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ANCC Domain 1 questions,100% accurate answers, latest updated
What direct-acting dopamine receptor agonist is recommended to be used in the treatment of neuroleptic malignant syndrome (NMS) to help lower the dopamine ... [Show More] receptor blockade? A. Dantrolene (Dantrium) B. Benztropine (Cogentin) C. Bromocriptine (Parlodel) D. Trihexyphenidyl (Artane) C. Bromocriptine (Parlodel) A 74 y/o female present for an evaluation. The psychiatric nurse practitioner has the patient complete the mini mental status examination and clock drawing. The patient is unable to correctly draw the face of the clock. Which area of the brain is likely to have compromised functioning? A. Corpus callosum B. Wernicke's Area C. Left Hemisphere D. Right Hemisphere D. Right Hemisphere Which of the following statements reflects current understanding of neurodevelopment and best explains risk-taking behaviors of adolescent males? A. Stimulant and substance use impairs judgment and cognitive appraisal B. Pruning of serotonin circuits in the adolescent brain is associated with increased impulsivity C. Maturation of the prefrontal cortex continues into mid-20s and early 30s D. Hormonal flooding, especially testosterone and oxytocin, increase dopamine levels in the brain C. Maturation of the prefrontal cortex continues into mid-20s and early 30s What cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is treated on clozapine? A. 2C19 B. 1A2 C. 2C9 D. 2D6 B. 1A2 As a psychiatric mental health nurse practitioner, 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. Sedation B. Weight gain C. Tardive dyskinesia D. Dry mouth C. Tardive dyskinesia Which mood stabilizer is most associated with a potentially life-threatening rash? A. Divalproex (depakote) B. Carbamazepine (tegretol) C. Lithium (eskalith) D. Lamotrigine (lamictal) D. Lamotrigine (lamictal) The psychiatric-Mental Health Nurse Practitioner would expect to see which of the following during a physical exam for a patient with bulimia nervosa? A. Alopecia areata B. Tachycardia C. Erosion of dental enamel D. Obesity C. Erosion of dental enamel Which of the following statements does not reflect current understanding of neurotransmitter pathways implicated in anxiety disorders? A. Decreasing norepinephrine in the locus ceruleus diminishes symptoms of anxiety B. Increasing serotonergic activity in the amygdala diminishes symptoms of anxiety C. Increased levels of CRF in the amygdala, hippocampus and locus ceruleus increases symptoms of anxiety D. Decreasing GABA in the mesolimbic cortex diminishes symptoms of anxiety D. Decreasing GABA in the mesolimbic cortex diminishes symptoms of anxiety Mr. Smith is a 56 y/o 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. Codeine B. NSAIDs C. Meperidine D. Morphine C. Meperidine Which of the following medications has a unique mechanism of action in that it is both a dopamine and norepinephrine reuptake inhibitor? A. Imipramine (Tofranil) B. Duloxetine (Cymbalta) C. Bupropion (Wellbutrin) D. Venlafaxine (Effexor) C. Bupropion (Wellbutrin) When assessing an elderly patient who complains of tinnitus, the PMHNP would associate which of the following findings with an acoustic neuroma? A. Perforation of tympanic membrane B. Suppuration of the labyrinth C. Unilateral ringing in ear D. Inflammation of middle ear C. Unilateral ringing in ear 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. A disulfiram-alcohol reaction can occur up to 1 week after discontinuing disulfiram C. Disulfiram can lower liver function tests so monitoring is necessary D. Avoid anything containing alcohol (I.e., vinegar, mouthwash, aftershave, cough medication) while using disulfiram and for 2 weeks after discontinuing D. Avoid anything containing alcohol (I.e., vinegar, mouthwash, aftershave, cough medication) while using disulfiram and for 2 weeks after discontinuing Which of the following findings would raise concern in an annual sports exam for a 15 y/o girl? A. BP 86/56 B. Ht 67 inches, wt 102 lb C. Pulse 60, respirations 26 D. Scar tissue from a hymenal tear at 11 o'clock (reported biking injury) B. Ht 67 inches, wt 102 lb Your patient comes into the office for her middle of the year appointment. She is diagnosed with Bipolar 1 disorder. She has been maintained well for the past 3 years on Oxcarbazepine (Trileptal) 900 mg PO Q HS. Her labs are normal except for a blood sugar of 114 and her HA1c is 5.6. She has normal energy level and states that her mood is stable but complains of excessive urination and thirst. You suspect: A. Side effects of Oxcarbazepine B. Possible hyponatremia C. Possible polydipsia D. Possible diabetes 2 A. Side effects of Oxcarbazepine Patty is a 62 y/o white female with Bipolar 1 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 psychiatric mental health nurse practitioner treating Patty, you are concerned that the addition of the corticosteroids may cause A. Neuroleptic Malignant Syndrome B. A hypertensive crisis C. Stevens-Johnson syndrome D. A manic episode D. A manic episode A 37 y/o patient with schizophrenia is started on a high dose of chlorpromazine (Thorazine). The next day, he complains of lightheadedness after standing up. Vital sign changes reflect a significant decrease in BP and an increase in heart rate. You suspect this is secondary to the alpha 1-adrenergic blockade which is causing A. Decreased sweating B. Dry mouth C. Respiratory depression D. Orthostatic hypotension D. Orthostatic hypotension Which of the following patients with generalized anxiety disorder is most likely to be a CYP 2C19 poor metabolizer and have an exaggerated response to diazepam (Valium) 5 mg TID with increased sedation, central nervous system, and cognitive side effects? A. 50 y/o Caucasian male B. 40y/o Asian male C. 20 y/o African American female D. 30 y/o African American male B. 40y/o Asian male You are on call for your service. You arrive at the Emergency Department to find a 22 y/o male patient complaining of having trouble with his eyes. His vitals are stable. He is 5 ft 7 in tall; his wt is 140 lbs; and 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 Q am 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 Abilify 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. Discontinue the Abilify and give Benztropine Mesylate (Cognetin) 1 mg IM. Have him take Cogentin 1mg PO BID for 5 days. Have him return to his provider for a different medication for his bipolar disorder the next day C. Continue the Abilify and give Cogentin 1mg IM. Have him take Cogentin 1 mg PO BID. Have him return to his provider for further management of his bipolar disorder the next day. D. Begin a cross titration downward of the Abilify and upwards of Haloperidol (Haldol) Have him return to his provider for further management of his bipolar disorder B. Discontinue the Abilify and give Benztropine Mesylate (Cognetin) 1 mg IM. Have him take Cogentin 1mg PO BID for 5 days. Have him return to