Exam (elaborations)
NR605 MIDTERM EXAM
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Exam of 36 pages for the course NR605 at NR605 (NR605 MIDTERM EXAM)
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NR605 MIDTERM EXAMPsychotherapy - 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 - answer- Intraprofessional 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 - 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 - answer- -holistic model of care with a focus on healing
-Holistic therapy respects the complexity of each unique individual
• appreciating 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 relationship 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 - answer- Maslow's Hierarchy of Needs
Health Belief Model
Transtheoretical Model of Change
,Maslow's Hierarchy of Needs - answer- framework 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 decreases once D-needs are met
-highest level of need, self-actualization, is considered a growth or being need (B-need)
• Once D-needs are met, clients can focus on self-actualization and personal growth
• As the B-need is met, motivation for further growth increases
self-actualized person - answer- is self-fulfilled
-Qualities exhibited by the self-actualized person include independence, autonomy,
creativity, and maturity
Maslow's Hierarchy of Needs Pyramid - answer- TOP: Self-actualization
-Morality, creativity, spontaneity, lack of prejudice, acceptance of facts
Esteem
-Self-esteem, respect, achievement, confidence
Love/Belonging
-Friendship, family, intimacy, sense of connection with others
Safety
-Security of body, of employment, of resources, of morality, of the family, and of health,
of property
Bottom: Physiological
-Air, food, water, shelter, clothing, sleep
Health Belief Model - answer- -used to explain and predict health behaviors
-a person's belief about a perceived threat of illness combined with belief in the
effectiveness of the recommended action predict the person's willingness to change
-constructs:
• perceived seriousness
• perceived susceptibility
• perceived benefits of treatment
• perceived barriers to treatment
• cues to action
• self-efficacy
Transtheoretical Model of Change - answer- assumes 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 - answer- Ask 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 - answer- therapeutic 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: - answer- -case
management
-provision of safety
-stress management
-management of physiological arousal
-exercise
-cognitive or dialectical behavioral therapy
-role play
Processing - answer- involves helping clients explore the meaning of adverse life events
-adapting memory, cognition, behavior, affect, and beliefs surrounding traumatic events
• achieve positive change
Cultural Considerations - answer- Culture 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 resilience
• cultural features of the relationship between the individual and clinician
• overall cultural assessment
Illness Perception - answer- psychodynamic approach
-attributes mental illness to environmental and psychosocial problems
biophysiological model
-attributes mental illnesses to chemical imbalances of neurotransmitters
epigenetics - answer- the study of how the environment and other factors change the
way genes are expressed
Documentation requirements - answer- -standard format of chief complaint, history of
present illness, review of systems, past psychiatric history, mental status exam,
diagnostic formulation, and treatment plan
-Psychotherapy sessions must include the following:
• target symptoms
• goals of therapy
• method of monitoring outcomes
• frequency of treatment
• clinical records to support relevant medical history
• results of diagnostic tests or
• procedures
• prognosis or progress to date
• estimated duration of treatment
Reimbursement - answer- Clinical procedural terminology (CPT) codes
-standardized codes used to communicate services completed to Medicare and other
insurance companies for reimbursement
-PMHNPs can bill for stand-alone psychotherapy using psychiatry specialty codes
• 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 - answer- specific 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
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