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

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iTHE PSYCHIATRIC-MENTALHEALTH NURSEPRACTITIONERCERTIFICATION REVIEWMANUAL

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iiRaymond Zakhari, DNP, EdM, NP,has a diverse clinical backgroundranging from intensive care to medical house calls. He began his career atDuke University Medical Center in the cardiothoracic ICU and made his wayback to the Northeast as a traveling ICU and ED nurse. In 2009 he foundedMetroMedicalDirect,thefirstconcierge,nursepractitioner-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 ofMedicine/Langone Medical Center by Dr. Virginia Sadock (co-author ofTheSynopsis of Psychiatry). Dr. Zakhari is appointed to the staff of NewYork-Presbyterian Hospital, Department of Internal Medicine in Psychiatry at thePayne Whitney Clinic, and provides consultative services as a Sexual AssaultForensic Examiner. He is a former officer of the New Jersey Air NationalGuard and has deployed in support of Operation Iraqi Freedom. He has heldadjunct faculty appointments at the Hunter Bellevue School of Nursing, NewYork University, and Liberty University. Dr. Zakhari hosts a podcast calledThe Psychology of It All. Over the years, Dr. Zakhari has published in peer-reviewedjournalsandhaspresentedatbothregionalandnationalconferences. He currently is a member of the American Academy of NursePractitioners(AANP),theSocietyforSexTherapistsandResearchers(SSTAR), and the International Association of Forensic Nurses. Dr. ZakhariisagraduateofLibertyUniversity(BSN),HunterCollege-TheCityUniversity 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. Hespends his downtime experimenting in the kitchen, hosting dinner parties,and planning his next endeavor.

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iiiTHE PSYCHIATRIC-MENTALHEALTH NURSEPRACTITIONERCERTIFICATION REVIEWMANUALRaymond Zakhari, DNP, EdM, NP

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viCopyright © 2021 Springer Publishing Company, LLCAll rights reserved.No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any formor by any means, electronic, mechanical, photocopying, recording, or otherwise, without the priorpermission of Springer Publishing Company, LLC, or authorization through payment of the appropriatefees 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, LLC11 West 42nd StreetNew York, NY 10036www.springerpub.comhttp://connect.springerpub.com/homeAcquisitions Editor: Adrianne BrigidoCompositor: diacriTechISBN:978-0-8261-7942-5ebook ISBN:978-0-8261-7943-2DOI:10.1891/978082617943220 21 22 23 / 5 4 3 2 1The author and the publisher of this Work have made every effort to use sources believed to be reliableto provide information that is accurate and compatible with the standards generally accepted at the timeof publication. The author and publisher shall not be liable for any special, consequential, or exemplarydamages resulting, in whole or in part, from the readers’ use of, or reliance on, the informationcontained in this book. The publisher has no responsibility for the persistence or accuracy of URLs forexternal or third-party Internet websites referred to in this publication and does not guarantee that anycontent on such websites is, or will remain, accurate or appropriate.Library of Congress Control Number: 2020900382Contact 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 guaranteedfor quality, authenticity, or access to any included digital components.Printed in the United States of America.

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vviTo my wife Lisa, my son Zachary, and mydaughter Elizabeth.Thank you for allowing me the time to do this, andfor encouraging me along the way.

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viiCONTENTSPrefaceAcknowledgmentsChapter 1:Preparing to Pass the Psychiatric-Mental Health NursePractitioner Certification ExamChapter 2:The Role of the Psychiatric-Mental Health NursePractitioner: Regulations and Scope of PracticeQuestionsAnswersChapter 3:Theoretical Foundations of Care and NonpharmacologicalTherapiesQuestionsAnswersChapter 4:Neuroanatomy, Physiology, and Mental IllnessQuestionsAnswersChapter 5:PsychopharmacologyQuestionsAnswersChapter 6:Physical Assessment, Diagnostic Tests, and DifferentialDiagnosisQuestions

