1. 1. You see a patient for a routine medication visit. At the end of the session, the patient asks questions and the session ends up 50 minutes in
... [Show More] length.You normally charge for the 30-minute appointment, but instead you charge for the 1-hour appointment. The 1-hour appointment includes a full body assessment that you did not perform. This violation is known as: - Over-coding - Super-coding - Down-coding - Up-coding 2. 1. During a session, your patient asks to be able to contact you via your Facebook page on the internet. You reply: - I cannot do that because I have a concealed Facebook identity; and I cannot reveal that to my patients - I would be happy to communicate with you. It makes it easier for me to reach you this way. - I would be happy to use Facebook but you will have to use a private message so that you can be anonymous - I cannot do that because Facebook does not protect your Private Health Information 3. 1. The Mental Health Parity and Addiction Equi- ty Act of 2008 (MHPAEA) insures which of the following? - Small employers who insure 50 or fewer cov- ered lives are exempt from the provisions of this MHPAEA law. - Annual or lifetime dollar limits on mental health and substance use disorder benefits are no lower than any such dollar limits for medical - Up-coding Rationale: Up-coding is a fraudulent practice in which the provider ser- vices are billed at high- er procedure codes than were actually performed, resulting in a higher pay- ment by Medicare or oth- er third-party payers. - I cannot do that because Facebook does not pro- tect your Private Health Information Rationale: Using Face- book breaks pa- tient-provider confiden- tiality, in addition to blur- ring ethical boundaries of the therapeutic relation- ship. Facebook does not protect private health in- formation. Information on the site is available for anyone to see or hack into even if private messaged. - Annual or lifetime dol- lar limits on mental health and substance use disor- der benefits are no lower than any such dollar lim- its for medical and surgi- cal benefits offered by a group health plan. Rationale: The Mental and surgical benefits offered by a group health plan. - Mental health and substance use disorder benefits must be available through both in-net- work providers and out-of-network providers by a group health plan. - Group health plans may obtain an exemption Health Parity and Addic- tion Equity Act of 2008 (MHPAEA) provides fed- eral legislation that re- quires any annual or life- time limits on medical and surgical benefits be the if they can demonstrate expected cost increase same for mental health resulting from implementation of the parity pro- visions greater than a 5% increase in the cost under existing plan. and substance use dis- order benefits. Small em- ployers who insure 2 to 50 employees can apply for an "opt-out" waiver, but they are not automatical- ly exempt from the MH- PAEA requirements. The group health plan will be required to provide in-network and out-of-net- work mental health and substance use disorder benefits only if it pro- vides both in-network and out-of-network med- ical and surgical bene- fits. The group health plan my obtain an exemption or waiver if the first year of implementation results in 2% increase in group health plan costs over pri- or year that covers the fol- lowing year, and if imple- mentation results in 1% increase in group health plan costs in subsequent years. A section on ac- tuarial determination of 4. 1. A 68-year-old, retired African-American wid- these increased costs is included in the law. - Respect ower who served for 30 years as an Army officer Rationale: Respect of cul- was recently diagnosed with terminal lung can- cer. He made plans to die at home with hospice care. He was hospitalized for a broken hip and succumbed to complications in the hospital. Despite his request to be addressed as "Mr. Baxter" the hospital staff persisted in calling him by his first name, "John." Which principle of culturally competent care does this violate? - Autonomy - Advocacy - Collaboration - Respect 5. 1. PMHNPs seeking admitting privileges at a community hospital with inpatient psychiatric services need to influence policymakers at which of the following levels? - State board of nursing - State legislature - County board of health - Local hospital tural values and beliefs is violated in this scenario. - Local hospital Rationale: Local PMH- NPs who want admit- ting privileges will want to persuade the appropriate hospital decision maker, through facts, figures, and a presentation of project- ed benefits to the hospi- tal, of the need to change policy and allow PMHNPs to admit patients. 6. 1. To demonstrate her support for social justice, - Volunteers her clinical within her role as a PMHNP caring for the per- son who is homeless with mental illness, the PMHNP: - Volunteers to serve food at the local Home for Girls. - Teaches Sunday School. - Volunteers to walk at the March of Dimes walk services at the psychiatric clinic, run by a local mis- sion project. Rationale: Social justice is bringing things to those who have the least means of getting them but need each year. - Volunteers her clinical services at the psychi- atric clinic, run by a local mission project. 7. 1. You have students from local psychiatric nurse practitioner programs follow you in your clinical practice to show them what you do as a PMHNP. This is called being a: - Preceptor - Mentor - Teacher - Professor 8. 