his provider for a different medication for his bipolar disorder the next day Sandy, a 32 y/o 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. amygdala B. Hippocampus C. thalamus D. Cingulate gyrus A. amygdala You have a 17 y/o female patient who suffers with bipolar disorder. The patient has history of impulsive acting out and promiscuity. You make a decision to add Folic acid 0.8 mg to her medication regimen of Lamotrigine (Lamictal) 200 mg po QHS and Quetiapine XR (Seroquel XR) 50mg PO QHS. Why is this important? A. The folic acid is important to help her with her hypotension induced by the Quetiapine XR (Seroquel XR) 50 mg PO QHS B. The folic acid is important for the continuing development of the patient's neuroendocrine system C. The folic acid is important to help her with the sleepiness induced by her bipolar medications D. The folic acid supports neural tube development during the first month that a woman is pregnant D. The folic acid supports neural tube development during the first month that a woman is pregnant A 17 y/o female presents to your clinic reporting anhedonia, decreased energy, and hopelessness for the past 2 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 a contraindication for bupropion? A. bulimia B. fatigue C. dysthymia D. smoking A. bulimia Which of the following statements reflects the current understanding of dopamine (DA) pathways and clinical symptoms of schizophrenia? A. Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolimbic system B. Negative symptoms are related to DA excess in the cerebral cortex; positive symptoms are related to DA deficit in the nucleus accumbens and mesolimbic system C. Negative symptoms are related to DA deficit in the mesolimbic system; positive symptoms are related to DA excess in the substantia nigra and ventral tegmental area D. Negative symptoms are related to DA excess in the mesolimbic system; positive symptoms are related to DA deficit in the substantia nigra and ventral tegmental area A. Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolimbic system Which serotonin receptor antagonism makes an antipsychotic "atypical"? A. 5HT1A B. 5HT2A C. 5HT3A D. 5HT4A B. 5HT2A A 24 y/o mother of a 2 y/o child presents to the clinic. Which of the following facial characteristics would lead the PMHNP to believe the child has fetal alcohol syndrome? A. High nasal bridge, plump midface, and large eyelid opening B. Large head, thick upper lip, and overdeveloped jaw C. Small head, thin upper lip, and smooth philtrum D. Long nose, large eyelid opening, and developed philtrum C. Small head, thin upper lip, and smooth philtrum The risk of bleeding on selective reuptake inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs), or aspirin, is an example of which of the following principles? A. Distribution B. Pharmacodynamic C. Absorption D. Pharmacokinetic B. Pharmacodynamic A 43 y/o male is treated for Bipolar I on lithium. Which of the following hematologic changes is associated with lithium? A. anemia B. leukocytosis C. leukopenia D. Agranulocytosis B. leukocytosis When studying pharmacodynamics involving receptors, you know that an inverse agonist produces the following effect: A. Activates a biological response, and opens the ion channels B. Does not fully activate the receptor and causes only limited actions C. Blocks the agonist from opening the channel, and does not activate a biological response D. Causes the opposite effect of agonist, and causes the receptor to close the ion channel D. Causes the opposite effect of agonist, and causes the receptor to close the ion channel What is a rate but serious side effect of trazodone (Desyrel)? A. tremor B. confusion C. priapism D. rash C. priapism Norepinephrine is a neurotransmitter that is implicated in alertness and anxiety. What area of the brain has a large majority of norepinephrine neurons? A. amygdala B. Locus coeruleus C. hippocampus D. Nucleus accumbens B. Locus coeruleus While treating a 12 y/o boy for ADHD, the PMHNP observes which of the following physical features that raise concerns for genetic evaluation for Fragile X syndrome? A. Small head, short palpebral fissure, inner epicanthal folds B. Long head and ears, short stature, hyperextensible joints C. Obesity, small stature, small hands and feet, hypotonia D. Café au lait spots on face and arms, neurofibromas B. Long head and ears, short stature, hyperextensible joints 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 drooling? B. Are you experiencing dizziness? C. Are you experiencing breast discharge? D. Are you experiencing tremors? C. Are you experiencing breast discharge? Which of the following findings on MRI and PET scans would be uncommon in individuals with schizophrenia? A. Decreased total brain volume B. Decreased size of cerebral ventricles C. Decreased electrical activity in the frontal lobes D. Decreased glutamate & GABA release B. Decreased size of cerebral ventricles [Show Less]
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ANCC Practice questions Domain 1, questions and answers, latest updated
As a PMHNP, you are aware of antipsychotic medication side effects. Which of the following side effects of antipsychotic medications has an insidious, dela... [Show More] yed-onset typically 1 to 2 years after initiation of the medication? a. Dry mouth b. Tardive dyskinesia c. Sedation d. Weight gain B 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 D 00:02 01:36 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 A 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) A 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 86/56 c. Height 67 inches, weight 102 pounds d. Pulse 60, respirations 26 C 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 A 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. B Which mood stabilizer is most associated with a potentially life-threatening rash? a. Divalproex (Depakote) b. Lamotrigine (Lamictal) c. Lithium (Eskalith) d. Carbamazepine (Tegretol) B Which of the following statements most accurately reflects the predominant risk factors of antisocial personality disorders? a. Gang affiliation and early substance abuse b. Genetic predisposition of first-degree family member c. Childhood abuse and trauma from domestic violence d. Lower socioeconomic status from single-parent families B A 37-year-old patient with schizophrenia is started on a high dose of chlorpromazine (Thorazine). The next day, he complains of lightheadedness after standing up. Vital sign changes reflect a significant decrease in blood pressure and an increase in heart rate. You suspect this is secondary to the alpha 1-adrenergic blockade which is causing a. Orthostatic hypotension b. Dry mouth c. Respiratory depression d. Decreased sweating A A 74-year-old female presents for an evaluation. The psychiatric nurse practitioner has the patient complete the mini mental status examination and clock drawing. The patient is unable to correctly draw the face of the clock. Which area