ANCC IQ Domain 5 Ethical and Legal Principles (72 questions with rationales)

ANCC IQ Domain 5: Ethical and Legal Principles (72 questions with rationales) You have students from local psychiatric nurse practitioner programs follow you in your clinical practice to show them what you do as a Psychiatric Nurse Practitioner. This is called being a: a. Preceptor b. Mentor c. Professor d. Teacher A A Psychiatric Mental Health Nurse Practitioner providing psychiatric consultation makes a home visit after the police found an 86-year-old widow wandering the streets at 4AM after emergency call from her daughter. The woman has been living with her daughter for the past ten years, after her husband died. Her daughter is a 66-year-old, single, retired schoolteacher, appears thin, exhausted, and reports little sleep for past two years trying to care for her mother. The daughter reports that her mother becomes increasingly confused every evening and wanders the house unable to sleep at night. The daughter is unable to leave her mother alone for even a short period of time because unsupervised her mother will turn on the gas stove burner, leave it unattended, and she escapes the house at every chance to wander the neighborhood. Her mother is socially pleasant, disoriented to time and place, and does not recognize her daughter. Her mother thinks that the daughter is a housekeeper intent on stealing her money and possessions, which is upsetting to the daughter. What is the most important in determining the level of care needed for this elderly client? A. Appraisal of daughter's health and her ability and willingness to continue caring for mother in home. B. Modification of environment such as bright lights in evening, identification bracelet, and safety lock on stove. C. Trial of low-dose atypical antipsychotic to reduce paranoid ideation, help sleep, and decrease wandering. D. Linkage with home health aide 4 to 6 hours, three times per week, and community resources for respite care. A As a psychiatric nurse practitioner, you evaluate your patients for health concerns and beyond, in a holistic manner. your current patient has a blood sugar of 186 and a hemoglobin A1C of 6.7. You refer this patient to an internal medicine practitioner with whom you frequently share patients. You have just violated: A. The DATA Act B. The Adams Act C. No statute D. The Stark law C Which of the following is not insured by the Universal Bill of Rights for Mental Health Patients? A. The right to refuse a particular mode of treatment regardless of informed, voluntary, written consent, or situation. B. The right to freedom from restraint or seclusion, other than as a mode of treatment during an emergency situation. C. The right to be given a reasonable explanation of one's general mental and physical condition, the objectives of treatment, and the possible adverse effects of recommended treatment. D. The right to ongoing participation in the planning of mental health services provided in a manner appropriate to a person's capabilities. A During an outpatient medication evaluation a depressed client reports persistent anger toward his former boss after losing his job due to arguments and assaultive behavior toward co-workers. The client has been waiting outside the plant in the afternoon, watching for the boss to leave to confront him regarding his terminated employment. What responsibility does the PMHNP have in this situation? A. Contact the client's boss to notify him of potential harm. B. Ask the client to sign a "no harm to others" agreement and document in chart. C. Consult state board of nursing regarding state law requirements on reporting potential harm. D. Advise the client to stop going to the plan and avoid any contact with his former boss. C Your patient is a 32-year-old who is diagnosed with major depressionrecurrent, insomnia, and chronic lower back pain. The patient has seen you for three medication management sessions over the last two months. During the fourth medication management session, the patient states that money is tight and an appointment is required with the general practice (GP) physician every time a refill of the Hydrocodone (pain medication) is needed. The patient asks you to refill the Hydrocodone to save the cost of another medical visit. you: A. State that you certification is for psychiatric care only and refer him back to his GP. B. State that you are willing to discuss alternative medications to manage his pain. C. State that you can refill this prescription just once. D. State that you would be willing to call his GP to discuss the issues and help him out. A You are a nurse practitioner (NP) who performs psychotherapy. your patient is distraught, and you call in the NP who is performing the medication management to sit in and discuss and determine if an emergency medication evaluation is needed. After the discussion of medication changes that will take place, the medication manager NP asks the crying patient if she needs a hug. The patient stands and extends her arms outward. The medication NP gives her a chaste hug and leaves the room. Is this a case of inappropriate touch or battery? A. Yes. This is inappropriate, as you never touch a patient under any circumstances. B. No but, nonverbal communication methods are not sufficient for ensuring agreement to hug a patient. C. Yes. This is a case of battery. The patient did not verbally say that it was okay to touch. D. No. This is a case where there was a question asked, nonverbal consent was given, and the NP gave the patient a hug to help the patient cope.D A social worker concerned about a Nigerian refugee who seems to be suffering from severe post-traumatic stress disorder since arriving in U.S. three months ago referred this man to an African American female Psychiatric-Mental Health Nurse Practitioner in the community mental health center. The PMHNP builds rapport by exploring the values, beliefs, life experiences, and accepted behaviors of this young Nigerian man as she seeks to understand the context of