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The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (2020)

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The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual (2020) provides everything you need to pass your certification test.

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    i THE PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER CERTIFICATION REVIEW MANUAL

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    ii Raymond Zakhari, DNP, EdM, NP, has a diverse clinical background ranging from intensive care to medical house calls. He began his career at Duke University Medical Center in the cardiothoracic ICU and made his way back to the Northeast as a traveling ICU and ED nurse. In 2009 he founded Metro Medical Direct, the first concierge, nurse practitioner-owned, medical/psychiatric house call and tele-health practice in New York City. Dr. Zakhari was also trained in sex therapy at the New York University School of Medicine/Langone Medical Center by Dr. Virginia Sadock (co-author of The Synopsis of Psychiatry ). Dr. Zakhari is appointed to the staff of NewYork- Presbyterian Hospital, Department of Internal Medicine in Psychiatry at the Payne Whitney Clinic, and provides consultative services as a Sexual Assault Forensic Examiner. He is a former officer of the New Jersey Air National Guard and has deployed in support of Operation Iraqi Freedom. He has held adjunct faculty appointments at the Hunter Bellevue School of Nursing, New York University, and Liberty University. Dr. Zakhari hosts a podcast called The Psychology of It All . Over the years, Dr. Zakhari has published in peer- reviewed journals and has presented at both regional and national conferences. He currently is a member of the American Academy of Nurse Practitioners (AANP), the Society for Sex Therapists and Researchers (SSTAR), and the International Association of Forensic Nurses. Dr. Zakhari is a graduate of Liberty University (BSN), Hunter College-The City University of New York (MS, ANP, PMHNP), Columbia University (EdM), Mount Saint Mary College (FNP), and Chatham University (DNP). Dr. Zakhari lives in Manhattan with his wife, two children, and dog Maslow. He spends his downtime experimenting in the kitchen, hosting dinner parties, and planning his next endeavor.

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    iii THE PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER CERTIFICATION REVIEW MANUAL Raymond Zakhari, DNP, EdM, NP

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    vi Copyright © 2021 Springer Publishing Company, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750- 8400, fax 978-646-8600, info@copyright.com or on the Web at www.copyright.com. Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com http://connect.springerpub.com/home Acquisitions Editor : Adrianne Brigido Compositor : diacriTech ISBN: 978-0-8261-7942-5 ebook ISBN: 978-0-8261-7943-2 DOI: 10.1891/9780826179432 20 21 22 23 / 5 4 3 2 1 The author and the publisher of this Work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. The author and publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Library of Congress Control Number: 2020900382 Contact us to receive discount rates on bulk purchases. We can also customize our books to meet your needs. For more information please contact: sales@springerpub.com

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    Publisher’s Note: New and used products purchased from third-party sellers are not guaranteed for quality, authenticity, or access to any included digital components. Printed in the United States of America.

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    v vi To my wife Lisa, my son Zachary, and my daughter Elizabeth. Thank you for allowing me the time to do this, and for encouraging me along the way.

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    vii CONTENTS Preface Acknowledgments Chapter 1: Preparing to Pass the Psychiatric-Mental Health Nurse Practitioner Certification Exam Chapter 2: The Role of the Psychiatric-Mental Health Nurse Practitioner: Regulations and Scope of Practice Questions Answers Chapter 3: Theoretical Foundations of Care and Nonpharmacological Therapies Questions Answers Chapter 4: Neuroanatomy, Physiology, and Mental Illness Questions Answers Chapter 5: Psychopharmacology Questions Answers Chapter 6: Physical Assessment, Diagnostic Tests, and Differential Diagnosis Questions

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    viii Answers Chapter 7: Substance Use Disorders Questions Answers Chapter 8: Delirium and Neurocognitive Disorders Questions Answers Chapter 9: Psychotic Disorders and Delusions Questions Answers Chapter 10: Sleep Disorders Questions Answers Chapter 11: Mood Disorders Questions Answers Chapter 12: Anxiety Disorders Questions Answers Chapter 13: Child/Adolescent Neurodevelopmental Disorders Questions Answers Chapter 14: Personality Disorders Questions

