In the aftermath of a tornado that destroyed over 100 homes in a rural Midwest community, the PMHNP draws on principles of crisis intervention while
... [Show More] working with an elderly couple who lost everything in the storm during the night. Which of the following statements is most appropriate at the initial encounter?
- What is your biggest concern right now? I will help you as much as you can.
- Tell me everything that happened. We'll sort through the next steps.
- You will be able to stay in the shelter until the FEMA trailers arrive. It's going to be OK.
- What medications were you taking? Let me work on that first.
- What is your biggest concern right now? I will help you as much as you can.
Rationale: Principles of crisis intervention guide the PMHNP to focus on one of the individual’s primary concerns at a time offering direct, realistic information, and emotional support. Do not give false reassurance which blocks communication; you don’t know whether everything will be resolved, and in this scenario, nothing can replace a lifetime of treasures and memories lost in their home. Do not focus on all implications at once or ask the individual to describe all of the losses or implications; this will be too overwhelming. While concerns about medication is important, first the PMHNP needs to assess what the primary concern is for this couple before addressing the medication issue.
1. During an initial assessment, the PMHNP asks the patient to perform the serial 7's. What aspect of the mental status exam would the nurse practitioner be assessing?
- Concentration
- Affect
- Memory
- Speech
- Concentration
Rationale: Subtracting serial 7’s from 100 is a simple task that requires intact concentration and cognitive capabilities.
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A 31-year old married woman with a history of anorexia nervosa, binging-purging type, during her teens and early 20's, is pregnant. She has had two prior spontaneous abortions in late 20's. She is worried whether this pregnancy may trigger recurrence of her prior eating disorder, adversely impact fetal development, or affect the likelihood of full-term delivery. At 5'7" she maintains a weight of 120 pounds by running 6-10 miles daily as conditioning for marathons and a 2,000 calorie daily vegan diet. What lifestyle modifications would reduce risks of exacerbating an eating disorder and increasing likelihood of normal fetal development and full-term delivery?
- Increase daily caloric intake by 250 calories, reduce running to 4-8 miles daily with reduction in second or third trimester, add pre-natal vitamin, Calcium supplement, and plan a 20-30# gradual weight gain over the course of pregnancy.
- Increase daily caloric intake by 1,000 calories, continue running as tolerated with reduction in second or third trimester, add pre-natal vitamin, vitamin E supplement, and B-complex supplement, plan a 20-30# gradual weight gain over the course of pregnancy.
- Increase daily caloric intake by 500 calories, reduce running to 2-4 miles daily, alternate with stretching and yoga in second and third trimesters, add pre-natal vitamin and vitamin b-12 supplement, plan a 28-40# gradual weight gain over the course of pregnancy.
- Increase daily caloric intake by 500 calories, reduce running to 2-4 miles daily, alternate with stretching and yoga in second and third trimesters, add pre-natal vitamin and vitamin b-12 supplement, plan a 28-40# gradual weight gain over the course of pregnancy.
Rationale: At 120 pounds for 5’7” her Body Mass Index is 18.8 (low).
BMI normal range for adults is 19.8 – 26.0.
BMI = 703 x weight (lbs) = 703 x 120 = 18.8
[Height (in)]2 672
Or Weight (kg)/ Stature (cm)/ Stature (cm) x 10,000 = BMI.
BMI = weight (kg)
[height (m)]2
Low pre-pregnancy BMI and failure to gain recommended weight during pregnancy are associated with increased risk for spontaneous abortions, pre-term delivery, and low birth weight infants. Recommended caloric intake for pregnant women during pregnancy varies from additional 150 calories in first trimester, 300 calories in second trimester, and 500 calories in third trimester before accounting for strenuous daily exercise. Recommended weight gain for pregnant women of normal BMI is 25-35# and 28-40# for women with low BMI as in this patient. The vegan diet lacks animal fat the only dietary source of Vitamin B-12. Addition of pre-natal vitamin and supplement of Vitamin B-12 is indicated for vegan diet.
- Increase daily caloric intake by 700 calories, continue running as tolerated with reduction in second or third trimester, add pre-natal vitamin, vitamin E supplement, and B-complex supplement, plan a 25-35# gradual weight gain over the course of the pregnancy.
