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ANCC IQ Domain 1-5 ANCC IQ Domains 1-5 Qbank 241Questions & Answers all correctly answered, Exams of Nursing

ANCC IQ Domain 1-5 ANCC IQ Domains 1-5 Qbank 241Questions & Answers all correctly answered ; latest updated2023/2024 summer RATED A+.

Typology: Exams

2023/2024

Available from 03/08/2024

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Download ANCC IQ Domain 1-5 ANCC IQ Domains 1-5 Qbank 241Questions & Answers all correctly answered and more Exams Nursing in PDF only on Docsity!

241Questions & Answers all correctly answered ; latest

updated2023/2024 summer RATED A+.

  1. You see a patient for a routine medication visit. At the end of the session, the patient asks questions and the session ends up 50 minutes in length. You normally charge for the 30-minute appointment, but instead you charge for the 1-hour appointment. The 1-hour appointment includes a full body assessment that you did not perform. This violation is known as:
  • Over-coding
  • Super-coding
  • Down-coding
  • Up-coding - CORRECT ANSWERS - Up-coding Rationale: Up-coding is a fraudulent practice in which the provider services are billed at higher procedure codes than were actually performed, resulting in a higher payment by Medicare or other third-party payers.
  1. During a session, your patient asks to be able to contact you via your Facebook page on the internet. You reply:
  • I cannot do that because I have a concealed Facebook identity; and I cannot reveal that to my patients
  • I would be happy to communicate with you. It makes it easier for me to reach you this way.
  • I would be happy to use Facebook but you will have to use a private message so that you can be anonymous
  • I cannot do that because Facebook does not protect your Private Health Information - CORRECT ANSWERS - I cannot do that because Facebook does not protect your Private Health Information

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Rationale: Using Facebook breaks patient-provider confidentiality, in addition to blurring ethical boundaries of the therapeutic relationship. Facebook does not protect private health information. Information on the site is available for anyone to see or hack into even if private messaged.

  1. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) insures which of the following?
  • Small employers who insure 50 or fewer covered lives are exempt from the provisions of this MHPAEA law.
  • Annual or lifetime dollar limits on mental health and substance use disorder benefits are no lower than any such dollar limits for medical and surgical benefits offered by a group health plan.
  • Mental health and substance use disorder benefits must be available through both in-network providers and out-of-network providers by a group health plan.
  • Group health plans may obtain an exemption if they can demonstrate expected cost increase resulting from implementation of the parity provisions greater than a 5% increase in the cost under existing plan. - CORRECT ANSWERS - Annual or lifetime dollar limits on mental health and substance use disorder benefits are no lower than any such dollar limits for medical and surgical benefits offered by a group health plan. Rationale: The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) provides federal legislation that requires any annual or lifetime limits on medical and surgical benefits be the same for mental health and substance use disorder benefits. Small employers who insure 2 to 50 employees can apply for an "opt-out" waiver, but they are not automatically exempt from the

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MHPAEA requirements. The group health plan will be required to provide in-network and out-of-network mental health and substance use disorder benefits only if it provides both in-network and out-of-network medical and surgical benefits. The group health plan my obtain an exemption or waiver if the first year of implementation results in 2% increase in group health plan costs over prior year that covers the following year, and if implementation results in 1% increase in group health plan costs in subsequent years. A section on actuarial determination of these increased costs is included in the law.

  1. A 68-year-old, retired African-American widower who served for 30 years as an Army officer was recently diagnosed with terminal lung cancer. He made plans to die at home with hospice care. He was hospitalized for a broken hip and succumbed to complications in the hospital. Despite his request to be addressed as "Mr. Baxter" the hospital staff persisted in calling him by his first name, "John." Which principle of culturally competent care does this violate?
  • Autonomy
  • Advocacy
  • Collaboration
  • Respect - CORRECT ANSWERS - Respect Rationale: Respect of cultural values and beliefs is violated in this scenario.

