PMHNP Final Exam 6|72 Questions with Verified Answers
Scope of practice - CORRECT ANSWER **Determined by state legislative statutes (State Board of
... [Show More] Nursing)
Defines NP roles and actions
Standard of practice - CORRECT ANSWER **Determined by ANA
Carry out care in accordance with what other reasonably prudent nurses would do in a similar circumstance.
Confidentiality - CORRECT ANSWER Info will not be disclosed
Medical auth signed to release records
Psychotherapy notes should be kept unless a separate second auth signed
Chemical and psychiatric are two separate ROIs
Tarasoff Principle - CORRECT ANSWER -1976 Duty to warn potential victim of imminent danger of homicidal clients
#1 Contact state board of nursing-may not have this law in every state
Informed consent - CORRECT ANSWER Communication process between provider and client that results in the client's acceptance or rejection of proposed treatment
An explanation of relevant info that enables the client to make an appropriate and informed decision
The right of all competent adults or emancipated minors, Younger than 18 married, parents, self sufficiently living away from family domicile, they have to show documentation.
Elements of informed consent: - CORRECT ANSWER Competency: a legal not medical concept
THE COURT will make this decision
Disclosure: risks and benefits of tx and med risks
Comprehension: comprehend relevant info
Justice - CORRECT ANSWER Doing what is fair and free from bias due to insurance or social status
Nonmaleficence - CORRECT ANSWER Doing no harm (Imminent danger). Finish one month supple in two weeks, do not write the script, that could cause harm to the patient. Write something different.
Beneficence- - CORRECT ANSWER promoting well-being and doing good.
Fidelity: - CORRECT ANSWER Loyal
Veracity: - CORRECT ANSWER Truthful
Autonomy- - CORRECT ANSWER doing for self-they can accept or refuse life sustaining treatment
Respect: - CORRECT ANSWER Treating everyone equally
Case management: - CORRECT ANSWER A system of OVERSIGHT and authorization of SERVICES and benefits provided to clients consisting of coordination care ensuring quality outcomes, monitoring plan of care and advocacy
Overall goal is to promote quality and cost effective outcomes
Working as a case manager for clients with severe mental health, Maintains in depth and accurate client records: - CORRECT ANSWER THE TREATMENT PLANS
Research - CORRECT ANSWER P- Pt population, Problem
I- Intervention
C- Comparison to other tx
O- Outcome
T- Time
Level I- - CORRECT ANSWER Evidence from a system review or meta analysis of 3 or more
Level II- - CORRECT ANSWER Evidence obtained from at least one well designed RCT (LARGE MULTI SITE RCT)
Recovery model - CORRECT ANSWER Focus in future, foster their abilities interests and dreams
Does not focus on the illness
It is self-directed
They choose the plan
Four dimensions of Recovery - CORRECT ANSWER Health
Home
Purpose
Community
Evidence based practice guidelines: - CORRECT ANSWER Client's ethnicity and culture
Accessing current journals
Client goal directed
Effective management of illness
Start thinking of cultural questions when they mention it in the scenario: always RESPECT
Cultural illness: is not mental illness, Brief supportive therapy can be offered, may not need medication
Assertive Community Treatment ACT - CORRECT ANSWER Community health service delivery
Mental health services in the community setting rather than more restrictive hospital setting to those with serious mental illness
Primary goal: decrease reliance on hospitals
Secondary: reduce homelessness and hospital stays focus on real works and uses the while team
Centered around personal strengths and future, strengths and needs
All areas of their life is a target for improvement
NP notices that few substances abuse tx programs apply evidence based practice, the NP wants to initiate such a tx program to: - CORRECT ANSWER improve outcomes through analysis and synthesis of evidence
NP recognized that a number of his colleagues are prescribing a certain med for off label use: first action: - CORRECT ANSWER conduct a literature to determine if data supports the off label use
Initial action - CORRECT ANSWER assessment first, collect data
Intervention: - CORRECT ANSWER doing something, prescribe the med
NP and a staff nurse are discussing the amount of time required to perform safety rounds, initial evidence based approach for investigating this topic: - CORRECT ANSWER Perform a literature Search
Evidence hierarchy ranks sources of knowledge according to strength of info: which is Level 1: - CORRECT ANSWER Meta Analysis
Level 2 - CORRECT ANSWER Randomized controlled trial
48 y/o pt with schizophrenia and working using the recovery model: - CORRECT ANSWER Focus on his feeling interests and dreams, his interest might not be getting a job, let him direct his care
While providing a hx, a pt requests the np not disclose any info to anyone other than spouse - CORRECT ANSWER Confidentiality
Right of patients: - CORRECT ANSWER Least restrictive environment, can withdrawal consent at any time.
