ANCC PMHNP Domains 1-5- Questions and Answers
- Meperidine is prohibited when a patient is taking an MAOI (Selegiline) due to
risk of HTN crisis and death.
Mr. Smith is going in for an elective surgical
procedure. He is currently taking Selegiline. Rationale: Meperidine is strictly prohibited when a patient is treated on a
Which medication is he not able to take? monoamine oxidase inhibitor (MAOI), due to the risk of hypertensive crisis and
death.
-Morphine
-Codeine
-NSAIDs Hypertensive crisis and death can also occur when MAOIs are taken in conjunction
-Meperidine with certain medications: meperidine (demerol), decongestants, TCAs, atypical
antipsychotics, st johns wort, l-tryptophan, stimulants (and other sympathomimetics),
asthma medications
17-year-old female presents to your clinic - Bulimia
reporting anhedonia, decreased energy,
and hopelessness for the past 2 years. She Rationale: Do not use bupropion if patient is bulimic, either currently or in the past.
denies drinking alcohol, smoking, or using Prohibition for use in eating disorders due to increased risk of seizures.
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 (macroorchidism)
While treating a 12-year-old boy for ADHD, -Short stature
the PMHNP observes which of the -hyperextensible joints, low muscle tones, soft fleshy tones
following physical features that raise
concerns for genetic evaluation for Fragile Rationale: Etiological factors in mental retardation can be primarily genetic,
X Syndrome? developmental, acquired, or in combination. Genetic causes included chromosomal
and inherited conditions. Many of these genetic disorders have characteristic
-obesity, small stature, small hands and physical features that warrant genetic testing for confirmatory diagnosis. Fragile X
feet, hypotonia Syndrome occurs in about 1 of every 1,000 males and 1 of every 2,000 females. The
-café au lait spots on face and arms, typical phenotype includes a large, long head and ears, short stature,
neurofibromas hyperextensible joints, and postpubertal macroorchidism. The mental retardation
-long head and ears, short stature, ranges from mild to severe. There is high rate of comorbid ADHD, learning disorder,
hyperextensible joints and pervasive developmental disorders, such as autism. Café au lait spots and
-small stature, short palpebral fissure, inner neurofibromas are common in von Recklinghausen's disease. Obesity, small stature,
epicanthal folds small hands and feet, hypotonia, and hypogonadism are characteristic of Prader-
Willi Syndrome. Small head, short palpebral fissure, and inner epicanthal folds are
characteristic of fetal alcohol syndrome.
A 43-year-old male is treated for Bipolar I - Leukocytosis
on lithium.
Rationale: While the mechanism of action is not clear, the use of lithium can raise
Which of the following hematologic white blood cell counts and, therefore, CBC should be monitored in patients treated
changes is associated with lithium? on lithium.
- Leukopenia
- Agranulocytosis
- Anemia
- Leukocytosis
A 37-year-old patient with schizophrenia is - Orthostatic hypotension
started on a high dose of chlorpromazine
(Thorazine). The next day, he complains of Rationale: Orthostatic hypotension, a drop in blood pressure while standing, is a
lightheadedness after standing up. Vital side effect from alpha 1-adrenergic blockade. This is especially troublesome with
sign changes reflect a significant decrease chlorpromazine and clozapine and is best handled by raising doses slowly
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
,Which of the following statements reflect - Negative symptoms are related to DA deficit in the cerebral cortex; positive
the current understanding of dopamine symptoms are related to DA excess in the nucleus accumbens and mesolimbic
(DA) pathways and clinical symptoms in system
schizophrenia?