1. As an individual advanced practitioner, you cannot afford to have a standalone Electron- ic Health Record (EHR) system to keep all of your patients' health information on a comput- er-based system. How could you problem-solve this dilemma? - Process your patient records manually, in your current fashion. You are keeping a full record according to HIPAA. them the most. In this case, the homeless men- tally ill need the PMHNP's skills more. - Preceptor Rationale: The preceptor is a 1;1 relationship sus- tained over a short time where each person brings something to the relation- ship. It is a contracted, de- fined role with goals. The preceptor is in a teach- ing role. Teaching is com- pleted through the ob- served performance, ex- amples, and role model- ing. - Process your notes and patient records in a se- cure electronic system with a template for patient information and interac- tions, supporting quick access within your net- work. Rationale: Having an - Process your notes manually and keep them in EHR system is the ide- a locked file. The records are available for copy and distribution at any time. - Process your notes and patient records on a laptop that you are able to transport between your office and home office. You always have the records available if needed. - Process your notes and patient records in a al situation according to the US Health and Hu- man Services and The Office of Clinical Quali- ty and Safety. Not all of- fices have the ability to af- ford installation and main- secure electronic system with a template for pa- tenance of such systems. The US government has tient information and interactions, supporting quick access within your network. 9. 1. You are in a meeting of your state nurse practitioner legislative group. The group's di- rector has asked you to present information on a law bill (LB) that is being presented for public hearing in the state legislature. The information covers how best to approach securing support from the state's Health and Human Services Committee (state senators and congressmen). As you begin to present the information, two of your colleagues on the committee begin to talk over you about their ideas and will now quiet down. The group director does not intervene to settle the meeting. You decide to: - Talk over colleagues. Ask them to allow you to finish before they make comments. Take ques- tions at the end of the presentation. - Clear your voice and ask for attention. When that does not work, stop speaking until the sit- uation resolves. If it does not resolve, sit down quietly until the behavior stops. - Confront the speakers for their ill behavior and ask them to be quiet until you have finished your presentation. - Ignore the speakers and ask the group direc- tor to settle the room so that you can finish your presentation. established financial help for EHRs in rural hospi- tals. For single practition- er offices, doing the best possible to keep informa- tion ready for quick ac- cess is the best possible solution. Without an EHR, incentives for having an EHR will not be available to you. - Clear your voice and ask for attention. When that does not work, stop speaking until the situa- tion resolves. If it does not resolve, sit down quietly until the behavior stops. Rationale: She should wait quietly for them to stop their behavior. This is a situation of indirect bullying where the two colleagues were direct- ly subverting the infor- mation that the presen- ter was attempting to pre- sent to the group. The definition of social bul- lying, which is defined as persistent, demean- ing, downgrading activi- ties incorporating vicious word and cruel acts that undermine self-es- teem. Bullying is mali- cious and psychological- ly damaging. The speak- 10. 1. Your mother calls you at the office and asks you to call in a prescription for her. The med- ication is for her sleeping pills, Eszopiclone (Lunesta) 3 mg 1 PO QHS #30. You: - Tell her to call the provider who normally pre- scribes that medication for her. - Call your mother's provider and ask the provider to call your mother's script in for her. - Tell her that you will only do it "just this once" for her and then call the script into her pharma- cy. - Call the script into her pharmacy with three additional refills, just like any other patient. 11. 1. As a PMHNP, you evaluate your patients for health concerns and beyond, in a holistic man- ner. Your current patient has a blood sugar of 186 and a hemoglobin A1C of 6.7. You refer this er could choose to make a spectacle and shout over the persons inter- fering and cause chaos, throwing bad publicity on the nursing group as a whole. She could lose her own power by asking the group director to manage the rowdy persons. - Tell her to call the provider who normally prescribes that medica- tion for her. Rationale: It is not illegal to call a family member's prescription in but it is not recommended to pre- scribe for someone with whom you have a close relationship. You do not have the proper distance and perspective to make the medical decisions that a disinterested third par- ty can make. Prescrib- ing scheduled medication for yourself or your family members can get you and your license in trouble. Do not call your mother's pre- scriber unless your moth- er is too ill to do it herself. - No statute. Rationale: You are permit- ted to refer your patient to an appropriate provider of patient to an internal medicine practitioner with whom you frequently share patients. You have just violated: - The Stark law. - The DATA Act. - No statute. - The Adams Act. 12. 