ANCC PMHNP Board Exam- Comprehensive Questions and Correct Answers, Updated 2024.

ANCC PMHNP Board Exam- Comprehensive Questions and Correct Answers, Updated 2024. Purpose of Dopamine Inhibition of prolactin production Sleep Learning Attention Pleasure and reward Movement Memory Mood What term best describes the reelationship between an individual's health and a number of other variables, including the amoutn of healthcare consumed? Health production function- math expression that shows the relationship between an individual's health and a number of other variables. Brainpower Read More Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:04 / 0:15 Full screen How much time should you allow for Celexa to provide its initial therapeutic effect and the patient to see an improvement in symptoms? 4-6 weeks Clients have what rights? Right to privacy and confidentiality Right to least restrictive treatment measures Right to consent and withdraw consent at any given time Which inferential statistic determines whether the means of 2 groups are statistically different from each other? t-test enables one to reach conclusions that extend beyond the immediate data alone (ANOVA tests the difference among 3 or more groups, Pearson's r correlation- tests the relationship between 2 variables, probability-likelihood, p value- probability of a particular result occurring by chance) What symptoms would a patient exhibit if they were experiencing an excess serotonin? Restlessness, agitation, myoclonus, vital sign abnormalilties What term descries a colletion of individuals who coordinate lobbying efforts around a common interest and seek to influence policymakers? Special interest group. What are 3 phases of a therapeutic relationship between NP and pt? 1. Intro 2. Working- 3. Termination The following describes what stage of a therapeutic relationship? Clarifying patient expectations, ID goals, treatment plan, preventative healthcare, measuring outcomes of care, reprioritizing plan Working phase Which type of family therapy uses genograms, structural mapping, emphasizes understanding to produce change in the family structure. Structural family therapy Symptoms of excess GABA excess sleepiness, increased blood pressure, shallow breathing Symptoms of insufficient GABA Sz, trouble concentrating, insomnia, depression, anxiety HAM-A Hamilton Anxiety Scale, most commonly used 14 domains, 14=mild, 18-24= moderate, 25-30=severe When would you not use seclusion and restraint? Extremely unstable medical or psychiatric conditions Delirious or demented patients unable to tolerate decreased stimulation Overtly suicidal patients When should you use seclusions and restraint? Prevent significant disruption to treatment program or physical surroundings Decrease sensory overstimulation What is the difference between pharmacokinetics, and pharmaodynamics? pharmacokinetics is whatthe body does to drugs, pharmacodynamics is what the drug does to the body Problems with the frontal lobe could lead to what personality changes problems with the temporal lobe can lead to aphasia and amnesia problems with the occipital lobe can lead to visual field defects problems with the parietal lobe can lead to densory perceptual disturbances and agnosia This type of advanced nurse evaluates, diagnoses, and treats a wide range of medical conditions nurse practitioner This type of advanced practice nurse consults researches educates and coordinates care Clinical nurse specialist This type of advnaced practice nurse provides well-woman gyno care, management pregnancy, child birth, antipartum post partum. Nurse midwife According to Piaget wat what cognitive stage do children develop object permanence? sensorimotor Occurs when a patient is unabe to see others as somethimes good sometimes bad splitting what is the therapeautic dose of riseridone for an adolescent? 3 mg What core comopetency is the NP demonstrating when she evaluates the appropriate use of seclusion and restraints? NP core competency: Quality What core competency is the NP demonstrating when participating in a special interest group? NP core competency: Policy By whom and where was the first NP role introduced? Loretta C. Ford, Henry Silver; University of Colorado What factors constrain the growth of the NP role? Increased concerns over reinbursement fraud and abuse, reinbursement struggles, need for formal supervisory or collaborative relationships with physicians, overlapping scope of practice What regulatory or statutory dimension provides different rules and regulations for each state? Statutory law What regulatory or statutory dimension forms a process by which an agency of state government grants permission to persons