Psychiatric Nurse Practitioner Program- goals could include mastering pharmacology and psychotherapy interventions
PSYCHIATRIC- MENTAL HEALTH NURSE PRACTITIONER 4th Edition
Nursing Certification Review Manual Continuing Education Resource Clinical Practice Resource
Kathryn Johnson, MSN, PMHNP-BC, PMHCNS-BC
Dawn Vanderhoef, PhD, DNP, PMHNP-BC, PMHCNS-BC
Review and Resource Manual
ental H ealth
N urse P
eso urce M
PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER Review and Resource Manual, 4th Edition
Are you looking into how to advance your professional development through certification? Need a reliable and credible reference resource? No matter where you are in the process, make sure you have the most valuable review and resource tool at your disposal.
The Nursing Knowledge Center’s Psychiatric-Mental Health Nurse Practitioner Review and Resource Manual is a must-have tool for nurses planning to take the American Nurses Credentialing Center’s (ANCC’s) Psychiatric-Mental Health Nurse Practitioner certification exam.
Based on the official ANCC certification exam test content outline, this review and resource manual will help you:
n Study and analyze comprehensive material and concepts written by nursing experts.
n Develop a recommended seven-step plan to equip you for the exam and map out what to do on the day of the exam.
n Prepare for and familiarize yourself with psychological-mental health practitioner standards of practice.
n And much more …
Make the Psychiatric-Mental Health Nurse Practitioner Review
and Resource Manual a key resource in your certification preparation.
AMERICAN NURSES ASSOCIATION 8515 GEORGIA AVE., SUITE 400 SILVER SPRING, MD 20910-3492 1.800.284.2378 | 301.628.5000
©2016 American Nurses Association. All rights reserved. Nursing Knowledge Center is part of the American Nurses Association.
Completion of this or any other course(s)/material(s) does not imply eligibility for certification or successful performance on any certification examination, nor is it a requirement to qualify for certification. The American Nurses Credentialing Center (ANCC) does not endorse any products or services.
Review and Resource Manual
Psychiatric– Mental Health Nurse Practitioner
NURSING KNOWLEDGE CENTER
CONTINUING EDUCATION SOURCE
NURSING CERTIFICATION REVIEW MANUAL
CLINICAL PRACTICE RESOURCE
Published by American Nurses Credentialing Center
Kathryn Johnson, MSN, PMHNP-BC, PMHCNS-BC Dawn Vanderhoef, PhD, DNP, PMHNP-BC, PMHCNS-BC
Library of Congress Cataloging-in-Publication Data
Names: Johnson, Kathryn, 1947-, author. | Vanderhoef, Dawn, author. | Nursing Knowledge Center, publisher. Title: Psychiatric-mental health nurse practitioner review and resource manual / Kathryn Johnson, Dawn Vanderhoe. Other titles: Psychiatric-mental health nurse practitioner review manual Description: 4th edition. | Silver Spring, MD : Nursing Knowledge Center, American Nurses Association, 2016. | Preceded by Psychiatric-mental health nurse practitioner review manual / by Kathryn Johnson and Dawn Vanderhoef. 3rd edition. 2013. | Includes bibliographical references and index. Identifiers: LCCN 2016012871| ISBN 9781935213796 (pbk.) | ISBN 9781935213802 (ePub) | ISBN 9781935213819 (prc) | ISBN 9781935213826 (epdf) Subjects: | MESH: Psychiatric Nursing–methods | Education, Nursing, Continuing Classification: LCC RC438 | NLM WY 18.5 | DDC 616.89/0231–dc23 LC record available at http://lccn.loc.gov/2016012871
The American Nurses Association (ANA) is the only full-service professional organization representing the interests of the nation’s 3.1 million registered nurses through its constituent/ state nurses associations and its organizational affiliates. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and lobbying the Congress and regulatory agencies on healthcare issues affecting nurses and the public.
