ANCC IQ domain 2
1. 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? - 35 years old pregnant, African-American woman living with her husband in suburb of Dallas, Texas - 17 years old, single, Native Alaskan woman living with employed boyfriend in Galena, Alaska - 42 years old, divorced, Caucasian woman dating a recently divorced man in Denver, Colorado - 26 years old, recently separated, Asian American woman living in Boston, Massachusetts
- 17 years old, single, Native Alaskan woman living with employed boyfriend in Galena, Alaska Rationale: Violence directed at women cuts across all ethinc, racial, and socioeconomic lines. However, epidemiologic studies find that Asian/Pacific Islander women report the lowest rates of intimate partner violence, and African-American and Native American/Alaska Native women report the highest rates (National Institute of Justice [NIJ] & Center for Disease Control [CDC], 2000). Evidence suggest that single, divorced, and separated women are at greater risk than married women. Other women at higher risk of abuse include: pregnant women (Surgeon General's Report, 1999); lower income women, less educated women, and women in relationships with income, educational & occupational disparities (NIJ & CDC, 2000). The young, single, Native Alaskan girl living in rural Alaska where there is age, education, and occupational disparity has greatest number of risk factors.
1. 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 major depressive disorder (MDD)? - 16-year-old, high school male, honors student, who runs cross-country track - 43-year-old, divorced woman, schoolteacher, raising three children - 28-year-old, single woman, working toward partner in a large law firm - 58-year-old, married male, computer analyst, whose work requires frequent travel.
- 43-year-old, divorced woman, schoolteacher, raising three children Rationale: Regardless of country or culture, women have a twofold greater prevalence of major depression than men. Hormonal differences, the effects of childbirth, differing psychosocial stressors, and behavioral models of learned helplessness are hypothesized reasons for this difference. The mean age of onset for major depressive episode is about 40 years of age, with 50 percent of all patients having an onset between the ages of 20 and 50. MDD occurs most often in persons without close interpersonal relationships or in those who are divorced or separated.
1. A PMHNP is working in an integrated care clinic and his FNP colleague asks for a consult. The FNP asks the PMHNP what antidepressant to start for a patient who has a score of 15 on the patient health questionnaire (PHQ-9). What is the appropriate response? - A score of 15 on the PHQ-9 indicates moderate depression, so you can refer the patient to therapy and start an antidepressant. - A score of 15 on the PHQ-9 indicates moderate depression, so the patient should be started on a selective serotonin norepinephrine reuptake inhibitor. - A score of 15 on the PHQ-9 indicates severe depression, so you should start a selective serotonin reuptake inhibitor and an atypical antipsychotic. - A score of 15 on the PHQ-9 indicates possible moderate depression, but a follow-up interview is required to assess for depression. I can see this patient today and further assess for depression and the appropriate treatment.
- A score of 15 on the PHQ-9 indicates possible moderate depression, but a follow-up interview is required to assess for depression. I can see this patient today and further assess for depression and the appropriate treatment. Rationale: The PHQ-9 is a screening instrument but should only be used in combination with follow-up questions.
1. The mother presents to the clinic with her 9-year-old daughter because she is worried about her. The mother tells ou that her daughter has been waking up in the middle of the night screaming off and on for the past several months. When she goes into her daughter's room, she is sitting up in bed and is initially inconsolable but eventually will go back to sleep. The mother is crying and tells you she is unable to go back to sleep after her daughter's episodes and feels exhausted all of the time. Which is the most appropriate initial response? - A. I can see this is very upsetting for you. - B. I know you are upset, but it will get better. - C. Tell me why you are unable to fall back asleep after your daughter does. - D. Are you worried that this is your fault?
- A. I can see this is very upsetting for you. Rationale: A simple, nonjudgmental statement, such as "I can see this is very upsetting for you, " conveys to the mother that you are concerned. This form of sentence also acts as an open-ended question that is most likely to elicit the most important information most efficiently. Specifically directed statements © or leading questions (D) are less likely to be helpful in gaining information than an open-ended statement or question. Statements such as option B may indicate that you do not take her problem seriously.
