Description

1. Question: 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 action by the PMHNP would be appropriate if she is in the contemplation stage?
2. Question: Which therapeutic aims at the base of the Treatment Hierarchy Framework must be addressed before a client can move up the triangle?
3. Question: Which strategies support resource development and stabilization in the Treatment Hierarchy Framework?
4. Question: What does “processing” involve when helping clients explore the meaning of adverse life events?
5. Question: What cultural elements must a PMHNP consider when performing a Cultural Formulation?
6. Question: What is epigenetics and why is it relevant to psychiatric practice?
7. Question: What documentation elements are required for psychotherapy sessions (what must be included in records)?
8. Question: What are Clinical Procedural Terminology (CPT) considerations when billing for psychotherapy alone versus psychotherapy plus medical evaluation/management?
9. Question: For Lori (42-year-old new client; 18 minutes psychotherapy included in a comprehensive initial evaluation), what is the appropriate CPT code?
10. Question: For Hannibal (23-year-old admitted to inpatient psych with acute psychosis and comprehensive initial eval), what is the appropriate CPT code?
11. Question: For Shakina (19-year-old referred from primary care; comprehensive assessment and medication prescribed; no psychotherapy provided), what is the appropriate CPT code?
12. Question: For Steve (30-year-old returning client receiving medication management and CBT in a focused encounter), what is the appropriate CPT code?
13. Question: The PMHNP initiated a one-hour grief support group that may include family — what is the appropriate CPT code for group psychotherapy?
14. Question: The PMHNP can take steps to prevent client-initiated premature termination. Which strategies help promote completion of therapy? (Select all that apply.)
15. Question: Under what circumstances may a provider ethically terminate therapy for cause, and what documentation (e.g., termination letter) is required?
16. Question: In court-mandated treatment, what limits on confidentiality must be discussed with the client?
17. Question: A client who is alert and oriented declines the PMHNP’s recommendation for an antipsychotic in a non-emergent situation — is informed consent required or is this an exception to informed consent?
18. Question: An agitated, hallucinating client with no decision-maker threatens others and is violent; the PMHNP orders haloperidol and lorazepam — is this an exception to informed consent or is informed consent required?
19. Question: A very anxious client asks the PMHNP to select the treatment option because she is “too anxious to hear them” — can the client waive informed consent (exception) or is full informed consent required?
20. Question: A client unhappy with an antidepressant wants to discuss alternative treatments — is informed consent required or is this an exception?
21. Question: Which individual, relationship, community, and societal circumstances increase suicide risk? (Identify risk factor categories or examples.)
22. Question: Which individual, relationship, community, and societal factors protect against suicide risk? (Identify protective factor categories or examples.)
23. Question: What are common warning signs for imminent suicide risk?
24. Question: What are the six steps in implementing a suicide safety plan?
25. Question: What is the role and limitation of a no-suicide / no-harm contract in clinical practice?
26. Question: What elements comprise the “frame of the relationship” (rules and boundaries) in psychotherapy?
27. Question: What practical elements should be considered when establishing a psychotherapeutic environment (office setup, therapist seating, etc.)?
28. Question: How should goals and expected duration of therapy be set and discussed with the client?
29. Question: What practical scheduling and fee considerations must be discussed at intake (session length, fees, missed-session policy)?
30. Question: What are the core documentation differences between process notes and progress notes?
31. Question: Ruben’s attorney requests his psychotherapy notes for a custody hearing—can the therapist share psychotherapy notes without client authorization?
32. Question: What are key components and clinical/legal purposes of psychotherapy documentation (clinical management, legal implications, risk management)?
33. Question: During the working phase of therapy, what drives selection of therapeutic interventions?
34. Question: What steps should the PMHNP take when termination of therapy is initiated by the provider (termination for cause) to meet legal/ethical obligations?
35. Question: What special confidentiality issues apply when therapy is court-mandated (e.g., parental/custody cases, sex offenders)?
36. Question: Which strategies can the PMHNP use to reduce client-initiated premature termination related to finances, perceived lack of benefit, or relocation?
37. Question: What is included in a comprehensive initial safety assessment done in the initiation phase of therapy?
38. Question: When should safety planning be collaboratively written and who should be involved?
39. Question: What are the PMHNP roles in interprofessional collaboration and referrals (who to refer to and when)?
40. Question: How do reimbursement and CPT rules affect documentation and billing for psychotherapy plus medication management?
41. Question: The PMHNP can take steps to prevent client-initiated premature termination. Which strategies can be used to help promote the completion of therapy?
42. Question: Can the therapist choose to share the psychotherapy notes when Ruben’s attorney requests them for a custody hearing?