1. The NP requires all patients to have a se of laboratory tests done each year to check changes in values as a safety measure. The patient states that these labs were done at his Internal Medicine Physician's office within the last month. The NP states that she will accept those labs as long as they cover all of the labs that she requires for the yearly check. The patient then verbally gives the NP his Internal Medicine Physician's office number to call and requests that she get the lab results. The NP then: - Faxes a formal request to the Internal Medi- cine Office and physician requesting the labo- ratory results. - Gets a signed release of information from the patient for the Internal Medicine Physician for the laboratory results. - Mails a formal request to the Internal Medicine office and physician requesting the laboratory results. - Calls the Internal Medicine office and verbally requests that they fax over the laboratory re- sults. care as long as you have no financial gain for the referral and are doing this in the best interest of the patient. - Gets a signed release of information from the pa- tient for the Internal Medi- cine Physician for the lab- oratory results. Rationale: Private health- care information is private and cannot be released without a signed release of information pe the Health Insurance Porta- bility and Accountability Act (HIPAA). As long as patients do not object, the health care provider is al- lowed to share or dis- cuss health information with the family, friends, or others involved in their care of payment for their care. The provider may ask your permission, may tell you he or she plans to discuss the information and provide an opportu- nity to object, or may de- cide, using his or her pro- fessional judgment, that you do not object. In any of these cases, the health care provider may dis- 13. 1. Which study design is appropriate in deter- mining the difference in effectiveness of one medication compared to another medication in the treatment of bipolar disorder? - Cross-sectional design - Case-controlled trial - Randomized controlled trial - Cohort design 14. 1. A newly graduated NP wants to open a pri- vate psychiatric practice in her hometown. She wants to find out about the laws that cover her responsibility and the legal liability that this practice will encounter for her as an indepen- dent PMHNP. Her best source of information is: - Local Psychiatric Nurse Practitioners in prac- tice. - Her City Statutes. - The American Academy of Nurse Practition- ers. - The State Statues on Nursing or Advanced Nursing Practice. 15. 15. cuss only the informa- tion that the person in- volved needs to know about the care or pay- ment for the care. Health- care providers must have a signed consent. - Randomized controlled trial Rationale: When the re- search question is treat- ment-based, you would likely choose a random- ized controlled trial where patients are randomly al- located to control or treat- ment groups. - The State Statues on Nursing or Advanced Nursing Practice. Rationale: In general, the states govern all nurs- ing and Advanced Nurs- ing Practice legislation. This is the law that gov- erns what a Nurse and Advanced Practice Nurse may do in that state. Fur- ther, the State's Health and Human Services De- partment will have doc- umentation on the laws, defining what the laws mean and how the laws are interpreted. 1. The core values that underlie advanced prac- tice nursing and culturally competent care in- clude: - Care, respect, collaboration - Autonomy, respect, collaboration - Respect, advocacy, partnership - Care, advocacy, respect 16. 1. As an NP, you teach your patients that mental illness is no different from any other physical illness that a person suffers. In classes for the community, you emphasize that everybody ahs a brain and it is another organ in the body. You remind your audience that illness in the brain is no different from illness in the heart, lungs, or liver. This is an example of: - Integrated health - Cross education - Holistic dynamism - Reducing stigma - Respect, advocacy, partnership Rationale: The cultural- ly competent PMHNP is knowledgeable and re- spectful of diverse cultur- al beliefs and practices, partners with the patient to develop a care regimen that produces the desired health outcomes within the context of the patient's cultural values, and advo- cates for the development of culturally appropriate patient care services. - Reducing stigma Rationale: Stigma is one of the worst offenders separating persons suf- fering with mental ill- ness from the main- stream. There is a spo- ken and unspoken preju- dice against anyone who suffers with a mental ill- ness. Persons suffering with schizophrenia are not treated the same way that other persons are treated in medical prac- titioner's offices, stores, postal offices, or other public and some private venues. It is the duty of every PMHNP to change this and reduce and/or eliminate this stigma. 17. 1. To advocate for the skills and value of the NP, - Arrange for a local TV you: - Arrange for a local TV station to interview you about what PMHNPs can do for the community. - Arrange a meet and greet with other nurses at a drug luncheon promoting a psychiatric med- ication. - Arrange for you and other psychiatric nurses to participate in a blood drive for a local psychi- atric hospital. - Arrange for your office to participate in a walk for Alzheimer's Disease. 18. 1. The NP sees and opportunity to help her patient who suffers from anxiety and hyper- tension by utilizing a medication that can treat both issues. She talks to her patient about us- station to interview you about what PMHNPs can do for the community. Rationale: Advocacy is more than doing some- thing altruistic as a PMH- NP. Advocacy is getting out, showing, and telling people the value of what you do as a PMHNP. - Telephones the patient's PCP to discuss the use of the Atenolol before start- ing the medication ing Atenolol 25 mg ½ tab PO QHS to manage his Rationale: Too often, hypertension and his chronic anxiety. To pro- mote both the patient's continued health and collaboration, the NP: - Telephones the PCP's office and leaves a mes- sage about the change in medication - Tells the patient to let his PCP know about the change in medication - Faxes a copy of her care notes to the PCP to inform the PCP of her plan of care - Telephones the patient's PCP to discuss the use of the Atenolol before starting the medica- tion 19. 