NR605 Midterm Exam questions and answers 100% verified guaranteed latest update, Exams of Psychotherapy

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Psychotherapy - - CORRECT ANSWER-nonpharmacological intervention -used to tx mental health diagnoses or distress -help clients improve functioning and well-being -talk therapy -provided by psychiatrists, psychologists, social workers, marriage and family therapists, counselors, and PMHNPs -may include individual, couple, family, or group sessions -Goals: symptom reduction, improvement in functioning, relapse prevention, empowerment, achievement of collaborative goals set by the client & therapist.

Methods of Collaboration - - CORRECT ANSWERIntraprofessional Collaboration -the interaction and efforts between two disciplines with the same profession

- Potential barriers: tension, large team size, high turnover, lack of familiarity and common goals, role ambiguity, generational differences, and lack of undergraduate nursing education on intraprofessional practice.

Transprofessional Collaboration -includes communication with various disciplines: physicians, physical/occupational therapy, and social services, along with others to ensure care is delivered safely

- Potential barrier: lack of training

Role of PMHNPs in Psychotherapy - - CORRECT ANSWER-unique, full-spectrum approach -may provide psychotherapy in addition to prescribing medications -providing client and family education -coordinating care and referrals as a part of the treatment plan -provide psychotherapy in a variety of ambulatory, emergency department, inpatient, and outpatient settings

Holistic Paradigm of Healing - - CORRECT ANSWER-holistic model of care with a focus on healing -Holistic therapy respects the complexity of each unique individual

- appr eciating the relationship between the client's mind, body, and spirit - recognizing the interdependence of all parts of the human system -Foundational to healing is the relationship between the client and therapist - Emotional connection in the relationshi p is critical to the success of psychotherapy - PMHNP approaches the nurse -client relationship with acceptance, empathy, patience, and kindness to create a space for healing -psychotherapy can help the individual accept dysregulation and disharmony in the present moment - achieves acceptance of the present, they may be able to let go of resistance, relax, and release fears

Theoretical Models in Psychotherapy - - CORRECT ANSWERMaslow's Hierarchy of Needs Health Belief Model Transtheoretical Model of Change

Maslow's Hierarchy of Needs - - CORRECT ANSWERframework for understanding client motivation -first four levels of need in the hierarchy (physiological needs, safety, love and belonging, and esteem) are sometimes referred to as deficiency needs (D-needs)

- Motivation decrea ses once D-needs are met

**- perceived benefits of treatment

• perceived barriers to treatment
• cues** to action - self -efficacy

Transtheoretical Model of Change - - CORRECT ANSWERassumes that behavior changes take place over time and that people move through stages of decision-making to make changes to behavior -stages:

**- precontemplation

• contemplation
• preparation
• action
• maintenance**

Nancy is a 64-year-old who is wondering if losing weight might benefit her self-esteem and self- confidence. Based on the transtheoretical model of change, which of the following actions by the PMHNP would be appropriate for Nancy if she is in the contemplation stage of change?

Ask Nancy to create a list of reasons that she wants to lose weight.

Refer Nancy to her primary provider to obtain medical clearance for an exercise program.

Explore Nancy's anxiety and emotional responses related to be - - CORRECT ANSWERAsk Nancy to create a list of reasons that she wants to lose weight.

Rationale: Creating a list of reasons to lose weight would be appropriate for the contemplation phase. Obtaining medical clearance for exercise is a part of the preparation phase of the Transtheoretical Model of Change. Exploring emotional responses to being overweight would be appropriate for the precontemplation phase. Addressing rewards for reinforcement of behaviors would occur in the action phase.