his transition to the U.S. before making any diagnosis or proposed intervention. The PMHNP is striving to provide what type of mental health care? a. Alternative care b. Individualized care c. Culturally competent care Culture specific car C You are a psychiatric nurse practitioner (NP) and have many patients with comorbid medical and mental health issues. As a part of your continuous quality improvement (CQI) process, you might best serve your practice by: a. Develop a journal group with a general practice colleague to read the latest articles on self-care for advanced practice nurses. b. Subscribe to Medscape and read it daily to see about new medications being developed for personality disorders. c. Developing a peer review process of your charts with a general practice colleague. d. Subscribe to Medscape Psychiatry and read it critically noting studies that apply to your patient's access to care issues. C The Nurse Practitioner (NP) attends a local meeting where allocation of resources for healthcare will be discussed. One of the stakeholders has a pamphlet that describes the types of healthcare providers available to help persons in need of health care. The NP notices that Nurse Practitioners are labeled as "Paraprofessionals". In the meeting, the NP asks the organization responsible for the pamphlet why they have identified the Nurse Practitioners as paraprofessionals when a Nurse Practitioner is by law working as 85-90% of the same capacity as a Medical Doctor. The NP goes on the explain what a Nurse Practitioner does in various areas of practice. This is an example of: a. Promoting nurse practitioners in the community b. Public education on the NP scope and standards of practice c. Correcting misinformation that deliberately misleads the public d. Advocating for the role and value of the Nurse Practitioner D As a nurse practitioner (NP), you teach your patients that mental illness is no different from any other physical illness that a person suffers. In classes for the community, you emphasize that everybody has a brain and it is another organ in the body. You remind the audience that illness in the brain is no different from illness in the heart, lungs, or liver. This is an example of: a. Reducing Stigma b. Cross education c. Holistic Dynamism d. Integrated health A The Veterans Health Administration (VHA) is asking to let its advanced practice registered nurses (APRNs) work independently, even in states that normally require physician oversight. You begin a writing campaign within your state nursing association and American Psychiatric Nurses Association to convince your state's congressman and senators to vote for the bills associated with this legislation. You are: a. Advocating for the total removal of physician supervision of Nurse Practitioners (NP). b. Advocating for the role and value of Nurse Practitioners (NP). c. Advocating for the healthcare of the nation's veterans. d. Advocating for the Nurse Practitioners (NP) to practice to the full extent of their education and training. D Which of the following is not associated with increased validity in a clinical research trial? a. Outcome measure b. Sample size c. Confounder d. Randomization C A 45-year-old woman with Type I Bipolar Disorder experiencing an acute episode of depression with psychotic features requires a temporary leave of absence from the job as an administrative assistant to a school principal. The patient has signed a release of information for the PMHNP to disclose full mental health records to the principal and the human resources department to facilitate her gradual return to work. The patient fears that she will lose her job due to her psychiatric disorder. What is the most appropriate information the PMHNP can provide in this situation? a. Employers cannot discriminate against individuals with a mental health disorder, which is considered equivalent to a medical disorder by the Mental health Parity Act of 1996. b. Employers cannot discriminate against individuals with a mental health disorder, which is considered a disability covered by the Americans with Disability Act of 1990. c. Employers cannot discriminate against individuals with a mental health disorder, which is protected as a confidential health care information by the Health Insurance Portability and Accountability Act of 1996. d. Employers cannot discriminate against individuals with a mental health disorder, which is a right insured by the Universal Bill of Rights for Mental Health Patients of 1980. B 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: a. Down-coding b. Super-coding c. Over-coding d. Up-coding D A primary care nurse practitioner consults the PMHNP for. Guidance on medication management for a family member she is prescribing medication for bipolar I disorder, because the family member does not have health insurance and cannot afford to see a mental health provider. What would be the most appropriate response by the PMHNP? a. Recommend that she not manage a family member's medication and recommend free clinic. b. Determine acuity and phase of bipolar I disorder to advise on appropriate generic medications c. Recommend free clinic and report nurse practitioner to state board of nursing for practice violation. d. Offer to see the patient pro bono and manage medications. A As a psychiatric nurse practitioner, you frequently are asked to "case manage" your patients for more than psychiatric issues. Your 68-year-old patient, with Medicare is the primary insurance, states that varicose veins are an issue and that treatment is needed. You know that your sister is the best vein surgeon in your city and refer the patient too her. You have just violated: a. The Stark Law b. The Harter Act c. The Adams Act d. The DATA Act A The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) insures which of the following? a. 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. b. Group health plans may obtain nan 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. c. Small employers who insure 50 or fewer covered lives are exempt from the provisions of this MHPPAEA law. d. 