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PMHNP ANCC REVIEW
QUESTIONS WITH 100%
COMPLETE SOLUTIONS
ThevpurposevofvthevAmericanvNursesvAssociation'svPsychiatric- MentalvHealthvNursing: ScopevandvStandardsvofvPracticevisvto a.vDefinevthevrolevandvactionsvforvthevNP b.vEstablishvthevlegalvauthorityvforvthevprescriptionvofvpsychotropicvmedications c.vDefinevthevlegalvstatutesvofvthevrolevofvthevPMHNP d.vDefinevthevdifferencesvbetweenvthevphysicianvrolevandvthevNPvrolev- vcorrectvanswer-A.vThevANAsvPsych- MentalvHealthvNursingvScopevandvStandardsvofvPracticevdefinesvthevrolevandvaction svofvthevnursevpractitioner. D.vInformationvreducesvincidencevofvdisease.v-vcorrectvanswer- PrimaryvpreventionvcarevpracticesvarevanvessentialvaspectvofvthevPMHNPvrole.vWhic hvofvthevfollowingvisvthevbestvexamplevofvavprimaryvpreventionvcarevstrategyvforvcom munityvbehavioralvhealth? a.vAftercarevprogramvforvchronicallyvmentallyvillvclientsvrecentlyvdischargedvfromvthev hospital b.vCourt-orderedvcounselingvforvabusivevparents c.v24-hourvcrisisvhotlines d.vParentingvskillsvclassesvforvpregnantvadolescents Thevtrendvinvlegalvrulingsvonvcasesvinvolvingvmentalvillnessvovervthevpastv 25 vyearsvh asvbeenvto a.vEncouragevjuriesvtovfindvdefendantsvnotvguiltyvbyvreasonvofvinsanity
b.vProtectvthevperson'svfreedomsvorvrightsvwhenvhevorvshevisvcommittedvtovavmental vhospital c.vPlacevincreasingvtrustvinvmentalvhealthvprofessionalsvtovmakevgoodvandvethicalvd ecisions d.vDecreasevthev"redvtape"vassociatedvwithvcommitmentsvsovthatvcommitmentsvarevf astervandveasierv-vcorrectvanswer- B.vIdentifiesvthevtrendvofvensuringvthevprotectionvofvindividualvcivilvlibertiesvforvpsychi atricvclients. Mr.vSmithers,vanvinvoluntarilyvhospitalizedvpatientvexperiencingvpsychoticvsymptoms ,vrefusesvtovtakevanyvofvhisvorderedvmedicationvbecausevhevbelievesv"JesusvChristvt oldvmevIvamvthevprophetvandvmustvfastvforvavyear."vYourvactionsvshouldvbevbasedvo nvyourvknowledgevofvwhichvofvthevfollowing? a.vPsychiatricvclientsvcannotvrefusevtreatment b.vPsychiatricvclientsvdovnotvalwaysvknowvwhatvisvgoodvforvthem c.vPsychiatricvclientsvcanvrefusevtreatment d.vPsychiatricvclientsvcannotvbevtrustedvtovmakevgoodvhealthcarevdecisionsvand,vthe refore,vthevnurse'svbestvclinicalvjudgmentvshouldvguidevactionsv-vcorrectvanswer- C.vAsvwithvanyvclient,vpsychiatricvclientsvcanvrefusevtreatmentvunlessvavlegalvproces svresultingvinvinvoluntaryvcommitmentvorvmandatoryvcourtvordervforvtreatmentvhasvb eenvobtained. Whichvofvthevfollowingvstatementsvbestvreflectsvthevdifferencevbetweenvthevnurse- clientv(N-C)vrelationshipvandvavsocialvrelationship? a.vInvthevN-Cvrelationship,vthevprimaryvfocusvisvonvthevclientvandvthevclient'svneeds. b.vGoalsvinvthevN- Cvrelationshipvarevdeliberatelyvleftvvaguevandvunspokenvsovthatvthevclientvcanvworkv onvanyvissue. c.vInvthevN- Cvrelationship,vthevnursevisvsolelyvresponsiblevforvmakingvthevrelationshipvwork. d.vInvthevN-Cvrelationship,vtherevisvnovplacevforvsocialvinteraction.v-vcorrectvanswer- A.vSocialvrelationshipsvarevmutualvinterpersonalvrelationshipsvinvwhichvthevneedsvofv bothvpartiesvarevaddressed.vThevN- Cvrelationshipvisvmostvconcernedvwithvmeetingvthevneedsvofvthevclient. Avcommunityvhasvanvunusuallyvhighvincidencevofvdepressionvandvdrugvusevamongvt hevteenagevpopulation.vThevpublicvhealthvnursesvdecidevtovaddressvthisvproblem,vinv part,vbyvmodifyingvthevenvironmentvandvstrengtheningvthevcapacitiesvofvfamiliesvtovp reventvthevdevelopmentvofvnewvcasesvofvdepressionvandvdrugvuse.vWhatvisvthisvisva nvexamplevof? a.vPrimaryvprevention b.vSecondaryvprevention c.vTertiaryvprevention d.vProtectivevfactorialvpreventionv-vcorrectvanswer- A.vThisvactionvfocusesvonvinterventionsvdesignedvtovreducevthevincidencevofvnewvca sesvofvdisease. Mrs.vKempvisvvoluntarilyvadmittedvtovthevhospital.vAfterv 24 vhours,vshevstatesvshevwis hesvtovleavevbecausev"thisvplacevcan'tvhelpvme."vThevbestvnursingvactionvthatvreflect svthevlegalvrightvofvthisvclientvis