Rationale: Negative symptoms and cognitive impairment are thought to be related
- Negative symptoms are related to DA to hypoactivity of the mesocortical dopaminergic tract, which by association with the
deficit in the mesolimbic system; positive prefrontal and neocortex contributes to motivation, planning, sequencing of
symptoms are related to DA excess in the behaviors in time, attention, and social behavior.
substantia nigra and ventral tegmental area Positive symptoms of schizophrenia (hallucinations and delusions) are thought to be
- Negative symptoms are related to DA caused by dopamine hyperactivity in the mesolimbic tract, which regulates memory
excess in the mesolimbic system; positive and emotion. This hyperactivity could result from overactive modulation of
symptoms are related to DA deficit in the neurotransmission from the nucleus accumbens.
substantia nigra and ventral tegmental area
- Negative symptoms are related to DA Another explanation for dopaminergic hyperactivity in the mesolimbic tract is the
deficit in the mesolimbic system; positive hypoactivity of the mesocortical tract, which normally inhibits dopamine activity in
symptoms are related to DA excess in the the mesolimbic tract by some type of feedback mechanism. In schizophrenia, the
substantia nigra and ventral tegmental area primary defect may be in the mesocortical tract, where dopaminergic function is
- Negative symptoms are related to DA diminished, thereby decreasing the inhibitory effects on the mesolimbic tract. This
deficit in the cerebral cortex; positive disinhibition may be responsible for the overactivity of dopamine in the mesolimbic
symptoms are related to DA excess in the tract, resulting in positive symptom cluster.
nucleus accumbens and mesolimbic system
Which of the following findings on MRI and -decreased size of cerebral ventricles
PET scans would be uncommon in
individuals with schizophrenia? Rationale: Individuals with schizophrenia have enlarged cerebral ventricles.
There is decreased electrical activity in frontal lobes, decreased glutamate and
-decreased electrical activity in the frontal GABA release, and decreased total brain volume.
lobes
-decreased total brain volume
-decreased size of cerebral ventricles Also, increased dopamine and decreased serotonin.
-decreased glutamate and GABA release
What direct-acting receptor agonist is - Bromocriptine (Parlodel)
recommended to be used in the treatment
of neuroleptic malignant syndrome (NMS) Rationale: Parlodel is the recommended direct acting dopamine receptor agonist to
to help lower the dopamine receptor help decrease the dopamine blockade. Dantrium is a muscle relaxant, and Cogentin
blockade? and Artane are anticholinergic medications used for extrapyramidal side effects
(EPS).
- Bromocriptine (Parlodel)
- Benztropine (Cogentin)
- Trihexyphenidyl (Artane)
- Dantrolene (Dantrium)
A 74-year-old female presents for an - Right hemisphere
evaluation. The psychiatric nurse
practitioner has the patient complete the Rationale: The right hemisphere of the brain is involved with the recognition of facial
mini mental status examination and clock expressions, music, and visual images. When the right hemisphere is compromised,
drawing. The patient is unable to correctly there are disturbances in drawing, such as clock drawing.
draw the face of the clock.
"Visualize a musician/artist making faces who lives in the right hemisphere of the
Which area of the brain is likely to have world".
compromised functioning?
- Left hemisphere
- Right hemisphere
- Wernicke's area
- Corpus callosum
, - Tardive dyskinesia
Rationale: Tardive dyskinesia (TD) is a delayed-onset involuntary movement disorder
As a psychiatric mental health nurse associated with antipsychotic medications. A typical clinical course of TD is marked
practitioner, you are aware of antipsychotic by insidious onset, usually after 1-2 years of continuous exposure to antipsychotics.
medication side effects. Which of the
following side effects of antipsychotic S/S:
medications has an insidious, delayed- -lip-smacking, rolling their tongue, grinding teeth, chewing motion
onset typically 1 to 2 years after initiation of
the medication? Tx:
1) decrease the dose of antipsychotic
- Tardive dyskinesia 2) discontinue med and switch antipsychotic
- Dry mouth 3) can switch them to Clozaril (lower chance of EPS)
- Sedation
- Weight gain o DO NOT give Cogentin, it can make TD worse!!!!
o Generally, takes 1-2 years, but can occur sooner
**Note: Reglan (metoclopramide) and Compazine are anti-emetics, can cause
tardive dyskinesia ("act regular compa")
You are on call for your service. You arrive - Discontinue the Aripiprazole and give Benztropine Mesylate (Cogentin) 1 mg IM.
