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ANCC REVIEW QUESTIONS (PMHNP IQ) LATEST
2025 UPDATED & VERIFIED EXAM WITH
ACTUAL QUESTIONS & CORRECT ANSWERS
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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) - โโA) 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 - โโD) 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.
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. - โโA) 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 - โโC) 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) 1A B) 2D C) 2C D) 2C19 - โโA) 1A 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. - โโC) 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" - โโC) "I evaluate" The ego is the logical and rational mind. The ego monitors the is and would say "I think. I evaluate."
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 - โโD) Vitamin B 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 - โโC) 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 - โโC) 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 - โโA) 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) - โโB) 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
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. - โโB) 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. - โโC) Discontinue the aripiprazole and give benzotropine mezylate (Congentin) 1 mg IM.
This is an aripiprazole-induced oculogyric crisis (acute dystonia)