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viiiAnswersChapter 7:Substance Use DisordersQuestionsAnswersChapter 8:Delirium and Neurocognitive DisordersQuestionsAnswersChapter 9:Psychotic Disorders and DelusionsQuestionsAnswersChapter 10: Sleep DisordersQuestionsAnswersChapter 11: Mood DisordersQuestionsAnswersChapter 12: Anxiety DisordersQuestionsAnswersChapter 13: Child/Adolescent Neurodevelopmental DisordersQuestionsAnswersChapter 14: Personality DisordersQuestions

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AnswersChapter 15: Violence and AbuseQuestionsAnswersChapter 16: Practice TestQuestionsAnswersIndex

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ixPREFACEThe work of psychiatry seeks to maintain and restore social order bymitigatingmaladaptivecopingmechanismsthatadverselyaffecttheindividual, family, and society. Psychiatry is a secular belief system thatattempts to help people feel better by reducing all suffering. TheDiagnosticand Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), calledthe Bible of psychiatry, requires faith (the confidence in what we hope forwhilerestingintheassuranceofwhatwedonotsee).Thevariouscommittees of the American Psychiatric Association categorize abnormalbehaviors of the human condition by classifying signs and symptoms withvarying degrees of duration and intensity in the hope of clearly distinguishingbetween mental illness and normal functioning. The things labeled disordersare social constructs articulated using biological metaphors. As the values ofsociety change, morality also changes. Etiology theories range from thesociological to the physiological and are subject to the will of currentsociopolitical values of an elite group of academics during a particular time inhistory.Research in the field is significantly limited due to ethical constraints, andoften offers correlation and association in place of cause and effect, andequates statistical significance with clinically meaningful outcomes. Thecaveat to all mental health professionals is that we should be cautious that ourstrong desire to relieve human suffering does not pull the veil over our eyesand cause us to diagnose all human suffering as a disorder. Irrational thoughtsand emotional variability require context to meet the criteria for mentalillness. Diagnosing and treating mental illness are often very complicated.The primary job of the psychiatric-mental health nurse practitioner is toidentifytheunifyingdisorderthataccountsforthevarioussignsandsymptoms. These signs and symptoms are often shared among numerousconditions and for this reason diagnostic certainty is currently impossible. Assuch, treatments often fail, and patients continue to suffer, some without

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xfinding meaning.We can offer our patients a sense of belonging and hope. We can helpthem develop a skill set that allows them to navigate the complexities of thisworld in which suffering and uncertainty are the only constants. Helpingpatients discover a sense of purpose and connection to something greater thanthemselves restores their dignity as a human being comprised of body, mind,and spirit (soul). Both patients and therapists are often very eager to bringorder to chaos by labeling a group of symptoms as a disorder. The clinician’seagerness to alleviate their personal feeling of powerlessness and reduce thepatient’s turmoil can lead to premature conclusions. The act of diagnosingand treating communicates to the patient that they are not alone in theircondition, but the diagnosis must be accurate because patients will oftenadopt an identity congruent with the disorder.This text provides a survey of core content that will be tested on thepsychiatric-mental health nurse practitioner board exam of the AmericanNurses Credentialing Center (ANCC). Practice questions and rationales arepresented at the end of each chapter and in a practice test to reinforce thechapter’s content and to stimulate critical thinking in the prospective testtaker.

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xixiiACKNOWLEDGMENTSKunsook Bernstein, PhD, PMHNP, my faculty chair at Hunter College of theCity University of New YorkElla C. Guy, MS, NP, my colleague at NewYork-Presbyterian HospitalThe faculty at Liberty University School of Nursing who are an inspirationand offered encouragement along the way

