ANCC IQ domain 3 Questions, Answers
2023 with Rationales
1. The PMHNP treating a patient for schizophrenia on ziprasidone orders an
electrocardiogram. Which QTc interval result places the patient at greatest risk for
torsades de pointes?
- 300-500 milliseconds
- 500-700 milliseconds
- 160-260 milliseconds
- 100-200 milliseconds - - 500-700 milliseconds
Rationale: A patient with a QTc interval of 500-700 milliseconds is at higher risk of
developing torsades de pointes.
1. A patient with a diagnosis of schizophrenia has a history of suicidal ideation and
suicide attempts. The PMHNP should consider which antipsychotic medication that is
the only known antipsychotic to reduce the risk of suicide in schizophrenia?
- Invega (iloperidone)
- Abilify (aripiprazole)
- Latuda (lurasidone)
- Clozaril (clozapine) - - Clozaril (clozapine)
Rationale: Clozaril (clozapine) is the only known antipsychotic medication that has been
shown to reduce the risk of suicide in patients diagnosed with schizophrenia.
1. A WBC of 4,000 in a patient taking clozapine would prompt the PMHNP to take
which of the following actions?
- Discontinue clozapine, initiate alternative antipsychotic medication and monitor
closely.
- Institute daily complete blood count with differentials and monitor closely.
- Consult with hematologist to determine appropriate antibiotic regimen and monitor
closely.
- Institute twice-weekly complete blood count with differentials and monitor closely. - -
Institute twice-weekly complete blood count with differentials and monitor closely.
Rationale: The recommended cut-points for discontinuation of clozapine are WBC of
2,000 to 3,000 or granulocytes of 1,000 to 1,500 for agranulocytosis and severely
compromised immune system. At a WBC of 4,000, the recommendation is to closely
monitor CBC with differential twice a week while patient may continue clozapine in the
absence of any other signs or symptoms.
1. When evaluating a woman with major depressive disorder, which of the following
would not be a major consideration in the differential diagnosis?
- Prior episodes of depression
- Any episodes of hypomania
- Any periods without sleep yet no fatigue
- Prior pregnancies - - Prior pregnancies
,Rationale: The primary concern is to rule out bipolar disorder whenever making
diagnosis of major depressive disorder. Asking about any prior episodes of mania,
hypomania, and extended periods of 2-3 days with little to no sleep while still not feeling
fatigued, or period of heightened energy lasting several days without fatigue are
indicative of possible bipolar disorder. Asking about prior episodes of depression, mood
swings, and chronic irritability is also indicated. Prior pregnancies are not the relevant
information needed, but whether she experienced any episodes of postpartum
depression and the severity of any episodes.
1. Electroconvulsive therapy (ECT) is a treatment of depression. What adverse effect
is uncommon for a patient to experience after receiving ECT treatments?
- Muscle soreness
- Headaches
- Fractures
- Memory disturbance - - Fractures
Rationale: Headaches, memory disturbance, and muscle soreness are common
immediately after ECT treatment.
1. An 88-year-old nursing home patient presents to the emergency department with
recent mental status changes, including aggression, confusion, and dizziness, over the
past two days. The patient scored a 20 on the MINI-Mental Status Exam (MMSE). In
addition to the MMSE, what additional information is needed to conduct a thorough
evaluation?
- Blood chemistry, complete blood count, and urinalysis
- Patient Health Questionnaire (PHQ-9) score
- Hamilton Depression Scale (HAM-D) score
- Electrocardiography and pharmacogenomics testing - - Blood chemistry, complete
blood count, and urinalysis
Rationale: A bedside MMSE can be used to document the cognitive impairment and to
provide a baseline form which to measure the patient's clinical course. The laboratory
workup of a patient should include standard tests (i.e., blood chemistries, CBC,
urinalysis) and additional studies indicated by the clinical situation.
1. A client says that because he wished his sister was dead, and your client's sister
subsequently was killed in a motor vehicle accident, the death was caused by the
client's wishes. The client also revealed that he can reach other's minds. This client is
most likely suffering from which personality disorder?
- Paranoid personality disorder
- Schizotypal personality disorder
- Schizoid personality disorder
- Delusional personality disorder - - Schizotypal personality disorder
Rationale: Schizotypal personality disorder is characterized by ideas of reference and
magical thinking.
1. In the American Journal of Psychiatry, you read an article that discusses a recent
study's evidence that the nicotine exposure in pregnant women increases the risk for
, schizophrenia in offspring (i.e., 38% increased likelihood of schizophrenia in young
adults whose mothers smoked heavily while pregnant). This inspires you to translate
this information in practice and teaching roles as a nurse practitioner. What
considerations are needed to translate this in to practice based on the best evidence?