of the brain is likely to have a compromised functioning? a. Wernicke's Area b. Corpus Callosum c. Left Hemisphere d. Right hemisphere D Your patient comes into the office for her middle of the year appointment. She is diagnosed with Bipolar I disorder. She has been maintained well for the past 3 years on Oxcarbazepine (Trileptal) 900 mg po QHS. Her labs are normal except for a blood sugar of 114 and her hemoglobin A1C is 5.6. She has a normal energy level and states that her mood is stable but complains of excessive urination and thirst. You suspect: a. Possible Diabetes 2 b. Possible hyponatremia c. Possible polydipsia d. Side effects of oxcarbazepine D 00:02 01:36 What is a rare but serious side effect of trazodone (Desyrel)? a. Confusion b. Priapism c. Rash d. Tremor B 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. B 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 B 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 C Which serotonin receptor antagonism makes an antipsychotic "atypical"? a. 5HT4A b. 5HT1A c. 5HT3A d. 5HT2A D 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) B 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 A 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. B Which of the following statements does not reflect current understanding of neurotransmitter pathways implicated in anxiety disorders? a. Decreasing norepinephrine in the locus coeruleus diminishes symptoms of anxiety. b. Increased levels of CRF in the amygdala, hippocampus and locus coeruleus increases symptoms of anxiety. c. Decreasing GABA in the mesolimbic cortex diminishes symptoms of anxiety. d. Increasing serotonergic activity in the amygdala diminishes symptoms of anxiety. C Which of the following findings on MRI and PET scans would be uncommon in individuals with schizophrenia? a. Decreased glutamate and GABA release b. Decreased total brain volume c. Decreased electrical activity in the frontal lobes d. Decreased size of cerebral ventricles D Which of the following findings would raise concern in a pre-school wellness exam for a 5-year-old girl? a. Blood pressure 92/52 b. Pulse 102, respirations 30 c. Completed immunizations: MMR, Varicella, DTap, IPV, PCV, Hib, HepB d. Height 43 inches, weight 55 lbs D The PMHNP would expect to see which of the following during a physical exam for a patient with bulimia nervosa? a. Obesity b. Tachycardia c. Alopecia areata d. Erosion of dental enamel D 1. While treating a 12-year-old boy for ADHD, the PMHNP observes which of the following physical features that raise concerns for genetic evaluation for Fragile X syndrome? a. Small head, short palpebral fissure, inner epicanthal folds b. Café au lait spots on face and arms, neurofibromas c. Long head and ears, short stature, hyperextensible joints d. Obesity, small stature, small hands and feet, hypotonia C 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. D 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 B 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? A [Show Less]
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ANCC Review Questions (PMHNP IQ),100% accurate answers. A+ content
What direct-acting dopamine receptor agonist is recommended to be used in the treatments of neuroleptic malignant syndrome (NMS) fo help lower the dopamine... [Show More] blockade? A) benzotropine (Cogentin) B) bromocriptine (Parlodel) C) dantrolene (Dantrium) D) trihexyphenidyl (Artane) A) Bromocriptine (Parlodel) is the recommended direct acting dopamine receptor agonist to help decrease the dopamine blockade. Danrolene (Dantrium) is a muscle relaxant. Benzotropine (Cogentin) and Trihexyphenidyl (Artane) are anticholinergic medications used for extrapyramidal side effects (EPS). 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 elective surgical procedure. Which medication is strictly contraindicated with Selegiline? A) Non-steroidal anti-inflammatory drugs (NSAIDS) B) Codeine C) Morphine D) Meperidine D) Meperidine is strictly prohibited when a patient is treated on a monoamine oxidase inhibitor (MAOI) due to the risk of hypertensive crisis and death. A WBC of 4,000 in a patient taking Clozapine would prompt the PMHNP to take which of the following actions? A) Consult with hematologist to determine appropriate antibiotic regimen and monitor closely. B) Institute twice-weekly complete blood count with differentials and monitor closely. C) Discontinue clozapine, initiate alternative antipsychotic medication and monitor closely. D) Institute daily complete blood count with differentials and monitor closely. B) Institute twice-weekly complete blood count with differentials and monitor closely. The recommended cut-points for discontinuation of clozapine are WBC of 2,000 to 3,000 or granulocytes of 1,000 to 1,500 for agranulocytosis and severely compromised immune system. At a WBC of 4,000, the recommendation is to closely monitor CBC with differential twice a week while patient may continue clozapine in the absence of any other signs or symptoms. A patient with a diagnosis of schizophrenia has a history of suicidal ideation and suicide attempts. The PMHNP should consider which antipsychotic medication that is the only antipsychotic to reduce the risk of suicide in schizophrenia? A) Abilify (aripriprazole) B) Latuda (lurasidone) C) Invega (iloperidone) D) Clozaril (clozapine) D) Clozaril (clozapine) is the only known antipsychotic medication that had been shown to reduce the risk of suicide in patients diagnosed with schizophrenia. A patient being treated for major depressive disorder and on sertraline (Zoloft), 150 mg po daily for the past 16 years, presents to the psychiatric mental health practitioner for an outpatient follow-up visit. During the visit she states that she has not been feeling well, reporting the flu. She also states she has not taken her medication in the last five days. Which of the following symptoms would she be describing if you suspect selective serotonin reputable inhibitors (SSRIs) discontinuation syndrome? A) Agitation, nausea, dysphoria, and diequilibrium B) Agitation, nausea, tremor, and ataxia. C) Restlessness, tremor, fever, and shivering. D) Restlessness, headache, increased heart rate, and diarrhea. A) Agitation; nausea, dysphoria, and disequilibrium The patient has SSRI discontinuation syndrome and would be presenting with flu-like symptoms. If the patient had serotonin syndrome, she would present with symptoms of autonomic instability. Which of the following statements reflect the current understanding of dopamine (DA) pathways and clinical symptoms in schizophrenia? A) Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolimbic system. B) Negative symptoms are related to DA excess in the cerebral cortex; positive symptoms are related to DA deficit in the nucleus accumbens and mesolimbic system. C) Negative symptoms are related to DA excess in the mesolimbic system; positive symptoms are related to DA deficit in the substantia nigra and ventral tegmental