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  1. PMHNPs seeking admitting privileges at a community hospital with inpatient psychiatric services need to influence policymakers at which of the following levels?
  • State board of nursing
  • State legislature
  • County board of health
  • Local hospital - CORRECT ANSWERS - Local hospital Rationale: Local PMHNPs who want admitting privileges will want to persuade the appropriate hospital decision maker, through facts, figures, and a presentation of projected benefits to the hospital, of the need to change policy and allow PMHNPs to admit patients.
  1. To demonstrate her support for social justice, within her role as a PMHNP caring for the person who is homeless with mental illness, the PMHNP:
  • Volunteers to serve food at the local Home for Girls.
  • Teaches Sunday School.
  • Volunteers to walk at the March of Dimes walk each year.
  • Volunteers her clinical services at the psychiatric clinic, run by a local mission project. - CORRECT ANSWERS - Volunteers her clinical services at the psychiatric clinic, run by a local mission project. Rationale: Social justice is bringing things to those who have the least means of getting them but need them the most. In this case, the homeless mentally ill need the PMHNP's skills more.

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  1. You have students from local psychiatric nurse practitioner programs follow you in your clinical practice to show them what you do as a PMHNP. This is called being a:
  • Preceptor
  • Mentor
  • Teacher
  • Professor - CORRECT ANSWERS - Preceptor Rationale: The preceptor is a 1;1 relationship sustained over a short time where each person brings something to the relationship. It is a contracted, defined role with goals. The preceptor is in a teaching role. Teaching is completed through the observed performance, examples, and role modeling.
  1. As an individual advanced practitioner, you cannot afford to have a standalone Electronic Health Record (EHR) system to keep all of your patients' health information on a computer-based system. How could you problem-solve this dilemma?
  • Process your patient records manually, in your current fashion. You are keeping a full record according to HIPAA.
  • Process your notes manually and keep them in a locked file. The records are available for copy and distribution at any time.
  • Process your notes and patient records on a laptop that you are able to transport between your office and home office. You always have the records available if needed.
  • Process your notes and patient records in a secure electronic system with a template for patient information and interactions,

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supporting quick access within your network. - CORRECT ANSWERS - Process your notes and patient records in a secure electronic system with a template for patient information and interactions, supporting quick access within your network. Rationale: Having an EHR system is the ideal situation according to the US Health and Human Services and The Office of Clinical Quality and Safety. Not all offices have the ability to afford installation and maintenance of such systems. The US government has established financial help for EHRs in rural hospitals. For single practitioner offices, doing the best possible to keep information ready for quick access is the best possible solution. Without an EHR, incentives for having an EHR will not be available to you.

  1. You are in a meeting of your state nurse practitioner legislative group. The group's director has asked you to present information on a law bill (LB) that is being presented for public hearing in the state legislature. The information covers how best to approach securing support from the state's Health and Human Services Committee (state senators and congressmen). As you begin to present the information, two of your colleagues on the committee begin to talk over you about their ideas and will now quiet down. The group director does not intervene to settle the meeting. You decide to:
  • Talk over colleagues. Ask them to allow you to finish before they make comments. Take questions at the end of the presentation.
  • Clear your voice and ask for attention. When that does not work, stop speaking until the situation resolves. If it does not resolve, sit down quietly until the behavior stops.

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  • Confront the speakers for t - CORRECT ANSWERS - Clear your voice and ask for attention. When that does not work, stop speaking until the situation resolves. If it does not resolve, sit down quietly until the behavior stops. Rationale: She should wait quietly for them to stop their behavior. This is a situation of indirect bullying where the two colleagues were directly subverting the information that the presenter was attempting to present to the group. The definition of social bullying, which is defined as persistent, demeaning, downgrading activities incorporating vicious word and cruel acts that undermine self-esteem. Bullying is malicious and psychologically damaging. The speaker could choose to make a spectacle and shout over the persons interfering and cause chaos, throwing bad publicity on the nursing group as a whole. She could lose her own power by asking the group director to manage the rowdy persons.
  1. Your mother calls you at the office and asks you to call in a prescription for her. The medication is for her sleeping pills, Eszopiclone (Lunesta) 3 mg 1 PO QHS #30. You:
  • Tell her to call the provider who normally prescribes that medication for her.
  • Call your mother's provider and ask the provider to call your mother's script in for her.
  • Tell her that you will only do it "just this once" for her and then call the script into her pharmacy.
  • Call the script into her pharmacy with three additional refills, just like any other patient. - CORRECT ANSWERS - Tell her to call the provider who normally prescribes that medication for her.