Treatment Hierarchy Framework - - CORRECT ANSWERtherapeutic aims at the base of the model must be addressed before the client can move up the triangle

Top: Stabilization Internal resources External resources Bottom: Foundational needs

strategies to support resource development and stabilization: - - CORRECT ANSWER-case management -provision of safety -stress management -management of physiological arousal -exercise -cognitive or dialectical behavioral therapy -role play

Processing - - CORRECT ANSWERinvolves helping clients explore the meaning of adverse life events -adapting memory, cognition, behavior, affect, and beliefs surrounding traumatic events

- achieve positive change

Cultural Considerations - - CORRECT ANSWERCulture shapes one's perceptions, attributions, emotions, and judgments in ways that are both conscious and unconscious -PMHNP must consider ethnicity, religion, race, class, cultural identity, and the cultural explanations of illness to effectively diagnose and treat mental health conditions -Outline for Cultural Formulation includes an assessment of the following categories:

**- cultural identity of the individual

• cultural conceptualizations of distress
• psychosocial stressors and cultural features of vulnerability and resi** lience

- if the encounter includes diagnosing and/or prescribing medications, a medical evaluation and management (E/M) base code should be used with an add-on psychotherapy procedure code

Medical Evaluation and Management Codes - - CORRECT ANSWERspecific five-digit E/M code -based on the type of client, location of service, and level of service

XX=20 new client office/inpatient visit XX=21 established client office/outpatient visit XX=24 consultation for office/outpatient XX=22 inpatient care

Medical Decision Making - - CORRECT ANSWERlevel of medical-decision-making (MDM) is rated as straightforward, low, moderate, or high -based on three components:

**- number of diagnoses

• amount of data being reviewed
• risk of mortality/morbidity** -The level of MDM is selected based on complexity

Psychotherapy Codes - - CORRECT ANSWER • 90832 - psychotherapy duration 16-37 minutes

- 90833 - psychotherapy duration 16-37 minutes used as an add on code to a E/M code - 90834 - psychotherapy 38-52 minutes - 90836 - psychotherapy duration 38 or more minutes used as an add on code to a E/M code - 90837 - psychotherapy 53 or more minutes - 90846 - family psychotherapy client not present - 90847 - family psychotherapy with client present - 90853 - group psychotherapy

Lori, a 42-year-old female, presents to the office for an initial consultation. She has just experienced a breakup after a 5-year relationship and is feeling "depressed." A comprehensive initial evaluation which includes chief complaint, history or present illness, medical history, previous psychiatric history, family history and a comprehensive review of systems was completed. Psychotherapy was included in the session - 18 minutes time.

provide the appropriate CPT code - - CORRECT ANSWER99205+

Rationale: The client is new to the practice (20) and presents with one problem which addressed 4 or more elements, had a comprehensive history and interview. No additional testing was needed, treatment was initiated (05). Psychotherapy was included in the session- 18 minutes time. Therapy goals were established and reviewed with the client.

Hannibal, a 23-year-old male, is admitted to an inpatient psychiatric facility with symptoms of auditory hallucinations, paranoia, and suicidal ideations. A comprehensive initial evaluation which includes chief complaint, history or present illness, medical history, previous psychiatric history, family history and a comprehensive review of systems was completed.

provide the appropriate CPT code - - CORRECT ANSWER 99223

Rationale: The client presents for initial hospital care (22) and has a high level of medical decision- making due to an acute illness that poses a threat to life (3).

Shakina, a 19-year-old transgender female, has been referred to the PMHNP from primary care. The PMHNP reviews the primary provider's note and identifies symptoms of bipolar I disorder. The PMHNP completes a comprehensive assessment and prescribes medications for the client.

provide the appropriate CPT code - - CORRECT ANSWER 99245

Rationale: The client has been referred (24), has complex medical decision-making needs (5) based on one undiagnosed new problem with an uncertain prognosis, required review of referral notes, and requires prescription drug management. No psychotherapy provided.