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. D You are a Psychiatric Nurse Practitioner (NP) working in a hospital health system. The hospital administration has implemented a productivity system where all the Psychiatrists and NPs in the department of psychiatry will now have to see four patients per hour. You have informed administration that this is not a good system because many patients are in fragile mental and physical health, require case management, and need extensive care during their medication management sessions to achieve good management of their symptoms and recovery. The hospital administration has reinformed that the productivity system will stay in place and is mandatory. If it is not met, persons not meeting the quota will be penalized. You inform the administration that you cannot work under these conditions. Administration informs you that you are abandoning your patients. You: a. Make the decision to leave your position. Tell your patients the hospital is treating them poorly. b. Make the decision to stay, telling your patients the hospital is treating them poorly. c. Make the decision to leave your position, as you cannot support a system that disregards the needs of the patient. d. Make the decision to stay, as you cannot abandon your patients. C The Nurse Practitioner (NP) has a Law Bill in the State Legislature passed so that funds will be released to be used for housing the severe and persistently mentally ill. The NP contacts eight persons and ask them to telephone the State Senator who heads the Health and Human Services committee. She asks them to tell the State Senator to vote to approve the bill. The NP is acting as an: a. Advocate b. Policy maker c. Stigma Reduction Agent d. Care Provider A Your patient is receiving Medicare and Social Security Disability payments. This money helps her to pay for food, clothing, shelter, and medications. She recently began to work part-time. Her work has greatly improved her mood and self-perception. She has taken on more work. The additional income has caused her to lose her disability and Medicare funding. She is concerned that she will not be able to get her medication, pay for housing, and some of the other things she was able to afford before. How do you counsel her? a. Discuss with her your assessment that her mood has improved since working and self-supporting. Assist her to find programs that will help her to continue. b. Advise her that her counselor can help her with financial issuesprograms, services, and resources. c. Advise her to maintain her Medicare and Social Security benefits because she will always have her food, clothing, shelter, and medication support. d. Discuss with her the consequences of taking on "too much" work ad losing her disability benefits.A The Nurse Practitioner (NP) is seeing a patient for both psychiatric and chemical dependency illnesses. The patient wants the NP to send medical records to his General Practitioner. The NP tells the patient that because of Federal Law 42 CFR he must: a. Sign two separate releases of information due to the special protected nature of chemical dependency information. b. Sign on combined release that designated that he is being treated for both chemical dependency and psychiatry illnesses. c. Sign two separate releases due to the special protected nature of psychiatric information. d. Sign one combined releases that does not mention his chemical dependency illness due to its special protected nature. A Psychiatric-Mental Health Nurse Practitioners seeking admitting privileges at a community hospital with inpatient psychiatric services need to influence policymakers at which of the following levels? a. State Legislature b. County board of health c. State board of nursing d. Local hospital D Your new 30-year-old patient with Generalized Anxiety Disorder has been on Alprazolam (Xanax) 0.5 mg 1 tab PO BID prn anxiety for the past 7 years after trials of multiple SSRI's. She uses this medication about two times per week for "extreme" anxiety. Your personal bias as a careful psychiatric nurse practitioner is that benzodiazepines should only be used with other non-addictive anti-anxiety medications and internally generated copping skills to manage anxiety. In discussing the case with the patient, you recognize that she has been carefully using the Alprazolam, has tried other methods o reduce anxiety, and is working with a therapist. What will your plan of care be? a. The patient is coping well with a limited amount of Alprazolam. Reinforce safe use of benzodiazepines. Continue the medication and encourage use of more internal coping mechanisms. b. The patient may do better with increased therapy. Consult the therapist and wean her off the Alprazolam. c. The patient is using Alprazolam too often. Reinforce safe use of benzodiazepines. Help her to wean off the medication and use more internal coping mechanisms. d. The patient is coping well with the limited amount of Alprazolam, but may do better with Atenolol (Tenormin) 25 mg po QHS. Change the medication prescribed.A You notice that you have begun to care less about your patient's needs. You are tired, unhappy and unsatisfied inn your job. You talk to your office confidant, another psychiatric nurse practitioner about your feelings and concerns about how this might impact your practice. Together, you discuss your need t: a. Reduce your present workload to get more rest and practice better living, eating, exercise, and living skills. b. Avoid those things about your present employment that upset you and get involved in a yoga class. c. Leave your present employment and find a different career in nursing that fulfills you better. d. Leave your present employment in nursing and fid a different career path in something that fulfills you better.A To demonstrate her support for social justice, within her role as a Psychiatric Nurse Practitioner caring for the person who is homeless with mental illness, the