ANCC IQ domain 1
2 yr. old child with Fetal Alcohol Syndrome (FAS)
small head, short eyelid 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 the 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)
The amygdala is important in the 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)
2 yr. old child with Fetal Alcohol Syndrome (FAS)
small head, short eyelid 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 the 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)
The amygdala is important in the 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)
