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ANCC IQ Domains 1 - 5 Qbank answered all
correctly answered; latest updated
summer 2022.
As a PMHNP, you are aware of antipsychotic medication side effects. Which of
the following side effects of antipsychotic medications has an insidious,
delayed-onset typically 1 to 2 years after initiation of the medication?
a. Dry mouth
b. Tardive dyskinesia
c. Sedation
d. Weight gain
In evaluating a 4-year-old, one would expect which of the following delays in
Asperger's Disorder?
a. Language development
b. Cognitive development
c. Motor skills coordination
d. Social skills development
Which area of the brain has been implicated to modulate pain and can help
explain how transcranial magnetic stimulation can help decrease pain?
a. Prefrontal cortex
b. Insula cortex
c. Dorsolateral prefrontal cortex
d. Anterior cingulate cortex
Which of the following antidepressants is associated with dose-related
cardiovascular adverse effects which require adherence to maximum
recommended dosing, unless higher doses are deemed appropriate despite
risks?
a. Citalopram (Celexa)
b. Venlafaxine (Effexor)
c. Mirtazapine (Remeron)
d. Sertraline (Zoloft)
Which of the following findings would raise concern in an annual sports exam
for a 15-year-old girl?
a. Scar tissue from hymenal tear at 11 o'clock (reported biking injury)
b. Blood pressure 86/
c. Height 67 inches, weight 102 pounds
d. Pulse 60, respirations 26
A week after raising the dose of risperidone (Risperdal), a patient treated for
schizophrenia presents to the clinic with reports of an acute change in mental
status, fever, and rigidity. As the treating PMHNP, you know these symptoms
are consistent with which of the following?
a. Neuroleptic malignant syndrome (NMS)
b. Anticholinergic withdrawal syndrome
c. Extrapyramidal side effects
d. Serotonin syndrome
Which of the following statements regarding disulfiram (Antabuse is correct?
a. Disulfiram should not be taken for at least 6 hours after drinking alcohol.
b. Avoid anything containing alcohol (i.e., vinegar, mouthwash, aftershave,
cough medication) while using disulfiram and for 2 weeks after discontinuing.
c. A disulfiram-alcohol reaction can occur up to 1 week after discontinuing
disulfiram.
d. Disulfiram can lower liver function tests so monitoring is necessary.
Which mood stabilizer is most associated with a potentially life-threatening
rash?
a. Divalproex (Depakote)
b. Lamotrigine (Lamictal)
c. Lithium (Eskalith)
d. Carbamazepine (Tegretol)
What is a rare but serious side effect of trazodone (Desyrel)?
a. Confusion
b. Priapism
c. Rash
d. Tremor
When studying pharmacodynamics involving receptors, you know that an
inverse agonist produces the following effect:
a. Does not fully activate the receptor and causes only limited actions
b. Causes the opposite effect of agonist, and causes the receptor to close the
ion channel
c. Blocks the agonist from opening the channel, and does not activate a
biological response
d. Activates a biological response, and opens the ion channel.
Mr. Smith is a 56-year-old white male who has been successfully treated on
Selegiline for over 4 years. Mr. Smith is going in for an elective surgical
procedure. Which medication is strictly contraindicated with Selegiline?
a. Non-steroidal anti-inflammatory drugs (NSAIDs)
b. Meperidine
c. Codeine
d. Morphine
Patty is a 62-year-old white female with Bipolar I Disorder and has been
stable for 2 years on valproate and risperidone. She was recently diagnosed
with shingles, and her primary care nurse practitioner started her on
corticosteroids. As the PMHNP treating Patty, you are concerned that the
addition of the corticosteroids may cause
a. Neuroleptic Malignant Syndrome
b. A hypertensive crisis
c. A manic episode
d. Stevens-Johnson syndrome
Which serotonin receptor antagonism makes an antipsychotic "atypical"?
