PMHNP ANCC Review Questions with verified correct answers

The purpose of the American Nurses Association's Psychiatric-Mental Health Nursing: Scope and Standards of Practice is to a. Define the role and actions for the NP b. Establish the legal authority for the prescription of psychotropic medications c. Define the legal statutes of the role of the PMHNP d. Define the differences between the physician role and the NP role A. The ANAs Psych-Mental Health Nursing Scope and Standards of Practice defines the role and actions of the nurse practitioner. D. Information reduces incidence of disease. Primary prevention care practices are an essential aspect of the PMHNP role. Which of the following is the best example of a primary prevention care strategy for community behavioral health? a. Aftercare program for chronically mentally ill clients recently discharged from the hospital b. Court-ordered counseling for abusive parents c. 24-hour crisis hotlines d. Parenting skills classes for pregnant adolescents The trend in legal rulings on cases involving mental illness over the past 25 years has been to a. Encourage juries to find defendants not guilty by reason of insanity b. Protect the person's freedoms or rights when he or she is committed to a mental hospital c. Place increasing trust in mental health professionals to make good and ethical decisions d. Decrease the "red tape" associated with commitments so that commitments are faster and easier B. Identifies the trend of ensuring the protection of individual civil liberties for psychiatric clients. Mr. Smithers, an involuntarily hospitalized patient experiencing psychotic symptoms, refuses to take any of his ordered medication because he believes "Jesus Christ told me I am the prophet and must fast for a year." Your actions should be based on your knowledge of which of the following? a. Psychiatric clients cannot refuse treatment b. Psychiatric clients do not always know what is good for them c. Psychiatric clients can refuse treatment d. Psychiatric clients cannot be trusted to make good healthcare decisions and, therefore, the nurse's best clinical judgment should guide actions C. As with any client, psychiatric clients can refuse treatment unless a legal process resulting in involuntary commitment or mandatory court order for treatment has been obtained. Which of the following statements best reflects the difference between the nurse-client (N-C) relationship and a social relationship? a. In the N-C relationship, the primary focus is on the client and the client's needs. b. Goals in the N-C relationship are deliberately left vague and unspoken so that the client can work on any issue. c. In the N-C relationship, the nurse is solely responsible for making the relationship work. d. In the N-C relationship, there is no place for social interaction. A. Social relationships are mutual interpersonal relationships in which the needs of both parties are addressed. The N-C relationship is most concerned with meeting the needs of the client. A community has an unusually high incidence of depression and drug use among the teenage population. The public health nurses decide to address this problem, in part, by modifying the environment and strengthening the capacities of families to prevent the development of new cases of depression and drug use. What is this is an example of? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Protective factorial prevention A. This action focuses on interventions designed to reduce the incidence of new cases of disease. Mrs. Kemp is voluntarily admitted to the hospital. After 24 hours, she states she wishes to leave because "this place can't help me." The best nursing action that reflects the legal right of this client is a. Discharge the client b. Explain that the client cannot leave until you can complete further assessment c. Allow the client to leave but have her sign forms stating she is leaving against medical advice d. Immediately start the paperwork to commit the client and to allow you to treat her against her wishes B. Almost every state allows for a brief for a period detainment to assess a client for dangerousness to self or others before allowing the client to leave a hospital setting, even if the admission was voluntary. In forming a therapeutic relationship with clients, the PMHNP must consider developing many characteristics that are known to be helpful in relationship-building. Which of the following is an essential part of building a therapeutic relationship? a. Collecting a family history b. Like-mindedness c. Authenticity d. Accuracy in assessment C. Authenticity. Being genuine, honest, and respectful are essential elements in establishing a working relationship with any client. Like-mindedness is not a part of the therapeutic relationship. Although an important aspect of the PMHNP role, collecting a family history and accuracy in assessment does not in and of itself facilitate relationship building. According to the DSM-5, which of the following is true? (Ch. 3) a. A mental disorder is equivalent to the need for treatment. b. Diagnostic criteria are used to inform clinical judgment. c. Socially deviant behavior is considered a mental disorder. d. A culturally expected response to a stressor is not a mental disorder. D. All DSM-5 disorders need to be made taking a person's culture into account. A cultural expression of a response to grief, loss, or stress is not considered a DSM-5 diagnosis. Mrs. French has been in