Avclientvisvdisplayingvlowvself-esteem,vpoorvself-control,vself- doubt,vandvavhighvlevelvofvdependency.vThesevbehaviorsvindicatevdevelopmentalvfail urevofvwhichvofvthevfollowingvstagesvofvdevelopment: a.vInfancy b.vEarlyvchildhood c.vLatevchildhood d.vSchoolvagev-vcorrectvanswer- B.vThesevsignsvindicatevdevelopmentalvfailurevofvearlyvchildhood. Mr.vThompsonvhasvbeenvforgetfulvlately,vforvexample,vforgettingvwherevhevhasvplace dvhisvkeysvorvwhatvtimevappointmentsvarevscheduled,vandvhevhasvstatedvthatvhevthin ksvthesevarevjustvrandomvbehaviorsvthatvhavevnovparticularvmeaning.vWhichvFreudia n- basedvpsychodynamicvprinciplevassumesvthatvallvbehaviorvandvactionsvarevpurposef ul? a.vPleasurevprinciple b.vPsychicvdeterminismvprinciple c.vRealityvprinciple d.vUnconsciousnessvprinciplev-vcorrectvanswer- B.vThevpsychicvdeterminismvprinciplevstatesvthatvallvbehaviorvhasvpurposevandvmea ning,voftenvunconsciousvinvnature,vandvthatvnovbehaviorsvoccurvrandomlyvorvbyvcoin cidence. Anvexamplevofvavmature,vhealthyvdefensevmechanismvis a.vDenial b.vRationalization c.vRepression d.vSuppressionv-vcorrectvanswer- D.vSuppressionvisvthevonlyvdefensevmechanismvlistedvinvwhichvthevclientvchannelsvc onflictingvenergiesvintovgrowth-promotingvactivities. Mr.vJohnsonvisvav54-year- oldvclientvyouvhavevbeenvseeingvforvseveralvweeksvinvtherapy.vWhilevdiscussingvhisv currentvconcernsvofvmaritalvstress,vhevliesvonvthevfloorvandvassumesvthevfetalvpositio n.vThisvisvmostvlikelyvanvexamplevof a.vImmaturevregressivevdefensevmechanism b.vDenialvofvreality c.vImmaturevfantasyvdefensevmechanism d.vRepressivevbehaviorv-vcorrectvanswer- A.vImmaturevregressivevdefensevmechanismvisvavreturnvtovavbehaviorvcommonvtova nvearliervstagevofvdevelopment. Defensevmechanismsvarevbestvviewedvasvavfunctionvofvthevego a.vTovalertvusvtovharmvandvdanger b.vTovalertvusvtovproblems c.vUsedvtovresolvevavconflict d.vUsedvtovprotectvthevidv-vcorrectvanswer- C.vDefensevmechanismsvarevavfunctionvofvthevegovusedvtovresolvevavconflict.
Onevofvthevhealthvcarevchangesvthatvhasvoccurredvasvavresultvofvthevaffordablevcare vactv(ACA)visvthatvdoctors/hospitals/ clinicvgroupsvorvhealthvsystemsvarevcomingvtogethervandvassumingvthevresponsibilit yvforvqualityvcarevtovlargevgroupsvofvindividualsvinsuredvbyvMedicare.vThevhealthvcar evclinics/ systemsvdoctorsvorvhospitalsvthatvjoinvtogethervarevcalledvwhichvofvthevfollowing? a.vHealthvMaintenancevOrganizationv(HMO) b.vPreferredvProvidervNetworkv(PPO) c.vAccountablevCarevOrganizationv(ACO) d.vIndividualvHealthvPlanv(IHP)v-vcorrectvanswer- C.vACO'svarevgroupsvofvdoctorsvorvothervhealthvcarevprovidersvwhovvoluntarilyvcome vtogethervandvassumevthevcarevprovidedvtovMedicarevpatients. Healthvcareveconomicsvisvconcernedvwithvmakingvdecisionsvsovthevbenefitsvoutweig hvthevcostvofvresourcevutilization.vWhatvarevtwovconceptsvthatvhealthcareveconomics visvconcernedvwithvinvregardvtovfairvdistributionvofvresourcesvandvallocation? a.vEquityvandvefficiency b.vCostvandvbenefits c.vOpportunityvandvwaste d.vAffordablevandvqualityv-vcorrectvanswer- A.vHealthvcarevefficiencyvisvmakingvriskvandvbenefitvdecisionvaboutvhowvcarevresour cesvarevallocatedvandvequityvisvensuringvthatvtherevisvavfairvdistributionvofvthevresour ces. Whatvfourvelementsvneedvtovbevpresentvforvavmalpracticevlawsuitvtovbevfiled? a.vBeneficence,vNon-Maleficence,vTruthfulness,vandvJustice b.vDutyvofvcare,vBreachvofvstandardvofvcare,vInjury,vandvInjuryvmustvbevrelatedvtovbr eachvofvthevstandardvofvcare c.vAbandonment,vBreachvofvcare,vViolationvofvethics,vandvReimbursementvforvpoorvc are d.vBreachvofvstandardvofvcare,vInjury,vDeceit,vandvMalpracticev-vcorrectvanswer- B.vThevfourvelementsvthatvmustvbevsatisfiedvforvmalpracticevtovhavevoccurredvarevav dutyvofvcarevbetweenvclinicianvandvpatient,vbreachvofvstandardvofvcare,vanvinjuryvtovt hevpatient,vandvthevpatient'svinjuryvmustvbevrelatedvtovthevclinician'svbreachvofvcare. MaryvisvavPsychiatric- MentalvHealthvNursevPractitionerv(PMHNP)vwhovisvworkingvinvavhospitalistvrole.vMar yvhasvencounteredvovervfivevincidencesvinvwhichvattendingvpsychiatristsvandvmedica lvresidentsvhavevbeenvdemeaningvtovnursingvstaffvandvnotvansweringvcallsvinvthevmi ddlevofvthevnightvorvtellingvthevnursingvstaffvtovwritevordersvandvthevMDvwouldvsignvo ffvinvtheva.m.vMaryvisvconcernedvaboutverrorsvandvwantsvtovimprovevquality,vreducev errorsvtovpromotevsafety.vWhatvconceptvisvMaryvemploying? a.vBullying b.vAbuse c.vCivilvDisobedience d.vJustvCulturev-vcorrectvanswer- D.vThevANAvhasvavpositionvstatementvthatvnursesvarevresponsiblevforvdevelopingvhe althvcarevsettingsvthatvincludevjustvculturevinitiativesvunderstandingvthatvhumanverror vcanvcauseverrorvandvharmvbyvcreatingvanvopenvandvfairvenvironment.
