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The purpose of the American Nurses Association's Psychiatric-Mental Health Nursing: Scope and Standards of Practice is to a. Define the role and actions for the NP b. Establish the legal authority for the prescription of psychotropic medications c. Define the legal statutes of the role of the PMHNP d. Define the differences between the physician role and the NP role - ✔✔A. The ANAs Psych-Mental Health Nursing Scope and Standards of Practice defines the role and actions of the nurse practitioner.
D. Information reduces incidence of disease. - ✔✔Primary prevention care practices are an essential aspect of the PMHNP role. Which of the following is the best example of a primary prevention care strategy for community behavioral health? a. Aftercare program for chronically mentally ill clients recently discharged from the hospital b. Court-ordered counseling for abusive parents c. 24-hour crisis hotlines d. Parenting skills classes for pregnant adolescents
The trend in legal rulings on cases involving mental illness over the past 25 years has been to a. Encourage juries to find defendants not guilty by reason of insanity b. Protect the person's freedoms or rights when he or she is committed to a mental hospital c. Place increasing trust in mental health professionals to make good and ethical decisions d. Decrease the "red tape" associated with commitments so that commitments are faster and easier - ✔✔B. Identifies the trend of ensuring the protection of individual civil liberties for psychiatric clients.
Mr. Smithers, an involuntarily hospitalized patient experiencing psychotic symptoms, refuses to take any of his ordered medication because he believes "Jesus Christ told me I am the prophet and must fast for a year." Your actions should be based on your knowledge of which of the following?
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a. Psychiatric clients cannot refuse treatment b. Psychiatric clients do not always know what is good for them c. Psychiatric clients can refuse treatment d. Psychiatric clients cannot be trusted to make good healthcare decisions and, therefore, the nurse's best clinical judgment should guide actions - ✔✔C. As with any client, psychiatric clients can refuse treatment unless a legal process resulting in involuntary commitment or mandatory court order for treatment has been obtained.
Which of the following statements best reflects the difference between the nurse-client (N-C) relationship and a social relationship? a. In the N-C relationship, the primary focus is on the client and the client's needs. b. Goals in the N-C relationship are deliberately left vague and unspoken so that the client can work on any issue. c. In the N-C relationship, the nurse is solely responsible for making the relationship work. d. In the N-C relationship, there is no place for social interaction. - ✔✔A. Social relationships are mutual interpersonal relationships in which the needs of both parties are addressed. The N-C relationship is most concerned with meeting the needs of the client.
A community has an unusually high incidence of depression and drug use among the teenage population. The public health nurses decide to address this problem, in part, by modifying the environment and strengthening the capacities of families to prevent the development of new cases of depression and drug use. What is this is an example of? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Protective factorial prevention - ✔✔A. This action focuses on interventions designed to reduce the incidence of new cases of disease.
Mrs. Kemp is voluntarily admitted to the hospital. After 24 hours, she states she wishes to leave because "this place can't help me." The best nursing action that reflects the legal right of this client is a. Discharge the client b. Explain that the client cannot leave until you can complete further assessment c. Allow the client to leave but have her sign forms stating she is leaving against medical advice
d. A sign of pathological attachment to the therapist that must be addressed - ✔✔C. Clients frequently display resistance and regression at the termination of a meaningful therapeutic process. The PMHNP is responsible for planning an effective termination and monitoring clients during the termination period.
A client is displaying low self-esteem, poor self-control, self-doubt, and a high level of dependency. These behaviors indicate developmental failure of which of the following stages of development: a. Infancy b. Early childhood c. Late childhood d. School age - ✔✔B. These signs indicate developmental failure of early childhood.
Mr. Thompson has been forgetful lately, for example, forgetting where he has placed his keys or what time appointments are scheduled, and he has stated that he thinks these are just random behaviors that have no particular meaning. Which Freudian-based psychodynamic principle assumes that all behavior and actions are purposeful? a. Pleasure principle b. Psychic determinism principle c. Reality principle d. Unconsciousness principle - ✔✔B. The psychic determinism principle states that all behavior has purpose and meaning, often unconscious in nature, and that no behaviors occur randomly or by coincidence.
An example of a mature, healthy defense mechanism is a. Denial b. Rationalization c. Repression d. Suppression - ✔✔D. Suppression is the only defense mechanism listed in which the client channels conflicting energies into growth-promoting activities.
