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NR605 / NR 605 Diagnosis & Management in Psychiatric-
Mental Health across the Lifespan I Practicum
Midterm Exam Weeks 1 - 4 Covered
100% Guarantee Pass - Chamberlain
- Psychotherapy Answer nonpharmacological intervention -used to tx mental health diagnoses or distress -help clients improve functioning and well-being -talk therapy -provided by psychiatrists, psychologists, social workers, marriage and family ther- apists, counselors, and PMHNPs -may include individual, couple, family, or group sessions -Goals: symptom reduction, improvement in functioning, relapse prevention, empow- erment, achievement of collaborative goals set by the client &
2 / therapist.
- Methods of Collaboration: Answer Intraprofessional Collaboration -the interaction and efforts between two disciplines with the same profession
- Potential barriers: tension, large team size, high turnover, lack of familiarity and common goals, role ambiguity, generational differences, and lack of undergraduate nursing education on intraprofessional practice. Transprofessional Collaboration -includes communication with various disciplines: physicians, physical/occupational therapy, and social services, along with others to ensure care is delivered safely
- Potential barrier: lack of training
- Role of PMHNPs in Psychotherapy Answer unique, full-spectrum approach -may provide psychotherapy in addition to prescribing medications -providing client and family education
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- Theoretical Models in Psychotherapy: Answer Maslow's Hierarchy of Needs Health Belief Model Transtheoretical Model of Change
- Maslow's Hierarchy of Needs : Answer framework for understanding client motivation -first four levels of need in the hierarchy (physiological needs, safety, love and belonging, and esteem) are sometimes referred to as deficiency needs (D-needs)
- Motivation decreases once D-needs are met -highest level of need, self-actualization, is considered a growth or being need (B-need)
- Once D-needs are met, clients can focus on self-actualization and personal growth
- As the B-need is met, motivation for further growth increases
- self-actualized person
5 / Answer : is self-fulfilled -Qualities exhibited by the self-actualized person include independence, autonomy, creativity, and maturity
- Maslow's Hierarchy of Needs Pyramid: Answer TOP: Self-actualization -Morality, creativity, spontaneity, lack of prejudice, acceptance of facts Esteem -Self-esteem, respect, achievement, confidence Love/Belonging
- Friendship, family, intimacy, sense of connection with others Safety -Security of body, of employment, of resources, of morality, of the family, and of health, of property
7 / changes to behavior -stages:
- precontemplation
- contemplation
- preparation
- action
- maintenance
- Nancy is a 64-year-old who is wondering if losing weight might benefit her self-esteem and self-confidence. Based on the transtheoretical model of change, which of the following actions by the PMHNP would be appropriate for Nancy if she is in the contemplation stage of change? Ask Nancy to create a list of reasons that she wants to lose weight. Refer Nancy to her primary provider to obtain medical clearance for an exer- cise program. Explore Nancy's anxiety and emotional responses related to be: Answer Ask Nancy to create a list of reasons that she wants to lose weight.
8 / Rationale: Creating a list of reasons to lose weight would be appropriate for the contemplation phase. Obtaining medical clearance for exercise is a part of the preparation phase of the Transtheoretical Model of Change. Exploring emotional re- sponses to being overweight would be appropriate for the precontemplation phase. Addressing rewards for reinforcement of behaviors would occur in the action phase.
