ANCC Question bank Domain 1 – 5 with
Answers
Domain 1
Which of the following statements reflect the current understanding of DA
pathways and clinical symptoms in schizophrenia? –
Symptoms are related to DA deficit in the cerebral cortex; + are related to DA
excess in the substantia nigra and VTA
Which of the following findings would raise concern in a pre-school wellness
exam for a 5 yo girl?
Height 43 in, weight 55 lbs (she is overwt)
A 24 yo mother of a 2 yo child presents to the clinic. Which of the following facial
characteristics would lead to the PMHNP to believe child has Fetal ETOH
syndrome?
Small head, thin upper lip, smooth philtrum.
Patty is a 62 yo female with BPDO I and has been stable for 2 yrs on valproate
and risperidone. She recently diagnosed with shingles, and her PCM started her
on corticosteroids. As the PMHNP treating Patty, you are concerned the addition
of steroids may cause:
Manic episode.
Which mood stabilizer is most associated with potentially life threatening rash?
Lamotrigine (Lamictal)
Which of the following statements most accurately reflects the predominant risk
factors for ASD?
Genetic of a first degree family member.
A 17yo female presents reporting anhedonia, decreased energy & hopelessness
for the past 2 yrs. She denies ETOH, smoking or using illegal substances. Her
physical exam results are WNL and she denies SI. As her PMHNP, you decide to
prescribe bupropion. Which of the following is a contraindication for
bupropion?
Bulimia
,You have a 17 yo female who suffers from BPDO. The pt has a hx of impulsive
acting out and promiscuity. You make a decision to add folic acid .8 mg to her
medication regimen of lamotrigine 200 mg Q HS and quetiapine XR 50 mg 1 PO
QHS. Why is this important?
FA supports neural tube development during the 1st month a woman is pregnant.
Which of the following medications has a unique mechanism of action that is
both DA and NE - RI?
Bupropion (Wellbutrin)
Which of the following pts with GAD is most likely to be a 2C19 poor metabolizer
and have an exaggerated response to diazepam 5 mg TID with increased
sedation, CNS & cognitive SE?
40 yo Asian male
Which of the following findings would raise concern in an annual sports exam for
a 15 yo girl?
Ht 67 in, wt 102 inch (under)
You are on call for your service. You arrive at the ED to find a 22 yo male
complaining of having trouble with his eyes. His vitals are stable. He is 5’7”,
weighs 140 lbs & his labs are WNL. He states he has been taking Abilify for the
last 2 months for BPDO. He had the dose raised to 15 mg po QAM 4 days ago to
manage a manic episode. He states that 1 and 2 times a day for the past 2 days
his eyes roll up for 10- 15 m, he is able to open his eyes but he is not able to
focus his eyes on you. His eyes are rolled upward about 2/3rds of the way
towards his upper eyelid. After exam, you decide to:
Discontinue the Abilify and give Cogentin 1mg IM. Have him return to his provider
for a different medication for his BPDO the next day.
,What direct acting DA agonist is recommended to be used in the treatment of
NMS to help lower the DA receptor blockade?
Bromocriptine (Parlodel)
A 43 yo male is treated for BPDO I on lithium. Which of the following
hematologic changes are associated with lithium?
Luekocytosis
Which of the following antidepressants is associated with dose-related
cardiovascular adverse effects which require adherence to maximum
recommended dosing, unless high doses are deemed appropriate despite risks?
Citalopram (40 mg/day due to heart changes)
A client is suffering from schizophrenia. Which of the following would be the
appropriate question for the PMHNP to ask when assessing SE produced by DA
antagonism in the tuberoinfundibular pathway? Breast discharge
When studying pharmacodynamics involving receptors, you know that inverse
agonists produce:
Opposite effect of an agonist, and causes the receptor to close the ion channel.
Which CYP enzyme is implicated as a tobacco inducer when an individual is
treated with clozapine?
1A2
A week after raising the dose of Risperdal, a patient treated for schizophrenia
presents with reports of acute change in mental status, fever and rigidity. The
PMHNP you know these symptoms are consistent with:
NMS.
NE is a neurotransmitter that is implicated in alertness and anxiety. What area
of the brain has a large majority of NE neurons?
Locus Coeruleus.
A 74 yo female presents for evaluation. PMHNP has the patient complete a
MMSE exam and clock drawing. The pt is unable to correctly draw the face of
the clock. Which area of the brain is likely to have compromised functioning?
Right Hemisphere.
Mr. Smith is a 56 yo white male who has been successfully treated on
Selegiline over 4 yrs. Mr. Smith is going in for an elective surgery. Which
, medication is contraindicated with Selegiliine.
Meperidine.
Sandy, a 32 yo separated female presents for initial intake. Sandy states she
recently left an abusive relationship, is living alone and experiencing fear, panic,
and extreme anxiety. Which brain structure is activated in pts w/ severe
anxiety, as expressed by Sandy?
Amygdala
A 37 yo pt with schizophrenia is started on a high dose of chlorpromazine. The
next day, he complains of lightheadedness after standing up. VS changes reflect
significant decrease in BP and increase in HR. You suspect this is secondary to
the alpha 1-adrenergic blockade which is causing:
Orthostatic HypoTN
Which of the following statements does not reflect current understanding of
neurotransmitter pathways implicated in anxiety disorders?
Decreasing GABA in the mesolimbic cortex diminishes symptoms of anxiety. (GABA
is inhibitory)
Which of the following statements regarding disulfiram is correct?
Avoid anything containing ETOH while using disulfiram and for 2 weeks after
discontinuing.
If given during pregnancy, lithium can cause which of the following?