- Determine if any other psychiatric or medical journal articles have commented on the
validity or generalizability of the original stud.
- If the research is published in a peer-reviewed journal such as the American Journal of
Psychiatry, it is sound research.
- Analyze the original and repeat studies for methodical rigor and verify that there were
randomized or non-randomized clinical trials with the same results.
- Analyze the original study only to determine that the research is sound and meets the
criteria for effectiveness of an intervention. - - Analyze the original and repeat studies
for methodical rigor and verify that there were randomized or non-randomized clinical
trials with the same results.
Rationale: Research Utilization begins with the idea of putting an innovation to use in
practice. The level of the evidence must be considered. The best of the best evidence
comes from reviewing several randomized clinical trials of the same thing with the same
results. Second to that are several non-randomized trials about the same thing with the
same results. Single randomized or non-randomized trials make up level 2 evidence
regarding the effectiveness of an intervention.
1. In distinguishing borderline personality disorder from chronic post-traumatic stress
disorder related to childhood sexual abuse and victimization, which of the following
would be more indicative of borderline personality disorder?
- Irritability or intense outbursts of anger
- Efforts to avoid real or imagined abandonment
- Affect lability often associated with intense fear
- Feeling of detachment or estrangement from others - - Efforts to avoid real or
imagined abandonment
Rationale: One hallmark of borderline personality disorder is the frantic efforts to avoid
real or imagined abandonment and the other is a pervasive pattern of unstable and
intense personal relationships characterized by alternating between extremes of
idealization and devaluation. Affect lability, intense fear, irritability, intense anger, and
feelings of detachment or estrangement are seen in both chronic PTSD and borderline
personality disorder.
1. Which of the following atypical antipsychotic medications has U.S. Food and Drug
Administration (FDA) approval for treatment of bipolar depression when combined with
fluoxetine (Prozac)?
- Risperidone (Risperdal)
- Quetiapine (Seroquel)
- Olanzapine (Zyprexa)
- Aripiprazole (Abilify) - - Olanzapine (Zyprexa)
Rationale: Olanzapine in combination with fluoxetine (Symbax) is FDA approved for the
treatment of bipolar depression.
2023 with Rationales
1. The PMHNP treating a patient for schizophrenia on ziprasidone orders an
electrocardiogram. Which QTc interval result places the patient at greatest risk for
torsades de pointes?
- 300-500 milliseconds
- 500-700 milliseconds
- 160-260 milliseconds
- 100-200 milliseconds - - 500-700 milliseconds
Rationale: A patient with a QTc interval of 500-700 milliseconds is at higher risk of
developing torsades de pointes.
1. A patient with a diagnosis of schizophrenia has a history of suicidal ideation and
suicide attempts. The PMHNP should consider which antipsychotic medication that is
the only known antipsychotic to reduce the risk of suicide in schizophrenia?
- Invega (iloperidone)
- Abilify (aripiprazole)
- Latuda (lurasidone)
- Clozaril (clozapine) - - Clozaril (clozapine)
Rationale: Clozaril (clozapine) is the only known antipsychotic medication that has been
shown to reduce the risk of suicide in patients diagnosed with schizophrenia.
1. A WBC of 4,000 in a patient taking clozapine would prompt the PMHNP to take
which of the following actions?
- Discontinue clozapine, initiate alternative antipsychotic medication and monitor
closely.
- Institute daily complete blood count with differentials and monitor closely.
- Consult with hematologist to determine appropriate antibiotic regimen and monitor
closely.
- Institute twice-weekly complete blood count with differentials and monitor closely. - -
Institute twice-weekly complete blood count with differentials and monitor closely.
Rationale: The recommended cut-points for discontinuation of clozapine are WBC of
2,000 to 3,000 or granulocytes of 1,000 to 1,500 for agranulocytosis and severely
compromised immune system. At a WBC of 4,000, the recommendation is to closely
monitor CBC with differential twice a week while patient may continue clozapine in the
absence of any other signs or symptoms.
1. When evaluating a woman with major depressive disorder, which of the following
would not be a major consideration in the differential diagnosis?