© 2016 American Nurses Association 8515 Georgia Ave., Suite 400 Silver Spring, MD 20910 All rights reserved. Third printing, August 2018
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INSTRUCTIONS FOR OBTAINING CONTINUING EDUCATION CREDIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . XI
CHAPTER 1 . Taking The Certification Examination . . . . . . . . . . . . .1
General Suggestions for Preparing for the Exam 1
About the Certification Exams 8
Internet Resources 9
CHAPTER 2 . Psychiatric–Mental Health Nurse Practitioner Role, Scope of Practice, and Regulatory Process . . . . . . . 11
Nurse Practitioner Advanced Practice Core Content 11
Nurse Practitioner Advanced Practice Specialized Content 12
History of the NP Role 13
Professional Role Responsibilities 16
Roles of the PMHNP 22
Culturally Competent Care and Special Populations 23
Case Study 1 29
Case Study 2 29
Answers to Case Study Discussion Questions 31
References and Resources 32
CHAPTER 3 . Theoretical Basis of Care . . . . . . . . . . . . . . . . . . . . . .37
Biopsychosocial Framework of Care 37
Classification of Psychiatric Disorders: DSM-5 38
Therapeutic Relationship 38
Developmental Theories 40
Foundational Theories Supporting PMHNP Role 41
Nursing Theories 47
Case Study 1 48
Case Study 2 48
Answers to Case Study Discussion Questions 49
References and Resources 49
CHAPTER 4 . Psychiatric–Mental Health Nurse Practitioner Professional Role and Health Policy: Leadership, Quality Improvement and Safety, Practice Inquiry, and Health Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . .51
Quality Improvement 55
Just Culture of Safety 55
Health Delivery Systems 56
Conflict of Interest 57
Rights of Clients 58
Health Policy Development 58
Case Study 59
Answers to Case Study Discussion Questions 60
References and Resources 60
CHAPTER 5 . Neuroanatomy, Neurophysiology, and Behavior . .63
The Nervous System 63
Neuroanatomy and the Brain 64
Neurophysiology and the Brain 68
Neuroimaging Assessment and Diagnostic Procedures 71
Case Study 1 76
Case Study 2 76
Answers to Case Study Discussion Questions 77
References and Resources 77
CHAPTER 6 . Advanced Health and Physical Health Assessment . .79
Physical Exam 79
Neurological Exam 80
Disease Prevention Activities 97
Gender-Based Medical Testing and Screening Recommendations for the General Public 99
Health Behavior Guidelines 101
Public Health Principles 103
Case Study 1 105
Case Study 2 105
Answers to Case Study Discussion Questions 107
References and Resources 107
CHAPTER 7 . Pharmacological Principles . . . . . . . . . . . . . . . . . . . 111
Concepts in Pharmacological Management 111
PMHNP Pharmacological Management Role 114
Case Study 1 120
Case Study 2 120
Case Study 3 120
Answers to Case Study Discussion Questions 122
References and Resources 123
CHAPTER 8 . Nonpharmacological Treatment . . . . . . . . . . . . . . .125
Individual Therapy 125
Group Therapy 127
Family Therapies 129
Complementary and Alternative Therapies (CATs) 132
Case Study 136
Answers to Case Study Discussion Questions 137
References and Resources 137
CHAPTER 9 . Depressive Disorders and Bipolar Disorders . . . . .139
Sadness as a Common Emotional State 139
Major Depressive Disorder (MDD) 140
Persistent Depressive Disorder (Dysthymia) 166
Grief and Bereavement 169
Premenstrual Dysphoric Disorder 173
Bipolar (BP) Disorder 173
Stevens Johnson Syndrome (SJS) 184
Cyclothymic Disorder 186
Case Study 189
Answers to Case Study Discussion Questions 191
References and Resources 191
CHAPTER 10 . Anxiety Disorders, Obsessive–Compulsive Disorder, and Trauma- and Stressor-Related Disorders . . . . .195
Anxiety Disorders 196
Panic Disorder 207
Specific Phobias (Simple Phobias) 211
Social Anxiety (Phobia) Disorder 214
Generalized Anxiety Disorder (GAD) 215
Separation Anxiety Disorder 218
Obsessive–Compulsive Disorder (OCD) 218