psychiatric nurse practitioner (NP): a. Volunteers her clinical services at the psychiatric clinic, run by a local mission project. b. Teaches Sunday School. c. Volunteers to serve food at the local Home for Girls. d. Volunteers to walk at the March of Dimes walk each year. A Per the Health Insurance Portability and Accountability Act (HIPPA), a Nurse practitioner (NP) who is in an independent, single practitioner practice is considered a "Covered Entity" because: a. The NP transmits protected health information in electronic forms. b. May accidently release protected health information. c. Writes information and generates protected health information. d. Maintains charts with the patient information that contains protected health information. A Your patient is a 37-year-old male who you have diagnosed with major depression. He was referred to you by a Licensed Alcohol and Drug Abuse Counselor (LADAC) who has diagnosed him with Opioid Use DisorderSevere. After your evaluation of the patient, you concur with the LADAC's diagnosis and treatment with an antidepressant and inpatient chemical dependency as his best chance for recovery. You discuss treatment with the patient and tell him the rationale for your treatment choice. You discuss his failure to maintain abstinence, his health issues, the loss of friends and family, and other issues that surround using. He refuses the treatment, citing that he is able to care for himself and will continue to try on his own to maintain abstinence. He states that he cannot go through inpatient treatment but will try antidepressant medication and continue seeing his therapist on an outpatient basis. You: a. Continue to discuss the benefits of inpatient treatment and the health needs of the patient until he accepts the recommendation. b. Dismiss the patient from your service. c. Contact the LADAC counselor to manage the patient to place him in protective custody. d. Accept his right to determine his own treatment path. D A newly graduated Nurse Practitioner (NP) wants to open a private psychiatric practice in her hometown. She wants to find out about the laws that cover her responsibility and legal liability that this practice will encounter for her as an independent psychiatric nurse practitioner. Her best source of information is: a. Local Psychiatric Nurse Practitioners in practice. b. The American Academy of Nurse Practitioners. c. The State Statutes on Nursing or Advanced Nursing practice. d. Her City Statutes. C A colleague emails on the company computer system regarding complaints about another coworker. In the message, the colleague makes several disparaging remarks about the other coworker and the difficulty of working with her. You reply: a. She is just not doing things the way we were taught. She can't help it if she is not us, but she could try harder! b. Really, I cannot believe that you get so upset over that little stuff. Help her understand where she is making a mistake and teach her how to do things correctly. c. I understand your feelings, just put up with it. You are going to another shift in one month and will leave the problem behind. d. Did you talk with her about the issue you have with her? Saying things about your co-worker will not resolve the problem or make it better. D The core values that underline advanced practice nursing and culturally competent care include: a. Care, advocacy, respect b. Autonomy, respect, collaboration c. Respect, advocacy, partnership d. Care, respect, collaboration C The Nurse practitioner (NP) is seeing a 72-year-old male for depression management. Upon assessment, the patient is alert, oriented, and nonsuicidal or homicidal. The patient is able to manage his activities of daily living. The NP witnesses the man's wife verbally abusing him on several occasions. The NP has verbal reports from staff nurses and their nursing notes that the man has come into the unit with bruising and contusions inconsistent with his affluent lifestyle and physical health condition. When the NP speaks to the man about the physical and verbal abuse, he tells her that it is occurring. He also tells her that he does not want to do anything about the situation. He tells her specifically that he does not want her to contact any authorities about the situation. a. She is required to contact Adult protective Services or similar services in the local community to investigate the senior citizen's safety. b. Take pictures of the brises and contusions and save them to the patient's record. c. Arrange to remove the patient to a safer environment. d. The NP must do as the patient requests as long as he is competent. D As a psychiatric mental health nurse practitioner who is working in a larger health system and understands models of change, which of the following processes are typically included in these models? a. Engaging stakeholders, addressing organizational barriers, and evaluating the impact of the practice change. b. Engage the unit-level manager, assess unit barriers, and obtain funding to implement the change. c. Conduct a literature search, write the proposal, and obtain funding for the change. d. Form a committee, identify the need, and evaluate staff satisfaction. A 7. A frail 76-year-old woman with Alzheimer's type dementia in a skilled nursing facility has been increasingly agitated, combative, and has struck out at other patients in the dining room and at staff attempting to care for her. What would be the most appropriate initial intervention by the consulting PMHNP who receives a call from the nursing staff requesting medication and restraint orders? a. Order close observation by staff in quiet area secluded from other patients until you can evaluate in person. b. Order low-dose atypical antipsychotic and soft vest restraint until you can evaluate in person. c. Order short-acting benzodiazepine and close observation until you can evaluate in person. d. Order soft wrist and vest restraints until you can evaluate in person. A During a medication follow-up appointment at student mental