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NR607 Final Exam with correct detailed
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The PMHNP (Psychiatric Mental Health Nurse Practitioner) is providing care to a 29-year-old client who presents with persistent sadness and hopelessness for the last two months. She is having difficulty sleeping and has a decreased appetite. This is the patient's first contact with with the healthcare system about her concerns. PMHNP role: Acute PMHNP Care Telehealth Case Management Primary Care Pharmacologic Intervention Crisis Intervention Partial Hospitalization/Intensive Outpatient Tx Community-Based Care Self-Employment Psychotherapy - correct answer ✔ Primary Care Rationale: This is the client's initial contact with the healthcare system about her concerns
The client has experienced depressive symptoms. The PMHNP prescribes a selective serotonin reuptake inhibitor (SSRI). PMHNP role: Acute PMHNP Care Telehealth Case Management Primary Care Pharmacologic Intervention Crisis Intervention Partial Hospitalization/Intensive Outpatient Tx Community-Based Care Self-Employment Psychotherapy - correct answer ✔ Pharmacologic Intervention Rationale: The PMHNP is prescribing psychopharmacotherapy for the client The PMHNP provides the client with some mindfulness techniques to try at home. PMHNP role: Acute PMHNP Care Telehealth Case Management Primary Care
Psychotherapy - correct answer ✔ Crisis Intervention Rationale: Suicidal ideation with a plan is a psychiatric emergency requiring immediate intervention. The client is admitted to the psychiatric and behavioral health unit at the local hospital for a 72-hour observation where the PMHNP works with her team providing treatment. The client remains hospitalized for a week while her medications are managed. The client attends individual and group therapy sessions. PMHNP role: Acute PMHNP Care Telehealth Case Management Primary Care Pharmacologic Intervention Crisis Intervention Partial Hospitalization/Intensive Outpatient Tx Community-Based Care Self-Employment Psychotherapy - correct answer ✔ Acute PMHNP Care Rationale: Acute inpatient care occurs in an intensive hospital or psychiatric facility setting.
Following hospitalization, the client returns home but commutes to a treatment center for 4 hours a day 5 days per week for ongoing therapy, medication management, and psychoeducation. PMHNP role: Acute PMHNP Care Telehealth Case Management Primary Care Pharmacologic Intervention Crisis Intervention Partial Hospitalization/Intensive Outpatient Tx Community-Based Care Self-Employment Psychotherapy - correct answer ✔ Partial Hospitalization/Intensive Outpatient Treatment Rationale: Partial Hospitalization/Intensive Outpatient Treatment occurs when a client receives intensive therapy on an outpatient basis, often used when a client do not require 24-hour care but still require intense treatment. The PMHNP serves as the point of contact person, coordinating the treatment team, which consists of the PMHNP, a social worker, and possibly a psychologist and psychiatrist. PMHNP role:
Community-Based Care Self-Employment Psychotherapy - correct answer ✔ Community-Based Care Rationale: Community-based care is provided in a non-hospital community setting. A global pandemic limits face-to-face mental health visits, the PMHNP determines that the patient requires ongoing mental health treatment. The PMHNP arranges to meet with the client via weekly interactive video sessions. PMHNP role: Acute PMHNP Care Telehealth Case Management Primary Care Pharmacologic Intervention Crisis Intervention Partial Hospitalization/Intensive Outpatient Tx Community-Based Care Self-Employment Psychotherapy - correct answer ✔ Telehealth Rationale: Telehealth services utilize telecommunication technology to deliver treatment to clients.