Posttraumatic Stress Disorder (PTSD) 222
Dissociative Disorders 225
Body Dysmorphic Disorder 226
Hoarding Disorder 226
Excoriation Disorder 226
Case Study 227
Answers to Case Study Discussion Questions 230
References and Resources 230
CHAPTER 11 . Schizophrenia Spectrum and Other Psychotic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .233
General Description of Psychotic Disorders 233
Schizophreniform Disorder 258
Schizoaffective Disorder 260
Delusional Disorder 262
Brief Psychotic Disorder 264
Shared Psychotic Disorder (Folie á Deux) 266
Case Study 268
Answers to Case Study Discussion Questions 269
References and Resources 269
CHAPTER 12 . Neurocognitive Disorders . . . . . . . . . . . . . . . . . . . .271
Cognitive Disorders 271
Major or Minor Neurocognitive Disorder Due to Traumatic Brain Injury 285
Case Study 291
Answers to Case Study Discussion Questions 292
References and Resources 292
CHAPTER 13 . Substance-Related and Addictive Disorders . . . . .293
Substance-Related Disorders 293
Case Study 308
Answers to Case Study Discussion Questions 310
References and Resources 310
CHAPTER 14 . Personality Disorders . . . . . . . . . . . . . . . . . . . . . . . .313
Personality Disorders 314
Case Study 324
Answers to Case Study Discussion Questions 325
References and Resources 325
CHAPTER 15 . Disorders of Childhood and Adolescence . . . . . . .327
Assessment and Care Planning for Children and Adolescents 327
Oppositional Defiant Disorder (ODD) 329
Conduct Disorder 332
Attention-Deficit Hyperactivity Disorder (ADHD) 335
Autism Spectrum Disorder 340
Rett Syndrome 343
Eating Disorders 346
Intellectual Disability 351
Disruptive Mood dysRegulation Disorder 355
Case Study 357
Answers to Case Study Discussion Questions 358
References and Resources 358
CHAPTER 16 . Sleep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .361
General Considerations 361
Case Study 1 369
Case Study 2 369
Case Study 3 369
Answers to Case Study Discussion Questions 370
References and Resources 371
CHAPTER 17 . Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .373
Intimate Partner Violence (IPV) 373
Sexual Assault and Abuse 376
Lethality Assessment 379
Violence in School 380
Suicide Assessment 380
Homicide: Early Warning Signs 381
Threats of Violence 381
Case Study 383
Answers to Case Study Discussion Questions 384
References and Resources 384
APPENDIX A . Review Questions . . . . . . . . . . . . . . . . . . . . . . . . . . .385
APPENDIX B . Review Question Answers . . . . . . . . . . . . . . . . . . . .409
INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .417
INSTRUCTIONS FOR OBTAINING CONTINUING EDUCATION CREDIT FOR STUDY OF THE PSYCHIATRIC–MENTAL HEALTH NURSE PRACTITIONER REVIEW AND RESOURCE MANUAL, 4TH EDITION The Nursing Knowledge Center offers continuing nursing education contact hours (CE) to those who review and study this manual and successfully complete an online module. To obtain CE credit you must purchase and review the manual, pay required fees to enroll in the online mod- ule, and complete all module components by the published CE expiration date including disclo- sures, pre- and posttests, and the course evaluation. The continuing nursing education contact hours online module can be completed at any time prior to the published CE expiration date and a certificate can be printed from the online learning management system immediately after suc- cessful completion of the online module. To purchase the online module for this manual visit the Nursing Knowledge Center’s online catalog at https://learn.ana-nursingknowledge.org/. Please contact online support with any questions about the CE or module.
Inquiries or Comments If you have any questions about the content of the manual please e-mail [email protected] You may also mail any comments to Editorial Project Manager at the address listed below.