health clinic, a 20-year-old college sophomore with depression and history of binge drinking disclosed that she has been struggling with recurrent intrusive thoughts to overdose. She recently broke up with her boyfriend when she learned that he was sleeping with her closest girlfriend. She admits to taking a handful of her sertraline prescribed by the PMHNP last weekend and was frustrated that it only made her sleep for a day. She's angry and ambivalent about the future, unwilling to make any promise not to harm herself, and has made veiled threats to "pay back both of them for cheating" (referring to her ex-boyfriend and girlfriend). What is the most appropriate intervention at this juncture? a. Ask the student to promise that she won't harm herself or anyone else and schedule next day counseling visit. b. Ask the student if she will agree to voluntary admission and arrange for involuntary admission if necessary. c. Counsel the student that she would regret hurting herself and can move beyond this broken relationship. d. Negotiate with the student to touch base daily by phone between counseling visits to avoid hospitalization. B During a session, your patient asks to be able to contact you via your Facebook page on the internet. You reply: a. I cannot do that because Facebook does not protect your Private Health Information. b. I would be happy to use Facebook but you will have to use a private message so that you can be anonymous. c. I cannot do that because I have a concealed Facebook identity; and I cannot reveal that to my patients. d. I would be happy to communicate with you. It makes it easier for me to reach you this way. A The Health Insurance Portability and Accountability Act of 1996 (HIPPA) is a federal law intended to protect employed Americans' privacy, confidentiality, and access to health care through health insurance coverage. Knowledge of major HIPPA provisions enables the PMHNP to advise patients regarding health care coverage. Which of the following statements regarding HIPPA is true? a. HIPPA replaces the State as the primary regulator of health insurance. b. HIPPA increases ability for workers changing jobs to get health coverage. c. HIPPA guarantees health coverage for all workers. d. HIPPA eliminates all use of pre-existing condition exclusions.B Your patient wants to communicate with you through email. You have a secure email account that is encrypted and will protect health information as required by Health Insurance Portability and Accountability Act (HIPPA). Your patient does not have an encrypted email account. Your patient does not have an encrypted email account. Your rely is: a. I can encrypt our email communications too be sure that your protected health information (PHI) is unavailable to others and protect you. b. I do not like to communicate through email I would refer to talk to you in person or over the telephone only. c. I have no problems with you communicating with me through my personal email. d. In order to communicate back and forth, you will have to find a way to encrypt your protected health information (PHI). D As an individual advanced practitioner, you cannot afford to have a standalone Electronic Health Record (EHR) system to keep all of your patient's health information on a computer-based system. How could you problem-solve this dilemma? a. Process your patient records manually, in your current fashion. You are keeping a full record according to HIPPA. b. Process your notes and patient records on a laptop that you are able to transport between your office and home office. You always have the records available if needed. c. Process your notes and patient records in a secure electronic system with a template for patient information and interactions, supporting quick access within your network. d. Process your notes manually and keep them in a locked file. The records are available for copy and distribution at any time. C Your patient is a 40-year-old male who has suffered from depression since he was age 21. He has tried numerous antidepressant medications and combinations of medications to no avail. There is a response but no recovery for this patient. He is currently taking Duloxetine 120 mg 1 po QAM with a response. You prescribe a new medication to help with resistant depression, Brexpiprasole (Rexulti) 0.5 mg 1 po QAM. He tries samples of the medication for 1 month and he experiences recovery from depression. When he takes the prescription too the pharmacy, he finds that his insurance will not cover the cost of the medication sufficiently. The patient tells you that he just cannot afford the medication and wants stop it. What do you do? a. Work with the pharmacy representative to get as many samples as possible. Give them all to the patient so that he has a supply of the Brexpiprasole. b. Refer the patient to a psychiatrist because you cannot help him. c. Stress the need for recovery and push for him to make the financial sacrifices to afford the Brexpiprasole. d. The patient is not in danger of self-harm and has the right to decline his own health. Continue to research other medications that will help him. D Your work as a nurse practitioner (NP) makes you aware that there are many people who cannot afford to get services for their mental health needs. As part of your concern for social justice, you: a. Care for a number of patients pro bono each year. b. Act as a delegate at your local nursing convention. c. Support a local candidate for office who is "progressive" about health care. d. Act as a health screener at your child's kindergarten. A A mobile crisis team responds to an emergency call by a residential care home (RCH) manager. A 65-year-old resident had become increasingly agitated, insisted that the RCH cook was poisoning her food, and verbally threatened the cook. The RCH manager had found several days of the resident's medications hidden in her dresser drawer. Which is the most appropriate intervention by the mobile crisis team? a. Admission to a nursing home. b. Admission to the gero-psychiatric