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11PREPARING TO PASS THEPSYCHIATRIC-MENTALHEALTH NURSE PRACTITIONERCERTIFICATION EXAMOBJECTIVES■ 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 areasINTRODUCTIONCongratulations! You have made it to a point in your career where you areallowed to sit for board certification as a psychiatric-mental health nursepractitioner(PMHNP).Thisreviewbookhelpsyouorganizethelargeamount of information that you have previously mastered in your graduateeducation. This chapter presents a method to help you organize and maximizeyourstudyingeffortsfortheexam,andprovidesanoverviewoftheinformation that will be tested based on the American Nurses CredentialingCenter (ANCC) test map. The ANCC testing and review handbook isavailable at www.nursingworld.org/ancc. Review and bookmark this site forfuture reference as this will contain the most up-to-date information about theexam. Finally, this chapter explains how to dissect questions in order to helpyou 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 thatmay give you comfort:■ You went to an accredited school, which means it met the standards ofpreparing 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 informationneeded to pass the test.■ This book will explain how to dissect a question to maximize selection ofthe best possible answer.■ This book will explain what to do after you pass.STUDYING AND CARING FOR YOURSELFPreparing to study for the exam is an important step in the process of passingthe boards. The subject matter can seem so voluminous that it may not seempossible to recall and apply everything that is covered on this exam. Thefollowingisalistofevidence-basedstudyingtechniquesthatcansignificantly increase your likelihood of passing. The study tips draw fromthe field of educational psychology, adult learning theory, and cognitivebehavioral theory. Reviewing and implementing these techniques before youbegin preparing for the ANCC exam will greatly increase your chance ofsuccess.In order for you to be successful and pass your test, you mustread this list, preferably twice.■Make time (6–8 months before applying for the test): Studying for animportant exam requires special dedication time. Studying will be far lesseffective if added on to existing obligations rather than having a dedicatedschedule for it in your life. In order to effectively study for this test usingtheevidence-basedstrategiessetforth,youwillneedtocreatethenecessary time to cover all the essential material on a consistent andscheduled 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 aspossible 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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2these on a grid with approximate time requirements.■ Decide how soon you will be taking the test (ideally within 90–120days of graduation).■ Review the table of contents of this book and the latest ANCC testmap.■ Identify when will be your study time. What will you have to cut outor do less of? Study times should be done in blocks of 2 to 4 hoursand free of all distractions. If this means driving to a library, you willneed to include that in your timeline. Decide if you are a morning ornight person and try to schedule your block of time accordingly. Beformal in your scheduling; add study time to a paper calendar ordigital calendar (smartphone, app, electronic reminders).•Distractions:Yourstudyingshouldbefreefromanydistractions.Ideally, you want to simulate the testing environment as much aspossible. During test day you will check all of your electronic devicesinto a locker and pass through a metal detector. You will not be able tobring anything into the test room with you. Practice being out of touchwhen 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 visualizeyourself doing the necessary work to pass. See yourself following yourstudy timeline, blocking time to study, delaying gratification, blockingdistractions, and putting off social obligations. Visualize yourself coveringthe various topics to be covered on the exam. Visualize yourself pressingthroughsomethingyoudidnotwanttodoandthesenseofaccomplishment you will have.■Rereading: This involves reading all study materials through twice, aswell 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 torefresh.Rereadingmorethantwicedoesnotincreaseretentionandbecomes a procrastination tactic that deceives the student into believingthey are making progress.■Note-taking: Note-taking (particularly by hand) while going throughprintedmaterialsignificantlyincreasesretentionofinformation.Reviewing notes and checking it against a source enhances your ability torecall.■Rehearsing: This technique involves going over information repeatedlyuntil you can remember it. This is best accomplished by removing alldistractions from the study environment and giving undivided attention tothe task at hand. It also helps to recite the material out loud, chunking italong the way.■Synthesizing: Piecing together information helpsyou understand therelationship between ideas and concepts. Synthesis is better than simplememorization because this will help you apply your information to variousscenarios. One way to synthesize is to draw graphs or charts reflecting thecore concepts. Organizing a chart will help you organize the informationfor easy recall. Mapping is particularly helpful when trying to rememberspecific steps in a procedure.■Practicing: Answering many practice questions is very useful in helpingovercome test anxiety. As you practice answering questions, you willdevelop a habit of carefully reading the stems of the questions and each ofthe answer choices to help you select the best answers.■Self-verbalizing: This procedure involves verbalizing the steps that youneed to follow in order to complete the task. In this processyou shouldwhisper to yourselfaloud a strategy that can work particularly well whileyou are actually taking the test.■Justifying: This procedure involves explaining important concepts thathelp to determine if the premise and a question are true. How do youdistinguish a brief psychotic episode from schizophrenia? How do youdistinguish dysthymia from major depressive disorder? Distinguish normaluse from a substance use disorder? Explaining the distinctions amongthese types of questions will help you solidify in your mind the rationalesfor the answers to various questions.■Self-care: The study tips are predicated on the assumption of consistent

