ANCC practice Exam Questions and Answers Rated A+ Guaranteed Success Latest Update 2023/2024

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 While treating a 12 yo boy for ADHD, the PMHNP observes which of the following physical features that raise concern for genetic eval for Fragile X syndrome? Long head and ears, short stature, hyper- extensible joints The PMHNP would expect to see which of the following during a physical exam for a patient with bulimia nervosa? Erosion of dental enamel. The risk of bleeding on SSRIs, NSAIDs or ASA, is example of which of the following principles? Pharmacodynamic. In evaluating a 4 yo, one would expect which of the following delays in Asperger’s disorder? Social skills development. Which of the following findings on MRI and PET scans would be uncommon in individuals with schizophrenia? Decreased size of cerebral ventricles. (ventricle size increases as brain tissue shrinks) Which of the following statements reflects current understanding of the neurodevelopment best explains risk-taking behavior of adolescent males? Maturation of the prefrontal cortex continues into mid-20s early 30s. What is a rate but serious side effect of Trazodone? Priapism. Arcus senilis when seen before 40 yrs is associated with which of the following? HLD Which serotonin receptor antagonism makes an antipsychotic atypical? 5HT2A As a PMHNP, you are aware of medication SE. Which of the following SE of antipsychotic medication has insidious, delayed onset typically 1-2 yrs after initial of medication? TD Your patient comes into the office for her middle of the year appointment. She is dx with BPDO I. She has been maintained well for the past 3 years on oxcarbazepine 900 mg PO Q HS. Her labs are normal except for blood sugar of 114 and her HgA1c is 5.6. She has normal energy and states her mood is stable but complaints of excessive urination and thirst. You suspect: SE of Trilpetal. When assessing an elderly pt that complains of tinnitus, the PMHNP would associate which of the following findings with an acoustic neuroma? Unilateral ringing in the ear. Which area of the brain has been impacted to modulate pain and can help explain how TMS can decrease pain? Prefrontal cortex. Domain 2 The WHO has predicted that depression will be the #1 world health problem in the 21st century. Lifetime prevalence for MDD is 12% (With a 5-17% range). Which of the following individuals has the greatest risk factors for MDD? 43 yo divorced woman, school teacher, raising 3 children An adult female pt has been rx an SSRI for initial episode of MDD. She is fearful of SE and becoming suicidal. Which of the following initial responses is most appropriate? Have you ever had feelings of hurting yourself? If you took medication and had thoughts like that, what would you do? Dementia screening for the general population is not recommended for the following reason: The service has unknown balance of benefit and harm: current treatments have limited effectiveness in modifying instrumental ADLs Violence directed toward women by an intimate partner is a serious health problem. Which of the following women has greatest risk factor for being victim of violence? 17 yo single Native Alaskan woman living with employed boy-friend in Galena, Alaska (native Americans have highest rates) In assessing sexual abuse of a 4-yo, which of the following would not be indicated? Has anyone invited you to a b-day party? A 36 yo woman was fired from her job as a paralegal at a law firm. She has worked for the same attorney for 10 years. As soon as she came in the door from work, her husband noticed she appeared upset and asked her if she was right. She immediately started yelling at her husband bc he had not given their 5 yo daughter a bath and had not cleaned the house. Which of the following defense mechanisms is being used by this woman? Displacement The MMSE is a brief, standardized screening tool designed for use: In adults to quantify cognitive status. What opening question or statement by a PMHNP facilitates communication at an initial visit? Tell me your concerns and how I may be of help. A 53 yo male w/ a hx of schizophrenia is being discharged from an inpatient admission to a psychiatric hospital and was refereed for to you for follow-up in your private practice. During your initial assessment with the pt, you as him about his education level and he talks about where he went to high school, his high school friends, activities he was involved in, and his high school graduation. He states, “That … education” Which of the following does the pt answer demonstrates? Circumstantiality Appraisal of the pt’s suicidal ideation, plan, method, intent and access to implementation plan would be documented in which part of the standard psychiatric evaluation? MSE When child, adult partner, or elder abuse Is suspected, the PMHNP needs to conduct an abuse assessment screen I privacy, away from the partner, child’s parents or guardian, or the elder person’s relative or companion. Simple, direct questions in a nonjudgmental interview are indicated. Which of the following would be an appropriate abuse screening question? Within the past year, have you been hit, slapped, kicked or physically hurt by someone? The ACOG recommends screening for postpartum depression with a validated screening tool. Which of the following is a validated screening tool which has been recommended by ACOG? EPDS In evaluating the function status of a 68 yo woman who has depression, the instrument ADLs include which of the following? Telephone use In the aftermath of a tornado that destroys 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 a following statements is most appropriate at the initial encounter? “What is your biggest concern right now? I will help you as much as possible” When questioning a patient regarding ETOH use during intake, the pt tells you they only drink socially. Which response is most appropriate? What amount and what kind of ETOH do you drink in a week? In assessing pt risks for binge drinking, which of the following statements is not accurate? Binge drinking is higher in urban, densely populated areas than rural, sparely populated areas. There is a growing recognition that adverse life experiences due to a variety of reasons underlie a wide range of psychiatric disorders and medical