NR 548 EXAM 3 2024/25/26 PSYCHIATRIC ASSESSMENT FOR THE PSYCHIATRIC-MENTAL HEALTH NURSE, Exams of Nursing

Download NR 548 EXAM 3 2024/25/26 PSYCHIATRIC ASSESSMENT FOR THE PSYCHIATRIC-MENTAL HEALTH NURSE and more Exams Nursing in PDF only on Docsity!

Who the first organized training school within a hospital for the insane in 1882? - CORRECT ANSWER >>>Dr. Edward Cowles Who developed the first nurse-organized training course for psychiatric nursing at Johns Hopkins Hospital. - CORRECT ANSWER >>>Effie Jane Taylor Who recommended standards of training for psychiatric nurses, which led to improved education and standards of care? - CORRECT ANSWER >>>Laura Fitzsimmons What year brought a transition towards deinstitutionalization in care for those with mental illnesses, which led to an increase in the number of psychiatric patients receiving care in the NR548/ NR 548 EXAM 3 2024/2025/2026 PSYCHIATRIC ASSESSMENT FOR THE PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER REVIEW |WEEKS 5-6 COVERED WITH VERIFIED SOLUTIONS

community rather than hospitals? - CORRECT ANSWER

1950s What Act allowed for the expansion of the PMHCNS role into community and ambulatory settings as they helped those who had been deinstitutionalized adapt (ANA, 2014). - CORRECT ANSWER >>>The Community Mental Health Centers Act of 1963 occur in a hospital, psychiatric facility or community setting. These services focus on psychiatric and substance-related emergencies. - CORRECT ANSWER >>>Crisis intervention and psychiatric emergency services is a short-term treatment. It occurs in the inpatient setting providing care for acutely ill patients at risk for harming self or others or unable to meet basic needs due to impairment. The focus is crisis stabilization. - CORRECT ANSWER >>>Acute inpatient care may admit clients directly or accept transfers from acute inpatient care. They provide intermediate or long-term care for patients at chronic risk to self or others or unable to function without supervision and support due to mental disorders. They include treatment, habilitation and rehabilitation and may be public, private, or state hospitals operated through the criminal justice system. - CORRECT ANSWER >>>Intermediate and long- term care

Has provided recommendations for licensure, accreditation, certification, and education (LACE) pertaining to all APRN practice. PMHNP certification exam criteria is set by the American Nurses Credentialing Center (ANCC). - CORRECT ANSWER >>>The consensus model focuses on the application of competencies, knowledge, and experience to individuals, families, or groups with complex psychiatric-mental health problems - CORRECT ANSWER

Role of the PMHNP-APRN involves a formally structured relationship between the therapist (PMHNP) and the healthcare consumer that applies evidence-based methods to effect negotiated outcomes. - CORRECT ANSWER >>>Psychotherapy The PMHNP prescribes or recommends pharmacologic agents and may order and interpret diagnostic and lab tests to assess treatment response or monitor for adverse effects. - CORRECT ANSWER >>>Psychopharmacological management The PMHNP is responsible for the coordination of care and related decision-making about mental health care for a client, family, group, or population. - CORRECT ANSWER >>>Case management The PMHNP engages in the design, implementation, management, and evaluation of programs, systems, or policies

to address the mental health needs of a population at risk for developing mental health problems through prevention, health promotion, identification and reduction of risk factors, screening, and early intervention. - CORRECT ANSWER

Program, system, and policy development management The role involves "the assessment, diagnosis, and treatment of behavioral, cognitive, developmental, emotional, and spiritual responses of individuals, families, and significant others with co-occurring [actual or potential] physical illness(es) and/or dysfunction" (ANA, 2014, p.33). The PCLN often works as a member of an interdisciplinary consultation-liaison team. - CORRECT ANSWER >>>Psychiatric Consultation-Liaison Nursing (PCLN) The PMHNP assists other mental health clinicians to evaluate their practice, expand their skills, and meet standards for ongoing peer supervision. Clinical supervision focuses on growth and development rather than performance evaluation. Administration, Education, and Research Practice: PMHNP may serve as administrators, educators, and researchers. - CORRECT ANSWER >>>Clinical Supervision: PMHNPs provide direct comprehensive mental health services in solo or group private practice settings or through contracts with other entities. - CORRECT ANSWER >>>Self employment The PMHNP functions as part of an interdisciplinary team, providing care and treatment for clients with mental disorders,

