Diagnosis & Management in Psychiatric-Mental
Health III Practicum | Questions & Verified
Answers 2025
_____________________________________________________________________________________
Mental Health Amercia's 2015 position statement stipulates that:
professionals must respect the client's fundamental rights of the client for dignity, autonomy, &
self-determination while addressing concerns about the safety & well-being of the client &
others.
six key core skills that are critical to ethical decision-making in mental health care
Ability to identify ethical issues
2. Ability to understand how one's values, beliefs, & sense of self, including implicit biases,
impact client care
3. Ability to recognize personal limits to knowledge & expertise & willingness to practice within
limits
4. Ability to recognize situations that present a high risk for ethical dilemmas
5. Willingness to seek information & consultation in difficult ethical or clinical situations
6. Ability to build ethical safeguards into one's practice
Unrepresented clients
clients without advance directives and available family or friends to make decisions
-State laws and institutional policies typically take one of three approaches in choosing a
decision-maker
• the physician or provider
• an ethics committee
• court-appointed guardian
Yolanda is a 20-year-old client who was referred to the PMHNP by her college health clinic for
symptoms consistent with bipolar II disorder. She initiates the interview by stating that she is not
willing to take any medications but is willing to engage in counseling or other therapies.
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent
provide additional education
Rationale: The client should receive education about the risks, benefits, and appropriateness of
pharmacological treatment. If, after receiving education, the client still refuses medication
therapy, it is important to document the education provided and the client's refusal of
treatment.
,Kevin is a 48-year-old with a 20-year history of schizophrenia. He has decided to stop pharmacological
treatment due to the intolerable adverse effects of his medications. Kevin and the provider have
discussed the benefits and drawbacks of ceasing treatment, and he has agreed to weekly telephone
check-ins to ensure his well-being.
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent
document refusal of treatment
Rationale: The client has the capacity to consent, and the situation is not emergent. The ethic of
autonomy provides for the client to refuse treatment.
Ashlei is a 19-year-old who presents to the clinic with severe anxiety symptoms. As the PMHNP begins
reviewing treatment options, Ashlei interrupts and states, "Hearing about these medications
increases my anxiety. Please prescribe what you think is best for me, and I will take it."
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent
initiate treatment without informed consent
Rationale: Clients may choose to waive their right to informed consent. The PMHNP should
clearly document the client's waiver.
Geoff is a 32-year-old who presents to the clinic with anhedonia, fatigue, feelings of worthlessness,
and a lack of focus. He admits to thinking about death but denies suicidal ideations or a plan. He has
been taking sertraline 50 mg daily and wishes to stop taking the medication as it does not seem to be
helping.
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent
provide additional education
Rationale: The client has the capacity to provide consent and the situation is not emergent;
however, the client should receive education about the risks, benefits, and appropriateness of
pharmacological treatment. At this time, the dose should be increased to achieve efficacy. If,
after receiving education, the client still refuses medication therapy, the PMHNP should
document the education provided and the client's refusal of treatment.
,Fritz is a 25-year-old who has been brought to the emergency department by the police after
threatening a server at a restaurant. The PMHNP on call has treated Fritz for schizophrenia in the past.
He has a history of poor treatment adherence. While in the emergency department, he admits to
auditory hallucinations. He becomes agitated and begins throwing items around the examination
room.
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent
initiate treatment without informed consent
Rationale: The client does not have the capacity to provide consent at this time due to active
hallucinations and agitation. For the safety of the client and staff, treatment should be initiated
without obtaining informed consent.
Acute inpatient care
short-term treatment to provide care for acutely ill clients who are unable to meet basic needs
due to a mental health condition or are at risk of harming themselves or others
-focus is crisis stabilization
-may be voluntary or involuntary
Voluntary Admission
-when a client & provider agree that client's symptoms meet criteria for inpatient hospitalization
& the client may benefit from admission
-client will sign consent form agreeing to a hospital stay in a locked unit
-not require a psychiatric hold
• if client requests discharge & provider determines the client is not yet safe, the provider may
initiate an emergency involuntary hold
Involuntary Admission
-when a client does not agree to hospitalization
-an evaluation by a mental health professional indicates that the client may be at high risk of
harming themselves or others
-Other terms denoting an involuntary admission include involuntary commitment, psychiatric
hold, or civil admission
-most states, clients can be held for up to 72 hours involuntary if deemed an imminent threat
• Providers must perform & document a detailed eval & a risk assessment.