to engage in the practice of that profession? Licensure What regulatory or statutory dimension forms a process used to protect the public by ensuring a minimum level of professional competence. Credentialing What regulatory or statutory dimension determines the scope of practice and assures the public that a person has mastery of a specified body of knowledge. Certification HITECH(health information technology for economic and clinical health Act) meaningful use incentive charting system for physician order set Incentive payment for sharing specific electronic health record(EHR) Basic criteria for involuntary admission danger to self or others unable to care for self poor nutritional intake What are the four main components of HIPPA To be educated, have access, the ability to request amendments and permission for disclosure Voluntary Commitment entails Admission, Client of all civils liberties, client consents to confinement What is the communication process between the provider and the client that results in acceptance or rejection of the the proposed treatment Informed Consent Promoting well-being and doing good Beneficence Doing no harm Nonmaleficence Being true and loyal fidelity Doing for self Autonomy Telling the truth Veracity A male client approached the NP for a date. The NP went out on one date with the client, but ended the relationship due to this element of negligence Breach of duty What Act of 2009 requires incentive if payments, is a part of the meaningful use and can improve health outcomes HITECH ( Heath Information Technology for economic health record) Durable power of attorney contracts are or are not legally binding in all 50 states Are legally binding in all 50 states Living wills are or are not legally binding in all 50 states Are not legally binding in all 50 states All of the following are Cluster A personality disorders Schizoid, Schizotypal Paranoid What is another name for durable POA a healthcare proxy All of the following are Cluster B personality disorders Histrionic, Borderline, Narcissistic, Antisocial All of the following are Cluster C personality disorders OCD, Dependent, Avoidant Cluster A personality disorders can best be described as what? Odd and eccentric Cluster B personality disorders can best be described as what? Dramatic and Erratic Cluster C personality disorders can best be described as what? Fearful and anxious • No: Ibuprofen increases plasma levels of lithium Would you give Ibuprofen to a patient receiving lithium? What are the two main types of a Systematic Review? • Meta- Analysis: Statistically analysis quantitative studies • Meta Synthesis: Statistically analysis Qualitative Studies What are the different types of Validity in research? • External Validity: When the sample is representative of the population and the results can be generalized. • Internal validity: When the independent variable causes a change in, he dependent variable. • Probability: The likelihood of an event occurring • Standard Deviation: Indication of possible deviation from the mean. What is the most used legal substance? ETOH ... See pg 296 of the purple book! Highest in the African American Population What is the difference between Certification and Credentialing • Certification is a process by which a professional organization certifies that an individual has net certain predetermines standards. • Credentialing is a process that is used to protect the public by ensuring a minimum level of professional competence. • Licensure: is a process by which an agency of state government grants permission to individuals to engage in practice Different types of Therapy • Klerman and Weissman created interpersonal Therapy. • Sigmund Freud created Psychoanalytic Therapy. • Anna Freud and Melanie Klein contribution sin Psychoanalytic Child Theory • Aaron Beck- Created Cognitive Therapy • Carl Rogers: Humanistic Therapy (Person Centered) Murray Bowen: Family Therapy Antidepressants that do not depend on the CYP2D6 for Metabolism. Lexapro, Zoloft and Remeron Medicare vs Medicaid -Medicare - Over 65, Younger individuals with disabilities, individuals with End stage Renal Disease. Individuals in he need of a kidney transplant, individuals receiving social security for a disability of amyotrophic lateral sclerosis. -Medicaid- Low-income children, Low income pregnant women, elderly and disabled individuals who qualify for the supplemental security income program -If a woman is taking tamoxifen for Breast Cancer do not RX: Paxil, Prozac, or Wellbutrin Valerian Root is considered a psychoactive herbal substance to treat insomnia, anxiety and restless. Risk factor for developing a somatic disorder Female Lower Socioeconomic