Page 1 of 79
NR 605 MIDTERM EXAM (DIAGNOSIS MANAGEMENT
IN PSYCHIATRIC) ACTUAL EXAM QUESTIONS AND
CORRECT ANSWERS AGRADE
RATED
Lori, a 42-year-old female, presents to the office for an initial consultation. She has just
experienced a breakup after a 5-year relationship and is feeling "depressed." A comprehensive
initial evaluation which includes chief complaint, history or present illness, medical history,
previous psychiatric history, family history and a comprehensive review of systems was
completed. Psychotherapy was included in the session - 18 minutes time.
provide the appropriate CPT code - ANSWER-99205+90833
Rationale: The client is new to the practice (20) and presents with one problem which
addressed 4 or more elements, had a comprehensive history and interview. No additional
testing was needed, treatment was initiated (05). Psychotherapy was included in the session-
18 minutes time. Therapy goals were established and reviewed with the client.
1
,Page 2 of 79
Hannibal, a 23-year-old male, is admitted to an inpatient psychiatric facility with symptoms of
auditory hallucinations, paranoia, and suicidal ideations. A comprehensive initial evaluation
which includes chief complaint, history or present illness, medical history, previous psychiatric
history, family history and a comprehensive review of systems was completed.
provide the appropriate CPT code - ANSWER-99223
Rationale: The client presents for initial hospital care (22) and has a high level of medical
decision-making due to an acute illness that poses a threat to life (3).
Shakina, a 19-year-old transgender female, has been referred to the PMHNP from primary care.
The PMHNP reviews the primary provider's note and identifies symptoms of bipolar I disorder.
The PMHNP completes a comprehensive assessment and prescribes medications for the client.
provide the appropriate CPT code - ANSWER-99245
Rationale: The client has been referred (24), has complex medical decision-making needs (5)
based on one undiagnosed new problem with an uncertain prognosis, required review of
referral notes, and requires prescription drug management. No psychotherapy provided.
Steve, a 30-year-old married client returns for a follow up appointment. He was initially seen 3
months ago due to increased anxiety over his marriage. His diagnoses include generalized
2
,Page 3 of 79
anxiety disorder (F41.1) and major depressive disorder (F32.1) The PMHNP has provided both
medication management and cognitive behavioral therapy (CBT). Today the PMHNP obtains a
chief complaint, history of present illness, reviews medical history, and a focused review of
three systems was completed. Medications - ANSWER-99214 + 90833
Rationale: This is a returning client with two documented diagnoses. A focused encounter was
conducted that included psychotherapy.
The PMHNP has initiated a grief support group at her practice. The support group is one hour in
length and can include the client and family members.
provide the appropriate CPT code - ANSWER-90853
Rationale: This is group psychotherapy with no medication management. Only a psychotherapy
code is necessary.
Interprofessional Collaboration and Referrals - ANSWER--PMHNPs may receive client referrals
from primary care providers to address mental health problems
-refer clients to primary care providers for medical care
-PMHNPs may collaborate with social workers to address clients' needs for social support
-vocational counselors to assist with employment needs
3
, Page 4 of 79
-refer clients to other therapists
• geriatrics, psychiatric emergencies, eating disorders, family therapy, or pediatrics
-telehealth services or a support group
Disparities in Mental Health Services - ANSWER-Racial, ethnic, gender, and sexual minorities
-often experience poor mental health outcomes due to inaccessibility of quality mental health
services, discrimination, a cultural stigma surrounding mental health care, and lack of
knowledge about mental health
• To address disparities, the American Psychological Association (2022) advocates for the
expansion and use of culturally and linguistically competent psychological and behavioral
research and services
Legal & Ethical Considerations - ANSWER-Provider initiated termination for cause
Termination letters
Court mandated treatment
Process and progress notes
Code of Ethics for Nurses - ANSWER-Respect for the Individual
Commitment to the Healthcare Consumer
Advocacy for the Healthcare Consumer
4
NR 605 MIDTERM EXAM (DIAGNOSIS MANAGEMENT
IN PSYCHIATRIC) ACTUAL EXAM QUESTIONS AND
CORRECT ANSWERS AGRADE
RATED
Lori, a 42-year-old female, presents to the office for an initial consultation. She has just
experienced a breakup after a 5-year relationship and is feeling "depressed." A comprehensive
initial evaluation which includes chief complaint, history or present illness, medical history,
previous psychiatric history, family history and a comprehensive review of systems was
completed. Psychotherapy was included in the session - 18 minutes time.