area. Negative symptoms are related to DA deficit in the mesolimbic system; positive symptoms are related to DA excess in the substantia nigra and ventral tegmental area. A) Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolimbic system. Negative symptoms & cognitive impairment are thought to be related to hypoactivity of the mesocortical dopiminergic tract, which by its association with the prefrontal cortex and neocortex contributes to motivation, planning, sequencing of behaviors in time, attention, and social behavior. Positive symptoms (hallucination and delusions) are thought to be caused by dopamine hyperactivity in the mesolimbic tract, which regulates emotion. This hyperactivity could result in overactive modulation of nueurotransmission from the nucleus accumbens. Norepinephrine is a neurotransmitter that is implicated in alertness and anxiety. What area of the brain has a large majority of norepinephrine neurons? A) Amygdala B) Hippocampus C) Locus Coeruleus D) Nucleus Accumbens C) Locus coeruleus There are two areas in the brain that produce norepinephrine neurons, one is the locus coeruleus and the other is the medullary reticular formation. Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is treated on clozapine? A) 1A2 B) 2D6 C) 2C9 D) 2C19 A) 1A2 When an individual is treated on clozapine and decreases tobacco use, the clozapine level with increase, as tobacco is an inducer to the clozapine, and the patient no longer needs the higher dose of clozapine. When working with an avoidant patient with a history of trauma, what type of communication techniques are helpful? A) Techniques to decrease arousal B) Clarification and close-ended questions C) Techniques to increase arousal D) Reflection and open-ended questions. C) Techniques to increase arousal Activation is needed to allow memories stored in the amygdala to be processed. The PMHNP knows that the ego is a part of the personality and is the logical/rational mind including defense mechanisms. What might this personality part say? A) "I should" B) "I want" C) "I evaluate" D) "I ought" C) "I evaluate" The ego is the logical and rational mind. The ego monitors the is and would say "I think. I evaluate." Mr. Jones, a 78 year old patient, presents to the PMHNP for a follow-up medication appointment. Mr. Jones' depression has been successfully treated with citalopram 20 mg by mouth daily. During the visit, Mr Jones complains that in the last 2 or 3 weeks, he has had nausea, fatigue, feeling weak, with a headache and decreased appetite. Which action would be most appropriate for Mr. Jones? A) Assess for other symptoms of hyponatremia and check a serum sodium level. B) Discuss SSRI discontinuation syndrome and stress importance of medication adherence. C) Discuss rates of relapse on a SSRI and increase his medication to citalopram 40 mg by mouth daily. D) Discuss rates of relapse on a SSRI and recommend switching his medication to a different class. A) Assess for other symptoms of hyponatremia and check serum sodium level. Hyponatremia can occur on SSRIs, and is more common in elderly patients. This patient is reporting symptoms of moderate hyponatremia and needs to be assessed, and his sodium levels need to be checked. Normal sodium level: 135-145 mEq/L The PMHNP mental health nurse practitioner treating a patient for schizophrenia on ziprasidone orders an electrocardiograph. Which QTc interval result places the patient at greatest risk for torsades de pointes? A) 100-200 milliseconds B) 160-260 milliseconds C) 300-500 milliseconds D) 500-700 milliseconds D) 500-700 milliseconds A patient with a QTc interval of 500-700 milliseconds is at a higher risk of developing torsades de pointes. Which lab test should be ordered to rule out a medical cause of dementia symptoms? A) Albumin B) thiamine C) Vitamin D3 D) Vitamin B12 D) Vitamin B12 Low vitamin B12 levels have been associated with the development of dementa- like symptoms, and when dementia is a differential diagnosis, a Vitamin B12 should be checked. Which of the following lab findings would raise the greatest concern when prescribing Lithium? A) BUN 20 mg/dL B) GFR 115 mL C) Serum Creatinine 3.0 mg/DL D) Serum Na+ 120 mEq/L C) Serum creatinine 3.0 mg/dL Normal serum creatinine is < 1.5 mg/dL. Elevated creatinine indicates decreased renal function. Lithium is excreted through the kidneys and decreased renal function can result in lithium toxicity. A 43-year-old male is treated for Bipolar 1 on lithium. Which of the following hematologic changes is associated with lithium? A) Agranulocytosis B) Anemia C) Leukocytosis D) Leukopenia C) Leukocytosis While the mechanism of action is not clear, the use of lithium can raise white blood cell counts and therefore, CBC should be monitored in patients treated on lithium. Which serotonin receptor antagonism makes an antipsychotic "atypical" A) 5HT2A B) 5HT1A C) 5HT3A D) 5HT4A A) 5HT2A The mechanism of action that makes an antipsychotic medication "atypical" is related to the 5HT2A receptor antagonism and D2 receptor antagonism. Sally is a 27-year-old attorney who recently moved to your area. Sally presents with social anxiety disorder, specifically symptoms of performance anxiety. Sally's only other medical condition is exercise induced asthma, and she is treated on Albuterol. Sally states she was in CBT without relief and would like to try a medication. Which is the most suitable initial treatment for Sally? A) clonazepam (Klonopin) B) sertraline (Zoloft) C) inderal (Propanolol) D) risperidone (Risperidal) B) sertraline (Zoloft) is used to treat social anxiety disorder and the patient is on albuterol; therefore the betablocker inderal is contraindicated with albuterol due to the risk of increased CNS stimulation. When suspecting a patient with neuroleptic malignant syndrome (NMS), which lab values would help confirm diagnosis? A) Leukocytosis and elevated creatinine phosphokinase. B) Leukocytosis and thrombocytosis C) Leukopenia and decreased creatinine phosphokinase D) Leukocytosis and thrombocytopenia A) Leukocytosis and elevated creatinine phosphokinase. With NMS, a patient has an elevated creatinine phosphokinase (CPK) due to skeletal muscle breakdown and an elevated white blood cell count (WBC). In managing the maintenance phase for Bipolar I disorder, which of the following statements is not supported by current evidence in the literature? A) Both lamotrigine and lithium are superior to placebo in delaying onset of mood-related disorders. B) Extended release formulation of carbamazepine is equivalent to lithium in preventing a manic, hypomanic, or mixed episode. C) Lamotrigine, but not lithium is superior to placebo in preventing a depressive episode. D) Lithium. but not lamotrigine, is superior to placebo in preventing a hypomanic, or mixed episode. B) Extended release formulation of carbamazepine is equivalent to lithium in preventing a manic, hypomanic, or mixed episode. Extended-release formulation of carbamazepine has