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PMHNP ACCREDITED FINAL EXAM QUESTIONS &
CORRECT ANSWERS (WELL VERIFIED) A+ GRADES
Professional role responsibilities - CORRECT ANSWER >>> Confidentiality, HIPAA, HITECH, telegraphy, informed consent, ethics intellectual disability age of onset - CORRECT ANSWER >>> infancy usually evident at birth ADHD age of onset - CORRECT ANSWER >>> early childhood by age 12 schizophrenia age of onset - CORRECT ANSWER >>> 18 - 25 for men 25 - 35 for women major depression age of onset - CORRECT ANSWER >>> late adolescence to young adulthood dementia age of onset - CORRECT ANSWER >>> most common after age 65 2 types of normal drives - CORRECT ANSWER >>> sexual drives (libido) aggressive drives psychosexual stages of development - CORRECT ANSWER >>> show age related behaviors commonly used for discharging drives and obtaining gratification normally different actions or behaviors are used at different ages to discharge tension from drives and seek gratification
oral stage - CORRECT ANSWER >>> Freud's first stage of psychosexual development during which pleasure is centered in the mouth 0 - 18 months sucking chewing feeding and crying psychiatric disorder linked to failure of oral stage - CORRECT ANSWER >>> schizophrenia substance abuse paranoia anal stage - CORRECT ANSWER >>> Freud's second stage of psychosexual development where the primary sexual focus is on the elimination or holding onto feces. The stage is often thought of as representing a child's ability to control his or her own world. 18 months- 3 years sphincter control, activities of expulsion and retension psychiatric disorder linked to failure of anal stage - CORRECT ANSWER >>> depressive disorders phallic stage - CORRECT ANSWER >>> Freud's third stage of psychosexual development pleasure is gained from self-stimulation of the sexual organs 3 - 6 years exhibitionism, masturbation with focus on Oedipal conflict, castration anxiety, and female fear of lost maternal love psychiatric disorder linked to phallic stage - CORRECT ANSWER >>> sexual identity disorders latency stage - CORRECT ANSWER >>> Freud's fourth stage of psychosexual development when the sex drive goes underground 6 years-puberty peer relationships, learning, motor skills development, socialization
mediates between demands of drivesand environmental realities operates on reality principle begins to develop at birth as infant struggles to deal with environment responsible for use of defense mechanisms the superego - CORRECT ANSWER >>> is the ego-ideal contains sense of conscience or right versus wrong also contains aspirations, ideals, and moral values regulated by guilt and shame begins to fully develop.around age six as a child comes into contact with external authority figures such as other parents, school teachers, coaches, or religious figures id says - CORRECT ANSWER >>> I want ego says - CORRECT ANSWER >>> I think, I evaluate superego says - CORRECT ANSWER >>> I should or ought psychic structure conflict - CORRECT ANSWER >>> exact nature of the conflict is often unconscious but conflict is experienced consciously as anxiety anxiety is used to alert the conscious mind to the presence of conflict
conflict is usually dealt with through defense mechanisms defense mechanisms - CORRECT ANSWER >>> in psychoanalytic theory, the ego's protective methods of reducing anxiety by unconsciously distorting reality they become part of the personality and maintain a sense of safety defense mechanisms - CORRECT ANSWER >>> in psychoanalytic theory, the ego's protective methods of reducing anxiety by unconsciously distorting reality they become part of the personality and maintain a sense of safety the Ego - CORRECT ANSWER >>> Exceptions to guaranteed confidentiality - CORRECT ANSWER >>> - The need for information outweigh confidentiality
- Intent to harm self or others,
- attorney involved in litigation
- records released to insurance companies,
- answering court orders, subpoenas, or summons
- mandatory reporting of diseases,
- Child or elder abuse
- duty to warn potential victims (Tarasoff principle, 1976) HITECH Act of 2009 - CORRECT ANSWER >>> The HITECH Act was created to motivate the implementation of electronic health records (EHR) and supporting technology in the United States such as E-prescribing, computerized physician order sets and tracking care/ avoiding duplication of services. Provided incentive payments for sharing specific EHR data and meaningful use incentives