Mr. Johnson is a 54-year-old client you have been seeing for several weeks in therapy. While discussing his current concerns of marital stress, he lies on the floor and assumes the fetal position. This is most likely an example of
a. Immature regressive defense mechanism b. Denial of reality c. Immature fantasy defense mechanism d. Repressive behavior - ✔✔A. Immature regressive defense mechanism is a return to a behavior common to an earlier stage of development.
Defense mechanisms are best viewed as a function of the ego a. To alert us to harm and danger b. To alert us to problems c. Used to resolve a conflict d. Used to protect the id - ✔✔C. Defense mechanisms are a function of the ego used to resolve a conflict.
One of the health care changes that has occurred as a result of the affordable care act (ACA) is that doctors/hospitals/clinic groups or health systems are coming together and assuming the responsibility for quality care to large groups of individuals insured by Medicare. The health care clinics/systems doctors or hospitals that join together are called which of the following? a. Health Maintenance Organization (HMO) b. Preferred Provider Network (PPO) c. Accountable Care Organization (ACO) d. Individual Health Plan (IHP) - ✔✔C. ACO's are groups of doctors or other health care providers who voluntarily come together and assume the care provided to Medicare patients.
Health care economics is concerned with making decisions so the benefits outweigh the cost of resource utilization. What are two concepts that healthcare economics is concerned with in regard to fair distribution of resources and allocation? a. Equity and efficiency b. Cost and benefits c. Opportunity and waste d. Affordable and quality - ✔✔A. Health care efficiency is making risk and benefit decision about how care resources are allocated and equity is ensuring that there is a fair distribution of the resources.
c. Raphe nuclei d. Substantia nigra - ✔✔C. Serotonin is produced in the raphe nuclei.
Dopamine is produced in which of the following locations: a. Locus ceruleus b. Nucleus basalis c. Raphe nuclei d. Substantia nigra - ✔✔D. Dopamine is produced in the substantia nigra.
A client presents with complaints of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions? a. Thalamus b. Hypothalamus c. Limbic system d. Hippocampus - ✔✔B. Appetite, sleep, and libido are regulated by the hypothalamus.
In considering whether to order an MRI of the head for a client, which of the following would be a contraindication to this diagnostic test? a. Prosthetic limb b. History of head trauma c. Pacemaker d. Pregnancy - ✔✔C. A client with a pacemaker should not receive an MRI of the head.
The primary excitatory neurotransmitter is a. GABA b. Serotonin c. Dopamine d. Glutamate - ✔✔D. Glutamate is the primary excitatory neurotransmitter.
A client who is experiencing difficulties with working memory, planning and prioritizing, insight into his problems, and impulse control presents for assessment. In planning his care, the PMHNP should apply his or her knowledge that these symptoms represent problems with the a. Frontal lobe b. Temporal lobe c. Parietal lobe d. Occipital lobe - ✔✔A. Problems with working memory, planning and prioritizing, insight into problems, and impulse control indicate a problem in the frontal lobe.
The concept of target symptom identification is best explained as a. Identification of the major clinical presentation of the client b. Identification of specific, precise, and individualized symptoms reasonably expected to improve with medication c. Identification of the secondary messenger system syndrome d. Intentional modulation of synaptic pathways - ✔✔B. Target symptom identification is the identification of specific, precise, and individualized symptoms reasonably expected to improve with a given medication.
The goal of the psychiatric assessment process performed by the PMHNP is to a. Gain an understanding of the life experiences of the client b. Correctly diagnose the client c. Identify the mental health needs of the client d. Be able to communicate with other staff about the client's health needs - ✔✔C. Although diagnosis is an important aspect of the assessment process, the assessment ultimately should identify the needs of the client.
Mr. Johnson is a client newly admitted to an inpatient psychiatric hospital. The PMHNP on call at the facility plans to perform the initial intake assessment and diagnostic process. Mr. Johnson asks to please talk in his room because, he says, "People make me nervous." His room is at the end of the hallway and is the farthest away from the nursing station. The PMHNP's action should be based on awareness that the best location to do the assessment is
a. "I wonder if confining him to his room was abusive?" b. "Maybe that depends on what you are trying to accomplish." c. "Perhaps talking to his friends and teachers would help." d. Remain silent - ✔✔B. This response will be the most therapeutic in moving forward with the client.
A client says to the PMHNP, "Some days life is just not worth it. All my wife and I ever do is fight and scream. Things at home would be calmer and simpler if I just wasn't there anymore." The most therapeutic response for the PMHNP to make is a. "Do you mean that you are thinking about leaving your wife and moving out?" b. "Tell me what you mean by 'it would be simpler if you just weren't there anymore.'" c. "So you are thinking suicide might be an option for you?" d. Remain silent - ✔✔B. This response is the most therapeutic, allowing the client to further clarify and express feelings.