demonstrated preliminary efficacy in the tx of acute manic or mixed episodes, but is not currently indicated in maintenance phase tx for Bipolar I disorder. Side effects include dizziness, somnolence, nausea, vomiting, ataxia, blurred vision, dyspepsia, dry mouth, pruritus, and speech disorder. The other responses are supported by current evidence in literature. A new patient comes to you on a medication regimen of: Adderall XR, Seroquel, Mirtazepine, Diazepam, Zolpidem. In addition if initial dose dose not help the patient sleep. You confirm the medication regimen with the patient's past records. You diagnose with PTSD, alcohol use disorder moderate by history in recovery, depressive disorder, and ADD. You tx the patient and find that the patient is resistant to changing the past medication regimen. The pt wants you to rewrite the script so that the medication is available. In checking with the pharmacy, you find out the pt has potentially used 60 tablets of Zolpidem (Ambien) in a 20 day period. Your best action is to: A) Refill the order for the med as requested. The med has not harmed the pt so far. B) Discontinue the prescription for Zolpidem (Ambien). Talk to the pt about the overuse of Zolpidem (Ambien) and the danger it poses to his health and wellbeing. C) Give the order for the Zolpidem (Ambien). Talk with the pt about the danger of using too much sleeping medication. Then, discontinue the medication. D) Refill the order for the medication. Then, send the pt for the chemical dependency evaluation. The pt is on too many sedative-type meds and is harming himself. B) Discontinue the prescription for Zolpidem. Talk to the pt about the overuse of Zolpidem and the danger it poses to his health and wellbeing. Zolpidem (Ambien) is a hypnotic med for the short-term management of insomnia. It can be stopped abruptly without significant harm to the patient other than rebound insomnia. You are protecting your patient by stopping the dangerous misuse of a hypnotic medication. You must also discuss the ramifications of the misuse with the pt and attempt to help him by giving him a rationale for the discontinuation and a healthy plan for managing the insomnia. You are on call for your service. You arrive at the Emergency Dept to find a 22 year old male patient complaining of having trouble with his eyes. His vitals are stable. He is 5 foot 7 inches tall. His weight is 140 lbs, and his labs are all normal range. He states he has been taking aripiprazole (Abilify) for the last 2 months for his bipolar 1 disorder. He had the dose raised 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 10-15 min and he will hav trouble seeing until they role back down. After examination you decide to: A) Discontinue to aripiprazole and begin the pt on a gradual regimen of Lamotigrine for 1 week. Have him return to his provider for further management of bipolar disorder. B) Continue the aripiproazole and give benzotropine mesylate. C) Discontinue the aripiprazole and give benzotropine mezylate (Congentin) 1 mg IM. D) Begin a cross titration downward of aripiprazole and upwards of haldol. C) Discontinue the aripiprazole and give benzotropine mezylate (Congentin) 1 mg IM. This is an aripiprazole-induced oculogyric crisis (acute dystonia) [Show Less]
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ANCC Domain 2 questions, 100% accurate answers, latest updated
A 78 y/o cattleman referred for treatment of refractory depression by his primary care provider reports continued thoughts of failure, lack of purpose in l... [Show More] ife, 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. Prior and current medications, dose, clinical response, side effects B. Extent of alcohol use and motivation to reduce to safe levels C. Thoughts of self-harm, plan, intent, access D. Sleep patterns (early-middle-late awakening), sleep hygiene C. Thoughts of self-harm, plan, intent, access A 32 y/o Caucasian Catholic female patient presents for her therapy session. She is upset because she and her husband have been in an argument over finances. She does not work and stays at home to take care of the children. She reports feeling sad and has had thoughts of hurting herself. She has a past history of overdosing with Tylenol several years ago. Which of the following places her at high-risk for suicide? A. age B. gender C. previous suicide attempt D. marital status C. previous suicide attempt During a follow-up medication visit with a 13 y/o male, his mother stayed longer to ask the psychiatric mental health nurse practitioner (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. As your son's PMHNP, I cannot provide you with information about immunizations B. I understand your concern with talking to your son about becoming sexually active. Let's address how to start the conversation. 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. You are correct, only females need to receive the human papillomavirus vaccination. The 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? What opening question or statement by a Psychiatric-Mental Health Nurse Practitioner facilitates communication at an initial visit? A. Tell me your concerns and how I may be of help. B. Tell me what you think the problem is. C. What seems to be the problem today? D. What problem does your primary care physician want us to evaluate? A. Tell me your concerns and how I may be of help. In evaluating the functional status of a 68 y/o woman who has depression, the Instrumental Activities of Daily Living Scale includes which of the following activities? A. Using telephone B. Filing taxes C. Bathing D. Toileting A. Using telephone 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 the safest antidepressant medications and rarely cause suicidal thoughts. Try the medication and we can watch closely for any side effects. B. 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. C. Have you ever had feelings of hurting yourself? If you took the medication and had thoughts like that, what would you do? D. 