a. 5HT4A
b. 5HT1A
c. 5HT3A
d. 5HT2A
What direct-acting dopamine receptor agonist is recommended to be used in
the treatment of neuroleptic malignant syndrome (NMS) to help lower the
dopamine receptor blockade?
a. Benztropine (Cogentin)
b. Bromocriptine (Parlodel)
c. Trihexyphenidyl (Artane)
d. Dantrolene (Dantrium)
A 17-year-old female presents to your clinic reporting anhedonia, decreased
energy, and hopelessness for the past two years. She denies drinking alcohol,
smoking, or using illegal substances. Her physical examination results are
within normal limits and she denies suicidal ideations. As the treating
psychiatric mental health nurse practitioner, you decide to prescribe her
bupropion (Wellbutrin). Of the following, which is contraindication for the use
of bupropion?
a. Bulimia
b. Dysthymia
c. Smoking
d. Fatigue
Which of the following statements reflects current understanding of
neurodevelopment and best explains risk-taking behaviors of adolescent
males?
a. Hormonal flooding, especially testosterone and oxytocin, increase dopamine
levels in the brain
b. Maturation of the prefrontal cortex continues into mid-20s and early 30s
c. Pruning of serotonin circuits in the adolescent brain is associated with
increased impulsivity
d. Stimulant and substance use impairs judgment and cognitive appraisal.
Which of the following statements does not reflect current understanding of
neurotransmitter pathways implicated in anxiety disorders?
You are on call for your service. You arrive at the emergency department to
find a 22-year-old male patient complaining of having trouble with his eyes.
His vitals are stable. He is 5 foot and 7 inches tall; his weight is 140 pounds;
his labs are all in the normal range. He states that he has been taking
Aripiprazole (Abilify) for the last 2 months for his Bipolar 1 disorder. He had
the dose raised to 15 mg po QAM 4 days ago to manage a manic episode. He
states that one to three times a day for the past 2 days his eyes will roll
upwards for 10 to 15 minutes and he will have trouble seeing until they roll
back down. When you examine his eyes, he is able to fully open his eyes but he
is not able to focus his eyes on you. His eyes are rolled upwards about 2/3rds
of the way towards his upper eyelid. After examination you decide to:
a. Discontinue the Aripiprazole and begin the patient on a gradually increasing
regimen of Lamotrigine 25 mg 1 po QHS for 1 week. Have him return to his
provider for further management of his bipolar disorder.
b. Continue the Aripiprazole and give Benztropine Mesylate (Cogentin) 1 mg
IM. Have him take Benztropine Mesylate (Cogentin) 1 mg po BID. Have him
return to his provider for further management of his bipolar disorder the next
day.
c. Begin a cross titration downward of the Aripiprazole and upwards of
Haloperidol (Haldol). Have him return to his provider for further management
of his bipolar disorder.
d. Discontinue the Aripiprazole and give Benztropine Mesylate (Cogentin) 1
mg IM. Have him take Benztropine Mesylate 1 mg po BID for 5 days. Have him
return to his provider for a different medication for his bipolar disorder the
next day.
A 24-year-old mother of a 2-year-old child presents to the clinic. Which of the
following facial characteristics would lead the psychiatric mental health nurse
practitioner to believe the child has fetal alcohol syndrome?
a. Large head, thick upper lip, and overdeveloped jaw
b. Small head, thin upper lip, and smooth philtrum
c. Long nose, large eyelid opening, and developed philtrum
d. High nasal bridge, plump midface, and large eyelid opening
A client is suffering from schizophrenia. Which of the following would be the
appropriate question for the PMHNP to ask when assessing side effects
produced by dopamine antagonism in the tuberoinfundibular pathway?
a. Are you experiencing breast discharge?
b. Are you experiencing drooling?
c. Are you experiencing tremors?
d. Are you experiencing dizziness?