Involuntary civil commitment
-legal intervention directed by a judge to order a person with serious symptoms of continued
danger to self or others, grave disability, or serious deterioration to either remain in a
psychiatric hospital or attend supervised outpatient treatment for a period of time
, -maximum length of inpatient commitment varies by state
-Outpatient commitment, or assisted outpatient treatment (AOT), may consist of supported
housing, intensive case management, medications, and frequent therapy
• tx may last for 6 to 12 months.
Approximately ____% of clients with serious mental illness are committed involuntarily each year
after a psychiatric hold
0.1%
Standards for Involuntary Commitment (Assisted Treatment) State-by-State
https://mentalillnesspolicy.org/national-studies/state-standards-involuntary-treatment.html
Keith is a 35-year-old who presents to the crisis clinic with his wife, who is very concerned about
Keith's recent behavior. He believes his neighbors have been spying on him using technology acquired
from a secret government source. He is agitated and states, "I just have to take them out. I can't have
them looking at us anymore. I'm going to have to build a blaster to take them out." Keith's wife
confirms that there are no weapons in the home. Keith is willing to initiate treatment but does not
want to be admitted as an inpatient at this time.
Does Keith require an emergency psychiatric hold?
yes
no
varies according to state legislation
no
Rationale: Keith does not meet the criteria for an emergency psychiatric hold. Although he is
experiencing active delusions, his behavior does not threaten the safety of himself or others.
Education, resources, and a plan for follow-up care should be established.
Dakota is a 24-year-old who presents to the emergency department with his sister. He endorses
taking a "handful" of pills after a fight with his boyfriend. He states that he regrets taking the pills,
and he does not want to end his life. He denies active suicidal ideations or a plan. Dakota plans to stay
with his sister for the next few days.
Does Dakota require an emergency psychiatric hold?
yes
no
varies according to state legislation
no
Rationale: Dakota does not meet the criteria for an emergency psychiatric hold. He does not
have active thoughts of killing himself. He should be provided with resources for follow-up as
well as information for the National Suicide Prevention Lifeline.
Health III Practicum | Questions & Verified
Answers 2025
_____________________________________________________________________________________
Mental Health Amercia's 2015 position statement stipulates that:
professionals must respect the client's fundamental rights of the client for dignity, autonomy, &
self-determination while addressing concerns about the safety & well-being of the client &
others.
six key core skills that are critical to ethical decision-making in mental health care
Ability to identify ethical issues
2. Ability to understand how one's values, beliefs, & sense of self, including implicit biases,
impact client care
3. Ability to recognize personal limits to knowledge & expertise & willingness to practice within
limits
4. Ability to recognize situations that present a high risk for ethical dilemmas
5. Willingness to seek information & consultation in difficult ethical or clinical situations
6. Ability to build ethical safeguards into one's practice
Unrepresented clients
clients without advance directives and available family or friends to make decisions
-State laws and institutional policies typically take one of three approaches in choosing a
decision-maker
• the physician or provider
• an ethics committee
• court-appointed guardian
Yolanda is a 20-year-old client who was referred to the PMHNP by her college health clinic for
symptoms consistent with bipolar II disorder. She initiates the interview by stating that she is not
willing to take any medications but is willing to engage in counseling or other therapies.
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent
provide additional education
Rationale: The client should receive education about the risks, benefits, and appropriateness of
pharmacological treatment. If, after receiving education, the client still refuses medication
therapy, it is important to document the education provided and the client's refusal of
treatment.
,Kevin is a 48-year-old with a 20-year history of schizophrenia. He has decided to stop pharmacological
treatment due to the intolerable adverse effects of his medications. Kevin and the provider have
discussed the benefits and drawbacks of ceasing treatment, and he has agreed to weekly telephone
check-ins to ensure his well-being.
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent
document refusal of treatment
Rationale: The client has the capacity to consent, and the situation is not emergent. The ethic of
autonomy provides for the client to refuse treatment.
Ashlei is a 19-year-old who presents to the clinic with severe anxiety symptoms. As the PMHNP begins
reviewing treatment options, Ashlei interrupts and states, "Hearing about these medications
increases my anxiety. Please prescribe what you think is best for me, and I will take it."
