PMHNP Comprehensive 2026 Complete Questions and Answers Solved 100%

AIMS

Abnormal Involuntary Movement Scale for 8 and older

12 item tool to assess symptoms of tardive dyskinesia for patients taking antipsychotics

Rating 0-4, >2 to diagnose TD and reduce dose

BARS

Barnes Akathisia Rating Scale for 8 and older

4 item tool to assess objective and subjective symptoms of akathisia with antipsychotics and/or SSRIs

CRS-R

Connors Rating Scales - Revised for 3-17

ADHD Parent (80 items) and Teacher Scales (59 items)

Low T-score of 61= mildly atypical; >70 = markedly atypical

Subscales for Oppositional Behaviors, Cognitive Problems, Hyperactivity, ADHD Index, Anxious-Shy, Perfectionism, Social Problems, DSM-IV Subscales and Connors' Global Index

Vanderbilt ADHD Parent and Teacher

55 parent, 43 teacher items for 6-12

Initial assessment rates symptoms and impairment in academic and behavioral performance

ASRS-1

Adult ADHD Self-Report Scale, 16 and older

Two-part Screening

Part A: 6 questions, 4 symptoms suggest ADHD

Part B: 12 questions to clarify and quantify

AUDIT-C

Alcohol Use Disorders Identification Test - Consumption, > 13

Documents use and frequency in prior year

0-4, F >3 = positive, M >4 = positive, >8 = hazardous drinking

CAGE-AID

IDs problem drinking or druging, 13 and older

(C=cut down, A=annoy, G=guilty, E=Eye-opener, AID=altered to include drugs

CRAFFT

6-item screen for alcohol or drugs in adolescents, 14-18

(C=car, R=relax, A=alone, F=forget, F= family or friends, T= trouble)

BAI

Beck Anxiety Inventory, 17 and older

Assesses 21 symptoms of anxiety, 0-36 scores

HAM-A

Hamilton Anxiety Scale, most commonly used

14 domains, 14=mild, 18-24= moderate, 25-30=severe

LSAS-CA

Liebowitz Social Anxiety Scale-Child/Adolescent Version, 7 and older

24 items, social and performance

55-65=moderate social phobia, 65-80=marked, 80-95=severe, >95=very severe

MMSE

Mini Mental Status Exam

30 items, 24-30= no cognitive impairment; 18-23=mild cognitive impairment; 0-17= severe cognitive impairment

MOCA

Montreal Cognitive Assessment

>26=normal, add point for <12th grade education

SPMSQ

Short Portable Mental Status Questionnaire

10 items, more than 3 incorrect indicates dementia

BDI-2

Beck Depression inventory, 13 and older

presence and impact of depressive symptoms

21 items, <10=normal; 11-17=mild depression; 18-23=moderate; 24+=severe

CCSD

Cornell Scale for Depression in Dementia

19 items, <6=no significant depression; 8-17=probable major depression; >18=definite depression

MDQ

Mood Disorder Questionnaire

Screen for mania or hypomania

positive if 7 or more of 13 items in question #1 present and #2 is yes and #3 gets moderate or serious problem response

YMRS

Young Mania Rating Scale, 11 items (adult)

Range 0-60; adults with 12 or more=mania

CY-BOCS

...

YBOCS

Yale-Brown Obsessive Compulsive Scale

10 items; age 14 and older

gold standard for OC symptoms

score indicates level of severity

BPRS

Brief Psychiatric Rating Scale, 18 and older

Assesses psychopathology (+, - and affective) with schizophrenia, not for screening or DX

PANSS

Positive and Negative Syndrome Scale, 18 and older

measures changes in symptom intensity in psychosis and schizophrenia

Gold standard in studies of treatment efficacy

SPS

Suicide Probability Scale, 13 and older

Rapid measure of suicide risk

higher score indicates greater risk

CIWA-Ar

Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised

9 item symptom rating scale, max score 67; <10 does not warrant intervention

COWS

Clinical Opiate Withdrawal Scale

Quantifies severity of withdrawal syndrome, guides dosing, monitors over time

Used for induction of Suboxone

5-12=mild; 13-24= moderate; 25-36=mod to severe; >36=severe

T4, FREE THYROXINE

0.8-2.8

Increased In Graves

Decreased In Hypothyroidism

TSH

2- 10 mu/l

Normal values can range from 0.4 - 4.0 mIU/L (milli-international units per liter),