Unemployed Olde age Fewer years of education Recent stressful life events Negative affectivity Childhood sexual abuse Comorbid psych condition Perceived illness benefits Sensitization of pain Heighted attention to body sensation -The difference between culture and ethnicity Culture is learned behaviors, socially inherited characteristic. Ethnicity: self-identified race, tribe, or nation -Family Vs Community: Family is defined as a group of adults and children who are usually related and carry out the essential functions of life. Community; group of families sharing the same race, tribe, or culture. Family Vs Community: Family is defined as a group of adults and children who are usually related and carry out the essential functions of life. Community; group of families sharing the same race, tribe, or culture. Competency to be executed was established in the supreme Court Ford Vs Wainwright -Depolarization- Influx of sodium and calcium into the cell Repolarization -Kt leaving the cell or Chloride entering the body. Therapeutic Relationship: Introduction: Boundaries, Agreed time frame Working: Measuring, reprioritizing Termination: long term plan of self-management, Reemergence of symptoms Countertransference delt with Peer to Peer Abilify has the lowest risk of sedation of all Antipsychotics the homeless population has a co-occurring Mental Health Issue and Substance Abuse. What Percent 50% the most widely used psychoactive drug in the US. Cannabis i The first step in hearing your patient say they will kill someone; you must notify the person that they are in danger and then call the police. - Stages of Psychosexual Development (Freud) - Oral- birth to 0-18 - Anal -12-18 to 3 years - Phallic- 3to 5-6 years - Latency- 5-6 to adolescence - Genital- adolescence to adulthood Stages of Erick Erikson see image Normal Labs Kt and NA see results Normal TSH 2-10mu/I see page 87 Normal lithium levels 0.5-1.2 Tests for Lithium -Cardiac: ECG, especially in patients at risk of unmasking Brugada syndrome; cardiac function at baseline and at regular intervals thereafter-Endocrine: Thyroid function at baseline and at regular intervals thereafter-Metabolic: Lithium levels at baseline and at regular intervals thereafter-Renal: Renal function tests (e.g., urinalysis, urine specific gravity, serum creatinine, creatinine clearance), especially in patients who develop polyuria and/or polydipsia And Pregnancy Test Deferential Vs Inferential Statistics see image What is the assessment for ETOH Detox CIWA What is the assessment for Opioids Detox COWS ETOH Screening Test for Geriatrics S-MAST /Known as the Alcohol Screening Test for Geriatric What antidepressant can give false positive for Methamphetamines' Wellbutrin What antidepressants can give a false positive for Benzo Zoloft What Benzo can give a false positive for ETOH Valium Nyquil can give a false positive for what methadone Assessment for Benzo withdrawal CNSDP What area of the body if dysregulated can result in anxiety and panic Vestibular Dysfunction What developmental phase, if not accomplished, can result in Conversion disorder Initiative vs guilt Culture explanations labels, attributes or features of a culturally recognized etiology for distress Culture bound syndromes Clusters of symptoms that tend to occur in or among individuals in a certain culture Culture idioms terms that are used to describe ways of sharing their experience of suffering Norepinephrine attention, focus, memory and learning (AFML)Apples falls more than leaves Dopamine Thinking, fine muscle action, reward ( TFR) Troy found Renee GABA Reduces Arousal Aggression and Anxiety ( AAA) Triple A Adam Asks Alison ( Two A's in GABA) Serotonin Regulates: Sleep, Mood, pain, and temp (SMPD) Basil Ganglia Somatic Motor Activity: initiates complex motor function and maintains tone posture and common reflexes A common psyhoactive herbal supplement used to treat insomnia Valerian root Patient was previously accepting of treatment but now appears agitated. Presents with personality changes over the past year, memory impairment, asterixis, palmar erythema, peripheral edema, and a large ecchymotic area left elbow. Why? Hepatic encephalopathy; the loss of brain function when a damaged liver does not remove toxins from the blood. This patient has presented with at least four mood episodes in the past year. What additional specifier will the practitioner add to the diagnosis of depression? Rapid cycling Which theorist believed that humans develop through learning, cmprehending, and cognition. Child's development is shaped through native endowment and factors. Jean Piaget Which statement most acurately describes grassroots lobbying When nonpaid