1. As a PMHNP who is working in a large health system and understands models of change, which of the following processes are typically there is little communi- cation between providers, and the patient suffers from this lack of com- munication. The collegial, and best practice, is for providers to communicate with each other about care for their shared pa- tient and make decisions together whenever possi- ble. Using one medication rather than multiple med- ications is in the patient's best interest and saves the patient from polyphar- macy. - Engaging stakeholders, addressing organization- al barriers, and evaluating included in these models? - Engaging stakeholders, addressing organiza- tional barriers, and evaluating the impact of the practice change - Engage the unit-level manager, assess unit barriers, and obtain funding to implement the change - Conduct a literature search, write the propos- al, and obtain funding for the change - Form a committee, identify the need, and eval- uate staff satisfaction 20. 1. A PCP consults the PMHNP for guidance on medication management for a family mem- ber she is prescribing medication for bipolar I disorder, because the family member does not have health insurance and cannot afford to see a mental health provider. What would be the most appropriate response by the PMHNP? - Determine acuity and phase of bipolar I dis- order to advise on appropriate generic medica- tions - Recommend free clinic and report nurse prac- titioner to state board of nursing practice viola- tion - Offer to see the patient pro bono and manage medications - Recommend that she not manage a fami- ly member's medication and recommend free clinic the impact of the practice change Rationale: Most organi- zational change mod- els (Hopkins, Iowa, and Stetler) include simi- lar processes neces- sary for organizational change, and these mod- els do not include obtain- ing funding, but rather fo- cus on stakeholders, or- ganizational barriers, and evaluation methods. - Recommend that she not manage a family member's medication and recommend free clinic Rationale: While there may be no law specifi- cally prohibiting a prac- titioner with prescriptive authority from prescrib- ing legend drugs, such as antibiotics, to family members or oneself, un- less a PMHNP or family member is enrolled as a patient at the PMHNP's practice setting, the PMH- NP is unlikely to be cov- ered under a collaborative agreement with a physi- cian for a diagnosis, med- ical management, and prescribing. Collaborative agreements are specific to a practice setting. In 21. 1. A colleague emails on the company comput- er system regarding complaints about another coworker. In the message, the colleague makes several disparaging remarks about the other states where no collab- orative agreement is re- quired, a PMHNP who prescribes for a family member is on somewhat firmer ground. The situa- tion is more serious when the drug is controlled. Pharmacy laws make it illegal in many states to prescribe controlled sub- stances for family mem- bers and oneself. - Did you talk with her about the issue you have with her? Saying bad things about your cowork- coworker and the difficulty of working with her. er will not solve the prob- You reply: - She is just not doing things the way they were taught. She can't help it if she is not us, but she could try harder! - Really, I cannot believe that you get so upset over that little stuff. Help her understand where she is making a mistake and teach her how to do things correctly. - Did you talk with her about the issue you have with her? Saying bad things about your coworker will not solve the problem or make it better. - I understand your feelings, just put up with it. You are going to another shift in one month and will leave the problem behind. 22. 1. Your patient wants to communicate with you through email.You have a secure email account that is encrypted and will protect health in- formation as required by the Health Insurance lem or make it better. Rationale: We are nurses and we must treat each other and all others ethi- cally with respect. Verbal bashing and avoiding is a type of lateral violence. If you have a problem with someone, talk to him or her and find out what the issue is before you com- plain. We have to break the chain of abuse and treat each other with re- spect and kindness. - In order to communi- cate back and forth, you will have to find a way to encrypt your protected Portability and Accountability Act (HIPAA).Your patient does not have an encrypted email ac- count. Your reply is: - I do not like to communicate through email. I would prefer to talk to you in person or over the telephone only. - In order to communicate back and forth, you will have to find a way to encrypt your protected health information (PHI). - I have no problems with you communicating with me through my personal email. - I can encrypt our email communications to be sure that your protected health information (PI) is unavailable to others and protect you. 23. 1. The NP is seeing a patient for both psychi- atric and chemical dependency illnesses. The patient wants the NP to send medical records to his General Practitioner. The NP tells the patient that because of Federal Law 42 CFR, he must: - Sign once combined release that does not mention his chemical dependency illness due to its special protected nature - Sign two separate releases due to the special protected nature of psychiatric information. - Sign two separate releases of information due to the special protected nature of chemical de- pendency information. - Sign one combined release that designated that he is being treated for both chemical de- pendency and psychiatric illnesses. 24. 