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3andadequateattentiontobasicphysiological,psychological,andsociological needs. Human beings require consistent care for optimalperformance.■Sleep: Impaired or inadequate sleep hinders your ability to learn and retaininformation. It is imperative that you get adequate and consistent sleep,particularlywhenpreparingforanexamorenduringsomethingparticularly stressful (Feldman & Kubota, 2015). On average, 6 to 8 hoursis recommended per night.As a PMHNP, one of the most commonareas you will counsel your patients about is the importance ofhealthy sleep hygiene. Some common recommendations include:■ Avoiding screen time (e.g., TV, computer, tablet) 2 hours beforegoing 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 havepreviously wasted and all the obligations you have failed to meet isessential (Feldman & Kubota, 2015). You must forgive yourself in orderto release this burden from your mind as you prepare for the exam.■Avoid extremes: Engaging in marathon study sessions has been shown toreduce retention by as much as 30% (Rohrer & Pashler, 2007). It is betterto study for shorter periods over a longer period of time so that yourhippocampus can consolidate your memory, making it easier to retrieveinformation through your limbic pathway during times of stress (like theANCC exam).■Enhance self-efficacy:AsaPMHNP,manytheoreticalmodelsandtreatment plans rely heavily on the concept of the belief in oneself or relyon the therapist expressing belief in the patient’s likelihood of success.Buildingyourconfidenceinyourstudyingandtestingabilitywillsignificantly increase your success (Feldman & Kubota, 2015). If you aresittingforboardcertification,youhavelikelypassedmanyexams

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4containing much more detailed content than the ANCC exam. Also,convince yourself how much you love studying and taking tests, whichmay require some effort. It may help just to do it and build yourself areward system. Eventually, you may truly enjoy studying.■Eating: It is important to eat consistent meals and avoid concentratedsweets that can surge and then plunge your blood sugar (Hasegawa,Tachibana, Ono, & Kishimoto, 2017). It is also best to avoid very heavymeals before a study or test session. Lightly sweetened coffee can behelpful if it is something you usually drink. Trying coffee for the first timejust before the exam is not a good idea. Gum chewing has also been foundto 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 ormaking noise. If you do chew gum, do it very quietly.■Exercise: Engaging in consistent physical activity for at least 20 minutesdaily can significantly increase your mental acuity and ability to retaininformation. Exercise can also help you build the necessary structure intoyour day as you prepare for the exam (van Dongen, Kersten, Wagner,Morris, & Fernández, 2016). While exercising you should not try to studyby listening to lectures or reading. Fast classical music has been shown toenhance retention by stimulating various neurons, a controversial theorycalled the Mozart effect (Hetland, 2000; Nantais & Schellenberg, 1999).■Relationships: It will be vital that you pay attention to close relationships.Thesepeoplehavebeenandwillbeyoursupportsystem.Socialinteractions can also significantly reduce stress and remind you of yourhigher purpose in life. Some experts say it is best not to broadcast yourtest date because it may add unnecessary pressure.■Personal hygiene: Attending to hygiene helps make your study effortsmore deliberate. You should prepare for your study sessions as if you aregoing to work. The ritual of preparation for the task helps organize themind and prepares it for the task at hand. While showering, shaving,brushing your teeth, and so on, visualize what your study session will belike, the topics that you will cover, the practices you will do, and howlong the study session will take. Some people who work from home evendress up as if they are going into the office because it makes them moreproductive. Studying in your pajamas or bathrobe does not prepare yourmind and body for serious work.