provide the appropriate CPT code - ANSWER-99205+90833
Rationale: The client is new to the practice (20) and presents with one problem which
addressed 4 or more elements, had a comprehensive history and interview. No additional
testing was needed, treatment was initiated (05). Psychotherapy was included in the session-
18 minutes time. Therapy goals were established and reviewed with the client.
1
,Page 2 of 79
Hannibal, a 23-year-old male, is admitted to an inpatient psychiatric facility with symptoms of
auditory hallucinations, paranoia, and suicidal ideations. A comprehensive initial evaluation
which includes chief complaint, history or present illness, medical history, previous psychiatric
history, family history and a comprehensive review of systems was completed.
provide the appropriate CPT code - ANSWER-99223
Rationale: The client presents for initial hospital care (22) and has a high level of medical
decision-making due to an acute illness that poses a threat to life (3).
Shakina, a 19-year-old transgender female, has been referred to the PMHNP from primary care.
The PMHNP reviews the primary provider's note and identifies symptoms of bipolar I disorder.
The PMHNP completes a comprehensive assessment and prescribes medications for the client.
provide the appropriate CPT code - ANSWER-99245
Rationale: The client has been referred (24), has complex medical decision-making needs (5)
based on one undiagnosed new problem with an uncertain prognosis, required review of
referral notes, and requires prescription drug management. No psychotherapy provided.
Steve, a 30-year-old married client returns for a follow up appointment. He was initially seen 3
months ago due to increased anxiety over his marriage. His diagnoses include generalized
2
,Page 3 of 79
anxiety disorder (F41.1) and major depressive disorder (F32.1) The PMHNP has provided both
medication management and cognitive behavioral therapy (CBT). Today the PMHNP obtains a
chief complaint, history of present illness, reviews medical history, and a focused review of
three systems was completed. Medications - ANSWER-99214 + 90833
Rationale: This is a returning client with two documented diagnoses. A focused encounter was
conducted that included psychotherapy.
The PMHNP has initiated a grief support group at her practice. The support group is one hour in
length and can include the client and family members.
provide the appropriate CPT code - ANSWER-90853
Rationale: This is group psychotherapy with no medication management. Only a psychotherapy
code is necessary.
Interprofessional Collaboration and Referrals - ANSWER--PMHNPs may receive client referrals
from primary care providers to address mental health problems
-refer clients to primary care providers for medical care
-PMHNPs may collaborate with social workers to address clients' needs for social support
-vocational counselors to assist with employment needs
3
, Page 4 of 79
-refer clients to other therapists
• geriatrics, psychiatric emergencies, eating disorders, family therapy, or pediatrics
-telehealth services or a support group
Disparities in Mental Health Services - ANSWER-Racial, ethnic, gender, and sexual minorities
-often experience poor mental health outcomes due to inaccessibility of quality mental health
services, discrimination, a cultural stigma surrounding mental health care, and lack of
knowledge about mental health
• To address disparities, the American Psychological Association (2022) advocates for the
expansion and use of culturally and linguistically competent psychological and behavioral
research and services
Legal & Ethical Considerations - ANSWER-Provider initiated termination for cause
Termination letters
Court mandated treatment
Process and progress notes
Code of Ethics for Nurses - ANSWER-Respect for the Individual
Commitment to the Healthcare Consumer
Advocacy for the Healthcare Consumer
4