Nursing Knowledge Center
Attn: Editorial Project Manager
8515 Georgia Avenue, Suite 400
Silver Spring, MD 20910-3492
Fax: (301) 628-5342
CE Provider Information ANA’s Center for Continuing Education and Professional Development is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
ANCC Provider Number 0023.
ANA is approved by the California Board of Registered Nursing, Provider Number CEP6178.
Disclaimer Review and study of this manual and successful completion of the online module do not guaran- tee success on a certification examination. Purchase of this manual and completion of the online module are not required to obtain certification.
TAKING THE CERTIFICATION EXAMINATION When you sign up to take a national certification exam, you will be instructed to go on- line and review the testing and review handbook (http://www.nursecredentialing.org/ GeneralTestingRenewalHandbook). Review it carefully and be sure to bookmark the site so you can refer to it frequently. It contains information on test content and sample questions. This is critical information; it will give you insight into the nature of the test. The agency will send you information about the test site; keep this in a safe place until needed.
GENERAL SUGGESTIONS FOR PREPARING FOR THE EXAM
Step One: Control Your Anxiety Everyone experiences anxiety when faced with taking the certification exam.
X Remember, your program was designed to prepare you to take this exam.
X Your instructors took a similar exam, and have probably talked to students who took exams more recently, so they know how to help you prepare.
X Taking a review course or setting up your own study plan will help you feel more confident about taking the exam.
Step Two: Do Not Listen to Gossip About the Exam A large volume of information exists about the tests based on reports from people who have taken the exams in the past. Because information from the testing facilities is limited, it is hard to ignore this gossip.
X Remember that gossip about the exam that you hear from others is not verifiable.
X Because this gossip is based on the imperfect memory of people in a stressful situa- tion, it may not be very accurate.
X People tend to remember those items testing content with which they are less com- fortable; for instance, those with a limited background in women’s health may say that the exam was “all women’s health.” In fact, the exam blueprint ensures that the exam covers multiple content areas without overemphasizing any one.
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Step Three: Set Reasonable Expectations for Yourself X Do not expect to know everything.
X Do not try to know everything in great detail.
X You do not need a perfect score to pass the exam.
X The exam is designed for a beginner level—it is testing readiness for entry-level practice.
X Learn the general rules, not the exceptions.
X The most likely diagnoses will be on the exam, not questions on rare diseases or atypical cases.
X Think about the most likely presentation and most common therapy.
Step Four: Prepare Mentally and Physically X While you are getting ready to take the exam, take good physical care of yourself.
X Get plenty of sleep and exercise, and eat well while preparing for the exam.
X These things are especially important while you are studying and immediately before you take the exam.
Step Five: Access Current Knowledge
You will be given a list of general topics that will be on the exam when you register to take the exam. In addition, examine the table of contents of this book and the test content outline, avail- able at http://nursecredentialing.org/FamilyPsychMentalHealthNP.
X What content do you need to know?
X How well do you know these subjects?
Take a Review Course
X Taking a review course is an excellent way to assess your knowledge of the content that will be included in the exam.
X If you plan to take a review course, take it well before the exam so you will have plenty of time to master any areas of weakness the course uncovers.
X If you are prepared for the exam, you will not hear anything new in the course. You will be familiar with everything that is taught.
X If some topics in the review course are new to you, concentrate on these in your studies.
X People have a tendency to study what they know; it is rewarding to study some- thing and feel a mastery of it! Unfortunately, this will not help you master unfamiliar content. Be sure to use a review course to identify your areas of strength and weak- ness, then concentrate on the weaknesses.
3taking the certification exaMination
Depth of Knowledge
How much do you need to know about a subject?
X You cannot know everything about a topic.
X Remember that the depth of knowledge required to pass the exam is for entry-level performance.
X Study the information sent to you from the testing agency, what you were taught in school, what is covered in this text, and the general guidelines given in this chapter.
X Look at practice tests designed for the exam. Practice tests for other exams will not be helpful.
