ANCC IQ Domains 2 answered all correctly answered;
latest updated summer 2022.
In the aftermath of a tornado that destroyed over 100 homes in a rural Midwest
community, the PMHNP draws on principles of crisis intervention while working with an
elderly couple who lost everything in the storm during the night. Which of the following
statements is most appropriate at the initial encounter?
- What is your biggest concern right now? I will help you as much as you can.
- Tell me everything that happened. We'll sort through the next steps.
- You will be able to stay in the shelter until the FEMA trailers arrive. It's going to be OK.
- What medications were you taking? Let me work on that first.
- What is your biggest concern right now? I will help you as much as you can.
Rationale: Principles of crisis intervention guide the PMHNP to focus on one of the
individual’s primary concerns at a time offering direct, realistic information, and
emotional support. Do not give false reassurance which blocks communication; you
don’t know whether everything will be resolved, and in this scenario, nothing can
replace a lifetime of treasures and memories lost in their home. Do not focus on all
implications at once or ask the individual to describe all of the losses or implications;
this will be too overwhelming. While concerns about medication is important, first the
PMHNP needs to assess what the primary concern is for this couple before addressing
the medication issue.
1. During an initial assessment, the PMHNP asks the patient to perform the serial 7's.
What aspect of the mental status exam would the nurse practitioner be assessing?
- Concentration
- Affect
- Memory
- Speech
- Concentration
Rationale: Subtracting serial 7’s from 100 is a simple task that requires intact
concentration and cognitive capabilities.
A 31-year old married woman with a history of anorexia nervosa, binging-purging type,
during her teens and early 20's, is pregnant. She has had two prior spontaneous
abortions in late 20's. She is worried whether this pregnancy may trigger recurrence of
her prior eating disorder, adversely impact fetal development, or affect the likelihood of
full-term delivery. At 5'7" she maintains a weight of 120 pounds by running 6-10 miles
daily as conditioning for marathons and a 2,000 calorie daily vegan diet. What lifestyle
modifications would reduce risks of exacerbating an eating disorder and increasing
likelihood of normal fetal development and full-term delivery?
- Increase daily caloric intake by 250 calories, reduce running to 4-8 miles daily with
reduction in second or third trimester, add pre-natal vitamin, Calcium supplement, and
plan a 20-30# gradual weight gain over the course of pregnancy.
- Increase daily caloric intake by 1,000 calories, continue running as tolerated with
reduction in second or third trimester, add pre-natal vitamin, vitamin E supplement, and
B-complex supplement, plan a 20-30# gradual weight gain over the course of
,pregnancy.
- Increase daily caloric intake by 500 calories, reduce running to 2-4 miles daily,
alternate with stretching and yoga in second and third trimesters, add pre-natal vitamin
and vitamin b-12 supplement, plan a 28-40# gradual weight gain over the course of
pregnancy.
- Increase daily caloric intake by 500 calories, reduce running to 2-4 miles daily,
alternate with stretching and yoga in second and third trimesters, add pre-natal vitamin
and vitamin b-12 supplement, plan a 28-40# gradual weight gain over the course of
pregnancy.
Rationale: At 120 pounds for 5’7” her Body Mass Index is 18.8 (low).
BMI normal range for adults is 19.8 – 26.0.
BMI = 703 x weight (lbs) = 703 x 120 = 18.8
[Height (in)]2 672
Or Weight (kg)/ Stature (cm)/ Stature (cm) x 10,000 = BMI.
BMI = weight (kg)
[height (m)]2
Low pre-pregnancy BMI and failure to gain recommended weight during pregnancy are
associated with increased risk for spontaneous abortions, pre-term delivery, and low
birth weight infants. Recommended caloric intake for pregnant women during pregnancy
varies from additional 150 calories in first trimester, 300 calories in second trimester,
and 500 calories in third trimester before accounting for strenuous daily exercise.
Recommended weight gain for pregnant women of normal BMI is 25-35# and 28-40# for
women with low BMI as in this patient. The vegan diet lacks animal fat the only dietary
source of Vitamin B-12. Addition of pre-natal vitamin and supplement of Vitamin B-12 is
indicated for vegan diet.
- Increase daily caloric intake by 700 calories, continue running as tolerated with
reduction in second or third trimester, add pre-natal vitamin, vitamin E supplement, and
B-complex supplement, plan a 25-35# gradual weight gain over the course of the
pregnancy.
Which of the following illustrates the role of the PMHNP in reducing the stigma of mental
illness through community education as primary intervention?
- Expert witness for standard of acre regarding psychiatric nursing staff in wrongful
death lawsuit
- Professional speaker interviewed by morning television talk show anchor on
depression
- Teaching high school class about depression and teen suicide
- Volunteering to help with depression screenings at a community health fair
- Professional speaker interviewed by morning television talk show anchor on
depression
Rationale: While all responses have an element of education, primary prevention
through community education is best illustrated by reaching the broadest general
audience with information about depression through television, radio, or newspaper
media.