The PMHNP owns the private practice that is providing services to the client. PMHNP role: Acute PMHNP Care Telehealth Case Management Primary Care Pharmacologic Intervention Crisis Intervention Partial Hospitalization/Intensive Outpatient Tx Community-Based Care Self-Employment Psychotherapy - correct answer ✔ Self-Employment Rationale: The PMHNP is providing direct services through her own private practice. Code of Ethics for Nurses - correct answer ✔ -Respect for the Individual -Commitment to the Healthcare Consumer -Advocacy for the Healthcare Consumer -Responsibility and Accountability for Practice -Duties to Self and Others -Contributions to Healthcare Environments
-recognizes the power differential in the therapeutic relationship & understands that any sort of sexual activity or intimacies with current clients, their close family members, guardians, or significant others is unethical. How the PMHNP does Code of Ethics: Responsibility and Accountability for Practice - correct answer ✔ -must be responsible & accountable for their own practice. -must be able to articulate competencies & be aware of scope of practice professional standards guiding their own practice. -must understand the scope of other team members' practice in order to delegate appropriately. How the PMHNP does Code of Ethics: Duties to Self and Others - correct answer ✔ -owes the same duties to self as to others. -accords moral worth & dignity to oneself & others, including colleagues. -is committed to practicing self-care, managing stress, & maintaining supportive relationships to meet personal needs outside of therapeutic relationships. -identifies & addresses moral distress. How the PMHNP does Code of Ethics: Contributions to Healthcare Environments
- correct answer ✔ -helps maintain & improve healthcare environments and conditions of employment. -recognizes signs & symptoms of psychiatric disorders in the workplace & reports peer observations or concerns to leadership. -helps address problems faced by colleagues that may impact patient safety or violate public trust, including substance abuse.
How the PMHNP does Code of Ethics: Advancement of the Nursing Profession - correct answer ✔ -contributes to advancing the professing through practice, education, administration, & knowledge development. -maintains knowledge of & apply evidence-based practice guidelines, including risk assessment & management. -participates in continuous quality improvement. -pursues continuing education. How the PMHNP does Code of Ethics: Collaboration to Meet Health Needs - correct answer ✔ -promotes community, national, & international efforts to meet health needs through collaboration with other healthcare professionals. -engages in partnerships with other specialty nurses, government agencies, professional nursing organizations, & mental health organizations to promote prevention, treatment, & recovery. How the PMHNP does Code of Ethics: Promotion of the Nursing Profession - correct answer ✔ -advocates for environments that respect human rights, customs, & spiritual beliefs of individuals, families, & communities. -engages in interactions & collaborations to articulate nursing values & maintain the integrity of the profession. -participates in policy development & implementation that recognizes PMH disorders as treatable & ensures that nursing care is delivered with respect to human needs & values without prejudice. Person A: "I can't believe you deal with these people every day. Schizophrenics would drive ME crazy!" PMHNP: "Actually, schizophrenia is a chronic treatable disease, much like diabetes or other physical illnesses. Patients who have mental illness deserve compassion and care."
-Duties to Self and Others -Contributions to Healthcare Environments -Advancement of the Nursing Profession -Collaboration to Meet Health Needs -Promotion of the Nursing Profession - correct answer ✔ Commitment to the Healthcare Consumer Rationale: The PMHNP demonstrates a commitment to the healthcare consumer by balancing the client's human rights with safety, including coercive measures when the client was unable to maintain their own safety. The PMHNP is sharing sexually explicit memes with a client that she saw earlier today in a group session. How the PMHNP applied ethical principles: -Respect for the Individual -Commitment to the Healthcare Consumer -Advocacy for the Healthcare Consumer -Responsibility and Accountability for Practice -Duties to Self and Others -Contributions to Healthcare Environments -Advancement of the Nursing Profession -Collaboration to Meet Health Needs -Promotion of the Nursing Profession - correct answer ✔ Advocacy for the Healthcare Consumer
Rationale: This is an unethical scenario. The PMHNP recognizes the power differential in the therapeutic relationship and understands that any sort of sexual activity or intimacies with current clients, their close family members, guardians, or significant others is unethical. The PMHNP has overbooked her sessions today, so she asks the registered nurse (RN) who works in her office to conduct one of her phone therapy sessions today. How the PMHNP applied ethical principles: -Respect for the Individual -Commitment to the Healthcare Consumer -Advocacy for the Healthcare Consumer -Responsibility and Accountability for Practice -Duties to Self and Others -Contributions to Healthcare Environments -Advancement of the Nursing Profession -Collaboration to Meet Health Needs -Promotion of the Nursing Profession - correct answer ✔ Responsibility and Accountability for Practice Rationale: This is an unethical scenario. The PMHNP must understand the scope of other team members' practice in order to delegate appropriately. Conducting a counseling session is outside of the RN's scope of practice. The PMHNP takes time for daily meditation to improve mindfulness and ease stress.
