistent depressive disorder than do individuals with major depressive disorder, and more depressive disorders in general. -A number of brain regions (e.g., prefrontal cortex, anterior cingulate, amygdala, hippocampus) have been implicated in persistent depressive disorder. Possible polysomnographic abnormalities exist as well. CN I olfactory-smell sensory CN II Optic - vision sensory CN III Oculomotor Nerve- Motor Controls eye movement, pupil constriction, & eyelid movement CN IV trochlear nerve-down and inward eye movement motor CN V trigeminal nerve-muscles of mastication; sensation of face, scalp cornea, mucus membranes and nose -assess the face for strength and sensation sensory and motor CN VI abducens nerve-lateral eye movement motor CN VII facial nerve-move face, close mouth and eyes, taste, saliva and tear secretion -assess mouth for taste -assess the face for symmetrical movement sensory and motor CN VIII acoustic sensory: hearing and equilibrium CN IX glossopharyngeal-PHONATION, GAG REFLEX CAROTID REFLEX SWALLOWING TASTE -assess mouth for taste -assess mouth for movement of soft palate and the gag reflex -assess swallowing and speech sensory and motor CN X vagus-TALKING, SWALLOWING, GENERAL SENSATION FROM THE CAROTID BODY, CAROTID REFLEX -assess mouth for movement of soft palate and the gag reflex -assess swallowing and speech sensory and motor CN XI spinal accessory-movement of trapezius and sternomastoid muscles -assess the shoulders for strength motor CN XII hypoglossal-tongue movement motor [Show Less]
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ANCC PMHNP Role and Scope of practice Question and answer 2023
State Legislative Statutes: What do they do? (law created by the state) -They are the Nurse Practice Act -Provides Title protection, -Grants legal auth... [Show More] ority; -Define Scope of Practice , -Defines advanced practice, -Puts restrictions on practice, -Sets credentialing requirements, -Sets grounds for disciplinary actions, -May require a Collaborative agreement Statutory Law (written law created by legislative body) -rules and regulations differ per state -may further define scope of practice requirements -may provide restrictions unique to each state Licensure The state grants permission to practice Credentialing ensuring minimum level of competence Certification -Is a credential that provides title protection, -Determine scope of practice -Process as to how ANCC certifies that NP has met specified standards; -Assures mastery and skills; -ANA is the only certifying body for psych nursing Scope of Practice -Define NP roles and actions -Identify competencies Standard of Practice -Provides a way to judge the nature of care -Reflex the expectation for the care -May include precise protocols or general guidelines What is HIPAA? -Privacy Protection Act -Garante 4 rights: 1. To be educated about privacy 2. Have access to their own med. record 3. Request amendments to their med record to which they object 4. Permission to disclose their records What is Health Information Technology for Economic And Clinical Health Act (HITECH)? -Provide intensive payment for sharing electronic medical record (EHR) data -Meaningful use incentive Exceptions to guaranteed confidentiality -The need for information outweigh confidentiality -Intent to harm self or others, -attorney involved in litigation -records released to insurance companies, -answering court orders, subpoenas, or summons -mandatory reporting of diseases, -Child or elder abuse -duty to warn potential victims (Tarasoff principle, 1976) Informed Consent -Communication between the patient and provider that results in patient accepting or rejecting the proposed treatment. -Explanation of relevant information that enables the client to make an informed decision. -Right of all adults and emancipated minors (person <18 who is married or live independently of parents) Elements of Informed Consent Nature and purpose of treatment Risks / Benefits of doing treatment Risks / Benefits of not doing it Alternatives treatments Diagnosis and prognosis Theoretical Approaches to Ethical Decision Making include the following theory: Deontological Theory Teleological Theory Virtue Ethics Deontological Theory Action is good or bad based on the act itself, regardless of the concsequences Theological Theory Action good or bad based on consequences or outcomes Virtue Ethics Action is chosen based on moral virtures (honesty, courage, compassion, wisdome...) or the character of the person making the decision Justice Doing what is fair, fairness in all aspects of care Beneficence Promoting well-being and doing good. Nonmaleficence Doing no harm Fidelity Being true and loyal Autonomy Doing for self Veracity Telling the truth Respect Treating