ingvhisvcare,vthevPMHNPvshouldvapplyvhisvorvhervknowledgevthatvthesevsymptomsvr epresentvproblemsvwithvthe a.vFrontalvlobe b.vTemporalvlobe c.vParietalvlobe d.vOccipitalvlobev-vcorrectvanswer- A.vProblemsvwithvworkingvmemory,vplanningvandvprioritizing,vinsightvintovproblems,v andvimpulsevcontrolvindicatevavproblemvinvthevfrontalvlobe. Thevconceptvofvtargetvsymptomvidentificationvisvbestvexplainedvas a.vIdentificationvofvthevmajorvclinicalvpresentationvofvthevclient b.vIdentificationvofvspecific,vprecise,vandvindividualizedvsymptomsvreasonablyvexpect edvtovimprovevwithvmedication c.vIdentificationvofvthevsecondaryvmessengervsystemvsyndrome d.vIntentionalvmodulationvofvsynapticvpathwaysv-vcorrectvanswer- B.vTargetvsymptomvidentificationvisvthevidentificationvofvspecific,vprecise,vandvindivid ualizedvsymptomsvreasonablyvexpectedvtovimprovevwithvavgivenvmedication. ThevgoalvofvthevpsychiatricvassessmentvprocessvperformedvbyvthevPMHNPvisvto a.vGainvanvunderstandingvofvthevlifevexperiencesvofvthevclient b.vCorrectlyvdiagnosevthevclient c.vIdentifyvthevmentalvhealthvneedsvofvthevclient d.vBevablevtovcommunicatevwithvothervstaffvaboutvthevclient'svhealthvneedsv- vcorrectvanswer- C.vAlthoughvdiagnosisvisvanvimportantvaspectvofvthevassessmentvprocess,vthevasses smentvultimatelyvshouldvidentifyvthevneedsvofvthevclient. Mr.vJohnsonvisvavclientvnewlyvadmittedvtovanvinpatientvpsychiatricvhospital.vThevPM HNPvonvcallvatvthevfacilityvplansvtovperformvthevinitialvintakevassessmentvandvdiagno sticvprocess.vMr.vJohnsonvasksvtovpleasevtalkvinvhisvroomvbecause,vhevsays,v"Peopl evmakevmevnervous."vHisvroomvisvatvthevendvofvthevhallwayvandvisvthevfarthestvaway vfromvthevnursingvstation.vThevPMHNP'svactionvshouldvbevbasedvonvawarenessvthat vthevbestvlocationvtovdovthevassessmentvisv a.vInvMr.vJohnson'svroom,vbecausevitvisvleastvnoisyvandvmostvcomfortablevforvhim,vth usvfacilitatingvdatavcollection b.vInvthevdayroom,vwhichvisvfullvofvpeople,vtovobservevhisvinteractionsvwithvothervpeo ple c.vInvavquietvplace,vbutvpublicvenoughvtovgetvassistancevwithvclientvcarevshouldvitvbev requiredvduringvthevassessment d.vInvthevtreatmentvroomvwithvthevdoorvclosed,vavneutralvlocationv-vcorrectvanswer- C.vOnevPMHNPvrolevisvtovcontrolvthevmilieuvasvanvaspectvofvassessment,vsovthevPM HNPvshouldvchoosevavquietvplacevthatvisvpublicvenoughvtovgetvassistancevwithvclient vcarevshouldvitvbevrequiredvduringvthevassessment. WhichvcommunicationvtechniquevisvthevPMHNPvusingvinvthevfollowingvsituation? vClient:v"SorryvIvwasvlate.vIvdidn'tvrealizevwhatvtimevitvwas."vPMHNP:v"Thisvisvthevthir dvtimevnowvthatvyouvhavevbeenvlatevforvourvsessions.vIvamvwonderingvhowvcommitte dvyouvarevtovourvworking onvyourvproblems." a.vTheming
b.vRecognizing c.vValidating d.vSequencingv-vcorrectvanswer- B.vThisvexchangevisvanvillustrationvofvthevtechniquevofvrecognizing. Invassessingvavclient,vyouvaskvhimvthevmeaningvofvthevproverbv"Peoplevwhovlivevinvg lassvhousesvshouldn'tvthrowvstones."vHevreplies,v"Becausevitvwillvbreakvthevwindows ."vThevcorrectvinterpretationvofvthisvfindingsvis a.vClientvhasvavprobablevmoodvdisorder b.vClientvhasvavprobablevanxietyvdisorder c.vClientvhasvlimitedvintellectualvability d.vUnablevtovinterpretvthevfindingvwithoutvknowingvthevclient'svagev-vcorrectvanswer- D.vThevanswervdemonstratesvconcretevthoughtvprocesses,vwhichvarevnormalvinvpers onsvyoungervthanvagev 12 vbutvarevabnormalvaftervagev12.vTovinterpretvthevfinding,vth evPMHNPvmustvknowvthevagevofvthevclient. ThevPMHNPvisvplanningvtovworkvwithvavclientvusingvanvindividualvtherapyvmodelvofvc are.vDuringvthevfirstvsession,vthevclientvmakesvthevfollowingvstatement:v"Thisvisvthevt hirdvtimevmyvsonvhasvrunvaway.vI'vevgroundedvhim,vtakenvawayvhisvbike,vevenvtriedv cuttingvoffvhisvallowancevandvconfiningvhimvtovhisvroom.vWhatvshouldvIvdovnow?"vTh evmostvtherapeuticvresponse forvthevPMHNPvtovmakevis a.v"Ivwondervifvconfiningvhimvtovhisvroomvwasvabusive?" b.v"Maybevthatvdependsvonvwhatvyouvarevtryingvtovaccomplish." c.v"Perhapsvtalkingvtovhisvfriendsvandvteachersvwouldvhelp." d.vRemainvsilentv-vcorrectvanswer- B.vThisvresponsevwillvbevthevmostvtherapeuticvinvmovingvforwardvwithvthevclient. AvclientvsaysvtovthevPMHNP,v"Somevdaysvlifevisvjustvnotvworthvit.vAllvmyvwifevandvIve vervdovisvfightvandvscream.vThingsvatvhomevwouldvbevcalmervandvsimplervifvIvjustvwa sn'tvtherevanymore."vThevmostvtherapeuticvresponsevforvthevPMHNPvtovmakevis a.v"Dovyouvmeanvthatvyouvarevthinkingvaboutvleavingvyourvwifevandvmovingvout?" b.v"Tellvmevwhatvyouvmeanvbyv'itvwouldvbevsimplervifvyouvjustvweren'tvtherevanymore .'" c.v"Sovyouvarevthinkingvsuicidevmightvbevanvoptionvforvyou?" d.vRemainvsilentv-vcorrectvanswer- B.vThisvresponsevisvthevmostvtherapeutic,vallowingvthevclientvtovfurthervclarifyvandvex pressvfeelings. Mrs.vSheavhasvcomevtovthevmentalvhealthvcentervseekingvtreatmentvforvdepression.v Shevhasvavhistoryvofvavsuicidevattemptvbyvoverdosev 1 vmonthvago.vShevwasvstartedv onvimipraminev(tricyclicvantidepressantv[TCA])vaftervthatveventvbutvstoppedvtakingvth evmedicationv 1 vweekvlatervbecausevitv"didvnovgood."vThevPMHNPvmeetsvwithvMrs.v Sheavtovplanvcarevwithvher.vWhichvofvthevfollowingvisvthevmostvappropriatevinitialvacti on? a.vAskingvMrs.vSheavhowvtovhelpvher b.vProvidingvclientvteachingvaboutvthevlongvtimevframevforvTCAsvtovwork c.vContractingvwithvMrs.vSheavforv 6 vsessionsvofvindividualvtherapy d.vProvidingvMrs.vSheavwithvfeedbackvaboutvhowvsuicidevmightvaffectvhervfamilyv- vcorrectvanswer-A.vAskingvthevclientvhowvtovhelpvisvanvaspectvofvassessment—