A patient comes into your office in 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: - Admit him to the inpatient chemical dependency program. - Admit him to the local psychiatric unit, with an order for the collection of laboratory values. - Send the patient home with his brother and a prescription for a new antipsychotic medication. - Admit him to the dual diagnosis chemical dependency unit with an order for the collection of laboratory values.
- Admit him to the local psychiatric unit, with an order for the collection of laboratory values. Rationale: While he is both manic and of danger to himself, he should be hospitalized. The patient will not be able to participate in any programming until he is out of his acute manic state. Going home is not an option unless the patient has someone who can be with him 24 hours and monitor his withdrawal from alcohol, his manic condition, and his suicidal issues and desire to leave the state.
1. There is a growing recognition that adverse life experiences due to a variety of reasons underlie a wide range of psychiatric disorders and medical problems. According to a seminal research study on adverse childhood experiences (ACE), a positive relationship exists between ACE and which of the following disorders? - Alcoholism, anxiety, heart disease, sleep disorders, and schizophrenia - Alcoholism, anxiety, depression, diabetes, and heart disease - Alcoholism, anorexia, depression, diabetes, and schizophrenia - Alcoholism, anxiety, depression, diabetes, and schizophrenia
- Alcoholism, anxiety, depression, diabetes, and heart disease Rationale: Felitti et al. (1988) seminal study of the long-term sequelae of ACE found a positive relationship between ACE and significant heart disease, fractures, diabetes, obesity, unintended pregnancy, sexually transmitted diseases, depression, anxiety, sleep disorder, dissociative disorders, eating disorders, and alcoholism.
1. Which of the following lifestyle factors poses the greatest risk for depression, irritability, liver problems, and hypertension in a college student? - Anabolic steroid use - Cocaine use - Marijuana use - Binge drinking
- Anabolic steroid use Rationale: Anabolic steroid use poses the greatest risk of the four lifestyle drug use patterns. Anabolic steroid use is associated with increased irritability and aggression, euphoria, increased energy, sexual arousal, mood swings, distractibility, forgetfulness, and confusion. With time, anabolic steroid use is associated with increased risk for heart attacks, strokes, blood clotting, cholesterol changes, hypertension, depressed mood, fatigue, restlessness, loss of appetite, insomnia, reduced libido, muscle and joint pain, and severe liver problems, including hepatic cancer. Males can have reduced sperm production, shrinking of the testes, and difficulty or pain urinating. There can be breast enlargement in men and masculinization of women's bodies. Both sexes can experience hair loss and acne. Intravenous or intramuscular use of the drug and needle sharing puts users at risk for HIV, hepatitis B and C, and endocarditis.
1. The Five A's for Health Behavior Change include the following: - Assess, Advise, Act, Access, Assist - Assess, Appraise, Agree, Access, Arrange - Assess, Advise, Agree, Assist, Arrange - Assess, Appraise, Advise, Act, Assist
- Assess, Advise, Agree, Assist, Arrange Rationale: The Five A's for Behavioral Counseling and Health Behavior Change are: Assess Advise Agree Assist Arrange.
A patient was started on a 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? - Simpson Angus EPS Scale - Dyskinesia Identification System Condensed User Scale (DISCUS) - Abnormal Involuntary Movement Scale (AIMS) - Barnes Akathisia Rating Scale
- Barnes Akathisia Rating Scale Rationale: The patient is experiencing symptoms consistent with akathisia. The BARS can be very useful in identifying akathisia, assess its severity, and monitor change in symptoms. Akathisia - restlessness Dyskinesia - abnormality or impairment of voluntary movement EPS - The extrapyramidal symptoms include acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome.
1. In assessing patient risks for binge drinking, which of the following statements is not accurate? - Binge drinking is higher in urban, densely populated areas than rural, sparsely populated areas. - Binge alcohol use rates are similar across different levels of education. - Men are much more likely than women to be binge drinkers. Whites have a higher rate of binge drinking than black or Hispanics.
