ANCC IQ domain 2 Questions and Answers with complete
solution
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.
solution
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.