individuals contact their legislators to influence policy Restless leg syndrome can be associated with compromised levels of what blood protein ferritin Anxiety and depression an be assoiated with compromised levels of what blood protein? folic acid What are the common with drawal symptoms assessed on the CIWA scale n&v, tremors, paroxysmal sweats, agitation, tactile disturbances, ha, altered sensorium Which theorist was the first person to develop specific phases of group Irvin Yalom Theoretical group phases developed by the first theorist to develop specific phases of group Pregroup, forming, storming, norming, performing, adjourning What vitamin is used in treating neurological disorders, diabetes, and premenstraul syndrome? Vitamin E What vitamin plays important roles in maintaining calcium absorption Vitamin D Acupuncture and acupressure aid in the activity of endorphins by manipulating point of energy flow in the body What vitamin plays important roles in the repair of tissue and enzymatic production of certain neurotransmitters Vitamin C What vitamin plays important roles in cell metabolism Vitamin B Biofeedback Teaches a patient to control their own physiological responses Massage Increases blood circulation, lymph flow and enhances musculoskeletal tone Aromatherapy simulates the olfactory system to elicit feeling and memories Technology Informatics Guiding Education Reform (TIGER) A 10-year plan Nursing path toward computer and information technology Literacy A Behavior Report Card commonly used to treat ADHD( Bridges the gap between school, therapy and home) schizophreniform disorder Psychotic disorder involving the symptoms of schizophrenia but lasting less than 6 months. 1-6 months schizoaffective disorder Psychotic disorder featuring symptoms of both schizophrenia and major mood disorder. delusional disorder a psychotic disorder in which the primary symptom is one or more delusions brief psychotic disorder brief episodes (lasting a month or less) of otherwise uncomplicated delusional thinking Mental status of Autism Little or no eye contact flat or blunted affect lack of emotional reciprocity Stereotyped or repetitive motor mannerisms medical care Describes goods and services that maintain, improve or restore an individuals physicals; social or mental well-being Same-e Treats depression osteoarthritis and liver disease omega-3 fatty acids polyunsaturated fatty acids commonly found in fish oils that are beneficial to cardiovascular health Tryptophan Aiding in nitrogen balance, which is essential in creating serotonin Pheochromocytoma a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine Should be a differential for panic disorder Shingles Vaccine 50 and over even if you have had or have not had the chicken pox Vestibulocochlear hearing and balance 8th Cranial Nerve studies estimate 15-24% of those incarcerated have a mental health disorder Trochlear eye muscle movement family systems therapy psychotherapy that focuses on the family, rather than the individual, as the source of problems; family therapists challenge communication styles, disrupt pathological family dynamics, and challenge defensive conceptions in order to harmonize relationships among all members and within each member Retinal Pigmentation Thioridazine side effect voyeuristic ACTS ARE THE MOST COMMON POTENTIALLY LAW BREAKING SEXUAL BEHAVIOR cyclothymic disorder Chronic (at least 2 years) mood disorder characterized by alternating mood elevation and depression levels that are not as severe as manic or major depressive episodes. bipolar disorder 1 full blown episodes of mania. MAY EXPEREINCE DEPPRSSION Bipolar 2 hypomania and depression. EXPEREINCE AT LEAST ONE Team Leadership Model Decision 1 Should the leader monitor the team or take action? Team Leadership Model Decision 2 Should the leader intervene to meet the task or relational need? Team Leadership Model Decision 3 Shoul the leader intervene internally or externally? Harmless mentally ill patients cannot be confined against their will if they can survive outside case? O'Conner vs Donaldson Patients have the right to refuse any treatment and use an appeal process Rennie vs Klein This case is know for originating the insanity defense Durham vs US The common method for adolescent suicide Firearm Piaget's stages of cognitive development sensorimotor, preoperational, concrete operational, formal operational Piaget Believed Humans developed through learning, comprehending and cognition Indicators of Child abuse Unexplained Fxs, Burns, Bites, Injuries in VARIOUS STAGES OF Healing, Evidence of Neglect (Poor Dental Issues), Bruising on padded parts of the body In Strategic Therapy Originated by Jay Haley is