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    Answers Chapter 15: Violence and Abuse Questions Answers Chapter 16: Practice Test Questions Answers Index

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    ix PREFACE The work of psychiatry seeks to maintain and restore social order by mitigating maladaptive coping mechanisms that adversely affect the individual, family, and society. Psychiatry is a secular belief system that attempts to help people feel better by reducing all suffering. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) , called the Bible of psychiatry, requires faith (the confidence in what we hope for while resting in the assurance of what we do not see). The various committees of the American Psychiatric Association categorize abnormal behaviors of the human condition by classifying signs and symptoms with varying degrees of duration and intensity in the hope of clearly distinguishing between mental illness and normal functioning. The things labeled disorders are social constructs articulated using biological metaphors. As the values of society change, morality also changes. Etiology theories range from the sociological to the physiological and are subject to the will of current sociopolitical values of an elite group of academics during a particular time in history. Research in the field is significantly limited due to ethical constraints, and often offers correlation and association in place of cause and effect, and equates statistical significance with clinically meaningful outcomes. The caveat to all mental health professionals is that we should be cautious that our strong desire to relieve human suffering does not pull the veil over our eyes and cause us to diagnose all human suffering as a disorder. Irrational thoughts and emotional variability require context to meet the criteria for mental illness. Diagnosing and treating mental illness are often very complicated. The primary job of the psychiatric-mental health nurse practitioner is to identify the unifying disorder that accounts for the various signs and symptoms. These signs and symptoms are often shared among numerous conditions and for this reason diagnostic certainty is currently impossible. As such, treatments often fail, and patients continue to suffer, some without

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    x finding meaning. We can offer our patients a sense of belonging and hope. We can help them develop a skill set that allows them to navigate the complexities of this world in which suffering and uncertainty are the only constants. Helping patients discover a sense of purpose and connection to something greater than themselves restores their dignity as a human being comprised of body, mind, and spirit (soul). Both patients and therapists are often very eager to bring order to chaos by labeling a group of symptoms as a disorder. The clinician’s eagerness to alleviate their personal feeling of powerlessness and reduce the patient’s turmoil can lead to premature conclusions. The act of diagnosing and treating communicates to the patient that they are not alone in their condition, but the diagnosis must be accurate because patients will often adopt an identity congruent with the disorder. This text provides a survey of core content that will be tested on the psychiatric-mental health nurse practitioner board exam of the American Nurses Credentialing Center (ANCC). Practice questions and rationales are presented at the end of each chapter and in a practice test to reinforce the chapter’s content and to stimulate critical thinking in the prospective test taker.

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    xi xii ACKNOWLEDGMENTS Kunsook Bernstein, PhD, PMHNP, my faculty chair at Hunter College of the City University of New York Ella C. Guy, MS, NP, my colleague at NewYork-Presbyterian Hospital The faculty at Liberty University School of Nursing who are an inspiration and offered encouragement along the way

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    1 1 PREPARING TO PASS THE PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER CERTIFICATION EXAM OBJECTIVES ■ Identify self-care strategies and a study timeline ■ Describe evidence-based study strategies ■ Demonstrate understanding of the American Nurses Credentialing Center (ANCC) test outline and major content areas INTRODUCTION Congratulations! You have made it to a point in your career where you are allowed to sit for board certification as a psychiatric-mental health nurse practitioner (PMHNP). This review book helps you organize the large amount of information that you have previously mastered in your graduate education. This chapter presents a method to help you organize and maximize your studying efforts for the exam, and provides an overview of the information that will be tested based on the American Nurses Credentialing Center (ANCC) test map. The ANCC testing and review handbook is available at www.nursingworld.org/ancc. Review and bookmark this site for future reference as this will contain the most up-to-date information about the exam. Finally, this chapter explains how to dissect questions in order to help you choose the best answer. You may be experiencing many feelings as you embark on this journey to