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ABOUT THE ANCC PMHNP BOARD CERTIFICATIONEXAM■ ANCC is a subsidiary of the American Nurses Association (ANA), servingastheindependentprofessionalcredentialingbodyforprofessionalnursing practice. The organization accredits healthcare organizations thatprovide and approve continuing nursing education. The ANCC offersAPRN 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)designationpost-nominally;forexample,RaymondZakhari,PMHNP-BC. The ANCC is the only credentialing body to offer a boardcertification exam for PMHNPs.■ ThetestisadministeredatvariousPrometricTestingCenters(prometric.com) around the world. You can only schedule your exam onceyou have received the Authorization to Test (ATT) from the ANCC. YourATT is only sent once your online application has been completed andyour transcripts have been validated by ANCC.■Qualifying: In order to qualify for board certification testing you must beagraduateofanaccreditedmaster’s,doctoral,orpostgraduateNPprogram. The program must have included at least 500 supervised clinicalhours in the respective specialty for which you are seeking certification.• The accreditation of the program must be by the Commission onCollegiate Nursing Education (CCNE) or the Accreditation Commissionfor Education in Nursing (ACEN).• Prospective candidates must also have an unencumbered RN license.• Students educated outside the United States or one of its territories maybe able to sit for the exam if the ANCC criteria have been met by thepreparatoryprograms.Forfurtherinformation,contacttheANCC(nursingworld.org/ancc/).■New exam release: A new Test Content Outline (formerly called the test

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5map) was released on December 16, 2019.Content on the PMHNPexam is based on theDiagnostic and Statistical Manual of MentalDisorders, Fifth Edition(DSM-5). It is always best to check the websitefor 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, extendedmultiple choice questions where you are asked to pick more than onecorrect answer, hot spot questions in which you will be asked to identifya structure in response to a test question; for example, which lobe of thebrain is responsible for executive functioning? You would have to clickon the lobe of the brain represented in a diagram.• The test will have 175 questions. Twenty-five of the questions are notgraded 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. Oncethe 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 theexam begins.• Sample ANCC exams are available on the website to try before you sitfor the exam. A sample test can be taken as many times as you wish.■Passing rate: According to ANCC (2017), 1,777 individuals took thePMHNP exam. Of those individuals, 1,563 passed the exam (88% of thepeople who took the test passed the test). Note that these data are based onresults 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 completingyour studies. The clinical hours and didactic content related to yourspecialty certification must be completed. The application must containproof of your RN licenses, an official transcript, and the validation ofeducation form signed by the NP program director.•ANCCcantake4to6weekstoprocessaCOMPLETED

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application. During slower times of the year, it may take as little as 3weeks.PeakapplicationseasonisfromApriltoJuly,andfromNovember to January.■Expediting: This option allows the processing time to be shortenedto 5 days (FOR COMPLETED APPLICATIONS ONLY). There isan additional cost for this option. Caveat: This assumes that allparties required to send information have done so. If your school isdelayed due to holiday or summer hours, or if it is using a third-partyvendor, you will not be processed in an expedited manner. I do notrecommend this option unless you know for sure all parties havefulfilled their obligations. For more information on this option,contact aprnvalidation@ana.org.■Validation of education: A form that is signed by the programdirector attesting to the content of your education. The original (NOTA COPY) must accompany your application for testing.■Scheduling your exam: Waiting to schedule your exam may limityour options. Schedule your exam as soon as you receive your ATT.•Make sure you have created your study timeline before youapply for the test, and that you have started studying.• If you must test on a certain day, you can broaden your search toanother testing center; you may have to look in another state.•Missed appointment OR expired ATT: You will be considered ano show and your testing window automatically expires. Call thePrometric testing center as soon as possible, then contact ANCC.ANCC will allow for one reschedule, but you will be charged arescheduling fee.■Pass/fail: You will find out immediately whether you passed orfailed the exam. Once you complete your exam and leave the room,the proctor will have a printout containing your unofficial result. Anofficial result will be mailed to you. The unofficial result cannot beused as proof of passing for any official purpose.•Notifying the state board of nursing: The ANCC does notautomatically notify the board of nursing. You will need to sign arelease of score consent form (part of the application package).•Certification:Validfor5years.Trackingyourcontinuingeducation credits will make recertifying much easier. If you fail to