a method for which interventions are both symptom and problem-focused -Symptoms are viewed as metaphors and reflect problems in the hierarchal structure xd Where do you see working on Long term plan Termination Phase When do you see Regression of Symptoms within a patient client relationship Termination Phase Cranial Nerves See Image Benzropine drug class Anticholinergic First Line Treatment for EPS Haldol Haloperidol_ Monitor for Pneumonia and oculogyric crisis in the older adult The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. The Future of Nursing Article A set of performance expectations for the 21st-century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Article: Crossing the Quality Chasm Wernicke's encephalopathy What encephalopathy causes ocular palsies, confusion, and gait abnormalities related to a lesion in the CNS caused by an exhaustion of VB1? Korsakoff's syndrome symptoms Difficulty in acquiring new information or learning new skills Change in personality. At one extreme may show apathy or at the other, talkative and repetitive behaviour.C onfabulation. Alcoholic hallucinosis involves auditory and visual hallucinations, usually accusatory or threatening ones. During acute intoxication or withdrawal Normal appearance except for auditory ,visual , tactile hallucinations Treatment : antipsychotics Delerium tremens Begin 48-72 hours after cessation of drinking; characterized by hallucinations, disorientation, and clouding of the sensorium; hyperventilation leading to respiratory alkalosis, hypovolemia, hypomagnesia, and hypophosphatemia SAM-e is an herbal supplement used for depression OA and liver disease Due to the risk of hypomania, hyperactive muscle movements, and possible serotonin syndrome which herbal supplement should not be prescribed to bipolar clients SAM-e Yin and Yang cold and wet/ hot and dry In family systems morphogenesis describes what a family's tendency to adapt to change when changes are necessary in family systems mophostasis describes what a family's tendency to remain stable in the midst of change Creator of the family systems therapy model Murray Bowen Creator of the structural family therapy model Salvador Minuchin Creator of strategic therapy model Jay Haley Creator of the separation and individualization stages Margaret Mahler Margaret Mahler's Separation-Individualization Theory of Child Development Stages The normal autistic phase 0-4 weeks- shows little social engagement. The normal symbiotic phase 1-6m- the child gains awareness of caregivers but has no sense of individuality. The separation-individuation phase (broken down over time) - as the child begins to develop a sense of self, separate from the mother. The normal autistic phase occurs during the first weeks of life and shows little social engagement. However, Mahler abandoned this phase later in her career. The normal symbiotic phase lasts through the first six months of life, and occurs when the child gains awareness of caregivers but has no sense of individuality. :Differentiation 5- 10m or "hatching," occurs when the child first gains awareness that he or she is separate from the mother. Practicing 10-16m occurs as the child becomes a toddler, gaining motor skills that enable the child to explore the world independently from his or her caregivers. Rapprochement 10-24m marks a "backing off" from separation, as the child becomes anxious about separating from his or her mother and tries to regain closeness. This can lead to separation anxiety and abandonment fears. As a child develops language skills, this phase winds down. Object Constancy 24-36m The following herbal is used for anxiety belladonna The following herbal is used for sedation catnip The following herbal is used for sedation and anxiety chamomile The following herbal is used for delerium, dementia, sexual dysfunction caused by SSRIs ginko The following herbal is used for depression and fatigue gensing the following herbal is used for sedation valarian root 1. You see a patient for a routine medication visit. At the end of the session, the patient asks questions and the session ends up 50 minutes in length. You normally charge for the 30-minute appointment, but instead you charge for the 1-hour appointment. The 1-hour appointment includes a full body assessment that you did not perform. This violation is known as: - Over-coding - Super-coding - Down-coding - Up-coding - Up-coding Rationale: Up-coding is a fraudulent practice in which the provider services are billed at higher procedure codes than were actually performed, resulting in a higher payment by Medicare or other third-party payers. 