ANCC Cumulative Exam Questions with Answers, Exams of Nursing

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ANCC - Cumulative Test

1. Frontal lobe syndrome is associated with a. personality changes. b. visual hallucinations. c. psychomotor retardation. d. memory impairment. .1. Correct answer : A. Frontal lobe syndrome influences all dimensions of the pre-frontal cortex.
2. A 64-year-old male with a history of bipolar I disorder presents to the community mental health center for his medication management appointment. He has been taking Depakote ER 500 mg iii at bedtime and Ambien 10 mg as needed for sleep. Today he states that he feels "just fine." His vital signs are: B/P 124/82, P 90, R 16, T 102. The nurse notes bruising on his arms and abdomen and suspects: a. decreased CPK levels. b. serotonin syndrome. c. neuroleptic malignant syndrome.

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d. thrombocytopenia. .2. Correct answer : D. The patient states he feels fine and none of the medications prescribed should result in A, B, or C. However, increased bleeding from development of thrombocytopenia (low platelet count) can result from use of Depakote ER.

3. A patient with a history of schizophrenia presents to the ED with acute mental status changes. His family reports adherence to medications. Labs were drawn and a urine sample was obtained. The urine culture showed a significantly high level of e. coli bacteria. Which DSM-IV-TR diagnosis can the nurse anticipate? a. Alzheimer's Dementia Not Otherwise Specified b. Delirium Not Otherwise Specified c. Schizophrenia. paranoid type d. Schizoid personality disorder.3. Correct answer : B. Before a psychiatric diagnosis is made, any substance-rdated or physical conditions must be ruled out. Because there was a rapid change in mental stalus, and there were high levels ofe. coli in the urine, a delirium diagnosis must first be
4. The nurse anticipates that a young child diagnosed with a developmental disability may have had:

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a. variable results on Hamilton Anxiety Test. b. normal results on PHQ12. c. normal IOWA Connors rating scores. d. low APGAR scores. .4. Correct answer : D. The only test that is directly related to a developmental disability is the low APGAR score.

5. A 55-year-old male whose wife was killed in an auto accident tells the nurse that he needs some help in accepting and dealing with the sudden loss of his wife. A guideline that would not be helpful is: a. "Try to take care of yourself" b. "Express how you feel." c. "Give yourself about 6 months to grieve" d. "Establish a daily structure and adhere to it" .5. Correct answer : C. The grieving proces usually takes a year, since this allows the person to experience all the holidays and special occasions without the deceaed
6. An implementation that supports behavioral change is

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a. dialectical behavioral therapy. b. Maslow's hierarchy of needs. c. dream analysis and interpretation. d. risk management. .6. Correct answer : A. Dialectical behavioral therapy is a technique that involves demonstration of unconditional acceptance of the patient as one of its strategies

7. Joe is a 75-year-old man who recently had cardiac surgery and developed physical complications. Cardiac rehabilitation was rescheduled due to decreased appetite, fatigue, and slowing of psychomotor activity. He was referred to psychiatry, and reported no previous history. During the assessment, he denied depression, hopelessness, helplessness, or suicidal ideation, but expressed uncertainty that he could get better. Cognitive functions seemed grossly intact. The most likely diagnosis is a. dementia. b. delirium. c. mood disorder. d. major depressive disorder. .7. Correct answer : C. The patient only meets the criteria for å mood disorder; the symptom onset

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follows complications of ardiac treatinent. There is no prior history of depression, no gross cognitive deficits, and no evidence of delirium based on symptoms and lab results.

8. A 60-year-old woman reports to the nurse that she has been experiencing weakness and numbness on her right side. She shares that her husband died 4 months ago from complications from a stroke. Physical examination is within normal limits. The nurse's best response to the patient at this time is: a. "Go home and try to worry less." b. "Sounds like you miss your husband." c. "How have you been coping since your husband died?" d. Are you afraid that you will die like him?" .8. Correct answer : C. Initially the nurse needs to understand how the palient has been coping with her situation since her husband's death.
9. An adult patient on the inpatient unit was receiving Xanax, 1 mg twice a day for treatment of an acute exacerbation of stress. While hospitalized, the patient was switched to Klonopin, 1 mg twice a day and then tapered over the next few days in preparation for discharge. The patient confides to the nurse that she is going to ask that the doctor discharge her with a prescription for Xanax because

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it seemed to be the only medication that worked. What is the nurse's responsibility when educating the patient about prescription benzodiazepine use? a. "Xanax, although a great calming drug, loses effectiveness over time." b. "Small sips of red wine with Xanax may cause your heart to race and make it hard for you to sleep." c. "This type of medication can be helpful when experiences are overwhelming, but routine use is rarely warranted due to risk of dependence and tolerance." d. "This classification of medication is lik .9. Correct answer : C. The other answers provide incorrect information.

