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NR548 / NR 548 LATEST EXAM WITH
DETAILED QUESTIONS AND
ANSWERS
question-What year brought a transition towards deinstitutionalization in care for those with mental illnesses, which led to an increase in the number of psychiatric patients receiving care in the community rather than hospitals? - answer-1950s question-What Act allowed for the expansion of the PMHCNS role into community and ambulatory settings as they helped those who had been deinstitutionalized adapt (ANA, 2014). - answer-The Community Mental Health Centers Act of 1963 question-occur in a hospital, psychiatric facility or community setting. These services focus on psychiatric and substance-related emergencies. - answer-Crisis intervention and psychiatric emergency services Who the first organized training school within a hospital for the insane in 1882? - answer-Dr. Edward Cowles question-Who developed the first nurse-organized training course for psychiatric nursing at Johns Hopkins Hospital. - answer-Effie Jane Taylor question-Who recommended standards of training for psychiatric nurses, which led to improved education and standards of care? - answer-Laura Fitzsimmons
question-is a short-term treatment. It occurs in the inpatient setting providing care for acutely ill patients at risk for harming self or others or unable to meet basic needs due to impairment. The focus is crisis stabilization. - answer-Acute inpatient care question-may admit clients directly or accept transfers from acute inpatient care. They provide intermediate or long-term care for patients at chronic risk to self or others or unable to function without supervision and support due to mental disorders. They include treatment, habilitation and rehabilitation and may be public, private, or state hospitals operated through the criminal justice system. - answer-Intermediate and long-term care question-provide acute symptom management, intensive treatment, and safe housing for patients who do not require 24-hour medical management or nursing care. These programs can be free standing or step-down facilities. - answer-Partial hospitalization and intensive outpatient treatment (IOP) question-provide 24-hour care and housing for an extended period. Services include psychoeducation, vocational rehabilitation, and training for activities of daily living. - answer- Residential Services question-is provided in non-hospital community settings such as mental health clinics, homes, worksites, shelters, crisis centers, senior centers, group homes, or schools. It can also provide care in an integrative primary health care setting. - answer-Community based Care question-is a team treatment approach to provide comprehensive, community-based psychiatric treatment, rehabilitation, and support to persons with severe mental illness (SMI). It provides individualized service 24 hours a day, 7 days a week. - answer-Assertive Community Treatment (ACT)
question-The PMHNP engages in the design, implementation, management, and evaluation of programs, systems, or policies to address the mental health needs of a population at risk for developing mental health problems through prevention, health promotion, identification and reduction of risk factors, screening, and early intervention. - answer-Program, system, and policy development management question-The role involves "the assessment, diagnosis, and treatment of behavioral, cognitive, developmental, emotional, and spiritual responses of individuals, families, and significant others with co-occurring [actual or potential] physical illness(es) and/or dysfunction" (ANA, 2014, p.33). The PCLN often works as a member of an interdisciplinary consultation-liaison team. - answer-Psychiatric Consultation-Liaison Nursing (PCLN) question-The PMHNP assists other mental health clinicians to evaluate their practice, expand their skills, and meet standards for ongoing peer supervision. Clinical supervision focuses on growth and development rather than performance evaluation. Administration, Education, and Research Practice: PMHNP may serve as administrators, educators, and researchers. - answer- Clinical Supervision: question-PMHNPs provide direct comprehensive mental health services in solo or group private practice settings or through contracts with other entities. - answer-Self employment question-The PMHNP functions as part of an interdisciplinary team, providing care and treatment for clients with mental disorders, including substance use disorders and co-occurring medical disorders. Integrative care helps improve care coordination between primary care providers and behavioral health. - answer-Integrative programs(Specialty Areas)
question-The PMHNP utilizes telecommunication technology such as telephone consultation, interactive video sessions, and e-mail to deliver care and treatment to clients. Telehealth must be practiced following all applicable laws and regulations - answer-Telehealth (Specialty Areas) question-involves the intersection of psychiatric nursing and the criminal justice system. Activities may include working with victims or offenders in settings including the community, jails, prisons, and state psychiatric hospitals. "Also perform psychiatric assessments, prescribe and administer psychiatric medications, and educate correctional officers about mental health issues. Provides therapeutic services to witnesses and victims of crime - answer-Forensic Mental Health (Specialty area) question-Is a growing field. As first responders, PMHNPs provide psychological first aid and mental health clinical services in response to environmental and man-made disasters. - answer- Disaster psychiatric-mental health nursing ( Specialty Areas) question-Scenario Person A: "I can't believe you deal with these people every day. Schizophrenics would drive ME crazy!" PMHNP: "Actually, schizophrenia is a chronic treatable disease, much like diabetes or other physical illnesses. Patients who have mental illness deserve compassion and care." - answer- Respect for the individual question-Scenario The client presents to the emergency department with hallucinations and is threatening self- harm. The PMHNP signs an involuntary admission order for emergent psychiatric care.