a.vDivalproex—Epsteinvanomaly;vlithium—cleftvpalate b.vDivalproex—spinavbifida;vlithium—Epsteinvanomaly c.vDivalproex—limbvmalformations;vlithium—seizurevdisorder d.vDivalproex—mentalvretardation;vlithium—spinavbifidav-vcorrectvanswer- B.vDivalproexvcanvcausevspinavbifidavandvlithiumvcanvcausevEpstein'svanomaly. Thevstudyvofvwhatvthevbodyvdoesvtovdrugsvisvcalled a.vPharmacodynamics b.vPharmacology c.vPharmacokinetics d.vDistributionv-vcorrectvanswer- C.vPharmacokineticsvisvthevstudyvofvwhatvthevbodyvdoesvtovdrugs. YourvclientvSamvisvbeingvtreatedvforvpanicvdisordervwithvagoraphobia.vHevcurrentlyvi svbeingvprescribedvparoxetinev(PaxilvCR,v37.5vmgvq.d.)vandvclonazepamv(Klonopin,v 0.5vmgvq.d.,vp.r.n.).vHevhasvbeenvonvclonazepamvforv 2 vyearsvandvadmitsvtovneeding v 4 vpillsvtovachievevthevsameveffectvthatv 1 vpillvinitiallyvproduced.vThisvisvpossiblyvanve xamplevofvwhichvprocess? a.vKindling b.vAddiction c.vTolerance d.vPotencyv-vcorrectvanswer- C.vTolerancevmeansvneedingvmorevtovachievevthevsameveffect. Whyvisvgroupvtherapyvbeneficial? a.vItvassistsvthevclientvtovfocusvonvself b.vItvlacksvtheoreticalvframeworks c.vItvenablesvparticipantsvtovacquirevtherapeuticvfactors d.vItvisvalwaysvtimevlimitedv-vcorrectvanswer- D.vGroupvtherapyvisvbeneficialvbecausevitvincreasesvsocialvskills,visvcost- effective,vandvenablesvparticipantsvtovacquirevthevcurativevfactors. Whichvofvthevfollowingvisvthevbestvrationalevforvusingvcognitivevbehavioralvtherapy? a.vRecognizevandvchangevhisvorvhervautomaticvthoughts b.vSeevrealityvasvyouvseevit c.vChangevhisvorvhervrealityvbyvchangingvhisvorvhervenvironment d.vRecognizevandvacceptvthatvautomaticvthoughtsvsuggestvdelusionalvthinkingv- vcorrectvanswer- A.vCognitivevbehavioralvtherapyvhelpsvclientsvrecognizevandvchangevtheirvautomaticv thoughts. Whenvworkingvwithvavdysfunctionalvfamily,vyouvfindvthatvthevfather,vJim,vworriesvexc essivelyvandvisvresistantvtovchange.vYouvgivevJimvavparadoxicalvdirectivevtovworryve xtremelyvwellvforv 1 vhourvpervday,vknowingvthatvhevwillvlikelyvbevnoncompliant,vandvth usvchangevwillvoccur.vWithvthisvtechnique,vyouvarevusingvwhichvtypevofvtherapy? a.vExperientialvtherapy b.vStructuralvtherapy c.vStrategicvtherapy d.vSolution-focusedvtherapyv-vcorrectvanswer- C.vParadoxicalvdirectivesvarevusedvinvstrategicvtherapy.
Whichvofvthevfollowingvbestvdescribesvhomeostasisvinvavfamilyvsystem? a.vChoicesvavfamilyvmakesvtovkeepvthevpeace b.vBalancevorvstabilityvthatvthevfamilyvreturnsvtovdespitevitsvdysfunction c.vNeedvforvchangevandvbalancevinvavfamily d.vCalmvinvavfamilyvthatvreturnsvaftervavcrisisv-vcorrectvanswer- B.vHomeostasisvisvbalancevorvstabilityvthatvthevfamilyvreturnsvtovdespitevitsvdysfuncti on. Invanvattemptvtovbringvthevclientvtowardvthevgoalvhevorvshevisvworkingvon,vyouvaskvth evclient,v"Ifvavmiraclevwerevtovhappenvtonightvwhilevyouvslept,vandvyouvawokevinvthev morningvandvthevproblemvnovlongervexisted,vhowvwouldvyouvknow,vandvwhatvwouldv bevdifferent?"vThis techniquevisvusedvinvwhichvtypevofvtherapy? a.vBehavioralvtherapy b.vSolution-focusedvtherapy c.vAdlerianvtherapy d.vExistentialvtherapyv-vcorrectvanswer-B.vMiraclevquestionsvarevusedvinvsolution- focusedvtherapy. Ms.vThomasvhasvbeenvdiagnosedvwithvmajorvdepressivevdisorderv(MDD)vandvisvplac edvonvfluoxetinev 20 vmgvforvhervdepression.vForvthevPMHNPvtoveffectivelyvmonitorvh ervusevofvthevmedication,vwhichvofvthevfollowingvactionsvshouldvbevpartvofvongoingvc are? a.vUsevofvavstandardizedvratingvscalevofvdepression b.vMonitoringvforvpotentialvabusevofvthevmedication c.vMonitoringvofvlabsvforvrenalvfunctioning d.vMonitoringvforvpotentialvcardiacvsideveffectsv-vcorrectvanswer- A.vThevusevofvavstandardizedvratingvscalevwillvallowvthevPMHNPvtovmonitorvthevlevel vofvclientvsymptomsvandvtovevaluatevthevefficacyvofvthevmedication. WhichvofvthevfollowingvisvthevbestvreasonvforvconsideringvthevSSRIvamongvthevfirst- linevdrugvchoicesvforvtreatingvmajorvdepression? a.vNeedvtovstair-stepvinitialvdosages b.vSedatingvandvcalmingveffectvofvthevmedication c.vSafevusevinvsuicidalvoverdosevclients d.vAbilityvtovobtainvtherapeuticvserumvdrugvlevelsv-vcorrectvanswer- C.vSSRIsvarevconsideredvamongvthevfirst- linevmedicationsvusedvtovtreatvdepressionvbecausevofvsafetyvinvsuicidalvoverdosevcli ents. Av23-year- oldvwomanvisvbroughtvintovthevERvaftervattemptingvsuicidevbyvcuttingvhervwrists.vWhi chvnursingvactionvbyvthevPMHNPvwouldvbevofvhighestvpriorityvinitially? a.vAssessvhervcopingvbehaviors b.vAssessvhervcurrentvlevelvofvsuicidality c.vTakevhervvitalvsigns d.vAssessvhervhealthvhistoryv-vcorrectvanswer- C.vThevPMHNPvneedsvtovensurevthatvhervsuicidevattemptvhasvnotvledvtovmedicalvins tability.