at the Emergency Department to find a 22- Have him take Benztropine Mesylate 1 mg PO BID for 5 days. Have him return to
year-old male patient complaining of his provider for a different medication for his bipolar disorder the next day.
having trouble with his eyes. His vitals are
stable. He is 5 foot 7 inches tall; his weight Rationale: This is an Aripiprazole-induced oculogyric crisis, a type of acute dystonia
is 140 pounds; and, his labs are all in the (i.e., muscle spasms and contractions that can cause strange posturing of the body
normal range. He states that he has been depending on the muscle groups affected). This is not as common with atypical
taking Aripiprazole (Abilify) for the last 2 antipsychotic medications as with the older antipsychotic medications. Aripiprazole
months for his Bipolar 1 disorder. He had has a half-life of 75 hours. Aripiprazole is the third generation atypical antipsychotic
the dose raised to 15 mg PO QAM 4 days and a dopamine serotonin system stabilizer (DSS) that is effective against positive
ago to manage a manic episode. He states and negative symptoms of schizophrenia. It has a low propensity for extrapyramidal
that one to three times a day for the past 2 side effects, causes minimal weight gain or sedation, produces no elevation in serum
days his eyes will roll upwards for 10 to 15 prolactin levels and does not cause prolongation of QTc interval.
minutes and he will have trouble seeing
until they roll back down. When you o This is a rare presentation of acute dystonia called oculogyric crisis, which can
examine his eyes, he is able to fully open lead to permanent injury. On physical exam, patients in an oculogyric crisis have
his eyes but he is not able to focus his eyes prolonged involuntary upwards deviation of the eyes bilaterally.
on you. His eyes are rolled upwards about o Tx: DC med and give IM benztropine/Cogentin 1-2 mg
2/3rds of the way towards his upper eyelid.
After examination you decide to:
- Continue the Aripiprazole and give
Benztropine Mesylate (Cogentin) 1 mg IM.
Have him
- Meperidine is prohibited when a patient is taking an MAOI (Selegiline) due to
risk of HTN crisis and death.
Mr. Smith is going in for an elective surgical
procedure. He is currently taking Selegiline. Rationale: Meperidine is strictly prohibited when a patient is treated on a
Which medication is he not able to take? monoamine oxidase inhibitor (MAOI), due to the risk of hypertensive crisis and
death.
-Morphine
-Codeine
-NSAIDs Hypertensive crisis and death can also occur when MAOIs are taken in conjunction
-Meperidine with certain medications: meperidine (demerol), decongestants, TCAs, atypical
antipsychotics, st johns wort, l-tryptophan, stimulants (and other sympathomimetics),
asthma medications
17-year-old female presents to your clinic - Bulimia
reporting anhedonia, decreased energy,
and hopelessness for the past 2 years. She Rationale: Do not use bupropion if patient is bulimic, either currently or in the past.
denies drinking alcohol, smoking, or using Prohibition for use in eating disorders due to increased risk of seizures.
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 (macroorchidism)
While treating a 12-year-old boy for ADHD, -Short stature
the PMHNP observes which of the -hyperextensible joints, low muscle tones, soft fleshy tones
following physical features that raise
concerns for genetic evaluation for Fragile Rationale: Etiological factors in mental retardation can be primarily genetic,
X Syndrome? developmental, acquired, or in combination. Genetic causes included chromosomal
and inherited conditions. Many of these genetic disorders have characteristic
-obesity, small stature, small hands and physical features that warrant genetic testing for confirmatory diagnosis. Fragile X
feet, hypotonia Syndrome occurs in about 1 of every 1,000 males and 1 of every 2,000 females. The
-café au lait spots on face and arms, typical phenotype includes a large, long head and ears, short stature,
neurofibromas hyperextensible joints, and postpubertal macroorchidism. The mental retardation
-long head and ears, short stature, ranges from mild to severe. There is high rate of comorbid ADHD, learning disorder,
hyperextensible joints and pervasive developmental disorders, such as autism. Café au lait spots and
-small stature, short palpebral fissure, inner neurofibromas are common in von Recklinghausen's disease. Obesity, small stature,
epicanthal folds small hands and feet, hypotonia, and hypogonadism are characteristic of Prader-
Willi Syndrome. Small head, short palpebral fissure, and inner epicanthal folds are
characteristic of fetal alcohol syndrome.