Calcium, Ca++

8.8-10.5

<7.0, tetany

>11.0, hyperparathyroidism

>13.5, hypercalcemic coma, metastatic cancer

Sodium, Na+

135-148 mEq/L

hypernatremia

dehydration

hypovolemia

diabetes insipidus

eating too much salt

gastroenteritis

drugs such as adrenocorticosteroids, methyldopa, hydrazine, cough meds

hyponatremia

drugs such as lithium, vasopressin, diuretics

addisons

renal disorder

gi fluid loss

Magnesium, Mg

1.3 - 2.1 mEq/L

lithium can increase

hypomagnesemia

depression, confusion, irritability,nystagmus, tetany, convulsions, ataxia, increased reflexes, muscle weakness

hypermagnesemia

N/V, respiratory depression, hypotension, depressed skeletal muscle contraction and nerve function, bradycardia

Potassium, K+

3.5-5.1 mEq/L

hyperkalemia

chronic marijuana use can elevate potassium

Chloride, Cl

98 - 106

passive transport through sodium

major anion in the extracellular fluid

Liver - ALT

5 - 35 U/L - depakote can increase, safe to use up to 2 times normal limit

Liver - AST

5 - 40 U/L

slight elevation can occur in DT's

depakote can increase, safe to use up to 2 times normal limit

Liver - GGT

10 - 38 IU/L

Thrombocytopenia

Platelet count normal = 150,000-450,000

if below - bone marrow doesn't make enough platelets.

or bone marrow makes enough platelets, but the body destroys them or uses them up.

or - The spleen holds on to too many platelets. The spleen is an organ that normally stores about one-third of the body's platelets. It also helps your body fight infection and remove unwanted cell material.

can be caused by Valproate

Neutropenia

A normal ANC is above 1,500 cells per microliter. An ANC less than 500 cells/µL is defined as neutropenia and significantly increases the risk of infection. Neutropenia is the condition of a low ANC,

Clozapine - WBC => 3500 to initiate therapy, ANC MUST BE =>2000/mm, ck wbc/anc weekly x 6 months, then Q other week for 6 months; if stable then Q 4 weeks. after therapy test for at least 4 weeks,

LIVER PANEL

ALP, AST, ASP, BILIRUBIN, ALBUMIN, TTL PROTEIN, CBC with WBC DIFFERENTIAL, PLATELET COUNT. FOR VALPROATE THERAPY - CK BASELINE AND MONTHLY FOR SEVERAL MONTHS

CREATININE

0.5-1.2 normal, kidney damage if elevated , athletes may be higher

BUN

10-20 mg/dL

LITHIUM THERAPY

CREATININE/BUN, SERUM ELECTROLYTES, CBC W/WBC & DIFF, URINALYSIS, EKG, ck levels (post dose 12 hrs trough), after 4 days on med, then q 4-5 days during initial therapy

lithium levels during acute tx

0.8 -1.2, during maintenance 0.6 - 1.0

ALP

44-147

CK, creatine kinase

<240, indicates muscle injury of heart, brain, skeletal muscle, elevated in MI, myositis, rhabdomysitis

BUN

10-20, increased in impaired kidney function, significant dehydration, measure with lithium

Creatinine

0.4-0.8, may vary with age gender, ethnicity, more sensitive then bun,

GFR

>90, best measurement of kidney function, no need to adjust dose depakote if GFR > 60

SIGNS OF LITHIUM TOXICITY

nystagmus, ataxia, increased deep tendon reflexes, altered mental status, cardiac arrhythmias

what meds do to lithium

ACE inhibitors, ARB's, nsaid, tetracyclines, metronidazole can INCREASE LITHIUM

DECREASES LITHIUM LEVELS

potassium-sparing diuretics, thiazide diuretics, theophyline decreases lithium

Examples of ARB's

ALL INCREASE LITHIUM

Valsartan

Telmisartan

Losartan

Irbesartan

Irbesartan

Azilsartan

Olmesartan

Olmesartan

Examples of Ace Inhibitors

ALL INCREASE LITHIUM

Enalapril (Vasotec/Renitec)

Ramipril (Altace/Prilace/Ramace/Ramiwin/Triatec/Tritace)

Quinapril (Accupril)

Perindopril (Coversyl/Aceon/Perindo)

Lisinopril (Listril/Lopril/Novatec/Prinivil/Zestril)

Benazepril (Lotensin)

Imidapril (Tanatril)

Trandolapril

examples of potassium-sparing diuretics

Epithelial sodium channel blockers

Amiloride

Triamterene

Aldosterone antagonists:

Spironolactone

Eplerenone

Core Competencies

Management of Health Status

Maintenance of Nurse-Patient Relationship

Teaching/Coaching

Professional Role

Managing and Negotiating Healthcare Delivery Systems

Monitoring Quality of Care

Providing Culturally Sensitive Care

When was NP role introduced and by whom

1965

Loretta Ford

University of Colorado

State Legislative Statutes

Grant legal authority for NP practice

Are the Nurse Practice Act of every state

Provide title protection

Define advanced practice

Are prevailing state laws that define scope of practice

Place restrictions on practice

Sets NP credentialing requirements

State grounds for disciplinary actions

May decide about collaborative agreements

Collaborative agreement

Protocol that describes what types of drugs might be prescribed and defines some form of oversight board for NP practice