Which of the following patients with generalized anxiety disorder is most
likely to be a CYP2C19 poor metabolizer and have an exaggerated response to
diazepam (Valium) 5 mg TID with increased sedation, central nervous system,
and cognitive side effects?
a. 40 - year-old Asian male
b. 20 - year-old African American female
c. 50 - year-old Caucasian male
d. 30 - year-old African American male
Norepinephrine is a neurotransmitter that is implicated in alertness and
anxiety. What areas of the brain has a large majority of norepinephrine
neurons?
a. Locus Coeruleus
b. Amygdala
c. Nucleus Accumbens
d. Hippocampus
When assessing an elderly patient who complains of tinnitus, the PMHNP
would associate which of the following findings with an acoustic neuroma?
a. Inflammation of middle ear
b. Perforation of tympanic membrane
c. Suppuration of the labyrinth
d. Unilateral ringing in ear
Which of the following medications has a unique mechanism of action in that
it is both a dopamine and norepinephrine reuptake inhibitor?
a. Bupropion (Wellbutrin)
b. Imipramine (Tofranil)
c. Agranulocytosis
d. Leukocytosis
If given during pregnancy, lithium can cause which of the following medical
problems in the baby?
a. Spina bifida
b. Ebstein's anomaly
c. Neural tube defect
d. Cleft palate
Sandy, a 32-year-old separated female presents for an initial intake. Sandy
states she recently left an abusive relationship, is living alone, and is
experiencing fear, panic, and extreme anxiety. Which brain structure is
activated in patients with severe anxiety, as expressed by Sandy?
a. Thalamus
b. Hippocampus
c. Amygdala
d. Cingulate gyrus
The risk of bleeding on SSRI, non-steroidal anti-inflammatory drugs (NSAIDs),
or aspirin, is an example of which of the following principles?
a. Pharmacodynamic
b. Absorption
c. Distribution
d. Pharmacokinetics
You have a 17-year-old female patient who suffers with bipolar disorder. The
patient has a history of impulsive acting out and promiscuity. You make a
decision to add folic acid 0.8mg to her medication regimen of lamotrigine
(Lamictal) 200 mg po QHS and Quetiapine XR (Seroquel XR) 50 mg 1 po QHS.
Why is this important?
a. The folic acid is important for the continuing development of the patient's
neuroendocrine system.
b. The folic acid is important to help her with the sleepiness induced by her
bipolar medications.
c. The folic acid is important to help her with her hypotension induced by the
Quetiapine XR (Seroquel XR) 50 mg po QHS.
d. The folic acid supports neural tube development during the first month that
a woman is pregnant.
ANCC Domain 2: Advanced Practice Skills
(49 questions & Answers) 2022.
A patient comes into your office inn a full manic episode. This patient has a diagnosis of Bipolar and Alcohol Use Disorder, moderate. You have a report from the patient's chemical dependency counselor indicating that inpatient chemical dependency counseling is needed. Your patient has been on the fence about inpatient chemical dependency treatment in the past. You assess the patient and find a strong odor of alcohol, auditory and visual hallucinations, flight of ideas, lack of sleep for 3 days, suicidal ideations without a firm plan, and plans to drive to another state to gamble. The patient's brother who accompanies him corroborates this information. In order to best treat this patient you: a. Admit him to the dual diagnosis chemical dependency unit with an order for the collection of laboratory values. b. Admit him to the inpatient chemical dependency program. c. Send the patient home with his brother and a prescription for a new antipsychotic medication. d. Admit him to the local psychiatric unit, with an order for the collection of laboratory values. Appraisal of the patient's suicidal ideation, plan, method, intent, and access to implement plan would be documented in which part of the standard psychiatric evaluation? a. History of Presenting Illness b. Review of Systems c. Diagnosis d. Mental Status Exam Violence directed toward women by an intimate partner is a serious health problem worldwide. Which of the following women has the greatest risk factors for being the victim of violence? a. 26 years old, recently separated, Asian American woman living in Boston, Massachusetts b. 42 years old, divorced, Caucasian woman dating a recently divorced man in Denver, Colorado c. 17 years old, single, Native American woman living with employed boyfriend in Galena, Alaska