10. Which of the following treatments shows evidence-based efficacy in the treatment of adolescent depression? a. Fluoxetine (Prozac) b. Dialectical behavioral therapy c. Situational therapy d. Hypnotherapy .10. Correct answer : A. This is the only evidence-based treatment listed for adolescent depression

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11. A patient was newly diagnosed with pancreatic cancer. He began crying, stating, "I cannot believe this. Both my father and grandfather died from cancer. How can I go through this?" The nurse's highest priority diagnosis is: a. grieving. b. risk for powerlessness. c. ineffective coping. d. risk for self-directed violence. .11. Correct answer : D. "How can I go through this?" suggests the need for further evaluation of the risk for self-directed violence; the nurse needs to clarify the meaning of the patient's statement.
12. The nurse cares for a patient who uses multiple vitamin therapies in addition to taking his prescribed medications for bipolar II disorder. The nurse's best initial action is to a. tell the patient he must stop the vitamins. b. understand what the patient perceives the vitamins are doing and teach him other strategies to achieve his desired outcome. c. determine whether the vitamins have any dangerous effects.

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d. tell the patient to inform his healthcare provider. .12. Correct answer : C. All the answers could be correct at different points in treatment, but C is the best inilial response.

13. A young adult male patient was informed that he tested positive for HIV. The patient's response was, "Well, I know what I need to do now." The nurse's priority intervention is to: a. give the patient information on the current research regarding treatments. b. call social services to assist in helping the patient access support groups. c. assess for suicidality. d. notify the healthcare provider regarding his or her concerns. .13. Correct answer : C. The priority intervention is C.
14. A psychiatric nurse is providing feedback to a patient during a counseling session. The patient angrily says, "You sound just like my mother!" The patient's remark illustrates which therapeutic concept? a. Identification

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b. Regression c. Resistance d. Transference .14. Correct answer : D. The patient is unconsciously transferring past negative feelings about his mother onto the nurse in the current situation. LNSWERS TO THE REVEW QUESTIONS 271

15. Cross-sectional findings from studies on teaching patients who have Human papillomavirus (HPV) indicate that sexual behaviors change from "unsafe" to "safe" when an understanding of the disease process is combined with a. belief in the efficacy of behavioral change. b. fear that others may catch the virus from them. c. anxiety over previous exposure. d. confidence in current research findings. .15. Correct answer : A. If a person believes that an action can be performed successfully and that this action can result in a positive outcome, there can be changes in behavior, such as practicing safe sex when unsafe sex was practiced.

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16. After a 2"week stay in the hospital for a psychiatric disorder, a patient returns to the community and finds a job. The patient then stops coming to the clinic for medication. When asked to explain, fire patient says, "I was never mentally ill and was just going through a difficult time for a while" The patient's statement is an example of: a. denial. b. rationalization. c. repression. d. Sublimation. 16. Correct answer : B. Rationalization is a defense mechanism in which one comes up with various explanations for justifying a situation..
17. Which treatment is the most teratogenic? a. Sertraline (Zoloft) b. Haloperidol (Haldol) c. Electroconvulsive therapy (ECT) d. Lithium (Eskalith) .17. Correct answer : D. Lithium can interfere with normal embryonic development and is, therefore, considered to be teratogenic.

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18. A 17-year-old girl is admitted the inpatient unit with a tentative diagnosis of schizophrenia. She has had episodes of school absenteeism, withdrawal from her friends, and bizarre behavior, including talking to her "keeper:" The psychiatric nurse's most appropriate initial response is to: a. acknowledge that the girl's perceptions seem real to her and refocus her attention on a task or activity. b. encourage the girl to express her thoughts to determine the meaning they have for her. c. ignore the girl's bizarre behavior because it will disappear after she has been given the correct medication. d. tell the girl that her perceptions of reality have become distorted because of her illness. .18. Correct answer : B. Because the nurse is just beginning to know the patient, it is important to understand the meaning that thoughts and behaviors have to the patient.
19. A woman of Hispanic descent reported that her husband of 45 years died 7 months ago. She describes difficulty sleeping and a weight loss of 35 pounds. According to the patient, her deceased husband has "visited" her several times and delivers an

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unintelligible message. Which is the most appropriate nursing diagnosis? a. Grieving b. Disturbed thought process c. Ineffective coping d. Ineffective denial .19. Correct answer : A. The patient is describing symptoms that can occur during the grieving process. If symptoms were to extend for a protracted linie or interfere with daily functioning, diagnosis might change and interventions would be different.