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Rationale: It is not illegal to call a family member's prescription in but it is not recommended to prescribe for someone with whom you have a close relationship. You do not have the proper distance and perspective to make the medical decisions that a disinterested third party can make. Prescribing scheduled medication for yourself or your family members can get you and your license in trouble. Do not call your mother's prescriber unless your mother is too ill to do it herself.

  1. As a PMHNP, you evaluate your patients for health concerns and beyond, in a holistic manner. Your current patient has a blood sugar of 186 and a hemoglobin A1C of 6.7. You refer this patient to an internal medicine practitioner with whom you frequently share patients. You have just violated:
  • The Stark law.
  • The DATA Act.
  • No statute.
  • The Adams Act. - CORRECT ANSWERS - No statute. Rationale: You are permitted to refer your patient to an appropriate provider of care as long as you have no financial gain for the referral and are doing this in the best interest of the patient.
  1. The NP requires all patients to have a se of laboratory tests done each year to check changes in values as a safety measure. The patient states that these labs were done at his Internal Medicine Physician's office within the last month. The NP states that she will accept those labs as long as they cover all of the labs

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that she requires for the yearly check. The patient then verbally gives the NP his Internal Medicine Physician's office number to call and requests that she get the lab results. The NP then:

  • Faxes a formal request to the Internal Medicine Office and physician requesting the laboratory results.
  • Gets a signed release of information from the patient for the Internal Medicine Physician for the laboratory results.
  • Mails a formal request to the Internal Medicine office and physician requesting the laboratory results.
  • Calls the Internal Medicine office and verbally requests that they fax over the l - CORRECT ANSWERS - Gets a signed release of information from the patient for the Internal Medicine Physician for the laboratory results. Rationale: Private healthcare information is private and cannot be released without a signed release of information pe the Health Insurance Portability and Accountability Act (HIPAA). As long as patients do not object, the health care provider is allowed to share or discuss health information with the family, friends, or others involved in their care of payment for their care. The provider may ask your permission, may tell you he or she plans to discuss the information and provide an opportunity to object, or may decide, using his or her professional judgment, that you do not object. In any of these cases, the health care provider may discuss only the information that the person involved needs to know about the care or payment for the care. Healthcare providers must have a signed consent.

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  1. Which study design is appropriate in determining the difference in effectiveness of one medication compared to another medication in the treatment of bipolar disorder?
  • Cross-sectional design
  • Case-controlled trial
  • Randomized controlled trial
  • Cohort design - CORRECT ANSWERS - Randomized controlled trial Rationale: When the research question is treatment-based, you would likely choose a randomized controlled trial where patients are randomly allocated to control or treatment groups.
  1. A newly graduated NP wants to open a private psychiatric practice in her hometown. She wants to find out about the laws that cover her responsibility and the legal liability that this practice will encounter for her as an independent PMHNP. Her best source of information is:
  • Local Psychiatric Nurse Practitioners in practice.
  • Her City Statutes.
  • The American Academy of Nurse Practitioners.
  • The State Statues on Nursing or Advanced Nursing Practice. - CORRECT ANSWERS - The State Statues on Nursing or Advanced Nursing Practice. Rationale: In general, the states govern all nursing and Advanced Nursing Practice legislation. This is the law that governs what a Nurse and Advanced Practice Nurse may do in that state. Further, the State's Health and Human Services Department will have

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documentation on the laws, defining what the laws mean and how the laws are interpreted.

  1. The core values that underlie advanced practice nursing and culturally competent care include:
  • Care, respect, collaboration
  • Autonomy, respect, collaboration
  • Respect, advocacy, partnership
  • Care, advocacy, respect - CORRECT ANSWERS - Respect, advocacy, partnership Rationale: The culturally competent PMHNP is knowledgeable and respectful of diverse cultural beliefs and practices, partners with the patient to develop a care regimen that produces the desired health outcomes within the context of the patient's cultural values, and advocates for the development of culturally appropriate patient care services.
  1. As an NP, you teach your patients that mental illness is no different from any other physical illness that a person suffers. In classes for the community, you emphasize that everybody ahs a brain and it is another organ in the body. You remind your audience that illness in the brain is no different from illness in the heart, lungs, or liver. This is an example of:
  • Integrated health
  • Cross education
  • Holistic dynamism