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    validate your knowledge and achieve board certification. Some things that may give you comfort: ■ You went to an accredited school, which means it met the standards of preparing graduates to successfully pass certification exams. ■ The pass rate for this test is >80% (a large majority of test takers pass). ■ Reviewing the material in this book will reassure you of the information needed to pass the test. ■ This book will explain how to dissect a question to maximize selection of the best possible answer. ■ This book will explain what to do after you pass. STUDYING AND CARING FOR YOURSELF Preparing to study for the exam is an important step in the process of passing the boards. The subject matter can seem so voluminous that it may not seem possible to recall and apply everything that is covered on this exam. The following is a list of evidence-based studying techniques that can significantly increase your likelihood of passing. The study tips draw from the field of educational psychology, adult learning theory, and cognitive behavioral theory. Reviewing and implementing these techniques before you begin preparing for the ANCC exam will greatly increase your chance of success. In order for you to be successful and pass your test, you must read this list, preferably twice . ■ Make time (6–8 months before applying for the test) : Studying for an important exam requires special dedication time. Studying will be far less effective if added on to existing obligations rather than having a dedicated schedule for it in your life. In order to effectively study for this test using the evidence-based strategies set forth, you will need to create the necessary time to cover all the essential material on a consistent and scheduled basis. • Timeline : Creating a timeline will help you learn to delay gratification. Learn to build a successful timeline for studying. ■ Create a list of all of your obligations including as many things as possible that you do on a regular basis (household cleaning, cooking, childcare, transporter, church, laundry, exercise, holiday gatherings, birthdays, phone calls, upcoming major life events) and then plot

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    2 these on a grid with approximate time requirements. ■ Decide how soon you will be taking the test (ideally within 90–120 days of graduation). ■ Review the table of contents of this book and the latest ANCC test map. ■ Identify when will be your study time. What will you have to cut out or do less of? Study times should be done in blocks of 2 to 4 hours and free of all distractions. If this means driving to a library, you will need to include that in your timeline. Decide if you are a morning or night person and try to schedule your block of time accordingly. Be formal in your scheduling; add study time to a paper calendar or digital calendar (smartphone, app, electronic reminders). • Distractions : Your studying should be free from any distractions. Ideally, you want to simulate the testing environment as much as possible. During test day you will check all of your electronic devices into a locker and pass through a metal detector. You will not be able to bring anything into the test room with you. Practice being out of touch when you are studying. Give your studies undivided attention and avoid: ■ Chatting ■ Eating, drinking ■ Social media ■ Phone, smart watch, and so on ■ Being responsible for watching children when studying if possible (or wait until they’re asleep) ■ Visualization : Appropriately done this can help you succeed as a student; the first step in this process is to imagine in detail passing your exam. Think deeply about where you’ll be when you find out that you’ve passed, how you’ll feel, and how your friends and family will feel. Then visualize yourself doing the necessary work to pass. See yourself following your study timeline, blocking time to study, delaying gratification, blocking distractions, and putting off social obligations. Visualize yourself covering the various topics to be covered on the exam. Visualize yourself pressing through something you did not want to do and the sense of accomplishment you will have. ■ Rereading : This involves reading all study materials through twice, as well as any associated materials you may not know well. Reading does not