- Prior episodes of depression
- Any episodes of hypomania
- Any periods without sleep yet no fatigue
- Prior pregnancies - - Prior pregnancies
,Rationale: The primary concern is to rule out bipolar disorder whenever making
diagnosis of major depressive disorder. Asking about any prior episodes of mania,
hypomania, and extended periods of 2-3 days with little to no sleep while still not feeling
fatigued, or period of heightened energy lasting several days without fatigue are
indicative of possible bipolar disorder. Asking about prior episodes of depression, mood
swings, and chronic irritability is also indicated. Prior pregnancies are not the relevant
information needed, but whether she experienced any episodes of postpartum
depression and the severity of any episodes.
1. Electroconvulsive therapy (ECT) is a treatment of depression. What adverse effect
is uncommon for a patient to experience after receiving ECT treatments?
- Muscle soreness
- Headaches
- Fractures
- Memory disturbance - - Fractures
Rationale: Headaches, memory disturbance, and muscle soreness are common
immediately after ECT treatment.
1. An 88-year-old nursing home patient presents to the emergency department with
recent mental status changes, including aggression, confusion, and dizziness, over the
past two days. The patient scored a 20 on the MINI-Mental Status Exam (MMSE). In
addition to the MMSE, what additional information is needed to conduct a thorough
evaluation?
- Blood chemistry, complete blood count, and urinalysis
- Patient Health Questionnaire (PHQ-9) score
- Hamilton Depression Scale (HAM-D) score
- Electrocardiography and pharmacogenomics testing - - Blood chemistry, complete
blood count, and urinalysis
Rationale: A bedside MMSE can be used to document the cognitive impairment and to
provide a baseline form which to measure the patient's clinical course. The laboratory
workup of a patient should include standard tests (i.e., blood chemistries, CBC,
urinalysis) and additional studies indicated by the clinical situation.
1. A client says that because he wished his sister was dead, and your client's sister
subsequently was killed in a motor vehicle accident, the death was caused by the
client's wishes. The client also revealed that he can reach other's minds. This client is
most likely suffering from which personality disorder?
- Paranoid personality disorder
- Schizotypal personality disorder
- Schizoid personality disorder
- Delusional personality disorder - - Schizotypal personality disorder
Rationale: Schizotypal personality disorder is characterized by ideas of reference and
magical thinking.
1. In the American Journal of Psychiatry, you read an article that discusses a recent
study's evidence that the nicotine exposure in pregnant women increases the risk for
, schizophrenia in offspring (i.e., 38% increased likelihood of schizophrenia in young
adults whose mothers smoked heavily while pregnant). This inspires you to translate
this information in practice and teaching roles as a nurse practitioner. What
considerations are needed to translate this in to practice based on the best evidence?
- Determine if any other psychiatric or medical journal articles have commented on the
validity or generalizability of the original stud.
- If the research is published in a peer-reviewed journal such as the American Journal of
Psychiatry, it is sound research.
- Analyze the original and repeat studies for methodical rigor and verify that there were
randomized or non-randomized clinical trials with the same results.
- Analyze the original study only to determine that the research is sound and meets the
criteria for effectiveness of an intervention. - - Analyze the original and repeat studies
for methodical rigor and verify that there were randomized or non-randomized clinical
trials with the same results.
Rationale: Research Utilization begins with the idea of putting an innovation to use in
practice. The level of the evidence must be considered. The best of the best evidence
comes from reviewing several randomized clinical trials of the same thing with the same
results. Second to that are several non-randomized trials about the same thing with the
same results. Single randomized or non-randomized trials make up level 2 evidence
regarding the effectiveness of an intervention.
1. In distinguishing borderline personality disorder from chronic post-traumatic stress
disorder related to childhood sexual abuse and victimization, which of the following
would be more indicative of borderline personality disorder?
- Irritability or intense outbursts of anger
- Efforts to avoid real or imagined abandonment
- Affect lability often associated with intense fear
- Feeling of detachment or estrangement from others - - Efforts to avoid real or
imagined abandonment
Rationale: One hallmark of borderline personality disorder is the frantic efforts to avoid
real or imagined abandonment and the other is a pervasive pattern of unstable and
intense personal relationships characterized by alternating between extremes of
idealization and devaluation. Affect lability, intense fear, irritability, intense anger, and
feelings of detachment or estrangement are seen in both chronic PTSD and borderline
personality disorder.
1. Which of the following atypical antipsychotic medications has U.S. Food and Drug
Administration (FDA) approval for treatment of bipolar depression when combined with
fluoxetine (Prozac)?
- Risperidone (Risperdal)
- Quetiapine (Seroquel)
- Olanzapine (Zyprexa)
- Aripiprazole (Abilify) - - Olanzapine (Zyprexa)
Rationale: Olanzapine in combination with fluoxetine (Symbax) is FDA approved for the
treatment of bipolar depression.