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  • Reducing stigma - CORRECT ANSWERS - Reducing stigma Rationale: Stigma is one of the worst offenders separating persons suffering with mental illness from the mainstream. There is a spoken and unspoken prejudice against anyone who suffers with a mental illness. Persons suffering with schizophrenia are not treated the same way that other persons are treated in medical practitioner's offices, stores, postal offices, or other public and some private venues. It is the duty of every PMHNP to change this and reduce and/or eliminate this stigma.
  1. To advocate for the skills and value of the NP, you:
  • Arrange for a local TV station to interview you about what PMHNPs can do for the community.
  • Arrange a meet and greet with other nurses at a drug luncheon promoting a psychiatric medication.
  • Arrange for you and other psychiatric nurses to participate in a blood drive for a local psychiatric hospital.
  • Arrange for your office to participate in a walk for Alzheimer's Disease. - CORRECT ANSWERS - Arrange for a local TV station to interview you about what PMHNPs can do for the community. Rationale: Advocacy is more than doing something altruistic as a PMHNP. Advocacy is getting out, showing, and telling people the value of what you do as a PMHNP.
  1. The NP sees and opportunity to help her patient who suffers from anxiety and hypertension by utilizing a medication that can treat both issues. She talks to her patient about using Atenolol 25 mg ½ tab PO QHS to manage his hypertension and his chronic

241Questions & Answers all correctly answered ; latest

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anxiety. To promote both the patient's continued health and collaboration, the NP:

  • Telephones the PCP's office and leaves a message about the change in medication
  • Tells the patient to let his PCP know about the change in medication
  • Faxes a copy of her care notes to the PCP to inform the PCP of her plan of care
  • Telephones the patient's PCP to discuss the use of the Atenolol before starting the medication - CORRECT ANSWERS - Telephones the patient's PCP to discuss the use of the Atenolol before starting the medication Rationale: Too often, there is little communication between providers, and the patient suffers from this lack of communication. The collegial, and best practice, is for providers to communicate with each other about care for their shared patient and make decisions together whenever possible. Using one medication rather than multiple medications is in the patient's best interest and saves the patient from polypharmacy.
  1. As a PMHNP who is working in a large health system and understands models of change, which of the following processes are typically included in these models?
  • Engaging stakeholders, addressing organizational barriers, and evaluating the impact of the practice change
  • Engage the unit-level manager, assess unit barriers, and obtain funding to implement the change

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  • Conduct a literature search, write the proposal, and obtain funding for the change
  • Form a committee, identify the need, and evaluate staff satisfaction - CORRECT ANSWERS - Engaging stakeholders, addressing organizational barriers, and evaluating the impact of the practice change Rationale: Most organizational change models (Hopkins, Iowa, and Stetler) include similar processes necessary for organizational change, and these models do not include obtaining funding, but rather focus on stakeholders, organizational barriers, and evaluation methods.
  1. A PCP consults the PMHNP for guidance on medication management for a family member she is prescribing medication for bipolar I disorder, because the family member does not have health insurance and cannot afford to see a mental health provider. What would be the most appropriate response by the PMHNP?
  • Determine acuity and phase of bipolar I disorder to advise on appropriate generic medications
  • Recommend free clinic and report nurse practitioner to state board of nursing practice violation
  • Offer to see the patient pro bono and manage medications
  • Recommend that she not manage a family member's medication and recommend free clinic - CORRECT ANSWERS - Recommend that she not manage a family member's medication and recommend free clinic

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Rationale: While there may be no law specifically prohibiting a practitioner with prescriptive authority from prescribing legend drugs, such as antibiotics, to family members or oneself, unless a PMHNP or family member is enrolled as a patient at the PMHNP's practice setting, the PMHNP is unlikely to be covered under a collaborative agreement with a physician for a diagnosis, medical management, and prescribing. Collaborative agreements are specific to a practice setting. In states where no collaborative agreement is required, a PMHNP who prescribes for a family member is on somewhat firmer ground. The situation is more serious when the drug is controlled. Pharmacy laws make it illegal in many states to prescribe controlled substances for family members and oneself.

