A 32-year-old male patient with a history of bipolar disorder presents to your clinic. He reports
experiencing elevated mood, racing thoughts, decreased need for sleep, and increased energy for
the past week. He has not been taking his prescribed mood stabilizers consistently. He mentions
that he feels invincible and has been spending money excessively on frivolous purchases. He
denies any suicidal ideation or aggression. Which of the following actions should the PMHNP
prioritize in the initial assessment?
A.Conduct a thorough mental status examination to assess cognitive function and judgment.
B.Inquire about the patient's support system and current stressors.
C.Administer a urine drug screen to rule out substance use.
D.Recommend immediate hospitalization due to manic symptoms.
Conduct a thorough mental status examination to assess cognitive function and judgment. This option
is a priority because it assesses the patient's current cognitive state and judgment, which are essential in
determining the severity of manic symptoms and assessing potential risks.
Inquire about the patient's support system and current stressors. While assessing the patient's support
system and current stressors is important, it may not be the initial priority when the patient is exhibiting
manic symptoms. Assessing cognitive function and judgment takes precedence.
Administer a urine drug screen to rule out substance use. While assessing for substance use is
important, it is not the initial priority in this case. The patient's presentation of classic manic symptoms
should be addressed first through a mental status examination.
Recommend immediate hospitalization due to manic symptoms. Hospitalization is a serious step and
should be considered when there is a risk of harm to the patient or others. However, it should not be the
immediate response in all cases of mania. Prioritizing a mental status examination to assess cognitive
function and judgment will help determine the need for hospitalization.
A Psychiatric Mental Health Nurse Practitioner (PMHNP) has been treating a 34-year-old male
patient diagnosed with major depressive disorder for the past three months. The patient has been
responding well to psychotherapy and medication. During a recent follow-up appointment, the
patient confides in the PMHNP that he is experiencing suicidal thoughts. He states that he has a
plan and has already written a suicide note. What should be the priority action of the PMHNP?
A.Advise the patient to keep his feelings to himself and not share them with anyone.
B.Inform the patient's family about his suicidal thoughts without his consent.
C.Collaborate with the patient to develop a safety plan, including identifying support systems
and contacting crisis services if necessary.
D.Increase the patient's medication dosage without discussing it with him to prevent further distress.
,Correct Answer: Collaborating with the patient to develop a safety plan is a standard practice for
PMHNPs when a patient expresses suicidal thoughts. It involves assessing the level of risk, identifying
coping strategies, and creating a plan to ensure the patient's safety, including involving crisis services if
necessary.
Advise the patient to keep his feelings to himself and not share them with anyone: This option is not
appropriate. Encouraging the patient to keep his suicidal thoughts to himself is contrary to the ethical
and clinical responsibility of a PMHNP, which includes ensuring the patient's safety.
Inform the patient's family about his suicidal thoughts without his consent: This option is not
recommended. Sharing the patient's confidential information without his consent can breach trust and
violate confidentiality unless there is an immediate risk to the patient's life.
Increase the patient's medication dosage without discussing it with him to prevent further distress: This
option is not appropriate. Making medication changes without discussing them with the patient can
lead to misunderstandings and may not address the underlying issues that have led to the patient's
current distress.
A 45-year-old male patient with a history of bipolar disorder presents to a mental health clinic.
He reports a recent manic episode characterized by decreased need for sleep, excessive spending,
and risky behaviors. He mentions that he stopped taking his prescribed mood stabilizer two
weeks ago. What should be the PMHNP's initial action in managing this patient?
A.Reassess the patient's diagnosis and medication history.
B.Perform a comprehensive mental status examination.
C.Ensure the patient's physical safety.
D.Explore potential triggers for the manic episode.
Ensure the patient's physical safety: This is the correct answer. The patient's recent manic episode,
combined with discontinuation of mood stabilizers, puts them at risk for impulsive and risky behaviors.
Ensuring the patient's physical safety by addressing potential harm to self or others is the highest
priority.
Reassess the patient's diagnosis and medication history: This option is important but not the highest
priority initially. It is crucial to verify the patient's diagnosis and review their medication history, but
immediate safety concerns should be addressed first.
Perform a comprehensive mental status examination: While assessing the patient's mental status is
essential, it is not the highest priority initially. Ensuring the patient's safety takes precedence.