A 43-year-old male is treated for Bipolar I - Leukocytosis
on lithium.
Rationale: While the mechanism of action is not clear, the use of lithium can raise
Which of the following hematologic white blood cell counts and, therefore, CBC should be monitored in patients treated
changes is associated with lithium? on lithium.
- Leukopenia
- Agranulocytosis
- Anemia
- Leukocytosis
A 37-year-old patient with schizophrenia is - Orthostatic hypotension
started on a high dose of chlorpromazine
(Thorazine). The next day, he complains of Rationale: Orthostatic hypotension, a drop in blood pressure while standing, is a
lightheadedness after standing up. Vital side effect from alpha 1-adrenergic blockade. This is especially troublesome with
sign changes reflect a significant decrease chlorpromazine and clozapine and is best handled by raising doses slowly
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
,Which of the following statements reflect - Negative symptoms are related to DA deficit in the cerebral cortex; positive
the current understanding of dopamine symptoms are related to DA excess in the nucleus accumbens and mesolimbic
(DA) pathways and clinical symptoms in system
schizophrenia?
Rationale: Negative symptoms and cognitive impairment are thought to be related
- Negative symptoms are related to DA to hypoactivity of the mesocortical dopaminergic tract, which by association with the
deficit in the mesolimbic system; positive prefrontal and neocortex contributes to motivation, planning, sequencing of
symptoms are related to DA excess in the behaviors in time, attention, and social behavior.
substantia nigra and ventral tegmental area Positive symptoms of schizophrenia (hallucinations and delusions) are thought to be
- Negative symptoms are related to DA caused by dopamine hyperactivity in the mesolimbic tract, which regulates memory
excess in the mesolimbic system; positive and emotion. This hyperactivity could result from overactive modulation of
symptoms are related to DA deficit in the neurotransmission from the nucleus accumbens.
substantia nigra and ventral tegmental area
- Negative symptoms are related to DA Another explanation for dopaminergic hyperactivity in the mesolimbic tract is the
deficit in the mesolimbic system; positive hypoactivity of the mesocortical tract, which normally inhibits dopamine activity in
symptoms are related to DA excess in the the mesolimbic tract by some type of feedback mechanism. In schizophrenia, the
substantia nigra and ventral tegmental area primary defect may be in the mesocortical tract, where dopaminergic function is
- Negative symptoms are related to DA diminished, thereby decreasing the inhibitory effects on the mesolimbic tract. This
deficit in the cerebral cortex; positive disinhibition may be responsible for the overactivity of dopamine in the mesolimbic
symptoms are related to DA excess in the tract, resulting in positive symptom cluster.
nucleus accumbens and mesolimbic system
Which of the following findings on MRI and -decreased size of cerebral ventricles
PET scans would be uncommon in
individuals with schizophrenia? Rationale: Individuals with schizophrenia have enlarged cerebral ventricles.
There is decreased electrical activity in frontal lobes, decreased glutamate and
-decreased electrical activity in the frontal GABA release, and decreased total brain volume.
lobes
-decreased total brain volume
-decreased size of cerebral ventricles Also, increased dopamine and decreased serotonin.
-decreased glutamate and GABA release
What direct-acting receptor agonist is - Bromocriptine (Parlodel)
recommended to be used in the treatment
of neuroleptic malignant syndrome (NMS) Rationale: Parlodel is the recommended direct acting dopamine receptor agonist to
to help lower the dopamine receptor help decrease the dopamine blockade. Dantrium is a muscle relaxant, and Cogentin
blockade? and Artane are anticholinergic medications used for extrapyramidal side effects
(EPS).