- Binge drinking is higher in urban, densely populated areas than rural, sparsely populated areas. Rationale: There is little variation seen in binge and heavy alcohol use rates by population density. There are regional differences in alcohol use, but not specifically binge drinking rates, with highest alcohol use in western states and lowest use in southern states. The other responses are accurate regarding binge drinking.
1. A 44-year-old man presents to the PMHNP at his wife's insistence. The patient was hospitalized for a mild head injury after a motor vehicle accident four weeks ago. He 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? - Delusion of doubles - Capgras syndrome - Clerambault syndrome - Fregoli phenomenon
- Capgras syndrome Rationale: The belief that people have been replaced by imposters is the hallmark of Capgras syndrome. The syndrome of subjective doubles is a rare delusional misidentification syndrome in which a person experiences the delusion that they have a double or Doppelgänger with the same appearance, but usually with different character traits, that is leading a life of its own. De Clerambault in 1885 is reviewed and a case is presented. Popularly called erotomania, the syndrome is characterized by the delusional idea, usually in a young woman, that a man whom she considers to be of higher social and/or professional standing is in love with her.Fregoli syndrome is the delusional belief that one or more familiar persons, usually persecutors following the patient, repeatedly change their appearance. Fregoli delusion is the mistaken belief that some person currently present in the deluded person's environment (typically a stranger) is a familiar person in disguise
A 53-year-old male with a history of schizophrenia is being discharged from an inpatient admission to a psychiatric hospital and was referred for you to follow up in your private practice. During your initial assessment with the patient, you ask him about his education level and he talks about where he went to high school, his high school friends, activities he was involved in, and his high school graduation. He then states, "That was the end of my education." Which of the following does the patient's answer demonstrate? - Perseveration - Circumstantiality - Tangentiality - Loosening of associations
- Circumstantiality Rationale: Circumstantiality is a disturbance in which a patient digresses into unnecessary details before communicating the central idea.
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? - Global Deterioration Scale - Mini-Mental Status Exam - Dementia rating scale - Clock Drawing Test
- Clock Drawing Test Rationale: The Clock Drawing Test (CDT) is highly correlated with the Mini-Mental Status Exam (MMSE), the Global Deterioration Scale, and the Dementia Rating Scale, yet takes minimum amount of time to administer (2-4 minutes). It is well-suited for clinical practice settings to screen and monitor progression of cognitive decline in older adults.
1. 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? - Concentration - Affect - Memory - Speech
- Concentration Rationale: Subtracting serial 7's from 100 is a simple task that requires intact concentration and cognitive capabilities.
1. 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? - I understand your concern with talking to your son about becoming sexually active. Let's address how to start the conversation. - 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? - As your son's PMHNP, I cannot provide you with information about immunizations. - You are correct, only females need to receive the human papillomavirus vaccination. This letter must have been sent to you by mistake.
- 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? Rationale: It is within the scope and role of the PMHNP to address health promotion and risk reduction, and have an understanding of immunizations. The Centers for Disease Control and Prevention recommend that all males between the ages of 11-12 have the human papillomavirus (HPV4) vaccination, or as early as 9 years of age.
1. 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 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-old daughter a bath and had not cleaned the house. Which of the following defense mechanisms is being demonstrated by this woman? - Rationalization - Displacement - Dissociation - Conversion
- Displacement Rationale: Displacement is a defense mechanism in which a person transfers their emotions from the person or situation that is the target of their frustration to someone or something else.
1. 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? - Edinburgh Postnatal Depression Scale (EPDS) - Montgomery-Asberg Depression Rating Scale (MADRS) - Hamilton Rating Scale for Depression (HRSD) - Major Depression Inventory (MDI)
- Edinburgh Postnatal Depression Scale (EPDS) Rationale: The EPDS is most frequently used in the research setting and clinical practice for several reasons. The scale consists of 10 self-reported questions that are health literacy appropriate and take less than 5 minutes to complete.