d. Tell me why you are unable to fall back asleep after your daughter does In assessing possible sexual abuse of a 4-year-old child, which of the following would not be indicated? a. Has anyone ever taken your picture without your clothes on? b. Has anyone else asked you to take off your clothes? c. Has anyone invited you to a birthday pool party? d. Has anyone done something you didn't like to your body? A 78-year-old cattleman referred for treatment of refractory depression by his primary care provider reports continued thoughts of failure, lack of purpose in life, lack of interest in ranching, fishing, hunting, or family since losing his driver's license due to DUI six months ago. Which of the following areas is an assessment priority? a. Extent of alcohol use and motivation to reduce to safe levels b. Prior and current medications, dose, clinical response, side effects c. Sleep patterns (early-middle-late awakening), sleep hygiene d. Thoughts of self-harm, plan, intent, access During an initial psychiatric evaluation, the patient reports use of alcohol and illicit drugs. This information would be most appropriate in which part of the evaluation? a. Review of Systems b. Personal and social history c. Chief complaint d. Mental Status Exam The American College of Obstetricians and Gynecologists (ACOG) recommends screening for postpartum depression with a validated screening tool. Which of the following is a validated screening tool which has been recommended by ACOG? a. Major Depression Inventory (MDI) b. Montgomery-Asberg Depression Rating Scale (MADRS) c. Edinburgh Postnatal Depression Scale (EPDS) d. Hamilton Rating Scale for Depression (HRSD) A 67 - year-old Vietnamese immigrant, who has been a resident in the U.S. for 3 years, comes to your clinic for an evaluation. Her first language is Vietnamese, but she does speak some English. She has problems with reading and writing, as she did not finish high school, or earn a GED (General Educational Development) equivalency. As the PMHNP, what is your priority disparity to address with this patient? a. Age b. Health literacy c. Reading level d. Race
An adult female patient has been prescribed an SSRI for an initial episode of major depression. She is fearful of side effects and of becoming suicidal. Which of the following initial responses is most appropriate? a. SSRI's are generally quite safe and rarely cause suicidal thoughts. I could call you every few days to see if you are having any of these thoughts. b. SSRI's are the safest antidepressant medications and rarely cause suicidal thoughts. Try the medication and we can watch closely for any side effects. c. Have you ever had feelings of hurting yourself? If you took the medication and had thoughts like that, would you be willing to call the crisis hotline? d. Have you ever had feelings of hurting yourself? If you took the medication and had thoughts like that, what would you do? The Mini-Mental Status Exam (MMSE) is a brief, standardized screening tool designed for use: a. Across the lifespan to document mental status b. In older adults ³ 65 years to quantify cognitive status c. In adults ³18 years to document mental status d. In adults to quantify cognitive status. A patient who works the night shift presents for a follow-up appointment to see the PMHNP and states, "I can't sleep when I get home from work." Upon assessment, the PMHNP learns the patient recently started an exercise regimen and is now exercising after work. Which response about sleep hygiene should the PMHNP provide to the patient? a. Exercising is a good way to help you get sleep, so keep up your schedule and your body will adjust to your new routine. b. Regular exercise can help promote sleep but should not be performed too close to your bedtime or it can interfere with sleep; try exercising before work. c. Exercise dose not promote or help deepen your sleep, so you should consider making changes in your daily routine. d. Regular exercise helps with sleep, so continue to exercise, and when you get home, watch television to help promote sleep. A 36 - year-old woman was fired from her job as a paralegal at a law firm. She had worked for the same attorney for 10 years. As soon as she came in the door from work, her husband noticed she appeared upset and asked her if she was alright. She immediately started yelling at her husband because he had not given their 5-year-od daughter a bath and had not cleaned the house. Which of the following defense mechanisms is being demonstrated by this woman? a. Dissociation b. Conversion c. Rationalization d. Displacement