everyone with equal respect What are the 4 Elements of Negligence to Prove Malpractice 1. Duty: to provide reasonable care 2.Breach of Duty: violation of standards 3. Proximate Cause: relationship between the breach of standard and patient's injuries 4. Damages: permanent and substantial What is Reflective Practice? -A model to systemically "make sense of practice" -Process to tell a story to gain insight into practice -Enhance critical thinking and problem-solve Primary Prevention -Decrease incidence or onset (# of new cases) -Help pts avoid deseases, stressors, or cope better -Ex: stress mgmt. classes, smoking prevention classes, immunizations Secondary Prevention -Decrease prevalence (# of existing cases) -Early case-finding, -Screening, (pop smear, BP) -Fast/effective treatment -Ex: hotlines, crisis intervention, disaster response, Tertiary Prevention -Decrease disability and severity -Rehab, avoid complications -Ex: day tx, case mgmt. for needs, social skills training Types of Risk factors predisposing a person to develop a disorder -Biological -Psychological: -Social Biological Risk factors Hx of mental illness, poor nutrition, poor general health [Show Less]
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PMHNP Practicum 1: Barkley Question and answers rated A+
Although the patient may be rationalizing her behavior as a righteous act, patients with kleptomania do not commit theft to express anger or vengeance. Kle... [Show More] ptomania is characterized as failing to resist the impulse to steal, and the stolen objects are typically not needed. The act of stealing, which usually is performed alone, gives the person gratification. Harriet is a well-established business woman who provides for her family. She was recently arrested for stealing over $10,000 worth of merchandise from the mall. When Harriet is asked to describe her behavior, she says: "It just comes on me quickly, and when it's done, I feel really good." She also describes how she grew up poor and sees the theft as a way to "even the score" against those with "empty wealth." Which of the following does not meet the diagnostic criteria for kleptomania? Harriet views her shoplifting as a righteous act. Harriet's stealing is described as pleasurable. Harriet is well-off and can support her family's needs. Harriet's stealing is described as impulsive. Borderline personality disorder is not considered a differential diagnosis for conduct disorder, as indicated by the patient's truancy, defiance of authority figures, fights with family members, poor academic performance, sexual promiscuity, running away from home, and "tough guy" demeanor. Oppositional defiant disorder, bipolar disorders, and adjustment disorders are all considered potential differential diagnoses for conduct disorder, as are depressive disorders, attention-deficit/hyperactivity disorder, and intermittent explosive disorder. Tony, a 16-year-old male, has been sent to your clinic for counseling. He has a long record of skipping school, talking back to his teachers, and getting poor grades. His parents say he has often gotten in fights with them, has frequently been caught sneaking girls into his room, and has run away from home on two occasions. During the session, you notice Tony acts tough and aloof, not deigning to speak much. If you suspect conduct disorder, which of the following conditions would you be least likely to include in your differential diagnosis? 1. Borderline personality disorder 2. Oppositional defiant disorder 3. Adjustment disorder with disturbance of conduct 4. Bipolar disorder Depressive symptoms are associated with decreased, not increased, levels of somatostatin in cerebrospinal fluid. Patients with depression may exhibit a decreased thyroid-stimulating hormone response to thyrotropin-releasing hormone, as well as hypersecretion of cortisol. Depressive symptoms are also associated with irregularities in growth hormone release, such as reduced nocturnal secretion and diurnal hypersecretion. Which of these lab findings would be least expected in a patient with depression? 1. Decreased nocturnal growth hormone secretion 2. Decreased thyroid-stimulating hormone response 3. Increased somatostatin in cerebrospinal fluid 4. Increased secretion of cortisol Although ambivalence regarding suicidal intent should be taken into account when considering level of observation in a patient, it indicates a moderate risk, not a severe risk. Close observation should be employed with patients who profess suicidal thoughts, are unable to commit to a "No Harm" contract, or experience withdrawal. Jeremy, a suicidal inpatient, is under close observation. He is able to be observed at all times by hospital staff during waking hours and when he sleeps, and is checked on every 15-30 minutes. Which of these reasons would least indicate the need for this level of supervision? 