As the PMHNP working with a young female recently diagnosed with bipolar disorder, and using a recovery model, what will be the focus of your interactions with this patient? - Assisting in gainful employment - Focus on the side effects of her medications - Psychoeducation about her disease process - Focus on her feelings, experience, and what she wants to achieve
- Focus on her feelings, experience, and what she wants to achieve Rationale: The PMHNP's role in recovery is to assist a patient to rebuild personal, social, and spiritual needs, along with how the individual is feeling and what she is experiencing, and what she wants.
1. In assessing possible sexual abuse of a 4-year-old child, which of the following would not be indicated? - Has anyone else asked you to take off your clothes? - Has anyone ever taken your picture without your clothes on? - Has anyone invited you to a birthday pool party? - Has anyone done something you didn't like to your body?
- Has anyone invited you to a birthday pool party? Rationale: Invitation of a 5-year-old to a birthday pool party is not indicative of sexual context ad would require parental involvement in the decision process. The other three questions directly explore inappropriate behavior of sexual nature pertinent to assessment for possible sexual abuse.
When assessing for alcohol use. What does the CAGE questionnaire ask? - Have you ever felt you should Cut down on your drinking, do you become Avoidant when you drink, do you feel Guilty about your alcohol use, have you ever had an Eye Opener in the morning to get rid of a hangover? - Have you ever felt you should Cut down on your drinking, do you get Angry when you drink, do you feel Guilty about your alcohol use, have you ever had an Eye Opener in the morning to get rid of a hangover? - Have you ever felt you should Cut down on your drinking, have people Annoyed you by criticizing your drinking, have you felt Guilty about your drinking, have you ever had an Eye Opener in the morning to get rid of a hangover? - Have you ever felt you should Cut down on your drinking, do people get Angry when you drink, do you feel Good about your alcohol use, have you ever had an Eye Opener in the morning to get rid of a hangover?
- Have you ever felt you should Cut down on your drinking, have people Annoyed you by criticizing your drinking, have you felt Guilty about your drinking, have you ever had an Eye Opener in the morning to get rid of a hangover? Rationale: The CAGE questionnaire is used to assess if a further evaluation of alcohol use is warranted by asking the following four questions: 1. Have you ever felt you should Cut down on your drinking? 2. Have people Annoyed you by criticizing your drinking? 3. Have you felt Guilty about your drinking? 4. Have you ever had an Eye Opener in the morning to get rid of a hangover?
1. 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? - 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. - Have you ever had feelings of hurting yourself? If you took the medication and had thought like that, what would you do? - SSRI's are the safest antidepressant medications and rarely cause suicidal thoughts. Try the medication and we can watch closely for any side effects? - 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?
- Have you ever had feelings of hurting yourself? If you took the medication and had thought like that, what would you do? Rationale: It is important to explore prior or current suicidal thoughts and how the patient would respond if she did have such thoughts. Only suggesting contact with crisis hotline without some contact with provider does not facilitate empathy or rapport. Statements offering reassurance only may or may not be true.
1. 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 Department) equivalency. As the PMHNP, what is your priority disparity to address with this patient? - Health literacy - Reading level - Race - age
- Health literacy Rationale: Adults meeting the following criteria are most likely to have limited health literacy, which has been related to health outcomes; one, over age 65 from racial and ethnic groups other than white; two, recent refugees and immigrants; three, less than a high school GED; four, low income; and five, non-native speaker of English.
When assessing a client, what is the most important predictor of potential for violence? - History of aggressive rage - History of substance abuse - History of head injury - History of seizures
- History of aggressive rage Rationale: History of previous episodes of rage and violent behavior, escalating irritability, intruding angry thoughts, and fear of losing control are the most important predictors of potential for violence. Head injury, substance use or abuse, and temporal lobe epilepsy have been discussed as possible predictors, but not conclusively.