PMHNP: "Actually, schizophrenia is a chronic treatable disease, much like diabetes or other physical illnesses. Patients who have mental illness deserve compassion and care." - CORRECT ANSWER >>>Respect for the individual Scenario The client presents to the emergency department with hallucinations and is threatening self-harm. The PMHNP signs an involuntary admission order for emergent psychiatric care. Rationale The PMHNP demonstrates a commitment to the healthcare consumer by balancing the client's human rights with safety, including coercive measures when the client was unable to maintain their own safety. - CORRECT ANSWER

Commitment to the Healthcare consumer Scenario The PMHNP is sharing sexually explicit memes with a client that she saw earlier today in a group session. Rationale This is an unethical scenario. The PMHNP recognizes the power differential in the therapeutic relationship and understands that any sort of sexual activity or intimacies with current clients, their close family members, guardians, or significant others is unethical. - CORRECT ANSWER >>>Advocacy for the Healthcare Consumer

Scenario The PMHNP has overbooked her sessions today, so she asks the RN who works in her office to conduct one of her phone therapy sessions today. Rationale This is an unethical scenario. The PMHNP must understand the scope of other team members' practice in order to delegate appropriately. Conducting a counseling session is outside of the RN's scope of practice. - CORRECT >>>Responsibility and Accountability for Practice Scenario The PMHNP takes time for daily meditation to improve mindfulness and ease stress. Rationale The PMHNP is committed to practicing self-care, managing stress, and maintaining supportive relationships to meet personal needs outside of therapeutic relationships. - CORRECT ANSWER >>>Duties of self and others Scenario A PMHNP discovers her colleague is diverting scheduled medications to self-medicate anxiety. The PMHNP reports the concerns to the colleagues supervisor. Rationale

Scenario A PMHNP speaks at a school board meeting about the need develop policies to expand mental health services for underserved students. Rationale The PMHNP participates in policy development and implementation that recognizes PMH disorders as treatable and ensures that nursing care is delivered with respect to human needs and values without prejudice. - CORRECT ANSWER >>>Promotion of the Nursing Profession How mental health diagnoses affect the average life expectancy

• CORRECT ANSWER >>>on average, people with SMI die 25 years earlier than those without these illnesses, Mental Status Exam (MSE) - CORRECT ANSWER >>>-best tool for establishing a psychiatric diagnosis
• combination of observations, impressions, & interpretation of client responses
• Eval of patients:
• appearance
• behavior
• speech
• affect
• thought process
• thought content

• cognition mental health - CORRECT ANSWER >>>"a state of well-being in which every individual realizes his or her own potential, can cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community" mental status - CORRECT ANSWER >>>-refers to emotional (feeling) and cognitive (knowing) function
• functioning is inferred through assessment of an individual's behaviors:
• consciousness
• language
• mood and affect
• orientation
• attention
• memory
• abstract reasoning
• thought process
• thought content
• perceptions Factors that affect the interpretation of the MSE - CORRECT ANSWER >>>culture native language educational level literacy social factors

MSE: Speech - CORRECT ANSWER >>>Assess general speech qualities:

• rate
• fast, rapidly, slowly
• rhythm
• monotone or slurred
• latency
• volume
• soft, normal, or loud
• content
• increased or decreased pauses between questions and answers?
• General quality individual who presents with an extremely rapid and pressured speech with constant interruptions may be experiencing or - CORRECT ANSWER >>>hypomania or mania An absence of speech is seen with some diagnoses such as
  • CORRECT ANSWER >>>dementia non-sensical speech is often associated with
• CORRECT ANSWER >>>psychotic disorders MSE: Mood and Affect - CORRECT ANSWER >>>Mood
• client's state of mind or prevalent emotional state
• subjective
• typically self-reported