b. Previous suicide attempt c. Marital status d. Gender During an initial assessment, the PMHNP asks the patient to perform the serial 7's. What aspect of the mental status exam would the nurse practitioner be assessing? a. Memory b. Concentration c. Speech d. Affect Which of the following illustrates the role of the PMHNP in reducing the stigma of mental illness through community education as primary prevention? a. Professional speaker interviewed by morning television talk show anchor on depression. b. Expert witness for standard of care regarding psychiatric nursing staff in wrongful death lawsuit c. Teaching high school class about depression and teen suicide d. Volunteering to help with depression screenings at a community health fair - A In a psychiatric emergency, the PMHNP is aware that the most important goal of the interview is self-protection. What can the PMHNP do to keep himself or herself safe? a. Make sure the patient is restrained before beginning the evaluation b. Enter the room alone, in order to build a therapeutic alliance c. Know as much about the person as possible prior to starting the interview d. Inform the patient that violence is not acceptable. When questioning a patient regarding alcohol use during an intake, the patient t3ells you he only drinks socially. Which initial response is most appropriate? a. What amount and what kind of alcohol do you drink in a week? b. I am glad you are a responsible drinker. c. Many people with alcohol issues say they are social drinkers. d. Do other people in your household drink alcohol? - A During a follow-up medication visit with a 13-year-old male, his mother stayed longer to ask the PMHNP a question. Specifically, his mother states, "The school sent home information about the human papillomavirus and suggested my son see his primary care provider to get an immunization. Why did I get this information for my son? Furthermore, he is not sexually active." Which of the following would be the PMHNP's best response? a. I understand your concern with talking to your son about becoming sexually active. Let's address how to start the conversation. b. You are correct, only females need to receive the human papillomavirus vaccination. This letter must have been sent to you by mistake.
c. Decisions about immunizations can be difficult. The Centers for Disease Control and Prevention recommend that all males between the ages of 11 - 12, or as early as 9 years of age, receive this vaccination. What concerns do you have? d. As your son's PMHNP, I cannot provide you with information about immunizations. The World Health Organization has predicted that depression will be the number one world health problem in the 21st century. Lifetime prevalence for major depressive episode is 12% (with a 5 - 17% range). Which of the following individuals has the greatest risk factors for MDD? a. 16 - year-old, high school male, honors student, who runs cross-country track b. 28 - year-old, single woman, working toward partner in a large law firm c. 43 - year-old, divorced woman, schoolteacher, raising three children d. 58 - year-old, married male, computer analyst, whose work requires frequent travel Which of the following interventions has greatest relevance when counseling parents of a 20 - year-old male patient who has recently been diagnosed with schizophrenia? a. Family therapy to facilitate gradual independence for the patient while addressing parental desire to protect their son b. Patient and family education about the disease course, treatment regimens, support systems, and life management skills c. Multi-system family therapy that includes in-home therapy as well as multiple family group therapy to facilitate shared learning from other families with members with schizophrenia d. Supportive psychotherapy group for the parents to facilitate their grief and build coping skills to help manage their son's life-changing mental illness. A patient was started on an antipsychotic medication two weeks ago and is now experiencing the following symptoms: inability to sit still, pacing, and feelings of inner restlessness. He does not complain of any anxiety or being worried about anything in particular. Which of the following rating scales would be the most appropriate to assess these symptoms? a. Abnormal Involuntary Movement Scale (AIMS) b. Barnes Akathisia Rating Scale (BARS) c. Dyskinesia Identification System d. Simpson Angus EPS Scale Which of the following screening tests has high sensitivity and specificity for identifying cognitive impairment in older adults while requiring the least amount of time to administer in a clinical setting? a. Global Deterioration Scale b. Clock Drawing Test c. Mini-Mental Status Exam d. Dementia Rating Scale