unit at the community hospital. c. Admission to the state psychiatric hospital. Admission to the crisis stabilization unit D You notice that you have begun to care less about your patient's needs. You are tired, unhappy, and unsatisfied with your job. You talk to your office confidant, another psychiatric nurse practitioner about feelings of "compassion fatigue." He indicates that while he can understand your concerns based on your self-assessment, but he does not believe you have compassion fatigue because he has not observed you: a. Staring off into the distance, suddenly crying for no reason, rapid changes in mood, impulsive spending, valuing and devaluing people. b. Constantly tired, wanting to do more of the paperwork and less of the patient work, wanting to stay longer and chat in the break room rather than be in your office alone. c. Heavily criticizing others during meetings, sitting in your office alone all the time, dressed in the same outfit all the time, and in denial about your problems. d. Hyperactive but having little productive work to show for it, poor concentration, not listening to others despite being present, and constantly forgetting things needed for daily work. C You frequently use your iPhone/smart phone to connect with your office, the pharmacy, and patients. These multifunction devices assist you in your practice. What needs to happen to the protected/private health information on your phone after you conclude a healthcare interaction? a. You document an abbreviated note of the phone conversation. b. You document that you had a telephone interaction only. c. You document it briefly, only if it is important. d. You document it fully in the patient record as a patient interaction. D When counseling a woman with children who is living in a violent domestic relationship, the PMHNP needs to advise that: a. Restraining orders can be helpful in preventing further violence. b. Anxiety, depression, dissociation, and PTSD symptoms are common in survivors. c. Shelters routinely provide care for both mothers and their children. d. Written material about shelters found by the perpetrator may trigger further violence. D You are treating a new patient. He indicates that he is a Muslim and follows all of the principles of that religion. He is suffering from depression. What special considerations should you take to help him in his treatment. a. Refer him to a male practitioner for medications and continue to research medications that do not contain any fish or animal fats. b. Refer him to a male therapist and continue to research medications that do not contain vanilla products. c. Refer him to a male practitioner for medications and explain that patient's need to use medications that contain no gelatin products. d. Refer him to a male therapist and continue to research medications that do not contain blood or horse byproducts. C Which of the following would not be included in a progress note? a. Incident report on medication error. b. Patient's self-rating on target symptoms. c. Risk/benefit analysis for change in medication. d. Standardized outcome measures C The guidelines that a group, community, or organization develop regarding its goals, direction, and priorities, and the way it implements its resources to attempt to reach those goals is the definition of: a. Law b. Policy c. Politics d. Precedent B A 37-year-old male with schizophrenia, paranoid type, lives in supervised housing and is followed by the Assertive Community Treatment Team through a Community Mental Health Center (CMHC) where the PMHNP notes that he has refused to see any primary care provider (PCP) during the past several years despite efforts by case managers to accompany him to medical visits. He has gained 30 pounds in the past three years on clozapine since his last inpatient hospitalization. His WBC and ANC counts remain within normal limits, but he has elevated cholesterol, lipids, and A1C levels. What is the most appropriate intervention to facilitate care for this patient? a. Advise the patient that he needs to see a PCP to treat his elevated cholesterol and blood sugar levels and ask his preference for referral to one of the CMHC's affiliated PCPs. b. Advise the patient that he needs to see a PCP to treat his elevated cholesterol and blood sugar levels and ask what has prevented him from seeing a PCP when referred in past. c. Explain the health risks of his elevated cholesterol and blood sugar levels and that he may eventually have to be hospitalized for medical treatment because this is a serious problem. d. Explain the health risks of his elevated cholesterol and blood sugar levels and separately ask the patient and case manager what has prevented him from seeing PCP when referred in the past. D The nurse practitioner (NP) sees an opportunity to help here patient who suffers from anxiety and hypertension by utilizing a medication that can treat both issues. She talks to her patient about using Atenolol 25 mg ½ tab po QHS to manage his hypertension and chronic anxiety. To promote both the patient's continued health and collaboration, the NP: a. Telephones the patient's primary care provider to discuss the use of the Atenolol before starting the medication. b. Faxes a copy of her car notes to the Primary Care Provider (PCP) to inform the PCP of her plan of care. c. Telephones the Primary Care Provider's office and leaves a message about the change in medication. d. Tells the patient to let his Primary Care Provider know about the change in medication. A. Which of the following best depicts the PMHNP in a grassroots mental health advocacy role? a. Meeting state legislators during RN lobbying day organized by the state nurses' association. b. Attending a town hall meeting to seek timely police response to rising domestic violence crisis calls. c. Working on the campaign of an individual running for the state senate. d. Assisting with depression screening at a health fair in a local shopping mall. B Outcomes measurement is the collecting and reporting of data