1. Jeremy has expressed suicidal thoughts. 2. Jeremy experiences withdrawal from alcohol and cocaine. 3. Jeremy is ambivalent about his intent to commit suicide. 4. Jeremy was unable to commit to a "No Harm" contract. The patient's recent involvement in risky pleasurable activity (e.g., unprotected sex), increase in goal-driven activity at work, decreased need for sleep, and subjective experience of racing thoughts all suggest a manic episode; as such, bupropion, an antidepressant, would not be considered because the patient has not displayed the diagnostic criteria for a major depressive episode. Pharmacologic options for the treatment of manic episodes include anticonvulsants (carbamazepine), antipsychotics (haloperidol), and benzodiazepines (lorazepam). Adam, a 23-year-old male, is undergoing an STD test at your clinic. When you ask him why he is here, he says, "I'm here because I've had this increased craving for sex. I've been picking up strangers in bars, not caring about using protection ... I don't know what it is. For the last week, I've just felt really driven. Keep throwing myself into my work, don't feel much need for sleep, feel like my thoughts are running a marathon in my head." The patient lives a "clean life," clarifying that he does not abuse any substance, "not even coffee or cigarettes." He also does not have a history of mental disorders. Given the most likely diagnosis, which of these medications would you least likely recommend for Adam? Lorazepam Haloperidol Carbamazepine Bupropion Lorazepam would not be the first choice to treat delirium in a dehydrated patient because benzodiazepines may cause respiratory depression, especially in debilitated patients. Antipsychotics such as haloperidol, quetiapine, and risperidone are considered the mainstay in managing agitation in delirium patients; haloperidol is considered the standard of care, but newer agents such as quetiapine and risperidone may be preferred due to reduced chance of side effects. You have determined that a patient's delirium stems from dehydration. As you begin treatment, you realize the patient will require pharmacologic management for his agitation. Which of these agents would be least appropriate in this situation? Risperidone Haloperidol Quetiapine Lorazepam Most inpatients who develop a suicide plan and follow it have agreed to a "No Harm" contract. The most common method of suicide among inpatients is hanging, not self-inflicted wounds. When "unsolvable" problems at work, school, or home motivate the ideation, inpatients are most likely to attempt suicide either within the first 5 days at the hospital or shortly after discharge, not after a month. The rate of suicide among bipolar patients is relatively low, about 10%-15%, and risk would be higher in patients with schizophrenia or an untreated anxiety disorder. Which of the following is true about suicide among inpatients? Most patients who develop a suicide plan and follow it have agreed to a "No Harm" contract. Self-inflicted wounds are the most common means of suicide. Inpatients with bipolar disorder are most likely to commit suicide. Patients who attempt suicide due to "unsolvable" problems usually do so after a month in care. [Show Less]
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Role of nurse practitioner pmhnp Question with complete solution 2023
Unlawful detention without a due process. Habeas Corpus Harmless mentally ill patients cannot be confined against their will if they can survive ou... [Show More] tside. Mental illness alone cannot justify involuntary hospitalization O'Connor versus Donaldson Right to refuse any treatment and use an appeal process Rennie versus Klein Patient has a right to refuse treatment, but a guardian may authorize their treatment Roger versus Oken Individual may not criminally be responsible if the unlawful act was the product of mental illness Dirham versus US Competency to be executed Ford versus Wainwright Duty to warn, potential victims who may be in immediate danger Doodoo expressed homicidal ideation of the patient Tarasoff The least restrictive environment - informed consent Patient Rights 10 year plan for nursing path towards computer and information literacy. The initiative declared that it is a nurse practitioners responsibility to understand and shape the landscape of healthcare technology to improve access quality and patient experience TIGER Technology informatics guiding education reform require technology curriculum for colleges A law that requires most hospitals to provide an exam and needed Stabilizing treatment without consideration of insurance coverage