NRNP 6665 WEEK 6 MIDTERM EXAM
COMPREHENSIVE EXAM 2026
◉ 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 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
-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
Responsibility and Accountability for Practice
Duties to Self and Others
Contributions to Healthcare Environments
, Advancement of the Nursing Profession
Collaboration to Meet Health Needs
Promotion of the Nursing Profession
◉ A client who is alert and oriented declines the PMHNP's treatment
recommendation for an antipsychotic in a non-emergent situation.
Informed consent required
Exception to informed consent. Answer: Informed consent required
Rationale: The client has the capacity to consent and the situation is
not emergent. The ethic of autonomy provides for the client to
refuse treatment options.
◉ An agitated, hallucinating client with a diagnosis of schizophrenia
and no designated decision-maker threatens to shoot his neighbors.
The client acts out violently towards the security guard in the
emergency department. The PMHNP orders haloperidol and
lorazepam for the client.
Exception to informed consent
Informed consent required. Answer: Exception to informed consent
Rationale: The client does not have the capacity to provide consent.
COMPREHENSIVE EXAM 2026
◉ 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 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
-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
Responsibility and Accountability for Practice
Duties to Self and Others
Contributions to Healthcare Environments
, Advancement of the Nursing Profession
Collaboration to Meet Health Needs
Promotion of the Nursing Profession
◉ A client who is alert and oriented declines the PMHNP's treatment
recommendation for an antipsychotic in a non-emergent situation.
Informed consent required
Exception to informed consent. Answer: Informed consent required
Rationale: The client has the capacity to consent and the situation is
not emergent. The ethic of autonomy provides for the client to
refuse treatment options.
◉ An agitated, hallucinating client with a diagnosis of schizophrenia
and no designated decision-maker threatens to shoot his neighbors.
The client acts out violently towards the security guard in the
emergency department. The PMHNP orders haloperidol and
lorazepam for the client.
Exception to informed consent
Informed consent required. Answer: Exception to informed consent
Rationale: The client does not have the capacity to provide consent.
