PMHNP Boards EXAM QUESTION AND
ANSWERS 2025
Medicare Part A Coverage - ANSWHospital insurance that covers inpatient and most
skilled care. Mandatory copays for hospital days 21-150, getting higher with each period
of time.
Medicare Part A Eligibility - ANSW>65 in social security automatic enrollment
Medicare Part A Cost - ANSWNo cost if automatically qualified. 30-39 work quarters:
~$250/mo <30 work quarters: ~$450/mo
Medicare Part B Coverage - ANSWSupplemental medical insurance. Outpatient services,
care, physical/speech therapy, some home health care, medical equipment
Medicare Part B Eligibility - ANSWVoluntary if >65
Medicare Part B Cost - ANSWDeducted from monthly social security check. *Enroll 3
months before 65th birthday or 4 months after, otherwise increased costs to enroll*
Medicare Part C - ANSWMedicare Advantage. Get all their medical services through that
plan.
Medicare Part D coverage - ANSWPrescription drug coverage
Medicare Part D Cost - ANSWVaries depending on how extensive drug benefit is.
Different plans have different benefits.
Medigap Plans - ANSWFill gaps in coverage that occur with Medicare
Medicare Advantage Plan - ANSWWill likely eliminate need for medigap insurance?
Medicaid Eligibility - ANSWAutomatic coverage not guaranteed except for poor pregnant
women and children. States can refuse to cover adults/head of households who lose
Temporary Assistance to Needy Families d/t refusal to work. Generally covers poor
people.
Medicaid funding - ANSWFederal + state. States determine how much they want to pay
in, different states have different qualities of Medicaid
HMO - ANSWFour components: Enrolled population, prepayment of premiums, coverage
of comprehensive medical svcs, centralization of medical and hospital svcs
,Closed-panel HMO - ANSWSpecific providers identified by plan to provide the medical
services to members. Staff can be salaried by HMO or an agency/group contracted by
the HMO.
Open-panel HMO - ANSWNetwork HMO, Individual Practice Association, Point of Service
Plans
Network HMO - ANSWHMO contracts with more than one group of practices
Individual Practice Association - ANSWInsurance coverage. Contract with an association
of physicians to provide services to members
Point of Service (POS) and Preferred Provider Organizations (PPOs) - ANSWInsurance
coverage. Patients allowed to self-refer to specialist but pay higher premium to do so.
POS requires PCP is gatekeeper but pt can see a provider outside of HMO for more $$.
PPOs contract to a selected group of participating providers and give discount for using
a selected group of providers. Financial risk held by insurer in PPO, held by providers in
POS
Managed indemnity - ANSWTraditional model insurance coverage.. Pre-certification,
catastrophic case management, minimal contract arrangement with providers. Provider
groups and health plans can use quality control, utilization review, bundling of services,
incentives for health behaviors. MUST seek National Committee on Quality Assurance
(NCQA) accreditation
Licensure - ANSWMember of profession is granted ability to practice
Accreditation - ANSWFormal review and approval by a recognized agency of
educational degree or certification programs in nursing or nursing-related programs.
Certification - ANSWTests knowledge, skills, abilities for entry into practice. Formal
recognition of the knowledge, skills, and experience
demonstrated by the achievement of standards identified by the profession
Education - ANSWFormal preparation of APRNs in graduate degree-granting or
postgraduate
certificate programs
Factors facilitating NP growth - ANSWDemand for svcs, acceptance of role, emphasis on
integrated healthcare svcs, emergence of PMHNP and decreasing stigmatization
Factors constraining NP growth - ANSWGrowth competition, reimbursement struggles,
overlapping scopes with other NPs, concerns about reimbursement fraud/abuse, scope
of practice requiring physician supervision/collab
, Exceptions to confidentiality - ANSWInformation given to attorneys involved in litigation,
records to insurance companies, answering court orders, mandatory state reporting,
harm to self or others or child/elder abuse, determined need for info outweighs principle
of confidentiality
Deontological Theory - ANSWAction is judged as good or bad based on the act itself
regardless of the consequences
Teleological Theory - ANSWAn action is judged as good or bad based on the
consequence or outcome
Virtue Ethics - ANSWActions are chosen based on moral virtues (honesty, courage,
compassion, etc) or the character of the person making the decision
Elements of negligence that must be established to prove malpractice - ANSWDuty,
breach of duty, proximate cause, damages
Duty (negligence) - ANSWNP had a duty to exercise reasonable care when undertaking
and providing treatment to the client
Breach of duty (negligence) - ANSWThe NP violated the applicable standard of care in
treating the client's condition
Proximate cause (negligence) - ANSWThere is a causal relationship between the breach
in the standard of care and the client's injuries
Damages (negligence) - ANSWClient experiences permanent and substantial damages as
a result of the breach in the standard of care
Competency: Legal or medical? - ANSWLegal (NOT medical)
Competency - ANSWDetermination that a client can make reasonable judgments and
decisions regarding treatment and other health concerns
Durable power of attorney - ANSWDesignates an agent to act on behalf of person should
he/she become unable to make healthcare decisions. Consider psychiatric DPOA for
chronically ill folks! LEGALLY BINDING ALL STATES
Living will - ANSWDocument prepared while client is mentally competent to designate
preferences for care if client becomes incompetent or terminally ill. NOT legally binding
in all states!