Avclientvreturnsvforvavfollow- upvappointmentv 3 vweeksvaftervstartingvonvfluoxetinev 20 vmg.vDuringvthisvappointment vyouvnoticevthatvhervspeechvisvavlittlevrapid,vinvmarkedvcontrastvtovthevpsychomotorvr etardationvandvpaucityvofvspontaneousvspeechvshevdisplayedvonvhervfirstvvisit.vInste advofvlookingvatvthevfloor,vshevnowvmakesvnormalveyevcontact.vHervaffectvhasvgonev fromvconstrictedvtovexpansive.vShevcontinuesvtovhavevdifficultyvsleeping,vbutvherven ergyvhasvimprovedvandvshevstatesvshevfeelsv"sovmuchvbetter!"vWhatvshouldvyouvcon cludevaboutvthevshiftvinvthevclient'svpresentation? a.vShevisvexperiencingvthevactivatingvsideveffectsvofvfluoxetine. b.vShevisvbecomingveuthymic. c.vShevisvbecomingvhypomanic. d.vShevisvinvavmixedvstate.v-vcorrectvanswer- C.vInvthisvcase,vyouvseevavshiftingvsetvofvsymptoms,vthevmostvimportantvbeingvherve xpansivevmoodvandvstatementv"sovmuchvbetter"vthatvindicatesvshe hasvgonevbeyondveuthymia. Mr.vD.visvav35-year-old,vmarried,vhigh- techvindustryvexecutivevwhovisvreferredvtovthevPMHNPvforv"insomnia."vMr.vD.vreports vthatvhevfallsvasleepvquickly,vbutvhasvdifficultyvstayingvasleep.vHevwakesvupvseveralvt imesvduringvthevnight,vandvbelievesvhevtossesvandvturnsvevenvwhenvhevisvsleeping.v Hevwakesvupvfeelingvexhaustedvandvdrinksv"avpotvofvcoffee"vtovstayvawakevandv concentratevduringvhisvlongvworkvday.vHevdrinksv 1 vglassvofvwinevmostvevenings.vHe vdeniesvanyvillicitvsubstancevuse.vHevdeniesvanyvsymptomsvofvavmoodvorvanxietyvdis order,vbutvisvfeelingvincreasinglyvfrustratedvandvconcernedvaboutvhisvsleep.vWhichvof vthevfollowingvisvthevmostvlikelyvcontributingvfactorvtovMr.vD.'svongoingvmiddlevinsom nia? a.vObstructivevsleepvapneav(OSA) b.vCaffeinevdependence c.vAlcoholvwithdrawal d.vAttention-deficitvhyperactivityvdisorderv(ADHD)v-vcorrectvanswer- A.vOSAvisvthevonlyvplausiblevpossibilityvifvthevrestvofvthevinformationvgivenvbyvthevcli entvisvaccurate.vOSAvcausesvclientsvtovhavevfrequentvawakeningsvand avsensevthatvtheyvarevnotvsleepingvdeeplyv("tossingvandvturning")vthatvisvcausedvbyv apnea.vThevclientvshouldvbevassessedvfurthervforvsnoringvandvawarenessvofvapnea.v Althoughvthevclientvstatesvhevdrinksvavlotvofvcoffee,vthisvisvdrivenvbyvhisvsleepvissues .vDrinkingv 1 vglassvofvwinevinvtheveveningvwouldvnotvcausevthevdegreevofvsleepvpath ology hevisvexhibiting.vOthervthanvdiminishingvconcentrationvthatvisvconsistentvwithvsleepvd eprivation,vtherevarevnovothervsignsvandvsymptomsvofvADHD. Tinavisvav54-year-oldvsinglevwhitevwomanvwhovhasvbeenvavPsychiatric- MentalvHealthvNursevPractitionervforvoverv 20 vyears.vShevisvconsideringvmakingvappli cationvtovavDoctorvofvNursingvPracticev(DNP)vprogramvbutvstatesv"ifvavDNPvisvrequir edvtovpracticevI'llvgetvgrandfatheredvin,vnovneedvforvmevtovgovbackvtovschool."vFollow ingvthev 2008 vLicense,vAccreditation,vCertification,vandvEducationv(LACE)vConsensu svModelvforvAdvancedvPracticevRegisteredvNursevRegulation,vwhichvstatementvisvco rrect? a.vTinavisvcorrect:vifvthevDNPvbecomesvavrequirement,vshevwillvbevgrandfatheredvinv andvobtainvavDNPvdegree.