1. During a session, your patient asks to be able to contact you via your Facebook page on the internet. You reply: - I cannot do that because I have a concealed Facebook identity; and I cannot reveal that to my patients - I would be happy to communicate with you. It makes it easier for me to reach you this way. - I would be happy to use Facebook but you will have to use a private message so that you can be anonymous - I cannot do that because Facebook does not protect your Private Health Information - I cannot do that because Facebook does not protect your Private Health Information Rationale: Using Facebook breaks patient-provider confidentiality, in addition to blurring ethical boundaries of the therapeutic relationship. Facebook does not protect private health information. Information on the site is available for anyone to see or hack into even if private messaged. 1. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) insures which of the following? - Small employers who insure 50 or fewer covered lives are exempt from the provisions of this MHPAEA law. - Annual or lifetime dollar limits on mental health and substance use disorder benefits are no lower than any such dollar limits for medical and surgical benefits offered by a group health plan. - Mental health and substance use disorder benefits must be available through both in-network providers and out-of-network providers by a group health plan. - Group health plans may obtain an exemption if they can demonstrate expected cost increase resulting from implementation of the parity provisions greater than a 5% increase in the cost under existing plan. - Annual or lifetime dollar limits on mental health and substance use disorder benefits are no lower than any such dollar limits for medical and surgical benefits offered by a group health plan. Rationale: The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) provides federal legislation that requires any annual or lifetime limits on medical and surgical benefits be the same for mental health and substance use disorder benefits. Small employers who insure 2 to 50 employees can apply for an “opt-out” waiver, but they are not automatically exempt from the MHPAEA requirements. The group health plan will be required to provide in-network and out-of-network mental health and substance use disorder benefits only if it provides both in-network and out-of-network medical and surgical benefits. The group health plan my obtain an exemption or waiver if the first year of implementation results in 2% increase in group health plan costs over prior year that covers the following year, and if implementation results in 1% increase in group health plan costs in subsequent years. A section on actuarial determination of these increased costs is included in the law. 1. A 68-year-old, retired African-American widower who served for 30 years as an Army officer was recently diagnosed with terminal lung cancer. He made plans to die at home with hospice care. He was hospitalized for a broken hip and succumbed to complications in the hospital. Despite his request to be addressed as "Mr. Baxter" the hospital staff persisted in calling him by his first name, "John." Which principle of culturally competent care does this violate? - Autonomy - Advocacy - Collaboration - Respect - Respect Rationale: Respect of cultural values and beliefs is violated in this scenario. 1. PMHNPs seeking admitting privileges at a community hospital with inpatient psychiatric services need to influence policymakers at which of the following levels? - State board of nursing - State legislature - County board of health - Local hospital - Local hospital Rationale: Local PMHNPs who want admitting privileges will want to persuade the appropriate hospital decision maker, through facts, figures, and a presentation of projected benefits to the hospital, of the need to change policy and allow PMHNPs to admit patients. 1. To demonstrate her support for social justice, within her role as a PMHNP caring for the person who is homeless with mental illness, the PMHNP: - Volunteers to serve food at the local Home for Girls. - Teaches Sunday School. - Volunteers to walk at the March of Dimes walk each year. - Volunteers her clinical services at the psychiatric clinic, run by a local mission project. - Volunteers her clinical services at the psychiatric clinic, run by a local mission project. Rationale: Social justice is bringing things to those who have the least means of getting them but need them the most. In this case, the homeless mentally ill need the PMHNP’s skills more. 1. You have students from local psychiatric nurse practitioner programs follow you in your clinical practice to show them what you do as a PMHNP. This is called being a: - Preceptor