ANCC Review Questions and Answers(PMHNP IQ)
(Latest 2023/2024 updated questions with complete
solution)
special considerations for Thiazides - ANSWER Chlorthalidone is preferred on the
basis of prolonged half-life and proven trial reduction of CVD.
Monitor for hyponatremia and hypokalemia, monitor uric acid and calcium levels.
Use with caution in patients with history of acute gout unless patient is on uric acid-
lowering therapy.
special considerations for ACE inhibitors - ANSWER Do not use in combination
with ARBs or direct renin inhibitor.
There is an increased risk of hyperkalemia, especially in patients with CKD or in
those on K+ supplements or K+-sparing drugs.
There is a risk of acute renal failure in patients with severe bilateral renal artery
stenosis.
Do not use if patient has history of angioedema with ACE inhibitors.
ACE inhibitor cough is common, in 5 to 20 percent of patients, due to bradykinin
production.
Avoid in pregnant females or females of reproductive age without adequate
contraception
special considerations for Angiotensin receptor blockers - ANSWER Do not use in
combination with ACE inhibitors or direct renin inhibitor.
There is an increased risk of hyperkalemia in CKD or in those on K+ supplements or
K+-sparing drugs.
There is a risk of acute renal failure in patients with severe bilateral renal artery
stenosis.
,Do not use if patient has history of angioedema with ARBs. Patients with a history of
angioedema with an ACE inhibitor can receive an ARB beginning 6 weeks after ACE
inhibitor is discontinued.
Avoid in pregnant females or females of reproductive age without adequate
contraception.
Lower risk of cough than ACE-Is.
special considerations for Calcium channel blockers - ANSWER Associated with
dose-related pedal edema, which is more common in females than men.
When should you Refer to a Nephrologist or Cardiologist in a hypertensive patient? -
ANSWER -signs of end-organ damage
-evidence of a secondary cause of hypertension
-only on one to two medications
Generally, failure to achieve blood pressure goal in patients who are adhering to full
doses of an appropriate three to four drug regimen that includes a diuretic may
warrant referral to a nephrologist or cardiologist
Before referring, clinicians should first review other causes of inadequate
hypertension control such as:
-Improper blood pressure measurement
-White coat hypertension
-Excess sodium intake
-Medication issues (e.g., nonsteroidal anti-inflammatory drugs (NSAIDs), illicit drugs,
sympathomimetics, oral contraceptives)
-Excess alcohol intake
-Underlying identifiable causes of hypertension (secondary hypertension)
A researcher is studying potential risk factors for obesity. She sends a questionnaire
to 5000 patients who meet the CDC criteria for obesity that asks them about
sedentary lifestyle factors, consumption of processed food, and family history of
obesity. The researcher sends the same questionnaire to 5000 patients who are not
obese. Which of the following best describes the design of the study?
A. Cross-sectional study
B. Randomized controlled trial
C. Meta-analysis
D. Case-control study - ANSWER Correct Answer: D. Case-control study
This is a retrospective case-control study. In this observational study design,
subjects are selected based on an outcome, and their prior exposures are assessed
and compared to subjects who do not have the particular outcome. The result of the
study is expressed as an odds ratio: OR = (# exposed with disease / # exposed
without disease) / (# not exposed with disease / # not exposed without disease). A
retrospective case-control study does not prove causation but demonstrates an
association.
Incorrect
Answers:
,A. A cross-sectional study is used to assess disease status and risk factors at 1 point
in time.
B. A randomized controlled trial refers to a study where a group is given a treatment
and outcomes are compared against a control group given a placebo or treated with
the standard of care.
C. A meta-analysis provides a statistical analysis of the results of multiple studies.
Vital Concepts:
In an observational study design, subjects are selected based on an outcome, and
their prior exposures are assessed and compared to subjects who do not have a
particular outcome. The result of the study is expressed as an odds ratio: OR = (#
exposed with disease / # exposed without disease) / (# not exposed with disease / #
not exposed without disease). A retrospective case-control study does not prove
causation but demonstrates an association.
A 49-year-old female presents to the office with a history of breast cancer who is
having frequent hot flashes who already tried first-line lifestyle changes without
improvement? What is the best treatment for this patient?