1. The Mini-Mental Status Exam (MMSE) is a brief, standardized screening tool designed for use: - In adults ≥ 18 years to document mental status. - Across the lifespan to document mental status. - In older adults ≥ 65 years to quantify cognitive status. - In adults to quantify cognitive status.
- In adults to quantify cognitive status. Rationale: The MMSE is a brief, quantitative measure of cognitive status in adults that assesses orientation, attention, calculation, recall, language, and motor skills. It can be used to screen for cognitive impairment, to estimate the severity of cognitive impairment at a given point in time, to follow the course of cognitive changes in an individual over time, and to document an individual's response to treatment.
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 and full-term delivery? - Increase daily caloric intake by 250 calories, reduce running to 4-8 miles daily with reduction in second or third trimester, add pre-natal vitamin, Calcium supplement, and plan a 20-30# gradual weight gain over the course of pregnancy. - 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 a 20-30# gradual weight gain over the course of pregnancy. - 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 pre-natal vitamin and vitamin b-12 supplement, plan a 28-40# gradual weight gain over the course of pregnancy.
- 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 pre-natal vitamin and vitamin b-12 supplement, plan a 28-40# gradual weight gain over the course of pregnancy. Rationale: At 120 pounds for 5'7" her Body Mass Index is 18.8 (low). BMI normal range for adults is 19.8 - 26.0. BMI = 703 x weight (lbs) = 703 x 120 = 18.8 [Height (in)]2 672 Or Weight (kg)/ Stature (cm)/ Stature (cm) x 10,000 = BMI. BMI = weight (kg) [height (m)]2 Low pre-pregnancy BMI and failure to gain recommended weight during pregnancy are associated with increased risk for spontaneous abortions, pre-term delivery, and low birth weight infants. Recommended caloric intake for pregnant women during pregnancy varies from additional 150 calories in first trimester, 300 calories in second trimester, and 500 calories in third trimester before accounting for strenuous daily exercise. Recommended weight gain for pregnant women of normal BMI is 25-35# and 28-40# for women with low BMI as in this patient. The vegan diet lacks animal fat the only dietary source of Vitamin B-12. Addition of pre-natal vitamin and supplement of Vitamin B-12 is indicated for vegan diet. - Increase daily caloric intake by 700 calories, continue running as tolerated with reduction in second or third trimester, add pre-natal vitamin, vitamin E supplement, and B-complex supplement, plan a 25-35# gradual weight gain over the course of the pregnancy.
1. In a psychiatric emergency, the psychiatric mental health nurse practitioner (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? - Enter the room alone, in order to build a therapeutic alliance. - Make sure the patient is restrained before beginning the evaluation. - Inform the patient that violence is not acceptable. - Know as much about the person as possible prior to starting the interview.
- Know as much about the person as possible prior to starting the interview. Rationale: Self-protection involves knowing as much about the patient as possible, being alert to pending violence, having others present or outside the room, and developing an alliance with the patient.
1. 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? - Review of Systems - History of Presenting Illness - Diagnosis - Mental Status Exam
- Mental Status Exam Rationale: Current suicidal ideation, plan, method, intent, and access to implement plan is documented in the Mental Status Exam under the section for thought content.
The PMHNP understands which factor to be the most important in the therapeutic communication: - Nonverbal communication - Verbal communication - Clarification - Feedback
- Nonverbal communication Rationale: Gestures, facial expressions, and body language actually communicate more than verbal messages.
1. 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? - Patient and family education about the disease course, treatment regimens, support systems, and life management skills. - Supportive psychotherapy group for the parents to facilitate their grief and build coping skills to help manage their son's life-changing mental illness. - 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 of schizophrenia. - Family therapy to facilitate gradual independence for the patient while addressing parental desire to protect their son.
- Patient and family education about the disease course, treatment regimens, support systems, and life management skills. Rationale: Because having a family member with schizophrenia is a life-changing event for the family and friends who provide care and support, educating patients and their families is crucial. It is a primary concern for the PMHNP. While the other interventions may be helpful over time, initially patient and family education is the priority.
