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NR 605 MIDTERM EXAM (DIAGNOSIS MANAGEMENT
IN PSYCHIATRIC) ACTUAL EXAM QUESTIONS AND
CORRECT ANSWERS AGRADE
RATED
Lori, a 42-year-old female, presents to the office for an initial consultation. She has just experienced a breakup after a 5-year relationship and is feeling "depressed." A comprehensive initial evaluation which includes chief complaint, history or present illness, medical history, previous psychiatric history, family history and a comprehensive review of systems was completed. Psychotherapy was included in the session - 18 minutes time.
provide the appropriate CPT code - ANSWER-99205+90833
Rationale: The client is new to the practice (20) and presents with one problem which addressed 4 or more elements, had a comprehensive history and interview. No additional testing was needed, treatment was initiated (05). Psychotherapy was included in the session- 18 minutes time. Therapy goals were established and reviewed with the client.
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2 Hannibal, a 23-year-old male, is admitted to an inpatient psychiatric facility with symptoms of auditory hallucinations, paranoia, and suicidal ideations. A comprehensive initial evaluation which includes chief complaint, history or present illness, medical history, previous psychiatric history, family history and a comprehensive review of systems was completed.
provide the appropriate CPT code - ANSWER-99223
Rationale: The client presents for initial hospital care (22) and has a high level of medical decision-making due to an acute illness that poses a threat to life (3).
Shakina, a 19-year-old transgender female, has been referred to the PMHNP from primary care.The PMHNP reviews the primary provider's note and identifies symptoms of bipolar I disorder.The PMHNP completes a comprehensive assessment and prescribes medications for the client.
provide the appropriate CPT code - ANSWER-99245
Rationale: The client has been referred (24), has complex medical decision-making needs (5) based on one undiagnosed new problem with an uncertain prognosis, required review of referral notes, and requires prescription drug management. No psychotherapy provided.
Steve, a 30-year-old married client returns for a follow up appointment. He was initially seen 3 months ago due to increased anxiety over his marriage. His diagnoses include generalized 2 / 4
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3 anxiety disorder (F41.1) and major depressive disorder (F32.1) The PMHNP has provided both medication management and cognitive behavioral therapy (CBT). Today the PMHNP obtains a chief complaint, history of present illness, reviews medical history, and a focused review of three systems was completed. Medications - ANSWER-99214 + 90833
Rationale: This is a returning client with two documented diagnoses. A focused encounter was conducted that included psychotherapy.
The PMHNP has initiated a grief support group at her practice. The support group is one hour in length and can include the client and family members.
provide the appropriate CPT code - ANSWER-90853
Rationale: This is group psychotherapy with no medication management. Only a psychotherapy code is necessary.
Interprofessional Collaboration and Referrals - ANSWER--PMHNPs may receive client referrals from primary care providers to address mental health problems -refer clients to primary care providers for medical care -PMHNPs may collaborate with social workers to address clients' needs for social support -vocational counselors to assist with employment needs 3 / 4
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4 -refer clients to other therapists • geriatrics, psychiatric emergencies, eating disorders, family therapy, or pediatrics -telehealth services or a support group
Disparities in Mental Health Services - ANSWER-Racial, ethnic, gender, and sexual minorities -often experience poor mental health outcomes due to inaccessibility of quality mental health services, discrimination, a cultural stigma surrounding mental health care, and lack of knowledge about mental health • To address disparities, the American Psychological Association (2022) advocates for the expansion and use of culturally and linguistically competent psychological and behavioral research and services
Legal & Ethical Considerations - ANSWER-Provider initiated termination for cause Termination letters Court mandated treatment Process and progress notes
Code of Ethics for Nurses - ANSWER-Respect for the Individual Commitment to the Healthcare Consumer Advocacy for the Healthcare Consumer
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