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    mean stopping to take notes along the way. Read for understanding and to refresh. Rereading more than twice does not increase retention and becomes a procrastination tactic that deceives the student into believing they are making progress. ■ Note-taking : Note-taking (particularly by hand) while going through printed material significantly increases retention of information. Reviewing notes and checking it against a source enhances your ability to recall. ■ Rehearsing : This technique involves going over information repeatedly until you can remember it. This is best accomplished by removing all distractions from the study environment and giving undivided attention to the task at hand. It also helps to recite the material out loud, chunking it along the way. ■ Synthesizing : Piecing together information helps you understand the relationship between ideas and concepts. Synthesis is better than simple memorization because this will help you apply your information to various scenarios. One way to synthesize is to draw graphs or charts reflecting the core concepts. Organizing a chart will help you organize the information for easy recall. Mapping is particularly helpful when trying to remember specific steps in a procedure. ■ Practicing : Answering many practice questions is very useful in helping overcome test anxiety. As you practice answering questions, you will develop a habit of carefully reading the stems of the questions and each of the answer choices to help you select the best answers. ■ Self-verbalizing : This procedure involves verbalizing the steps that you need to follow in order to complete the task. In this process you should whisper to yourself aloud a strategy that can work particularly well while you are actually taking the test. ■ Justifying : This procedure involves explaining important concepts that help to determine if the premise and a question are true. How do you distinguish a brief psychotic episode from schizophrenia? How do you distinguish dysthymia from major depressive disorder? Distinguish normal use from a substance use disorder? Explaining the distinctions among these types of questions will help you solidify in your mind the rationales for the answers to various questions. ■ Self-care : The study tips are predicated on the assumption of consistent

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    3 and adequate attention to basic physiological, psychological, and sociological needs. Human beings require consistent care for optimal performance. ■ Sleep : Impaired or inadequate sleep hinders your ability to learn and retain information. It is imperative that you get adequate and consistent sleep, particularly when preparing for an exam or enduring something particularly stressful (Feldman & Kubota, 2015). On average, 6 to 8 hours is recommended per night. As a PMHNP, one of the most common areas you will counsel your patients about is the importance of healthy sleep hygiene . Some common recommendations include: ■ Avoiding screen time (e.g., TV, computer, tablet) 2 hours before going to bed ■ Setting a cool enough room temperature ■ Going to bed at the same time each night ■ Ensuring the room is as dark as possible ■ Implementing white noise ■ Turning on a fan to keep the air circulating ■ Sleeping naked or with minimal clothing ■ Taking any medications for sleep as prescribed ■ Avoiding alcohol and caffeine ■ Radical acceptance : Forgiving yourself for all of the time you have previously wasted and all the obligations you have failed to meet is essential (Feldman & Kubota, 2015). You must forgive yourself in order to release this burden from your mind as you prepare for the exam. ■ Avoid extremes : Engaging in marathon study sessions has been shown to reduce retention by as much as 30% (Rohrer & Pashler, 2007). It is better to study for shorter periods over a longer period of time so that your hippocampus can consolidate your memory, making it easier to retrieve information through your limbic pathway during times of stress (like the ANCC exam). ■ Enhance self-efficacy : As a PMHNP, many theoretical models and treatment plans rely heavily on the concept of the belief in oneself or rely on the therapist expressing belief in the patient’s likelihood of success. Building your confidence in your studying and testing ability will significantly increase your success (Feldman & Kubota, 2015). If you are sitting for board certification, you have likely passed many exams

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    4 containing much more detailed content than the ANCC exam. Also, convince yourself how much you love studying and taking tests, which may require some effort. It may help just to do it and build yourself a reward system. Eventually, you may truly enjoy studying. ■ Eating : It is important to eat consistent meals and avoid concentrated sweets that can surge and then plunge your blood sugar (Hasegawa, Tachibana, Ono, & Kishimoto, 2017). It is also best to avoid very heavy meals before a study or test session. Lightly sweetened coffee can be helpful if it is something you usually drink. Trying coffee for the first time just before the exam is not a good idea. Gum chewing has also been found to be minimally helpful while studying or taking a test (Hasegawa et al., 2017). It can also be a great distraction if you are blowing bubbles or making noise. If you do chew gum, do it very quietly. ■ Exercise : Engaging in consistent physical activity for at least 20 minutes daily can significantly increase your mental acuity and ability to retain information. Exercise can also help you build the necessary structure into your day as you prepare for the exam (van Dongen, Kersten, Wagner, Morris, & Fernández, 2016). While exercising you should not try to study by listening to lectures or reading. Fast classical music has been shown to enhance retention by stimulating various neurons, a controversial theory called the Mozart effect (Hetland, 2000; Nantais & Schellenberg, 1999). ■ Relationships : It will be vital that you pay attention to close relationships. These people have been and will be your support system. Social interactions can also significantly reduce stress and remind you of your higher purpose in life. Some experts say it is best not to broadcast your test date because it may add unnecessary pressure. ■ Personal hygiene : Attending to hygiene helps make your study efforts more deliberate. You should prepare for your study sessions as if you are going to work. The ritual of preparation for the task helps organize the mind and prepares it for the task at hand. While showering, shaving, brushing your teeth, and so on, visualize what your study session will be like, the topics that you will cover, the practices you will do, and how long the study session will take. Some people who work from home even dress up as if they are going into the office because it makes them more productive. Studying in your pajamas or bathrobe does not prepare your mind and body for serious work.