1. A female client has gradually assumed increasing responsibility for the care of her aging parents. Her mother was diagnosed with Alzheimer's type dementia three years ago and is increasingly disoriented to her home surroundings. Her father insists on keeping her mother at home to provide care until she dies. What is the first priority in counseling this couple and their caretaking adult daughter? - Patient safety - Patient and family education - Caregiver strain - Anticipatory guidance
- Patient safety Rationale: Although all four are important aspects related to care, patient safety must take priority before the other three responses. In counseling about safety issues regarding risk for wandering, leaving stove burner on unattended, slips, or falls the PMHNP can introduce the other areas of education, anticipatory guidance, and community resources.
During an initial psychiatric evaluation, the patient reports use of alcohol and illicit drugs. This information would be the most appropriate in which part of the evaluation? - Personal and social history - Mental status exam - Review of systems - Chief complaint
- Personal and social history Rationale: Habits are included under personal and social history.
Which of the following risk of factors is not amenable to lifestyle changes in reducing lifetime risk of depressive disorders? - Alcohol use - Personality - Work-related stress - Stressful family life
- Personality Rationale: Modifiable risk factors are those that can be changed through lifestyle choices and habits. Personality change is not a risk factor amenable to lifestyle change and not ordinarily considered a risk factor.
A 32-year-old Caucasian Catholic female patient presents for her therapy session. She is upset because she and her husband have been in an argument over finances. She does not work and stays at home to take care of the children. She reports feeling sad and has had thought of hurting herself. She has a past history of overdosing with Tylenol several years ago. Which of the following places her at high-risk for suicide? - Marital status - Previous suicide attempt - Age - gender
- Previous suicide attempt Rationale: Severity and risk factors are usually rated as low, moderate, or high. Factors that increase severity include: previous suicide attempts
Which of the following illustrates the role of the PMHNP in reducing the stigma of mental illness through community education as primary intervention? - Expert witness for standard of acre regarding psychiatric nursing staff in wrongful death lawsuit - Professional speaker interviewed by morning television talk show anchor on depression - Teaching high school class about depression and teen suicide - Volunteering to help with depression screenings at a community health fair
- Professional speaker interviewed by morning television talk show anchor on depression Rationale: While all responses have an element of education, primary prevention through community education is best illustrated by reaching the broadest general audience with information about depression through television, radio, or newspaper media.
1. A ten-year-old child lost her father to an unexpected heart attack. Normally confident, sociable, and an excellent student, her teachers and mother report that she ahs withdrawn, become disinterested in schoolmates and schoolwork, and easily becomes tearful if anyone mentions her father. What non-pharmacologic intervention would be most helpful at this time to facilitate her grieving and loss? - Play therapy - Psychoeducation group - Individual therapy - bibliotherapy
- Psychoeducation group Rationale: While any of these modalities could be helpful, normalizing the experience of grief and loss with peers with similar losses in psychoeducation group format builds on the value of peer support, instillation of hope, and universality that she is not alone in this experience.
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: - Acknowledgement of family risk factor and open discussion with teen - Parental presence and involvement in child's school and sports activities - Parental networking and supervision of any teen parties - Random urine testing using home drug testing kits
- Random urine testing using home drug testing kits Rationale: Parental presence, support, and fostering a sense of connectedness with teens are primary strategies for reducing risk for teen substance abuse. Fostering communication among other parents, endorsing parental supervision of all parties, and knowing the extent of parental supervision at parties is another important strategy. Home urine testing for alcohol and drugs by parents may be advised for monitoring teens that already have a demonstrated alcohol or drug problem as part of a rehabilitation contract, but it is not considered a risk strategy.
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 form 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? - 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. - Exercise does not promote or help deepen your sleep, so you should consider making changes in your daily routine. - Regular exercise helps with sleep, so continue to exercise, and when you get home, watch television to help promote sleep. - Exercising is a good way to help you get sleep, so keep up your schedule and your body will adjust to your new routine.