• Stable: mood is appropriate to their current situation
• other: bright, happy, angry, agitated, irritable, labile, anxious, depressed, or euphoric Affect
• physical manifestation of the client's emotional state as observed by the provider
• normal, blunted, flat, bizarre, dysphoric, or euphoric
• Qualities of affect
• stability (stable or labile)
• appropriateness
• range (does it change with diff. situations)
• intensity MSE: Thought Process - CORRECT ANSWER >>>-rate of thoughts and how they flow and are connected
• coherent vs. incoherent
• Normal: linear & goal-directed
• Other: loose, circumstantial, or tangential
• Clients may experience flight of ideas with little connection between thoughts or words
• Assessment: questioning client, listening to responses MSE: Suicidal and Homicidal Ideation - CORRECT ANSWER >>>- Direct terms should be used to assess suicide preoccupation and planning
• assess for homicidal ideation, intent, attempts, and plans
• critical to determine whether a plan exists
• access to the resources needed to execute the plan

• Stress, anxiety, and depression can also impact memory
• orientation, three-object recall
• Mini-Cog exam is commonly used to help rule out significant cognitive issues Two attention and concentration assessments - CORRECT ANSWER >>>digit span test
• patient is given 5 - 7 numbers & asked to repeat them forward and backward SSST
• pt asked to subtract 7 from 100 and to continue counting back by 7s until told to stop *research studies have not endorsed them
• SSST given to 132 normal adults, only 42% with errorless performance
• 325 hospitalized psychiatric pts given SSST, no diff. in performance from 50 healthy control subjects
• Digit span test among 60 elderly pts with memory impairment and 44 elderly who were healthy found no difference MMSE - CORRECT ANSWER >>>-Mini-Mental State Exam
• 30 - point questionnaire
• measures cognitive impairment in the areas of orientation, attention, memory, language, and visual-spatial skills
• method of monitoring deterioration over time
• age, education, and visual or hearing impairment may impact scores

• Most studies have defined poorly educated as 8 or fewer years of education—that is, no high school
• sensitivity of the test is high, specificity is low Interpret a mini-cog score - CORRECT ANSWER >>>(Total Possible Score: 0 - 5): Add the 3 - item recall and clock drawing scores together. Recall Score (Total Possible Score: 0 - 3)
• 1 point for each word correctly recalled Clock Drawing Score (Total Possible Score: 0 - 2)
• 2 points for normal clock (include all numbers, 1 - 12)
• 0 points for abnormal clock
• must be 2 hands present (one pointing to the 11 and one pointing to 2)
• hand length not scored Mini-Cog exam - CORRECT ANSWER >>>-streamlined dementia screen
• score range is from 0 - 5
• obtained from adding the 3 - item recall and clock drawing scores together.
• A total score of 0, 1, or 2 indicates higher likelihood of clinically important cognitive impairment
• A total score of 3, 4, or 5 indicates lower likelihood of dementia
• does not rule out some degree of cognitive impairment.

• When did World War II happen? (Any time in the 1930s or 1940s is adequate.)
• When was John F. Kennedy assassinated? (Sometime in the 1960s.)
• Lists of information
• screening for dementia is the set test: patient to name as many items (up to ten) as he can recall in each of four categories: colors, animals, fruits, and towns; max of 40, score of 25 or above excludes dx of dementia Personal Knowledge - CORRECT ANSWER >>>memory of remote personal events
• Cognitively intact patients should be able to tell you:
• Current address and phone number
• Names and ages of spouse, siblings, and children
• Spouse's birthday, wedding anniversary, and date and place of marriage (if married)
• Parents' names and birthdays (primarily for younger patients who are not married) MSE: Insight and Judgment - CORRECT ANSWER >>>-final components of the mental status exam
• determined to be good, limited, or poor depending on the actions the client has taken, awareness of their illness, and the plans they have for the future. Insight
• client's awareness of their illness or situation

Judgment

• ability to anticipate the consequences of their behavior and safeguard their well-being
• may be measured with a standard question but should be assessed throughout the entire interview Q's to probe for degree of insight - CORRECT ANSWER >>>-So, why do you think you've been having these problems?
• What do you think needs to happen for your life to improve? Pt's with poor insight may respond with:
• I don't know. You're the doctor.
• People need to stop hassling me. (A paranoid patient.) ABSATTC - CORRECT ANSWER >>>Mnemonic for Elements of the Mental Status Examination
• All Borderline Subjects Are Tough, Troubled Characters
• Appearance
• Behavior
• Speech
• Affect
• Thought process
• Thought content
• Cognitive examination closure - CORRECT ANSWER >>>-final phase of the psychiatric interview process
• provides the client with a summary and findings of the interview and allows for discussion of future plans