b.vThevDNPvisvanvacademicvterminalvdegreevandvtherevwillvnotvbevanvopportunityvfor vTinavtovbevgrandfatheredvinvavDNP. c.vTinavwillvbevgrandfatheredvinvandvobtainvavDNPvonlyvifvhervstatevrequiresvavDNPvt ovpracticevasvanvAPRN. d.vThevDNPvisvavcertificationvandvTinavwillvhavevtovtakevanvexaminationvtovbevgrandf atheredvinvtovobtainvavDNv-vcorrectvanswer- B.vAPRNsvarevnotvgrandfatheredvintovanvacademicvdegree;vdegreesvmustvbevearne dvfromvaccreditedvacademicvinstitutions. Timvisvavboard-certifiedvPsychiatric- MentalvHealthvNursevPractitionerv(PMHNP)vworkingvinvavbusyvcommunityvmentalvhe althvcenterv(CMHC).vHevisvcurrentlyvseeingvavclientvdiagnosedvwithvbipolarvIvdisorde rvwhovhasvcomorbidvhypertensionvandvdiabetes.vDuringvthevvisit,vTimvtakesvthevclien t'svbloodvpressurevandvhervreadingvisv160/94vmmvHg.vThevclientvdeniesvany headaches,vnausea,vchestvpain,vorvshortnessvofvbreath.vThevclientvstatesv"Ivcan'tvaff ordvallvthesevmedicationsvsovIvhaven'tvseenvmyvdoctorvinv 7 vmonthsvandvIvamvoutvofv allvmyvbloodvpressurevandvsugarvmedications,vcanvyouvgivevmevsome?"vWhatvisvTi m'svmostvappropriate action? a.vCallvthevpharmacyvtovfindvoutvwhatvmedicationsvthevclientvisvtakingvandvrefillvforv 1 vmonth tovcovervuntilvshevcanvgetvinvtovseevhisvprimaryvcarevprovider. b.vTellvthevclientvhevcannotvrefillvhervmedicationsvandvinformvhervtovgovtovthevemerg ency roomvshouldvshevdevelopvanyvsignsvorvsymptomsvofvanv-vcorrectvanswer- C.vItvisvnotvwithinvthevscopevofvpracticevofvavPMHNPvtovtreatvhypertension.vCoordina tionvofvcarevtovensurevthevclientvdoesvnotvrunvoutvofvmedicationvisvthevappropriatevc oursevofvaction. ThevchiefvnursingvofficervofvavlargevbehavioralvhealthvsystemvapproachedvthevPMHN PvtovdiscussvthevnewvHealthcarevEffectivenessvDatavandvInformationvSetv(HEDIS)vb ehavioralvhealthvmeasuresvandvspecifications.vThevPMHNPvisvaskedvtovdovavretrosp ectivevchartvreviewvofvallvhospitalvdischargevclientsvwhovreceivedvavfollow- upvvisitvwithinv 7 vdaysvofvdischargevandvwithinv 30 vdaysvofvdischarge.vThevPMHNPvha svbeenvaskedvtovengagevinvwhichvofvthevfollowing? a.vNeedsvassessmentvproject b.vPlan,vdo,vstudy,vactvproject c.vAvtaskvthatvisvoutsidevofvthevPMHNP'svscopevofvpractice d.vQualityvimprovementvinitiativv-vcorrectvanswer- D.vEngagingvinvavprojectvtovassessvwhethervavstandardvofvcarevwasvmetvisvavqualityv improvementvproject. AvPMHNPvwhovisvworkingvonvthevconsultvliaisonvservicevisvreferredvtovavpatientvinvth evmedicalvintensivevcarevunitvbyvthevattendingvhospitalist.vThevconsultvnotevreadv"Ev aluatevthevpatientvforvcompetencyvtovmakevindependentvmedicalvdecisionsvandvcons entvforvavsurgicalvprocedure."vBasedvonvthevscopevofvpracticevofvavPMHNP,vwhichvr esponsevwouldvbevmostvappropriate? a.vCompletevthevpatientvassessmentvandvwritevupvthevfindingsvinvthevpatient'svmedic alvrecord.
a.vUnderstandvthevclient'svpsychosocialvneedsvandvcommunicatevthemvtovthevtreatm entvteam b.vIdentifyvthevmentalvhealthvneedsvofvthevclient c.vReviewvpreviousvmedicalvrecords d.vEvaluatevavtreatmentvplanv-vcorrectvanswer- B.vDuringvavpsychiatricvinterview,vthevPMHNPvisvresponsiblevtovidentifyvsymptomsva ndvneedsvofvavclientvtovdevelopvanvappropriatevtreatmentvplan. Av74-year- oldvmarriedvwhitevwomanvwasvreferredvtovyouvbyvhervprimaryvcarevprovidervforvavps ychiatricvevaluation.vShevhadvavnormalvmedicalvandvneurologicalvexaminationvinvthe vlastv 2 vmonths.vThevclientvpresentsvwithvhervhusbandvofv 45 vyearsvwhovstates,v"Myvw ifevisvjustvnotvthevsamevanymore,vshevisvirritablevandvasksvthevsamevquestionvsever alvtimes,vevenvthoughvI'vevansweredvitvmanyvtimes."vThevclientvresponds,v"Oh,vHenr y,vyouvdovthevsamevthing,vit'svjustvavnormalvpartvofvgettingvolder,vandvthevkidsvthinkv everythingvisvfine."vDuringvthevassessmentvyouvcompetevthevminivmentalvstatusvexa minationv(MMSE)vandvthevclientvscoresv18.vAsvthevPMHNPvtreatingvthevclient,vyouvk