ANCC IQ domain 1 Questions and Answers with complete
solution
2 yr. old child with Fetal Alcohol Syndrome (FAS)
small head, short eye lid opening, flat midface, smooth philtrum, underdeveloped jaw,
thin upper lip, and short nose
Neuroleptic Malignant Syndrome (NMS)
- Acute mental status change, muscular rigidity, and autonomic instability (fever)
Elderly pt c/o tinnitus; the PMHNP would associate which of the following
findings with an acoustic neuroma?
- Unilateral tinnitus (ringing in the ears) may be the first symptom of an acoustic
neuroma
- Sx/sx infection of the ear - perforation of tympanic membrane, inflammation of the
middle ear, and suppuration of the labyrinth
Brain structure is activated in patients with severe anxiety (fear, panic, extreme
anxiety)
- Amygdala is important in mediation of fear, anxiety, and panic
Which of the following does not reflect current understanding of neurotransmitter
pathways implicated in anxiety disorders?
-FALSE: decreasing GABA in the mesolimbic cortex diminishes symptoms of
anxiety
-TRUE: increasing serotonergic activity in the amygdala diminishes symptoms of
anxiety
-TRUE: decreasing norepinephrine in the locus ceruleus diminishes symptoms of
anxiety
-TRUE: increased levels of CRF in the amygdala, hippocampus and locus
ceruleus increases symptoms of anxiety
-FALSE: decreasing GABA in the mesolimbic cortex diminishes symptoms of anxiety
Rationale: GABA (Gamma-aminobutyric acid) is the most abundant inhibitory
neurotransmitter in the brain. Decreasing GABA would increase anxiety.
Benzodiazepines are used to bind with GABA receptors to potentiate the anxiolytic
(calming) effects of GABA. The other responses are all accurate regarding effect on
anxiety symptoms.
While treating a 12-year-old boy for ADHD, the PMHNP observes which of the
following physical features that raise concerns for genetic evaluation for Fragile
X Syndrome?
-obesity, small stature, small hands and feet, hypotonia
-café au lait spots on face and arms, neurofibromas
-long head and ears, short stature, hyperextensible joints
-small stature, short palpebral fissure, inner epicanthal folds
-long head and ears, short stature, hyperextensible joints
Rationale: Etiological factors in mental retardation can be primarily genetic,
developmental, acquired, or in combination. Genetic causes included chromosomal and
inherited conditions. Many of these genetic disorders have characteristic physical
features that warrant genetic testing for confirmatory diagnosis. Fragile X Syndrome
, occurs in about 1 of every 1,000 males and 1 of every 2,000 females. The typical
phenotype includes a large, long head and ears, short stature, hyperextensible joints,
and postpubertal macroorchidism. The mentalretardation ranges from mild to severe.
There is high rate of comorbid ADHD, learning disorder, and pervasive developmental
disorders, such as autism. Café au lait spots and neurofibromas are common in von
Recklinghausen’s disease. Obesity, small stature, small hands and feet, hypotonia, and
hypogonadism are characteristic of Prader-Willi Syndrome. Small head, short palpebral
fissure, and inner epicanthal folds are characteristic of fetal alcohol syndrome.
Which of the following patients with generalized anxiety disorder is most likely to
be a CYP 2C19 poor metabolizer and have an exaggerated response to diazepam
(Valium) 5 mg TID with increased sedation, central nervous system, and cognitive
side effects?
-40-year-old Asian male
-30-year-old African American male
20-year-old African American male
50-year-old Caucasian male
-40-year-old Asian male
Rationale: The frequency of poor metabolizers of CYP 2C19 is low among Caucasians
(3%), intermediate among African Americans (18%), and higher in Asian and Japanese
populations (up to 20%).
Which serotonin receptor antagonism makes an antipsychotic "atypical"?
-5HT2A
-5HT1A
-5HT4A
-5HT3A
-5HT2A
Rationale: The mechanism of action that makes an antipsychotic medication "atypical"
is related to the 5HT2A receptor antagonism and D2 receptor antagonism.
-5HT1A
-5HT4A
-5HT3A
Which mood stabilizer is most associated with a potentially life-threatening rash?
-lamotrigine (Lamictal)
Lamotrigine is associated with a rare, serious, and potentially life-threatening rash
(Steven Johnsons syndrome
Which of the following findings would raise concern in a pre-school wellness
exam for a 5-year-old girl?
height 43 inches, weight 55 lbs
Rationale: Body Mass Index (BMI) calculated for this height and weight is 21, which is
greater than 95th percentile for her age, placing her in overweight category. Calculation:
Weight (lbs) /Stature (inches) / Stature (inches) x 703 = BMI
BMI = 703 x weight (lbs) = 703 x 55
[Height (in)]2 432
Or Weight (kg)/ Stature (cm)/ Stature (cm) x 10,000 = BMI.