43. Question: Kathy is in court-mandated therapy, and the social worker requests her progress notes for investigation. Is the therapist obligated to provide the progress notes?
44. Question: Juanita’s mother requests psychotherapy notes to see her daughter’s progress, and Juanita agrees. Is the therapist obligated to provide the psychotherapy notes?
45. Question: Raghu’s therapist receives a subpoena requesting progress notes after Raghu was arrested for assault. Is the therapist obligated to provide the progress notes?
46. Question: Which theory would the PMHNP most need to consider when conducting a psychiatric interview with a 35-year-old homeless client presenting with suicidal ideation?
47. Question: Which theory would the PMHNP most need to consider when conducting a psychiatric interview with a 14-year-old foster child struggling to develop trusting relationships with foster parents?
48. Question: Which theory would the PMHNP most need to consider when conducting a psychiatric interview with a 4-year-old who is struggling to understand civil protests seen on television?
49. Question: A client and her husband approach the psychotherapist at a mutual friend’s party. The client introduces her husband to the provider. Is this a boundary violation?
50. Question: A psychotherapist holds the client’s hand during a retelling of a traumatic event after the client reaches out. Is this a boundary violation?
51. Question: A psychotherapist agrees to a blind date with a client’s sister. Is this a boundary violation?
52. Question: A psychotherapist realizes that her auto repair shop is managed by one of her clients and proceeds with the service. Is this a boundary violation?
53. Question: A psychotherapist orders flowers from a shop owned by a current client. Is this a boundary violation?
54. Question: A psychotherapist shares her history of sexual assault with a client who has had a similar experience. Is this a boundary violation?
55. Question: Aleksander received an inferior work evaluation and shouted at his child afterward. Which defense mechanism is he using?
56. Question: Frieda drinks heavily each night but denies having a drinking problem because she functions at work. Which defense mechanism does this represent?
57. 1. Question: The PMHNP can take steps to prevent client-initiated premature termination. Which strategies can be used to help promote the completion of therapy? Select all that apply.
58. 2. Question: 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?
59. Question: Kathy is a 32-year-old who has been in court-mandated therapy for two months after her children were removed from the home by Child Protective Services for suspected physical abuse and neglect. The social worker has requested copies of her progress notes as a part of the investigation. Is the therapist obligated to provide the progress notes?
60. Question: Juanita is a 17-year-old who has been in therapy for 3 months for major depressive disorder. Her mother is requesting a copy of her psychotherapy notes so she can better understand the progress her daughter is making. Juanita has indicated that she is “ok” with her mom accessing the notes. Is the therapist obligated to provide the psychotherapy notes?
61. Question: Raghu is a 22-year-old who has been in therapy for two years. Recently, he was arrested on charges of assault with a deadly weapon. The therapist receives a subpoena from the court with requests for his progress notes. Is the therapist obligated to provide the progress notes?
62. Question: Which theory would the psychiatric mental health nurse practitioner (PMHNP) most need to consider when conducting a psychiatric interview in the following situations?
    A 35-year-old homeless client is in the emergency department with suicidal ideations.
63. Question: Which theory would the PMHNP most need to consider when conducting a psychiatric interview in the following situations?
    A 14-year-old foster child struggling to develop trusting relationships with his foster parents.
64. Question: Which theory would the PMHNP most need to consider when conducting a psychiatric interview in the following situations?
    A 4-year-old is struggling to understand what she has seen on television about civil protests.
65. Question: A client and her husband approach the psychotherapist at a mutual friend’s party. The client introduces her husband to the provider who returns the greeting.
66. Question: A psychotherapist holds the client’s hand during the client’s retelling of a traumatic event after the client reaches out.
67. Question: A psychotherapist agrees to a blind date with a client’s sister.
68. Question: A psychotherapist was in a car accident and needs auto body work completed. When the psychotherapist arrives at the auto body shop suggested by the insurance company, she realizes that the shop is managed by one of her clients. The psychotherapist schedules the needed repairs.
69. Question: A client has a florist shop in town. The psychotherapist needs to send an arrangement to a friend and typically orders from another shop when he remembers that his client owns a shop. He orders the flowers from the client’s shop.
70. Question: A psychotherapist shares her history of sexual assault with a client who has had a similar experience.
71. Question: Aleksander received an inferior performance evaluation at work. When he arrived home after a long day, he shouted at his 3-year-old daughter for leaving her toys out in the playroom.
72. Question: Frieda drinks 5-6 alcoholic beverages each night when she comes home from work. She typically drinks until she passes out; however, she never drinks during the day and never misses work due to her drinking, though her drinking has impacted her relationship with her spouse. She does not believe that her drinking is a problem because she goes to work and pays bills on time.
73. Question: 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.
74. Question: 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.
75. Question: 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.