nowvthevresultsvofvhervMMSEvindicatevwhichvlevelvofvcognitivevimpairment? a.vNovcognitivevimpairment b.vMildvcognitivevimpairment c.vModeratevcognitivevimpairment d.vSeverevcognitivevimpairmentv-vcorrectvanswer- C.vCutvpointsvonvthevMMSEvarevasvfollows:vtotalvscorev30,v25- 30 vquestionablevsignificance,v20-25vmildvimpairment,v10- 20 vmoderatevimpairment,vandv 10 vorvlowervseverevimpairment. YouvarevthevPMHNPvtreatingvTim,vav10-year- oldvchild,vforvADHDvandvsocialvanxietyvdisorder.vHisvmothervpresentsvwithvTimvforvhi svscheduledvindividualvtherapyvsession.vAtvthevendvofvthevsessionvhisvmothervsays,v" IvneedvtovtakevTimvtovseevhisvpediatricianvandvatvthevlastvvisitvIvwasvtoldvhevneededv somevHPVvshot.vIvdon'tvknow,vhe'svavboy,vwhyvwouldvhevneedvthat? vWhatvdovyouvthink?"vWhatvisvthevPMHNP'svbestvresponsevtovhervquestion? a.v"ThevCentersvforvDiseasevControlvandvPreventionv(CDC)vrecommendsvthevhuman vpapillomavirusv(HPV)vvaccinevforvallvboysvandvgirlsvatvagev10.vHPVvcanvcausevcan cervinvbothvmenvandvwomen,vandvthevvaccinevisveffectivevinvprotectingvagainstvthevv irus.vCanvyouvtellvmevyourvconcernsvaboutvTimvgettingvthisvvaccine?" b.v"WhilevthevCentersvforvDiseasevControlvandvPreventionv(CDC)vrecommendsvthevv accine,veveryvparentvhasvthevrightvtovchoosevandvifvyouvdovnotvthinkvTimvneedsvthisv vaccine,vasvhisvparentvyov-vcorrectvanswer- A.vWhenvfamilyvmembersvorvclientsvaskvquestionsvaboutvillnessesvandvtreatment,vitvi svthevPMHNP'svresponsibilityvtovprovidevdatavandvthenvassessvunderstandingvandvm eaning. AsvavPMHNPvworkingvinvavcrisisvevaluationvcenter,vyouvarevawarevthatvthevinitialvfoc usvofvavcrisisvassessmentvisvonvwhichvofvthevfollowing? a.vClient'svpastvdiagnosisvandvmedicationvtrials b.vPsychosocialvhistoryvandvsupports c.vSafetyvofvthevclientvandvothers
d.vCurrentvlivingvsituationvandvcopingvskilv-vcorrectvanswer- C.vInvavcrisis,vthevfirstvassessmentvshouldvbevsafetyvofvthevclientvandvthosevnearvthe vclient. Whenvconductingvavneurologicalvexaminationvonvavclient,vthevPMHNPvasksvthevclien tvtovholdvoutvhervarmsvandvstickvoutvhervtonguevwhilevassessingvforvtremors.vWhichv cranialvnervevisvbeingvassessed? a.vGlossopharyngeal b.vVagus c.vTrigeminal d.vHypoglossalv-vcorrectvanswer- D.vThevtonguevisvcontrolledvbyvthevhypoglossalvcranialvnerve. Av20-year- oldvAsianvmanvwhovwasvrecentlyvdiagnosedvwithvschizophreniavcomesvtovyourvoffice vforvavfollow- upvappointment.vDuringvthevassessment,vhevtalksvaboutvhisvexperiencevinvthevgroup vhome,vthinkingvthatvthevtelevisionvisvsendingvhimvmessagesvthroughvnewsvanchorsv duringvthev 10 vp.m.veveningvnews.vWhatvsymptomvisvthevclientvdescribing? a.vParanoia b.vIllusions c.vIdeasvofvreference d.vNeologismsv-vcorrectvanswer- C.vIdeasvofvreferencevarevmisinterpretationsvofvincidentsvandveventsvthatvonevbeliev esvhavevavdirectvpersonalvreferencevtovoneself. Youvarevworkingvwithvavfamily:vmother,vfather,vandvtwovbiologicalvchildren.vSam,vthe vfather,visvveryvrigidvandvcontrolling,vwhichvseemsvtovbevoutvofvfearvthatvsomethingv mightvhappenvtovhisvfamily.vHevworriesvdailyvandvitvaffectsvhisvfamilyvrelationships.vY ouvgivevSamvavparadoxicalvdirectivevandvinstructvhimvtovintenselyvworryvaboutvevery thingvhevcanvthinkvofvforv 1 vhourvavday.vUsingvavparadoxicalvdirectivevisvpartvofvwhich vtherapy? a.vExperimental b.vStructural c.vStrategic d.vCognitivev-vcorrectvanswer- C.vParadoxicalvdirectivesvmayvbevusedvinvstrategicvfamilyvtherapy. AsvavPMHNPvworkingvinvanvoutpatientvaddictionvclinic,vyouvoftenvrefervyourvclientsvt ovcommunityvAAvandvNAvmeetings.vUsingvYalom'svtherapeuticvfactors,vyouvarevawa revthatvpeer- ledvgroupsvcanvinspirevandvencouragevothervgroupvparticipants.vWhichvtherapeuticvf actorvisvinstilledvinvAAvandvNAvgroupvmembers? a.vHope b.vAltruism c.vCatharsis d.vExistentialvfactorsv-vcorrectvanswer- A.vWorkingvinvsupportvgroupsvsuchvasvAAvandvNA,vhearingvstoriesvofvothersvwhovha dvsimilarvstruggles,vinstillsvhope.
