WGU D344 Section 2: Conduct a Structured Assessment Questions with 100% corrrect answers + rationales

Which clinician behavior can foster a therapeutic alliance?

-Educating the client about the nature of the interview

-Protecting one's own time

-Starting the interview with questions about sensitive topics

-Doing the majority of the talking while the client does the majority of the listening

-Educating the client about the nature of the interview

What could be a primary reason the PMHNP would ask a patient to talk a little about himself/herself?

-To fill an uncomfortable silence

-To get to know the patient better

-Because the PMHNP is not sure what to ask the patient first

-To make small talk

-To get to know the patient better

During an initial meeting, the client asks the PMHNP what city he lives in, whether he is married, and whether he has any children. Which of the following would be the best response by the PMHNP?

-"You are asking intrusive questions that are not any of your business."

-"I'm going to ignore those questions because this interview is about you, not me."

-"Let's talk about you right now."

-"I live in Charlestown and I have been married for 13 wonderful years. My wife and I are trying to have a baby but no luck with that yet."

-"Let's talk about you right now."

The PMHNP is interviewing a client admitted with severe depression. The client responds to the PMHNP's open-ended questions with brief answers, lacking in elaboration. Which strategy should the PMHNP employ?

-Switch to more directive, closed-ended questions.

-Terminate the interview until the client is more talkative.

-Ask another clinician to assist in interviewing the client.

-Continue asking open-ended questions.

-Switch to more directive, closed-ended questions.

How does the PMHNP demonstrate active listening in this scenario?

Jon replies, "Sure. I'm 31 years old and I am a driver for a major package delivery service. I live with my partner and her two-year-old daughter in an apartment in Bradenton. I enjoy watching movies and playing baseball, but lately, I have not had much interest in either of those things. I don't even want to play with my partner's daughter anymore like I used to. My doctor suggested I come here because I have been feeling so depressed."

-Sitting quietly with arms folded across chest

-Interrupting the client to ask what types of movies he enjoys

-Sitting forward, maintaining eye contact, nodding his head, and stating, "You looked sad when you spoke of not wanting to play with your partner's daughter."

-Responding by asking, "Do you like driving for a major package delivery service?"

-Sitting forward, maintaining eye contact, nodding his head, and stating, "You looked sad when you spoke of not wanting to play with your partner's daughter."

During the initial interview, the client was hostile and made sarcastic and angry comments to the PMHNP. The PMHNP was puzzled by the client's demeanor, as they had just met for the first time. Which of the following does the PMHNP realize, upon reflection, the client may be experiencing, based on these behaviors?

-Positive transference

-Negative transference

-Positive countertransference

-Negative countertransference

-Negative transference

According to the author, which of the following is true about transference and countertransference?

-Transference and countertransference can be avoided by a skillful interviewer.

-Transference and countertransference always contribute to decreased empathy.

-Transference and countertransference always impede the therapeutic relationship.

-Transference and countertransference can provide useful clinical information about therapeutic relationships, leading to increased empathy.

-Transference and countertransference can provide useful clinical information about therapeutic relationships, leading to increased empathy.

One day Jon is holding a brightly wrapped gift box that he presents to the PMHNP. "For you," he says, "for being so patient with me." The PMHNP says, "This is very thoughtful and generous, but our agency usually does not allow us to accept gifts" "Open it, at least, "and see what it is." Said Jon. The gift is a gold keychain. "That's 14-karat gold," Jon states proudly. "Jon, this is a lovely gift and so thoughtful of you to think of me. However, I cannot accept such an expensive piece from a client. Further, the agency does not allow us to accept any gifts."Jon looks crestfallen, and then annoyed. "See, this is how it always is. Anytime I try to show appreciation to someone, I get rejected. My mother did the same thing every time I tried to make her happy. Nothing I do is ever good enough for any of you!"Which dynamic is occurring in this exchange?

-Countertransference

-Rejection

-Transference

-Termination

-Transference

Why do clients employ "testing behaviors" such as forgetting an appointment or arriving late?