question-Scenario The PMHNP takes time for daily meditation to improve mindfulness and ease stress. Rationale The PMHNP is committed to practicing self-care, managing stress, and maintaining supportive relationships to meet personal needs outside of therapeutic relationships. - answer-Duties of self and others question-Scenario A PMHNP discovers her colleague is diverting scheduled medications to self-medicate anxiety. The PMHNP reports the concerns to the colleagues supervisor. Rationale The PMHNP recognizes signs/symptoms of psychiatric disorders in the workplace reporting peer observations to leadership. The PMHNP helps address problems faced by colleagues that impact client safety or violate public trust, including substance abuse. - answer-Contributions to Healthcare Environments question-Scenario The PMHNP gives a presentation at a national conference on best practices in depression treatment. Rationale The PMHNP contributes to advancing the professing through practice, education, administration, and knowledge development. - answer-Advancement of the Nursing Profession
question-Scenario The PMHNP is a member of the ANA and NAMI and regularly participates in workgroups that seek to expand access to care for healthcare consumers with PMH disorders. Rationale The PMHNP promotes community, national, and international efforts to meet health needs through collaboration with other healthcare professionals to promote prevention, treatment, and recovery. - answer-Collaboration to meet health needs question-Scenario A PMHNP speaks at a school board meeting about the need develop policies to expand mental health services for underserved students. Rationale The PMHNP participates in policy development and implementation that recognizes PMH disorders as treatable and ensures that nursing care is delivered with respect to human needs and values without prejudice. - answer-Promotion of the Nursing Profession question-How mental health diagnoses affect the average life expectancy - answer-on average, people with SMI die 25 years earlier than those without these illnesses, In 2018, the American Psychiatric Association (APA), in conjunction with the American Telemedicine Association (ATA) developed: - answer-best practices for providing
question-Telepsychiatry Legal and Regulatory Considerations: Licensure requirements - answer- Licensure requirements differ from in-person practice.-Providers must hold a license to practice in the state where the client resides.-The PMHNP is responsible for following standards for the state in which they are practicing. question-Telepsychiatry Legal and Regulatory Considerations: Federal and state prescribing guidelines - answer-Federal and state prescribing guidelines differ for telepsychiatry.-The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 governs the prescribing of controlled substances via teleconferencing.• To safely prescribe, the provider must conduct an in-person medical evaluation at least once every 24 months and comply with all federal and state prescribing guidelines. question-Telepsychiatry Legal and Regulatory Considerations: Billing and Reimbursement - answer--Reimbursement varies by state and insurance provider.• Currently, 48 states provide Medicaid reimbursement for telepsychiatry services.-pt made aware of any and all financial charges that may arise from the services prior to the commencement of initial services question-Best practices for determining the appropriateness of telepsychiatry services include consideration of the following: - answer--cognitive capacity of the client-client history and medical status - geographic distance to emergency facilities - client support system question-Best practices related to special populations: Forensic and Correctional - answer-- follow applicable standards of consent in terms of client's legal status and rights - develop clear, site-specific protocols
question-Telemental health Children and Adolescents: environment - answer-should facilitate the assessment by providing an adequate room size, furniture arrangement, toys, and activities that allow the youth to engage with the accompanying parent, presenter, and provider and demonstrate age-appropriate skills question-best practices related to special populations: Children and Adolescents - answer-follow the same guidelines presented for adults•modify care based on developmental status (motor functioning, speech and language capabilities, relatedness, and relevant regulatory issues)- include family as appropriate-Providers should consider how the presenter's involvement can affect service delivery - Appropriateness for telemental care shall consider safety of the youth, the availability of supportive adults, the mental health status of those adults, and ability of the site to respond to any urgent or emergent situations. question-Best practices related to special populations: Geriatric - answer--include family as clinically appropriate-adapt care for cognitive or sensory impairment question-best practices related to special populations: Military and Veteran - answer--be familiar with federal and organizational structures and guidelines - be familiar with military cultural competence question-best practices related to special populations: Substance Use Disorder Treatment - answer-comply with federal, state, and local regulations related to prescribing controlled substances
