FINAL EXAM: NR548/ NR 548 2024 -2025 PSYCHIATRIC ASSESSMENT FOR THE PSYCHIATRIC-MENTAL H, Exams of Nursing

Download FINAL EXAM: NR548/ NR 548 2024 -2025 PSYCHIATRIC ASSESSMENT FOR THE PSYCHIATRIC-MENTAL H and more Exams Nursing in PDF only on Docsity! 1 FINAL EXAM: NR548/ NR 548 2024 -2025 PSYCHIATRIC ASSESSMENT FOR THE PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER REVIEW |WEEKS 7-8 COVERED QUESTIONS WITH CORRECT DETAILED ANSWERS GRADED A The American Psychiatric Association (APA, 2020) supports telemedicine as a legitimate component of a mental health delivery system when telepsychiatry services: - CORRECT ANSWER>>-benefit the client -maintain client autonomy, confidentiality, and privacy -when used consistent with APA medical ethics policies and established telepsychiatry laws Telepsychiatry services are provided in diverse settings, including: - CORRECT ANSWER>>• private practice • outpatient clinics • schools • nursing homes • correctional facilities • military facilities Telepsychiatry - CORRECT ANSWER>>a provider administers psychiatric care from a distance through a technological interface -a subset of telehealth -telepsychiatric services • psychiatric interview • psychiatric evaluations • therapy • medication management • consultation • client education telepsychiatry services are delivered through: - CORRECT ANSWER>>• videoconferencing technology • websites • recorded medical information • support or chat groups • asynchronous client-provider interactions social media • links to self-directed or assisted assessment 2 Benefits of telepsychiatry services: - CORRECT ANSWER>>• improved access to care • reduced costs • improved efficiency • improved integration of care • decreased emergency department visits • fewer delays in care • improved continuity of care • reduction of transportation-associated barriers Telepsychiatry __________, _________, _________, and _________ outcomes are comparable to in-person services. - CORRECT ANSWER>>validity, reliability, assessment, and treatment outcomes most common modalities for providing telepsychiatric services is via _______________________ - CORRECT ANSWER>>videoconferencing technology In 2018, the American Psychiatric Association (APA), in conjunction with the American Telemedicine Association (ATA) developed: - CORRECT ANSWER>>best practices for providing videoconferencing-based telepsychiatric care -guidelines inform the technical considerations and administrative requirements needed to provide these services best practices for providing videoconferencing-based telepsychiatric care: - CORRECT ANSWER>>-Use of a designated technology platform. Telesessions should not be conducted using alternate platforms; however, an alternate plan, such as a telephone call, may be used in case of technology failure. -Provisions for the verification of confidential and secure client information. -Sufficient bandwidth to provide clear, appropriate video and audio quality. -Device compliance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) and state requirements. During telepsychiatry sessions, both the provider and client locations should be treated as a ______________ - CORRECT ANSWER>>confidential space During telepsychiatry sessions, provisions must be taken to ensure: - CORRECT ANSWER>>-the discussion cannot be overheard by other -adequate lighting and ambiance is provided that is appropriate to the session -place the camera so that the eyes and face of the participants are visible 5 Step 4: Provide guidance for appropriate contact between sessions and review emergency management protocols for client. -If client is in a location with clinical staff, the provider will inform staff of emergent situations -If client is in another location, the provider may identify a support person to contact for potential emergencies. -If the client requires emergency intervention in the community setting, the provider must coordinate with local emergency staff. Telehealthcare - CORRECT ANSWER>>the use of telecommunications technology to remove time and distance barriers from the delivery of health care services and related health care activities -Traditionally, the use of telehealth and tele-mental health care was designed to meet the needs of rural populations and geographic areas with identified shortages of specialty health care professionals Forensic Mental Health Care - CORRECT ANSWER>>Any cross between the criminal justice system and psychiatric nursing can be considered forensic mental health -64% of U.S. inmates have mental health concerns or disorders -15% to 20% of inmates in jails and prisons suffer from serious mental illness -Over 90% of federal inmates with mental health conditions are