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| Section | Objectives |
|---|---|
| Ethics, Legal, and Professional Practice | - Patient Safety and Quality Improvement - Scope of Practice and Regulations - Ethical Decision-Making |
| Psychotherapeutic Modalities | - Group and Family Therapy - Individual Psychotherapy - Crisis Intervention |
| Scientific Foundations | - Pathophysiology and Psychopathology - Research and Evidence-Based Practice - Psychopharmacology |
| Advanced Practice Skills | - Diagnosis and Differential Diagnosis - Treatment Planning - Advanced Psychiatric Assessment |
| Diagnosis and Management of Psychiatric Disorders | - Mood Disorders - Psychotic Disorders - Personality Disorders - Substance Use Disorders - Anxiety and Trauma-Related Disorders |
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質問 # 1351
A PMHNP is reviewing a client's medical history and notes that the client has been prescribed an antipsychotic medication. What type of adverse effect is the PMHNP most concerned about regarding antipsychotics?
正解：C
解説：
Tardive dyskinesia is a serious adverse effect associated with the use of antipsychotic medications. This type of movement disorder can result from long-term use of these medications and is characterized by involuntary movements of the mouth, face, and tongue. PMHNPs must be vigilant for this adverse effect and monitor for its development in clients taking antipsychotics.
質問 # 1352
Your 55-year-old female client has been diagnosed with a delusional disorder that involves the client thinking that a particular famous actor is in love with her. You understand that this is which of the following types of delusional disorder?
正解：B
解説：
The correct type of delusional disorder in this scenario is "erotomanic." In an erotomanic delusional disorder, the individual firmly believes that another person, often someone of a higher status or a public figure, is in love with them. This belief persists despite clear evidence to the contrary and is not influenced by any real interaction or relationship that might justify such a conviction.
Erotomanic delusions typically involve idealized romantic love and spiritual union rather than sexual attraction. The object of the delusion is often unattainable due to their social status, their marital status, or their complete lack of personal acquaintance with the deluded person. The person with the delusion may believe that the object of their affection is communicating their love through subtle cues or secret messages.
This type of delusional disorder can lead to significant distress and problematic behaviors. For example, the individual may attempt to contact the object of their delusion through letters, phone calls, or even personal visits. In more severe cases, this can escalate to stalking, which can be perceived as threatening and can lead to legal consequences.
Treatment for erotomanic delusional disorder primarily involves psychotherapy. Cognitive-behavioral therapy (CBT) is often used to challenge and modify the delusional beliefs and reduce any resultant distress or dysfunction. Antipsychotic medications might also be prescribed depending on the severity and persistence of the delusions. Creating a supportive therapeutic environment is crucial to help the individual discuss their beliefs without judgment, fostering insight, and promoting healthier and more adaptive perspectives and behaviors.
In summary, the 55-year-old female client who believes a famous actor is in love with her, despite no reciprocal or realistic basis for this belief, is experiencing an erotomanic type of delusional disorder. This condition requires a careful and empathetic approach to treatment, focusing on psychotherapy and possibly pharmacological support to manage symptoms effectively.
質問 # 1353
A woman is brought to the emergency department by her husband. She has insulin-dependent diabetes with a history of medical noncompliance and missed medical appointments. The patient's husband is attentive and hovers by her side. She presents as possibly malnourished and dehydrated. She is crying and refusing to look at the provider, and her husband answers all the questions. When the provider asks him to leave the room so the patient can be assessed, the husband becomes angry and refuses.
What must be considered as part of a differential diagnosis, in addition to diabetic management and noncompliance?
正解：A
解説：
The PMH-BC should rule out IPV. Although the patient is a diabetic and some, if not all, of her symptoms can be explained by a lack of self-care, they are also signs of IPV.
The husband's refusal to leave the patient alone and insistence on answering her questions are suspicious. Victims of IPV often look unkempt and may present with signs of malnourishment and dehydration. Missed medical appointments and lack of self-care are also signature signs.
質問 # 1354
A PMHNP is reviewing their practice's HEDIS measures for behavioral health. Which of the following measures would be used to assess the percentage of patients with major depressive disorder who receive appropriate follow-up care after a new diagnosis?
正解：C
解説：
The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of performance measures used to assess the quality of care provided by healthcare organizations. HEDIS measures are used by health plans and other organizations to evaluate and compare the quality of care provided by different providers.
One of the measures used to assess the quality of care provided to patients with major depressive disorder is the Follow-up after hospitalization for mental illness. This measure assesses the percentage of patients who were hospitalized for a mental health condition, including major depressive disorder, and who received follow-up care within 7 or 30 days of discharge.
Depression remission or response for adolescents and adults is not a HEDIS measure. Antidepressant medication management and diabetes screening for people with schizophrenia or bipolar disorder who are using antipsychotic medications are HEDIS measures but do not assess the percentage of patients with major depressive disorder who receive appropriate follow-up care after a new diagnosis.
質問 # 1355
The federal government offered financial awards to encourage hospitals to implement meaningful use. Which of the following is least likely to be the outcome of this incentive program?
正解：C
解説：
The federal government offered financial awards to encourage hospitals to implement meaningful use. The incentive program required hospitals to demonstrate:
* Effective data capturing and sharing
* Technologically advanced clinical processes
* Improved patient outcomes
質問 # 1356
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