individual therapy for 3 months. She has shown much growth and improvement in her functioning and insight and is to discontinue services within the next few weeks. In the next session, after you discuss service termination, she suddenly begins to demonstrate the original symptoms that had brought her to treatment initially. She is now hesitant to discharge, wants to continue services, and is displaying an increase in regressive defense mechanisms. What is the best explanation for Ms. French's behavior? a. An exacerbation of her symptoms related to stress b. The normal cyclic nature of chronic mental health symptoms c. A sign of normal resistance to termination seen in the termination phase of therapy d. A sign of pathological attachment to the therapist that must be addressed C. Clients frequently display resistance and regression at the termination of a meaningful therapeutic process. The PMHNP is responsible for planning an effective termination and monitoring clients during the termination period. A client is displaying low self-esteem, poor self-control, self-doubt, and a high level of dependency. These behaviors indicate developmental failure of which of the following stages of development: a. Infancy b. Early childhood c. Late childhood d. School age B. These signs indicate developmental failure of early childhood. Mr. Thompson has been forgetful lately, for example, forgetting where he has placed his keys or what time appointments are scheduled, and he has stated that he thinks these are just random behaviors that have no particular meaning. Which Freudian-based psychodynamic principle assumes that all behavior and actions are purposeful? a. Pleasure principle b. Psychic determinism principle c. Reality principle d. Unconsciousness principle B. The psychic determinism principle states that all behavior has purpose and meaning, often unconscious in nature, and that no behaviors occur randomly or by coincidence. An example of a mature, healthy defense mechanism is a. Denial b. Rationalization c. Repression d. Suppression D. Suppression is the only defense mechanism listed in which the client channels conflicting energies into growth-promoting activities. Mr. Johnson is a 54-year-old client you have been seeing for several weeks in therapy. While discussing his current concerns of marital stress, he lies on the floor and assumes the fetal position. This is most likely an example of a. Immature regressive defense mechanism b. Denial of reality c. Immature fantasy defense mechanism d. Repressive behavior A. Immature regressive defense mechanism is a return to a behavior common to an earlier stage of development. Defense mechanisms are best viewed as a function of the ego a. To alert us to harm and danger b. To alert us to problems c. Used to resolve a conflict d. Used to protect the id C. Defense mechanisms are a function of the ego used to resolve a conflict. One of the health care changes that has occurred as a result of the affordable care act (ACA) is that doctors/hospitals/clinic groups or health systems are coming together and assuming the responsibility for quality care to large groups of individuals insured by Medicare. The health care clinics/systems doctors or hospitals that join together are called which of the following? a. Health Maintenance Organization (HMO) b. Preferred Provider Network (PPO) c. Accountable Care Organization (ACO) d. Individual Health Plan (IHP) C. ACO's are groups of doctors or other health care providers who voluntarily come together and assume the care provided to Medicare patients. Health care economics is concerned with making decisions so the benefits outweigh the cost of resource utilization. What are two concepts that healthcare economics is concerned with in regard to fair distribution of resources and allocation? a. Equity and efficiency b. Cost and benefits c. Opportunity and waste d. Affordable and quality A. Health care efficiency is making risk and benefit decision about how care resources are allocated and equity is ensuring that there is a fair distribution of the resources. What four elements need to be present for a malpractice lawsuit to be filed? a. Beneficence, Non-Maleficence, Truthfulness, and Justice b. Duty of care, Breach of standard of care, Injury, and Injury must be related to breach of the standard of care c. Abandonment, Breach of care, Violation of ethics, and Reimbursement for poor care d. Breach of standard of care, Injury, Deceit, and Malpractice B. The four elements that must be satisfied for malpractice to have occurred are a duty of care between clinician and patient, breach of standard of care, an injury to the patient, and the patient's injury must be related to the clinician's breach of care. Mary is a Psychiatric-Mental Health Nurse Practitioner (PMHNP) who is working in a hospitalist role. Mary has encountered over five incidences in which attending psychiatrists and medical residents have been demeaning to nursing staff and not answering calls in the middle of the night or telling the nursing staff to write orders and the MD would sign off in the a.m. Mary is concerned about errors and wants to improve quality, reduce errors to promote safety. What concept is Mary employing? a. Bullying b. Abuse c. Civil Disobedience d. Just Culture D. The ANA has a position statement that nurses are responsible for developing health care settings that include just culture initiatives understanding that human error can cause error and harm by creating