-Duties to Self and Others -Contributions to Healthcare Environments -Advancement of the Nursing Profession -Collaboration to Meet Health Needs -Promotion of the Nursing Profession - correct answer ✔ Contributions to Healthcare Environments Rationale: The PMHNP recognizes signs/symptoms of psychiatric disorders in the workplace reporting peer observations to leadership. The PMHNP helps address problems faced by colleagues that impact client safety or violate public trust, including substance abuse. The PMHNP gives a presentation at a national conference on best practices in depression treatment. How the PMHNP applied ethical principles: -Respect for the Individual -Commitment to the Healthcare Consumer -Advocacy for the Healthcare Consumer -Responsibility and Accountability for Practice -Duties to Self and Others -Contributions to Healthcare Environments -Advancement of the Nursing Profession -Collaboration to Meet Health Needs -Promotion of the Nursing Profession - correct answer ✔ Advancement of the Nursing Profession
Rationale: The PMHNP contributes to advancing the professing through practice, education, administration, and knowledge development. The PMHNP is a member of the American Nurses Association (ANA) and National Alliance on Mental Illness (NAMI) and regularly participates in workgroups that seek to expand access to care for healthcare consumers with PMH disorders. How the PMHNP applied ethical principles: -Respect for the Individual -Commitment to the Healthcare Consumer -Advocacy for the Healthcare Consumer -Responsibility and Accountability for Practice -Duties to Self and Others -Contributions to Healthcare Environments -Advancement of the Nursing Profession -Collaboration to Meet Health Needs -Promotion of the Nursing Profession - correct answer ✔ Collaboration to meet health needs Rationale: The PMHNP promotes community, national, and international efforts to meet health needs through collaboration with other healthcare professionals to promote prevention, treatment, and recovery. A PMHNP speaks at a school board meeting about the need develop policies to expand mental health services for underserved students.
steps required to obtain informed consent, according to the American Medical Association - correct answer ✔ -Assess client ability to understand medical info. & tx options & to make a voluntary decision. -Present relevant info. with accuracy & sensitivity. Include:
- diagnosis
- nature & purpose of tx options
- benefits, risks, & burdens of all tx options, including forgoing tx -Document informed consent conversation in the medical record, including all consent forms. exceptions to informed consent - correct answer ✔ -incapacitation -situations involving life-threatening emergencies in which there is no time for informed consent -client's voluntary waiver of informed consent -When a client is incapable of informed consent due to the nature or severity of their mental illness
- PMHNP must determine if a client has the capacity to make medical decisions steps in evaluating a client's capacity for decision-making. - correct answer ✔ 1. Assess for communication barriers: language, hearing or vision impairments, dysarthria
- Evaluate for reversible causes of incapacity: infection, medications or other substances, acute neurologic & psychiatric disorders
- Identify values & cultural influences that may impact client decision making
- Ask questions: determine the client's ability to understand the tx & how tx applies to their situation.
- Identify a surrogate if needed: healthcare advance directive, medical power of attorney, spouse, adult children, other close relatives
- Document formal assessment tool to assist in determining capacity - correct answer ✔ Aid To Capacity Evaluation (ACE) Practice Settings for complex mental health care - correct answer ✔ -mental health settings -primary care -pediatrics -family and internal medicine -home health care -hospitals -schools -prisons Legal & Ethical Implications in the Tx of Clients with Complex Disorders - correct answer ✔ -mental illness can impair a client's capacity to make informed decisions for themselves -side effects of some mental health txs may lead clients to choose nonadherence to tx recommendations -client's psychiatric symptoms may compromise their safety or the safety of others. -ethical dilemmas may arise when clients' wishes differ from treatment recommendations or when interprofessional team members disagree about the best course of action in the treatment of a client