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6take the required 75 credit hours, your certification will expire andyou will have to retest. If your certification expires, you can nolonger claim to be BC. THERE IS NO GRACE PERIOD ORBACKDATING.□Renewal:Youcanstartthisprocess1yearbeforeyourexpiration date but no later than 3 months before.□Practice hours: You must have 1,000 clinical practice hours inthe clinical specialty within the preceding 5 years.□Continuingeducation:Seventy-fivecontacthoursarerequired. Also, you need one or more of the eight ANCCrenewal categories (academic credits, presentations, preceptorhours,qualityimprovementprojects,professionalservice,practice hours, research, publication, or retest). This meansthat, in addition to continuing education hours, you must do oneof these eight things every 5 years.□Pharmacology: Of the contact hours, 25 of them must be inpharmacotherapy.•If you fail: The ANCC allows you to retake the exam up to threetimes in 12 months, but there must be at least 60 days betweenattempts. You must wait 5 days (after taking your exam) toreapply to test.•Reapplying: You must resubmit all materials as if you wereapplying 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%),AdvancedPracticeSkills(25%),DiagnosisandTreatment(25%),Psychotherapy and Related Theories (15%), and Ethical and LegalPrinciples (15%). Approximately 40% to 50% of the test contents(pathophysiology,pharmacology,physicalassessment,healthpromotion, ethics, scope of practice, role delineation, ethics, screenings,and regulatory requirements) are common to all of the nurse practitionerspecialities. The test will contain a total of 175 questions, of which only150 will be counted for scoring. The test is not presented in a categoricalformat, but rather questions can come from any of the five domains atany point during the test. You should not ascribe any special meaning ifyou 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 seeminglycommon topic related to psychiatric-mental health care, this does notmean you are taking the wrong exam. Following is more detailedinformationregardingthetestcontentoutlineandthenumberofquestions you can expect for each category.■Scientific foundation(30 questions)—Includes content related to generalpathophysiology,pharmacology(includingtherapeuticandadverseeffects), and physical assessment across the life span. Following is a list ofother key terms and concepts included in this section of the test:• Physiology, neurodevelopment, genomics, and epigenetics• Pathophysiology and clinical manifestation of altered health states• Anatomyandphysiology,specificallyneuroanatomyandneurophysiology• The relationship between physiology and pathophysiology produced byaltered health states (including common movement disorders associatedwith 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 thework of nurse practitioners such as interviewing, obtaining history andphysical examination, assessing for intoxication and withdrawal, alteredmental status, using psychometrically validated tools, and suicide risk

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7assessment. Following is a list of other key terms and concepts included inthis 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 usingmultiple modalities■Diagnosis and treatment(37 questions)—Includes content related to theDSM-5classifications,aswellasdevelopingdifferentialdiagnoses,ordering and interpreting diagnostic tests, appropriate referrals, therapeuticdrug monitoring, and applying evidence-based practice. Following is a listof other key terms and concepts included in this section of the test:• Mental health disorders due to general medical conditions and physicalconditions associated with mental health disorders■ Developingacomprehensivehealthassessmentthatincludesneuropsychiatric developmental, genetic, and epidemiological factors■ Complementary and alternative treatments■ Assess risk factors and barriers to health promotion and diseaseprevention(socioeconomic,genetics,biological,environmental,community-specific variables)■ Synthesize epidemiological data to design and deliver evidence-based practice