Statutory Law

Rules and regulations differ for each state

May further define scope of practice and practice requirements

May provide restrictions in practice unique to specific state

Licensure

A process by which an agency of state government grants permission to individuals accountable for the practice of a profession to engage in the practice of that profession

Credentialing

Process used to protect the public by ensuring a minimum level of professional competence

Certification

Credential that provides title protection

Determines scope of practice

Is the process by which a professional organization/association certifies that an individual licensed to practice as a professional has met certain predetermined standards

Assures the public that an individual has mastery of a body of knowledge

Assures that the individual has acquired the skills necessary to function in a particular specialty

ANCC only one for psych

Scope of practice

Defines NP roles and actions

Identifies competencies assumed to be held by all NPs who function in a particular role

Has broad variations from state to state

Standards of Practice

Gives authoritative statements regarding the quality and type of practice that should be provided

Provides a way to judge the nature of care provided

Reflects the expectation for the care that should be provided to patients with various illnesses

Reflects professional agreement focused on the minimum levels of acceptable performance

Can be used to legally describe the standard of care that must be met by a provider

May be precise protocols that must be followed or more general guidelines that recommend actions

Four Rights of HIPAA

1. To be educated about HIPAA privacy protection

2. To have access to their own medical records

3. To request amendment of their health information to which they object

4. To require their permission for disclosure of their personal information

HITECH

Incentive payments for sharing specific EHR data

Meaningful use incentives

Improves outcomes

Exceptions to confidentiality

Intent to harm self or others

Attorneys involved in litigation

When records are released to insurance companies

Answering court orders, subpoenas, summons

Mandatory reporting of disease and conditions

Tarasoff principle: Duty to warn potential victims of imminent danger of homicidal patients

Child/elder abuse

Justice

Doing what is fair, fairness in all aspects of care

Beneficience

Promoting well being and doing good

Nonmalfeasance

Doing no harm

Fidelity

Being true and loyal

Autonomy

Doing for self

Veracity

Telling the truth

Respect

Treating everyone with equal respect

Deontological Theory

An action is judged as good or bad based on the act itself regardless of the consequences

Teleological Theory

An action is judged as good or bad based on the consequence or outcome

Virtue Ethics

Actions are chosen based on the moral virtues (honesty, courage, compassion, wisdom, gratitude, self respect) or the character of the person making the decision

Four elements of negligence to prove malpractice

Duty: NP had a duty to exercise reasonable care when undertaking and providing treatment to the patient

Breach of duty: NP violated the applicable standard of care in treating the patient's condition

Proximate cause: causal relationship between the breach in the standard of care and the patient's injuries

Damages:there are permanent and substantial damages to the patient as a result of the breach in the standard of care

Commitment Criteria

Person has a diagnosed psychiatric disorder

Person is harmful to self or others as a consequence of the disorder

Person is unaware or unwilling to accept the nature and severity of the disorder

Treatment is likely to improve functioning

Primary Prevention

Aimed at decreasing the incidence (number of new cases) of mental disorders (prevention)

Secondary Prevention

Aimed at decreasing prevalence (number of existing cases) of mental disorders (screening)

Tertiary Prevention

Aimed at decreasing the disability and severity of a mental disorder (rehab)

Ethnicity

Self identified race, tribe, or nation with which a person or group identifies and which greatly influences beliefs and behaviors

Schizophrenia accounts for ____% of US homelessness

15-45%

Sexual Identity

How people identify psychologically on a continuum between female and male and to whom they are sexually or affectionately attracted

Gender Identity

A person's identity along a continuum between normative constructs of masculinity and femininity

PICO

P-patient, population, problem

I-intervention

C-comparison

O-outcome

Internal validity

When the independent variable (treatment) caused a change in the dependent variable (outcome)

External validity

When the sample is representative of the population and the results can be generalized

Mean

Average of scores

Standard deviation

Indication of the possible deviations from the mean

Variance

How the values are dispersed around the mean; the larger the variance, the larger the dispersion of scores

Inferential statistics

Numerical values that enable one to reach conclusions that extend beyond the immediate data alone; generated by quantitative research designs

t test

Assesses whether the means of 2 groups are statistically different from each other

Analysis of Variance (ANOVA)

Tests the difference among 3 or more groups

Pearson's r correlation

Tests the relationship between 2 variables