Which of the following illustrates the role of the PMHNP in reducing the stigma of mental illness through community education as primary intervention?
- Expert witness for standard of acre regarding psychiatric nursing staff in wrongful death lawsuit
- Professional speaker interviewed by morning television talk show anchor on depression
- Teaching high school class about depression and teen suicide
- Volunteering to help with depression screenings at a community health fair
- Professional speaker interviewed by morning television talk show anchor on depression
Rationale: While all responses have an element of education, primary prevention through community education is best illustrated by reaching the broadest general audience with information about depression through television, radio, or newspaper media.
A patient comes into your office in a full manic episode. This patient has a diagnosis of Bipolar and Alcohol Use disorder, moderate. You have a report from the patient's chemical dependency counselor indicating that inpatient chemical dependency counseling is needed. Your patient has been on the fence about inpatient chemical dependency treatment in the past. You assess the patient and find a strong odor of alcohol, auditory and visual hallucinations, flight of ideas, lack of sleep for 3 days, suicidal ideations without a firm plan, and plans to drive to another state to gamble. The patient's brother who accompanies him corroborates this information. In order to best treat this patient, you:
- Admit him to the inpatient chemical dependency program.
- Admit him to the local psychiatric unit, with an order for the collection of laboratory values.
- Send the patient home with his brother and a prescription for a new antipsychotic medication.
- Admit him to the dual diagnosis chemical dependency unit with an order for the collection of laboratory values.
- Admit him to the local psychiatric unit, with an order for the collection of laboratory values.
Rationale: While he is both manic and of danger to himself, he should be hospitalized. The patient will not be able to participate in any programming until he is out of his acute manic state. Going home is not an option unless the patient has someone who can be with him 24 hours and monitor his withdrawal from alcohol, his manic condition, and his suicidal issues and desire to leave the state.
When assessing a client, what is the most important predictor of potential for violence?
- History of aggressive rage
- History of substance abuse
- History of head injury
- History of seizures
- History of aggressive rage
Rationale: History of previous episodes of rage and violent behavior, escalating irritability, intruding angry thoughts, and fear of losing control are the most important predictors of potential for violence. Head injury, substance use or abuse, and temporal lobe epilepsy have been discussed as possible predictors, but not conclusively.
1. Which of the following statements would be most likely to be effective in changing sexual behavior when counseling a sexually active 15-year-old adolescent girl?
- Require your partner to use a condom.
- Use this sample condom.
- Always use condoms when having sex.
- Always carry condoms in your purse.
- Use this sample condom.
Rationale: Use specific risk-reduction steps rather than global statements. Providing an actual condom to try confers direct responsibility for condom use rather than relying on partner to use condom. An adolescent girl is less likely to purchase condoms than initially using a sample condom from a provider.
1. In evaluating the functional status of a 68-year-old woman who has depression, the Instrumental Activities of Daily Living Scale includes which of the following activities?
- Using telephone
- Filing taxes
- Toileting
bathing
- Using telephone
Rationale: Instrumental activities of daily living (IADLs) include those that facilitate or enhance the performance of ADLs (i.e. shopping, using the telephone, and using transportation). Functional activities or activities of daily living (ADLs) are the activities necessary for self-care (i.e., bathing, toileting, dressing, and transferring). Cognitive executive function includes higher-order activities such as balancing a check book, assembling tax records, filing taxes, and driving.
1. The American College of Obstetricians and Gynecologists (ACOG) recommends screening for postpartum depression with a validated screening tool. Which of the following is a validated screening tool which has been recommended by ACOG?
- Edinburgh Postnatal Depression Scale (EPDS)
- Montgomery-Asberg Depression Rating Scale (MADRS)
- Hamilton Rating Scale for Depression (HRSD)
- Major Depression Inventory (MDI)
- Edinburgh Postnatal Depression Scale (EPDS)
Rationale: The EPDS is most frequently used in the research setting and clinical practice for several reasons. The scale consists of 10 self-reported questions that are health literacy appropriate and take less than 5 minutes to complete.