  1. A colleague emails on the company computer system regarding complaints about another coworker. In the message, the colleague makes several disparaging remarks about the other coworker and the difficulty of working with her. You reply:
  • She is just not doing things the way they were taught. She can't help it if she is not us, but she could try harder!
  • Really, I cannot believe that you get so upset over that little stuff. Help her understand where she is making a mistake and teach her how to do things correctly.
  • Did you talk with her about the issue you have with her? Saying bad things about your coworker will not solve the problem or make it better.
  • I understand your feelings, just put up with it. You are going to another shift in one month and will leave the problem behind. - CORRECT ANSWERS - Did you talk with her about the issue you

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have with her? Saying bad things about your coworker will not solve the problem or make it better. Rationale: We are nurses and we must treat each other and all others ethically with respect. Verbal bashing and avoiding is a type of lateral violence. If you have a problem with someone, talk to him or her and find out what the issue is before you complain. We have to break the chain of abuse and treat each other with respect and kindness.

  1. Your patient wants to communicate with you through email. You have a secure email account that is encrypted and will protect health information as required by the Health Insurance Portability and Accountability Act (HIPAA). Your patient does not have an encrypted email account. Your reply is:
  • I do not like to communicate through email. I would prefer to talk to you in person or over the telephone only.
  • In order to communicate back and forth, you will have to find a way to encrypt your protected health information (PHI).
  • I have no problems with you communicating with me through my personal email.
  • I can encrypt our email communications to be sure that your protected health information (PI) is unavailable to others and protect you. - CORRECT ANSWERS - In order to communicate back and forth, you will have to find a way to encrypt your protected health information (PHI). Rationale: Unencrypted email is "like sending a postcard through the mail," everyone can read it. Without encryption on both sides of the communication, there is no way to provide protection for PHI.

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  1. The NP is seeing a patient for both psychiatric and chemical dependency illnesses. The patient wants the NP to send medical records to his General Practitioner. The NP tells the patient that because of Federal Law 42 CFR, he must:
  • Sign once combined release that does not mention his chemical dependency illness due to its special protected nature
  • Sign two separate releases due to the special protected nature of psychiatric information.
  • Sign two separate releases of information due to the special protected nature of chemical dependency information.
  • Sign one combined release that designated that he is being treated for both chemical dependency and psychiatric illnesses. - CORRECT ANSWERS - Sign two separate releases of information due to the special protected nature of chemical dependency information. Rationale: Federal Law 42 CFR requires a separate release of information for the release of any information on chemical dependency.
  1. An NP decides to back to school to gain further knowledge about the neurological basis of psychiatric illnesses. She is not doing this to maintain her licensure but to enhance her knowledge. This is an example of:
  • Nursing informatics
  • Nursing research
  • Professional development

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  • Continuing education credits - CORRECT ANSWERS - Professional development Rationale: Professional development is a lifelong phase of learning that the nurse uses to develop, maintain, enhance professional nursing practice, and support individual nursing goals.
  1. Which of the following is not insured by the Universal Bill of Rights for Mental Health Patients?
  • The right to freedom from restraint or seclusion, other than as a mode of treatment during an emergency situation.
  • The right to be given a reasonable explanation of one's general mental and physical condition, the objectives of treatment, and the possible adverse effects of recommended treatment.
  • The right to refuse a particular mode of treatment regardless of informed, voluntary, written consent, or situation.
  • The right to ongoing participation in the planning of mental health services provided in a manner appropriate to a person's capabilities. - CORRECT ANSWERS - The right to refuse a particular mode of treatment regardless of informed, voluntary, written consent, or situation. Rationale: The right to refuse a particular mode fo treatment is insured except during an emergency situation wherein the patient is deemed imminent danger to self or to others, which includes the treatment team staff. All other responses are included in the Universal Bill of Rights for Mental Health Patients (Title II, Public Law 99-319, Restatement of Bill of Rights for Mental health Patients established by Mental Health Systems Act of 1980).