A. Hormonal therapy with estrogen and progesterone
B. Bioidentical hormones
C. Citalopram
D. Black cohosh - ANSWER Correct Answer: C. Citalopram
Selective serotonin reuptake inhibitors (SSRI)s are the most effective pharmacologic
choice for the vasomotor symptoms of menopause. Citalopram is an SSRI that has
good evidence of efficacy against these symptoms and is typically well-tolerated.
Incorrect Answers:
A. Women with a history of breast cancer are not candidates for hormone
replacement therapy.
B. "Bioidentical hormones" are compounded mixtures of multiple hormones. There is
no evidence to support their use at this time, and again, hormone treatment would be
contraindicated in a patient with a history of breast cancer.
D. Black cohosh is an herbal remedy marketed for use with hot flashes. However, it
has not been demonstrated to be more effective than a placebo for this use. In
addition, it has been posited to have a possible estrogenic effect on breast tissue,
which should be avoided in patients with a history of breast cancer.
Vital Concepts:
Selective serotonin reuptake inhibitors (SSRI)s are the most effective pharmacologic
choice for the vasomotor symptoms of menopause. Citalopram is an SSRI that has
good evidence of efficacy against these symptoms and is typically well-tolerated.
A 20-year-old presents to the office for a wellness check. What is the prevalence of
bulimia nervosa in female college students?
A. 1%
B.2%
C. 4%
D. 5% - ANSWER Correct Answer: D. 5%
Bulimia nervosa occurs in approximately 5% of female college students, who are 10x
more likely than male college students to develop this disorder. The prevalence of
anorexia nervosa is 1.5% in teenage girls overall.
Incorrect Answers:
(A), (B), (C) are the not correct prevalence.
, A 16-year-old male presents because he is concerned about acne. He first began to
notice worsening acne 6 months ago and began using over-the-counter benzoyl
peroxide and, after 3 months, saw his primary care physician who prescribed
tretinoin and oral tetracycline. He states that he has been using both medications for
the last 3 months but there is no improvement in acne. He also states he has noticed
he is very quick to anger and moody over the last few months and wonders whether
that is a side effect of the acne medications. He is a football player for his high
school and has been participating in extra practices to "bulk up" in the hopes of
achieving a college scholarship. Upon closer inspection, he has gained 30 pounds in
the last 3 months but does not appear overweight, rather has increased muscle
mass. He states that a friend on the football team has been giving him pills to help
his performance. Which of the - ANSWER Correct Answer: C. Lowered thyroxine
binding globulin (TBG) levels
Anabolic steroids can lower thyroxine-binding globulin (TBG) levels which, in turn,
can decrease total T4 levels, although free T4 remains the same.
Incorrect Answers:
A. This patient has multiple features that are consistent with anabolic steroid use,
including acne, a rapid increase in weight and muscle mass, and mood swings. In
men steroid use decreases serum luteinizing hormone and follicle-stimulating
hormone levels, which leads to decreased endogenous testosterone production,
decreased spermatogenesis, and testicular atrophy. There is also an increased
estrogen production due to the aromatization of circulating testosterone which can
lead to gynecomastia.
B. Anabolic steroid use can lead to increased prothrombin time as well as a
suppression of clotting factors II, V, VII, and X.
D. Anabolic steroid use can have multiple cardiovascular effects including decreased
serum HDL cholesterol, increased serum LDL cholesterol, increased total
cholesterol, and increased blood pressure. These effects appear to be reversible
when anabolic steroid use is discontinued. The risk of sudden death from
cardiovascular causes can occur in an athlete abusing anabolic steroids even when
there is no evidence of atherosclerosis. This is due to an increased risk of thrombus
formation while using anabolic steroids.
A 45-year-old woman presents with abnormal uterine bleeding. You discuss your
recommendation for endometrial sampling to rule out endometrial hyperplasia and
carcinoma. What is the most common cause of endometrial cancer?
A. Human papilloma virus
B. Hereditary nonpolyposis colorectal cancer
C. Multiple endocrine neoplasia
D. Unopposed estrogen - ANSWER Correct Answer: D. Unopposed estrogen
Unopposed estrogen can lead to overgrowth of endometrial tissue, ultimately
prompting endometrial hyperplasia and endometrial cancer. Endometrial cancers
occur that are not related to estrogen exposure, which have a different pathologic
appearance and a worse prognosis. Women with anovulation or other types of
unopposed estrogen exposure should have exposure to progesterone or progestins
at least every 3 months to reduce the risk of endometrial hyperplasia and cancer.