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    ABOUT THE ANCC PMHNP BOARD CERTIFICATION EXAM ■ ANCC is a subsidiary of the American Nurses Association (ANA), serving as the independent professional credentialing body for professional nursing practice. The organization accredits healthcare organizations that provide and approve continuing nursing education. The ANCC offers APRN board certification exams for: • Family Nurse Practitioner (FNP) • Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP) • Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) • Pediatric Primary Care Nurse Practitioner (PPCNP) • Psychiatric-Mental Health Nurse Practitioner (PMHNP) ■ Passing the exam allows the nurse practitioner to apply the board certified (BC) designation post-nominally; for example, Raymond Zakhari, PMHNP-BC. The ANCC is the only credentialing body to offer a board certification exam for PMHNPs. ■ The test is administered at various Prometric Testing Centers (prometric.com) around the world. You can only schedule your exam once you have received the Authorization to Test (ATT) from the ANCC. Your ATT is only sent once your online application has been completed and your transcripts have been validated by ANCC. ■ Qualifying : In order to qualify for board certification testing you must be a graduate of an accredited master’s, doctoral, or postgraduate NP program. The program must have included at least 500 supervised clinical hours in the respective specialty for which you are seeking certification. • The accreditation of the program must be by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN). • Prospective candidates must also have an unencumbered RN license. • Students educated outside the United States or one of its territories may be able to sit for the exam if the ANCC criteria have been met by the preparatory programs. For further information, contact the ANCC (nursingworld.org/ancc/). ■ New exam release : A new Test Content Outline (formerly called the test

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    5 map) was released on December 16, 2019. Content on the PMHNP exam is based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5 ). It is always best to check the website for the latest test content outline. • Each ANCC exam has several versions. • Each version of the exam is randomly assigned. • The exam is not computer adaptive. • Most of the exam questions will be multiple choice. • There are alternate format questions including drag and drop, extended multiple choice questions where you are asked to pick more than one correct answer, hot spot questions in which you will be asked to identify a structure in response to a test question; for example, which lobe of the brain is responsible for executive functioning? You would have to click on the lobe of the brain represented in a diagram. • The test will have 175 questions. Twenty-five of the questions are not graded and are only used for statistical validation purposes. • The time limit is 3.5 hours to complete the test. Once the clock starts, there is no way to pause the time even if you go to the bathroom. Once the allotted time expires, the test will automatically shut down. • Unanswered questions are marked as incorrect. • You can mark and return to questions within the allotted time. • There will be separate time allocated for a computer tutorial before the exam begins. • Sample ANCC exams are available on the website to try before you sit for the exam. A sample test can be taken as many times as you wish. ■ Passing rate : According to ANCC (2017), 1,777 individuals took the PMHNP exam. Of those individuals, 1,563 passed the exam (88% of the people who took the test passed the test). Note that these data are based on results prior to the December 2019 test revision. ■ Applying for the exam : If you are in a Doctorate of Nursing Practice (DNP) program, you can apply when you are 6 months from completing your studies. The clinical hours and didactic content related to your specialty certification must be completed. The application must contain proof of your RN licenses, an official transcript, and the validation of education form signed by the NP program director. • ANCC can take 4 to 6 weeks to process a COMPLETED