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  1. You are a PMHNP and have many patients with comorbid and mental health issues. As a part of your continuous quality improvement (CQI) process you might best serve your practice by:
  • Develop a journal group with a general practice colleague to read the latest articles on self-care for advanced practice nurses.
  • Subscribe to Medscape and read it daily to see about new medications being developed for personality disorders.
  • Subscribe to Medscape Psychiatry and read it critically noting studies that apply to your patient's access to care issues.
  • Developing a peer review process of your charts with a general practice colleague. - CORRECT ANSWERS - Developing a peer review process of your charts with a general practice colleague. Rationale: While all of these practices could serve continuous quality improvement, the only one that directly serves the needs of the comorbid medical /mental patient population is to begin a peer review process with an NP with a general practice/medical background.
  1. You notice that you have begun to care less about your patient's needs. You are tired, unhappy, and unsatisfied in your job. You talk to your office confidant, another PMHNP about your feelings and concerns about how this might impact your practice. Together, you discuss your need to:
  • Leave your present employment in nursing and find a different career path in something that fulfills you better.
  • Leave your present employment and find a different career in nursing that fulfills you better.

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  • Reduce your present workload to get more rest and practice better living, eating, exercise, and living skills.
  • Avoid those things about your present employment that upset you and get involved in a yoga class. - CORRECT ANSWERS - Reduce your present workload to get more rest and practice better living, eating, exercise, and living skills. Rationale: Psychiatric Nursing teaches holistic wellness through a balance lifestyle and correct use of medications and therapy. The NP needs to heed her own advice/practice. In order to be good role models to our patients, we have to lead the balanced holistic lives we preach. We have to be healthy enough in our own bio/psycho/socio/spiritual realms to help our patients heal. Leaving your present job for another without looking at what is problematic will only take the problems you now have with you. Avoiding problems does not resolve them. The Yoga class might help begin a path of healing but not without a healthy lifestyle.
  1. Which of the following best depicts the PMHNP in a grassroots mental health advocacy role?
  • Assisting with depression screening at a health fair in a local shopping mall.
  • Meeting state legislators during RN lobbying day organized by the state nurses' association.
  • Working on the campaign of an individual running for the state senate.
  • Attending a town hall meeting to seek timely police response to rising domestic violence crisis calls. - CORRECT ANSWERS - Attending a town hall meeting to seek timely police response to rising domestic violence crisis calls.

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Rationale: While all descriptions can be categorized under professional activism, the response involving a specific mental health issue with a proposed action to improve care is timely police response to domestic violence crisis calls. Assisting with depression screening is a primary intervention and health promotion strategy.

  1. Outcomes measurement is the collecting and reporting of data about the effect of an intervention. Purposes of outcome measurement include all of the following except:
  • To suggest changes in treatment
  • To analyze the effectiveness of an intervention
  • To practice profile patterns of providers
  • To observe errors in data reporting of an intervention - CORRECT ANSWERS - To observe errors in data reporting of an intervention Rationale: Outcomes measurement entails evaluating the outcome of care. Outcomes are measured to suggest changes in treatment, to analyze the effectiveness of an intervention, or to profile practice patterns of providers.
  1. A mobile crisis team responded to an emergency call by a residential care home (RCH) manager. A 65-year-old resident had become increasingly agitated, insisted that the RCH cook was poisoning her food, and verbally threatened the cook. The RCH manager had found several days of the resident's medications hidden in her dresser drawer. Which is the most appropriate intervention by the mobile crisis team?

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  • Admission to the gero-psychiatric unit at the community hospital.
  • Admission to the state psychiatric hospital.
  • Admission to a nursing home.
  • Admission to the crisis stabilization unit. - CORRECT ANSWERS
  • Admission to the crisis stabilization unit. Rationale: The Universal Bill of Rights for Mental Health Patients (Title II, Public Law 99-319, Restatement of Bill of Rights for Mental Health Patients established by the Mental Health Systems Act of 1980) supports evaluation and treatment in the least restrictive environment. The crisis stabilization unit represents the least restrictive choice of the four listed and will likely have a much shorter period of stay before returning the patient to the RCH.
  1. In counseling a 23-year-old, married Hispanic mother who brought her 4-year-old son to the clinic for "mal de ojo" with symptoms of fitful sleep, diarrhea, vomiting, and fever, the PMHNP:
  • Educates about importance of maintaining fluid and electrolyte imbalance
  • Explains that the symptoms are most likely caused by viral infection
  • Identifies what steps the mother has already tried in caring for the child's symptoms
  • Respects the mother's understanding of the child's illness - CORRECT ANSWERS - Respects the mother's understanding of the child's illness

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Rationale: The culturally competent PMHNP respects culture- bound beliefs before proceeding with further steps in the assessment and appropriate interventions. The culturally competent PMHNP would then proceed to negotiate with the mother to reach beneficial health outcome for the child.