1. An NP decides to back to school to gain further knowledge about the neurological basis of psychiatric illnesses. She is not doing this to maintain her licensure but to enhance her knowledge. This is an example of: - Nursing informatics - Nursing research health information (PHI). Rationale: Unencrypted email is "like sending a postcard through the mail," everyone can read it. Without encryption on both sides of the commu- nication, there is no way to provide protection for PHI. - Sign two separate re- leases of information due to the special protected nature of chemical de- pendency information. Rationale: Federal Law 42 CFR requires a sep- arate release of informa- tion for the release of any information on chemical dependency. - Professional develop- ment Rationale: Professional development is a lifelong phase of learning that the nurse uses to de- velop, maintain, enhance - Professional development - Continuing education credits 25. 1. Which of the following is not insured by the Universal Bill of Rights for Mental Health Pa- tients? - The right to freedom from restraint or seclu- sion, other than as a mode of treatment during an emergency situation. - The right to be given a reasonable explanation professional nursing prac- tice, and support individ- ual nursing goals. - The right to refuse a particular mode of treat- ment regardless of in- formed, voluntary, written consent, or situation. Rationale: The right to refuse a particular mode of one's general mental and physical condition, fo treatment is insured the objectives of treatment, and the possible adverse effects of recommended treatment. - The right to refuse a particular mode of treat- ment regardless of informed, voluntary, written consent, or situation. - The right to ongoing participation in the plan- ning of mental health services provided in a manner appropriate to a person's capabilities. 26. 1. You are a PMHNP and have many patients with comorbid and mental health issues. As a part of your continuous quality improvement (CQI) process you might best serve your prac- tice by: - Develop a journal group with a general prac- tice colleague to read the latest articles on self-care for advanced practice nurses. - Subscribe to Medscape and read it daily to see about new medications being developed except during an emer- gency situation wherein the patient is deemed im- minent danger to self or to others, which includes the treatment team staff. All other responses are included in the Universal Bill of Rights for Men- tal Health Patients (Ti- tle II, Public Law 99-319, Restatement of Bill of Rights for Mental health Patients established by Mental Health Systems Act of 1980). - Developing a peer re- view process of your charts with a general practice colleague. Rationale: While all of these practices could serve continuous quali- ty improvement, the only one that directly serves the needs of the comor- for personality disorders. - Subscribe to Medscape Psychiatry and read it critically noting studies that apply to your patient's access to care issues. - Developing a peer review process of your charts with a general practice colleague. 27. 1. You notice that you have begun to care less about your patient's needs. You are tired, un- happy, and unsatisfied in your job. You talk to your office confidant, another PMHNP about your feelings and concerns about how this might impact your practice. Together, you dis- cuss your need to: - Leave your present employment in nursing and find a different career path in something that fulfills you better. - Leave your present employment and find a dif- ferent career in nursing that fulfills you better. - Reduce your present workload to get more bid medical /mental pa- tient population is to be- gin a peer review process with an NP with a gener- al practice/medical back- ground. - Reduce your present workload to get more rest and practice better living, eating, exercise, and liv- ing skills. Rationale: Psychiatric Nursing teaches holistic wellness through a bal- ance lifestyle and correct use of medications and therapy. The NP needs to heed her own ad- vice/practice. In order to rest and practice better living, eating, exercise, be good role models to and living skills. - Avoid those things about your present em- ployment that upset you and get involved in a yoga class. our patients, we have to lead the balanced holistic lives we preach. We have to be healthy enough in our own bio/psycho/so- cio/spiritual realms to help our patients heal. Leaving your present job for another without look- ing at what is problemat- ic will only take the prob- lems you now have with you. Avoiding problems does not resolve them. The Yoga class might help begin a path of healing but not without a healthy lifestyle. 28. 1. Which of the following best depicts the PMH- NP in a grassroots mental health advocacy role? - Assisting with depression screening at a health fair in a local shopping mall. - Meeting state legislators during RN lobbying day organized by the state nurses' association. - Working on the campaign of an individual run- ning for the state senate. - Attending a town hall meeting to seek timely police response to rising domestic violence cri- sis calls. 29. 1. Outcomes measurement is the collecting and reporting of data about the effect of an inter- vention. Purposes of outcome measurement in- clude all of the following except: - To suggest changes in treatment - To analyze the effectiveness of an intervention - To practice profile patterns of providers - To observe errors in data reporting of an inter- vention 30. 1. A mobile crisis team responded to an emer- gency call by a residential care home (RCH) manager. A 65-year-old resident had become in- creasingly agitated, insisted that the RCH cook was poisoning her food, and verbally threat- - Attending a town hall meeting to seek timely police response to rising domestic violence crisis calls. Rationale: While all de- scriptions can be catego- rized under professional activism, the response in- volving a specific men- tal health issue with a proposed action to im- prove care is timely po- lice response to domes- tic violence crisis calls. Assisting with depression screening is a primary in- tervention and health pro- motion strategy. - To observe errors in data reporting of an interven- tion Rationale: Outcomes measurement entails evaluating the outcome of care. Outcomes are mea- sured to suggest changes in treatment, to analyze the effectiveness of an intervention, or to pro- file practice patterns of providers. - Admission to the crisis stabilization unit. Rationale: The Universal Bill of Rights for Mental Health Patients (Title II, ened the cook. The RCH manager had found several days of the resident's medications hid- den in her dresser drawer. Which is the most appropriate intervention by the mobile crisis team? - Admission to the gero-psychiatric unit at the community hospital. - Admission to the state psychiatric hospital. - Admission to a nursing home. - Admission to the crisis stabilization unit. 31. 