Mr Smithers, involuntary hosp experiencing psychotic symptoms refuses to take his meds he believes Jesus told him he is the profit Actions based on - CORRECT ANSWER Psych pt can refuse treatment
process - CORRECT ANSWER formulation, implementation and evaluation
Policy reform - CORRECT ANSWER changes in programs and practices
policy environment - CORRECT ANSWER govt media public
Policy makers - CORRECT ANSWER key player
Assess organizational - CORRECT ANSWER barriers and facilitators
Meet with - CORRECT ANSWER stake holders
Asked to consult with local inpt facility to provide nursing staff development after consultation: - CORRECT ANSWER utilize a survey to assess the educational needs of the staff.
Assessment means - CORRECT ANSWER collect data
Initial action - CORRECT ANSWER always get more data first
Before implementing evidence-based practice changes, an adult NP initial action: - CORRECT ANSWER NOT - Brainstorm with stakeholders and draft a detailed problem list
Identify potential barriers and facilitators that reflect pt values and expectations
You want to collect data
NP working with a large hospital and understands models of change, which process are typically included in these models? - CORRECT ANSWER Addressing organizational barriers, engaging stakeholders accordingly and evaluating the impact of the practice change
Do not obtain funding for change
Meet with stakeholders first before going to the manager to implement change
(YOU DON'T IMPLEMENT CHANGE)
REDUCE STIGMA OF MENTAL ILLNESS - CORRECT ANSWER EDUCATION (advocacy role)
Follow pt directive
You want to reach more people
Advocate by showing up and telling people the value of NPs
Promote health by participating in one or more of these professionals
Help pt receive additional services.
Pt from a culture refusing to accept a mental health dx due to shame, what can be done? - CORRECT ANSWER Community education programs
Just culture - CORRECT ANSWER Create environment that encourages individuals to report mistakes so that precursors to errors can be found
SAFETY and accountability
Continually learning designing safe systems and managing behavioral choices
Holds people accountable for their behaviors and investigate errors
Not held accountable to errors made due to system errors
NP most effective avenue for developing and advocating for policy is: - CORRECT ANSWER working with the local chapter of the nurse's professional association
NP collaborates with a multidisciplinary team, initially educated the team that APRN can autonomously provide a full range of comprehensive services - CORRECT ANSWER (advocating for the role of NP)(umbrella answer).
Pt no longer wants to be treated and does not want to take his meds: - CORRECT ANSWER Autonomy
Np as an employee inpt role, to promote interprofessional environment the NP: - CORRECT ANSWER Assigns a role for all staff members in improving patient outcomes. Do not focus on just doctor or just nurses or just NP.
NP group meeting, Manager suddenly becomes resistant: - CORRECT ANSWER meet individually with the nurse manager
Habeas Corpus: - CORRECT ANSWER a person can report an unlawful hospitalization to a court for the court to determine whether the it was required.
ADA 1990- - CORRECT ANSWER prevent employers discriminating against individuals with MH disorders, reasonable accommodations must be made
Quality improvement: - CORRECT ANSWER decrease cost, improve systems, improve productivity
Provides standardized method to identify gaps in practice and systems to - CORRECT ANSWER evaluate ways to improve structure, function and resources in care delivery within complex health systems
PDSA - CORRECT ANSWER Plan Do Study Act
Plan the change
Carry out the plan
Examine the results
Decide what actions will improve the process
Chief nurse approaches NP about HEDIS. NP to review charts of DC pts and they must get an f/u apt in 7 days (retroactive chart review): - CORRECT ANSWER QUALITY IMPROVEMENT INITIATIVE
Retrospective audit involves: - CORRECT ANSWER exam charts of dc pt and using specific criteria to determine the quality of patient care
The NP is resp for initiating quality improvement at a comm health clinic: evaluating clinic services: - CORRECT ANSWER PDSA
Root cause- - CORRECT ANSWER something happened-go to find out what happened
Failure modes and effects analysis: - CORRECT ANSWER proactive method evaluating the process, ID parts that are most in need of change
Reviews 4 charts per month to assure Diabetes protocols are met: - CORRECT ANSWER Peer Review
Core competency: - CORRECT ANSWER the ability to practice nursing that meets the needs of pt care by using logical thinking and current nursing skills
Forced Field analysis- - CORRECT ANSWER hepling or hindering forces
Risk analysis: - CORRECT ANSWER ongoing to provide risks
Reflective practice - CORRECT ANSWER **Linking theory to practice
Enhance clinical reasoning and decisions making
Social cultural competence - CORRECT ANSWER Health literacy, family patterns and situation and traditions
Folk remedies, communicate so pt can understand
NP via telemed, pt has questions about med she started: - CORRECT ANSWER NP email drug information and resources
The member of a 2nd generation family of Mediterranean ancestry express concern about their immigrant grandma's behavior, she wears heavy black clothing, secludes, discusses impending death: - CORRECT ANSWER cultural factors may negate the significance of seemingly obvious symptoms.
Concept map - CORRECT ANSWER relationships between concepts
Discovery - CORRECT ANSWER learning from past experiences [Show Less]