X Consult your class notes or clinical diagnosis and management textbook for the ma- jor points about a disease. Additional reference books can be found online at http:// nursecredentialing.org/PsychNP-TestReferenceList.
X For example, with regard to medications, know the drug categories and the major medications in each. Assume all drugs in a category are generally alike, and then fo- cus on the differences among common drugs. Know the most important indications, contraindications, and side effects. Emphasize safety. The questions usually do not require you to know the exact dosage of a drug.
Step Six: Institute a Systematic Study Plan
Develop Your Study Plan
X Write up a formal plan of study.
Z Include topics for study, timetable, resources, and methods of study that work for you.
Z Decide whether you want to organize a study group or work alone.
Z Schedule regular times to study.
Z Avoid cramming; it is counterproductive. Try to schedule your study periods in 1-hour increments.
X Identify resources to use for studying. To prepare for the examination, you should have the following materials on your shelf:
Z A good pathophysiology text.
Z This review book.
Z A physical assessment text.
Z Your class notes.
Z Other important sources, including: information from the testing facility, a clinical diagnosis textbook, favorite journal articles, notes from a review course, and practice tests.
Z Know the important national standards of care for major illnesses.
Z Consult the bibliography on the test blueprint. When studying less familiar material, it is helpful to study using the same references that the testing center uses.
X Study the body systems from head to toe.
4 Psychiatric-Mental health nurse Practitioner review and resource Manual, 4th edition
X The exams emphasize health promotion, assessment, differential diagnosis, and plan of care for common problems.
X You will need to know facts and be able to interpret and analyze this information utilizing critical thinking.
Personalize Your Study Plan
X How do you learn best?
Z If you learn best by listening or talking, attend a review course or discuss topics with a colleague.
X Read everything the test facility sends you as soon as you receive it and several times during your preparation period. It will give you valuable information to help guide your study.
X Have a specific place with good lighting set aside for studying. Find a quiet place with no distractions. Assemble your study materials.
Implement Your Study Plan
You must have basic content knowledge. In addition, you must be able to use this information to think critically and make decisions based on facts.
X Refer to your study plan regularly.
X Stick to your schedule.
X Take breaks when you get tired.
X If you start procrastinating, get help from a friend or reorganize your study plan.
X It is not necessary to follow your plan rigidly. Adjust as you learn where you need to spend more time.
X Memorize the basics of the content areas you will be required to know.
Focus on General Material
X Most of what you need to know is basic material that does not require constant updating.
X You do not need to worry about the latest information being published as you are studying for the exam. Remember, it can take 6 to 12 months for new information to be incorporated into test questions.
Pace Your Studying
X Stop studying for the examination when you are starting to feel overwhelmed and look at what is bothering you. Then make changes.
X Break overwhelming tasks into smaller tasks that you know you can do.
X Stop and take breaks while studying.
Work With Others
X Talk with classmates about your preparation for the exam.
X Keep in touch with classmates, and help each other stick to your study plans.
5taking the certification exaMination
X If your classmates become anxious, do not let their anxiety affect you. Walk away if you need to.
X Do not believe bad stories you hear about other people’s experiences with previous exams.
X Remember, you know as much as anyone about what will be on the next exam!
Consider a Study Group
X Study groups can provide practice in analyzing cases, interpreting questions, and critical thinking.
X You can discuss a topic and take turns presenting cases for the group to analyze.
X Study groups can also provide moral support and help you continue studying.
Step Seven: Strategies Immediately Before the Exam
Final Preparation Suggestions
X Use practice exams when studying to get accustomed to the exam format and time restrictions.
Z Many books that are labeled as review books are simply a collection of examination questions.
Z If you have test anxiety, such practice tests may help alleviate the anxiety.
Z Practice tests can help you learn to judge the time it should take you to complete the exam.
Z Practice tests are useful for gaining experience in analyzing questions.
Z Books of questions may not uncover the gaps in your knowledge that a more systematic content review text will reveal.