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? C. Have you ever had feelings of hurting yourself? If you took the medication and had thoughts like that, what would you do? A psychiatric mental health nurse practitioner (PMHNP) is working in an integrated care clinic and his family nurse practitioner colleague asks for a consult. The family nurse practitioner asks the PMHNP what antidepressant to start for a patient who has a score of 15 on the patient health questionnaire 9 (PHQ9). What is the appropriate response? A. A score of 15 on the patient health questionnaire indicates moderate depression, so the patient should be started on a selective serotonin norepinephrine reuptake inhibitor. B. A score of 15 on the patient health questionnaire 9 indicates possible moderate depression, but a follow-up interview is required to assess for depression. I can see this patient today and further assess for depression and the appropriate treatment C. A score of 15 on the patient health questionnaire 9 indicates severe depression, so you should start a selective serotonin reuptake inhibitor and an atypical antipsychotic. D. A score of 15 on the patient health questionnaire 9 indicates moderate depression, so you can refer the patient to therapy and start an antidepressant B. A score of 15 on the patient health questionnaire 9 indicates possible moderate depression, but a follow-up interview is required to assess for depression. I can see this patient today and further assess for depression and the appropriate treatment An example of a screening tool that measures severity and tracks change in specific symptoms is A. The mini-mental state examination (MMSE) B. The behavior and Symptom Identification Scale (BASIS) C. The Short Form 36 (SF-36) D. The CAGE A. The mini-mental state examination (MMSE) A ten y/o child lost her father to an unexpected heart attack. Normally confident, sociable and an excellent student, her teachers and mother report that she has withdrawn, become disinterested in schoolmates and schoolwork, and easily becomes tearful if anyone mentions her father. What non-pharmacologic intervention would be most helpful at this time to facilitate her grieving and loss? A. Play therapy B. Individual therapy C. Psychoeducation group D. Bibliotherapy C. Psychoeducation group Which of the following risk factors is not amenable to lifestyle changes in reducing lifetime risk of depressive disorders? A. Work-related stress B. Stressful family life C. Alcohol use D. Personality D. Personality The Five A's for Health Behavior Change include the following: A. Assess, Advise, Act, Access, Assist B. Assess, Appraise, Advise, Act, Assist C. Assess, Advise, Agree, Assist, Arrange D. Assess, Appraise, Agree, Access, Arrange C. Assess, Advise, Agree, Assist, Arrange A psychiatric mental health nurse practitioner realizes she is frustrated and easily angered with one of her patients for no apparent reason. When discussing the situation with a colleague, she states the patient reminds her of her abusive stepfather. Which of the following best describes the nurse practitioner's reaction? A. Countertransference B. Displacement C. Transference D. Projection A. Countertransference Dementia screening for the general population is not recommended for the following reason: A. The service has unknown balance of benefit and harm; current treatments have limited effectiveness in modifying instrumental activities of daily living B. The service benefits few people; target condition has high prevalence in the chosen population C. The service causes net harm in the target population; time involved in screening detracts from higher priority preventive health measures in general population D. The service is unfocused for target condition: sensitivity and specificity of dementia screening measures do not currently warrant widespread use A. The service has unknown balance of benefit and harm; current treatments have limited effectiveness in modifying instrumental activities of daily living 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 major depressive disorder (MDD)? A. 16 y/o, high school male, honors student, who runs cross-country track B. 43 y/o, divorced woman, schoolteacher, raising three children C. 58 y/o, married male, computer analyst, whose work requires frequent travel D. 28 y/o, single woman, working toward partner in a large law firm B. 43 y/o, divorced woman, schoolteacher, raising three children A patient who works the night shift presents for a follow-up appointment to see the psychiatric mental health nurse practitioner (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. Exercise does not promote or help deepen your sleep, so you should consider making changes in your daily routine B. Exercising is a good way to help you get sleep, so keep up your schedule and your body will adjust to your new routine. C. Regular exercise helps with sleep, so continue to exercise, and when you get home, watch television to help promote sleep D. 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 D. 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 There is a growing recognition that adverse life experiences due to a variety of reasons underlie a wide range of psychiatric disorders and medical problems. According to a seminal research study on adverse childhood experiences (ACE), a positive relationship exists between ACE and which of the following disorders? A. Alcoholism, anxiety, depression, diabetes, and heart disease B. Alcoholism, anxiety, heart disease, sleep disorders, and schizophrenia C. Alcoholism, anorexia, depression, diabetes, and schizophrenia D. Alcoholism, anxiety, depression, diabetes, and schizophrenia A. Alcoholism, anxiety, depression, diabetes, and heart disease In a psychiatric emergency, the psychiatric mental health nurse practitioner (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. Know as much about the person as possible prior to starting the interview B. Inform the patient that violence is not acceptable C. Enter the room alone, in order to build a therapeutic alliance D. Make sure the patient is restrained before beginning the evaluation A. Know as much about the person as possible prior to starting the interview 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. Edinburgh Postnatal Depression Scale (EPDS) B. Major Depression Inventory (MDI) C. Montgomery-Asberg Depression Rating Scale (MADRS) D. Hamilton Rating Scale for ... A 36 y/o 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 is she was alright. She immediately started yelling at her husband because he had not given their 5 y/o daughter a bath and had not cleaned the house. Which of the following defense mechanisms is being demonstrated by this woman? A. Conversion B. Dissociation C. Displacement D. Rationalization C. Displacement When questioning a patient regarding alcohol use during an intake, the patient tells you he only drinks socially. Which initial response is most appropriate? A. I am glad you are responsible drinker B. Do other people in your household drink alcohol? C. What amount and what kind of alcohol do you drink in a week? D. Many people with alcohol issues say they are social drinkers. C. What amount and what kind of alcohol do you drink in a week? A 44 y/o man presents to the psychiatric mental health nurse practitioner at his wife's insistence. The patient was hospitalized for a mild hear injury after a motor vehicle accident four weeks ago. He 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. Clerambault syndrome B. Delusion of doubles C. Capgras syndrome D. Fregoli phenomenon C. Capgras syndrome 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. 