an open and fair environment. The role of neurotransmitters in the central nervous system is to function as a. A communication medium b. A gatekeeper for transmissions c. A building block for amino acids d. An agent to break down enzymes A. Neurotransmitters in the central nervous system function as a communication medium. Serotonin is produced in which of the following locations: a. Locus ceruleus b. Nucleus basalis c. Raphe nuclei d. Substantia nigra C. Serotonin is produced in the raphe nuclei. Dopamine is produced in which of the following locations: a. Locus ceruleus b. Nucleus basalis c. Raphe nuclei d. Substantia nigra D. Dopamine is produced in the substantia nigra. A client presents with complaints of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions? a. Thalamus b. Hypothalamus c. Limbic system d. Hippocampus B. Appetite, sleep, and libido are regulated by the hypothalamus. In considering whether to order an MRI of the head for a client, which of the following would be a contraindication to this diagnostic test? a. Prosthetic limb b. History of head trauma c. Pacemaker d. Pregnancy C. A client with a pacemaker should not receive an MRI of the head. The primary excitatory neurotransmitter is a. GABA b. Serotonin c. Dopamine d. Glutamate D. Glutamate is the primary excitatory neurotransmitter. A client who is experiencing difficulties with working memory, planning and prioritizing, insight into his problems, and impulse control presents for assessment. In planning his care, the PMHNP should apply his or her knowledge that these symptoms represent problems with the a. Frontal lobe b. Temporal lobe c. Parietal lobe d. Occipital lobe A. Problems with working memory, planning and prioritizing, insight into problems, and impulse control indicate a problem in the frontal lobe. The concept of target symptom identification is best explained as a. Identification of the major clinical presentation of the client b. Identification of specific, precise, and individualized symptoms reasonably expected to improve with medication c. Identification of the secondary messenger system syndrome d. Intentional modulation of synaptic pathways B. Target symptom identification is the identification of specific, precise, and individualized symptoms reasonably expected to improve with a given medication. The goal of the psychiatric assessment process performed by the PMHNP is to a. Gain an understanding of the life experiences of the client b. Correctly diagnose the client c. Identify the mental health needs of the client d. Be able to communicate with other staff about the client's health needs C. Although diagnosis is an important aspect of the assessment process, the assessment ultimately should identify the needs of the client. Mr. Johnson is a client newly admitted to an inpatient psychiatric hospital. The PMHNP on call at the facility plans to perform the initial intake assessment and diagnostic process. Mr. Johnson asks to please talk in his room because, he says, "People make me nervous." His room is at the end of the hallway and is the farthest away from the nursing station. The PMHNP's action should be based on awareness that the best location to do the assessment is a. In Mr. Johnson's room, because it is least noisy and most comfortable for him, thus facilitating data collection b. In the dayroom, which is full of people, to observe his interactions with other people c. In a quiet place, but public enough to get assistance with client care should it be required during the assessment d. In the treatment room with the door closed, a neutral location C. One PMHNP role is to control the milieu as an aspect of assessment, so the PMHNP should choose a quiet place that is public enough to get assistance with client care should it be required during the assessment. Which communication technique is the PMHNP using in the following situation? Client: "Sorry I was late. I didn't realize what time it was." PMHNP: "This is the third time now that you have been late for our sessions. I am wondering how committed you are to our working on your problems." a. Theming b. Recognizing c. Validating d. Sequencing B. This exchange is an illustration of the technique of recognizing. In assessing a client, you ask him the meaning of the proverb "People who live in glass houses shouldn't throw stones." He replies, "Because it will break the windows." The correct interpretation of this findings is a. Client has a probable mood disorder b. Client has a probable anxiety disorder c. Client has limited intellectual ability d. Unable to interpret the finding without knowing the client's age D. The answer demonstrates concrete thought processes, which are normal in persons younger than age 12 but are abnormal after age 12. To interpret the finding, the PMHNP must know the age of the client. The PMHNP is planning to work with a client using an individual therapy model of care. During the first session, the client makes the following statement: "This is the third time my son has run away. I've grounded him, taken away his bike, even tried cutting off his allowance and confining him to his room. What should I do now?" The most therapeutic response for the PMHNP to make is a. "I wonder if confining him to his room was abusive?" b. "Maybe that depends on what you are trying to accomplish." c. "Perhaps talking to his friends and teachers would help." d. Remain silent B. This response will be the most therapeutic in moving forward with the client.