Explore potential triggers for the manic episode: Investigating triggers is an important part of the
assessment, but it should come after ensuring the patient's immediate safety.
,Sarah, a 30-year-old woman with a history of major depressive disorder, is exploring treatment
options with her mental health provider. Which statement aligns best with the recovery model?
A."Sarah, we will manage your symptoms through medication and therapy."
B."Let's work together to identify your personal goals and strengths for a meaningful life."
C."Our primary focus is on symptom reduction to achieve stability."
D."I will provide you with a treatment plan that outlines specific interventions."
"Let's work together to identify your personal goals and strengths for a meaningful life." The recovery
model in mental health emphasizes a person-centered and strengths-based approach. It focuses on
empowering individuals to set their own goals and work towards a fulfilling life, rather than just
symptom management. Option B aligns with this recovery-oriented approach by emphasizing
collaboration with Sarah to identify her personal goals and strengths, which is key to her recovery
journey.
"Sarah, we will manage your symptoms through medication and therapy." This option primarily
focuses on symptom management, which is a more traditional medical model approach rather than a
recovery-oriented one. It may not fully align with the recovery model's emphasis on personal goals and
strengths.
"Our primary focus is on symptom reduction to achieve stability." This option also emphasizes
symptom reduction and stability, which are important but may not fully capture the broader goals of the
recovery model, which include personal growth and meaning beyond symptom management.
"I will provide you with a treatment plan that outlines specific interventions." This option implies a
more prescriptive and provider-driven approach to treatment, which may not align as closely with the
recovery model's emphasis on individual empowerment and collaboration in goal setting.
Mark, a 25-year-old diagnosed with schizophrenia, is considering vocational rehabilitation
services. What approach is most consistent with the recovery model?
A.Focusing on managing symptoms before addressing employment goals.
B.Encouraging Mark to accept a sheltered workshop position.
C.Collaboratively exploring vocational aspirations and providing support accordingly.
D.Recommending long-term disability as the primary option.
Collaboratively exploring vocational aspirations and providing support accordingly. The recovery
model in mental health emphasizes a person-centered and strengths-based approach. It focuses on
empowering individuals to set their own goals and work towards a fulfilling life, which includes
vocational aspirations. This option aligns with this recovery-oriented approach by emphasizing
collaboration with Mark to explore his vocational aspirations and providing support based on his goals
, and preferences. This approach respects his autonomy and recognizes that employment can be a
meaningful part of his recovery journey.
Focusing on managing symptoms before addressing employment goals. This option prioritizes
symptom management, which is important, but it may not fully align with the recovery model's
emphasis on a holistic approach that includes vocational aspirations. In the recovery model,
employment is seen as a potential part of an individual's recovery process.
Encouraging Mark to accept a sheltered workshop position. While sheltered workshops can be a
valuable option for some individuals, it may not be the most recovery-oriented approach for Mark if it
does not align with his vocational aspirations and goals. The recovery model emphasizes individual
choice and empowerment.
Recommending long-term disability as the primary option. This option does not align with the
recovery model, as it does not support Mark's exploration of vocational aspirations or his potential for
employment. The recovery model encourages individuals to pursue meaningful and fulfilling lives,
which can include work, rather than assuming long-term disability as the primary option.
Emily, a 35-year-old with bipolar disorder, expresses a desire to reduce her reliance on
medication. What response is most consistent with the recovery model?
A."It's crucial to maintain your current medication regimen for stability."
B."Let's explore your reasons for wanting to reduce medication and develop a plan together."
C."You should follow the prescribed medication plan without questioning it."
D."Reducing medication is not a viable option at this time."
"Let's explore your reasons for wanting to reduce medication and develop a plan together. “The
recovery model emphasizes collaboration and shared decision-making. This option acknowledges
Emily's perspective and encourages joint exploration and planning.
"It is crucial to maintain your current medication regimen for stability." While medication stability is
important in managing bipolar disorder, this response does not consider Emily's desire to be involved in
her treatment decisions. It does not engage her in a collaborative discussion about her goals and
concerns.
"You should follow the prescribed medication plan without questioning it." This response is
authoritarian and does not respect Emily's autonomy or her right to have a say in her treatment plan. It
does not align with the recovery model's principles of shared decision-making.