- To address disparities, the American Psychological Association (2022) advocates for the expansion and use of culturally and linguistically competent psychological and behavioral research and services

Legal & Ethical Considerations - - CORRECT ANSWERProvider initiated termination for cause Termination letters Court mandated treatment Process and progress notes

Code of Ethics for Nurses - - CORRECT ANSWERRespect for the Individual Commitment to the Healthcare Consumer Advocacy for the Healthcare Consumer Responsibility and Accountability for Practice Duties to Self and Others Contributions to Healthcare Environments Advancement of the Nursing Profession Collaboration to Meet Health Needs Promotion of the Nursing Profession

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 ANSWERInformed 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.

Exception to informed consent Informed consent required - - CORRECT ANSWERException 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.

Exception to informed consent Informed consent required - - CORRECT ANSWERException 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 ANSWERInformed consent required

Rationale: Clients have a right to information about treatment options with associated risks and benefits.

Circumstances that increase suicide risk: Individual Risk Factors - - CORRECT ANSWERPrevious suicide attempt History of depression and other mental illnesses Serious illness such as chronic pain Criminal/legal problems Job/financial problems or loss

Circumstances that protect against suicide risk: Relationship Protective Factors - - CORRECT ANSWERSupport from partners, friends, and family Feeling connected to others

Circumstances that protect against suicide risk: Community Protective Factors - - CORRECT ANSWERFeeling connected to school, community, and other social institutions Availability of consistent and high quality physical and behavioral healthcare

Circumstances that protect against suicide risk: Societal Protective Factors - - CORRECT ANSWERReduced access to lethal means of suicide among people at risk Cultural, religious, or moral objections to suicide

warning signs for suicide: - - CORRECT ANSWERTalking about being a burden Being isolated Increased anxiety Talking about feeling trapped or in unbearable pain Increased substance use Looking for a way to access lethal means Increased anger or rage Extreme mood swings Expressing hopelessness Sleeping too little or too much Talking or posting about wanting to die Making plans for suicide

Phases of Therapy - - CORRECT ANSWERInitiation Working Termination

Initiation of Therapy - - CORRECT ANSWER-one of the most important goals of the first session is establishing a therapeutic alliance

- fundamental component of successful therapy -comprehensive history & mental status examination - collect info to establish a psych iatric history and dx - guide the development of a tx plan -location, frequency of sessions, and payment -safety, primary consideration in psychotherapy - safety assessment should be conducted in the initial session, questions regarding suicidal and homicidal thoughts and thoughts of self-harm - collaboratively written safety plan should be created for any client identified to be at risk for self - harm

suicide - - CORRECT ANSWER-a leading cause of death in the U.S. -In 2020, suicide was the:

- 12th leading cause of death overall **- 2nd leading cause of death among individuals between the ages of 10 and 34

• 3rd leading cause of death among individuals between the ages of 35 and 44** -clients with mental health diagnoses such as mood disorders, psychotic disorders, and substance use disorder are at particularly high risk - 50% of those who die by suicide do not have a previous psychiatric history

safety plan includes: - - CORRECT ANSWERa prioritized list of coping strategies and resources the client can use when thinking about suicide or self-harm

Implementing the Safety Plan: 6 Step Process - - CORRECT ANSWERStep 1: Warning Signs Step 2: Internal Coping Strategies Step 3: Social Contacts Who May Distract from the Crisis Step 4: Family Members or Friends Who May Offer Help

-Miscellaneous -Adherence

Setting Goals and Duration of Therapy - - CORRECT ANSWER-overall goal of psychotherapy is to help clients gain self-awareness and decision-making -psychotherapy is goal-directed

- Goal -setting should be a collaborative process between the therapist and the client -duration of therapy varies - common for therapy to last for at least 3 -4 months - client's financial situation & insurance coverage may also impact the duration of therapy

Practical considerations for psychotherapy - - CORRECT ANSWERscheduling -outpatient therapy, sessions are typically scheduled in 45 to 50-minute blocks -permits time between sessions to document and prepare for the next -initial intake session may be up to 90 minutes -inpatient psychotherapy will vary based on unit scheduling & ind client needs.