20. The nurse has observed that the patient who received an 8 a.m. dose of Haldol 5 mg and Cogentin 0.5 mg by mouth has not voided. The nurse understands that this problem represents which effect? a. Dopaminergic effects b. Serotonergic effects c. GABAminergic effects d. Anticholinergic effects .20. Correct answer : D. One of the side effects of the medications can be difficulty urinating this is a result of the anticholinergic effect.

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21. A nurse colleague consults you for guidance on furthering her education. She says "I don't believe I can do this, it's way too much to ask of me with all I have going on now." The best response from the nurse would be: a. "It is too much. Jobs are so demanding." b. "Why should you make that decision right now? You have plenty of time to do it." c. "I'm sure you are capable if you want to do it." d. "You think it's too much for you?" .21. Correct answer : D. This is the only answer that is rellecting what the patient is saying The other statements are either judgmental or advice-giving,
22. A research study in which study participants are drawn from a randomized pooI and both the researcher and study participants are unaware of which treatment study participants receive is known as a(n): a. randomized double-blind study. b. quasi-experimental study. c. randomized control-placebo study.

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d. experimental case-control study. .22. Correct answer : A. This type of study allows the nurse to see the efficacy of a treatment or medication without any confounding variables.

23. A patient complains to the nurse that not only does he never know the answers to questions, his opinion does not seem to be acknowledged, either. The nurse's assessment is that, according to Erikson, the patient has not resolved issues concerning which stage? a. Autonomy vs. shame and doubt b. Trust vs. mistrust c. Identity vs. role confusion d. Initiative vs. guilt .23. Correct answer : A. During this stage of development, the person becomes more autonomous. If there are conflicts and unresolved issues during this period (from 1 to 3 years), there can be issues of self-doubt.
24. An evidence-based screening tool for detecting abnormal movements in a patient with a history of antipsychotic medication use is the:

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a. CAGE. b. AIMS. c. MMPI. d. PANSS. .24. Correct answer : B. The Abnormal Involuntary Movement Scale (AIMS) is used to evaluate the occurrence of tardive dyskinesia in the population of patients receiving antipsychotic medications. While the risk of TD is higher in those patients receiving conventional antipsychotics, it can also be seen in those receiving the atypical antipsychotics.

25. The initial step in dealing with inappropriate expression of anger by a patient is to first become aware of: a. the meaning the anger has to the patient. b. the staff available to handle a potentially explosive situation. c. the defense mechanisms that the patient is using. d. one's own response to anger in self and others. .25. Correct answer : D. To work with an aggressive, hostile patient, the nurse must first be aware of his or her own anger and how to appropriately handle it:

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26. A 15-year-old boy was referred to the school nurse because of reports that he becomes agitated, reacts excessively to minor stressors, and is restless in class. His grades have been falling as well. The previous year, he was active in student council and sports and did well academically. The next step in the evaluation process would include: a. screening for depression and SI/HI. b. asking him if there is a trusted teacher with whom he might wish to speak c. having him meet with iris peers about this. d. making a referral for counseling. .26. Correct answer : A. The question asks for the next step. Because the student has been showing behavioral changes, as reflected in his grades, participation in school activities, and emotional agitation, it would be important to next evaluate for any thought of harming himself or any other person. Many of the behaviors might be the equivalent of a depressive disorder. 272 PSYCHIATRIC-HENTAL HEALTH NURSING REVIEW AND RESOURCE MANUAL 4TH EDITION
27. Which is of primary importance for the nurse to explore within him- or herself when communicating with patients from various cultures?

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a. Meaning of gestures b. Facial expressions c. Tone of voice d. Personal biases or prejudices about specific cultures .27. Correct answer : D. The nurse needs to examinc his or her own thoughts and feelings about others in order to begin learning to provide care to patients from various backgrounds. This is an awareness step toward developing an ability to provide culturally competent and respectful care.