reports a 3 - year history of drinking alcohol. The patient states he was at the store a week ago when he realized the store clerk was an imposter replacing his wife. The patient's wife insists that her husband is delusional and she intends to file for divorce if he does not get help. Which of the following types of delusions is the patient expressing? a. Fregoli phenomenon b. Capgras syndrome c. Delusion of doubles d. Clerambault syndrome In advising parents how to reduce the risk for teen substance abuse when there is positive family history of alcohol dependence, a PMHNP encourages all of the following recommendations except: a. Acknowledgement of family risk factor and open discussion with teen b. Parental presence and involvement in child's school and sports activities c. Random urine testing using home drug testing kits d. Parental networking and supervision of any teen parties. In assessing patient risks for binge drinking, which of the following statements is not accurate? a. Binge alcohol use rates are similar across different levels of education b. Binge drinking is higher in urban, densely populated areas than rural, sparsely populated areas. c. Whites have a higher rate of binge drinking than black or Hispanics. d. Men are much more likely than women to be binge drinkers. A 14-year-old girl admitted to a psychiatric unit following an overdose on alcohol and benzodiazepines after the breakup of a relationship has made seductive comments to her roommate, which is upsetting her roommate. In assessing the girl's behavior toward her roommate, the PMHNP needs to include the topic of sexual orientation. What is the best introductory approach to this topic? a. Are you sexually active? b. Are you attracted to girls rather than boys? c. What is your experience in sexual relationships? d. Did you overdose after breaking up with a girlfriend or boyfriend? An example of a screening tool that measures severity and tracks change in specific symptoms is a. The CAGE b. The Mini-Mental State Examination (MMSE) c. The Short Form 36 (SF-36) d. The Behavior and Symptom Identification Scale (BASIS)
Which of the following risk factors is not amenable to lifestyle changes in reducing lifetime risk of depressive disorders? a. Alcohol use b. Stressful family life c. Personality d. Work-related stress A 31 - year-old married woman with a history of anorexia nervosa, binging-purging type, during her teens and early 20's, is pregnant. She has had two prior spontaneous abortions in late 20's. She is worried whether this pregnancy may trigger recurrence of her prior eating disorder, adversely impact fetal development, or affect the likelihood of full-term delivery. At 5'7" she maintains a weight of 120 pounds by running 6-10 miles daily as conditioning for marathons and a 2,000 calorie daily vegan diet. What lifestyle modifications would reduce risks of exacerbating an eating disorder and increasing likelihood of normal fetal development full-term delivery. a. Increase daily caloric intake by 1,000 calories, continue running as tolerated with reduction in second or third trimester, add pre-natal vitamin, vitamin E supplement, and B- complex supplement, plan 20- 30 - pound gradual weight gain over the course of pregnancy. b. Increase daily caloric intake by 500 calories, reduce running to 2-4 miles daily, alternate with stretching and yoga in second and third trimesters, add prenatal vitamin and vitamin B- 12 supplement, plan a 28 - 40 - pound gradual weight gain over the course of pregnancy. c. Increase daily caloric intake by 250 calories, reduce running to 4-8 miles daily with reduction in second or third trimester, add prenatal vitamin, Calcium supplement, and plan a 20 - 30 - pound gradual weight gain over the course of pregnancy. d. Increase daily caloric intake by 700 calories, continue running as tolerated with reduction in second or third trimester, add prenatal vitamin E supplement, and B-complex supplement, plan a 25 - 35 - pound gradual weight gain over the course of the pregnancy. In the aftermath of a tornado that destroyed over 100 homes in a rural Midwest community, the PMHNP draws on principles of crisis intervention while working with an elderly couple who lost everything in the storm during the night. Which of the following statements is most appropriate at the initial encounter? a. "What medications were you taking? Let me work on that first." b. "Tell me everything that happened. We'll sort through the next steps." c. "What is your biggest concern right now? I will help you as much as possible." d. "You will be able to stay in the shelter until the FEMA trailers arrive. It's going to be OK." When child, adult partner, or elder abuse is suspected, the PMHNP needs to conduct an abuse assessment screen in privacy, away from the partner, the child's parents or guardians, or the elder person's relative or companion. Simple, direct questions in a nonjudgmental interview are indicated. Which of the following would be an appropriate abuse screening question?