Respect: treating everyone with equal respect ethical principles in psychiatry - CORRECT ANSWER >>> Clients must be involved in decision- making to the full extent of their capacity (mutual decision making) Clients have a right to treatment in the least restrictive setting Clients have a right to refuse treatment unless a legal process resulting in a mandatory court order for treatment has been obtained ethical dilemma - CORRECT ANSWER >>> 1. A situation in which there are 2 or more justifiable alternatives
- Occurs when the choice is made to promote good
- Harm reduction approach (which option sacrifices the fewest high priority values?) Theoretical approaches to ethical decision making - CORRECT ANSWER >>> Deontological Theory Teleological Theory Virtue Ethics deontological theory - CORRECT ANSWER >>> An action is judged as good or bad based on the act itself regardless of the consequences Teleological theory - CORRECT ANSWER >>> An action is judged as good or bad based on the consequence or outcome Virtue Ethics - CORRECT ANSWER >>> Perspective that what is moral comes from what a mature person with "good" moral character would deem right Actions are chosen on the moral virtues or the character of the person making the decision
Ethics of disclosure by providers - CORRECT ANSWER >>> Patients have the right to know whats happening during their treatment. Providers have an ethical responsibility to disclose medical errors, accidents, injuries, and negative results to patients, and as a result of the disclosure they may have legal rights to compensation. Malpractice Insurance - CORRECT ANSWER >>> Provides financial protection against claims of malpractice Does not protect NPs from charges of practicing outside their legal scope of practice Provided NP their own legal representation to advocate for them Four elements of negligence - CORRECT ANSWER >>> Duty: NP had a duty to exercise reasonable care when undertaking and providing treatment to the client Breach of duty: NP violated applicable standard of care in treating the clients condition Proximate cause: there's a causal real auto shop between the breach in the standard of care and the clients injuries Damages: the client experiences permanent and substantial damages as a result of the breach in the standard of care Competency - CORRECT ANSWER >>> Determination that a client can make reasonable judgements and decisions regarding treatment and other health concerns Legal not a medical concept When is a person considered incompetent - CORRECT ANSWER >>> A person is considered competent until a court ruled the person to be incompetent If a person is deemed incompetent a court appointed guardian will make health related decisions for that person
psychodynamic theory - CORRECT ANSWER >>> (psychoanalytic theory) by signing Freud 1856 - 1939 focused on concepts of intrapsychic conflict among structures of the mind initially designed to explain neurosis and high anxiety but expanded to normal and abnormal development and personality development Risk Management - CORRECT ANSWER >>> Systems to recognize and intervene to reduce risk of injury to clients Appropriate interventions implemented to reduce non healthy behaviors in clients and high risk situations Recognition and intervention to reduce subsequent claims against healthcare providers. advance directives - CORRECT ANSWER >>> legal documents that allow individuals to state what medical treatment they want or do not want in the event that they become incapacitated and are unable to express their wishes regarding medical care Power of attorney and living will power of attorney - CORRECT ANSWER >>> Designated someone to act on your behalf should you become unable to make healthcare decisions; not limited to terminal illness and should be considered when someone with chronic mental illness relapses. LEGALLY BINDING IN ALL 50 states Living will - CORRECT ANSWER >>> A document prepared when a person is well, directing medical care providers to terminate life-sustaining treatment in the event he or she becomes incapacitated, terminally ill, or unable to speak. NOT legally binding in all states
Culture - CORRECT ANSWER >>> Learned beliefs and behaviors or the socially inherited characteristics that a common among all members of a group; may be a racial, social, ethnic, or religious grouping culture-bound syndromes - CORRECT ANSWER >>> Specific behaviors related to a persons culture and not linked to a psychiatric disorder (Be cognizant of inaccurately judging a client's behavior as psychopathology when it is really related to his or her culture) Ethnicity - CORRECT ANSWER >>> Self- identified race, tribe or nation with which a person or group identifies and which greatly influenced beliefs and behavior family - CORRECT ANSWER >>> Group of adults and children who are usually related and whose adults carry out essential functions of providing food, clothing, shelter, safety and education in children What does family teach - CORRECT ANSWER >>> Belief patterns, religion, culture, and mores of a society Community - CORRECT ANSWER >>> Group of families often sharing the same race tribe or culture who have beliefs or behavior not shared by others environment - CORRECT ANSWER >>> Physical and psychosocial factors (general circumstances of a persons life) Factors contributing to environment - CORRECT ANSWER >>> Social contacts Housing surroundings Climate