A patient comes into your office in a full manic episode. This patient has a diagnosis of
Bipolar and Alcohol Use disorder, moderate. You have a report from the patient's
chemical dependency counselor indicating that inpatient chemical dependency
, counseling is needed. Your patient has been on the fence about inpatient chemical
dependency treatment in the past. You assess the patient and find a strong odor of
alcohol, auditory and visual hallucinations, flight of ideas, lack of sleep for 3 days,
suicidal ideations without a firm plan, and plans to drive to another state to gamble. The
patient's brother who accompanies him corroborates this information. In order to best
treat this patient, you:
- Admit him to the inpatient chemical dependency program.
- Admit him to the local psychiatric unit, with an order for the collection of laboratory
values.
- Send the patient home with his brother and a prescription for a new antipsychotic
medication.
- Admit him to the dual diagnosis chemical dependency unit with an order for the
collection of laboratory values.
- Admit him to the local psychiatric unit, with an order for the collection of laboratory
values.
Rationale: While he is both manic and of danger to himself, he should be hospitalized.
The patient will not be able to participate in any programming until he is out of his acute
manic state. Going home is not an option unless the patient has someone who can be
with him 24 hours and monitor his withdrawal from alcohol, his manic condition, and his
suicidal issues and desire to leave the state.
When assessing a client, what is the most important predictor of potential for violence?
- History of aggressive rage
- History of substance abuse
- History of head injury
- History of seizures
- History of aggressive rage
Rationale: History of previous episodes of rage and violent behavior, escalating
irritability, intruding angry thoughts, and fear of losing control are the most important
predictors of potential for violence. Head injury, substance use or abuse, and temporal
lobe epilepsy have been discussed as possible predictors, but not conclusively.
1. Which of the following statements would be most likely to be effective in changing
sexual behavior when counseling a sexually active 15-year-old adolescent girl?
- Require your partner to use a condom.
- Use this sample condom.
- Always use condoms when having sex.
- Always carry condoms in your purse.
- Use this sample condom.
Rationale: Use specific risk-reduction steps rather than global statements. Providing an
actual condom to try confers direct responsibility for condom use rather than relying on
partner to use condom. An adolescent girl is less likely to purchase condoms than
initially using a sample condom from a provider.
1. In evaluating the functional status of a 68-year-old woman who has depression, the
Instrumental Activities of Daily Living Scale includes which of the following activities?
- Using telephone
- Filing taxes
latest updated summer 2022.
In the aftermath of a tornado that destroyed over 100 homes in a rural Midwest
community, the PMHNP draws on principles of crisis intervention while working with an
elderly couple who lost everything in the storm during the night. Which of the following
statements is most appropriate at the initial encounter?
- What is your biggest concern right now? I will help you as much as you can.
- Tell me everything that happened. We'll sort through the next steps.
- You will be able to stay in the shelter until the FEMA trailers arrive. It's going to be OK.
- What medications were you taking? Let me work on that first.
- What is your biggest concern right now? I will help you as much as you can.
Rationale: Principles of crisis intervention guide the PMHNP to focus on one of the
individual’s primary concerns at a time offering direct, realistic information, and
emotional support. Do not give false reassurance which blocks communication; you
don’t know whether everything will be resolved, and in this scenario, nothing can
replace a lifetime of treasures and memories lost in their home. Do not focus on all
implications at once or ask the individual to describe all of the losses or implications;
this will be too overwhelming. While concerns about medication is important, first the
PMHNP needs to assess what the primary concern is for this couple before addressing
the medication issue.
1. During an initial assessment, the PMHNP asks the patient to perform the serial 7's.
What aspect of the mental status exam would the nurse practitioner be assessing?
- Concentration
- Affect
- Memory
- Speech
- Concentration
Rationale: Subtracting serial 7’s from 100 is a simple task that requires intact
concentration and cognitive capabilities.
A 31-year old married woman with a history of anorexia nervosa, binging-purging type,
during her teens and early 20's, is pregnant. She has had two prior spontaneous
abortions in late 20's. She is worried whether this pregnancy may trigger recurrence of
her prior eating disorder, adversely impact fetal development, or affect the likelihood of
full-term delivery. At 5'7" she maintains a weight of 120 pounds by running 6-10 miles
daily as conditioning for marathons and a 2,000 calorie daily vegan diet. What lifestyle
modifications would reduce risks of exacerbating an eating disorder and increasing
likelihood of normal fetal development and full-term delivery?
- Increase daily caloric intake by 250 calories, reduce running to 4-8 miles daily with
reduction in second or third trimester, add pre-natal vitamin, Calcium supplement, and
plan a 20-30# gradual weight gain over the course of pregnancy.
- Increase daily caloric intake by 1,000 calories, continue running as tolerated with
reduction in second or third trimester, add pre-natal vitamin, vitamin E supplement, and
B-complex supplement, plan a 20-30# gradual weight gain over the course of
,pregnancy.