Emergency medical treatment and labor act EMT LA Established provide improved access to services for older adults, additional services for Native Americans including community services Older Americans Act Guidelines for nursing facilities as long term care Omnibus budget reconciliation act Provides physically and mentally disabled patient access to employment and community Americans with disability act Reduces suicide rate in attempts by adolescence, eating disorders Healthy people 2020 Medicaid direct reimbursement for NP's under federal law Balanced budget act of 1997 Signed into law in 1996 requires annual or lifetime dollar limit on mental health benefits to be no lower than any such dollar limits for medical or surgical benefits offered by a group health plan or health insurance issue were offering coverage in connection with a group health plan The mental health parody act MHPA Ask contains provisions for meaningful use of health information technology Health information technology For economic and clinical health act HITECH Cannot self refer patients for monetary gains. Example. Pharmaceutical company pays off student loans and you work for the company providing samples to patients and provide company sponsored education and get paid, conflict of interest Stark Law Allows insurance up to 26 years of age or a parent Affordable Care Act Helps families of mentally ill, education, support groups National alliance on mental illness NAMI access, cost, quality Healthcare policy model Formulation + implementation + evaluation Phases of policymaking Changes in programs and practices. Policymakers and key stakeholder such as government media public. Assess address organization barriers and facilitators to evidence based practice first. Access is baseline knowledge, beliefs, practices using a survey Policy reform Act must be reviewed by a certain date or it will be automatically resend it Sunset Legislation Legislation design to increase transparency in government processes Sunrise legislation Defines the practitioners rolls and actions, identifies competencies assumed to be held by all and peas who function in a roll, has brought variations from state to state due to outdated least legislation, comes from the state board of nursing scope of practice [Show Less]
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pmhnp-25 Question well answered and correct
It enables participants to acquire therapeutic factors Why is group therapy beneficial? Closed group A group that was designed to meet weekly for ... [Show More] 10 sessions to deal with feelings of depression would be a Cognitive therapy Correcting how one thinks about the world and oneself is the focus of All phases of the relationship Building trust is important in Cultural Factors Which of the following is most influential in determining health benefits and practices Define the role and actions for the NP The purpose of the American Nurses Association's Psychiatric Mental health nursing: scope and standard of practice is to authenticity In forming a therapeutic relationship with clients, the PMHNP must consider developing many characteristics that are known to be helpful in relationship-building. Which of the following is an essential part of building a therapeutic relationship? Hope As a PMHNP working as an outpatient clinic, you often refer to your clients to community AA and NA meetings. Using Yalom, you are aware that peer led groups can inspire and encourage other group participants. which therapeutic factor is instilled in AA and NA group members group members begin to model aspects of other members of the group and group leaders Which of the following client statements best described imitative behavior as a therapeutic factor in group therapy Cognitive behavioral therapy Labeling of distortions is a technique often used in Reflection The communication skill that involves repeating what is said in a different way and with different words Countertransference When the PMHNP experiences feelings or thoughts towards a client The main goal of communication is understanding Which of the following is true concerning communication the nurse client relationship was in the orientation phase In a peer supervision group a PMHNP is discussing a recent self disclosure to a client. The group is most likely to question the appropriateness of the behavior if Emphasis on the individual at the expense of the group To which of the following values would the PMHNP working to maintain a therapeutic environment probably not subscribe Interpersonal Learning Therapy group, client makes inappropriate demands of PMHNP who responds assertively and effectively resolves the problem to the satisfaction of all concerned. What curative/therapeutic factor, according