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    application . During slower times of the year, it may take as little as 3 weeks. Peak application season is from April to July, and from November to January. ■ Expediting : This option allows the processing time to be shortened to 5 days (FOR COMPLETED APPLICATIONS ONLY). There is an additional cost for this option. Caveat: This assumes that all parties required to send information have done so. If your school is delayed due to holiday or summer hours, or if it is using a third-party vendor, you will not be processed in an expedited manner. I do not recommend this option unless you know for sure all parties have fulfilled their obligations. For more information on this option, contact aprnvalidation@ana.org. ■ Validation of education : A form that is signed by the program director attesting to the content of your education. The original (NOT A COPY) must accompany your application for testing. ■ Scheduling your exam : Waiting to schedule your exam may limit your options. Schedule your exam as soon as you receive your ATT. • Make sure you have created your study timeline before you apply for the test, and that you have started studying. • If you must test on a certain day, you can broaden your search to another testing center; you may have to look in another state. • Missed appointment OR expired ATT : You will be considered a no show and your testing window automatically expires. Call the Prometric testing center as soon as possible, then contact ANCC. ANCC will allow for one reschedule, but you will be charged a rescheduling fee. ■ Pass/fail : You will find out immediately whether you passed or failed the exam. Once you complete your exam and leave the room, the proctor will have a printout containing your unofficial result. An official result will be mailed to you. The unofficial result cannot be used as proof of passing for any official purpose. • Notifying the state board of nursing : The ANCC does not automatically notify the board of nursing. You will need to sign a release of score consent form (part of the application package). • Certification : Valid for 5 years. Tracking your continuing education credits will make recertifying much easier. If you fail to

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    6 take the required 75 credit hours, your certification will expire and you will have to retest. If your certification expires, you can no longer claim to be BC. THERE IS NO GRACE PERIOD OR BACKDATING. □ Renewal : You can start this process 1 year before your expiration date but no later than 3 months before. □ Practice hours : You must have 1,000 clinical practice hours in the clinical specialty within the preceding 5 years. □ Continuing education : Seventy-five contact hours are required. Also, you need one or more of the eight ANCC renewal categories (academic credits, presentations, preceptor hours, quality improvement projects, professional service, practice hours, research, publication, or retest). This means that, in addition to continuing education hours, you must do one of these eight things every 5 years. □ Pharmacology : Of the contact hours, 25 of them must be in pharmacotherapy. • If you fail : The ANCC allows you to retake the exam up to three times in 12 months, but there must be at least 60 days between attempts. You must wait 5 days (after taking your exam) to reapply to test. • Reapplying : You must resubmit all materials as if you were applying for the first time and pay all the associated fees again. ■ PMHNP test content map • The test is comprised of five domains: Scientific Foundation (20%), Advanced Practice Skills (25%), Diagnosis and Treatment (25%), Psychotherapy and Related Theories (15%), and Ethical and Legal Principles (15%). Approximately 40% to 50% of the test contents (pathophysiology, pharmacology, physical assessment, health promotion, ethics, scope of practice, role delineation, ethics, screenings, and regulatory requirements) are common to all of the nurse practitioner specialities. The test will contain a total of 175 questions, of which only 150 will be counted for scoring. The test is not presented in a categorical format, but rather questions can come from any of the five domains at any point during the test. You should not ascribe any special meaning if you find yourself answering a string of questions related to a specific

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    topic. Likewise, if you find you are not asked about a seemingly common topic related to psychiatric-mental health care, this does not mean you are taking the wrong exam. Following is more detailed information regarding the test content outline and the number of questions you can expect for each category. ■ Scientific foundation (30 questions)—Includes content related to general pathophysiology, pharmacology (including therapeutic and adverse effects), and physical assessment across the life span. Following is a list of other key terms and concepts included in this section of the test: • Physiology, neurodevelopment, genomics, and epigenetics • Pathophysiology and clinical manifestation of altered health states • Anatomy and physiology, specifically neuroanatomy and neurophysiology • The relationship between physiology and pathophysiology produced by altered health states (including common movement disorders associated with psychopharmacology) • Pharmacology and psychopharmacology • Pharmacotherapeutic categories of medications ■ Anti-infectives ■ Antineoplastic ■ Cardiovascular ■ Endocrine ■ Eye, ear, and skin ■ Gastrointestinal ■ Genitourological ■ Immunological ■ Musculoskeletal/analgesic ■ Neurological ■ Psychiatric ■ Respiratory • Pharmacokinetics and pharmacodynamics of the broad categories • Pharmacokinetics and pharmacodynamics of psychotropic medications ■ Advanced practice skills (38 questions)—Includes content specific to the work of nurse practitioners such as interviewing, obtaining history and physical examination, assessing for intoxication and withdrawal, altered mental status, using psychometrically validated tools, and suicide risk