about the effect of an intervention. Purposes of outcome measurement include all of the following except: a. To profile practice patterns of providers. b. To observe errors in data reporting of an intervention. c. To suggest changes in treatment. d. To analyze the effectiveness of an intervention. B A Nurse Practitioner decides to go back to school to gain further knowledge about the neurological basis of psychiatric illnesses. She is not doing this to maintain her licensure but to enhance her own knowledge. This is an example of: a. Continuing Education Credits b. Nursing Informatics c. Nursing Research d. Professional DevelopmentD 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? a. Respect b. Autonomy c. Advocacy d. Collaboration A 43-year-old male patient presents to the psychiatric mental health nurse practitioner (PMHNP) for a medication follow-up appointment. As part of his follow-up visit, his blood pressure reading is 156/102 millimeters of mercury. The patient states he has been having headaches for the last few weeks since he ran out of his blood pressure medication. The PMHNP's best action nis which of the following? a. Contact the patient's primary care provider, explain the patient's symptoms, and request his medication be refilled and he be given a followup appointment b. Call a local family nurse practitioner and request that she refill this patient's medication c. Refer the patient to the emergency department for an evaluation d. Call the pharmacy to confirm which antihypertensive the patient is taking and write a 30-day supply of this medication A The initial advanced practice role for the Psychiatric Mental Health nurses was the Clinical Nurse Specialist (CNS) that worked as a therapist and educator. Later, the PMHNP role was developed to serve the need of a primary care psychiatric provider that could perform evaluations and medication management services in hospitals and other venues. As of 2015, the Consensus Model for Advanced Practice Registered Nurse (APRN) practice regulation (i.e., licensure, accreditation, certification, and education-LACE) for the Psychiatric APRN role is approved for a: a. Nurse Practitioner that treats the psychiatric mental health population from birth through geriatrics. b. Nurse Practitioner that treats the psychiatric mental health population only. c. Nurse Practitioner that treats the psychiatric mental health population in the hospital setting only. d. Nurse Practitioner that treats the adult psychiatric mental health population only, under the supervision of a physician. A When a clinical trial fails to reject the null hypothesis (i.e., when p-value > 0.05), the investigator may have missed a true intervention effect. One should consider the following to avoid a Type II error: a. Power b. Sample bias c. Alpha level d. Effect size A You are in a meeting of your state nurse practitioner legislative group. The group's director has asked you to present information on a law bill (LB) that is being presented for public hearing in the state legislature. The information covers how best to approach securing support from the state's Health and Human Services Committee (state senators and congressmen). As you begin to present the information, two of your colleagues on the committee begin to talk over you about their ideas and will not quiet down. The group director does not intervene to settle the meeting. You decide to: a. Talk over the colleagues. Ask them to allow you to finish before they make comments. Take questions at the end of the presentation. b. Clear your voice and ask for attention. When that does not work, stop speaking until the situation resolves. If it does not resolve, sit down quietly until the behavior stops. c. Confront the speakers for their ill behavior and ask them to be quiet until you have finished your presentation. d. Ignore the speakers and ask the group director to settle the room so that you can finish your presentation. B The Nurse Practitioner (NP) is working with a patient secondary to an injury that he sustained while working on the job. The NP is managing both the medications and psychotherapy portions of this patient's care. The patient is involved in workman's compensation regarding his injury. The patient's employer sends the NP a release of information form requesting the patient's complete medical record. The NP: a. Talks to the patient before sending any records to the employer. b. Sends the complete record but withholds the psychotherapy notes. c. Sends the complete record including the psychotherapy notes. d. Declines to send the records due to the workman's compensation case. B As a Psychiatric nurse practitioner (NP), you accept an RN student who is studying to become a psychiatric NP. You ask the student to perform an initial psychiatric evaluation on a new patient while you observe. As the preceptor, you are responsible for: a. Satisfaction of the patient with the outcome of the evaluation. b. The patient feeling that he or she is being judged for "incarceration" in a chemical dependency treatment program. c. Gaining permission from the patient for the student to perform the evaluation and to ensure the quality of the evaluation. d. Gaining permission from the patient for the student to perform the evaluation. The ability of the student to perform the evaluation is their professional responsibility. C Which study design is appropriate in determining the difference in effectiveness of one medication compared to another medication in the treatment of bipolar disorder? a. Cross-sectional design b. Cohort design c. Randomized controlled trial d. Case-controlled trial C Which of the following is not the responsibility of Institutional Review Boards (IRB) in the research process? a. Ensure that adverse events are reported and risks/benefits are reevaluated. b. Ensure that informed consent is obtained and documented. c. Ensure that animal studies are conducted using humane methods. d. Ensure that risks to participants are minimized. C The Nurse Practitioner (NP) requires