ANCC DOMAIN 1 SCIENTIFIC FOUNDATION EXAM 40
QUESTIONS WITH VERIFIED ANSWERS 2025/2026
- Meperidine is prohibited when a patient is taking an MAOI (Selegiline) due to
risk of HTN crisis and death.
Rationale: Meperidine is strictly prohibited when a patient is treated on a
monoamine oxidase inhibitor (MAOI), due to the risk of hypertensive crisis and
death.
Hypertensive crisis and death can also occur when MAOIs are taken in conjunction
with certain medications: meperidine (Demerol), decongestants, TCAs, atypical
antipsychotics, set john’s wort, l-tryptophan, stimulants (and other
sympathomimetics), asthma medications - CORRECT ANSWER Mr. Smith is going in
for an elective surgical procedure. He is currently taking Selegiline. Which
medication is he not able to take?
-Morphine
-Codeine
-NSAIDs
-Meperidine
- Bulimia
,Rationale: Do not use bupropion if patient is bulimic, either currently or in the
past. Prohibition for use in eating disorders due to increased risk of seizures. -
CORRECT ANSWER 17-year-old female presents to your clinic reporting anhedonia,
decreased energy, and hopelessness for the past 2 years. She denies drinking
alcohol, smoking, or using illegal substances. Her physical examination results are
within normal limits and she denies suicidal ideations. As the treating psychiatric
mental health nurse practitioner, you decide to prescribe her bupropion
(Wellbutrin).
Of the following, which is a contraindication for bupropion?
- Dysthymia
- Fatigue
- Smoking
- Bulimia
-long head and ears, short stature, hyperextensible joints
-Most features are large: a broad forehead, elongated face, large ears, enlarged
testicles (matriarchisms)
-Short stature
-hyperextensible joints, low muscle tones, soft fleshy tones
Rationale: Etiological factors in mental retardation can be primarily genetic,
developmental, acquired, or in combination. Genetic causes included
chromosomal and inherited conditions. Many of these genetic disorders have
characteristic physical features that warrant genetic testing for confirmatory
diagnosis. Fragile X Syndrome occurs in about 1 of every 1,000 males and 1 of
,every 2,000 females. The typical phenotype includes a large, long head and ears,
short stature, hyperextensible joints, and post pubertal matriarchisms. The mental
retardation ranges from mild to severe. There is high rate of comorbid ADHD,
learning disorder, and pervasive developmental disorders, such as - CORRECT
ANSWER While treating a 12-year-old boy for ADHD, the PMHNP observes which
of the following physical features that raise concerns for genetic evaluation for
Fragile X Syndrome?
-obesity, small stature, small hands and feet, hypotonia
-café au lait spots on face and arms, neurofibromas
-long head and ears, short stature, hyperextensible joints
-small stature, short palpebral fissure, inner epicanthal folds
- Leukocytosis
Rationale: 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. - CORRECT ANSWER A 43-year-old male is treated for Bipolar I
on lithium.
Which of the following hematologic changes is associated with lithium?
- Leukopenia
- Agranulocytosis
- Anemia
- Leukocytosis
, - Orthostatic hypotension
Rationale: Orthostatic hypotension, a drop in blood pressure while standing, is a
side effect from alpha 1-adrenergic blockade. This is especially troublesome with
chlorpromazine and clozapine and is best handled by raising doses slowly -
CORRECT ANSWER A 37-year-old patient with schizophrenia is started on a high
dose of chlorpromazine (Thorazine). The next day, he complains of
lightheadedness after standing up. Vital sign changes reflect a significant decrease
in blood pressure and an increase in heart rate.
You suspect this is secondary to the alpha 1-adrenergic blockade which is causing
- Decreased sweating
- Orthostatic hypotension
- Respiratory depression
- Dry mouth
- Negative symptoms are related to DA deficit in the cerebral cortex; positive
symptoms are related to DA excess in the nucleus accumbent and mesolimbic
system
Rationale: Negative symptoms and cognitive impairment are thought to be related
to hypoactivity of the neocortical dopaminergic tract, which by association with
the prefrontal and neocortex contributes to motivation, planning, sequencing of
behaviors in time, attention, and social behavior.
