Exam 1: NR548/ NR 548 (NEW Update 2026/ 2027) Psychiatric Assessment for the PMHNP |Complete Guide with Questions and Verified Answers| 100% Correct- Chamberlain

Exam 1: NR548/ NR 548 (NEW Update 2026/ 2027) Psychiatric Assessment for the PMHNP |Complete Guide with Questions and Verified Answers| 100% Correct- Chamberlain Q. Who developed the first organized training school within a hospital for the insane 1882? A. Effie Jones B. Edward Cowles C. Dorothea Dix D. Loretta Ford ANSWER B. Edward Cowles Q. Which of the following is not a factor that led to treatment of psychiatric illness shifted away from hospital to community settings? A. Increased funding for psychiatric nursing education and training and led to a growth in university-level nursing education. B. Passage of legislation supporting the construction of community mental health centers. C. Establishment of Medicaid and Medicare. D. The changing of rules that governed involuntary confinement. ANSWER A. Increased funding for psychiatric nursing education and training and led to a growth in university-level nursing education. Q. PMHNPs can work in residential service setting. Which best describes residential service? A. It provides 24-hour care and housing for an extended period. B. It is a short-term treatment for acutely ill clients at risk for harming self or others or unable to meet basic needs due to impairment. C. It provides intermediate or long-term care for clients at chronic risk to self or others or unable to function without supervision and support due to mental disorders. D. It is a team treatment approach to provide comprehensive, community-based psychiatric treatment, rehabilitation, and support to persons with severe mental illness (SMI). ANSWER A. It provides 24-hour care and housing for an extended period. Q. PMHNPs can work in a partial hospitalization setting. Which best describes partial hospitalization? A. It provides short-term treatment for acutely ill clients at risk for harming self or others or unable to meet basic needs due to impairment. B. It focuses on psychiatric and substance-related emergencies C. It provides care in non-hospital community settings such as mental health clinics, homes, worksites, shelters, crisis centers, senior centers, group homes, or schools. D. It provides acute symptom management, intensive treatment, and safe housing for clients who do not require 24-hour medical management or nursing care. ANSWER D. It provides acute symptom management, intensive treatment, and safe housing for clients who do not require 24-hour medical management or nursing care. Q. PMHNPs can work in psychiatric emergency services. Which best describes psychiatric emergency services? A. It provide acute symptom management, intensive treatment, and safe housing for clients who do not require 24-hour medical management. B. It occurs in the inpatient setting providing care for acutely ill clients at risk for harming self or others or unable to meet basic needs due to impairment. C. It focuses on psychiatric and substance-related emergencies. D. It provides comprehensive, community-based psychiatric treatment, rehabilitation, and it provides individualized service 24 hours a day, 7 days a week. ANSWER C. It focuses on psychiatric and substance-related emergencies. Q. "The PMHNP assists other mental health clinicians to evaluate their practice, expand their skills, and meet standards for ongoing peer supervision" describes which of the following PMHNP roles? A. Clinical Supervision B. Case management C. Psychiatric Consultation-Liaison Nursing D. Administration, Education, and Research Practice ANSWER A. Clinical Supervision Q. "PMHNPs provide direct comprehensive mental health services in solo or group private practice settings or through contracts with other entities" describes which of the following PMHNP roles? A. Primary care B. Self-Employment C. Psychotherapy D. Case management ANSWER B. Self-Employment Q. PMHNPs can in the role of Psychiatric Consultation-Liaison Nursing. Which of the following best describes the Psychiatric Consultation-Liaison Nursing role? A. Prescribes or recommends pharmacologic agents and may order and interpret diagnostic and lab tests to assess treatment response or monitor for adverse effects. B. Work in collaboration or consultation with a primary care provider or independently provide behavioral health care in an integrated setting. C. Involves the assessment, diagnosis, and treatment of behavioral, cognitive, developmental, emotional, and spiritual responses of individuals, families, and significant others with co-occurring physical illness and/or dysfunction. D. Serves as administrators, educators, and researchers. ANSWER C. Involves the assessment, diagnosis, and treatment of behavioral, cognitive, developmental, emotional, and spiritual responses of individuals, families, and significant others with co-occurring physical illness and/or dysfunction. Q. Which of the following PMH APRN speciality areas are correctly paired with their definition? A. Integrative Programs- Involves the intersection of psychiatric nursing and the criminal justice system. B. Forensic Mental Health- Involves providing care and treatment for clients with mental disorders, including substance use disorders and co-occurring medical disorders. C. Disaster psychiatric mental health nursing- Involves the coordination of care and related decision-making about mental health care for a client, family, group, or population. D. Telehealth- Utilizes telecommunication technology to deliver care and treatment. ANSWER D. Telehealth- Utilizes telecommunication technology to deliver care and treatment. Q. The Consensus Model for APRN Regulation has provided recommendations for L.A.C.E pertaining to all APRN practice. What does the acronym L.A.C.E. stand for? A. Licensure and Association of Clinical speciality and Education B. Licensure Accreditation Certification and Examination C. Licensure Advanced placement Competency and Education D. Licensure Accreditation Certification, and Education ANSWER D. Licensure Accreditation Certification, and Education Q. How does mental health diagnoses affect the average life expectancy? A. Those with psychiatric and mental health conditions have a decreased life expectancy of approximately 6-15-years. B. There is no association with mental health diagnoses and life expectancy. C. Those with psychiatric and mental health conditions have a decreased life expectancy of approximately 20-years. D. Those with psychiatric and mental health conditions have an increased life expectancy of approximately 10-years if they are medication compliant. ANSWER C. Those with psychiatric and mental health conditions have a decreased life expectancy of approximately 20-years. Q. The PMHNP begins to develop a sexual relationship with their pediatric client's guardian. Which ethical principle does this violate? A. Commitment to the Healthcare Consumer B. Advocacy for the Healthcare Consumer C. Duties to Self and Others D. Collaboration to Meet Health Needs ANSWER B. Advocacy for the Healthcare Consumer Q. The PMHNP is committed to practicing self-care, managing their personal stress, and maintaining supportive relationships outside of work. Which ethical principle is applicable? A. Duties to Self and Others B. Commitment to the Healthcare Consumer C. Collaboration to Meet Health Needs D. Contributions to Healthcare Environments ANSWER A. Duties to Self and Others Q. The PMHNP understands that behavioral change may involve setback. Which ethical principle is applicable? A. Respect for the Individual B. Commitment to the Healthcare Consumer C. Advancement of the Nursing Profession D. Responsibility and Accountability for Practice ANSWER B. Commitment to the Healthcare Consumer Q. The PMHNP witnessed their using an a illegal substance but did not report this to leadership because they did not want to incite workplace conflict. Which ethical principle does this violate? A. Promotion of the Nursing Profession B. Contributions to Healthcare Environment C. Duties to Self and Others D. Respect for the Individual ANSWER B. Contributions to Healthcare Environment Person A: "I can't believe you deal with these people every day. Schizophrenics would drive ME crazy!" PMHNP: "Actually, schizophrenia is a chronic treatable disease, much like diabetes or other physical illnesses. Clients who have mental illness deserve compassion and care." Q. Which ethical principle is applicable? A. Advocacy for the Healthcare Consumer B. Advancement of the Nursing Profession C. Respect for the Individual D. Promotion of the Nursing Profession ANSWER C. Respect for the Individual Q. The client presents to the emergency department with hallucinations and is threatening self-harm. The PMHNP signs an involuntary admission order for emergent psychiatric care. Which ethical principle is applicable? A. Advocacy for the Healthcare Consumer B. Duties to self and others C. Respect for the Individual D. Commitment to the Health Care Consumer ANSWER D. Commitment to the Health Care Consumer Q. The scenario below best describes which clinical setting? The PMHNP is providing care to a 29-year-old client who presents with persistent sadness and hopelessness for the last two months. She is having difficulty sleeping and has a decreased appetite. This is the client's first contact with the healthcare system about her concerns. A. Community based care B. Crisis Intervention C. Primary Care D. Self-Empolyment ANSWER C. Primary Care The scenario below best describes which clinical setting? Two weeks after starting on an SSRI, the client begins to experience suicidal ideations and develops a plan to kill herself. A friend brings the client to the emergency room. The PMHNP meets the client at the emergency room and collaborates with the physician to coordinate care. A. Psychotherapy B. Case Management C. Crisis Intervention D. Acute PMHNP care C. Crisis Intervention The PMHNP gives a presentation at a national conference on best practices in depression treatment. Which ethical principle is applicable? A. Duties to Self and Others B. Advancement of the Nursing Profession C. Promotion of the Nursing Profession D. Contributions to Healthcare Environment B. Advancement of the Nursing Profession The PMHNP is a member of the ANA and NAMI and regularly participates in workgroups that seek to expand access to care for healthcare consumers with PMH disorders. Which ethical principle is applicable? A. Collaboration to meet health needs B. Promotion of the Nursing Profession C. Advocacy for the Healthcare Consumer D. Advancement of the Nursing Profession A. Collaboration to meet health needs Who developed the first nurse-organized training course for psychiatric nursing at Johns Hopkins Hospital? A. Effie Jones B. Edward Cowles C. Dorothea Dix D. Loretta Ford A. Effie Jones Which of the following is NOT considered disparities in mental health treatment? A. Neighborhood and Built Environment B. Increased use of Primary Care Behavioral Health (PCBH) C. Economic Stability D. Education B. Increased use of Primary Care Behavioral Health (PCBH) Which of the following best describes PMHNP standards of Practice, Standard 2: Diagnosis? A. PMHNPs facilitate the use of system and community resources to implement the plan of care. B. PMHNPs evaluate the accuracy of diagnosis and effectiveness of interventions in reaching the client's desired outcomes. C. The PMHNP must be able to use data obtained during the interview, examination, and diagnostic procedures to develop standard psychiatric and substance use diagnoses. D. The PMHNP must be able to perform a comprehensive, person-centered psychiatric and mental health diagnostic evaluation, using relevant diagnostic tests and procedures. C. The PMHNP must be able to use data obtained during the interview, examination, and diagnostic procedures to develop standard psychiatric and substance use diagnoses. PMH-APRN a nurse with graduate-level training who provides psychiatric-mental health care and promotes mental health across the lifespan -assess, diagnose and treat individuals and families who have psychiatric and/or substance disorders -work in a variety of health care settings and practices and are eligible for reimbursement through private insurers, HMOs, PPOs, Medicare and Medicaid ANA Code of Ethics: anticipatory guidance competency ANA Standards and Scope: Standard 5B: Health Teaching & Promotion -An educated professional nurse is aware of normal developmental and situational threats to wellness and can educate healthcare consumers to avoid them. • Example: Moving a toddler from a crib to a bed can prevent injury associated with climbing out of the crib at that developmental age. ANA Code of Ethics: the art of nursing is based on? caring and respect for human dignity ANA Code of Ethics: the fundamental principle of and attitude that the professional nurse must have as outlined in Provision 1 ANA Code of Ethics: Provision 1 -"the nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person" (ANA, 2015b, p. 1). ANA Code of Ethics: How should the nurse respond to the discovery of human trafficking in his or her practice? ANA Code of Ethics: Provision 8 -Nurses must "bring attention to human rights violations in all settings and contexts. . . . The nursing profession must respond when these violations are encountered" (ANA, 2015b, p. 33). Dr. Edward Cowles created in 1882 the first organized training school within a hospital for the insane 1913, Effie Jane Taylor developed the first nurse-organized training course for psychiatric nursing at Johns Hopkins Hospital (before early psychiatric nurses were trained by physicians) Following WWI, the National League for Nursing Education added: "nursing in nervous and mental diseases" to curriculum guides In WWII, many potential military recruits deemed unfit for service due to psychiatric concerns, while many veterans experienced combat-related neuropsychiatric conditions. Laura Fitzsimmons recommended: standards of training for psychiatric nurses, which led to improved education and standards of care. National Mental Health Act (NMHA) of 1946 -psychiatric nursing was recognized as one of the four core disciplines in psychiatric care and treatment -The act increased funding for psychiatric nursing education programs and contributed to a growth in university-based nursing education. 1954 -the first graduate program in psychiatric nursing was established at Rutgers University by Hildegarde Peplau • to prepare nurse therapists. -The first advanced practice nursing role was the psychiatric-mental health clinical nurse specialist (PMHCNS) role. The Community Mental Health Centers Act of 1963 (1950s brought a transition towards deinstitutionalization in care for those with mental illnesses, which led to an increase in the number of psychiatric clients receiving care in the community rather than hospitals) -The Community Mental Health Centers Act of 1963 allowed for the expansion of the PMHCNS role into community and ambulatory settings as they helped those who had been deinstitutionalized adapt 1965 Loretta Ford, RN and Henry Silver MD introduce the nurse practitioner role. 1973 ANA first published: Standards of Psychiatric-Mental Health Nursing Practice 1980s states began to grant: prescriptive authority to advanced practice registered nurse (APRN), adding medication prescribing and management to the traditional therapy role of the psychiatric mental health (PMH) APRN. 2000s these exams were developed: Certification exams for adult and family psychiatric mental health nurse practitioner (PMHNP) developed. -These exams were retired in 2015 when psychiatric certification exams were combined to a single Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) Certification (PMHNP-BC). The 21st Century Cures Act of 2016: -resulted in the creation of the U.S. Department of Health and Human Services (HHS) Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) -group is charged with compiling a summary of advances in serious mental illness (SMI) and serious emotional disturbance (SED) research, evaluating federal programs and treatment services related to SMI and SED, and making specific recommendations to better coordinate the administration of mental health services present: Current trends in care focus on integrated treatment of those with co-occurring medical and psychiatric diagnoses and co-occurring psychiatric and substance use disorders, leading to a need to add content in advanced health assessment, pharmacology, pathophysiology, and the diagnosis of psychiatric illness to graduate psychiatric nursing curricula. -Primary care has become the point of entry to psychiatric care for many clients. -PMHNPs are helping to address the growing need for primary mental health services and mental illness prevention. -Though the number of advanced practice psychiatric nurses has increased, there are still limitations in access for many clients, which has led to disparities in mental health treatment. PMHNP scope of practice broad and includes practice in a variety of possible roles and clinical settings -Education • A master's degree, post master's certificate, or doctoral degree is required for PMH APRN practice. -Clinical Practice Settings • Crisis intervention and psychiatric emergency services • Acute inpatient care • Intermediate and long-term care • Partial hospitalization and intensive outpatient treatment (IOP) • Residential services • Community-based care • Assertive Community Treatment (ACT) -PMHNP APRN Roles • Primary care • Psychotherapy • Psychopharmacological management • Case management • Program, system, and policy development management • Psychiatric Consultation-Liaison Nursing (PCLN) • Clinical Supervision • Self-Employment -PMH APRN Specialty Areas • Integrative programs • Telehealth • Forensic mental health • Disaster psychiatric-mental health nursing match the practice setting with the correct scenario: The PMHNP is providing care to a 29-year-old client who presents with persistent sadness and hopelessness for the last two months. She is having difficulty sleeping and has a decreased appetite. This is the client's first contact with the healthcare system about her concerns. Primary Care Rationale: This is the client's initial contact with the healthcare system about her concerns match the practice setting with the correct scenario: The client has experienced depressive symptoms. The PMHNP prescribes a selective serotonin reuptake inhibitor (SSRI). Pharmacologic Intervention Rationale: The PMHNP is prescribing psychopharmacotherapy for the client match the practice setting with the correct scenario: The PMHNP provides the client with some mindfulness techniques to try at home. Psychotherapy Rationale: The PMHNP is utilizing a psychotherapeutic approach to help the client gain insight match the practice setting with the correct scenario: Two weeks after starting on the SSRI, the client begins to experience suicidal ideations and develops a plan to kill herself. A friend brings the client to the emergency room. The PMHNP meets the client at the emergency room and collaborates with the physician to coordinate care. Crisis Intervention Rationale: Suicidal ideation with a plan is a psychiatric emergency requiring immediate intervention match the practice setting with the correct scenario: The client is admitted to the psychiatric and behavioral health unit at the local hospital for a 72-hour observation where the PMHNP works with her team providing treatment. The client remains hospitalized for a week while her medications are managed. The client attends individual and group therapy sessions. Acute PMHNP Care Rationale: Acute inpatient care occurs in an intensive hospital or psychiatric facility setting match the practice setting with the correct scenario: Following hospitalization, the client returns home but commutes to a treatment center for 4 hours a day 5 days per week for ongoing therapy, medication management, and psychoeducation Partial Hospitalization/Intensive Outpatient Treatment Rationale: Partial Hospitalization/Intensive Outpatient Treatment occurs when a client receives intensive therapy on an outpatient basis, often used when a client does not require 24-hour care but still require intense treatment match the practice setting with the correct scenario: The PMHNP serves as the point of contact person, coordinating the treatment team, which consists of the PMHNP, a social worker, and possibly a psychologist and psychiatrist Case Management Rationale: Case management involves oversight and/or coordination of care match the practice setting with the correct scenario: Over the course of 2 months, the client's condition improves. She is discharged from intensive outpatient treatment and begins weekly appointments with the PMHNP at the PMHNP's clinic Community-Based Care Rationale: Community-based care is provided in a non-hospital community setting match the practice setting with the correct scenario: A global pandemic limits face-to-face mental health visits, the PMHNP determines that the client requires ongoing mental health treatment. The PMHNP arranges to meet with the client via weekly interactive video sessions Telehealth Rationale: Telehealth services utilize telecommunication technology to deliver treatment to clients match the practice setting with the correct scenario: The PMHNP owns the private practice that is providing services to the client Self-Employment Rationale: The PMHNP is providing direct services through private practice Code of Ethics provides guidance to nurses about ethical behavior and mandates a minimum standard of practice -nine provisions within the Code • Within the nine provisions, three groupings exist • specific applications have been developed for PMHNP practice Code of Ethics 9 Provisions -Respect for the Individual • Provision 1: The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. -Commitment to the Healthcare Consumer • Provision 2: The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population. -Advocacy for the Healthcare Consumer • Provision 3: The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. -Responsibility and Accountability for Practice • Provision 4: The nurse has authority, accountability, and responsibility for nursing practice; makes decisions and takes action consistent with the obligation to promote health and provide optimum patient care. -Duties to Self and Others • Provision 5: The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. -Contributions to Healthcare Environments • Provision 6: The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care. -Advancement of the Nursing Profession • Provision 7: The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards of development, and the generation of both nursing and health policy. -Collaboration to Meet Health Needs • Provision 8: The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. -Promotion of the Nursing Profession • Provision 9: The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy. Match the ethical principles to the scenario it represents: Person A: "I can't believe you deal with these people every day. Schizophrenics would drive ME crazy!" PMHNP: "Actually, schizophrenia is a chronic treatable disease, much like diabetes or other physical illnesses. Clients who have mental illness deserve compassion and care." Respect for the Individual (Provision 1) Rationale: Respect for the individual affirms the worth and dignity of those with PMH disorders by advocating to overcome negative stigmas towards PMH diagnoses to ensure access to care. Match the ethical principles to the scenario it represents: The client presents to the emergency department with hallucinations and is threatening self-harm. The PMHNP signs an involuntary admission order for emergent psychiatric care. Commitment to the Healthcare Consumer (provision 2) Rationale: The PMHNP demonstrates a commitment to the healthcare consumer by balancing the client's human rights with safety, including coercive measures when the client was unable to maintain their own safety. Match the ethical principles to the scenario it represents: The PMHNP is sharing sexually explicit memes with a client that she saw earlier today in a group session. Advocacy for the Healthcare Consumer (provision 3) This is an unethical scenario. The PMHNP recognizes the power differential in the therapeutic relationship and understands that any sort of sexual activity or intimacies with current clients, their close family members, guardians, or significant others is unethical. Match the ethical principles to the scenario it represents: The PMHNP has overbooked her sessions today, so she asks the RN who works in her office to conduct one of her phone therapy sessions today. Responsibility and Accountability for Practice (provision 4) Rationale: This is an unethical scenario. The PMHNP must understand the scope of other team members' practice in order to delegate appropriately. Conducting a counseling session is outside of the RN's scope of practice. Match the ethical principles to the scenario it represents: The PMHNP takes time for daily meditation to improve mindfulness and ease stress. Duties to Self and Others (provision 5) Rationale: The PMHNP is committed to practicing self-care, managing stress, and maintaining supportive relationships to meet personal needs outside of therapeutic relationships. Match the ethical principles to the scenario it represents: A PMHNP discovers her colleague is diverting scheduled medications to self-medicate anxiety. The PMHNP reports the concerns to the colleague's supervisor. Contributions to Healthcare Environments (provision 6) Rationale: The PMHNP recognizes signs/symptoms of psychiatric disorders in the workplace reporting peer observations to leadership. The PMHNP helps address problems faced by colleagues that impact client safety or violate public trust, including substance abuse. Match the ethical principles to the scenario it represents: The PMHNP gives a presentation at a national conference on best practices in depression treatment. Advancement of the Nursing Profession (provision 7) Rationale: The PMHNP contributes to advancing the profession through practice, education, administration, and knowledge development. Match the ethical principles to the scenario it represents: The PMHNP is a member of the ANA and NAMI and regularly participates in workgroups that seek to expand access to care for healthcare consumers with PMH disorders. Collaboration to meet health needs (provision 8) Rationale: The PMHNP promotes community, national, and international efforts to meet health needs through collaboration with other healthcare professionals to promote prevention, treatment, and recovery. Match the ethical principles to the scenario it represents: A PMHNP speaks at a school board meeting about the need develop policies to expand mental health services for underserved students. Promotion of the Nursing Profession (provision 9) Rationale: The PMHNP participates in policy development and implementation that recognizes PMH disorders as treatable and ensures that nursing care is delivered with respect to human needs and values without prejudice. Strategies to eliminate disparities in behavioral health: -increasing the number of minority providers -improving access to services through telehealth and other technologies -examining and understanding the social determinants of health in underserved communities -using cultural humility to enhance communication in populations served -increasing the use of Primary Care Behavioral Health (PCBH) integrative practice clinics that provide medical and behavioral health services in one location Social Determinants of Health (SDOH) The World Health Organization (n.d., para. 1) defines the SDOH as "the conditions in which people are born, grow, live, work, and age. These conditions are influenced by economics, political influence, and resources at the global, national, and local levels." -Another key determinant of health is access to quality, affordable healthcare Healthy People 2030 a national initiative for discerning individual and population risk factors and health indicators -The Healthy People initiative developed a "place-based" organizing framework to consider SDOH which highlights five key areas of SDOH and underlying factors that may contribute to DISPARITIES. • Health and Health Care • Neighborhood and Built Environment • Social and Community Context • Economic Stability • Education Match the disparity to the key area of the Social Determinants of Health: Incarceration Crime and Violence Access to Mental Health Services Housing Instability Language and Literacy Incarceration - Social and Community Context Crime and Violence - Neighborhood and Built environment Access to Mental Health Services - Health and Healthcare Housing Instability - Economic Stability Language and Literacy - Education personal health literacy The U.S. Department of Health and Human Services (HHS) defined as "the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others" the leading causes of disability, disease burden, premature mortality, and suicide. neuropsychiatric disorders mental illness has ripple effects on: the person, family, community, and world impacts of mental illness Person -Reduced ability to maintain physical health -Increased risk of cardiovascular and metabolic disease -Increased risk for unemployment -DECREASED LIFE EXPECTANCEY 11-30 YEARS Family -Increased stress -Caregiver fatigue Community -Mental health and substance abuse disorders are involved in 1/8 ED visits by adults in U.S. -Mood disorders are the most common cause of hospitalization for those under 45 years of age in U.S. -Over $190 billion lost earnings -Increased risk for homelessness, incarceration World -Depression and anxiety cost global economy $1 trillion in lost productivity each year -Depression is the leading cause of disability worldwide Person-Centered, Recovery-Oriented Model of Public Health Substance Abuse and Mental Health Services Administration's (SAMHSA, 2022) strategic plan for -advancing recovery support services is essential for treating the opioid crisis and substance abuse disorders -improve access to and quality of care, reduce mental illness • Prevention • Screening • Early intervention • Integrated care • Innovative use of health information technology • Appropriate number and distribution of mental health professionals PMH-NPs fulfill three key roles provision of psychotherapy provision of psychopharmacological interventions provision of clinical supervision The Standards of Practice and Standards of Professional Performance for Psychiatric and Mental Health Nursing specify the minimum levels of acceptable performance which can legally be used to describe the standard of care that psychiatric mental health nurse practitioners (PMHNPs) must demonstrate -Each standard for the psychiatric mental health registered nurse (PMH-RN) also applies to the PMHNP role 17 standards of professional performance Guide PMHNP practice: Standard 1: Assessment Standard 2: Diagnosis Standard 3: Outcomes Identification Standard 4: Planning Standard 5: Implementation Standard 6: Evaluation Standard 7: Ethics Standard 8: Cultural Humanity Standard 9: Communication Standard 10: Professional Collaboration Standard 11: Leadership Standard 12: Education Standard 13: Evidence-Based Practice and Research Standard 14: Quality of Practice Standard 15: Professional Practice Evaluation Standard 16: Resource Utilization Standard 17: Environmental Health PMHNP standards of Practice: Standard 1 Standard 1: Assessment The PMHNP must be able to perform a comprehensive, person-centered psychiatric and mental health diagnostic evaluation, using relevant diagnostic tests and procedures. Evidence-based clinical practice guidelines inform screening and diagnostic activities when appropriate. Assessment may include a multigenerational family assessment as well as the assessment of interactions between the individual, family, community, and social systems as they relate to mental health. PMHNP standards of Practice: Standard 2 Standard 2: Diagnosis The PMHNP must be able to use data obtained during the interview, examination, and diagnostic procedures to develop standard psychiatric and substance use diagnoses. The PMHNP evaluates the effects of psychiatric disorders on recovery, quality of life, and functional status and may examine the impact of stressors, trauma, and situational crisis in the context of the family cycle. The PMHNP may assist other staff in developing competence in the diagnostic process. PMHNP standards of Practice: Standard 3 Standard 3: Outcomes Identification The PMHNP assists the PMH-RN to identify expected outcomes based on scientific evidence. Outcomes identification includes consideration of costs, clinical effectiveness, satisfaction, consistency, and continuity among providers. The PMHNP develops and applies clinical guidelines associated with positive clinical outcomes. PMHNP standards of Practice: Standard 4 Standard 4: Planning The PMHNP applies current evidence and expert clinical knowledge to the identification of assessment and diagnostic strategies and therapeutic interventions. Individualized plans of care incorporate the client's beliefs and values and may include treatment modalities such as psychopharmacology and psychodynamic, cognitive behavioral, and supportive interpersonal therapies. PMHNP standards of Practice: Standard 5 Standard 5: Implementation PMHNPs facilitate the use of system and community resources to implement the plan of care. The implementation standard incorporates coordination of care across disciplines; health teaching and health promotion; consultation; prescriptive authority and treatment; pharmacological, biological, and integrative therapies; milieu therapy, therapeutic relationships and counseling, and psychotherapy. The PMHNP functions as the single point of accountability for all medical and psychiatric services. PMHNP standards of Practice: Standard 6 Standard 6: Evaluation PMHNPs evaluate the accuracy of diagnosis and effectiveness of interventions in reaching the client's desired outcomes. Evaluation includes consideration of the impact of the plan of care on the client, family, group, community, and institutions. Results of evaluations may lead to recommendations for process, protocol, or policy changes. PMHNP standards of Practice: Standard 7 Standard 7: Ethics PMHNPs use the ANA Code of Ethics with Interpretive Statements to guide practice including informing the client of risks, benefits, and outcomes associated with care; participation in interprofessional teams to address ethical concerns; promotion of environments that support ethical care; and use of ethical principles to engage in advocacy for those with mental health problems, psychiatric disorders, and addiction services. PMHNP standards of Practice: Standard 8 Standard 8: Cultural Humanity PMHNPs engage in self-reflection to assess for personal biases when working with culturally diverse individuals, groups, and communities. They strive to cultivate curiosity about the experience and treatment desires of clients from diverse backgrounds. They promote an inclusive work environment and participate in lifelong learning to develop and reinforce working effectively and inclusively with diverse populations. PMHNP standards of Practice: Standard 9 Standard 9: Communication PMHNPs assess communication preferences of healthcare consumers, families, and colleagues. They seek to assess and improve personal communication skills, accurately conveying information, and thoroughly documenting care. They maintain communication with other members of the interprofessional and contribute their professional perspective. PMHNP standards of Practice: Standard 10 Standard 10: Professional Collaboration PMHNPs partner with other disciplines to improve care through activities that include consultation, education, research, and technological development. They model expert practice, mentor colleagues, and facilitate interprofessional processes. PMHNP standards of Practice: Standard 11 Standard 11: Leadership PMHNPs provide leadership by influencing decision-making bodies and health policy to promote person-centered, recovery-oriented mental health services, and improvement of the practice environment. They provide direction to interprofessional teams and design innovations to improve practice and health outcomes. PMHNPs model expert practice and mentor colleagues. PMHNP standards of Practice: Standard 12 Standard 12: Education PMHNPs seek current evidence to expand clinical knowledge, improve role performance, and increase understanding of professional issues. In the advanced role, they model expert practice; mentor RNs and other colleagues as appropriate; and participate in interprofessional teams that contribute to the promotion of interprofessional education, role development, advanced nursing practice, and health care. PMHNP standards of Practice: Standard 13 Standard 13: Evidence-Based Practice and Research PMHNPs contribute to nursing knowledge by conducting, appraising, or synthesizing research to improve healthcare practice. PMHNPs engage in activities that promote research and clinical inquiry, including the dissemination of research findings and the integration of current evidence into practice. PMHNP standards of Practice: Standard 14 Standard 14: Quality of Practice PMHNPs obtain and maintain professional certification at the advanced level. PMHNPs may evaluate the practice environment in relation to existing evidence, design quality improvement initiatives, and identify opportunities for the generation or use of research. PMHNP standards of Practice: Standard 15 Standard 15: Professional Practice Evaluation PMHNPs formally seek feedback regarding their practice from healthcare consumers, colleagues, peers, and others. They reflect on and evaluate their practice and role performance to model self-improvement. PMHNP standards of Practice: Standard 16 Standard 16: Resource Utilization PMHNPs effectively use organizational and community resources to create innovative, interprofessional plans of care that address healthcare consumers' concerns. Evaluation strategies demonstrate quality, cost-effectiveness, cost-benefit, and efficiency. PMHNPs build collaborative relationships to identify and meet resource needs. PMHNP standards of Practice: Standard 17 Standard 17: Environmental Health PMHNPs work to analyze the impact of social, political, and economic influences on the environment and human health exposures, creating partnerships that promote sustainable environmental health policies. Select the most appropriate standard for each scenario: The PMHNP prescribes clozapine for a client experiencing symptoms of schizophrenia. He reminds the client to follow up with the lab to have bloodwork drawn every two weeks to monitor white blood cell count. Standard 5: Implementation Rationale: Under the implementation standard 5D, the PMHNP prescribes pharmacologic agents based on current knowledge of pharmacology and physiology and provides healthcare consumers with information about intended effects and potential adverse effects of proposed prescriptive therapies. Select the most appropriate standard for each scenario: The PMHNP is treating a client who comes in with the following symptoms: trouble sleeping, low energy, difficulty concentrating, and a persistent sad mood for the last four weeks. Due to the symptoms, the client has withdrawn from her friends and is experiencing difficulties at work. The PMHNP correctly determines that the client's symptoms fit the criteria for Major Depressive Disorder. Standard 2: Diagnosis Rationale: Under the Diagnosis standard, the PMHNP develops standard psychiatric and substance use diagnoses. Select the most appropriate standard for each scenario: The PMHNP serves as a peer reviewer of articles for the Journal of the American Psychiatric Nurses Association. Standard 13: Evidence-Based Practice and Research Rationale: Under the Evidence-Based Practice and Research standard, the PMHNP contributes to nursing knowledge by conducting, critically appraising, or synthesizing research that discovers, examines, and evaluates knowledge, theories, criteria, and creative approaches to improve healthcare practice.