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    7 assessment. Following is a list of other key terms and concepts included in this section of the test: • Analyzing response to illness and treatment modalities ■ Assessing neurological function based on patient presentation ■ Interpreting findings from diagnostic testing • Identifying the needs of individuals with system dysfunction ■ Risk assessment ■ Assessing facilitators and barriers to care ■ Health promotion and disease prevention ■ Growth and development ■ Neuroprotective strategies ■ Individualizing strategies ■ Anticipatory guidance ■ Interviewing and formulating ■ Crisis intervention ■ Group dynamics ■ Starting, weaning, tapering, and titrating medication ■ Evidence-based practice ■ Translating research into practice ■ Disseminating evidence from inquiry to diverse populations using multiple modalities ■ Diagnosis and treatment (37 questions)—Includes content related to the DSM-5 classifications, as well as developing differential diagnoses, ordering and interpreting diagnostic tests, appropriate referrals, therapeutic drug monitoring, and applying evidence-based practice. Following is a list of other key terms and concepts included in this section of the test: • Mental health disorders due to general medical conditions and physical conditions associated with mental health disorders ■ Developing a comprehensive health assessment that includes neuropsychiatric developmental, genetic, and epidemiological factors ■ Complementary and alternative treatments ■ Assess risk factors and barriers to health promotion and disease prevention (socioeconomic, genetics, biological, environmental, community-specific variables) ■ Synthesize epidemiological data to design and deliver evidence- based practice

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    ■ Incorporating patient ability, experiences, preferences, lifestyle, values, goals, rights, and responsibilities into care ■ Cultural competencies and spirituality ■ Enhancing health literacy ■ Promoting resilience and recovery ■ Psychotherapy and related theories (22 questions)—Includes content related to conceptual models and frameworks for understanding behavior across the life span, theories of change, and the family system applied to various clinical situations. The primary skill is to develop a therapeutic alliance. Following are some key terms and concepts included in this section of the test: • Trauma-informed care • Recovery-oriented care • Transtheoretical model/motivational interviewing • Developmental theories • Establishing and maintaining a therapeutic alliance • Nonpharmacological treatment modalities (types of talk therapy) • Psychotherapeutic theories ■ Ethical and legal principles (23 questions)—Includes content related to the role of the nurse practitioner, legal barriers, political activities, advocacy, social justice, patients’ rights, team building, and collaboration. Following are some key terms and concepts that are included in this section of the test: • Principles and concepts of interprofessional and intradisciplinary practice ■ Reflective thinking principles, concepts, and practices ■ Conflict resolution, negotiation, mediation, and professional civility ■ Political activism ■ Advocating for the value and role of the nurse practitioner ■ Fostering collaboration with multiple stakeholders to improve healthcare ■ Building and leading collaborative interprofessional care teams ■ Communicating within or across organizations ■ Advancing practice through the development and implementation of innovations incorporating principles of change • Health policy development