Positive symptoms of schizophrenia (hallucinations and delusions) are thought to
be caused by dopamine hyperactivity in the mesolimbic tract, which regulates
QUESTIONS WITH VERIFIED ANSWERS 2025/2026
- Meperidine is prohibited when a patient is taking an MAOI (Selegiline) due to
risk of HTN crisis and death.
Rationale: Meperidine is strictly prohibited when a patient is treated on a
monoamine oxidase inhibitor (MAOI), due to the risk of hypertensive crisis and
death.
Hypertensive crisis and death can also occur when MAOIs are taken in conjunction
with certain medications: meperidine (Demerol), decongestants, TCAs, atypical
antipsychotics, set john’s wort, l-tryptophan, stimulants (and other
sympathomimetics), asthma medications - CORRECT ANSWER Mr. Smith is going in
for an elective surgical procedure. He is currently taking Selegiline. Which
medication is he not able to take?
-Morphine
-Codeine
-NSAIDs
-Meperidine
- Bulimia
,Rationale: Do not use bupropion if patient is bulimic, either currently or in the
past. Prohibition for use in eating disorders due to increased risk of seizures. -
CORRECT ANSWER 17-year-old female presents to your clinic reporting anhedonia,
decreased energy, and hopelessness for the past 2 years. She denies drinking
alcohol, smoking, or using illegal substances. Her physical examination results are
within normal limits and she denies suicidal ideations. As the treating psychiatric
mental health nurse practitioner, you decide to prescribe her bupropion
(Wellbutrin).
Of the following, which is a contraindication for bupropion?
- Dysthymia
- Fatigue
- Smoking
- Bulimia
-long head and ears, short stature, hyperextensible joints
-Most features are large: a broad forehead, elongated face, large ears, enlarged
testicles (matriarchisms)
-Short stature
-hyperextensible joints, low muscle tones, soft fleshy tones
Rationale: Etiological factors in mental retardation can be primarily genetic,
developmental, acquired, or in combination. Genetic causes included
chromosomal and inherited conditions. Many of these genetic disorders have
characteristic physical features that warrant genetic testing for confirmatory
diagnosis. Fragile X Syndrome occurs in about 1 of every 1,000 males and 1 of
,every 2,000 females. The typical phenotype includes a large, long head and ears,
short stature, hyperextensible joints, and post pubertal matriarchisms. The mental
retardation ranges from mild to severe. There is high rate of comorbid ADHD,
learning disorder, and pervasive developmental disorders, such as - CORRECT
ANSWER While treating a 12-year-old boy for ADHD, the PMHNP observes which
of the following physical features that raise concerns for genetic evaluation for
Fragile X Syndrome?
-obesity, small stature, small hands and feet, hypotonia
-café au lait spots on face and arms, neurofibromas
-long head and ears, short stature, hyperextensible joints
-small stature, short palpebral fissure, inner epicanthal folds
- Leukocytosis
Rationale: 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. - CORRECT ANSWER A 43-year-old male is treated for Bipolar I
on lithium.
Which of the following hematologic changes is associated with lithium?
- Leukopenia
- Agranulocytosis
- Anemia
- Leukocytosis
, - Orthostatic hypotension
Rationale: Orthostatic hypotension, a drop in blood pressure while standing, is a
side effect from alpha 1-adrenergic blockade. This is especially troublesome with
chlorpromazine and clozapine and is best handled by raising doses slowly -
CORRECT ANSWER A 37-year-old patient with schizophrenia is started on a high
dose of chlorpromazine (Thorazine). The next day, he complains of
lightheadedness after standing up. Vital sign changes reflect a significant decrease
in blood pressure and an increase in heart rate.
You suspect this is secondary to the alpha 1-adrenergic blockade which is causing
- Decreased sweating
- Orthostatic hypotension
- Respiratory depression
- Dry mouth
- Negative symptoms are related to DA deficit in the cerebral cortex; positive
symptoms are related to DA excess in the nucleus accumbent and mesolimbic
system
Rationale: Negative symptoms and cognitive impairment are thought to be related
to hypoactivity of the neocortical dopaminergic tract, which by association with
the prefrontal and neocortex contributes to motivation, planning, sequencing of
behaviors in time, attention, and social behavior.
Positive symptoms of schizophrenia (hallucinations and delusions) are thought to
be caused by dopamine hyperactivity in the mesolimbic tract, which regulates