1. When child, adult partner, or elder abuse is suspected, the PMHNP needs to conduct an abuse assessment screen in privacy, away from the partner, the child's parents or guardians, or the elder person's relative or companion. Simple, direct questions in a nonjudgmental interview are indicated. Which of the following would be an appropriate abuse screening question?
- Within the past year, has anyone ever forced you to do something by threatening you with a gun?
- Within the past year, have you ever threatened or tried to commit suicide to escape the abuse?
- Within the past year, have you been hit, slapped, kicked or otherwise physically hurt by someone?
- Within the past year, has anyone ever threatened to kill you?
- Within the past year, have you been hit, slapped, kicked or otherwise physically hurt by someone?
Rationale: This response is one of four items on a standardized abuse assessment screen, The other items are part of a danger assessment that may be used following a positive response to one of the abuse screening questions.
Which of the following would not be advised to divorced parents to facilitate recovery for their children?
- The divorced couple must provide an age-appropriate truthful explanation why they divorced
- The divorced couple must avoid arguing with one another
- The divorced couple must show consistent behavior toward the child
- The divorced couple must continue to relate to the child despite the child's anger
- The divorced couple must provide an age-appropriate truthful explanation why they divorced
Rationale: Divorce recovery for children does not necessarily require an explanation of why the parents divorced, particularly if circumstances are damaging or affix blame to one parent over the other (e.g., infidelity, sexual orientation, illicit drug use, etc.) despite framing in age-appropriate context. Avoiding parental arguments, demonstrating fair and consistent behavior toward the child, and continuing respectful communication despite a child’s anger are recognized principles of divorce recovery.
In advising parents how to reduce the risk for teen substance abuse when there is positive family history of alcohol dependence, a PMHNP encourages all of the following recommendations except:
- Acknowledgement of family risk factor and open discussion with teen
- Parental presence and involvement in child's school and sports activities
- Parental networking and supervision of any teen parties
- Random urine testing using home drug testing kits
- Random urine testing using home drug testing kits
Rationale: Parental presence, support, and fostering a sense of connectedness with teens are primary strategies for reducing risk for teen substance abuse. Fostering communication among other parents, endorsing parental supervision of all parties, and knowing the extent of parental supervision at parties is another important strategy. Home urine testing for alcohol and drugs by parents may be advised for monitoring teens that already have a demonstrated alcohol or drug problem as part of a rehabilitation contract, but it is not considered a risk strategy.
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A PMHNP realizes she is frustrated and easily angered with one of her patients for no apparent reason. When discussing the situation with a colleague, she states the patient reminds her of her abusive stepfather. Which of the following best describes the nurse practitioner's reaction?
- Countertransference
- Displacement
- Transference
- Projection
Countertransference
Rationale: Countertransference is the nurse practitioner’s emotional reaction to the patient based on his/her past experiences.
Countertransference is essentially the reverse of transference. In contrast to transference (which is about the client's emotional reaction to the therapist), countertransference can be defined as the therapist's emotional reaction to the client.
An example of a screening tool that measures severity and tracks change in specific symptoms is
- The Mini-Mental Status Examination (MMSE)
- The Behavior and Symptom Identification Scale (BASIS)
- The Short Form 36 (SF-36)
- The CAGE
- The Mini-Mental Status Examination (MMSE)
Rationale: The MMSE is an example of a screening tool that measures the severity and tracking change in specific symptoms. It is used to provide an assessment of a broad array of cognitive function, including orientation, attention, memory, construction, and language. It is commonly used to screen for dementia and in following the progression of dementia over time.
1. A 67-year-old Vietnamese immigrant, who has been a resident in the U.S. for 3 years, comes to your clinic for an evaluation. Her first language is Vietnamese, but she does speak, some English. She has problems with reading and writing, as she did not finish high school, or earn a GED (General Educational Department) equivalency. As the PMHNP, what is your priority disparity to address with this patient?
- Health literacy
- Reading level
- Race
- age
- Health literacy
Rationale: Adults meeting the following criteria are most likely to have limited health literacy, which has been related to health outcomes; one, over age 65 from racial and ethnic groups other than white; two, recent refugees and immigrants; three, less than a high school GED; four, low income; and five, non-native speaker of English. [Show Less]