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent
initiate treatment without informed consent
Rationale: Clients may choose to waive their right to informed consent. The PMHNP should
clearly document the client's waiver.
Geoff is a 32-year-old who presents to the clinic with anhedonia, fatigue, feelings of worthlessness,
and a lack of focus. He admits to thinking about death but denies suicidal ideations or a plan. He has
been taking sertraline 50 mg daily and wishes to stop taking the medication as it does not seem to be
helping.
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent
provide additional education
Rationale: The client has the capacity to provide consent and the situation is not emergent;
however, the client should receive education about the risks, benefits, and appropriateness of
pharmacological treatment. At this time, the dose should be increased to achieve efficacy. If,
after receiving education, the client still refuses medication therapy, the PMHNP should
document the education provided and the client's refusal of treatment.
,Fritz is a 25-year-old who has been brought to the emergency department by the police after
threatening a server at a restaurant. The PMHNP on call has treated Fritz for schizophrenia in the past.
He has a history of poor treatment adherence. While in the emergency department, he admits to
auditory hallucinations. He becomes agitated and begins throwing items around the examination
room.
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent
initiate treatment without informed consent
Rationale: The client does not have the capacity to provide consent at this time due to active
hallucinations and agitation. For the safety of the client and staff, treatment should be initiated
without obtaining informed consent.
Acute inpatient care
short-term treatment to provide care for acutely ill clients who are unable to meet basic needs
due to a mental health condition or are at risk of harming themselves or others
-focus is crisis stabilization
-may be voluntary or involuntary
Voluntary Admission
-when a client & provider agree that client's symptoms meet criteria for inpatient hospitalization
& the client may benefit from admission
-client will sign consent form agreeing to a hospital stay in a locked unit
-not require a psychiatric hold
• if client requests discharge & provider determines the client is not yet safe, the provider may
initiate an emergency involuntary hold
Involuntary Admission
-when a client does not agree to hospitalization
-an evaluation by a mental health professional indicates that the client may be at high risk of
harming themselves or others
-Other terms denoting an involuntary admission include involuntary commitment, psychiatric
hold, or civil admission
-most states, clients can be held for up to 72 hours involuntary if deemed an imminent threat
• Providers must perform & document a detailed eval & a risk assessment.
Involuntary civil commitment
-legal intervention directed by a judge to order a person with serious symptoms of continued
danger to self or others, grave disability, or serious deterioration to either remain in a
psychiatric hospital or attend supervised outpatient treatment for a period of time
, -maximum length of inpatient commitment varies by state
-Outpatient commitment, or assisted outpatient treatment (AOT), may consist of supported
housing, intensive case management, medications, and frequent therapy
• tx may last for 6 to 12 months.
Approximately ____% of clients with serious mental illness are committed involuntarily each year
after a psychiatric hold
0.1%
Standards for Involuntary Commitment (Assisted Treatment) State-by-State
https://mentalillnesspolicy.org/national-studies/state-standards-involuntary-treatment.html
Keith is a 35-year-old who presents to the crisis clinic with his wife, who is very concerned about
Keith's recent behavior. He believes his neighbors have been spying on him using technology acquired
from a secret government source. He is agitated and states, "I just have to take them out. I can't have
them looking at us anymore. I'm going to have to build a blaster to take them out." Keith's wife
confirms that there are no weapons in the home. Keith is willing to initiate treatment but does not
want to be admitted as an inpatient at this time.
Does Keith require an emergency psychiatric hold?
yes
no
varies according to state legislation
no
Rationale: Keith does not meet the criteria for an emergency psychiatric hold. Although he is
experiencing active delusions, his behavior does not threaten the safety of himself or others.
Education, resources, and a plan for follow-up care should be established.
Dakota is a 24-year-old who presents to the emergency department with his sister. He endorses
taking a "handful" of pills after a fight with his boyfriend. He states that he regrets taking the pills,
and he does not want to end his life. He denies active suicidal ideations or a plan. Dakota plans to stay
with his sister for the next few days.
Does Dakota require an emergency psychiatric hold?
yes
no
varies according to state legislation
no
Rationale: Dakota does not meet the criteria for an emergency psychiatric hold. He does not
have active thoughts of killing himself. He should be provided with resources for follow-up as
well as information for the National Suicide Prevention Lifeline.