- 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. Rationale: Measures to promote or induce sleep, known as sleep hygiene, are to establish an exercise routine early during the day and avoid evening stimulation such as TV.
1. What opening question or statement by a Psychiatric-Mental-Health Nurse Practitioner facilitates communication at an initial visit? - Tell me what you think the problem is. - What seems to be the problem today? - Tell me your concerns and how I may be of help. - What problem does your primary care physician want us to evaluate?
- Tell me your concerns and how I may be of help. Rationale: This statement asks the patient's perspective and conveys the offer to help, which conveys empathy, provides hope, and facilitates communication. While the open-ended questions promote patient-centered counseling as opposed to closed-ended questions, the questioning options above lack empathy.
An example of a screening tool that measures severity and tracks change in specific symptoms is - The Mini-Mental Status Examination (MMSE) - The Behavior and Symptom Identification Scale (BASIS) - The Short Form 36 (SF-36) - The CAGE
- The Mini-Mental Status Examination (MMSE) Rationale: The MMSE is an example of a screening tool that measures the severity and tracking change in specific symptoms. It is used to provide an assessment of a broad array of cognitive function, including orientation, attention, memory, construction, and language. It is commonly used to screen for dementia and in following the progression of dementia over time.
Which of the following would not be advised to divorced parents to facilitate recovery for their children? - The divorced couple must provide an age-appropriate truthful explanation why they divorced - The divorced couple must avoid arguing with one another - The divorced couple must show consistent behavior toward the child - The divorced couple must continue to relate to the child despite the child's anger
- The divorced couple must provide an age-appropriate truthful explanation why they divorced Rationale: Divorce recovery for children does not necessarily require an explanation of why the parents divorced, particularly if circumstances are damaging or affix blame to one parent over the other (e.g., infidelity, sexual orientation, illicit drug use, etc.) despite framing in age-appropriate context. Avoiding parental arguments, demonstrating fair and consistent behavior toward the child, and continuing respectful communication despite a child's anger are recognized principles of divorce recovery.
1. Dementia screening for the general population is not recommended for the following reasons? - The service benefits few people: target condition has high prevalence in the chosen population - The service causes net harm in the target population: time involved in screening detracts from higher priority preventive health measures in general population - The service has unknown balance of benefit and harm: current treatments have limited effectiveness in modifying instrumental activities of daily living - The service is unfocused for target condition: sensitivity and specificity of dementia screening measures do not currently warrant widespread use
- The service has unknown balance of benefit and harm: current treatments have limited effectiveness in modifying instrumental activities of daily living Rationale: Dementia screening is not indicated for the general population because the target condition is largely prevalent in the elderly. The balance of benefit and harm is unknown and current treatments have limited effectiveness in modifying instrumental activities of daily living.
1. 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 6 months age. Which of the following areas is an assessment priority? - Extent of alcohol use and motivation to reduce to safe levels. - Thoughts of self-harm, plan, intent, access. - Sleep patterns (early-middle-late awakening), sleep hygiene. - Prior and current medications, dose, clinical response, side effects.
- Thoughts of self-harm, plan, intent, access. Rationale: Evaluation for suicide risk and insuring safety is greatest priority, particularly in an elderly man who has multiple risk factors: gender, age, loss, embarrassment to self and family (DUI), access to guns, and alcohol use. Other areas need to be included in assessment; however, suicide risk and safety is the priority.
1. Which of the following statements would be most likely to be effective in changing sexual behavior when counseling a sexually active 15-year-old adolescent girl? - Require your partner to use a condom. - Use this sample condom. - Always use condoms when having sex. - Always carry condoms in your purse.
- Use this sample condom. Rationale: Use specific risk-reduction steps rather than global statements. Providing an actual condom to try confers direct responsibility for condom use rather than relying on partner to use condom. An adolescent girl is less likely to purchase condoms than initially using a sample condom from a provider.