Youvhavevbeenvworkingvwithvav54-year- oldvmanvwhovhasvbeenvtreatedvforvschizophreniavsincevagev19.vHevhasvlimitedvsocia lvinteractions,vlikesvtovbevalone,vandvhasvnevervdatedvnorvhadvavdesirevtovdate.vHisv symptomsvarevbestvexplainedvbyvwhichvofvthevfollowing? a.vAntisocialvpersonalityvdisorder b.vLackvofvpersonalvhygiene c.vNegativevsymptoms d.vPositivevsymptomsv-vcorrectvanswer- C.vNegativevsymptomsvincludevflatvaffect,valogia,vavolition,vpoorvattention,vandvanhe donia.vInvthevcasevstudy,vthevsymptomsvarevavolitionvand anhedonia. Followingvevidence- basedv(EB)vpractice,vwhichvlaboratoryvscreeningvtestsvandvassessmentsvshouldvbev completedvpriorvtovplacingvavpersonvonvavsecond- generationv("atypical")vantipsychoticvmedication? a.vSerumvglucose,vlipidvprofile,vweight,vbloodvpressure,vwaistvcircumference,vandvfa milyvhistoryvofvcardiovascularvdisease b.vComprehensivevmetabolicvpanel,vbodyvmassvindex,vcompletevbloodvcount,vandvth yroidvpanel c.vSerumvglucosevorvhemoglobinvA1c,vlipidvprofile,vweight,vbodyvmassvindex,vbloodv pressure,vwaistvcircumference,vandvfamilyvhistoryvofvcardiovascularvdisease d.vSerumvglucose,vcompletevbloodvcount,vassessmentvofvfamilyvhistoryvofvcardiovas cularvdiseasevandvcancerv-vcorrectvanswer- C.vEBvpracticevguidelinesvindicatevthatvallvclientsvshouldvhavevthevfollowingvpriorvtov startingvantipsychoticvmedication:vfastingvglucosevorvA1c,vlipidvprofile,vweight,vbodyv massvindex,vbloodvpressure,vwaistvcircumference,vandvfamilyvhistoryvofvcardiovascul arvdisease. Whichvtypevofvhallucinationvisvrarevinvpersonsvwithvpsychoticvillnessesvandvisvoftenva ssociatedvwithvanvorganicvetiology? a.vAuditoryvhallucinations b.vGustatoryvhallucinations c.vVisualvhallucinations d.vCombinationvhallucinationsv-vcorrectvanswer- B.vThevmostvcommonvtypevofvhallucinationsvinvpersonsvwithvpsychoticvillnessesvarev auditoryvandvvisual.vTactilevandvgustatoryvhallucinationsvarevless commonvandvmorevlikelyvrelatedvtovanvorganicvillness. Whatvdifferentiatesvatypicalvantipsychoticvmedicationsvfromvfirst- generationvorvtypicalvantipsychoticvmedications? a.v5HT2avreceptorvantagonistvproperties b.v5HT2avreceptorvagonistvproperties c.vSpecificvdopaminevreceptorv 3 vandv5HT2avblockade d.vDopaminevreceptorv 2 vantagonistvpropertiesv-vcorrectvanswer- A.vTypicalvantipsychoticvmedicationsvblockvD2vreceptors;vatypicalvantipsychoticvmed icationsvblockvD2vreceptorsvandvhavev5HT2avantagonistvproperties. Youvarevtreatingvavclientvwithvschizophreniavwhovtakesvclozapine.vWhatvlaboratoryvv aluesvwillvindicatevthevclientvneedsvtovdiscontinuevtreatment?
a.vWhitevbloodvcellvcountvofvlessvthanv1,800/ mm3vandvabsolutevneutrophilvcountvofvlessvthanv1,200/mm b.vAbsolutevneutrophilvcountvofvlessvthanv1,000/uL c.vWhitevbloodvcellvcountvofvlessvthanv1,200/mm d.vAbsolutevneutrophilvcountvofvlessvthanv2,000/uLv-vcorrectvanswer- B.vThevrecentvchangevinvmonitoringvclozapinevclientsvusingvthevriskvevaluationvandv mitigationvstrategyv(REMS)vindicatesvpersonsvtreatedvonvclozapinevneedvtovhavevab solutevneutrophilvcountvmonitoredvand,vifvitvdropsvbelowv1,000/ uL,vtreatmentvmustvbevinterruptedvandvcanvbevresumedvoncevthevabsolutevneutrophi lvcountvnormalizesvabovev1,000/uL. Seanvisvav47-year- oldvGulfvWarvveteranvwhovwasvinvcombatvduringvOperationvDesertvStorm.vSeanvhas vbeenvtreatedvbyvthevPMHNPvforvmajorvdepressivevdisordervandvassociatedvanxietyv symptoms.vDuringvthevmostvrecentvvisit,vthevPMHNPvlearnsvthatvSeanvsustainedvavt raumaticvbrainvinjuryvduringvhisvservice,vwhichvwasvrecentlyvdiagnosedvatvthevTBIvcli nicvinvthevVeterans Affairsvclinic.vWhatvisvthevrationalevforvthevPMHNPvtovtapervSeanvoffvclonazepam? a.vBenzodiazepinesvcausesvmemoryvproblemsvandvconfusionvinvclientsvwithvavhistor yvofvavTBI. b.vBenzodiazepinesvlowervthevseizurevthresholdvinvclientsvwithvavhistoryvofvavTBI. c.vVeteransvAffairsvhasvbannedvbenzodiazepinesvfromvthevmedicationvformulary. d.vBenzodiazepinesvplacevclientsvwithvavTBIvatvriskvforvavsecondvheadvinjury.v- vcorrectvanswer- A.vBenzodiazepinesvarevcontraindicatedvinvclientsvwithvavTBIvduevtovincreasevratesv ofvconfusionvandvmemoryvproblems. Alicevisvav68-year- oldvwomanvwhovpresentsvtovyouvwithvconcernsvaboutvhervmemory.vShevexplainsvtha tvhervmothervandvgrandmothervbothvexperiencedvdementiavandvshevwantsvtovdovwh atvshevcanvtovpreventvthisvterriblevdisease.vAlicevisvtreatedvforvhypertension,vwhichvi svwellvcontrolled;vothervthanvthatvshevisvinvgoodvhealth.vShevisvsociallyvandvphysicall yvactivevandvparticipatesvinvavmonthlyvcookingvclass,vvolunteersvatvhervchurch,vandv playsvbridgevtwicevavweekvatvthevseniorvcenter.vShevsays,v"IvunderstandvthatvIvamvlo singvbrainvcellsvatvmyvage,vbutvIvwouldvstillvlikevtovkeepvmyvmindvandvbodyvactive."v WhichvisvthevbestvresponsevtovAlice? a.v"Youvarevcorrectvthatvyouvcannotvformvnewvbrainvcellsvatvyourvagevbutvyouvshould vcontinuevwithvyourvactivitiesvbecausevtheyvoffervexcellentvphysicalvandvmentalvhealt hvbenefitsvandvinvturnvwillvlowervyourvriskvforvdementia." b.v"Althoughvmostvbrainvdevelopmentvoccursvearlyvinvlife,vwevstilv-vcorrectvanswer- B.vWhilevitvwasvoncevthoughtvthatvbrainvneuronsvdidvnotvregenerate,vwevnowvknownv thatvwhilevmostvbrainvdevelopmentvoccursvearlyvinvlife,vwevcontinue tovformvsomevnewvbrainvcellsvthroughoutvlife.vAsvwevage,vwevneedvtovengagevinvacti vitiesvthatvkeepvourvbrainsvhealthyvbyvencouragingvthisvgrowth.vExamplesvarevdiet,ve xercise,vsocialization,vandvcognitivevstimulation. WhatvisvthevbestvtreatmentvforvAIDSvdementiavcomplex? a.vAcetylcholinesterasevinhibitors b.vSymptom-targetedvpharmacologicvtreatments c.vNonpharmacologicvsupportivevcare