Mrs. Shea has come to the mental health center seeking treatment for depression. She has a history of a suicide attempt by overdose 1 month ago. She was started on imipramine (tricyclic antidepressant [TCA]) after that event but stopped taking the medication 1 week later because it "did no good." The PMHNP meets with Mrs. Shea to plan care with her. Which of the following is the most appropriate initial action? a. Asking Mrs. Shea how to help her b. Providing client teaching about the long time frame for TCAs to work c. Contracting with Mrs. Shea for 6 sessions of individual therapy d. Providing Mrs. Shea with feedback about how suicide might affect her family - ✔✔A. Asking the client how to help is an aspect of assessment—all other answers are aspects of interventions, which are not initial actions of the PMHNP.
In completing the PMHNP assessment for the Mrs. Shea, the most appropriate lab test for the PMHNP to order at this time is a. CBC b. TSH c. Liver function tests d. Electrolyte panel - ✔✔C. Client overdosed and then was placed on a medication that affects the liver. The PMHNP needs to assess the client's liver function as an aspect of
care planning for her.
A client comes into the clinic with a longstanding history of depression and chronic renal failure. He is on an antidepressant and a diuretic and complains of increased depression, mild confusion, irritability, and overall apathy from being too tired to do anything. The best initial PMHNP action to take at this time is a. Increase his dose of antidepressant medication to better capture symptoms b. Change him to another antidepressant for better symptom control c. Augment his antidepressant with an atypical antipsychotic medication d. Order a comprehensive metabolic panel - ✔✔D. Client symptoms are consistent with electrolyte imbalance and a physical cause of his symptoms must be ruled out first.
Sarah presents for her initial intake appointment with complaints of depression. She is being treated for hypertension and asthma by her primary care provider. Knowing that certain medications can cause or exacerbate depression, you obtain a complete medication history. Which of the following medications is known to exacerbate or cause depression? a. Omeprazole b. Propranolol c. Levothyroxine d. Clarithromycin - ✔✔B. Beta blockers can cause or exacerbate depression.
When treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which of the following reasons? a. Decreased body fat b. Increased liver capacity c. Decreased protein binding d. Increased muscle concentration - ✔✔C. Older adults usually have decreased protein levels. Most psychotropic medications are highly protein-bound. It is the unbound (free) concentration of the drug that is active; the bound concentration of the drug is inert. Thus, with decreased protein available for binding, more free (active) drug remains in the body, which then predisposes older adults to toxicity.
a. Recognize and change his or her automatic thoughts b. See reality as you see it c. Change his or her reality by changing his or her environment d. Recognize and accept that automatic thoughts suggest delusional thinking - ✔✔A. Cognitive behavioral therapy helps clients recognize and change their automatic thoughts.
When working with a dysfunctional family, you find that the father, Jim, worries excessively and is resistant to change. You give Jim a paradoxical directive to worry extremely well for 1 hour per day, knowing that he will likely be noncompliant, and thus change will occur. With this technique, you are using which type of therapy? a. Experiential therapy b. Structural therapy c. Strategic therapy d. Solution-focused therapy - ✔✔C. Paradoxical directives are used in strategic therapy.
Which of the following best describes homeostasis in a family system? a. Choices a family makes to keep the peace b. Balance or stability that the family returns to despite its dysfunction c. Need for change and balance in a family d. Calm in a family that returns after a crisis - ✔✔B. Homeostasis is balance or stability that the family returns to despite its dysfunction.
In an attempt to bring the client toward the goal he or she is working on, you ask the client, "If a miracle were to happen tonight while you slept, and you awoke in the morning and the problem no longer existed, how would you know, and what would be different?" This technique is used in which type of therapy? a. Behavioral therapy b. Solution-focused therapy c. Adlerian therapy d. Existential therapy - ✔✔B. Miracle questions are used in solution-focused therapy.
Ms. Thomas has been diagnosed with major depressive disorder (MDD) and is placed on fluoxetine 20 mg for her depression. For the PMHNP to effectively monitor her use of the medication, which of the following actions should be part of ongoing care? a. Use of a standardized rating scale of depression b. Monitoring for potential abuse of the medication c. Monitoring of labs for renal functioning d. Monitoring for potential cardiac side effects - ✔✔A. The use of a standardized rating scale will allow the PMHNP to monitor the level of client symptoms and to evaluate the efficacy of the medication.