Fees -Fees & payment options should be discussed during the initial visit -private practice typically collect insurance co-pays or fees directly -PMHNPs who work within a larger health system may not be responsible for discussing or collecting fees from clients -discuss charges for missed sessions as well as the required notification to prevent charges

confidentiality -paramount to establishing a therapeutic alliance -Providers must abide by the standards set by HIPAA as well as any applicable state laws

- must provide clients with information regarding HIPAA and explain what informa tion will be shared and with whom -mandated to report concerns of threat of harm to self or others and child abuse.

Psychotherapy Contracts - - CORRECT ANSWERnot required to begin therapy -best practice is to provide a written therapy contract detailing:

- terms o f the therapeutic relationship **- scheduling

• missed appointments
• fees
• confidentiality
• termination**

setting for psychotherapy - - CORRECT ANSWER-Create a warm, welcoming, and safe environment -tissues available -clock where it is visible by both therapist and client -ensure client and provider safety -Therapist should avoid sitting behind a desk

- instead sit 3 -4 ft. away but not directly across from client. -Office uses neutral décor

working phase of therapy - - CORRECT ANSWER-when therapeutic interventions typically take place. -content of the working phase is driven by:

**- client's diagnosis

• identified goals
• selected treatment modality**

Termination - - CORRECT ANSWERnumber of therapy sessions is often dependent on the type of therapy -CBT typically engage in 5-20 sessions

-client's needs are beyond the scope of the provider's competence or license, the provider may refer the client and terminate therapy -PMHNP changes employment or moves, they have a responsibility to provide a referral to another provider -Providers may consider termination for noncompliance or missed sessions -client presents a safety risk to the provider and the provider is unwilling to meet with the client in person, termination may be appropriate -Failure to pay or insurance authorization denial is not acceptable grounds for termination during a crisis

-PMHNP should prepare a termination letter that delineates the reasons for termination and provides recommendations regarding further treatment if applicable.copy of the letter should be retained in the client's records.

Court-Mandated Treatment - - CORRECT ANSWER-require treatment for individuals or families. -Mandated therapy may be ordered as an alternative to jail for clients with mental health or substance use disorders -Parents may be compelled to attend therapy during a divorce trial or as a stipulation to regain custody after allegations of abuse or neglect -Sex offenders may also be obligated to attend mandated therapy -Clients who fail to meet the requirements of court-mandated therapy may be found in contempt of court or be required to serve jail time -Confidentiality

**- provider may be required to share information with the court

• must frankly discuss the limits of confidentiality with the client**

psychotherapy documentation: Provider Responsibilities - - CORRECT ANSWERClinical Management -Informs the provision of care and provides a review of past proceedings -Supports the continuity of care when referrals or interdisciplinary care occurs

Legal Implications -Records may be shared during civil proceedings, such as for divorce or custody cases -Courts may subpoena records for criminal proceedings -Court-ordered counseling records may be shared with the court

Risk Management -Documentation of high-risk situations can be protective in litigation and should include:

**- situation

• severity of threat
• all possible interventions considered
• colleague consultations
• intervention implemented
• follow** -up

Process Notes versus Progress Notes - - CORRECT ANSWERProcess notes -personal tool for the therapist to record thoughts, feelings, observations, or hypotheses during or immediately following the session -private; Clients, other providers, and insurance companies may request access to process notes; however, the provider is not obligated to share them except in limited situations

Progress notes -contain treatment plan: history, diagnosis, medication details, and progress summaries -considered a part of the medical record and may be shared, as appropriate, with other providers, insurance companies, and the client.

Ruben is a 36-year-old who has been in therapy for 5 months. He is in the process of divorcing his wife of 12 years and is seeking custody of his daughter. His attorney has requested copies of his psychotherapy notes to use in support of the custody hearing. Can the therapist choose to share the psychotherapy notes?

Yes, no client authorization necessary