ANCC Review Questions (PMHNP IQ) with Complete Answers, Exams of Nursing

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ANCC Review Questions (PMHNP IQ) with complete

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1.What direct-acting dopamine receptor agonist is recommended to be used in the treatments of neuroleptic malignant syndrome (NMS) fo help lower the dopamine 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 block- ade. Danrolene (Dantrium) is a muscle relaxant. Benzotropine (Cogentin) and Tri- hexyphenidyl (Artane) are anticholinergic medications used for extrapyramidal side effects (EPS). 2.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. 3.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 close- ly.: B) Institute twice-weekly complete blood count with differentials and monitor closely.

2 / 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 com- promised 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. 4.A patient with a diagnosis of schizophrenia has a history of suicidal ideation and suicide attempts. The PMHNP should consider which antipsychotic med- ication that is the only antipsychotic to reduce the risk of suicide in schizo- phrenia? 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. 5.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 rep- utable 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. 6.Which of the following statements reflect the current understanding of dopamine (DA) pathways and clinical symptoms in schizophrenia?

3 / 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; pos- itive 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 delu- sions) 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. 7.Norepinephrine is a neurotransmitter that is implicated in alertness and anx- iety. 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. 8.Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is treated on clozapine?

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A) 1A

B) 2D

C) 2C

D) 2C19: A) 1A

When an individual is treated on clozapine and decreases tobacco use, the cloza- pine level with increase, as tobacco is an inducer to the clozapine, and the patient no longer needs the higher dose of clozapine. 9.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. 10.The PMHNP knows that the ego is a part of the personality and is the logi- cal/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." 11.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

5 / serum sodium level. B) Discuss SSRI discontinuation syndrome and stress importance of medica- tion adherence. C) Discuss rates of relapse on a SSRI and increase his medication to citalo- pram 40 mg by mouth daily. D) Discuss rates of relapse on a SSRI and recommend switching his medica- tion 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 12.The PMHNP mental health nurse practitioner treating a patient for schiz- ophrenia 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. 13.Which lab test should be ordered to rule out a medical cause of dementia symptoms? A) Albumin B) thiamine C) Vitamin D D) Vitamin B12: D) Vitamin B Low vitamin B12 levels have been associated with the development of dementa- like symptoms, and when dementia is a differential diagnosis,

6 / a Vitamin B12 should be checked. 14.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. 15.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. 16.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 D receptor antagonism. 17.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

7 / 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 con- traindicated with albuterol due to the risk of increased CNS stimulation. 18.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). 19.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 depres- sive episode. D) Lithium. but not lamotrigine, is superior to placebo in preventing a hypo- manic, or mixed episode.: B) Extended release formulation of carbamazepine is equivalent to lithium in preventing a manic, hypomanic, or mixed episode.

8 / Extended-release formulation of carbamazepine has demonstrated preliminary effi- cacy in the tx of acute manic or mixed episodes, but is not currently indicated in main- tenance 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. 20.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

9 / 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. 21.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 Lam- otigrine 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)