1. In counseling a 23-year-old, married Hispanic mother who brought her 4-year-old son to the clinic for "mal de ojo" with symptoms of fitful sleep, diarrhea, vomiting, and fever, the PMH- NP: - Educates about importance of maintaining flu- id and electrolyte imbalance - Explains that the symptoms are most likely caused by viral infection - Identifies what steps the mother has already tried in caring for the child's symptoms - Respects the mother's understanding of the child's illness 32. 1. As a PMHNP you frequently are asked to Public Law 99-319, Re- statement of Bill of Rights for Mental Health Patients established by the Men- tal Health Systems Act of 1980) supports eval- uation and treatment in the least restrictive envi- ronment. The crisis sta- bilization unit represents the least restrictive choice of the four listed and will likely have a much shorter period of stay before re- turning the patient to the RCH. - Respects the moth- er's understanding of the child's illness Rationale: The cultural- ly competent PMHNP re- spects culture-bound be- liefs before proceed- ing with further steps in the assessment and appropriate interventions. The culturally competent PMHNP would then pro- ceed to negotiate with the mother to reach benefi- cial health outcome for the child. - The Stark Law "case manage" your patients for more than psy- Rationale: Per the Stark chiatric issues. Your 68-year-old patient, with Medicare as the primary insurance, states that varicose veins are an issue and that treatment Law, you are not per- mitted to refer family members for treatment is needed. You know that your sister is the best vein surgeon in your city and refer the patient to her. You have just violated: - The Stark Law - The DATA Act - The Harter Act - The Adams Act 33. 1. You notice that you have begun to care less about your patient's needs. You are tired, un- happy, and unsatisfied in your job. You talk to your office confidant, another PMHNP about feeling possible "compassion fatigue." He in- dicates that while he can understand your con- cerns based on your self-assessment, but he does not believe you have compassion fatigue because he has not observed you: - Heavily criticizing others during meetings, sit- ting in your office alone all the time, dressed in the same outfit all the time, and in denial about your problems. - Constantly tired, wanting to do more of the pa- per work and less of the patient work, wanting to stay longer and chat in the break room rather than be in your office alone. - Hyperactive but having little productive work to show for it, poor concentration, not listening to others despite being present, and constantly forgetting things needed for daily work. - Staring off into the distance, suddenly crying for no reason, rapid changes in mood, impul- sive spending, valuing and devaluing people. of your patients as this could be seen as fraud- ulent by the Federal gov- ernment/Medicare. Stark law Guidelines-Chapter IV-Centers for Medicare & Medicaid Services, De- partment of Health and Human Services-Part 411-limits Medicare pay- ment to siblings. - Heavily criticizing others during meetings, sitting in your office alone all the time, dressed in the same outfit all the time, and in denial about your prob- lems. Rationale: It is a profes- sional responsibility, as an NP, to monitor our- selves for compassion fatigue. Compassion fa- tigue is a state expe- rienced by those help- ing people or animals in distress. It is an ex- treme state of tension and preoccupation with the suffering of those be- ing helped to the degree that it can create a sec- ondary traumatic stress for the helper. Some of the symptoms include de- nial about problems, ex- cessive blaming, hold- ing in emotions, isolating 34. 1. During a medication follow-up appointment at a student mental health clinic, a 20-year-old college sophomore with depression and a history of binge drinking disclosed that she has been struggling with recurrent intrusive thoughts to overdose. She recently broke up with her boyfriend when she learned that he was sleeping with her closest girlfriend. She admits taking a handful of her sertraline pre- scribed by the PMHNP last weekend and was form others, an unusu- al amount of complaints, complaining about admin- istrative functions, sub- stance abuse used to mask feelings, compul- sive spending, over eat- ing, gambling, or sexu- al addiction, and poor self-care and self-hy- giene. - Ask the student if she will agree to voluntary admission and arrange involuntary admission if necessary Rationale: When signifi- cant harm to the per- son or others are cer- tain or highly likely, then a more stringent evalu- frustrated that it only made her sleep for a day. ation is warranted and She's angry and ambivalent about the future, unwilling to make any promise not to harm herself, and has made veiled threats to "pay back both of them for cheating" (referring to her ex-boyfriend and girlfriend). What is the most appropriate intervention at this juncture? - Ask the student if she will agree to voluntary admission and arrange involuntary admission if necessary - Counsel the student that she would regret hurting herself and can move beyond this bro- ken relationship - Ask the student to promise that she won't harm herself or anyone else and schedule next day counseling visit - Negotiate with the student to touch base daily a responsibility to inter- vene may exist. The pur- pose of intervening when self-harm or harm to oth- ers is likely is to re- store the person to his or her previous ability to exercise autonomy. Chod- off (1976, 1999) argued defense of both of the need for involuntary hos- pitalization and the crite- ria that should be applied to such decisions. He ar- gues that involuntary hos- pitalization may be war- by phone between counseling visits to avoid hospitalization 35. 