NR548 Final Exam 100% VERIFIED ANSWERS 2024/2025 CORRECT, Exams of Nursing

Download NR548 Final Exam 100% VERIFIED ANSWERS 2024/2025 CORRECT and more Exams Nursing in PDF only on Docsity! 1 / 17 NR548 Final Exam 100% VERIFIED ANSWERS 2024/2025 CORRECT 1. Telepsychiatry: 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 2. The American Psychiatric Association (APA, 2020) supports telemedicine as a legitimate component of a mental health delivery system when telepsy- chiatry services:: -benefit the client -maintain client autonomy, confidentiality, and privacy -when used consistent with APA medical ethics policies and established telepsychi- atry laws 3. Telepsychiatry services are provided in diverse settings, including:: • private practice • outpatient clinics • schools • nursing homes • correctional facilities • military facilities 4. telepsychiatry services are delivered through:: • videoconferencing technolo- gy • websites • recorded medical information • support or chat groups • asynchronous client-provider interactions social media • links to self-directed or assisted assessment 5. Benefits of telepsychiatry services:: • improved access to care • reduced costs • improved efficiency • improved integration of care 2 / 17 • decreased emergency department visits • fewer delays in care • improved continuity of care • reduction of transportation-associated barriers 5 / 17 21. best practices related to special populations: Geriatric: -include family as clinically appropriate -adapt care for cognitive or sensory impairment 22. best practices related to special populations: Military and Veteran: -be familiar with federal and organizational structures and guidelines -be familiar with military cultural competence 23. best practices related to special populations: Substance Use Disorder Treatment: -comply with federal, state, and local regulations related to prescribing controlled substances -coordinate with on-site staff as appropriate to ensure care coordination and moni- toring 24. best practices related to special populations: Inpatient and Residential Settings: -participate in administration and organizational meetings as appropriate -optimize use of site-staff for consultation and care coordination 25. best practices related to special populations: Primary Care: leverage telepsychiatry to support integrated care 26. best practices related to special populations: Rural: be aware of impact of rural environments in relation to firearm ownership, kinship, and geographic barriers to care 27. Typically, the standard operating procedures (SOP) addresses:: roles, re- sponsibilities, licensing, client identification, and systematic quality improvement. -backup plan to address technical difficulties is frequently included 28. standard protocols to support telepsychiatry services: (4 steps): Step 1: Confirm the name and credentials of provider and the name of the client. Step 2: Identify the location of the client. Step 3: Gather contact information for provider and client in case of interruption of session. 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. 6 / 17 29. Telehealthcare: 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 30. Forensic Mental Health Care: 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 31. Informed Consent: 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 32. Clinically unsupervised settings: -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 manage- ment 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 33. If a patient and/or a PSP will not cooperate in his or her own emergency management:: providers shall be prepared to work with local emergency personnel in case the patient needs emergency services and/or involuntary hospitalization. 34. Care Coordination: 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. 35. TECHNICAL CONSIDERATIONS: VIDEOCONFERENCING PLATFORM RE- QUIREMENTS: should select video conferencing applications that have the appro- priate 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 profes- 7 / 17 sional 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 36. TECHNICAL CONSIDERATIONS: security issues: -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) 37. telemental health PHYSICAL LOCATION/ROOM REQUIREMENTS: -both lo- cations 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 38. Child & Adolescent Telepsychiatry: Legal and Regulatory Issues: -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 39. Child & Adolescent Telepsychiatry: Patient Safety: -·Psychiatrists telecom- muting 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 10 / 17 working with the family: -John's sister -Law enforcement near the sister's home -A social worker from the Board of Developmental Disabilities who has been working with the family Rationale: The Privacy Rule permits a health care provider to disclose necessary information about a client to law enforcement, family members of the client, or other persons when the provider believes the client presents a serious and imminent threat to self or others. Specifically, when a health care provider believes in good faith that such a warning is necessary to prevent or lessen a serious and imminent threat to the health or safety of the client or others, the Privacy Rule allows the provider, consistent with applicable law and standards of ethical conduct, to alert those persons whom the provider believes are reasonably able to prevent or lessen the threat. 50. Informed Consent: for care and treatment is a fundamental ethical and legal principle -respects the client's autonomy in medical decision-making -Clients have the right to receive information and ask questions about recommended treatments so they can make decisions about their care that are consistent with their beliefs, values, and goals of treatment -Clients have the right to knowledge about their treatment under "reasonable prac- titioner" or "reasonable person" standards under U. S. law. -may change over time and in different circumstances • is an ongoing process 51. Steps to Obtaining Informed Consent: -Assess client ability to understand medical information & tx options & to make a voluntary decision -Present relevant information with accuracy and sensitivity, Should include informa- tion about: • Diagnosis • Nature and purpose of treatment options • Benefits, risks, and burdens of all treatment options, including forgoing treatment -Document informed consent conversation in the medical record, including all con- sent forms 52. Informed Consent: Documentation: Documentation of the discussion to ob- tain informed consent should include: -treatment plans with risks and benefits identified -reasonable alternatives with risks and benefits identified 11 / 17 -assessment of client understanding of the discussion *must demonstrate that the client participated in the decision-making process and that the client was not coerced into treatment 53. Exceptions to Informed Consent:: -client incapacitation -life-threatening emergencies -voluntary waived consent -client unable to make decisions and has no designated decision-maker -involuntary treatment 54. A client who is alert and oriented declines the PMHNP's treatment recom- mendation for an antipsychotic in a non-emergent situation: Informed consent required Exception to informed consent: 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. 