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ANCC (PMHNP IQ) Review Questions And Answers A+
Verified
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
2 / 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. The recommended cut-points for discontinuation of clozapine are WBC of 2,000 to 3, 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 / autonomic instability.
6. 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.
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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
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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 serum sodium
8 / 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
10 / 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?
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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 D2 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 like to try a medication. Which is the most suitable initial treatment for Sally?
A) clonazepam (Klonopin)
B) sertraline (Zoloft)
13 / 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. 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
14 / 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.
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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)