- Increase daily caloric intake by 500 calories, reduce running to 2-4 miles daily,
alternate with stretching and yoga in second and third trimesters, add pre-natal vitamin
and vitamin b-12 supplement, plan a 28-40# gradual weight gain over the course of
pregnancy.
- Increase daily caloric intake by 500 calories, reduce running to 2-4 miles daily,
alternate with stretching and yoga in second and third trimesters, add pre-natal vitamin
and vitamin b-12 supplement, plan a 28-40# gradual weight gain over the course of
pregnancy.
Rationale: At 120 pounds for 5’7” her Body Mass Index is 18.8 (low).
BMI normal range for adults is 19.8 – 26.0.
BMI = 703 x weight (lbs) = 703 x 120 = 18.8
[Height (in)]2 672
Or Weight (kg)/ Stature (cm)/ Stature (cm) x 10,000 = BMI.
BMI = weight (kg)
[height (m)]2
Low pre-pregnancy BMI and failure to gain recommended weight during pregnancy are
associated with increased risk for spontaneous abortions, pre-term delivery, and low
birth weight infants. Recommended caloric intake for pregnant women during pregnancy
varies from additional 150 calories in first trimester, 300 calories in second trimester,
and 500 calories in third trimester before accounting for strenuous daily exercise.
Recommended weight gain for pregnant women of normal BMI is 25-35# and 28-40# for
women with low BMI as in this patient. The vegan diet lacks animal fat the only dietary
source of Vitamin B-12. Addition of pre-natal vitamin and supplement of Vitamin B-12 is
indicated for vegan diet.
- Increase daily caloric intake by 700 calories, continue running as tolerated with
reduction in second or third trimester, add pre-natal vitamin, vitamin E supplement, and
B-complex supplement, plan a 25-35# gradual weight gain over the course of the
pregnancy.
Which of the following illustrates the role of the PMHNP in reducing the stigma of mental
illness through community education as primary intervention?
- Expert witness for standard of acre regarding psychiatric nursing staff in wrongful
death lawsuit
- Professional speaker interviewed by morning television talk show anchor on
depression
- Teaching high school class about depression and teen suicide
- Volunteering to help with depression screenings at a community health fair
- Professional speaker interviewed by morning television talk show anchor on
depression
Rationale: While all responses have an element of education, primary prevention
through community education is best illustrated by reaching the broadest general
audience with information about depression through television, radio, or newspaper
media.
A patient comes into your office in a full manic episode. This patient has a diagnosis of
Bipolar and Alcohol Use disorder, moderate. You have a report from the patient's
chemical dependency counselor indicating that inpatient chemical dependency
, counseling is needed. Your patient has been on the fence about inpatient chemical
dependency treatment in the past. You assess the patient and find a strong odor of
alcohol, auditory and visual hallucinations, flight of ideas, lack of sleep for 3 days,
suicidal ideations without a firm plan, and plans to drive to another state to gamble. The
patient's brother who accompanies him corroborates this information. In order to best
treat this patient, you:
- Admit him to the inpatient chemical dependency program.
- Admit him to the local psychiatric unit, with an order for the collection of laboratory
values.
- Send the patient home with his brother and a prescription for a new antipsychotic
medication.
- Admit him to the dual diagnosis chemical dependency unit with an order for the
collection of laboratory values.
- Admit him to the local psychiatric unit, with an order for the collection of laboratory
values.
Rationale: While he is both manic and of danger to himself, he should be hospitalized.
The patient will not be able to participate in any programming until he is out of his acute
manic state. Going home is not an option unless the patient has someone who can be
with him 24 hours and monitor his withdrawal from alcohol, his manic condition, and his
suicidal issues and desire to leave the state.
When assessing a client, what is the most important predictor of potential for violence?
- History of aggressive rage
- History of substance abuse
- History of head injury
- History of seizures
- History of aggressive rage
Rationale: History of previous episodes of rage and violent behavior, escalating
irritability, intruding angry thoughts, and fear of losing control are the most important
predictors of potential for violence. Head injury, substance use or abuse, and temporal
lobe epilepsy have been discussed as possible predictors, but not conclusively.
1. Which of the following statements would be most likely to be effective in changing
sexual behavior when counseling a sexually active 15-year-old adolescent girl?
- Require your partner to use a condom.
- Use this sample condom.
- Always use condoms when having sex.
- Always carry condoms in your purse.
- Use this sample condom.
Rationale: Use specific risk-reduction steps rather than global statements. Providing an
actual condom to try confers direct responsibility for condom use rather than relying on
partner to use condom. An adolescent girl is less likely to purchase condoms than
initially using a sample condom from a provider.
1. In evaluating the functional status of a 68-year-old woman who has depression, the
Instrumental Activities of Daily Living Scale includes which of the following activities?
- Using telephone
- Filing taxes