Homeless people with co-occurring disorders are at greater risk for **- CORRECT ANSWER
** Violence, medication noncompliance, and treatment resistance Strategies for reducing homelessness - CORRECT ANSWER >>> Outreach Integrated care Supporting services to persons in housing Prevention Homelessness outreach - CORRECT ANSWER >>> Introducing services to homeless persons with serious mental illness in various settings, building an empathetic, consistent, and caring relationship to provide treatment Homelessness integrated care - CORRECT ANSWER >>> Treatment combining mental health and medical care to improve overall functioning in the community may also include access to dental care and pharmacy services (colocation) Homelessness supporting services to persons in housing - CORRECT ANSWER >>> Effective in moving homeless persons with serious mental illness directly to independent housing with support and intensive attention Homelessness prevention - CORRECT ANSWER >>> Beginning with discharge planning in inpatient settings, provide resources for mental health care, housing, transitioning service and follow up
** Physical and psychosocial factors (general circumstances of a persons life) Factors contributing to environment - CORRECT ANSWER >>> Social contacts Housing surroundings Climate Homeless people with co-occurring disorders are at greater risk for - CORRECT ANSWER >>> Violence, medication noncompliance, and treatment resistance Strategies for reducing homelessness - CORRECT ANSWER >>> Outreach Integrated care Supporting services to persons in housing Prevention Homelessness outreach - CORRECT ANSWER >>> Introducing services to homeless persons with serious mental illness in various settings, building an empathetic, consistent, and caring relationship to provide treatment Homelessness integrated care - CORRECT ANSWER >>> Treatment combining mental health and medical care to improve overall functioning in the community may also include access to dental care and pharmacy services (colocation) Homelessness supporting services to persons in housing - CORRECT ANSWER >>> Effective in moving homeless persons with serious mental illness directly to independent housing with support and intensive attention Homelessness prevention - CORRECT ANSWER >>> Beginning with discharge planning in inpatient settings, provide resources for mental health care, housing, transitioning service and follow up Migrant and seasonal workers - CORRECT ANSWER >>> High incidence of depression anxiety and substance abuse sexual identity - CORRECT ANSWER >>> How people identify psychologically on a continuum between female and male and to whom they are sexually and/or affectionately attracted.
gender identity - CORRECT ANSWER >>> A person's identity along a continuum between normative constructs of masculinity and femininity Influences on gender identity - CORRECT ANSWER >>> Biological and social factors such as hormone levels, gene expression, gender messages from family, mass media and cultural attitudes gender dysphoria - CORRECT ANSWER >>> Diagnosis describing a marked incongruence between ones experienced and expressed gender and the gender assigned at birth sexual orientation - CORRECT ANSWER >>> Direction of sexual attraction (preferred over sexual preference or lifestyle which imply choice) Sexual orientations - CORRECT ANSWER >>> heterosexuality, homosexuality, bisexuality, asexuality Asexual - CORRECT ANSWER >>> not attracted to either sex Basic Tenets of Psychodynamic Theory - CORRECT ANSWER >>> assumes that all behavior is purposeful and meaningful even apparently meaningless, random, or accidental behavior is actually motivated by underlying unconscious mental content most mental activity is unconscious (urges, feelings, and fantasies that would be unacceptable to the persons values if consciously experienced conscious behaviors and choices are affected by unconscious mental content childhood experiences shape adult personality Bisexual - CORRECT ANSWER >>> attracted to both sexes
