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A wide range of topics in psychiatric mental health nursing, including the evaluation and management of various psychiatric disorders, pharmacological interventions, and the role of the psychiatric nurse practitioner (pmhnp) in providing comprehensive care. It delves into the assessment and treatment of conditions like tardive dyskinesia, asperger's disorder, schizophrenia, bipolar disorder, and depression, among others. The document also explores the pharmacodynamics of different medications, the importance of cultural competence, and the application of the recovery model in patient care. Additionally, it addresses ethical considerations, such as patient privacy and the pmhnp's role in advocating for the profession. This comprehensive resource provides valuable insights for healthcare professionals, particularly those specializing in psychiatric mental health nursing, to enhance their knowledge and improve patient outcomes.
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A patient comes into your office inn a full manic episode. This patient has a diagnosis of Bipolar and Alcohol Use Disorder, moderate. You have a report from the patient's chemical dependency counselor indicating that inpatient chemical dependency counseling is needed. Your patient has been on the fence about inpatient chemical dependency treatment in the past. You assess the patient and find a strong odor of alcohol, auditory and visual hallucinations, flight of ideas, lack of sleep for 3 days, suicidal ideations without a firm plan, and plans to drive to another state to gamble. The patient's brother who accompanies him corroborates this information. In order to best treat this patient you: a. Admit him to the dual diagnosis chemical dependency unit with an order for the collection of laboratory values. b. Admit him to the inpatient chemical dependency program. c. Send the patient home with his brother and a prescription for a new antipsychotic medication. d. Admit him to the local psychiatric unit, with an order for the collection of laboratory values. Appraisal of the patient's suicidal ideation, plan, method, intent, and access to implement plan would be documented in which part of the standard psychiatric evaluation? a. History of Presenting Illness b. Review of Systems c. Diagnosis d. Mental Status Exam Violence directed toward women by an intimate partner is a serious health problem worldwide. Which of the following women has the greatest risk factors for being the victim of violence? a. 26 years old, recently separated, Asian American woman living in Boston, Massachusetts b. 42 years old, divorced, Caucasian woman dating a recently divorced man in Denver, Colorado c. 17 years old, single, Native American woman living with employed boyfriend in Galena, Alaska
d. Tell me why you are unable to fall back asleep after your daughter does In assessing possible sexual abuse of a 4-year-old child, which of the following would not be indicated? a. Has anyone ever taken your picture without your clothes on? b. Has anyone else asked you to take off your clothes? c. Has anyone invited you to a birthday pool party? d. Has anyone done something you didn't like to your body? A 78-year-old cattleman referred for treatment of refractory depression by his primary care provider reports continued thoughts of failure, lack of purpose in life, lack of interest in ranching, fishing, hunting, or family since losing his driver's license due to DUI six months ago. Which of the following areas is an assessment priority? a. Extent of alcohol use and motivation to reduce to safe levels b. Prior and current medications, dose, clinical response, side effects c. Sleep patterns (early-middle-late awakening), sleep hygiene d. Thoughts of self-harm, plan, intent, access During an initial psychiatric evaluation, the patient reports use of alcohol and illicit drugs. This information would be most appropriate in which part of the evaluation? a. Review of Systems b. Personal and social history c. Chief complaint d. Mental Status Exam The American College of Obstetricians and Gynecologists (ACOG) recommends screening for postpartum depression with a validated screening tool. Which of the following is a validated screening tool which has been recommended by ACOG? a. Major Depression Inventory (MDI) b. Montgomery-Asberg Depression Rating Scale (MADRS) c. Edinburgh Postnatal Depression Scale (EPDS) d. Hamilton Rating Scale for Depression (HRSD) A 67 - year-old Vietnamese immigrant, who has been a resident in the U.S. for 3 years, comes to your clinic for an evaluation. Her first language is Vietnamese, but she does speak some English. She has problems with reading and writing, as she did not finish high school, or earn a GED (General Educational Development) equivalency. As the PMHNP, what is your priority disparity to address with this patient? a. Age b. Health literacy c. Reading level d. Race