Which of the following is the best reason for considering the SSRI among the first-line drug choices for treating major depression? a. Need to stair-step initial dosages b. Sedating and calming effect of the medication c. Safe use in suicidal overdose clients d. Ability to obtain therapeutic serum drug levels - ✔✔C. SSRIs are considered among the first-line medications used to treat depression because of safety in suicidal overdose clients.
A 23-year-old woman is brought into the ER after attempting suicide by cutting her wrists. Which nursing action by the PMHNP would be of highest priority initially? a. Assess her coping behaviors b. Assess her current level of suicidality c. Take her vital signs d. Assess her health history - ✔✔C. The PMHNP needs to ensure that her suicide attempt has not led to medical instability.
Which of the following interventions by the PMHNP for a person experiencing ataque de nervios demonstrates culturally informed care? a. Offering brief supportive psychotherapy b. Offering a brief hospitalization c. Requesting a family member act as an interpreter d. Offering low-dose, short-term anxiolytic medication - ✔✔A. The literature suggests that although short-term anxiolytic medication may be offered in an emergency room setting, ataque de nervios is best
A client returns for a follow-up appointment 3 weeks after starting on fluoxetine 20 mg. During this appointment you notice that her speech is a little rapid, in marked contrast to the psychomotor retardation and paucity of spontaneous speech she displayed on her first visit. Instead of looking at the floor, she now makes normal eye contact. Her affect has gone from constricted to expansive. She continues to have difficulty sleeping, but her energy has improved and she states she feels "so much better!" What should you conclude about the shift in the client's presentation? a. She is experiencing the activating side effects of fluoxetine. b. She is becoming euthymic. c. She is becoming hypomanic. d. She is in a mixed state. - ✔✔C. In this case, you see a shifting set of symptoms, the most important being her expansive mood and statement "so much better" that indicates she has gone beyond euthymia.
Mr. D. is a 35-year-old, married, high-tech industry executive who is referred to the PMHNP for "insomnia." Mr. D. reports that he falls asleep quickly, but has difficulty staying asleep. He wakes up several times during the night, and believes he tosses and turns even when he is sleeping. He wakes up feeling exhausted and drinks "a pot of coffee" to stay awake and concentrate during his long work day. He drinks 1 glass of wine most evenings. He denies any illicit substance use. He denies any symptoms of a mood or anxiety disorder, but is feeling increasingly frustrated and concerned about his sleep. Which of the following is the most likely contributing factor to Mr. D.'s ongoing middle insomnia? a. Obstructive sleep apnea (OSA) b. Caffeine dependence c. Alcohol withdrawal d. Attention-deficit hyperactivity disorder (ADHD) - ✔✔A. OSA is the only plausible possibility if the rest of the information given by the client is accurate. OSA causes clients to have frequent awakenings and a sense that they are not sleeping deeply ("tossing and turning") that is caused by apnea. The client should be assessed further for snoring and awareness of apnea. Although the client states he drinks a lot of coffee, this is driven by his sleep issues. Drinking 1 glass of wine in the evening would not cause the degree of sleep pathology he is exhibiting. Other than diminishing concentration that is consistent with sleep deprivation, there are no other signs and symptoms of ADHD.
Tina is a 54-year-old single white woman who has been a Psychiatric-Mental Health Nurse Practitioner for over 20 years. She is considering making application to a Doctor of Nursing Practice (DNP) program but states "if a DNP is required to practice I'll get grandfathered in, no need for me to go back to school." Following the 2008 License, Accreditation, Certification, and Education (LACE) Consensus Model for Advanced Practice Registered Nurse Regulation, which statement is correct? a. Tina is correct: if the DNP becomes a requirement, she will be grandfathered in and obtain a DNP degree. b. The DNP is an academic terminal degree and there will not be an opportunity for Tina to be grandfathered in a DNP. c. Tina will be grandfathered in and obtain a DNP only if her state requires a DNP to practice as an APRN. d. The DNP is a certification and Tina will have to take an examination to be grandfathered in to obtain a DN - ✔✔B. APRNs are not grandfathered into an academic degree; degrees must be earned from accredited academic institutions.