- Treatment Hierarchy Framework : Answer therapeutic aims at the base of the model must be addressed before the client can move up the triangle Top: Stabilization Internal resources External resources Bottom: Foundational needs
- strategies to support resource development and stabilization Answer -case man- agement
10 / -Outline for Cultural Formulation includes an assessment of the following categories:
- cultural identity of the individual
- cultural conceptualizations of distress
- psychosocial stressors and cultural features of vulnerability and resilience
- cultural features of the relationship between the individual and clinician
- overall cultural assessment
- Illness Perception Answer : psychodynamic approach -attributes mental illness to environmental and psychosocial problems biophysiological model -attributes mental illnesses to chemical imbalances of neurotransmitters
- epigenetics: Answer the study of how the environment and other factors change the way genes are expressed
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- Documentation requirements Answer standard format of chief complaint, history of present illness, review of systems, past psychiatric history, mental status exam, diagnostic formulation, and treatment plan -Psychotherapy sessions must include the following:
- target symptoms
- goals of therapy
- method of monitoring outcomes
- frequency of treatment
- clinical records to support relevant medical history
- results of diagnostic tests or
- procedures
- prognosis or progress to date
- estimated duration of treatment
- Reimbursement: Answer Clinical procedural terminology (CPT) codes -standardized codes used to communicate services completed to Medicare and
13 / moderate, or high -based on three components:
- number of diagnoses
- amount of data being reviewed
- risk of mortality/morbidity -The level of MDM is selected based on complexity
- Psychotherapy Codes Answer : • 90832- psychotherapy duration 16-37 minutes
- 90833- psychotherapy duration 16-37 minutes used as an add on code to a E/M code
- 90834- psychotherapy 38-52 minutes
- 90836- psychotherapy duration 38 or more minutes used as an add on code to a E/M code
- 90837- psychotherapy 53 or more minutes
- 90846- family psychotherapy client not present
- 90847- family psychotherapy with client present
- 90853- group psychotherapy
- Lori, a 42-year-old female, presents to the office for an initial consulta- tion. She has just experienced a breakup after a 5-year
14 / relationship and is feeling "depressed." A comprehensive initial evaluation which includes chief complaint, history or present illness, medical history, previous psychiatric history, family history and a comprehensive review of systems was completed. Psychotherapy was included in the session - 18 minutes time. provide the appropriate CPT code Answer : 99205+ Rationale: The client is new to the practice (20) and presents with one problem which addressed 4 or more elements, had a comprehensive history and interview. No additional testing was needed, treatment was initiated (05). Psychotherapy was included in the session- 18 minutes time. Therapy goals were established and reviewed with the client.
- Hannibal, a 23-year-old male, is admitted to an inpatient psychiatric facility with symptoms of auditory hallucinations, paranoia, and suicidal ideations. A comprehensive initial evaluation which includes chief complaint, history or present illness, medical history, previous
16 / uncertain prognosis, required review of referral notes, and requires prescription drug management. No psychotherapy provided.
- Steve, a 30-year-old married client returns for a follow up appointment. He was initially seen 3 months ago due to increased anxiety over his marriage. His diagnoses include generalized anxiety disorder (F41.1) and major depressive disorder (F32.1) The PMHNP has provided both medication management and cognitive behavioral therapy (CBT). Today the PMHNP obtains a chief com- plaint, history of present illness, reviews medical history, and a focused review of three systems was completed. Medications Answer : 99214 + 90833 Rationale: This is a returning client with two documented diagnoses. A focused encounter was conducted that included psychotherapy.
- The PMHNP has initiated a grief support group at her practice.The support group is one hour in length and can include the client and family members. provide the appropriate CPT code: Answer
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Rationale: This is group psychotherapy with no medication management. Only a psychotherapy code is necessary.
- Interprofessional Collaboration and Referrals Answer PMHNPs may receive client referrals from primary care providers to address mental health problems -refer clients to primary care providers for medical care -PMHNPs may collaborate with social workers to address clients' needs for social support -vocational counselors to assist with employment needs -refer clients to other therapists
- geriatrics, psychiatric emergencies, eating disorders, family therapy, or pediatrics -telehealth services or a support group
- Disparities in Mental Health Services: Racial, ethnic, gender, and sexual minorities -often experience poor mental health outcomes due to inaccessibility of quality mental health services, discrimination, a cultural stigma surrounding mental health care, and lack of knowledge about mental health
19 / Exception to informed consent: Informed consent required
20 / Rationale: The client has the capacity to consent and the situation is not emergent. The ethic of autonomy provides for the client to refuse treatment options.
- An agitated, hallucinating client with a diagnosis of schizophrenia and no designated decision-maker threatens to shoot his neighbors. The client acts out violently towards the security guard in the emergency department. The PMHNP orders haloperidol and lorazepam for the client. Exception to informed consent Informed consent required: Exception to informed consent Rationale: The client does not have the capacity to provide consent.
- A very anxious client is seeking treatment for anxiety symptoms. When the PMHNP begins to explain the treatment options, the client says she is too anxious to hear them and asks that the PMHNP select the best option. Exception to informed consent Informed consent required: Exception to informed consent Rationale: Clients may choose to waive their right to informed consent.