Z If you feel that you don’t know enough about a topic, refer to a text to learn more. After you feel that you have learned the topic, practice questions are a wonderful tool to help improve your test-taking skill.
X Know your test-taking style.
Z Do you rush through the exam without reading the questions thoroughly?
Z Do you get stuck and dwell on a question for a long time?
Z You should spend about 45 to 60 seconds per question and finish with time to review the questions you were not sure about.
Z Be sure to read the question completely, including all four answer choices. Choice “a” may be good, but “d” may be best.
The Night Before the Exam
X Be prepared to get to the exam on time.
Z Know the test site location and how long it takes to get there.
Z Take a “dry run” beforehand to make sure you know how to get to the testing site, if necessary.
6 Psychiatric-Mental health nurse Practitioner review and resource Manual, 4th edition
Z Get a good night’s sleep.
Z Eat sensibly.
Z Avoid alcohol the night before.
Z Assemble the required material—two forms of identification, admission card, pencil, and watch. Both IDs must match the name on the application, and one photo ID is preferred.
Z Know the exam room rules.
X You will be given scratch paper, which will be collected at the end of the exam.
X Nothing else is allowed in the exam room.
X You will be required to put papers, backpacks, etc., in a corner of the room or in a locker.
X No water or food will be allowed.
X You will be allowed to walk to a water fountain and go to the bathroom one at a time.
The Day of the Exam
X Get there early. You must arrive to the test center at least 15 minutes before your scheduled appointment time. If you are late, you may not be admitted.
X Think positively. You have studied hard and are well-prepared.
X Remember your anxiety reduction strategies.
Specific Tips for Dealing With Anxiety
Test anxiety is a specific type of anxiety. Symptoms include upset stomach, sweaty palms, tachycardia, trouble concentrating, and a feeling of dread. But there are ways to cope with test anxiety.
X There is no substitute for being well-prepared.
X Practice relaxation techniques.
X Avoid alcohol, excess coffee, caffeine, and any new medications that might sedate you, dull your senses, or make you feel agitated.
X Take a few deep breaths and concentrate on the task at hand.
Focus on Specific Test-Taking Skills
To do well on the exam, you need good test-taking skills in addition to knowledge of the content and ability to use critical thinking.
All Certification Exams Are Multiple Choice X Multiple-choice tests have specific rules for test construction.
X A multiple-choice question consists of three parts: the information (or stem), the question, and the four possible answers (one correct and three distracters).
7taking the certification exaMination
X Careful analysis of each part is necessary. Read the entire question before answering.
X Practice your test-taking skills by analyzing the practice questions in this book and on the ANCC website.
Analyze the Information Given
X Do not assume you have more information than is given.
X Do not overanalyze.
X Remember, the writer of the question assumes this is all of the information needed to answer the question.
X If information is not given, it is not relevant and will not affect the answer.
X Do not make the question more complicated than it is.
What Kind of Question Is Asked?
X Are you supposed to recall a fact, apply facts to a situation, or understand and dif- ferentiate between options?
Z Read the question thinking about what the writer is asking.
Z Look for key words or phrases that lead you (see Figure 1 –1). These help determine what kind of answer the question requires.
Read All of the Answers
X If you are absolutely certain that answer “a” is correct as you read it, mark it, but read the rest of the question so you do not trick yourself into missing a better answer.
X If you are absolutely sure answer “a” is wrong, cross it off or make a note on your scratch paper and continue reading the question.
X After reading the entire question, go back, analyze the question, and select the best answer.
X Do not jump ahead.
X If the question asks you for an assessment, the best answer will be an assessment. Do not be distracted by an intervention that sounds appropriate.
X If the question asks you for an intervention, do not answer with an assessment.
of the following
most consistent with
FIGURE 1–1 . EXAMPLES OF KEY WORDS AND PHRASES
8 Psychiatric-Mental health nurse Practitioner review and resource Manual, 4th edition
X When two answer choices sound very good, the be
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