"Reducing medication is not a viable option at this time." This response dismisses Emily's expressed
desire without exploring her reasons or discussing potential alternatives. It does not involve her in the
decision-making process and does not respect her autonomy and preferences.
experiencing elevated mood, racing thoughts, decreased need for sleep, and increased energy for
the past week. He has not been taking his prescribed mood stabilizers consistently. He mentions
that he feels invincible and has been spending money excessively on frivolous purchases. He
denies any suicidal ideation or aggression. Which of the following actions should the PMHNP
prioritize in the initial assessment?
A.Conduct a thorough mental status examination to assess cognitive function and judgment.
B.Inquire about the patient's support system and current stressors.
C.Administer a urine drug screen to rule out substance use.
D.Recommend immediate hospitalization due to manic symptoms.
Conduct a thorough mental status examination to assess cognitive function and judgment. This option
is a priority because it assesses the patient's current cognitive state and judgment, which are essential in
determining the severity of manic symptoms and assessing potential risks.
Inquire about the patient's support system and current stressors. While assessing the patient's support
system and current stressors is important, it may not be the initial priority when the patient is exhibiting
manic symptoms. Assessing cognitive function and judgment takes precedence.
Administer a urine drug screen to rule out substance use. While assessing for substance use is
important, it is not the initial priority in this case. The patient's presentation of classic manic symptoms
should be addressed first through a mental status examination.
Recommend immediate hospitalization due to manic symptoms. Hospitalization is a serious step and
should be considered when there is a risk of harm to the patient or others. However, it should not be the
immediate response in all cases of mania. Prioritizing a mental status examination to assess cognitive
function and judgment will help determine the need for hospitalization.
A Psychiatric Mental Health Nurse Practitioner (PMHNP) has been treating a 34-year-old male
patient diagnosed with major depressive disorder for the past three months. The patient has been
responding well to psychotherapy and medication. During a recent follow-up appointment, the
patient confides in the PMHNP that he is experiencing suicidal thoughts. He states that he has a
plan and has already written a suicide note. What should be the priority action of the PMHNP?
A.Advise the patient to keep his feelings to himself and not share them with anyone.
B.Inform the patient's family about his suicidal thoughts without his consent.
C.Collaborate with the patient to develop a safety plan, including identifying support systems
and contacting crisis services if necessary.
D.Increase the patient's medication dosage without discussing it with him to prevent further distress.
,Correct Answer: Collaborating with the patient to develop a safety plan is a standard practice for
PMHNPs when a patient expresses suicidal thoughts. It involves assessing the level of risk, identifying
coping strategies, and creating a plan to ensure the patient's safety, including involving crisis services if
necessary.
Advise the patient to keep his feelings to himself and not share them with anyone: This option is not
appropriate. Encouraging the patient to keep his suicidal thoughts to himself is contrary to the ethical
and clinical responsibility of a PMHNP, which includes ensuring the patient's safety.
Inform the patient's family about his suicidal thoughts without his consent: This option is not
recommended. Sharing the patient's confidential information without his consent can breach trust and
violate confidentiality unless there is an immediate risk to the patient's life.
Increase the patient's medication dosage without discussing it with him to prevent further distress: This
option is not appropriate. Making medication changes without discussing them with the patient can
lead to misunderstandings and may not address the underlying issues that have led to the patient's
current distress.
A 45-year-old male patient with a history of bipolar disorder presents to a mental health clinic.
He reports a recent manic episode characterized by decreased need for sleep, excessive spending,
and risky behaviors. He mentions that he stopped taking his prescribed mood stabilizer two
weeks ago. What should be the PMHNP's initial action in managing this patient?
A.Reassess the patient's diagnosis and medication history.
B.Perform a comprehensive mental status examination.
C.Ensure the patient's physical safety.
D.Explore potential triggers for the manic episode.
Ensure the patient's physical safety: This is the correct answer. The patient's recent manic episode,
combined with discontinuation of mood stabilizers, puts them at risk for impulsive and risky behaviors.
Ensuring the patient's physical safety by addressing potential harm to self or others is the highest
priority.
Reassess the patient's diagnosis and medication history: This option is important but not the highest
priority initially. It is crucial to verify the patient's diagnosis and review their medication history, but
immediate safety concerns should be addressed first.
Perform a comprehensive mental status examination: While assessing the patient's mental status is
essential, it is not the highest priority initially. Ensuring the patient's safety takes precedence.
Explore potential triggers for the manic episode: Investigating triggers is an important part of the
assessment, but it should come after ensuring the patient's immediate safety.