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■ Incorporatingpatientability,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 contentrelated to conceptual models and frameworks for understanding behavioracross the life span, theories of change, and the family system applied tovarious clinical situations. The primary skill is to develop a therapeuticalliance. Following are some key terms and concepts included in thissection 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 totheroleofthenursepractitioner,legalbarriers,politicalactivities,advocacy, social justice, patients’ rights, team building, and collaboration.Following are some key terms and concepts that are included in thissection of the test:• Principlesandconceptsofinterprofessionalandintradisciplinarypractice■ 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■ Fosteringcollaborationwithmultiplestakeholderstoimprovehealthcare■ Building and leading collaborative interprofessional care teams■ Communicating within or across organizations■ Advancing practice through the development and implementation ofinnovations 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• Analyzingethical,legal,andsocialfactorsinfluencingpolicydevelopment• Influencinghealthpoliciestoamelioratetheimpactofstigmaonservices for the prevention and treatment of mental health problems andsubstance use disorders• Ethical and legal issues related to the use of information technology,including scope of confidentiality, release of information, and duty towarn• Usinginformationandcommunicationtechnologies,resources,andprinciples of learning to teach and/or treat• Translating technical and scientific health information for complexdecision-making• Organizational practices• Analyzing and organizational structure, functions, and resourcestoimprove and sustain the delivery of care• Current American Nurses Association scope and standards of practice• Regulations and guidelines related to the psychiatric-mental health nursepractitioner practice• Promoting just culture of safety■Dissecting questions: In order to choose the best possible answer, youmust know exactly what you are being asked. The majority of questionswill be multiple choice. Multiple choice questions consist of three parts.They are the entire question, the stem (the essential information of thequestion), and the answer choices (one correct and three distractors).ALWAYSREADTHEENTIREQUESTIONANDALLTHEANSWERS BEFORE SELECTING ANYTHING!• Do not read into the question.• Donotassumeinformationthatisnotpresented;thatis,donotoveranalyze.■ If the information is not given, assume it is not needed and has noeffect 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 outsomething?

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■ Are there any keywords in the question such asavoid, best, except,not, initial, first, most, least, of the following?(Are you looking forcorrect answers or wrong answers?)• Step 2: Can you apply Maslow’s hierarchy of needs? Just because this isa psychiatric exam you cannot forget that physiological needs alwaystake priority over psychosocial needs. Remember to choose the safestanswer and consider what would happen if each answer is chosen. (Doesthe answer choice answer the question?)• Step 3: Is the answer choice an assessment or implementation? For theexam, assessment answers are when you are gathering more informationeither by physical exam, ordering a diagnostic test, or by interviewingthe patient or collateral sources. Implementation answers are when yougive advice, change medication, or teach something. Also, consider ifthe assessment or implementation matches the stem of the question.■ EXAMPLE: A client with an absolute neutrophil count <1,000 hasbeen taking his clozapine 500 mg daily. What should the PMHNP dofirst?A.Tell the patient to stop taking the medication immediatelyB.Order a stat complete blood count (CBC)C.Instruct the patient on the importance of taking the medicationexactly as prescribedD.Remind the patient of the importance of proper hand hygieneThe stem of this question deals with agranulocytosis in someonetaking clozapine. The question asks for an implementation. The stemis asking about a physiological condition. The answer should be aphysiological intervention that addresses the stem. Based on thisinformation the correct answer is A.Orderingastatbloodtestdoesnotaddresstheproblem.Instructingontheimportanceofmedicationadherencewouldworsen the problem in this case. Reminding of good hand hygiene,while helpful and related to the agranulocytosis, would not takepriority over stopping the medication.• Step4:Selectthecorrectanswer.Remembertoeliminateanswerchoices after you have read the entire question and all the choices toincrease your odds of selecting the correct answer. Do not second guessyour answer choice unless you have a compelling reason, you recall an

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9essential concept that directly relates to the stem, or you have a clearerunderstanding of the question that you did not initially have.• Most people change the correct answer to the wrong answer rather thana wrong answer to the correct answer.• If you are unsure about an answer choice, you can mark the question andcome back to it for later review.■ Drag and drop questions:• In this question format, you will be asked to match the choices that arealpha-numerically presented. This is common with questions aboutevidence-based practice or anatomy.EXAMPLE: Correlate the lobes of the brain with their respectivefunctions:1) Frontal lobeA) Memory, understanding, and language2) Parietal lobeB) Vision3) Occipital lobeC) Executive functions4) Temporal lobeD) Auditory perceptionAnswers: 1: C, 2: A, 3: B, 4: D■ Hot spot questions• In this question format, you may be asked to identify a specific locationon 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 leastexpensive, least invasive option that allows you to answer the question.For example, if your choice is between a CT scan of the head or afocused neurological exam, the latter will likely be the best option.(There are no scans or biomarkers in psychiatry that can diagnose apsychiatric condition. Once something appears on a scan it becomesa neurological condition.)• See whether the answer choices have something in common or are verysimilar. If two answers are very similar, they are likely incorrect. If allthree 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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