-To end the therapeutic relationship

-To assert dominance in the therapeutic relationship

-To see if the nurse will really accept them

-To passively express anger about their nursing care

-To see if the nurse will really accept them

Jon has been meeting regularly with the PMHNP. He feels comfortable talking with him about his relationship with his partner and her child, his family of origin, his struggles at work, and his concerns and worries. Over time, he has become more open to looking at challenges differently and trying new strategies instead of withdrawing and becoming more depressed. He has not thought about suicide for several weeks.

Jon's behavior best describes which stage of the nurse-client relationship?

-Orientation

-Resolution

-Working

-Maintenance

-Working

The PMHNP goes on vacation and has a colleague provide coverage for his clients. Upon his return, one of his clients does not call or keep three appointments in a row. According to the reading in Carlat (2017), which type of defense mechanism is this most likely an example of?

-Psychotic

-Mature

-Immature

-Neurotic

-Immature

A client gets upset with the PMHNP after they disagree on the treatment plan. The client gets up, punches the wall, and leaves the room, slamming the office door. Which defense mechanism is the client using?

-Displacement

-Omnipotence

-Projection

-Dissociation

-Displacement

Which of the following is the primary reason individuals use defense mechanisms?

-They feel threatened in a situation.

-They are not being truthful.

-They feel they need to defend themselves against an accusation.

-They have not established rapport with the person they are interacting with.

-They feel threatened in a situation.

Which of the following is true about decision-making within the therapeutic relationship?

-All decisions should be made by the client, who is an expert in their own situation.

-Decisions are not made within the context of the therapeutic relationship.

-All decisions should be made by the PMHNP, who is an expert in psychiatric mental health.

-Decision-making should be shared between the PMHNP and the client

-Decision-making should be shared between the PMHNP and the client

A work relationship with a colleague is considered a therapeutic relationship. True or False

-True

-False

-False

What does Carlat suggest it is best to do when you feel a negative countertransference to your client?

-Suppress your negative feelings.

-Confront the client about the behavior that is eliciting your negative feelings.

-Analyze the possible connection between your feelings and the patient's psychopathology.

-Ask a colleague to work with the client instead.

-Analyze the possible connection between your feelings and the patient's psychopathology.

During a 1:1, the client tells the PMHNP that on the way to the appointment, the client was pulled over by a police officer and issued a ticket for speeding. The client wanted to yell at the officer and tell them to use their time arresting drug dealers and other criminals. Instead, the client apologized and accepted the ticket. What does the PMHNP assess?

-The client used the defense mechanism of suppression to hold back their angry feelings.

-The client's behavior is an example of their psychopathology.

-The client experienced transference when they became angry at the police officer.

-The client used the defense mechanism of repression to deal with their angry feelings

-The client used the defense mechanism of suppression to hold back their angry feelings.

Which of the following occurs during the resolution phase of the therapeutic nurse-client relationship?

-The nurse outlines expectations and boundaries of the relationship.

-The client identifies at least one problem to address.

-The client resolves their identified problem, and the relationship draws to a close.

-The client employs behaviors to test the relationship.

-The client resolves their identified problem, and the relationship draws to a close.

During a heated couple's therapy meeting, a client states angrily to her husband, "If you weren't so miserable to live with, I wouldn't need to drink wine every day." Which defense mechanism is the client using in this situation?

-Devaluation

-Displacement

-Projection

-Denial

-Projection

During the initial assessment, the PMHNP states, "I notice your hands are shaking and your lips are trembling. I'm wondering if you are feeling anxious right now." Which therapeutic technique is this an example of?

-Restatement

-Validation

-Confrontation

-Acceptance

-Validation

Which preparation should the PMHNP make prior to the interview?

-Overbook clients in case someone does not show up

-Prevent interruptions

-Wear a wristwatch and check it frequently during the interview

-Prevent interruptions

According to Carlat (2017), what are some ways one can encourage a client to continue speaking?

-Give the client a piece of paper and pen and ask them to write down their thoughts.

-End the session early because the client is not cooperating.

-Sit in silence until the client becomes uncomfortable and speaks to fill the silence.

-Use prompts such as "Go on" and "Uh huh" while nodding head.

-Use prompts such as "Go on" and "Uh huh" while nodding head.