  1. As a PMHNP you frequently are asked to "case manage" your patients for more than psychiatric issues. Your 68-year-old patient, with Medicare as the primary insurance, states that varicose veins are an issue and that treatment is needed. You know that your sister is the best vein surgeon in your city and refer the patient to her. You have just violated:
  • The Stark Law
  • The DATA Act
  • The Harter Act
  • The Adams Act - CORRECT ANSWERS - The Stark Law Rationale: Per the Stark Law, you are not permitted to refer family members for treatment of your patients as this could be seen as fraudulent by the Federal government/Medicare. Stark law Guidelines-Chapter IV-Centers for Medicare & Medicaid Services, Department of Health and Human Services-Part 411-limits Medicare payment to siblings.
  1. You notice that you have begun to care less about your patient's needs. You are tired, unhappy, and unsatisfied in your job. You talk to your office confidant, another PMHNP about feeling possible "compassion fatigue." He indicates that while he can understand your concerns based on your self-assessment, but he

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does not believe you have compassion fatigue because he has not observed you:

  • Heavily criticizing others during meetings, sitting in your office alone all the time, dressed in the same outfit all the time, and in denial about your problems.
  • Constantly tired, wanting to do more of the paper work and less of the patient work, wanting to stay longer and chat in the break room rather than be in your office alone.
  • Hyperactive but having little productive work to show for it, poor concentration, not listening to others despite being present, and constantly forgetting things needed for daily work.
  • Staring - CORRECT ANSWERS - Heavily criticizing others during meetings, sitting in your office alone all the time, dressed in the same outfit all the time, and in denial about your problems. Rationale: It is a professional responsibility, as an NP, to monitor ourselves for compassion fatigue. Compassion fatigue is a state experienced by those helping people or animals in distress. It is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it can create a secondary traumatic stress for the helper. Some of the symptoms include denial about problems, excessive blaming, holding in emotions, isolating form others, an unusual amount of complaints, complaining about administrative functions, substance abuse used to mask feelings, compulsive spending, over eating, gambling, or sexual addiction, and poor self-care and self-hygiene.
  1. During a medication follow-up appointment at a student mental health clinic, a 20-year-old college sophomore with depression and a history of binge drinking disclosed that she has been

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struggling with recurrent intrusive thoughts to overdose. She recently broke up with her boyfriend when she learned that he was sleeping with her closest girlfriend. She admits taking a handful of her sertraline prescribed by the PMHNP last weekend and was frustrated that it only made her sleep for a day. She's angry and ambivalent about the future, unwilling to make any promise not to harm herself, and has made veiled threats to "pay back both of them for cheating" (referring to her ex-boyfriend and girlfriend). What is the most appropriate intervention at this juncture?

  • Ask the student if she will agree to voluntary admission and arrange involuntary admission if necessary
  • Counsel the student that she would regret hurting herse - CORRECT ANSWERS - Ask the student if she will agree to voluntary admission and arrange involuntary admission if necessary Rationale: When significant harm to the person or others are certain or highly likely, then a more stringent evaluation is warranted and a responsibility to intervene may exist. The purpose of intervening when self-harm or harm to others is likely is to restore the person to his or her previous ability to exercise autonomy. Chodoff (1976, 1999) argued defense of both of the need for involuntary hospitalization and the criteria that should be applied to such decisions. He argues that involuntary hospitalization may be warranted if "obvious disturbances that are both intrapsychic (for example, the suffering of severe depression) and interpersonal (for example, withdrawal from others because of depression)" exist. The student's unwillingness or inability to commit to no self-harm, her recent overdose attempt, her history of binge drinking, the inherent impaired judgment form binge drinking, and her veiled threats to harm