1. In evaluating the functional status of a 68-year-old woman who has depression, the Instrumental Activities of Daily Living Scale includes which of the following activities? - Using telephone - Filing taxes - Toileting bathing
- Using telephone Rationale: Instrumental activities of daily living (IADLs) include those that facilitate or enhance the performance of ADLs (i.e. shopping, using the telephone, and using transportation). Functional activities or activities of daily living (ADLs) are the activities necessary for self-care (i.e., bathing, toileting, dressing, and transferring). Cognitive executive function includes higher-order activities such as balancing a check book, assembling tax records, filing taxes, and driving.
1. When questioning a patient regarding alcohol use during an intake, the patient tells you he only drinks socially. Which initial response is most appropriate? - I am glad you are a responsible drinker. - Many people with alcohol issues say they are social drinkers. - What amount and what kind of alcohol do you drink in a week? - Do other people in your household drink alcohol?
- What amount and what kind of alcohol do you drink in a week? Rationale: This answer clarifies the patient's own answer while eliciting more information.
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? - What is your biggest concern right now? I will help you as much as you can. - Tell me everything that happened. We'll sort through the next steps. - You will be able to stay in the shelter until the FEMA trailers arrive. It's going to be OK. - What medications were you taking? Let me work on that first.
- What is your biggest concern right now? I will help you as much as you can. Rationale: Principles of crisis intervention guide the PMHNP to focus on one of the individual's primary concerns at a time offering direct, realistic information, and emotional support. Do not give false reassurance which blocks communication; you don't know whether everything will be resolved, and in this scenario, nothing can replace a lifetime of treasures and memories lost in their home. Do not focus on all implications at once or ask the individual to describe all of the losses or implications; this will be too overwhelming. While concerns about medication is important, first the PMHNP needs to assess what the primary concern is for this couple before addressing the medication issue.
1. A 14-year-old girl admitted to a psychiatric unit following an overdose on alcohol and 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? - Are you sexually active? - What is your experience in sexual relationships? - Did you overdose after breaking up with a girlfriend or boyfriend? - Are you attracted to girls rather than boys?
- What is your experience in sexual relationships? Rationale: Although the other responses can open the topic, they are close-ended and can be answered simply by "yes" or "no" response. The open-ended question introduces the topic in a broad, nonjudgmental way that affords the respondent to provide prior history of relationships both heterosexual and same-sex, possible history of abuse, and her thoughts and feelings about her experience. Changes in sexual activity as well as comfort with sexual orientation are important to assess. Issues involving sexual orientation may still be in a formative stage leading to an adolescent's identity confusion and self-esteem. Added to this is the relationship between the adolescent and family member (s) who may or may not be aware of the adolescent's sexual orientation. This may be a source of anxiety, shame, or discomfort for the adolescent vis-à-vis their family.
1. 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? - Within the past year, has anyone ever forced you to do something by threatening you with a gun? - Within the past year, have you ever threatened or tried to commit suicide to escape the abuse? - Within the past year, have you been hit, slapped, kicked or otherwise physically hurt by someone? - Within the past year, has anyone ever threatened to kill you?
- Within the past year, have you been hit, slapped, kicked or otherwise physically hurt by someone? Rationale: This response is one of four items on a standardized abuse assessment screen, The other items are part of a danger assessment that may be used following a positive response to one of the abuse screening questions.
A PMHNP realizes she is frustrated and easily angered with one of her patients for no apparent reason. When discussing the situation with a colleague, she states the patient reminds her of her abusive stepfather. Which of the following best describes the nurse practitioner's reaction? - Countertransference - Displacement - Transference - Projection
Countertransference Rationale: Countertransference is the nurse practitioner's emotional reaction to the patient based on his/her past experiences. Countertransference is essentially the reverse of transference. In contrast to transference (which is about the client's emotional reaction to the therapist), countertransference can be defined as the therapist's emotional reaction to the client.