The goals of the initial psychiatric interview include building rapport, understanding the psychosocial dimensions of the person, and conducting a physical examination. True or False

-True

-False

-False

The PMHNP is interviewing a new client, a 52-year-old female with a history of suicide attempts. In which section of the interview is a current suicide and violence assessment conducted?

-History of present illness

-Past psychiatric history

-Developmental and social history

-Chief complaint

-History of present illness

The client is talking to the PMHNP about her partner's infidelity. The client's facial expression is very tense. Her eyes look wet, and she looks at the floor. Her arms are crossed tightly over her chest. The client states, "What he chooses to do really does not bother me a bit."Based on the client's verbal and nonverbal communication, what is the PMHNP's assessment?

-The client is upset about the infidelity of her partner.

-The client is not bothered by the infidelity of her partner.

-The client is ambivalent about the infidelity of her partner.

-The client is confused about how she feels.

-The client is upset about the infidelity of her partner.

What is the concept of mirroring or pacing with the client?

-Pacing the halls while talking with a restless or agitated client

-Mimicking the client

-Assuming a similar body posture and language to that of the client

-Using reflective responses

-Assuming a similar body posture and language to that of the client

Which question or statement is open-ended?

-"Are you feeling sad right now?"

-"Has your morning been going well so far?"

-"Would you like to sit in this chair?"

-"Tell me about your visit with your sister."

-"Tell me about your visit with your sister."

During an initial psychiatric interview, the PMHNP asks the client what prompted them to make an appointment. The client replies, "I'm very depressed."What is the information provided by the client referred to as?

-Chief complaint

-Review of systems

-The history of present illness

-Developmental and social history

-Chief complaint

An example of a screening tool that can be used to assist in gathering data about the client's substance use is the CAGE-AID.

True or False

True

According to Carlat, which element of the psychiatric interview is the most important?

-Psychiatric history

-History of present illness

-Screening for general medical conditions

-Chief complaint

-History of present illness

What is the best course of action by the clinician, according to Carlat (2017), if a client refuses to allow a family member to be interviewed?

-Tell the client you are unable to treat them unless they consent to having family interviewed

-Accept the client's refusal

-Interview the family member despite the client's objection

-Try to find out the reason the client is refusing to allow family to be interviewed

-Try to find out the reason the client is refusing to allow family to be interviewed

The PMHNP is assessing a client's risk for suicide. The client states, "Sometimes I think about dying and wish I was dead." The client denies having made any attempts and denies having a plan to harm themselves.Which of the following best describes the client's response?

-The client is not at any risk for suicide.

-The client is being manipulative for secondary gain.

-The client is expressing active suicidal ideation.

-The client is expressing passive suicidal ideation.

-The client is expressing passive suicidal ideation.

Why is it essential to reserve at least five minutes for the closing phase of the interview?

-To ask any last-minute questions

-To explain and negotiate the treatment plan with the client

-To have time to straighten up the interview room for the next group

-To request that the nurse come in and take vital sign

-To explain and negotiate the treatment plan with the client

According to Carlat (2017), the tasks of the diagnostic interview are 1) build a therapeutic alliance, 2) interview for diagnosis, and 3) negotiate a treatment plan. True or False

False

If a client's verbal and nonverbal messages conflict, what should the PMHNP do?

-Ignore both the nonverbal and verbal messages

-Rely on the nonverbal message

-Rely on both nonverbal and verbal messages equally

-Rely on the verbal message

-Rely on the verbal message

Which statement is correct about introspection and self-awareness?

It is important for the PMHNP to deny their own beliefs, biases, thoughts, motivations, and limitations when working with clients.

Self-awareness and introspection refer to the PMHNP's awareness of the client's beliefs, thoughts, motivations, and limitations.

It is not necessary for the PMHNP to practice self-awareness and introspection.

It is essential that the PMHNP engage in self-awareness and introspection on an ongoing basis.

It is essential that the PMHNP engage in self-awareness and introspection on an ongoing basis.

What do the elements of the psychiatric interview include?

-History of present illness

-Writing the client a referral to neurology

-Asking the patient to draw a clockface

-Family dynamic

-History of present illness

Which of the following is an example of using a normalizing statement when asking a client about their sexual preferences?