to Yalom does this situation exemplify? The fact that others supports one another in learning to change will encourage her to take the risks needed to grow Mrs D is extremely shy admitted to hospital with depression. What characteristics of therapy groups will best serve her needs Heterogeneuos, open ended NP is called to as a consultant to NH seeking to enhance the morale of its residents. She decides to begin an ongoing re-socialization group since many of the clients have been isolated from others in their previous living situations. how is this group classified? Supportive/Therapeutic group Sarah and John lose their first child to SIDS. They decide to attend a hospital sponsored group for people who have had this experience. What type of group will they be attending [Show Less]
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PMHNP Study from Vital Boards Question and answers 2023
Outspoken opponent of NP role Martha Rogers Treatment for AUD Naltrexone 50mg daily to prevent relapse Acamprosate resembles GABA and NMDA... [Show More] antagonist. Anti-craving drug used for maintenance therapy of alcohol withdrawal. Dose 2000 mg/day. Combining acamprosate and naltrexone may be more beneficial together Disulfiram- 250mg day What drug is used to prevent alcohol consumption by blocking aldehyde dehydrogenase? Naloxone (Narcan) opiate antagonist, reverses opioid induced resiratory depression Buprenorphine Suboxone- used for detoxification and part of maintenance therapy in opioid withdrawal. temporal lobe key role in long-term memory, hearing, and interpretation of visual stimuli Salvador Minuchin Structural Family Therapy: uses joining, enactment, boundary making, and mimesis techniques Carol Anderson and William McFarlane psychoeducational family therapy Robert Liberman and Lawrence Weathers behavioral family therapy Michael White & David Epston Narrative Therapy Inhibitor substance that decreases the metabolism of drugs and leads to higher levels leading to toxicity Inducer a substance that increases the rate of a specific enzyme synthesis from a lower to a higher level Cyclothymic Disorder Criteria A) For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode. B) During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time. C) Criteria for a major depressive, manic, or hypomanic episode have never been met. D) The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. E) The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism). F) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. negative reinforcement the reinforcement of a response by the removal, escape from, or avoidance of an unpleasant stimulus positive reinforcement Increasing behaviors by presenting positive stimuli, such as food. A positive reinforcer is any stimulus that, when presented after a response, strengthens the response. negative punishment the removal of a stimulus to decrease the probability of a behavior's recurring positive punishment The application of an undesirable stimulus to reduce specific behavior Persistent Depressive Disorder (Dysthymia) Moderate depression that persists for two years or more Clozapine the drug of choice for treatment-resistnat shizophrenia. Can cause increased weight gain and agranulocytosis rarely so must monitor the absolute neutrophil count. Also good choice for drug-induced psychosis in patients with Parkinson's Disease. Glutamyltransferase (GGT) and carbohydrate deficient transferrin (CDT) provides up to 90% of sensitivity for heavy, chronic alcohol usage Gamma-hydroxybutyric acid (GHB) W/D similiar to ETOH w/d and benzo w/d and is rare due to rapid elimination of the drug. Sx's include anxiety, insomnia, tremor, confusion, nausea, and vomiting Medicare Part B The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies. Part of brain smaller in patients with dissociative identity disorder Hippocampus and Amygdala "claims-made policy" -a liability policy that pays claims only during the period that the policy is active. A "tail coverage" covers future claims should the NP change insurers or retire. cross-sectional study A study in which a representative cross section of the population is tested or surveyed at one specific time to assess disease incidence and prevalence. Case-control study One type of epidemiological study design used to identify factors that may contribute to a medical condition by comparing a group of patients who have that condition with a group of patients who do not. randomized controlled trial An experimental study in which researchers randomly assign individuals to either an experimental or a control group and expose the experimental group to the manipulated variable of interest. [Show Less]
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