1. The NP is on an airplane and the flight at- tendant asks if there is a medical professional on the flight. The NP agrees to help. The NP is presented with a young woman who is suffer- ing from a severe panic attack. The woman is nauseated and lying on the floor of the plane. The woman has trouble communicating much more that she is upset, afraid, and her husband is a few airplane stops away at an air force base where she is headed. The woman's pulse is 89 and regular and her respirations are 18 and regular. The woman occasionally pants and vomits some pale brown liquid. You provide in- formation to the flight medical doctor on call. At the destination, the flight attendant offers to ranted if "obvious distur- bances that are both in- trapsychic (for example, the suffering of severe depression) and interper- sonal (for example, with- drawal from others be- cause of depression)" ex- ist. The student's unwill- ingness or inability to commit to no self-harm, her recent overdose at- tempt, her history of binge drinking, the in- herent impaired judgment form binge drinking, and her veiled threats to harm others, are all risk factors which compound her lev- el of imminent risk. Closer evaluation for safety on an inpatient unit is warrant- ed. - Do not give the med- ication. Instead, wait until the plane lands and a full evaluation can be com- pleted at the local hospi- tal. Rationale: The NP can- not assess if this person is under the influence of any medications or chem- icals of abuse Giving her medication could poten- tially worsen the condi- tion. It is better for the NP to be with the per- give you some Alprazolam 0.5 mg to give to the patient. You: - Give her the Alprazolam to help her calm down until you get to the destination. Then, she can go to the hospital. - Do not give the medication. Ask her if she son, help her emotional- ly, observe, and manage her until the plane lands. Then, she can turn the patient over to the Emer- gency Medical Technician would like to take the medication. If she agrees, (EMT) team waiting at the allow the flight attendant to give it to her. - Give her the Alprazolam so that she can calm down and go on to her next flight - Do not give the medication. Instead, wait until the plane lands and a full evaluation can be completed at the local hospital. terminal. 36. 1. You are considering using text message tech- - Text messaging using nology with your patients as a way to com- municate quickly in our fast-paced world. What considerations are necessary when texting? - Text messaging using a secure text messag- ing platform within specific Joint Commission guidelines could be used for orders only. - The use of text message technology is not recommended by regulatory agencies. - Text messaging is safe because of advanced security platforms for protecting protected health information (PHI) in smart devices. - Text messaging is becoming the accepted standard of communication since the availabil- ity of means for retrieving protected health in- formation (PHI) from any device. a secure text messaging platform within specific Joint Commission guide- lines could be used for or- ders only. Rationale: Unsecured texting and emailing from mobile devices is risky because these mobile de- vices are at risk for be- ing lost, stolen, or dam- aged. Theft and loss of a mobile device containing PHI presents obvious se- curity reasons. In a de- parture from prior poli- cy, the Joint Commission now permits licensed in- dependent practitioners, in accordance with the law and other relevant regulations and policies, to send orders via text messaging "as long as 37. 1. Which of the following is not the responsibil- ity of Institutional Review Boards (IRB) in the research process? - Ensure that animal studies are conducted us- ing humane methods - Ensure that informed consent is obtained and documented - Ensure that risks to participants are mini- mized - Ensure that adverse events are reported and risks/benefits are re-evaluated 38. 1. Which of the following would not be included in a progress note? - Risk/benefit analysis for change of medication - Patient's self-rating on target symptoms - Incident report on medication error - Standardized outcome measures a secure text messag- ing platform is used and the required components of an order are includ- ed." Criteria for a secure platform include a se- cure sign-on process, en- crypted messaging, de- livery, and read receipts, date and time stamp, cus- tomized message reten- tion time frames, and a specified contact list of those authorized to re- ceive and record orders. - Ensure that animal stud- ies are conducted using humane methods Rationale: IRBs were es- tablished to protect the rights and welfare of human research partici- pants. Animal studies are not within the purview of IRBs. - Incident report on med- ication error Rationale: Incident re- ports are part of an organizational reporting mechanism for risk man- agement, but are not in- cluded in the medical record. The progress note is part of the medical record that included doc- 39. 