-Adolescents often experiment with different sexual lifestyles. What's your current sexual preference?

-How many sexual partners have you had?

-Are you attracted to men, women, or both?

-Are you gay, straight, or bisexual?

-Adolescents often experiment with different sexual lifestyles. What's your current sexual preference?

While documenting an MSE, the PMHNP noted that the client had a "blunted affect."Which of the following best defines the term "affect"?

-Affect refers to the PMHNP's observation of the client's mood state.

-Affect refers to the client's quality of speech.

-Affect refers to the client's ability to coherently connect ideas.

-Affect refers to the client's subjective report of how they are feeling.

-Affect refers to the PMHNP's observation of the client's mood state.

According to Carlat (2017), what is the best way to assess a client's current level of judgment?

-By requesting the client's medical records and reviewing the results of a mental status examination conducted during a prior psychiatric hospitalization

-By assessing the client's responses to questions during the interview and MSE

-By asking the client's collateral informants their opinions about the client's judgment

-By asking the client the question, "If you found a stamped and addressed envelope lying on the sidewalk, what would you do?"

-By assessing the client's responses to questions during the interview and MSE

Tia was brought to the emergency department by the police after Tia tried to leave the store with several pieces of clothing without paying. When Tia was confronted she said "You don't know who you are dealing with!" Tia insisted that she was personal friends with the owner of the store and could take any clothing she wanted at any time. She also stated that she had recently been appointed mayor of the city and would fire the officers if they did not stop harassing her. The officers confirmed with the store manager that Tia does not know the owner of the store or have permission to take clothes without paying.

Which of the following is Tia's insistence that she has recently been elected mayor an example of?

-Thought insertion

-Hallucination

-Illusion

-Delusion

-Delusion

Which of the following is Tia's reply best described as?

-Circumstantial

-Neologism

-Thought blocking

-Clang association

-Clang association

During the mental status examination, the PMHNP asks Tia to repeat three objects after her. Then, after two minutes, the PMHNP asks Tia to recall the three objects.

Which of the following is the PMHNP assessing?

-Cognition

-Thought process

-Insight

-Orientation

-Cognition

In the mnemonic MIDAS, the D stands for developmental issues. True or False

False

What does the term "diagnostic overshadowing" refer to, according to Mitchell and Hill (2020)?

-Automatically attributing a client's physical symptoms to their mental illness

-Misdiagnosing psychiatric symptoms as medical symptoms

-Ordering unnecessary tests to assess for medical conditions

-Ignoring any medical symptoms

-Automatically attributing a client's physical symptoms to their mental illness

What are the key elements of the psychiatric interview?

-Mental status exam and review of systems

-Review of systems and diagnosis

-Chief complaint and history

-History and mental status exam

-History and mental status exam

During the mental status examination, the PMHNP asks the client how an apple and an orange are similar.

What is this question testing?

-Abstract reasoning

-Orientation

-Thought processes

-Judgment

-Abstract reasoning

Which type of information can a general observation of the client provide?

-The client's ability to think abstractly

-The client's gait

-The client's orientation

-The client's safety risk

-The client's gait

In the mental status examination, which of the following is categorized as a perceptual abnormality?

-Circumstantiality

-Tangentiality

-Pressured

-Hallucinations

-Judgment

-Hallucinations

In many cases, patients whose disorders were initially thought to be emotional proved to be occurring secondary to medical conditions. True or False

True

Which risky health behaviors has been identified as common among people with severe mental illness?

-Unprotected sex

-Driving at excessive speed

-Sedentary lifestyle

-Gambling

-Sedentary lifestyle

Which statement about the multiaxial system in the DSM-5-TR is correct?

-DSM-5 requires that clients be diagnosed on Axes I, II, and III.

-DSM-5-TR has moved to a nonaxial documentation of diagnosis.

-Clinicians must diagnose clients on five separate axes.

-No revision of the DSM has ever used a multiaxial diagnostic system.

correct

-DSM-5-TR has moved to a nonaxial documentation of diagnosis.

According to Carlat (2017), what is the next step after a short list of potential diagnoses is generated?

-Conclude the assessment.

-Develop treatment recommendations.