ANSWERS 2025
Medicare Part A Coverage - ANSWHospital insurance that covers inpatient and most
skilled care. Mandatory copays for hospital days 21-150, getting higher with each period
of time.
Medicare Part A Eligibility - ANSW>65 in social security automatic enrollment
Medicare Part A Cost - ANSWNo cost if automatically qualified. 30-39 work quarters:
~$250/mo <30 work quarters: ~$450/mo
Medicare Part B Coverage - ANSWSupplemental medical insurance. Outpatient services,
care, physical/speech therapy, some home health care, medical equipment
Medicare Part B Eligibility - ANSWVoluntary if >65
Medicare Part B Cost - ANSWDeducted from monthly social security check. *Enroll 3
months before 65th birthday or 4 months after, otherwise increased costs to enroll*
Medicare Part C - ANSWMedicare Advantage. Get all their medical services through that
plan.
Medicare Part D coverage - ANSWPrescription drug coverage
Medicare Part D Cost - ANSWVaries depending on how extensive drug benefit is.
Different plans have different benefits.
Medigap Plans - ANSWFill gaps in coverage that occur with Medicare
Medicare Advantage Plan - ANSWWill likely eliminate need for medigap insurance?
Medicaid Eligibility - ANSWAutomatic coverage not guaranteed except for poor pregnant
women and children. States can refuse to cover adults/head of households who lose
Temporary Assistance to Needy Families d/t refusal to work. Generally covers poor
people.
Medicaid funding - ANSWFederal + state. States determine how much they want to pay
in, different states have different qualities of Medicaid
HMO - ANSWFour components: Enrolled population, prepayment of premiums, coverage
of comprehensive medical svcs, centralization of medical and hospital svcs
,Closed-panel HMO - ANSWSpecific providers identified by plan to provide the medical
services to members. Staff can be salaried by HMO or an agency/group contracted by
the HMO.
Open-panel HMO - ANSWNetwork HMO, Individual Practice Association, Point of Service
Plans
Network HMO - ANSWHMO contracts with more than one group of practices
Individual Practice Association - ANSWInsurance coverage. Contract with an association
of physicians to provide services to members
Point of Service (POS) and Preferred Provider Organizations (PPOs) - ANSWInsurance
coverage. Patients allowed to self-refer to specialist but pay higher premium to do so.
POS requires PCP is gatekeeper but pt can see a provider outside of HMO for more $$.
PPOs contract to a selected group of participating providers and give discount for using
a selected group of providers. Financial risk held by insurer in PPO, held by providers in
POS
Managed indemnity - ANSWTraditional model insurance coverage.. Pre-certification,
catastrophic case management, minimal contract arrangement with providers. Provider
groups and health plans can use quality control, utilization review, bundling of services,
incentives for health behaviors. MUST seek National Committee on Quality Assurance
(NCQA) accreditation
Licensure - ANSWMember of profession is granted ability to practice
Accreditation - ANSWFormal review and approval by a recognized agency of
educational degree or certification programs in nursing or nursing-related programs.
Certification - ANSWTests knowledge, skills, abilities for entry into practice. Formal
recognition of the knowledge, skills, and experience
demonstrated by the achievement of standards identified by the profession
Education - ANSWFormal preparation of APRNs in graduate degree-granting or
postgraduate
certificate programs
Factors facilitating NP growth - ANSWDemand for svcs, acceptance of role, emphasis on
integrated healthcare svcs, emergence of PMHNP and decreasing stigmatization
Factors constraining NP growth - ANSWGrowth competition, reimbursement struggles,
overlapping scopes with other NPs, concerns about reimbursement fraud/abuse, scope
of practice requiring physician supervision/collab
, Exceptions to confidentiality - ANSWInformation given to attorneys involved in litigation,
records to insurance companies, answering court orders, mandatory state reporting,
harm to self or others or child/elder abuse, determined need for info outweighs principle
of confidentiality
Deontological Theory - ANSWAction is judged as good or bad based on the act itself
regardless of the consequences
Teleological Theory - ANSWAn action is judged as good or bad based on the
consequence or outcome
Virtue Ethics - ANSWActions are chosen based on moral virtues (honesty, courage,
compassion, etc) or the character of the person making the decision
Elements of negligence that must be established to prove malpractice - ANSWDuty,
breach of duty, proximate cause, damages
Duty (negligence) - ANSWNP had a duty to exercise reasonable care when undertaking
and providing treatment to the client
Breach of duty (negligence) - ANSWThe NP violated the applicable standard of care in
treating the client's condition
Proximate cause (negligence) - ANSWThere is a causal relationship between the breach
in the standard of care and the client's injuries
Damages (negligence) - ANSWClient experiences permanent and substantial damages as
a result of the breach in the standard of care
Competency: Legal or medical? - ANSWLegal (NOT medical)
Competency - ANSWDetermination that a client can make reasonable judgments and
decisions regarding treatment and other health concerns
Durable power of attorney - ANSWDesignates an agent to act on behalf of person should
he/she become unable to make healthcare decisions. Consider psychiatric DPOA for
chronically ill folks! LEGALLY BINDING ALL STATES
Living will - ANSWDocument prepared while client is mentally competent to designate
preferences for care if client becomes incompetent or terminally ill. NOT legally binding
in all states!