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    8 • Advocating for social justice, and improved access to quality and cost- effective care • Analyzing ethical, legal, and social factors influencing policy development • Influencing health policies to ameliorate the impact of stigma on services for the prevention and treatment of mental health problems and substance use disorders • Ethical and legal issues related to the use of information technology, including scope of confidentiality, release of information, and duty to warn • Using information and communication technologies, resources, and principles of learning to teach and/or treat • Translating technical and scientific health information for complex decision-making • Organizational practices • Analyzing and organizational structure, functions, and resources to improve and sustain the delivery of care • Current American Nurses Association scope and standards of practice • Regulations and guidelines related to the psychiatric-mental health nurse practitioner practice • Promoting just culture of safety ■ Dissecting questions : In order to choose the best possible answer, you must know exactly what you are being asked. The majority of questions will be multiple choice. Multiple choice questions consist of three parts. They are the entire question, the stem (the essential information of the question), and the answer choices (one correct and three distractors). ALWAYS READ THE ENTIRE QUESTION AND ALL THE ANSWERS BEFORE SELECTING ANYTHING! • Do not read into the question. • Do not assume information that is not presented; that is, do not overanalyze. ■ If the information is not given, assume it is not needed and has no effect on the answer. • Step 1: Is the question asking you to recall a fact or apply information? Moreover, is the question asking you to do something or find out something?

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    ■ Are there any keywords in the question such as avoid, best, except, not, initial, first, most, least, of the following? (Are you looking for correct answers or wrong answers?) • Step 2: Can you apply Maslow’s hierarchy of needs? Just because this is a psychiatric exam you cannot forget that physiological needs always take priority over psychosocial needs. Remember to choose the safest answer and consider what would happen if each answer is chosen. (Does the answer choice answer the question?) • Step 3: Is the answer choice an assessment or implementation? For the exam, assessment answers are when you are gathering more information either by physical exam, ordering a diagnostic test, or by interviewing the patient or collateral sources. Implementation answers are when you give advice, change medication, or teach something. Also, consider if the assessment or implementation matches the stem of the question. ■ EXAMPLE: A client with an absolute neutrophil count <1,000 has been taking his clozapine 500 mg daily. What should the PMHNP do first? A. Tell the patient to stop taking the medication immediately B. Order a stat complete blood count (CBC) C. Instruct the patient on the importance of taking the medication exactly as prescribed D. Remind the patient of the importance of proper hand hygiene The stem of this question deals with agranulocytosis in someone taking clozapine. The question asks for an implementation. The stem is asking about a physiological condition. The answer should be a physiological intervention that addresses the stem. Based on this information the correct answer is A. Ordering a stat blood test does not address the problem. Instructing on the importance of medication adherence would worsen the problem in this case. Reminding of good hand hygiene, while helpful and related to the agranulocytosis, would not take priority over stopping the medication. • Step 4: Select the correct answer. Remember to eliminate answer choices after you have read the entire question and all the choices to increase your odds of selecting the correct answer. Do not second guess your answer choice unless you have a compelling reason, you recall an

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    9 essential concept that directly relates to the stem, or you have a clearer understanding of the question that you did not initially have. • Most people change the correct answer to the wrong answer rather than a wrong answer to the correct answer. • If you are unsure about an answer choice, you can mark the question and come back to it for later review. ■ Drag and drop questions: • In this question format, you will be asked to match the choices that are alpha-numerically presented. This is common with questions about evidence-based practice or anatomy. EXAMPLE: Correlate the lobes of the brain with their respective functions: 1) Frontal lobe A) Memory, understanding, and language 2) Parietal lobe B) Vision 3) Occipital lobe C) Executive functions 4) Temporal lobe D) Auditory perception Answers: 1: C, 2: A, 3: B, 4: D ■ Hot spot questions • In this question format, you may be asked to identify a specific location on a diagram. To do this, you would point and click with the mouse. ■ Final tips about choosing the correct answer • If you have two answers that seem equally good, choose the least expensive, least invasive option that allows you to answer the question. For example, if your choice is between a CT scan of the head or a focused neurological exam, the latter will likely be the best option. (There are no scans or biomarkers in psychiatry that can diagnose a psychiatric condition. Once something appears on a scan it becomes a neurological condition.) • See whether the answer choices have something in common or are very similar. If two answers are very similar, they are likely incorrect. If all three are related, they too can usually be excluded. • Be mindful of results that are wide ranging. Middle of the road values

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