BMI = weight (kg)
[height (m)]2
solution
2 yr. old child with Fetal Alcohol Syndrome (FAS)
small head, short eye lid opening, flat midface, smooth philtrum, underdeveloped jaw,
thin upper lip, and short nose
Neuroleptic Malignant Syndrome (NMS)
- Acute mental status change, muscular rigidity, and autonomic instability (fever)
Elderly pt c/o tinnitus; the PMHNP would associate which of the following
findings with an acoustic neuroma?
- Unilateral tinnitus (ringing in the ears) may be the first symptom of an acoustic
neuroma
- Sx/sx infection of the ear - perforation of tympanic membrane, inflammation of the
middle ear, and suppuration of the labyrinth
Brain structure is activated in patients with severe anxiety (fear, panic, extreme
anxiety)
- Amygdala is important in mediation of fear, anxiety, and panic
Which of the following does not reflect current understanding of neurotransmitter
pathways implicated in anxiety disorders?
-FALSE: decreasing GABA in the mesolimbic cortex diminishes symptoms of
anxiety
-TRUE: increasing serotonergic activity in the amygdala diminishes symptoms of
anxiety
-TRUE: decreasing norepinephrine in the locus ceruleus diminishes symptoms of
anxiety
-TRUE: increased levels of CRF in the amygdala, hippocampus and locus
ceruleus increases symptoms of anxiety
-FALSE: decreasing GABA in the mesolimbic cortex diminishes symptoms of anxiety
Rationale: GABA (Gamma-aminobutyric acid) is the most abundant inhibitory
neurotransmitter in the brain. Decreasing GABA would increase anxiety.
Benzodiazepines are used to bind with GABA receptors to potentiate the anxiolytic
(calming) effects of GABA. The other responses are all accurate regarding effect on
anxiety symptoms.
While treating a 12-year-old boy for ADHD, the PMHNP observes which of the
following physical features that raise concerns for genetic evaluation for Fragile
X Syndrome?
-obesity, small stature, small hands and feet, hypotonia
-café au lait spots on face and arms, neurofibromas
-long head and ears, short stature, hyperextensible joints
-small stature, short palpebral fissure, inner epicanthal folds
-long head and ears, short stature, hyperextensible joints
Rationale: Etiological factors in mental retardation can be primarily genetic,
developmental, acquired, or in combination. Genetic causes included chromosomal and
inherited conditions. Many of these genetic disorders have characteristic physical
features that warrant genetic testing for confirmatory diagnosis. Fragile X Syndrome
, occurs in about 1 of every 1,000 males and 1 of every 2,000 females. The typical
phenotype includes a large, long head and ears, short stature, hyperextensible joints,
and postpubertal macroorchidism. The mentalretardation ranges from mild to severe.
There is high rate of comorbid ADHD, learning disorder, and pervasive developmental
disorders, such as autism. Café au lait spots and neurofibromas are common in von
Recklinghausen’s disease. Obesity, small stature, small hands and feet, hypotonia, and
hypogonadism are characteristic of Prader-Willi Syndrome. Small head, short palpebral
fissure, and inner epicanthal folds are characteristic of fetal alcohol syndrome.
Which of the following patients with generalized anxiety disorder is most likely to
be a CYP 2C19 poor metabolizer and have an exaggerated response to diazepam
(Valium) 5 mg TID with increased sedation, central nervous system, and cognitive
side effects?
-40-year-old Asian male
-30-year-old African American male
20-year-old African American male
50-year-old Caucasian male
-40-year-old Asian male
Rationale: The frequency of poor metabolizers of CYP 2C19 is low among Caucasians
(3%), intermediate among African Americans (18%), and higher in Asian and Japanese
populations (up to 20%).
Which serotonin receptor antagonism makes an antipsychotic "atypical"?
-5HT2A
-5HT1A
-5HT4A
-5HT3A
-5HT2A
Rationale: The mechanism of action that makes an antipsychotic medication "atypical"
is related to the 5HT2A receptor antagonism and D2 receptor antagonism.
-5HT1A
-5HT4A
-5HT3A
Which mood stabilizer is most associated with a potentially life-threatening rash?
-lamotrigine (Lamictal)
Lamotrigine is associated with a rare, serious, and potentially life-threatening rash
(Steven Johnsons syndrome
Which of the following findings would raise concern in a pre-school wellness
exam for a 5-year-old girl?
height 43 inches, weight 55 lbs
Rationale: Body Mass Index (BMI) calculated for this height and weight is 21, which is
greater than 95th percentile for her age, placing her in overweight category. Calculation:
Weight (lbs) /Stature (inches) / Stature (inches) x 703 = BMI
BMI = 703 x weight (lbs) = 703 x 55
[Height (in)]2 432
Or Weight (kg)/ Stature (cm)/ Stature (cm) x 10,000 = BMI.
BMI = weight (kg)
[height (m)]2