,Sarah, a 30-year-old woman with a history of major depressive disorder, is exploring treatment
options with her mental health provider. Which statement aligns best with the recovery model?
A."Sarah, we will manage your symptoms through medication and therapy."
B."Let's work together to identify your personal goals and strengths for a meaningful life."
C."Our primary focus is on symptom reduction to achieve stability."
D."I will provide you with a treatment plan that outlines specific interventions."
"Let's work together to identify your personal goals and strengths for a meaningful life." The recovery
model in mental health emphasizes a person-centered and strengths-based approach. It focuses on
empowering individuals to set their own goals and work towards a fulfilling life, rather than just
symptom management. Option B aligns with this recovery-oriented approach by emphasizing
collaboration with Sarah to identify her personal goals and strengths, which is key to her recovery
journey.
"Sarah, we will manage your symptoms through medication and therapy." This option primarily
focuses on symptom management, which is a more traditional medical model approach rather than a
recovery-oriented one. It may not fully align with the recovery model's emphasis on personal goals and
strengths.
"Our primary focus is on symptom reduction to achieve stability." This option also emphasizes
symptom reduction and stability, which are important but may not fully capture the broader goals of the
recovery model, which include personal growth and meaning beyond symptom management.
"I will provide you with a treatment plan that outlines specific interventions." This option implies a
more prescriptive and provider-driven approach to treatment, which may not align as closely with the
recovery model's emphasis on individual empowerment and collaboration in goal setting.
Mark, a 25-year-old diagnosed with schizophrenia, is considering vocational rehabilitation
services. What approach is most consistent with the recovery model?
A.Focusing on managing symptoms before addressing employment goals.
B.Encouraging Mark to accept a sheltered workshop position.
C.Collaboratively exploring vocational aspirations and providing support accordingly.
D.Recommending long-term disability as the primary option.
Collaboratively exploring vocational aspirations and providing support accordingly. The recovery
model in mental health emphasizes a person-centered and strengths-based approach. It focuses on
empowering individuals to set their own goals and work towards a fulfilling life, which includes
vocational aspirations. This option aligns with this recovery-oriented approach by emphasizing
collaboration with Mark to explore his vocational aspirations and providing support based on his goals
, and preferences. This approach respects his autonomy and recognizes that employment can be a
meaningful part of his recovery journey.
Focusing on managing symptoms before addressing employment goals. This option prioritizes
symptom management, which is important, but it may not fully align with the recovery model's
emphasis on a holistic approach that includes vocational aspirations. In the recovery model,
employment is seen as a potential part of an individual's recovery process.
Encouraging Mark to accept a sheltered workshop position. While sheltered workshops can be a
valuable option for some individuals, it may not be the most recovery-oriented approach for Mark if it
does not align with his vocational aspirations and goals. The recovery model emphasizes individual
choice and empowerment.
Recommending long-term disability as the primary option. This option does not align with the
recovery model, as it does not support Mark's exploration of vocational aspirations or his potential for
employment. The recovery model encourages individuals to pursue meaningful and fulfilling lives,
which can include work, rather than assuming long-term disability as the primary option.
Emily, a 35-year-old with bipolar disorder, expresses a desire to reduce her reliance on
medication. What response is most consistent with the recovery model?
A."It's crucial to maintain your current medication regimen for stability."
B."Let's explore your reasons for wanting to reduce medication and develop a plan together."
C."You should follow the prescribed medication plan without questioning it."
D."Reducing medication is not a viable option at this time."
"Let's explore your reasons for wanting to reduce medication and develop a plan together. “The
recovery model emphasizes collaboration and shared decision-making. This option acknowledges
Emily's perspective and encourages joint exploration and planning.
"It is crucial to maintain your current medication regimen for stability." While medication stability is
important in managing bipolar disorder, this response does not consider Emily's desire to be involved in
her treatment decisions. It does not engage her in a collaborative discussion about her goals and
concerns.
"You should follow the prescribed medication plan without questioning it." This response is
authoritarian and does not respect Emily's autonomy or her right to have a say in her treatment plan. It
does not align with the recovery model's principles of shared decision-making.
"Reducing medication is not a viable option at this time." This response dismisses Emily's expressed
desire without exploring her reasons or discussing potential alternatives. It does not involve her in the
decision-making process and does not respect her autonomy and preferences.