- Bromocriptine (Parlodel)
- Benztropine (Cogentin)
- Trihexyphenidyl (Artane)
- Dantrolene (Dantrium)
A 74-year-old female presents for an - Right hemisphere
evaluation. The psychiatric nurse
practitioner has the patient complete the Rationale: The right hemisphere of the brain is involved with the recognition of facial
mini mental status examination and clock expressions, music, and visual images. When the right hemisphere is compromised,
drawing. The patient is unable to correctly there are disturbances in drawing, such as clock drawing.
draw the face of the clock.
"Visualize a musician/artist making faces who lives in the right hemisphere of the
Which area of the brain is likely to have world".
compromised functioning?
- Left hemisphere
- Right hemisphere
- Wernicke's area
- Corpus callosum
, - Tardive dyskinesia
Rationale: Tardive dyskinesia (TD) is a delayed-onset involuntary movement disorder
As a psychiatric mental health nurse associated with antipsychotic medications. A typical clinical course of TD is marked
practitioner, you are aware of antipsychotic by insidious onset, usually after 1-2 years of continuous exposure to antipsychotics.
medication side effects. Which of the
following side effects of antipsychotic S/S:
medications has an insidious, delayed- -lip-smacking, rolling their tongue, grinding teeth, chewing motion
onset typically 1 to 2 years after initiation of
the medication? Tx:
1) decrease the dose of antipsychotic
- Tardive dyskinesia 2) discontinue med and switch antipsychotic
- Dry mouth 3) can switch them to Clozaril (lower chance of EPS)
- Sedation
- Weight gain o DO NOT give Cogentin, it can make TD worse!!!!
o Generally, takes 1-2 years, but can occur sooner
**Note: Reglan (metoclopramide) and Compazine are anti-emetics, can cause
tardive dyskinesia ("act regular compa")
You are on call for your service. You arrive - Discontinue the Aripiprazole and give Benztropine Mesylate (Cogentin) 1 mg IM.
at the Emergency Department to find a 22- Have him take Benztropine Mesylate 1 mg PO BID for 5 days. Have him return to
year-old male patient complaining of his provider for a different medication for his bipolar disorder the next day.
having trouble with his eyes. His vitals are
stable. He is 5 foot 7 inches tall; his weight Rationale: This is an Aripiprazole-induced oculogyric crisis, a type of acute dystonia
is 140 pounds; and, his labs are all in the (i.e., muscle spasms and contractions that can cause strange posturing of the body
normal range. He states that he has been depending on the muscle groups affected). This is not as common with atypical
taking Aripiprazole (Abilify) for the last 2 antipsychotic medications as with the older antipsychotic medications. Aripiprazole
months for his Bipolar 1 disorder. He had has a half-life of 75 hours. Aripiprazole is the third generation atypical antipsychotic
the dose raised to 15 mg PO QAM 4 days and a dopamine serotonin system stabilizer (DSS) that is effective against positive
ago to manage a manic episode. He states and negative symptoms of schizophrenia. It has a low propensity for extrapyramidal
that one to three times a day for the past 2 side effects, causes minimal weight gain or sedation, produces no elevation in serum
days his eyes will roll upwards for 10 to 15 prolactin levels and does not cause prolongation of QTc interval.
minutes and he will have trouble seeing
until they roll back down. When you o This is a rare presentation of acute dystonia called oculogyric crisis, which can
examine his eyes, he is able to fully open lead to permanent injury. On physical exam, patients in an oculogyric crisis have
his eyes but he is not able to focus his eyes prolonged involuntary upwards deviation of the eyes bilaterally.
on you. His eyes are rolled upwards about o Tx: DC med and give IM benztropine/Cogentin 1-2 mg
2/3rds of the way towards his upper eyelid.
After examination you decide to:
- Continue the Aripiprazole and give
Benztropine Mesylate (Cogentin) 1 mg IM.
Have him