42 y/o, divorced, Caucasian woman dating a recently divorced man in Denver, Colorado B. 35 y/o, pregnant, African-American woman living with her husband in suburb of Dallas, Texas C. 17 y/o, single, Native Alaskan woman living with employed boyfriend in Gelena, Alaska D. 26 y/o, recently separated, Asian American woman living in Boston, Massachusetts C. 17 y/o, single, Native Alaskan woman living with employed boyfriend in Gelena, Alaska In assessing possible sexual abuse of a 4 y/o child, which of the following would not be indicated? A. Has anyone else asked you to take off your clothes? B. Has anyone done something you didn't like to your body? C. Has anyone ever taken your picture without your clothes on? D. Has anyone invited you to a birthday pool party? D. Has anyone invited you to a birthday pool party? In advising parents how to reduce the risk for teen substance abuse when there is positive family history of alcohol dependence, a psychiatric-mental health nurse practitioner 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 C. Random urine testing using home drug testing kits When assessing a client, what is the most important predictor of potential for violence? A. History of seizures B. History of head injury C. History of aggressive rage D. History of substance abuse C. History of aggressive rage 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. Barnes Akathisia Rating Scale (BARS) B. Abnormal Involuntary Movement Scale (AIMS) C. Simpson Angus EPS Scale D. Dyskinesia Identification System Condensed User Scale (DISCUS) A. Barnes Akathisia Rating Scale (BARS) Which of the following statements would be most likely to be effective in changing sexual behavior when counseling a sexually active 15 y/o adolescent girl? A. Always use condoms when having sex B. Use the sample condom C. Require your partner to use a condom D. Always carry condoms in your purse B. Use the sample condom As the psychiatric mental health nurse practitioner (PMHNP) working with a young female recently diagnosed with bipolar disorder, and using a recovery model, what will be the focus of your interactions with this patient? A. Assisting in gainful employment B. Psychoeducation about her disease process C. Focus on her feelings experience, and what she wants to achieve D. Focus on the side effects of her medications C. Focus on her feelings experience, and what she wants to achieve When child, adult partner, or elder abuse is suspected, the Psychiatric-Mental Health Nurse Practitioner 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? A. Within the past year, has anyone ever forced you to do something by threatening you with a gun? B. Within the past year, has anyone ever threatened to kill you? C. Within the past year, have you been hit, slapped, kicked or otherwise physically hurt by someone? D. Within the past year, have you ever threatened or tried to commit suicide to escape the abuse? C. Within the past year, have you been hit, slapped, kicked or otherwise physically hurt by someone? A 14 y/o 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, the Psychiatric-Mental Health Nurse Practitioner needs to include the topic of sexual orientation. What is the best introductory approach to this topic? A. Are you attracted to girls rather than boys? B. Did you overdose after breaking up with a girlfriend or boyfriend? C. What is your experience in sexual relationships? D. Are you sexually active? C. What is your experience in sexual relationships? [Show Less]
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ANCC Practice Questions Domain 2 questions and answers, verified content
What direct-acting dopamine receptor agonist is recommended to be used in the treatment of neuroleptic malignant syndrome (NMS) to help lower the dopamine ... [Show More] receptor blockade? A. Dantrolene (Dantrium) B. Benztropine (Cogentin) C. Bromocriptine (Parlodel) D. Trihexyphenidyl (Artane) C. Bromocriptine (Parlodel) A 74 y/o female present for an evaluation. The psychiatric nurse practitioner has the patient complete the mini mental status examination and clock drawing. The patient is unable to correctly draw the face of the clock. Which area of the brain is likely to have compromised functioning? A. Corpus callosum B. Wernicke's Area C. Left Hemisphere D. Right Hemisphere D. Right Hemisphere 00:02 01:30 Which of the following statements reflects current understanding of neurodevelopment and best explains risk-taking behaviors of adolescent males? A. Stimulant and substance use impairs judgment and cognitive appraisal B. Pruning of serotonin circuits in the adolescent brain is associated with increased impulsivity C. Maturation of the prefrontal cortex continues into mid-20s and early 30s D. Hormonal flooding, especially testosterone and oxytocin, increase dopamine levels in the brain C. Maturation of the prefrontal cortex continues into mid-20s and early 30s What cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is treated on clozapine? A. 2C19 B. 1A2 C. 2C9 D. 2D6 B. 1A2 As a psychiatric mental health nurse practitioner, 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. Sedation B. Weight gain C. Tardive dyskinesia D. Dry mouth C. Tardive dyskinesia Which mood stabilizer is most associated with a potentially life-threatening rash? A. Divalproex (depakote) B. Carbamazepine (tegretol) C. Lithium (eskalith) D. Lamotrigine (lamictal) D. Lamotrigine (lamictal) The psychiatric-Mental Health Nurse Practitioner would expect to see which of the following during a physical exam for a patient with bulimia nervosa? A. Alopecia areata B. Tachycardia C. Erosion of dental enamel D. Obesity C. Erosion of dental enamel Which of the following statements does not reflect current understanding of neurotransmitter pathways implicated in anxiety disorders? A. Decreasing norepinephrine in the locus ceruleus diminishes symptoms of anxiety B. Increasing serotonergic activity in the amygdala diminishes symptoms of anxiety C. Increased levels of CRF in the amygdala, hippocampus and locus ceruleus increases symptoms of anxiety D. Decreasing GABA in the mesolimbic cortex diminishes symptoms of anxiety D. Decreasing GABA in the mesolimbic cortex diminishes symptoms of anxiety Mr. Smith is a 56 y/o 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. Codeine B. NSAIDs C. Meperidine D. Morphine C. Meperidine Which of the following medications has a unique mechanism of action in that it is both a dopamine and norepinephrine reuptake inhibitor? A. Imipramine (Tofranil) B. Duloxetine (Cymbalta) C. Bupropion (Wellbutrin) D. Venlafaxine (Effexor) C. Bupropion (Wellbutrin) When assessing an elderly patient who complains of tinnitus, the PMHNP would associate which of the following findings with an acoustic neuroma? A. Perforation of tympanic membrane B. Suppuration of the labyrinth C. Unilateral ringing in ear D. Inflammation of middle ear C. Unilateral ringing in ear 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. A disulfiram-alcohol reaction can occur up to 1 week after discontinuing disulfiram C. Disulfiram can lower liver function tests so monitoring is necessary D. Avoid anything containing alcohol (I.e., vinegar, mouthwash, aftershave, cough medication) while using disulfiram and for 2 weeks after