PMHNP Boards Exam Questions With
Correct Answers
Medicare Part A Coverage - answerHospital insurance that covers inpatient and most skilled
care. Mandatory copays for hospital days 21-150, getting higher with each period of time.
Medicare Part A Eligibility - answer>65 in social security aut...
Medicare Part A Coverage - answer✔Hospital insurance that covers inpatient and most skilled
care. Mandatory copays for hospital days 21-150, getting higher with each period of time.
Medicare Part A Eligibility - answer✔>65 in social security automatic enrollment
Medicare Part A Cost - answer✔No cost if automatically qualified. 30-39 work quarters:
~$250/mo <30 work quarters: ~$450/mo
Medicare Part B Coverage - answer✔Supplemental medical insurance. Outpatient services, care,
physical/speech therapy, some home health care, medical equipment
Medicare Part B Eligibility - answer✔Voluntary if >65
Medicare Part B Cost - answer✔Deducted from monthly social security check. *Enroll 3 months
before 65th birthday or 4 months after, otherwise increased costs to enroll*
Medicare Part C - answer✔Medicare Advantage. Get all their medical services through that plan.
Medicare Part D coverage - answer✔Prescription drug coverage
Medicare Part D Cost - answer✔Varies depending on how extensive drug benefit is. Different
plans have different benefits.
Medigap Plans - answer✔Fill gaps in coverage that occur with Medicare
Medicare Advantage Plan - answer✔Will likely eliminate need for medigap insurance?
Medicaid Eligibility - answer✔Automatic coverage not guaranteed except for poor pregnant
women and children. States can refuse to cover adults/head of households who lose Temporary
Assistance to Needy Families d/t refusal to work. Generally covers poor people.
Medicaid funding - answer✔Federal + state. States determine how much they want to pay in,
different states have different qualities of Medicaid
HMO - answer✔Four components: Enrolled population, prepayment of premiums, coverage of
comprehensive medical svcs, centralization of medical and hospital svcs
Closed-panel HMO - answer✔Specific providers identified by plan to provide the medical
services to members. Staff can be salaried by HMO or an agency/group contracted by the HMO.
Open-panel HMO - answer✔Network HMO, Individual Practice Association, Point of Service
Plans
Network HMO - answer✔HMO contracts with more than one group of practices
Individual Practice Association - answer✔Insurance coverage. Contract with an association of
physicians to provide services to members
Point of Service (POS) and Preferred Provider Organizations (PPOs) - answer✔Insurance
coverage. Patients allowed to self-refer to specialist but pay higher premium to do so. POS
requires PCP is gatekeeper but pt can see a provider outside of HMO for more $$. PPOs contract
to a selected group of participating providers and give discount for using a selected group of
providers. Financial risk held by insurer in PPO, held by providers in POS
Managed indemnity - answer✔Traditional model insurance coverage.. Pre-certification,
catastrophic case management, minimal contract arrangement with providers. Provider groups
and health plans can use quality control, utilization review, bundling of services, incentives for
health behaviors. MUST seek National Committee on Quality Assurance (NCQA) accreditation
Licensure - answer✔Member of profession is granted ability to practice
Accreditation - answer✔Formal review and approval by a recognized agency of
educational degree or certification programs in nursing or nursing-related programs.
Certification - answer✔Tests knowledge, skills, abilities for entry into practice. Formal
recognition of the knowledge, skills, and experience
demonstrated by the achievement of standards identified by the profession
Education - answer✔Formal preparation of APRNs in graduate degree-granting or postgraduate
certificate programs
Factors facilitating NP growth - answer✔Demand for svcs, acceptance of role, emphasis on
integrated healthcare svcs, emergence of PMHNP and decreasing stigmatization
Factors constraining NP growth - answer✔Growth competition, reimbursement struggles,
overlapping scopes with other NPs, concerns about reimbursement fraud/abuse, scope of practice
requiring physician supervision/collab
Exceptions to confidentiality - answer✔Information given to attorneys involved in litigation,
records to insurance companies, answering court orders, mandatory state reporting, harm to self
or others or child/elder abuse, determined need for info outweighs principle of confidentiality
Deontological Theory - answer✔Action is judged as good or bad based on the act itself
regardless of the consequences
Teleological Theory - answer✔An action is judged as good or bad based on the consequence or
outcome
Virtue Ethics - answer✔Actions are chosen based on moral virtues (honesty, courage,
compassion, etc) or the character of the person making the decision
Elements of negligence that must be established to prove malpractice - answer✔Duty, breach of
duty, proximate cause, damages
Duty (negligence) - answer✔NP had a duty to exercise reasonable care when undertaking and
providing treatment to the client
Breach of duty (negligence) - answer✔The NP violated the applicable standard of care in
treating the client's condition
Proximate cause (negligence) - answer✔There is a causal relationship between the breach in the
standard of care and the client's injuries
Damages (negligence) - answer✔Client experiences permanent and substantial damages as a
result of the breach in the standard of care
Competency: Legal or medical? - answer✔Legal (NOT medical)
Competency - answer✔Determination that a client can make reasonable judgments and decisions
regarding treatment and other health concerns
Durable power of attorney - answer✔Designates an agent to act on behalf of person should
he/she become unable to make healthcare decisions. Consider psychiatric DPOA for chronically
ill folks! LEGALLY BINDING ALL STATES
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