- coordinate with on-site staff as appropriate to ensure care coordination and monitoring
Traditionally, the use of telehealth and tele-mental health care was designed to meet the needs of rural populations and geographic areas with identified shortages of specialty health care professionals question-Forensic Mental Health Care - answer-Any cross between the criminal justice system and psychiatric nursing can be considered forensic mental health-64% of U.S. inmates have mental health concerns or disorders-15% to 20% of inmates in jails and prisons suffer from serious mental illness
- Over 90% of federal inmates with mental health conditions are without access to mental health treatment question-Informed Consent - answer-Local, state, and national laws regarding verbal or written consent shall be followed-If written consent is required, then electronic signatures, assuming these are allowed in the relevant jurisdiction, may be used-The provider shall document the provision of consent in the medical record question-Informed Consent - answer-for care and treatment is a fundamental ethical and legal principle-respects the client's autonomy in medical decision-making-Clients have the right to receive information and ask questions about recommended treatments so they can make decisions about their care that are consistent with their beliefs, values, and goals of treatment- Clients have the right to knowledge about their treatment under "reasonable practitioner" or "reasonable person" standards under U. S. law.-may change over time and in different circumstances• is an ongoing process question-Steps to Obtaining Informed Consent - answer--Assess client ability to understand medical information & tx options & to make a voluntary decision
- Present relevant information with accuracy and sensitivity, Should include information about: • Diagnosis• Nature and purpose of treatment options• Benefits, risks, and burdens of all treatment options, including forgoing treatment
- Document informed consent conversation in the medical record, including all consent forms question-Informed Consent: Documentation - answer-Documentation of the discussion to obtain informed consent should include: - treatment plans with risks and benefits identified-reasonable alternatives with risks and benefits identified-assessment of client understanding of the discussion *must demonstrate that the client participated in the decision-making process and that the client was not coerced into treatment question-Exceptions to Informed Consent: - answer--client incapacitation-life-threatening emergencies-voluntary waived consent-client unable to make decisions and has no designated decision-maker - involuntary treatment question-Clinically unsupervised settings - answer--Providers should discuss the importance of having consistency in where the patient is located for sessions-knowing a patient's location at the time of care, as it impacts emergency management and local available resources
- As patients change locations, providers shall be aware of the impact of location on emergency management protocols (police, emergency rooms, crisis teams)-provider should consider the use of a "Patient Support Person" (PSP) as clinically indicated• a family, friend or community member selected by the patient who could be called upon for support in the case of an emergency
Providers shall ensure privacy so clinical discussion cannot be overheard by others outside of the room
- patient and provider cameras should be placed at the same elevation as the eyes with the face clearly visible to the other person-features of the physical environment for both shall be adjusted so the physical space, to the degree possible, maximizes lighting, comfort and ambiance question-Child & Adolescent Telepsychiatry: Legal and Regulatory Issues - answer-Many states require guardian consent, written and/or verbal, for telepsychiatry services in addition to the usual consent for care-reporting requirements may vary by jurisdiction and ensure that relevant personnel at the distant (provider location) and originating (patient location) sites are informed of reporting requirements for youth
- Telepsychiatrists should comply with the AACAP Code of Ethics-absence of a comprehensive policy for delivering telemedicine services, individual states have proposed legislation to expand services:• reimbursing for school-based telepsychiatry services• repealing laws that mandate minimum distance requirements between distant and originating sites in order to receive reimbursement question-Child & Adolescent Telepsychiatry: Patient Safety - answer--·Psychiatrists telecommuting to any setting must consider whether appropriate emergency management protocols are in place and develop any needed protocols.-utilizes the local community's emergency resources-Telesychiatrists managing emergencies must rely on a team of individuals