discontinuing D. Avoid anything containing alcohol (I.e., vinegar, mouthwash, aftershave, cough medication) while using disulfiram and for 2 weeks after discontinuing Which of the following findings would raise concern in an annual sports exam for a 15 y/o girl? A. BP 86/56 B. Ht 67 inches, wt 102 lb C. Pulse 60, respirations 26 D. Scar tissue from a hymenal tear at 11 o'clock (reported biking injury) B. Ht 67 inches, wt 102 lb Your patient comes into the office for her middle of the year appointment. She is diagnosed with Bipolar 1 disorder. She has been maintained well for the past 3 years on Oxcarbazepine (Trileptal) 900 mg PO Q HS. Her labs are normal except for a blood sugar of 114 and her HA1c is 5.6. She has normal energy level and states that her mood is stable but complains of excessive urination and thirst. You suspect: A. Side effects of Oxcarbazepine B. Possible hyponatremia C. Possible polydipsia D. Possible diabetes 2 A. Side effects of Oxcarbazepine Patty is a 62 y/o white female with Bipolar 1 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 psychiatric mental health nurse practitioner treating Patty, you are concerned that the addition of the corticosteroids may cause A. Neuroleptic Malignant Syndrome B. A hypertensive crisis C. Stevens-Johnson syndrome D. A manic episode D. A manic episode A 37 y/o patient with schizophrenia is started on a high dose of chlorpromazine (Thorazine). The next day, he complains of lightheadedness after standing up. Vital sign changes reflect a significant decrease in BP and an increase in heart rate. You suspect this is secondary to the alpha 1-adrenergic blockade which is causing A. Decreased sweating B. Dry mouth C. Respiratory depression D. Orthostatic hypotension D. Orthostatic hypotension Which of the following patients with generalized anxiety disorder is most likely to be a CYP 2C19 poor metabolizer and have an exaggerated response to diazepam (Valium) 5 mg TID with increased sedation, central nervous system, and cognitive side effects? A. 50 y/o Caucasian male B. 40y/o Asian male C. 20 y/o African American female D. 30 y/o African American male B. 40y/o Asian male You are on call for your service. You arrive at the Emergency Department to find a 22 y/o male patient complaining of having trouble with his eyes. His vitals are stable. He is 5 ft 7 in tall; his wt is 140 lbs; and 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 Q am 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 Abilify 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. Discontinue the Abilify and give Benztropine Mesylate (Cognetin) 1 mg IM. Have him take Cogentin 1mg PO BID for 5 days. Have him return to his provider for a different medication for his bipolar disorder the next day C. Continue the Abilify and give Cogentin 1mg IM. Have him take Cogentin 1 mg PO BID. Have him return to his provider for further management of his bipolar disorder the next day. D. Begin a cross titration downward of the Abilify and upwards of Haloperidol (Haldol) Have him return to his provider for further management of his bipolar disorder B. Discontinue the Abilify and give Benztropine Mesylate (Cognetin) 1 mg IM. Have him take Cogentin 1mg PO BID for 5 days. Have him return to his provider for a different medication for his bipolar disorder the next day Sandy, a 32 y/o 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. amygdala B. Hippocampus C. thalamus D. Cingulate gyrus A. amygdala You have a 17 y/o female patient who suffers with bipolar disorder. The patient has history of impulsive acting out and promiscuity. You make a decision to add Folic acid 0.8 mg to her medication regimen of Lamotrigine (Lamictal) 200 mg po QHS and Quetiapine XR (Seroquel XR) 50mg PO QHS. Why is this important? A. The folic acid is important to help her with her hypotension induced by the Quetiapine XR (Seroquel XR) 50 mg PO QHS B. The folic acid is important for the continuing development of the patient's neuroendocrine system C. The folic acid is important to help her with the sleepiness induced by her bipolar medications D. The folic acid supports neural tube development during the first month that a woman is pregnant D. The folic acid supports neural tube development during the first month that a woman is pregnant A 17 y/o female presents to your clinic reporting anhedonia, decreased energy, and hopelessness for the past 2 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 a contraindication for bupropion? A. bulimia B. fatigue C. dysthymia D. smoking A. bulimia Which of the following statements reflects the current understanding of dopamine (DA) pathways and clinical symptoms of schizophrenia? A. Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolimbic system B. Negative symptoms are related to DA excess in the cerebral cortex; positive symptoms are related to DA deficit in the nucleus accumbens and mesolimbic system C. Negative symptoms are related to DA deficit in the mesolimbic system; positive symptoms are related to DA excess in the substantia nigra and ventral tegmental area D. Negative symptoms are related to DA excess in the mesolimbic system; positive symptoms are related to DA deficit in the substantia nigra and ventral tegmental area A. Negative symptoms are related to DA deficit in the cerebral cortex; positive symptoms are related to DA excess in the nucleus accumbens and mesolimbic system Which serotonin receptor antagonism makes an antipsychotic "atypical"? A. 5HT1A B. 5HT2A C. 5HT3A D. 5HT4A B. 5HT2A A 24 y/o mother of a 2 y/o child presents to the clinic. Which of the following facial characteristics would lead the PMHNP to believe the child has fetal alcohol syndrome? A. High nasal bridge, plump midface, and large eyelid opening B. Large head, thick upper lip, and overdeveloped jaw C. Small head, thin upper lip, and smooth philtrum D. Long nose, large eyelid opening, and developed philtrum C. Small head, thin upper lip, and smooth philtrum The risk of bleeding on selective reuptake inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs), or aspirin, is an example of which of the following principles? A. Distribution B. Pharmacodynamic C. Absorption D. Pharmacokinetic B. Pharmacodynamic A 43 y/o male is treated for Bipolar I on lithium. Which of the following hematologic changes is associated with lithium? A. anemia B. leukocytosis C. leukopenia D. Agranulocytosis B. leukocytosis When studying pharmacodynamics involving receptors, you know that an inverse agonist produces the following effect: A. Activates a biological response, and opens the ion channels B. Does not fully activate the receptor and causes only limited actions C. Blocks the agonist from opening the channel, and does not activate a biological response D. Causes the opposite effect of agonist, and causes the receptor to close the ion channel D. Causes the opposite effect of agonist, and causes the receptor to close the ion channel [Show Less]
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