An adult female patient has been prescribed an SSRI for an initial episode of major depression. She is fearful of side effects and of becoming suicidal. Which of the following initial responses is most appropriate? a. SSRI's are generally quite safe and rarely cause suicidal thoughts. I could call you every few days to see if you are having any of these thoughts. b. SSRI's are the safest antidepressant medications and rarely cause suicidal thoughts. Try the medication and we can watch closely for any side effects. c. Have you ever had feelings of hurting yourself? If you took the medication and had thoughts like that, would you be willing to call the crisis hotline? d. Have you ever had feelings of hurting yourself? If you took the medication and had thoughts like that, what would you do? The Mini-Mental Status Exam (MMSE) is a brief, standardized screening tool designed for use: a. Across the lifespan to document mental status b. In older adults ³ 65 years to quantify cognitive status c. In adults ³18 years to document mental status d. In adults to quantify cognitive status. A patient who works the night shift presents for a follow-up appointment to see the PMHNP and states, "I can't sleep when I get home from work." Upon assessment, the PMHNP learns the patient recently started an exercise regimen and is now exercising after work. Which response about sleep hygiene should the PMHNP provide to the patient? a. Exercising is a good way to help you get sleep, so keep up your schedule and your body will adjust to your new routine. b. Regular exercise can help promote sleep but should not be performed too close to your bedtime or it can interfere with sleep; try exercising before work. c. Exercise dose not promote or help deepen your sleep, so you should consider making changes in your daily routine. d. Regular exercise helps with sleep, so continue to exercise, and when you get home, watch television to help promote sleep. A 36 - year-old woman was fired from her job as a paralegal at a law firm. She had worked for the same attorney for 10 years. As soon as she came in the door from work, her husband noticed she appeared upset and asked her if she was alright. She immediately started yelling at her husband because he had not given their 5-year-od daughter a bath and had not cleaned the house. Which of the following defense mechanisms is being demonstrated by this woman? a. Dissociation b. Conversion c. Rationalization d. Displacement
b. Previous suicide attempt c. Marital status d. Gender During an initial assessment, the PMHNP asks the patient to perform the serial 7's. What aspect of the mental status exam would the nurse practitioner be assessing? a. Memory b. Concentration c. Speech d. Affect Which of the following illustrates the role of the PMHNP in reducing the stigma of mental illness through community education as primary prevention? a. Professional speaker interviewed by morning television talk show anchor on depression. b. Expert witness for standard of care regarding psychiatric nursing staff in wrongful death lawsuit c. Teaching high school class about depression and teen suicide d. Volunteering to help with depression screenings at a community health fair - A In a psychiatric emergency, the PMHNP is aware that the most important goal of the interview is self-protection. What can the PMHNP do to keep himself or herself safe? a. Make sure the patient is restrained before beginning the evaluation b. Enter the room alone, in order to build a therapeutic alliance c. Know as much about the person as possible prior to starting the interview d. Inform the patient that violence is not acceptable. When questioning a patient regarding alcohol use during an intake, the patient t3ells you he only drinks socially. Which initial response is most appropriate? a. What amount and what kind of alcohol do you drink in a week? b. I am glad you are a responsible drinker. c. Many people with alcohol issues say they are social drinkers. d. Do other people in your household drink alcohol? - A During a follow-up medication visit with a 13-year-old male, his mother stayed longer to ask the PMHNP a question. Specifically, his mother states, "The school sent home information about the human papillomavirus and suggested my son see his primary care provider to get an immunization. Why did I get this information for my son? Furthermore, he is not sexually active." Which of the following would be the PMHNP's best response? a. I understand your concern with talking to your son about becoming sexually active. Let's address how to start the conversation. b. You are correct, only females need to receive the human papillomavirus vaccination. This letter must have been sent to you by mistake.
c. Decisions about immunizations can be difficult. The Centers for Disease Control and Prevention recommend that all males between the ages of 11 - 12, or as early as 9 years of age, receive this vaccination. What concerns do you have? d. As your son's PMHNP, I cannot provide you with information about immunizations. The World Health Organization has predicted that depression will be the number one world health problem in the 21st century. Lifetime prevalence for major depressive episode is 12% (with a 5 - 17% range). Which of the following individuals has the greatest risk factors for MDD? a. 16 - year-old, high school male, honors student, who runs cross-country track b. 28 - year-old, single woman, working toward partner in a large law firm c. 43 - year-old, divorced woman, schoolteacher, raising three children d. 58 - year-old, married male, computer analyst, whose work requires frequent travel Which of the following interventions has greatest relevance when counseling parents of a 20 - year-old male patient who has recently been diagnosed with schizophrenia? a. Family therapy to facilitate gradual independence for the patient while addressing parental desire to protect their son b. Patient and family education about the disease course, treatment regimens, support systems, and life management skills c. Multi-system family therapy that includes in-home therapy as well as multiple family group therapy to facilitate shared learning from other families with members with schizophrenia d. Supportive psychotherapy group for the parents to facilitate their grief and build coping skills to help manage their son's life-changing mental illness. A patient was started on an antipsychotic medication two weeks ago and is now experiencing the following symptoms: inability to sit still, pacing, and feelings of inner restlessness. He does not complain of any anxiety or being worried about anything in particular. Which of the following rating scales would be the most appropriate to assess these symptoms? a. Abnormal Involuntary Movement Scale (AIMS) b. Barnes Akathisia Rating Scale (BARS) c. Dyskinesia Identification System d. Simpson Angus EPS Scale Which of the following screening tests has high sensitivity and specificity for identifying cognitive impairment in older adults while requiring the least amount of time to administer in a clinical setting? a. Global Deterioration Scale b. Clock Drawing Test c. Mini-Mental Status Exam d. Dementia Rating Scale