-Share your findings with the client.

-Ask screening questions.

-Ask screening questions.

You should not test for things that are exceedingly rare, unpredictable, and unpreventable during initial testing. True or False

True

In which lab test are kidney and liver functioning assessed?

-Complete blood count (CBC)

-Complete metabolic panel (CMP)

-Acetaminophen level

-Thyroid stimulating hormone (TSH)

-Complete metabolic panel (CMP)

Reasons that laboratory, imaging, and other tests are ordered include establishing a diagnosis and determining that the administration of a particular treatment will be safe. True or False

True

Which of the following is a quality of psychological tests?

-To evaluate results, standards based on data are not necessary.

-Psychological tests are samples of attitude.

-Psychological tests can confirm a diagnosis.

-Psychological tests are evaluated and scored.

-Psychological tests are evaluated and scored.

Which test is the most widely used and best researched projective test?

-Thematic Apperception Test

-Rorschach test

-Minnesota Multiphasic Personality Inventory (MMPI)

-Beck Depression Inventory

-Rorschach test

Which instrument was developed primarily to measure the severity of psychiatric symptomology and covers a broad range of areas?

-Positive and Negative Syndrome Scale

-Beck Depression Inventory

-Connors Rating Scales

-Brief Psychiatric Rating Scale

-Brief Psychiatric Rating Scale

In the mnemonic SIGECAPS, which symptom does the S stand for?

-Sleep disorder

-Satisfaction with life

-Sexual behavior

-Sentinel event

-Sleep disorder

Which of the following is one of the seven major adult diagnostic categories in the DSM-5-TR?

-Behavior disorders

-Eating disorders

-Somatic disorders

-Obsessive compulsive disorders

-Somatic disorders

During the review of systems, the PMHNP suspects the client may have anemia.Which test would be most appropriate to order?

-CBC

-TSH

-UA

-CMP

-CBC

Which test is best for measuring kidney function?

-Compound blood count

-Thyroid stimulating hormone

-Creatinine and blood urea nitrogen

-Salicylate level

-Creatinine and blood urea nitrogen

Regarding psychiatric testing, which of the following best defines the psychometric term "reliability"?

-The ability of the scale to correctly identify people who do not have a disease or condition

-The accuracy of a measure

-The ability to correctly identify clients with a particular disease or condition

-The consistency and repeatability of ratings; validity refers to conformity with the truth

-The consistency and repeatability of ratings; validity refers to conformity with the truth

The PMHNP is evaluating a child who has symptoms of attention deficit disorder.Which scale would be appropriate to use?

-Hamilton Rating Scale

-CAGE

-Brief Psychiatric Rating Scale

-Vanderbilt Diagnostic Rating Scale

-Vanderbilt Diagnostic Rating Scale

During a psychotherapy appointment, a patient making progress in processing their trauma becomes anxious and tearful when a nurse practitioner (NP) makes an observation about the trauma. The NP recognizes that the patient has become overwhelmed.Which therapeutic communication technique should the NP use for stabilization?

-Interpretation

-Immediate

-Reflection

-Focusing

-Reflection

A patient with generalized anxiety disorder sees a nurse practitioner (NP) weekly for psychotherapy. The patient's job has been a major source of stress recently, and in this week's therapy session, the patient tells the NP, "When I emailed my boss my monthly progress report, I forgot to attach the document to the email. I know my boss thinks I am an idiot now. Sometimes I think I am not able to work in sales; I get so overwhelmed. Do you think I should just change my career altogether?"Which response by the NP communicates reflection?

-"You feel overwhelmed by your job sometimes, and you are asking if I think you should change careers."

-"How did it make you feel when you first realized you had forgotten to attach the document to the email?"

-"What do you mean when you say you get so overwhelmed?"

-"It may help to make a list of daily tasks to keep organized."

-"You feel overwhelmed by your job sometimes, and you are asking if I think you should change careers."