1. The NP is seeing a 72-year-old male for de- pression management. Upon assessment, the patient is alert, oriented, and non-suicidal or umentation of patient en- counters with the follow- ing format: 1) reason for the encounter and rele- vant history; 2) physical exam findings, prior diag- nostic test results; 3) as- sessment, clinical impres- sion, or diagnosis; 4) plan for care; and 5) legible identity of the provider. Additionally, if not docu- mented the rationale for ordering diagnostic and other ancillary services should be easily inferred; past and present diag- noses should be accessi- ble to the treating and/or consulting provider; ap- propriate health risk fac- tors identified; patient's progress, response to and changes in treat- ment, and revision of di- agnosis should be doc- umented. The progress note should reflect the type of services and di- agnostic codes reflected on the billing statement: CPT codes for service provided, and ICD-9_CM and/or DSM-IV diagnostic codes. - The NP must do as the patient requests as long as he is competent. homicidal. The patient is able to manage his activities of daily living. The NP witnesses the man's wife verbally abusing him on several oc- casions. The NP has verbal reports from staff nurses and their nursing notes that the man has come into the unit with bruising and con- tusions inconsistent with his affluent lifestyle and physical health condition. When the NP speaks to the man about the physical and ver- bal abuse, he tells her that it is occurring. He also tells her that he does not want to do any- thing about the situation. He tells her specifi- cally that he does not want her to contact any authorities about the situation. - She is required to contact Adult Protective Services or similar services in the local com- munity to investigate the senior citizen's safety. - The NP must do as the patient requests as long as he is competent. - Take pictures of the bruises and contusions and save them to the patient's record. - Arrange to remove the patient to a safer envi- ronment. 40. 1. The NP attends a local meeting where allo- cation of resources for healthcare will be dis- cussed. One of the stakeholders has a pam- phlet that describes the types of healthcare providers available to help persons in need of health care. The NP notices that NPs are labeled as "Paraprofessionals." In the meeting, the NP asks the organization responsible for the pam- phlet why they have identified the NPs as para- professionals when an NP is by law working as 85-90% of the same capacity as a Medical Doctor. The NP goes on to explain what an NP does in various areas of practice. This is an example of: - Promoting nurse practitioners in the commu- Rationale: The patient is an adult, competent to arrange his own life. He has the right to make de- cisions for himself. Not all states have mandato- ry elder abuse statutes or mandatory domestic abuse statutes. - Advocating for the role and value of the NP Rationale: In 2009, an American Association of Retired Persons (AARP) pamphlet identified NPs as paraprofessionals, de- fined as personnel who are not members of a health profession but are trained to assist these professionals. NPs are expected to advocate for the role and value of the NP. nity - Public education on the NP scope and stan- dards of practice - Correcting misinformation that deliberately misleads the public - Advocating for the role and value of the NP 41. 1. A 43-year-old male patient presents to the PMHNP for a medication follow-up appoint- ment. As part of his follow-up visit, his blood pressure reading is 156/102 millimeters of mer- cury. The patient states he has been having headaches for the last few weeks since he ran out of his blood pressure medication. The PMH- NP's best action is which of the following? - Call the pharmacy to confirm which antihyper- tensive the patient is taking and write a 30-day supply of this medication - Contact the patient's pri- mary care provider, ex- plain the patient's symp- toms, and request his medication be refilled and he be given a follow-up appointment Rationale: According to the scope and standards, standard 5A addresses the need for coordina- - Refer the patient to the emergency department tion of care for patients, for an evaluation - Contact the patient's primary care provider, explain the patient's symptoms, and request his medication be refilled and he be given a follow-up appointment - Call a local FNP and request that she refill this patient's medication 42. 1. When a clinical trial fails to reject the null hypothesis (i.e., when p-value > 0.05), the in- using an interdisciplinary approach to care delivery. - Power Rationale: Type II error vestigator may have missed a true intervention occurs when investiga- effect. One should consider the following to avoid a Type II error: - Alpha level - Power - Effect size - Sample bias tors falsely reject the null hypothesis and conclude that no relationship exists between variables when, in fact, a relationship does exist. This occurs when there is insufficient pow- er to detect the differ- ence between variables, 43. 1. Your patient is receiving Medicare and Social Security Disability payments. This money helps her to pay for food, clothing, shelter, and med- ications. She recently began to work part-time. Her work has greatly improved her mood and self-perception. She has taken on more work. The additional income has caused her to lose her disability and Medicare funding. She is con- cerned that she will not be able to get her med- ication, pay for housing, and some of the other things she was able to afford before. How do you counsel her? - Advise her that her counselor can help her with financial issues - programs, services, and resources. - Discuss with her your assessment that her mood has improved since working and self-supporting. Assist her to find programs that will help her continue. - Advise her to maintain her Medicare and So- cial Security benefits because she will always have her food, clothing, shelter, and medication support. - Discuss with her the consequences of taking on "too much" work and losing her disability benefits. [Show Less]