- · need to be able to effectively manipulate telepsychiatry technology in order to maximize video and audio quality to optimally assess signs of agitation, substance use, and medication side effects.• If technology falters, psychiatrists should be prepared to quickly initiate a pre-planned backup emergency management plan. question-The Ryan Haight Online Consumer Pharmacy Protection Act of 2008 - answer-impacts the legitimate practice of child and adolescent telepsychiatry.-requirement for the initial in-
person evaluation is a major barrier for telepsychiatry with youth and the exceptions to this requirement are narrow and do not apply to many telepsychiatry applications question-The Ryan Haight Act is relevant to the increasing trend towards: - answer-direct-to- consumer telepsychiatry as the home setting is not an approved site of service for prescribing controlled substances. question-Child & Adolescent Telepsychiatry: Developing a Virtual Therapeutic Space - answer-- starts with the rooms at both the patient's and psychiatrist's sites-rooms should be set up to establish a typical clinical experience-psychiatrist's room should be conservatively appointed both to facilitate the camera's focus and to not distract the patient-patient's room should be of appropriate size to optimally conduct a mental status examination• including observation of gross motor and fine motor skills, affect and relatedness question-Health Insurance Portability and Accountability Act (HIPAA) - answer-provides a legal framework for handling client information-HIPAA rules help protect the privacy of the client's identifiable health information while facilitating communication among providers and other entities• ensure information is available for treatment and other purposes such as insurance benefits - health professionals may be held legally liable by state and federal law for breaching confidentiality question-HIPPPA- Release of Information - answer--HIPAA guides the PMHNP in making decisions about when to share information based on their professional judgment to prevent harm• may be necessary for providers to share mental and behavioral health information to enhance treatment or ensure the health and safety of the client and others
- PMHNPs are mandatory reporters in cases of suspected child abuse
question-Piaget's cognitive stage: Sensorimotor - answer- 0 - 2 years of age• cognitive abilities based on reflexes• children master object permanence and causality question-Cognitive Development: Piaget's cognitive stages - answer--Sensorimotor - Preoperational - Concrete Operational - Formal Operational question-Piaget's cognitive stage: Preoperational - answer- 2 - 7 years of age child can use mental representations, symbolic thought, and language • thinking is egocentric question-Piaget's cognitive stage: Concrete Operational - answer- 7 - 11 years of age child uses logical operations when thinking and solving problems thinking is concrete question-Formal Operational - answer-12 years and older• adolescent can use abstract reasoning in addition to logical operations can understand theories, hypothesize, and comprehend abstract ideas such as love and justice question-Psychosocial Development: Erikson's developmental theory - answer-individuals go through a series of eight stages of psychosocial development from birth to death - each stage, individuals must resolve a psychosocial crisis to move to the next stage• Unsuccessful resolution could impair the development of a healthy personality and sense of self, which could negatively impact mental health and relationships
question-Erikson's psychosocial stages - answer--Infancy: Trust vs. Mistrust (birth-18 months)
- Early Childhood: Autonomy vs. Shame and Doubt (ages 18 months-2 to 3 years)
- Preschool: Initiative vs. Guilt (ages 3-5)
- School Age: Industry vs. Inferiority (ages 6-11)
- Adolescence: Identity vs. Role Confusion (ages 12-18)
- Young Adulthood: Intimacy vs. Isolation (ages 19-40)
- Middle Adulthood: Generativity vs. Stagnation (ages 40-65)
- Maturity: Integrity vs. Despair (ages 65-death) question-Abraham Maslow's Hierarchy of Needs - answer-motivational theory that examines people's behavior as it relates to five categories of needs - Needs arranged in a pyramid, most basic needs at the foundation:• self-actualization (top of pyramid)• esteem
- love/social needs• safety• physiological (bottom of pyramid) question-Special Considerations: Children - answer--Legislation regarding minors and informed consent is based on state law • be familiar with the req in state of practice• Children under 17 typically cannot provide informed consent-Parents must give permission for tx in most circumstances, exceptions:
- under 18 and married • serving in the military
- able to provide financial independence • mother of a child (married or not) question-Special consideration: disregarding parental rights - answer--A parent may not be allowed to access info. in the following circumstances: • info. is contained in the therapist's psychotherapy notes• parent not designated as the child's personal representative• parent voluntarily agrees that info can be kept confidential