without access to mental health treatment Informed Consent - CORRECT ANSWER>>Local, state, and national laws regarding verbal or written consent shall be followed -If written consent is required, then electronic signatures, assuming these are allowed in the relevant jurisdiction, may be used -The provider shall document the provision of consent in the medical record Clinically unsupervised settings - CORRECT ANSWER>>-Providers should discuss the importance of having consistency in where the patient is located for sessions -knowing a patient's location at the time of care, as it impacts emergency management and local available resources • As patients change locations, providers shall be aware of the impact of location on emergency management protocols (police, emergency rooms, crisis teams) -provider should consider the use of a "Patient Support Person" (PSP) as clinically indicated • a family, friend or community member selected by the patient who could be called upon for support in the case of an emergency If a patient and/or a PSP will not cooperate in his or her own emergency management: - CORRECT ANSWER>>providers shall be prepared to work with local emergency personnel in case the patient needs emergency services and/or involuntary hospitalization. 6 Care Coordination - CORRECT ANSWER>>With consent from the patient and in accordance with privacy guidelines, telemental health providers should arrange for appropriate and regular communication with other professionals and organizations involved in the care of the patient. TECHNICAL CONSIDERATIONS: VIDEOCONFERENCING PLATFORM REQUIREMENTS - CORRECT ANSWER>>should select video conferencing applications that have the appropriate verification, confidentiality, and security parameters necessary to be properly utilized for this purpose -event of a technology breakdown, causing a disruption of the session, the professional shall have a backup plan in place (telephone access) -services at a bandwidth and with sufficient resolutions to ensure the quality of the image and/or audio received is appropriate to the services being delivered TECHNICAL CONSIDERATIONS: security issues - CORRECT ANSWER>>-policies and procedures in place to ensure the physical security of telehealth equipment and the electronic security of data -Organizations shall ensure compliance with all relevant safety laws, regulations, and codes for technology and technical safety -HIPAA and state privacy requirements shall be followed at all times to protect patient privacy -mental health and substance use disorder services are afforded a higher degree of patients' rights as well as organizational responsibilities (e.g., need for specific consent from patients to release information around substance use) telemental health PHYSICAL LOCATION/ROOM REQUIREMENTS - CORRECT ANSWER>>-both locations shall be considered a patient examination room regardless of a room's intended use -Providers shall ensure privacy so clinical discussion cannot be overheard by others outside of the room -patient and provider cameras should be placed at the same elevation as the eyes with the face clearly visible to the other person -features of the physical environment for both shall be adjusted so the physical space, to the degree possible, maximizes lighting, comfort and ambiance Child & Adolescent Telepsychiatry: Legal and Regulatory Issues - CORRECT ANSWER>>-Many states require guardian consent, written and/or verbal, for telepsychiatry services in addition to the usual consent for care -reporting requirements may vary by jurisdiction and ensure that relevant personnel at the distant (provider location) and originating (patient location) sites are informed of reporting requirements for youth -Telepsychiatrists should comply with the AACAP Code of Ethics -absence of a comprehensive policy for delivering telemedicine services, individual states have proposed legislation to expand services: • reimbursing for school-based telepsychiatry services • repealing laws that mandate minimum distance requirements between distant and originating sites in order to receive reimbursement 7 Child & Adolescent Telepsychiatry: Patient Safety - CORRECT ANSWER>>-·Psychiatrists telecommuting to any setting must consider whether appropriate emergency management protocols are in place and develop any needed protocols. -utilizes the local community's emergency resources -Telesychiatrists managing emergencies must rely on a team of individuals -· need to be able to effectively manipulate telepsychiatry technology in order to maximize video and audio quality to optimally assess signs of agitation, substance use, and medication side effects. • If technology falters, psychiatrists should