all patients to have a set of laboratory tests done each year to check changes in values as a safety measure. The patient states that these labs were done at his Internal Medicine Physician's office within the last month. The NP states that she will accept those labs as long as they cover all of the labs that she requires for the yearly check. The patient then verbally gives the NPP his Internal Medicine Physician's office number to call and requests that she get the lab results. The NP then: a. Mails a formal request to the Internal Medicine Office and physician requesting the laboratory results. b. Faxes a formal request to the Internal Medicine Office and physician requesting the laboratory results. c. Get a signed release of information for the patient for the Internal Medicine Physician for the laboratory results. d. Calls the internal Medicine office and verbally requests that they fax over the laboratory results. C In a therapy session, a five-year-old patient shows the Nurse Practitioner (NP) bruises on her back and legs. The child discloses that her mother's boyfriend hits her and tells her to "shut up". The NP is required to: a. Contact the mother to investigate the situation further. b. Take pictures of the bruises and save them in the child's file. c. Contact Child Protective Services or similar services in the local community to investigate the child's safety. d. Arrange to remove the child from the dangerous situation to protect her. C The PMHNP joined the local National Alliance on Mental Illness Board. Serving as a board member to advocate for access to care and parity of services is an example of which standard of professional performance? a. Collegiality b. Leadership c. Practice d. Consultation B When interpreting confidence intervals around relative risk reduction, a wider confidence interval reflects that: a. The estimate of effect is more precise b. The estimate of effect is less precise c. There is not statistically significant difference in effect d. There is a statistically significant difference in effect B You are considering using text message technology with your patients as a way to communicate quickly in our fast-paced world. What considerations are necessary when texting? a. Text messaging is safe because of advanced security platforms for protecting protected health information (PHI) in smart devices. b. Text messaging is becoming the accepted standard of communication since the availability of means for retrieving protected health information (PHI) from any device. c. The use of text message technology is not recommended by regulatory agencies. d. Text messaging using a secure text messaging platform within specific Joint Commission guidelines could be used for orders only. D A PMHNP practices in a state requiring a collaborating psychiatrist. The PMHNP reviews all new and complex cases with the psychiatrist on a monthly basis. A young adult patient with recurrent depression has been under the care of the PMHNP for 3 months when she commits suicide. The family sues for wrongful death. Who is legally responsible for this patient's care in a court of law? a. PMHNP b. Psychiatrist c. Primary responsibility of PMHNP and secondary responsibility of psychiatrist Equal responsibility of PMHNP and psychiatrist A To advocate for the skills and value of the psychiatric nurse practitioner (NP), you: a. Arrange for you and other psychiatric nurses to participate in a blood drive for a local psychiatric hospital. b. Arrange for your office to participate in a walk for Alzheimer's Disease. c. Arrange for a local TV station to interview you about what Psychiatric NPs can do for the community. d. Arrange a meet and greet with other nurses at a drug luncheon promoting a psychiatric medication. C Your mother calls you at the office and asks you to call in a prescription for her. The medication is for her sleeping pills, Eszopiclone (Lunesta) 3 mg 1 po QHS #30. You: a. Call the script into her pharmacy with three additional refills, just like any other patient. b. Tell her that you will only do it "just this once" for her and then call the script into her pharmacy. c. Call your mother's provider and ask the provider to call your mother's script in for her. d. Tell her to call the provider who normally prescribes that medication for her. D In counseling a 23-year-old, married Hispanic mother who brought her 4- year-old son to the clinic for "mal de ojo" with symptoms of fitful sleep, diarrhea, vomiting, and fever, the PMHNP: a. Educates about importance of maintaining fluid and electrolyte imbalance. b. Respect the mother's understanding of the child's illness. c. Identifies what steps the mother has already tried in caring for child's symptoms. d. Explains that the symptoms are most likely caused by viral infection. B The nurse practitioner (NP) is on an airplane and the flight attendant asks if there is a medical professional on the flight. The NP agrees to help. The NP is presented with a young woman who is suffering from a severe panic attack. The woman is nauseated and lying on the floor of the plane. The woman has trouble communicating much more than she is upset, afraid, and her husband is a few airplane stops away at an air force base where she is headed. The woman's pulse if 89 and regular and her respirations are 18 and regular. The woman occasionally pants and vomits some pale brown liquid. You provide information to the flight medical doctor on call. At the destination, the flight attendant offers to give you some Alprazolam 0.5 mg to give to the patient. You: a. Give her the Alprazolam to help her calm down until you get to the destination. Then, she can go to the hospital. b. Do not give the medication. Ask her if she would like to take the medication. If she agrees, allow the flight attendant to give it to her. c. Do not give the medication. Instead, wait until the plane lands and a full evaluation can be completed at the local hospital. d. Give her the Alprazolam so that she can calm down and go on to her next flight. C