Raymond Zakhari DNP EdM ANP-BC FNP-BC PMHNP-BC - The Psychiatric-Mental Health Nurse Practitioner Certification Review Manual – Mental Health Book Uses Outline Format, Highlights Psychiatric Nurse Practitioner Board Certification Practice Exam

i THE PSYCHIATRIC-MENTAL
HEALTH NURSE PRACTITIONER
CERTIFICATION REVIEW MANUAL

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.

iii THE PSYCHIATRIC-MENTAL
HEALTH NURSE PRACTITIONER
CERTIFICATION REVIEW MANUAL

Raymond Zakhari, DNP, EdM, NP

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v 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. vi

vii CONTENTS

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 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 clinicians eagerness to alleviate their personal feeling of powerlessness and reduce the patients 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 chapters content and to stimulate critical thinking in the prospective test taker. x