be prepared to quickly initiate a pre-planned backup emergency management plan. The Ryan Haight Online Consumer Pharmacy Protection Act of 2008 - CORRECT ANSWER>>impacts the legitimate practice of child and adolescent telepsychiatry. -requirement for the initial in-person evaluation is a major barrier for telepsychiatry with youth and the exceptions to this requirement are narrow and do not apply to many telepsychiatry applications. The Ryan Haight Act is relevant to the increasing trend towards: - CORRECT ANSWER>>direct- to-consumer telepsychiatry as the home setting is not an approved site of service for prescribing controlled substances. Child & Adolescent Telepsychiatry: Developing a Virtual Therapeutic Space - CORRECT ANSWER>>-starts with the rooms at both the patient's and psychiatrist's sites -rooms should be set up to establish a typical clinical experience -psychiatrist's room should be conservatively appointed both to facilitate the camera's focus and to not distract the patient -patient's room should be of appropriate size to optimally conduct a mental status examination • including observation of gross motor and fine motor skills, affect and relatedness Health Insurance Portability and Accountability Act (HIPAA) - CORRECT ANSWER>>provides a legal framework for handling client information -HIPAA rules help protect the privacy of the client's identifiable health information while facilitating communication among providers and other entities • ensure information is available for treatment and other purposes such as insurance benefits -health professionals may be held legally liable by state and federal law for breaching confidentiality Release of Information - CORRECT ANSWER>>-HIPAA guides the PMHNP in making decisions about when to share information based on their professional judgment to prevent harm • may be necessary for providers to share mental and behavioral health information to enhance treatment or ensure the health and safety of the client and others -PMHNPs are mandatory reporters in cases of suspected child abuse Duty to Warn - CORRECT ANSWER>>exception to requirements for confidentiality 10 -life-threatening emergencies -voluntary waived consent -client unable to make decisions and has no designated decision-maker -involuntary treatment A client who is alert and oriented declines the PMHNP's treatment recommendation for an antipsychotic in a non-emergent situation: Informed consent required Exception to informed consent - CORRECT ANSWER>>Informed consent required Rationale: The client has the capacity to consent and the situation is not emergent. The ethic of autonomy provides for the client to refuse treatment options. An agitated, hallucinating client with a diagnosis of schizophrenia and no designated decision- maker threatens to shoot his neighbors. The client acts out violently towards the security guard in the emergency department. The PMHNP orders haloperidol and lorazepam for the client. Informed consent required Exception to informed consent - CORRECT ANSWER>>Exception to informed consent Rationale: The client does not have the capacity to provide consent. A very anxious client is seeking treatment for anxiety symptoms. When the PMHNP begins to explain the treatment options, the client says she is too anxious to hear them and asks that the PMHNP select the best option. Informed consent required Exception to informed consent - CORRECT ANSWER>>Exception to informed consent Rationale: clients may choose to waive their right to informed consent. A client with depression is unhappy about the performance of the anti-depressant that has been prescribed and would like to discuss alternate treatment options with the PMHNP. Informed consent required Exception to informed consent - CORRECT ANSWER>>Informed consent required Rationale: Clients have a right to information about treatment options with associated risks and benefits. ______________________, or __________________, are treated differently than other types of mental health information and receive special protections under HIPAA - CORRECT ANSWER>>Psychotherapy notes, or process notes 11 -HIPAA Privacy Rule requires that clients provide authorization, using a HIPAA-compliant authorization form, before the disclosure of the notes for any reason -Providers are not required to provide their psychotherapy notes to the client. psychotherapy notes definition - CORRECT ANSWER>>"notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual's medical record" Must the PMHNP release a client's medical record to a client's insurer? - CORRECT ANSWER>>Yes Must the PMHNP release psychotherapy notes to the client? - CORRECT ANSWER>>No Must the PMHNP release medical records to the