Ebstein’s anomaly
Answers
Domain 1
Which of the following statements reflect the current understanding of DA
pathways and clinical symptoms in schizophrenia? –
Symptoms are related to DA deficit in the cerebral cortex; + are related to DA
excess in the substantia nigra and VTA
Which of the following findings would raise concern in a pre-school wellness
exam for a 5 yo girl?
Height 43 in, weight 55 lbs (she is overwt)
A 24 yo mother of a 2 yo child presents to the clinic. Which of the following facial
characteristics would lead to the PMHNP to believe child has Fetal ETOH
syndrome?
Small head, thin upper lip, smooth philtrum.
Patty is a 62 yo female with BPDO I and has been stable for 2 yrs on valproate
and risperidone. She recently diagnosed with shingles, and her PCM started her
on corticosteroids. As the PMHNP treating Patty, you are concerned the addition
of steroids may cause:
Manic episode.
Which mood stabilizer is most associated with potentially life threatening rash?
Lamotrigine (Lamictal)
Which of the following statements most accurately reflects the predominant risk
factors for ASD?
Genetic of a first degree family member.
A 17yo female presents reporting anhedonia, decreased energy & hopelessness
for the past 2 yrs. She denies ETOH, smoking or using illegal substances. Her
physical exam results are WNL and she denies SI. As her PMHNP, you decide to
prescribe bupropion. Which of the following is a contraindication for
bupropion?
Bulimia
,You have a 17 yo female who suffers from BPDO. The pt has a hx of impulsive
acting out and promiscuity. You make a decision to add folic acid .8 mg to her
medication regimen of lamotrigine 200 mg Q HS and quetiapine XR 50 mg 1 PO
QHS. Why is this important?
FA supports neural tube development during the 1st month a woman is pregnant.
Which of the following medications has a unique mechanism of action that is
both DA and NE - RI?
Bupropion (Wellbutrin)
Which of the following pts with GAD is most likely to be a 2C19 poor metabolizer
and have an exaggerated response to diazepam 5 mg TID with increased
sedation, CNS & cognitive SE?
40 yo Asian male
Which of the following findings would raise concern in an annual sports exam for
a 15 yo girl?
Ht 67 in, wt 102 inch (under)
You are on call for your service. You arrive at the ED to find a 22 yo male
complaining of having trouble with his eyes. His vitals are stable. He is 5’7”,
weighs 140 lbs & his labs are WNL. He states he has been taking Abilify for the
last 2 months for BPDO. He had the dose raised to 15 mg po QAM 4 days ago to
manage a manic episode. He states that 1 and 2 times a day for the past 2 days
his eyes roll up for 10- 15 m, he is able to open his eyes but he is not able to
focus his eyes on you. His eyes are rolled upward about 2/3rds of the way
towards his upper eyelid. After exam, you decide to:
Discontinue the Abilify and give Cogentin 1mg IM. Have him return to his provider
for a different medication for his BPDO the next day.
,What direct acting DA agonist is recommended to be used in the treatment of
NMS to help lower the DA receptor blockade?
Bromocriptine (Parlodel)
A 43 yo male is treated for BPDO I on lithium. Which of the following
hematologic changes are associated with lithium?
Luekocytosis
Which of the following antidepressants is associated with dose-related
cardiovascular adverse effects which require adherence to maximum
recommended dosing, unless high doses are deemed appropriate despite risks?
Citalopram (40 mg/day due to heart changes)
A client is suffering from schizophrenia. Which of the following would be the
appropriate question for the PMHNP to ask when assessing SE produced by DA
antagonism in the tuberoinfundibular pathway? Breast discharge
When studying pharmacodynamics involving receptors, you know that inverse
agonists produce:
Opposite effect of an agonist, and causes the receptor to close the ion channel.
Which CYP enzyme is implicated as a tobacco inducer when an individual is
treated with clozapine?
1A2
A week after raising the dose of Risperdal, a patient treated for schizophrenia
presents with reports of acute change in mental status, fever and rigidity. The
PMHNP you know these symptoms are consistent with:
NMS.
NE is a neurotransmitter that is implicated in alertness and anxiety. What area
of the brain has a large majority of NE neurons?
Locus Coeruleus.
A 74 yo female presents for evaluation. PMHNP has the patient complete a
MMSE exam and clock drawing. The pt is unable to correctly draw the face of
the clock. Which area of the brain is likely to have compromised functioning?
Right Hemisphere.
Mr. Smith is a 56 yo white male who has been successfully treated on
Selegiline over 4 yrs. Mr. Smith is going in for an elective surgery. Which
, medication is contraindicated with Selegiliine.
Meperidine.
Sandy, a 32 yo separated female presents for initial intake. Sandy states she
recently left an abusive relationship, is living alone and experiencing fear, panic,
and extreme anxiety. Which brain structure is activated in pts w/ severe
anxiety, as expressed by Sandy?
Amygdala
A 37 yo pt with schizophrenia is started on a high dose of chlorpromazine. The
next day, he complains of lightheadedness after standing up. VS changes reflect
significant decrease in BP and increase in HR. You suspect this is secondary to
the alpha 1-adrenergic blockade which is causing:
Orthostatic HypoTN
Which of the following statements does not reflect current understanding of
neurotransmitter pathways implicated in anxiety disorders?
Decreasing GABA in the mesolimbic cortex diminishes symptoms of anxiety. (GABA
is inhibitory)
Which of the following statements regarding disulfiram is correct?
Avoid anything containing ETOH while using disulfiram and for 2 weeks after
discontinuing.
If given during pregnancy, lithium can cause which of the following?
Ebstein’s anomaly