Incorrect Answers:
(Latest 2023/2024 updated questions with complete
solution)
special considerations for Thiazides - ANSWER Chlorthalidone is preferred on the
basis of prolonged half-life and proven trial reduction of CVD.
Monitor for hyponatremia and hypokalemia, monitor uric acid and calcium levels.
Use with caution in patients with history of acute gout unless patient is on uric acid-
lowering therapy.
special considerations for ACE inhibitors - ANSWER Do not use in combination
with ARBs or direct renin inhibitor.
There is an increased risk of hyperkalemia, especially in patients with CKD or in
those on K+ supplements or K+-sparing drugs.
There is a risk of acute renal failure in patients with severe bilateral renal artery
stenosis.
Do not use if patient has history of angioedema with ACE inhibitors.
ACE inhibitor cough is common, in 5 to 20 percent of patients, due to bradykinin
production.
Avoid in pregnant females or females of reproductive age without adequate
contraception
special considerations for Angiotensin receptor blockers - ANSWER Do not use in
combination with ACE inhibitors or direct renin inhibitor.
There is an increased risk of hyperkalemia in CKD or in those on K+ supplements or
K+-sparing drugs.
There is a risk of acute renal failure in patients with severe bilateral renal artery
stenosis.
,Do not use if patient has history of angioedema with ARBs. Patients with a history of
angioedema with an ACE inhibitor can receive an ARB beginning 6 weeks after ACE
inhibitor is discontinued.
Avoid in pregnant females or females of reproductive age without adequate
contraception.
Lower risk of cough than ACE-Is.
special considerations for Calcium channel blockers - ANSWER Associated with
dose-related pedal edema, which is more common in females than men.
When should you Refer to a Nephrologist or Cardiologist in a hypertensive patient? -
ANSWER -signs of end-organ damage
-evidence of a secondary cause of hypertension
-only on one to two medications
Generally, failure to achieve blood pressure goal in patients who are adhering to full
doses of an appropriate three to four drug regimen that includes a diuretic may
warrant referral to a nephrologist or cardiologist
Before referring, clinicians should first review other causes of inadequate
hypertension control such as:
-Improper blood pressure measurement
-White coat hypertension
-Excess sodium intake
-Medication issues (e.g., nonsteroidal anti-inflammatory drugs (NSAIDs), illicit drugs,
sympathomimetics, oral contraceptives)
-Excess alcohol intake
-Underlying identifiable causes of hypertension (secondary hypertension)
A researcher is studying potential risk factors for obesity. She sends a questionnaire
to 5000 patients who meet the CDC criteria for obesity that asks them about
sedentary lifestyle factors, consumption of processed food, and family history of
obesity. The researcher sends the same questionnaire to 5000 patients who are not
obese. Which of the following best describes the design of the study?
A. Cross-sectional study
B. Randomized controlled trial
C. Meta-analysis
D. Case-control study - ANSWER Correct Answer: D. Case-control study
This is a retrospective case-control study. In this observational study design,
subjects are selected based on an outcome, and their prior exposures are assessed
and compared to subjects who do not have the particular outcome. The result of the
study is expressed as an odds ratio: OR = (# exposed with disease / # exposed
without disease) / (# not exposed with disease / # not exposed without disease). A
retrospective case-control study does not prove causation but demonstrates an
association.
Incorrect
Answers:
,A. A cross-sectional study is used to assess disease status and risk factors at 1 point
in time.
B. A randomized controlled trial refers to a study where a group is given a treatment
and outcomes are compared against a control group given a placebo or treated with
the standard of care.
C. A meta-analysis provides a statistical analysis of the results of multiple studies.
Vital Concepts:
In an observational study design, subjects are selected based on an outcome, and
their prior exposures are assessed and compared to subjects who do not have a
particular outcome. The result of the study is expressed as an odds ratio: OR = (#
exposed with disease / # exposed without disease) / (# not exposed with disease / #
not exposed without disease). A retrospective case-control study does not prove
causation but demonstrates an association.
A 49-year-old female presents to the office with a history of breast cancer who is
having frequent hot flashes who already tried first-line lifestyle changes without
improvement? What is the best treatment for this patient?