problems. According to a seminal research study on adverse childhood exp, a positive relationship between ACE and which of the following? ETOH, anxiety depression, DM, heart disease A PMHNP realizes she is frustrated w one of her pt for no reason. When discussing with a colleague, she states the pt reminds her of her abusive step father. Which of the following describes the NP reaction? Countertransference A patient who works the night shift presents for a FU appointment to see a PMHNP and states, “I can’t sleep when I get home from work.” Upon assessment, the PMHNP learns the pt recently started an exercise regimen and is now exercising after work. Which response is appropriate for this pt? Regular exercise can help promote sleep but should not be performed too close to your bedtime or it can interfere w/ sleep; try exercise before work. In advising parents how to reduce the risk for teen substance abuse when there is a + fam hx of ETOH dependence, a PMHNP recommends all of the following except: Random urine testing using home drug testing kits In a psych emergency, the PMHNP is aware that most important goal of the interview is self protection. What can the PMHNP do to stay safe? Know as much about the person as possible prior to interview A 14 yo girl admitted to the psych unit following an OD on ETOH and benzos after the breakup of a relationship has made seductive comments to her roommate, which is upsetting her roommate. In assessing the girls behavior to the roommate, the PMHNP needs to include topic of sx orientaition. What is the best introduction to this topic? What is your exp in sexual relationships? Which of the following screening test high sensitivy and specificity for identify cognitive impairment in older adults while requiring the least amount of time to administer in a clinical setting? Clocking drawing test A pt was started on antipsychotic medication 2 weeks ago and is now experiencing the following symptoms: inability to sit still, pacing, and feelings of inner restlessness. He does not complain of anxiety or being worried about anything in particular. Which of the scales would be most appropriate? Barnes akathisia rating scale 32 yo Caucasian catholic female presents for her therapy session. She is upset because hse and her husband have bene in an argument over finances. She does not work and stays at home to take care of the children. She reports feelings sad and has had thoughts of hurting herself. She has a past hx of OD w Tylenol several years ago. Which of the following places her at high risk for suicide? Previous attempt A 78 yo cattleman referred for tx of refractory depression by his primary care provider reports continued thoughts of failure, lack of purpose in life, lack of purpose in life, lack of interest in ranching, fishing, hunting, or family since losing his driver’s license due to DUI 6 months ago. Which of the following areas is an assessment priority? Thoughts of self-harm, plan, intent, access. As a PMHNP working with a young female dx with bipolar and using a recovery model, what will the focus of your interactions be? Focus on feelings, experience, and what she wants to achiveve A 10 yo child lost her father to a MI. Normally confident, sociable and an excellent student, her teachers and mother report that she has withdrawn and become disinterested in schoolmates and schoolwork, and easily becomes tearful if someone mentions her father. What non-pharm intervention would be most helpful at this time to facilitate her grieving and loss? Psychoeducation group During an initial assessment, the PMHNP asks the pt to perform the serial 7s. What aspect of the MSE would the NP be assessing. Concentration Domain 3 A 34 yo AA female presents for initial eval. ON exam, she reports thinking she has ADHD because she has short attention span, poor recent memory, neverousness, mood lability and is sweating more. Which lab test should the PMHNP order to rule out organic etiology of symptoms? Thyroid panel Which is the only medication approve by the FDA to treat depression in children? Prozac Sally is a 27 yo attorney who recently moved to your area. She presents with anxiety disorder, specifically symptoms mof performance anxiety. Sally’s only otherwise condition is exercise induced asthma. She is on Albuteral. She states in CBT she didn’t get relief and would like to try a medication. Which is most suitable for initial treatement for Sally? Zoloft The PMHNP evals a 3 yo male and dx him with ADD. Following the FDA labeling of approved medication for children, which medication can be started in children age 3? Amphetamines A middle school boy repeatedly lies, steals, bullies, peers, instigates fights, and inflicts harm without feeling any regret or remose. These are characteristics of which disorder? CD ECT is a treatment for depression. What adverse effect is uncommon for pt to exp after reciving ECT tx? Fractures For a pt who has a long hx of opiate dependence and is newly recovery, which of the following is most likely to aid in tx process ? Buprenorphine Making an EBP decision regarding implementation of an intervention includes current research evidence and all of the following expect the: generalizability of the findings Mr. Jones is a 78 yo male pt, presents to the PMHNP for a FU med apt. Mr. Jones depression has ben successfully treated with citalopram 20 mg by mouth daily. During the visit, Mr. Jones complains that in the last 2 -3 weeks he has had nausea, fatigue, feeling weak, with HA and decreased appetite. Which action would be the most apporpiriate for Mr. Jones? Assess for other symptom sof hyponatremia and check serum NA Which of the following is not characteristic of individual siwth APD? APD is idenifiied predominanlt in European and Western countries. In distinguishing between dementia and pseudo dementia which of the following findings would be expected in a pt with pseudo dementia? “Don’t know” answers typical A new pt comes to you on med regimen of: Adderall XR 30 mg PO QAM, Seroquel 300 mg PO QHS, Mirtazapine 45mg PO QHS, Diazepam 5 mg PO TID, Ambien 10 mg PO Q HS. In addition if initial dose does not help the pt to sleep. You confirm the medication with your pt’s past records. You diagnose the pt with PTSD, Panic disorder, MDD, ADD, ETOH use disorder. You treat the pt and find the pt is