Tim is a board-certified Psychiatric-Mental Health Nurse Practitioner (PMHNP) working in a busy community mental health center (CMHC). He is currently seeing a client diagnosed with bipolar I disorder who has comorbid hypertension and diabetes. During the visit, Tim takes the client's blood pressure and her reading is 160/94 mm Hg. The client denies any headaches, nausea, chest pain, or shortness of breath. The client states "I can't afford all these medications so I haven't seen my doctor in 7 months and I am out of all my blood pressure and sugar medications, can you give me some?" What is Tim's most appropriate action? a. Call the pharmacy to find out what medications the client is taking and refill for 1 month to cover until she can get in to see his primary care provider. b. Tell the client he cannot refill her medications and inform her to go to the emergency room should she develop any signs or symptoms of an - ✔✔C. It is not within the scope of practice of a PMHNP to treat hypertension. Coordination of care to ensure the client does not run out of medication is the appropriate course of action.
The chief nursing officer of a large behavioral health system approached the PMHNP to discuss the new Healthcare Effectiveness Data and Information Set (HEDIS) behavioral health measures and specifications. The PMHNP is asked to do a retrospective chart review of all hospital discharge clients who received a follow-up visit within 7 days of discharge and within 30 days of discharge. The PMHNP has been asked to engage in which of the following? a. Needs assessment project
b. Nonmaleficence c. Justice d. Beneficence - ✔✔A. Clients who are legally competent have the ability to make medical decisions and maintain individual autonomy.
A new client reveals to the PMHNP that her boyfriend screams at her and has repeatedly slapped and pushed her in front of her 3-year-old son. She goes on to say that the boyfriend has thrown things at her and on one occasion threw a glass of water at her that hit her son in the back. Should the PMHNP report this to child protective services (CPS)? a. Yes, the client is issuing a cry for help for her son. b. Yes, the PMHNP has a duty to report. c. No, this does not constitute a reportable offense. d. No, a report to CPS will escalate the violence. - ✔✔B. PMHNPs are mandated reporters of child abuse. The 3-year-old is being exposed to violence and although not the target, could have been injured when the boyfriend threw the glass of water.
Which of the following is a function of the psychiatric interview? a. Understand the client's psychosocial needs and communicate them to the treatment team b. Identify the mental health needs of the client c. Review previous medical records d. Evaluate a treatment plan - ✔✔B. During a psychiatric interview, the PMHNP is responsible to identify symptoms and needs of a client to develop an appropriate treatment plan.
A 74-year-old married white woman was referred to you by her primary care provider for a psychiatric evaluation. She had a normal medical and neurological examination in the last 2 months. The client presents with her husband of 45 years who states, "My wife is just not the same anymore, she is irritable and asks the same question several times, even though I've answered it many times." The client responds, "Oh, Henry, you do the same thing, it's just a normal part of getting older, and the kids think everything is fine." During the assessment you compete the mini mental status examination (MMSE) and the client scores 18. As the PMHNP treating the client, you know the results of her MMSE indicate which level of cognitive impairment? a. No cognitive impairment b. Mild cognitive impairment
c. Moderate cognitive impairment d. Severe cognitive impairment - ✔✔C. Cut points on the MMSE are as follows: total score 30, 25- questionable significance, 20-25 mild impairment, 10-20 moderate impairment, and 10 or lower severe impairment.
You are the PMHNP treating Tim, a 10-year-old child, for ADHD and social anxiety disorder. His mother presents with Tim for his scheduled individual therapy session. At the end of the session his mother says, "I need to take Tim to see his pediatrician and at the last visit I was told he needed some HPV shot. I don't know, he's a boy, why would he need that? What do you think?" What is the PMHNP's best response to her question? a. "The Centers for Disease Control and Prevention (CDC) recommends the human papillomavirus (HPV) vaccine for all boys and girls at age 10. HPV can cause cancer in both men and women, and the vaccine is effective in protecting against the virus. Can you tell me your concerns about Tim getting this vaccine?" b. "While the Centers for Disease Control and Prevention (CDC) recommends the vaccine, every parent has the right to choose and if you do not think Tim needs this vaccine, as his parent yo - ✔✔A. When family members or clients ask questions about illnesses and treatment, it is the PMHNP's responsibility to provide data and then assess understanding and meaning.
As a PMHNP working in a crisis evaluation center, you are aware that the initial focus of a crisis assessment is on which of the following? a. Client's past diagnosis and medication trials b. Psychosocial history and supports c. Safety of the client and others d. Current living situation and coping skil - ✔✔C. In a crisis, the first assessment should be safety of the client and those near the client.
When conducting a neurological examination on a client, the PMHNP asks the client to hold out her arms and stick out her tongue while assessing for tremors. Which cranial nerve is being assessed? a. Glossopharyngeal b. Vagus c. Trigeminal d. Hypoglossal - ✔✔D. The tongue is controlled by the hypoglossal cranial nerve.