A. Hormonal therapy with estrogen and progesterone
B. Bioidentical hormones
C. Citalopram
D. Black cohosh - ANSWER Correct Answer: C. Citalopram
Selective serotonin reuptake inhibitors (SSRI)s are the most effective pharmacologic
choice for the vasomotor symptoms of menopause. Citalopram is an SSRI that has
good evidence of efficacy against these symptoms and is typically well-tolerated.
Incorrect Answers:
A. Women with a history of breast cancer are not candidates for hormone
replacement therapy.
B. "Bioidentical hormones" are compounded mixtures of multiple hormones. There is
no evidence to support their use at this time, and again, hormone treatment would be
contraindicated in a patient with a history of breast cancer.
D. Black cohosh is an herbal remedy marketed for use with hot flashes. However, it
has not been demonstrated to be more effective than a placebo for this use. In
addition, it has been posited to have a possible estrogenic effect on breast tissue,
which should be avoided in patients with a history of breast cancer.
Vital Concepts:
Selective serotonin reuptake inhibitors (SSRI)s are the most effective pharmacologic
choice for the vasomotor symptoms of menopause. Citalopram is an SSRI that has
good evidence of efficacy against these symptoms and is typically well-tolerated.
A 20-year-old presents to the office for a wellness check. What is the prevalence of
bulimia nervosa in female college students?
A. 1%
B.2%
C. 4%
D. 5% - ANSWER Correct Answer: D. 5%
Bulimia nervosa occurs in approximately 5% of female college students, who are 10x
more likely than male college students to develop this disorder. The prevalence of
anorexia nervosa is 1.5% in teenage girls overall.
Incorrect Answers:
(A), (B), (C) are the not correct prevalence.
, A 16-year-old male presents because he is concerned about acne. He first began to
notice worsening acne 6 months ago and began using over-the-counter benzoyl
peroxide and, after 3 months, saw his primary care physician who prescribed
tretinoin and oral tetracycline. He states that he has been using both medications for
the last 3 months but there is no improvement in acne. He also states he has noticed
he is very quick to anger and moody over the last few months and wonders whether
that is a side effect of the acne medications. He is a football player for his high
school and has been participating in extra practices to "bulk up" in the hopes of
achieving a college scholarship. Upon closer inspection, he has gained 30 pounds in
the last 3 months but does not appear overweight, rather has increased muscle
mass. He states that a friend on the football team has been giving him pills to help
his performance. Which of the - ANSWER Correct Answer: C. Lowered thyroxine
binding globulin (TBG) levels
Anabolic steroids can lower thyroxine-binding globulin (TBG) levels which, in turn,
can decrease total T4 levels, although free T4 remains the same.
Incorrect Answers:
A. This patient has multiple features that are consistent with anabolic steroid use,
including acne, a rapid increase in weight and muscle mass, and mood swings. In
men steroid use decreases serum luteinizing hormone and follicle-stimulating
hormone levels, which leads to decreased endogenous testosterone production,
decreased spermatogenesis, and testicular atrophy. There is also an increased
estrogen production due to the aromatization of circulating testosterone which can
lead to gynecomastia.
B. Anabolic steroid use can lead to increased prothrombin time as well as a
suppression of clotting factors II, V, VII, and X.
D. Anabolic steroid use can have multiple cardiovascular effects including decreased
serum HDL cholesterol, increased serum LDL cholesterol, increased total
cholesterol, and increased blood pressure. These effects appear to be reversible
when anabolic steroid use is discontinued. The risk of sudden death from
cardiovascular causes can occur in an athlete abusing anabolic steroids even when
there is no evidence of atherosclerosis. This is due to an increased risk of thrombus
formation while using anabolic steroids.
A 45-year-old woman presents with abnormal uterine bleeding. You discuss your
recommendation for endometrial sampling to rule out endometrial hyperplasia and
carcinoma. What is the most common cause of endometrial cancer?
A. Human papilloma virus
B. Hereditary nonpolyposis colorectal cancer
C. Multiple endocrine neoplasia
D. Unopposed estrogen - ANSWER Correct Answer: D. Unopposed estrogen
Unopposed estrogen can lead to overgrowth of endometrial tissue, ultimately
prompting endometrial hyperplasia and endometrial cancer. Endometrial cancers
occur that are not related to estrogen exposure, which have a different pathologic
appearance and a worse prognosis. Women with anovulation or other types of
unopposed estrogen exposure should have exposure to progesterone or progestins
at least every 3 months to reduce the risk of endometrial hyperplasia and cancer.
Incorrect Answers:
