Exam 4: NR548/ NR 548 (2026/2027 Update) Psychiatric Assessment for the PMHNP |Questions with solutions- Chamberlain.

Exam 4: NR548/ NR 548 (2026/2027 Update) Psychiatric Assessment for the PMHNP |Questions with solutions- Chamberlain. Q. What must the chief complaint always include? ANSWER The patient's own words in quotation marks. Q. What are the major components of a psychiatric history? ANSWER Identifying info, CC, HPI, past psych hx, substance use, medical hx, meds, family hx, social hx, developmental hx, ROS, MSE. Q. What occurs in the working phase of the interview? ANSWER Gathering detailed history and assessing symptoms using therapeutic communication. Q. Name a therapeutic communication technique that validates feelings. ANSWER Reflection. Q. Give an example of a transition statement. ANSWER "Now I'd like to discuss how your mood has changed." Q. Where should the clinician sit during a psychiatric interview? ANSWER Nearest to the exit for safety. Q. When is a complete physical exam required? ANSWER First psychiatric visits, new-onset symptoms, suspected medical causes. Q. Define transference. ANSWER Patient projects feelings from past relationships onto clinician. Q. Define countertransference. ANSWER Clinician projects personal feelings onto the patient. Q. What does OLDCARTS stand for? ANSWER Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Timing, Severity. Q. Which type of ROS assesses hallucinations, mood, SI/HI? ANSWER Psychiatric ROS. Q. Hyperthyroidism commonly mimics what psychiatric condition? ANSWER Anxiety. Q. UTI causing acute confusion is most consistent with what condition? ANSWER Delirium. Q. What is the risk of bipolar disorder if one parent has it? ANSWER Approximately 10-25%. Q. Why is family history essential? ANSWER Helps predict genetic risk and medication response. Q. Why ask about job performance during a psych interview? ANSWER To assess functional impairment. Psychiatric History components include: - chief complaint - history of the present illness (HPI) - psychiatric history - medical history - family history - social and developmental history Q. Chief Complaint ANSWER - Verbatim statement of the client's reason for seeking treatment or evaluation. - Using the client's own words to document the chief complaint, even if improbable or nonsensical, conveys valuable information about the client's capacity for self-observation and insight. Q. History of present illness (HPI) ANSWER - A concise, clear, chronological description of the chief complaint. - The HPI details what the client believes to be causing the present symptoms. - The HPI includes recent psychiatric symptoms, including both pertinent positives and negatives. - To be diagnostically useful, symptom characteristics should be described in detail. - The provider should gather information about the timeframe of symptom onset or exacerbation, triggers or stressful life events, and recent treatment and treatment changes. Information about the nature of the symptoms, when they emerged, and how they have progressed is essential. Q. Psychiatric History ANSWER - Describes previous episodes of mental health symptoms, whether treated or not. - The history should detail the initial onset of symptoms and progress chronologically to the current episode. - Symptom characteristics and progression should be described in detail. - If the client has taken psychiatric medication in the past, the psychiatric history should note which drug(s) have been prescribed, the dosage and length of treatment, and the client's response to treatment. - The provider should note which medications have been therapeutic and whether the client experienced adverse effects. - If the client has received psychotherapy, the PMHNP should note which therapy modality was used, the frequency and length of therapy, and any benefits the client experienced. - Previous psychiatric hospitalizations should be noted, as should past suicide attempts, ideation, or episodes of self-harm. Q. Medical History ANSWER - A thorough, accurate medical history helps inform the psychiatric interview. - The past medical history (PMH) encompasses information about all current and past medical conditions from childhood and adulthood including physical, surgical, psychiatric, and obstetric/gynecologic health history, and health maintenance. - A major medical illness or surgery may precipitate a psychiatric disturbance while underlying medical conditions will inform diagnosis and treatment decisions. - The PMHNP should obtain the name and dosing schedule for all currently prescribed medications to avoid the risk of adverse interactions with new psychiatric prescriptions. - Similarly, client use of tobacco, alcohol, or other substances should be detailed. - The PMHNP should conduct a brief review of systems (ROS). Q. Medical diagnoses may present with psychiatric symptoms, including but not limited to: ANSWER - hyperthyroidism: anxiety, panic attacks, and mood swings - hypothyroidism: depression, difficulty sleeping, and loss of appetite - diabetes: mood disturbances - chronic pain: depression, anxiety, poor sleep - serious or terminal illnesses such as cancer or chronic autoimmune disorders: anxiety and depression Q. Family psychiatric history ANSWER - Many psychiatric disorders have a genetic component. - Information about a client's family's psychiatric history, including which treatments have been successful or unsuccessful, may help inform the diagnosis and treatment planning. - Information from the family history also helps identify family members who may be available for support, what stresses may have been caused by the client's symptoms, and who may be contributing to the exacerbation of the client's condition. Q. Social and developmental history ANSWER - The client's social and developmental history helps the PMHNP gain insight into the client's home life, childhood experiences, and relationships. - Information about relationships with parents, siblings, and others outside the family can help the provider identify available systems and assess the client's ability to form and maintain long-term relationships. - Education and employment histories also provide valuable information about the client's life. Q. Questions: Psychiatric History ANSWER Have you ever been hospitalized for any mental health issues? Have you ever had counseling or