Forensic risk assessment - CORRECT ANSWER >>> Protects the public from individuals with known mental disorders having dangerous, violent and criminal histories risk assessment in ED - CORRECT ANSWER >>> Psychiatric evaluation performed in ED after arrest and before person is confined to a correctional facility Forensic PMHNP - CORRECT ANSWER >>> Knowledge of fiction of court Litigation procedures Workings of criminal justice system Relevant case law and health litigation Understanding of mental health distorted thinking patterns and impaired cognition Competence therapeutic relationship - CORRECT ANSWER >>> Mutual, interactive, interpersonal relationship specifically to focus on the identified needs of the client. Focused on the clients needs and goal directed, theory based and open to supervision phases of therapeutic relationship - CORRECT ANSWER >>> Orientation, working, termination Key concepts in the nurse- client relationship - CORRECT ANSWER >>> Transference and counterteansference Transference - CORRECT ANSWER >>> Displacement of feelings for significant people in the clients past onto the PMHNP in the present relationship Countertransference - CORRECT ANSWER >>> The nurses emotional reaction to the client based on her or his past experiences
Signs indicating countertransference in the PMHNP - CORRECT ANSWER >>> Intense emotional reactions on first contact with client (negative or positive) Recurrent anxiety or uneasiness while dealing with client Uncharacteristic carelessness in interaction and follow up with client Difficulty empathizing Resistance to others treating or interacting with the client Preoccupation with or dreaming about the client Running overtime or cutting time short often Depression or other strong emotions during or after interaction Introduction phase of nurse client relationship - CORRECT ANSWER >>> Also known as orientation phase Creating a trusting environment, establishing professional boundaries, establishing the length of anticipated interaction, providing diagnostic evaluation, and setting mutually agreed upon treatment objectives Working phase of nurse client relationship - CORRECT ANSWER >>> Also known as identification and exploitation phase Clarifying client expectations and mutually set goals, implementing treatment plan, monitoring health, undertaking preventative healthcare, measuring outcomes of care, evaluating outcomes of care, reprioritizing plan and objectives as indicated Termination phase of nurse client relationship - CORRECT ANSWER >>> Also known as resolution phase
a person forgets where he parked the car because he really does not wish to go wherever it was that he was headed Erik Erickson's school age stage - CORRECT ANSWER >>> Industry vs inferiority Erik Erickson's adolescent stage - CORRECT ANSWER >>> Identity vs role confusion Erik Erickson's early adulthood stage - CORRECT ANSWER >>> Intimacy vs isolation Erik Erickson's middle adulthood stage - CORRECT ANSWER >>> Generativity vs self absorption or stagnation Erik Erickson's late adulthood stage - CORRECT ANSWER >>> Integrity vs despair Trust vs mistrust - CORRECT ANSWER >>> Infancy; birth to 1 year Mastery of infancy stage - CORRECT ANSWER >>> Ability to form meaningful relationships, hope about the future, trust in others Developmental failure- poor relationships, lack of future hope, suspicious of others Mastery of early childhood stage - CORRECT ANSWER >>> Self control, self esteem, willpower Developmental failure- poor self control low self esteem, self doubt, lack of independence Mastery of late childhood stage - CORRECT ANSWER >>> Self directed behavior, goal formation, sense of purpose
Developmental failure- lack of self initiated behavior, lack of goal orientation Mastery of school age stage - CORRECT ANSWER >>> Ability to work, sense of competency and achievement Developmental failure- sense of inferiority, difficulty with working and learning Mastery of adolescence stage - CORRECT ANSWER >>> Personal sense of identity Developmental failure- identity confusion, poor self identification in group settings Mastery of early adulthood stage - CORRECT ANSWER >>> Committed relationships, capacity to love Developmental failure- emotional isolation, egocentrism Mastery of middle adulthood stage - CORRECT ANSWER >>> Ability to give time and talents to others, ability to care for others Developmental failure- self-absorption, inability to grow and change as a person; inability to care for others Mastery of late adulthood stage - CORRECT ANSWER >>> Fulfillment and comfort with life, willingness to face death, insight and balanced perspective on life's events Developmental failure- bitterness, sense of dissatisfaction with life, despair over impending death Autonomy vs shame and doubt - CORRECT ANSWER >>> Early childhood; 1-3 years old Initiative vs guilt - CORRECT ANSWER >>> Late childhood; 3-6 years old