court with a subpoena? - CORRECT ANSWER>>Yes with client authorization Must the PMHNP release medical records to the client? - CORRECT ANSWER>>Yes Must the PMHNP release psychotherapy notes to another provider? - CORRECT ANSWER>>No Types of development the PMHNP should consider include: - CORRECT ANSWER>>cognitive and psychosocial development _________________ theory regarding human needs may also inform the PMHNP's approach to psychiatric interviewing. - CORRECT ANSWER>>Abraham Maslow's Piaget's cognitive stage: Sensorimotor - CORRECT ANSWER>>• 0-2 years of age • cognitive abilities based on reflexes • children master object permanence and causality Cognitive Development: Piaget's cognitive stages - CORRECT ANSWER>>-Sensorimotor -Preoperational -Concrete Operational -Formal Operational Piaget's cognitive stage: Preoperational - CORRECT ANSWER>>• 2-7 years of age • child can use mental representations, symbolic thought, and language • thinking is egocentric Piaget's cognitive stage: Concrete Operational - CORRECT ANSWER>>• 7-11 years of age • child uses logical operations when thinking and solving problems • thinking is concrete 12 Piaget's cognitive stage: Formal Operational - CORRECT ANSWER>>• 12 years and older • adolescent can use abstract reasoning in addition to logical operations • can understand theories, hypothesize, and comprehend abstract ideas such as love and justice Psychosocial Development: Erikson's developmental theory - CORRECT ANSWER>>individuals go through a series of eight stages of psychosocial development from birth to death -each stage, individuals must resolve a psychosocial crisis to move to the next stage • Unsuccessful resolution could impair the development of a healthy personality and sense of self, which could negatively impact mental health and relationships Erikson's psychosocial stages - CORRECT ANSWER>>-Infancy: Trust vs. Mistrust (birth-18 months) -Early Childhood: Autonomy vs. Shame and Doubt (ages 18 months-2 to 3 years) -Preschool: Initiative vs. Guilt (ages 3-5) -School Age: Industry vs. Inferiority (ages 6-11) -Adolescence: Identity vs. Role Confusion (ages 12-18) -Young Adulthood: Intimacy vs. Isolation (ages 19-40) -Middle Adulthood: Generativity vs. Stagnation (ages 40-65) -Maturity: Integrity vs. Despair (ages 65-death) Abraham Maslow's Hierarchy of Needs - CORRECT ANSWER>>motivational theory that examines people's behavior as it relates to five categories of needs -Needs arranged in a pyramid, most basic needs at the foundation: • self-actualization (top of pyramid) • esteem • love/social needs • safety • physiological (bottom of pyramid) Which theory would the psychiatric mental health nurse practitioner (PMHNP) most need to consider when conducting a psychiatric interview in the following situations? A 35-year-old homeless client is in the emergency department with suicidal ideations. Hierarchy of Needs Theory Psychosocial Development Theory Cognitive development Theory - CORRECT ANSWER>>Hierarchy of Needs Theory 15 Rationale: Parents and clients do not have a right to view a therapist's private psychotherapy notes. Special Considerations: Older Adults - CORRECT ANSWER>>When conducting a psychiatric interview with an older adult, the PMHNP must consider the following: -developmental issues of older adulthood -generational perspectives and beliefs -comorbid physical illness -polypharmacy -cognitive or sensory impairments -history of physical/mental disorders Sociocultural factors that may influence the experience and expression of health and of psychological problems in later life - CORRECT ANSWER>>gender race ethnicity socioeconomic status sexual orientation disability status urban/rural residence Older adults: changes that impact cognitive functioning - CORRECT ANSWER>>-Sensory deficits, especially vision and hearing -Physical health -Poverty -Medications -Active use of information processing strategies -Lifestyle factors -Neurodegenerative conditions Stereotypes about Older Adults may include: - CORRECT ANSWER>>Older adults have dementia Older adults have high rates of mental illness such as depression Older adults are not productive in the workplace Older adults are ill and frail Older adults are socially isolated Older adults have no interest in sex/intimacy Older adults are stubborn and inflexible Older adults are "cute" or "childlike" Family Educational Rights and Privacy Act (FERPA) - CORRECT ANSWER>>A federal law that governs student confidentiality in schools. 16 -requires that schools not divulge, reveal or share any personally identifiable information about a student or his/her family, unless it is with another school employee who needs the information to work with the student.