psychotherapy? Have you ever taken medications for your mental health in the past? Are you currently on any medications for mental health or sleep? Q. Questions: Family Psychiatric History ANSWER Has any relative of yours ever been hospitalized for a mental health issue? Has any blood relative of yours ever been diagnosed with a mental health issue? Has any blood relative of yours had a history of seizures or dementia/Alzheimer's? Q. Questions: Social and Developmental Issues ANSWER Tell me a little bit about your childhood and how you grew up. How was your experience in school when you were younger? Did you enjoy school? How do you support yourself with your finances? Do you have a good support system? Are you currently in a relationship? Where do you live? Who do you live with? What do you do in your free time? What activities do you enjoy? Questions: Medical History/Screening for General Medical Conditions Do you have a primary care provider? Do you have any medical illnesses? Are you currently taking any medications or herbal supplements? Do you have any allergies to medications? Have you ever been hospitalized for any reason? Have you ever had surgery? Questions: History of Present Illness How long have you been feeling this way? Did something happen in your life that may have triggered these emotions? How is this current situation impacting your life? Chief Complaint The chief complaint is the primary problem that prompted the client to schedule a visit with the provider and is a starting point to begin information gathering. When documenting the chief complaint, attempt to use the client's own words. For a client who presents with multiple complaints, it is important to determine if a relationship exists between the symptoms and if there is a primary problem with accompanying symptoms. If the client reports no specific complaints, report the reason for their visit such as "I am here for a regular check-up." History of Present Illness (HPI) The history of the present illness is a concise, clear, and chronological description of the chief complaint which prompted the client's visit. A symptom analysis guided by the mnemonic "OLDCARTS" will reveal information regarding the onset, location, duration, characteristics, aggravating factors, relieving factors, treatments, and severity of the symptoms. Documentation of History of Present Illness (HPI) - The history of present illness documentation should include an opening statement, a characterization of the chief complaint in chronological order, pertinent positive symptoms, pertinent negative symptoms, and other relevant information from the history. - Pertinent positives are symptoms that are expected with a potential diagnosis related to the chief complaint. - Pertinent negatives are symptoms the client does not have that are expected with a potential diagnosis related to the chief complaint. Past Medical History The past medical history includes all current and old medical problems. It should include childhood and adult medical, surgical, psychiatric, and obstetric/gynecologic health information, as well as health maintenance information. - Childhood illnesses: Inquire about childhood illnesses such as measles, chickenpox, or scarlet fever and chronic childhood illnesses such as diabetes or asthma. - Obstetric/Gynecologic: Document the number of pregnancies (gravida), number of deliveries (para-term, preterm, abortions, and living children), menstrual history, methods of contraception, and sexual function. - Adult illnesses: Inquire about illnesses such as diabetes, hypertension, or asthma and hospitalizations. - Psychiatric: Document diagnoses, hospitalizations, treatments, and the time frame. - Surgical: Document dates, indications, and types of surgical procedures. - Health maintenance: Document immunizations and screening tests such as pap smears, mammograms, or colonoscopies. Include the results and dates of screening tests. Medications and Allergies Document the name, dose, route, and frequency of use of all medications. List home remedies, nonprescription drugs, vitamins, mineral or herbal supplements, oral contraceptives, and medications borrowed from family members or friends. Document specific reactions to medications, such as a rash or nausea, as well as allergies to foods, insects, or environmental factors. Differentiate between adverse drug reactions, allergic reactions, and medication side effects. Family History Document information about the client's parents, grandparents, siblings, children, and grandchildren regarding their age, health, and cause of death. Include whether they have conditions such as hypertension, coronary artery disease, stroke, diabetes, or cancer. Personal and Social History The client's personal history includes personality and interests, sources of support, coping style, strengths, and concerns. The personal history also includes information such as sexual orientation and gender identification, occupation and education, relationships, safety, spirituality, and support systems. For older adults or clients with disabilities, it is important to inquire about the level of function and activities of daily living. The social history includes information about the client's tobacco product (i.e., cigarettes, chewing tobacco, e-cigarettes, hookah, cigars), illicit drug, and alcohol use. The provider should also inquire about sexuality and risk-taking sexual practices. The mnemonic Five Ps+ can be used to guide an assessment of sexual history. Review of Systems The review of systems is used to obtain additional information about the client's chief complaint and history of present illness and to uncover any additional symptoms related to potential problems in systems unrelated to the chief complaint. The most effective way to complete the review of systems is to follow a head-to-toe approach with yes or no questions and then follow up when there is a response that indicates an abnormality with open-ended questions. This method requires that the provider have a strong understanding of normal expectations within the review of systems, as well as the ability to formulate appropriate questions to focus on abnormalities discovered. Data obtained in the review of systems is subjective. Objective data collected during the physical examination should be documented separately in the health record.