28. The nurse has been engaged in a substance abuse group with adolescents using techniques of cognitive-behavioral therapy. An expected outcome for the adolescents is that they will begin to: a. connect thoughts, behaviors, and feelings to challenge irrational thinking. b. use measured breaths and imagery to interrupt delusional thinking. c. formulate goals that will assist with their plans to continue schooling with less peer pressure.

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d. Identify and seek out school counselors who are adept with this technique. .28. Correct answer : A. The desired outcome of cognitive-behavioral therapy is to correct the distorted thinking, and thereby improve the disturbances in mood and behavior.

29. The nurse recognizes that a patient is unconsciously filling in memories by pretending that things have happened when there is no basis in fact. The nurse understands that this is a result of: a. apraxia. b. expressive aphasia. c. confabulation. d. circumstantiality.. .29. Correct answer : C. Patients with dementia will frequently confabulatc when questions are asked of them.
30. Which is an example of a sensory perceptual disturbance? a. Clang associations b. Neuralgia c. Illusions

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d. Ecllolalia .30. Correct answer : C. Echolalia is not a sensory disturbance, but rather, an involuntary repetition of another's words. Cang associations are expressions of thought processes in which the patient peaks using phrases and statements that rhyme Neuralgia refers to pain in the nerves. Hallucinations are another example of sensory perceptual alterations

31. A psychiatric-mental health nurse is preparing psycho- educational materials for newly discharged psychiatric patients. Which teaching/learning principles are most relevant to this situation? a. Learning occurs best when the nurse is enthusiastic about the subject matter. b. Learning occurs best when there is a perceived need to learn on the part of the patient. c. The clinical specialist must believe in what is being taught. d. The patient must view the nurse as an expert on the topic being taught. .31. Correct answer : B. This is the only answer in which the patient has expressed desire to learn.

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32. Alcohol abuse screening is an example of what level of prevention? a. Primary b. Secondary c. Universal d. Tertiary .32. Correct answer : B. Secondary-level prevention focuses on reducing the prevalence of a disease through early identification and treatment. The problem is already present.
33. Irvin Yalom identified 11 curative factors that are part of a successful group therapy experience. One of the factors is altruism. Altruism is: a. the ability of group members to rework family issues. b. the ability of group members to express pain and successes. c. the gaining of increased self-esteem related to helping others. d. recognition by group members that they are not alone and that other members share similar thoughts and feelings. .33. Correct answer : C. Altruism is one of Yaloms 11 curative factors for effective group

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therapy: Answer A describes corrective opportunity to rework earlier Issues, Answer B describes catharsis and Answer D describes universality.

34. Which theorist developed the structural model of family therapy as a tool for working with families? a. Cloe Madanes b. Jay Haley c. Salvador Minuchin d. Murray Bowen .34. Correct answer : C. Salvadore Minuchin is recognized for his work with structural therapy: Madanes and Haley for their work with strategic family therpy; and Bowen for his family systems theory
35. According to Murray Bowen, a dysfunctional family will: a. form dyads. b. exhibit differentiation of self. c. have triangulated relationships. d. not be enmeshed.35. Correct answer : C. According to Bowen, triangulation in a dysfunctional family system

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is used to diffuse anxicty in the dyad. Another person is brought into the system to deal with the increasing anxiety:.

36. Which is a step in developing an evidence-based practice? a. Use of expert opinions in the field b. Discussions with colleagues about anecdotal experiences c. Answerable clinical questions d. Use of statistical measures .36. Correct answer : C. The first step in developing evidence-based practices is to ask an appropriate and answerable dinical question.
37. The ability of healthcare providers to perform their jobs with reasonable skill and care can be related to: a. education at the highest attainable levels. b. physical conditioning and strong cognition. c. positive attitude and good work ethic. d. complete resolution of personal behavioral health issues. .37. Correct answer : C. This describes an attitudinal state that demonstrates more

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emotional intelligence and adaptability. The other answers are not absolute factors that ensure job performance.

38. A psychological factor that contributes to eating disorders includes: a. perfectionism. b. anger turned inward. c. ambivalent gender identity. d. powerlessness. .38. Correct answer : A. Answers B, C and Dare not factors that influence one's vulnerability for developing an eating disorder.