55. 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: Exception to informed consent Rationale: The client does not have the capacity to provide consent. 56. 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: Exception to informed consent Rationale: clients may choose to waive their right to informed consent. 57. A client with depression is unhappy about the performance of the anti-de- pressant that has been prescribed and would like to discuss alternate treat- ment options with the PMHNP. Informed consent required 12 / 17 Exception to informed consent: Informed consent required Rationale: Clients have a right to information about treatment options with associat- ed risks and benefits. 58. , or , are treated differently than other types of mental health information and receive special protections under HIPAA: Psychotherapy notes, or process notes -HIPAA Privacy Rule requires that clients provide authorization, using a HIPAA-com- pliant authorization form, before the disclosure of the notes for any reason -Providers are not required to provide their psychotherapy notes to the client. 59. psychotherapy notes definition: "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" 60. Must the PMHNP release a client's medical record to a client's insurer?: Yes 61. Must the PMHNP release psychotherapy notes to the client?: No 62. Must the PMHNP release medical records to the court with a subpoena?- : Yes with client authorization 63. Must the PMHNP release medical records to the client?: Yes 64. Must the PMHNP release psychotherapy notes to another provider?: No 65. Types of development the PMHNP should consider include:: cognitive and psychosocial development 66. theory regarding human needs may also inform the PMHNP's approach to psychiatric interviewing.: Abraham Maslow's 67. Piaget's cognitive stage: Sensorimotor: • 0-2 years of age • cognitive abilities based on reflexes • children master object permanence and causality 68. Cognitive Development: Piaget's cognitive stages: -Sensorimotor -Preoperational -Concrete Operational -Formal Operational 69. Piaget's cognitive stage: Preoperational: • 2-7 years of age • child can use mental representations, symbolic thought, and language • thinking is egocentric 70. Piaget's cognitive stage: Concrete Operational: • 7-11 years of age • child uses logical operations when thinking and solving problems • thinking is concrete 15 / 17 • info. is contained in the therapist's psychotherapy notes • parent not designated as the child's personal representative • parent voluntarily agrees that info can be kept confidential • provider has a reasonable belief that abuse or neglect exists or parent is a danger to the child • provider believes it is not in the child's best interest to treat the parent as the child's representative 79. Interviewing children and adolescents: -PMHNP may need to speak with family members separately from the child to gain additional information about the child's mental health concern -Family issues and family dynamics often play a role in the child's or adolescent's psychiatric disorder -Common topics to cover in an adolescent interview include: • interests • school and activities • drug and alcohol use • sexual activity • conduct problems 80. In which of these situations would it be appropriate to share a child or adolescent's protected health information with a parent? A 12-year-old who has designated the parent to be the personal representative in a state allowing adolescents to consent to their treatment. Appropriate Inappropriate: Appropriate Rationale: In states where consent to treat is required and the child has indicated that the parent should be the personal representative, it would be appropriate to share the information so long as the PMHNP does not suspect abuse, neglect, or that sharing would not be in the child's best interests. 81. In which of these situations would it be appropriate to share a child or adolescent's protected health information with a parent? A 17-year-old on active duty in the Navy. Appropriate Inappropriate: Inappropriate Rationale: Under most state laws, an adolescent serving in the military would be 16 / 17 considered emancipated, therefore, the parent would not have the right to view the records without the adolescent's permission. 82. In which of these situations would it be appropriate to share a child or adolescent's protected health information with a parent? A parent requesting to see the therapist's psychotherapy notes from sessions with a 6-year-old child. Appropriate Inappropriate: Inappropriate Rationale: Parents and clients do not have a right to view a therapist's private psychotherapy notes. 83. Special Considerations: Older Adults: When conducting a psychiatric inter- view 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 84. Sociocultural factors that may influence the experience and expression of health and of psychological problems in later life: gender race ethnicity socioeconomic status sexual orientation disability status urban/rural residence 85. Older adults: changes that impact cognitive functioning: -Sensory deficits, especially vision and hearing -Physical health -Poverty -Medications -Active use of information processing strategies -Lifestyle factors -Neurodegenerative conditions 86. Stereotypes about Older Adults may include:: Older adults have dementia Older adults have high rates of mental illness such as depression Older adults are not productive in the workplace 17 / 17 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" 87. Family Educational Rights and Privacy Act (FERPA): A federal law that governs student confidentiality in schools. -requires that schools not divulge, reveal or share any personally identifiable infor- mation about a student or his/her family, unless it is with another school employee who needs the information to work with the student.