A 21 y/o college student with complaints of depressed mood, irritability, insomnia, and anhedonia. The student reports having been diagnosed with major depressive disorder six months ago, for which they have been taking fluoxetine (Prozac) daily. For the last three months, he has had an increasingly difficult time finishing work, skipping classes, falling behind on obligations, and is at risk of losing a scholarship. The patient says he doesn't understand why he feels this way because, initially, after starting the antidepressant, he excelled at work, stating, "It was like a machine drove me. I was pulling all-nighters, and I felt on top of the world, and now I feel at the bottom."Which screening tool should the NP include as part of the assessment?

-Mood Disorder Questionnaire (MDQ)

-Generalized Anxiety Disorder Assessment (GAD-7)

-Drug Abuse Screening Test (DAST)

-Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)

-Mood Disorder Questionnaire (MDQ)

A patient comes in to see a nurse practitioner (NP) for "sadness." The patient describes a low mood with sleep disturbances, lack of focus, fatigue, and decreased appetite for most days of the week that has persisted for almost two weeks. The patient is expressionless while reporting this, and when the NP asks if the patient has suicidal ideation, the patient starts laughing uncontrollably and energetically replies, "Of course not. Anyone who knows me knows that is not something I would even think about." The patient gets angry and states, "The fact you think I would do this to my family is absurd!" The NP then asks for a more detailed description of the patient's mood, and the patient returns to an expressionless demeanor and replies, "I already told you I feel sad."How should the NP interpret the patient's mood and affect assessment?

-Euthymic; normal

-Depressed; blunted

-Depressed; labile

-Anxious; congruent

-Depressed; labile

A nurse practitioner (NP) doing a diagnostic evaluation asks a patient, "Have you ever been diagnosed with any psychiatric disorders?" The patient replies, "Well, everyone has had a psychiatric history of some kind in our lives, right? One time, my partner had to go to the hospital for a fractured arm due to an injury after a sporting event. I made sure I went with them to the hospital because, otherwise, they would not have remembered their medications, or they would tell the doctors nothing so that they would be able to leave the hospital. Then, my family would show up at the hospital wanting to know everything was OK. Anyway, yeah, sorry, I do not have any psychiatric history."What should the NP identify as the patient's thought process?

-Tangential

-Linear

-Circumstantial

-Disorganized

-Circumstantial

A client with a hx of depression and anxiety is being evaluated for health maintenance. The patient is engaged and cooperative with appropriate dress and hygiene, demonstrating no cognitive deficits, and is answering questions appropriately. When the NP asks about history of traumatic experiences, the client experiences an episodic change in demeanor. She appears anxious, with rapid speech and experiences changing thoughts and ideas while describing the traumatic event. The NP actively listens and empathizes with the client's trauma. The client returns to a calm state with linear thought processes throughout the rest of the evaluation.How would the NP interpret the client's change in behavior and demeanor?

-Circumstantiality consistent with a traumatic brain injury

-Derailment consistent with schizophrenia

-Flight of ideas consistent with a manic episode

-Anxiety response triggered by discussing trauma

-Anxiety response triggered by discussing trauma

A patient with cancer is experiencing fatigue and other symptoms of depression. A nurse practitioner (NP) wants to use a screening instrument for depression. The NP wants to avoid crossover between fatigue from cancer and fatigue from depression.Which screening instrument should the NP use?

-Beck Depression Inventory (BDI)

-Center for Epidemiological Studies (CED-D)

-Hospital Anxiety and Depression Scale (HADS)

-Brief Symptom Inventory (BSI)

-Hospital Anxiety and Depression Scale (HADS)

A nurse practitioner (NP) wants to administer a screening instrument to a patient for a mental health problem. The NP knows that a high sensitivity setting on the instrument means that the instrument will miss fewer individuals with the problem.

Which sensitivity setting should the instrument have?

-0.68

-0.85

-0.95

-0.77

-0.95

A patient presents to an outpatient mental health clinic with sadness, fatigue, low appetite, and loss of interest in usual activities. A nurse practitioner (NP) wants to administer the Patient Health Questionnaire (PHQ-9) or the Hamilton Depression Rating Scale (HAM-D). The NP will review sensitivity, specificity, validity, and variability for each instrument and select the instrument that will minimize the chance for the patient to receive unnecessary treatment.

Which statistic is related to minimizing this risk?

-Specificity

-Variability

-Sensitivity

-Validity

-Specificity