ANCC PRACTICE QUESTIONS DOMAIN 2 WITH 100% CORRECT ANSWERS ALREADY GRADED A+/24/25, Exams of Nursing

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ANCC PRACTICE QUESTIONS

DOMAIN 2 WITH 100% CORRECT

ANSWERS ALREADY GRADED

A+/24/

1. 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 antipsy- chotic medication. d. Admit him to the local psychiatric unit, with an order for the collection of laboratory values.: D

2. Appraisal of the patient's suicidal ideation, plan, method, intent, and access to implement plan would be documented in which part of the standard psy- chiatric evaluation? a. History of Presenting Illness b. Review of Systems c. Diagnosis d. Mental Status Exam: D 3. 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. 35 years old, pregnant, African American woman living with her husband in suburb of Dallas, Texas: C

4. Which of the following statements would be most likely to be effective in changing sexual behavior when counseling a sexually active 15-year- old adolescent girl? a. Always use condoms when having sex. b. Use this sample condom c. Require your partner to use a condom d. Always carry condoms in your purse.: B 5. A 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 PHQ-9. What is the appropriate response? a. A score of 15 on the PHQ9 indicates moderate depression, so the patient should be started on a selective serotonin norepinephrine reuptake inhibitor. b. A score of 15 on the PHQ9 indicates severe depression, so you should start a SSRI and an atypical antipsychotic c. A score of 15 on the PHQ9 indicates moderate depression, so y9ou can refer the patient to therapy and start an antidepressant. d. A score of 15 on the PHQ9 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.: D

6. A 10-year-old child lost her father to an unexpected heart attack. Normal- ly 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-pharmacological intervention would be most helpful at this time to facil- itate her grieving and loss? a. Bibliotherapy b. Play therapy

c. Individual therapy d. Psychoeducation group: D

7. A mother presents to the clinic with her 9-year-old daughter because she is worried about her. The mother tells you that her daughter has been waking up in the middle of the night screaming off and on for the past several months. When she goes into her daughter's room, she is sitting up in bed and is initially inconsolable but eventually will go back to sleep. The mother is crying and tells you she is unable to go back to sleep after her daughter's episodes and feels exhausted all of the time. Which is the most appropriate initial response? a. I know you are upset, but it will get better b. Are you worried that this is your fault? c. I can see this is very upsetting for you d. Tell me why you are unable to fall back asleep after your daughter does: C 8. 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?: C

9. 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: D 10. 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: B

11. The American College of Obstetricians and Gynecologists (ACOG) rec- ommends 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): C 12. 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 read- ing 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: B

13. 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?: D 14. 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.: D

15. 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 regi- men 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.: B 16. 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: D

17. The Five A's for Health Behavior Change include the following: a. Assess, Appraise, Advise, Act, Assist b. Assess, Appraise, Agree, Access, Arrange c. Assess, Advise, Act, Access, Assist d. Assess, Advise, Agree, Assist, Arrange: D 18. Dementia screening for the general population is not recommended for the following reason: a. The service benefits few people: target condition has high prevalence in the chosen population b. The service is unfocused for target condition: sensitivity and specificity of dementia screening measures do not currently warrant widespread use.

c. The service has unknown balance of benefit and harm: current treatments have limited effectiveness in modifying instrumental activities of daily living. d. The screening causes net harm in the target population: time involved in screening detracts from higher priority preventive health measures in general population.: C

19. What opening question or statement by a PMHNP facilitates communica- tion at an initial visit? a. Tell me what you think the problem is b. What seems to be the problem today? c. What problem does your primary care physician want us to evaluate? d. Tell me your concerns and how I may help.: D 20. When assessing a client, what is the most important predictor of potential violence? a. History of substance abuse b. History of seizures c. History of aggressive rage d. History of head injury: C

21. As the 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. Psychoeducation about her disease process b. Assisting in gainful employment c. Focus on the side effects of her medications d. Focus on her feelings, experience, and what she wants to achieve: D 22. A 32-year-old 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. Previous suicide attempt c. Marital status d. Gender: B

23. 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: B 24. Which of the following illustrates the role of the PMHNP in reducing the stigma of mental illness through community education as primary preven- tion? 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 25. 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.: C

26. 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 27. uring 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 immu- nizations.: C

28. 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: C

29. Which of the following interventions has greatest relevance when coun- seling 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 multi- ple 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.: B

30. 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: B 31. 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: B

32. The PMHNP understands which factor to be the most important in thera- peutic communication: a. Verbal communication b. Feedback c. Clarification d. Nonverbal communication: D 33. In evaluating the functional status of a 68-year-old woman who has depres- sion, the Instrumental Activities of Daily Living Scale includes which of the following activities? a. Toileting b. Filing taxes c. Using telephone d. Bathing: C 34. Which of the following lifestyle factors poses the greatest risk for depres- sion, irritability, liver problems, and hypertension in a college student? a. Binge drinking b. Marijuana use c. Anabolic steroid use

d. Cocaine use: C

35. A female client has gradually assumed increasing responsibility for the care of her aging parents. Her mother was diagnosed with Alzheimer's type dementia three years ago and is increasingly disoriented to her home sur- roundings. Her father insists on keeping her mother at home to provide care until she dies. What is the first priority in counseling this couple and their caretaking adult daughter? a. Anticipatory guidance b. Caregiver strain c. Patient safety d. Patient and family education: C 36. There is a growing recognition that adverse life experiences due to a variety of reasons underlie a wide range of psychiatric disorders and med- ical 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, heart disease, sleep disorders, and schizophrenia b. Alcoholism, anorexia, depression, diabetes, and schizophrenia

c. Alcoholism, anxiety, depression, diabetes, and schizophrenia d. Alcoholism, anxiety, depression, diabetes, and heart disease: D

37. A 44-year-old man presents to the PMHNNP at his wife's insistence. The patient was hospitalized for a mild head 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. Fregoli phenomenon b. Capgras syndrome c. Delusion of doubles d. Clerambault syndrome: B 38. 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.: C

39. In assessing patient risks for binge drinking, which of the following state- ments 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.: B 40. 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?: C

41. 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): B 42. 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: C 43. A 31-year-old married woman with a history of anorexia nervosa, bing- ing- 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.: B

44. 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.": C 45. 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? a. Within the past year, have you been hit, slapped, kicked or otherwise phys- ically hurt by someone?

b. Within the past year, has anyone ever forced you to do something by threatening you with a gun? c. Within the past year, have you ever threatened or tried to commit suicide to escape the abuse? d. Within the past year, has anyone ever threatened to kill you?: A

46. A PMHNP realizes she is frustrated and easily angered with one of her patients for no apparent reason. When discussing the situation with a col- league, she states the patient reminds her of her abusive stepfather. Which of the following best describes the nurse practitioner's reaction? a. Projection b. Displacement c. Transference d. Countertransference: D 47. When assessing for alcohol use, what does the CAGE questionnaire ask? a. Have you ever felt that you should cut down on your drinking, do you get angry when you drink, do you feel good about your alcohol use, have you ever had an eye- opener in the morning to get rid of a hang over?