reports a 3 - year history of drinking alcohol. The patient states he was at the store a week ago when he realized the store clerk was an imposter replacing his wife. The patient's wife insists that her husband is delusional and she intends to file for divorce if he does not get help. Which of the following types of delusions is the patient expressing? a. Fregoli phenomenon b. Capgras syndrome c. Delusion of doubles d. Clerambault syndrome In advising parents how to reduce the risk for teen substance abuse when there is positive family history of alcohol dependence, a PMHNP encourages all of the following recommendations except: a. Acknowledgement of family risk factor and open discussion with teen b. Parental presence and involvement in child's school and sports activities c. Random urine testing using home drug testing kits d. Parental networking and supervision of any teen parties. In assessing patient risks for binge drinking, which of the following statements is not accurate? a. Binge alcohol use rates are similar across different levels of education b. Binge drinking is higher in urban, densely populated areas than rural, sparsely populated areas. c. Whites have a higher rate of binge drinking than black or Hispanics. d. Men are much more likely than women to be binge drinkers. A 14-year-old girl admitted to a psychiatric unit following an overdose on alcohol and benzodiazepines after the breakup of a relationship has made seductive comments to her roommate, which is upsetting her roommate. In assessing the girl's behavior toward her roommate, the PMHNP needs to include the topic of sexual orientation. What is the best introductory approach to this topic? a. Are you sexually active? b. Are you attracted to girls rather than boys? c. What is your experience in sexual relationships? d. Did you overdose after breaking up with a girlfriend or boyfriend? An example of a screening tool that measures severity and tracks change in specific symptoms is a. The CAGE b. The Mini-Mental State Examination (MMSE) c. The Short Form 36 (SF-36) d. The Behavior and Symptom Identification Scale (BASIS)
Which of the following risk factors is not amenable to lifestyle changes in reducing lifetime risk of depressive disorders? a. Alcohol use b. Stressful family life c. Personality d. Work-related stress A 31 - year-old married woman with a history of anorexia nervosa, binging-purging type, during her teens and early 20's, is pregnant. She has had two prior spontaneous abortions in late 20's. She is worried whether this pregnancy may trigger recurrence of her prior eating disorder, adversely impact fetal development, or affect the likelihood of full-term delivery. At 5'7" she maintains a weight of 120 pounds by running 6-10 miles daily as conditioning for marathons and a 2,000 calorie daily vegan diet. What lifestyle modifications would reduce risks of exacerbating an eating disorder and increasing likelihood of normal fetal development full-term delivery. a. Increase daily caloric intake by 1,000 calories, continue running as tolerated with reduction in second or third trimester, add pre-natal vitamin, vitamin E supplement, and B- complex supplement, plan 20- 30 - pound gradual weight gain over the course of pregnancy. b. Increase daily caloric intake by 500 calories, reduce running to 2-4 miles daily, alternate with stretching and yoga in second and third trimesters, add prenatal vitamin and vitamin B- 12 supplement, plan a 28 - 40 - pound gradual weight gain over the course of pregnancy. c. Increase daily caloric intake by 250 calories, reduce running to 4-8 miles daily with reduction in second or third trimester, add prenatal vitamin, Calcium supplement, and plan a 20 - 30 - pound gradual weight gain over the course of pregnancy. d. Increase daily caloric intake by 700 calories, continue running as tolerated with reduction in second or third trimester, add prenatal vitamin E supplement, and B-complex supplement, plan a 25 - 35 - pound gradual weight gain over the course of the pregnancy. In the aftermath of a tornado that destroyed over 100 homes in a rural Midwest community, the PMHNP draws on principles of crisis intervention while working with an elderly couple who lost everything in the storm during the night. Which of the following statements is most appropriate at the initial encounter? a. "What medications were you taking? Let me work on that first." b. "Tell me everything that happened. We'll sort through the next steps." c. "What is your biggest concern right now? I will help you as much as possible." d. "You will be able to stay in the shelter until the FEMA trailers arrive. It's going to be OK." When child, adult partner, or elder abuse is suspected, the PMHNP needs to conduct an abuse assessment screen in privacy, away from the partner, the child's parents or guardians, or the elder person's relative or companion. Simple, direct questions in a nonjudgmental interview are indicated. Which of the following would be an appropriate abuse screening question?