ANCC DOMAIN 1-5 QUESTIONS AND ANSWERS
A newly graduated nurse practitioner (NP) wants to open a private psychiatric practice
in her hometown. She wants to find out about the laws that cover her responsibility and
the legal liability that this practice will encounter for her as an independent psychiatric
nurse practitioner. Her best source of information is:
A. The State Statues on Nursing or Advanced Nursing Practice
B. Her city statutes
C. Local Psychiatric Nurse Practitioners in practice
D. The American Academy of Nurse practitioners - Answers -A. The State Statues on
Nursing or Advanced Nursing Practice
Which of the following best depicts the Psychiatric-Mental Health Nurse Practitioner in a
grassroots mental health advocacy role?
A. Attending a town hall meeting to seek timely police response to rising domestic
violence crisis calls.
B. Working on the campaign of an individual running for the state senate.
C. Assisting with depression screening at a health fair in a local shopping mall
D. Meeting states legislators during RN lobbying day organized by the state nurses'
association - Answers -A. Attending a town hall meeting to seek timely police response
to rising domestic violence crisis calls.
A frail 76 y/o woman with Alzheimer's type dementia in a skilled nursing facility has
been increasingly agitated, combative, and has struck out at other patients in the dining
room and at staff attempting to care for her. What would be the most appropriate initial
intervention by the consulting Psychiatric-Mental Health Nurse Practitioner who receives
a call from the nursing staff requesting medication and restraint orders?
A. Order close observation by staff in quiet area secluded from other patients until you
can evaluate in person
B. Order soft wrist and vest restraints until you can evaluate in person
C. Order short-acting benzodiazepine and close observation until you can evaluate in
person
D. Order low-dose atypical antipsychotic and soft vest restraint until you can evaluate in
person - Answers -A. Order close observation by staff in quiet area secluded from other
patients until you can evaluate in person
You frequently use your iPhone/smart phone to connect with your office, the pharmacy
and patients. These multifunction devices assist you in your practice. What needs to
happen to the protected/private health information on your phone after you conclude a
healthcare interaction?
A. You document an abbreviated note of the phone conversation
B. You document that you had a telephone interaction only
C. You document it briefly, only if it is important
D. You document it fully in the patient record as a patient interaction - Answers -D. You
document it fully in the patient record as a patient interaction
,A Psychiatric-Mental Nurse Practitioner practices in a state requiring a collaborating
psychiatrist. The Psychiatric-Mental Health Nurse Practitioner review all new and
complex cases with the psychiatrist on a monthly basis. A young adult patient with
recurrent depression has been under the care of the Psychiatric-Mental Health Nurse
Practitioner for 3 months when she commits suicide. The family sues for wrongful death.
Who is legally responsible for this patient's care in a court of law?
A. Equal responsibility of Psychiatric-Mental Health Nurse Practitioner and psychiatrist
B. Psychiatrist
C. Primary responsibility of Psychiatric-Mental health Nurse Practitioner and secondary
responsibility of psychiatrist
D. Psychiatric-Mental Health Nurse Practitioner - Answers -D. Psychiatric-Mental Health
Nurse Practitioner
The Nurse Practitioner (NP) is seeing a patient for both psychiatric and chemical
dependency illnesses. The patient wants the NP to send medical records to his General
Practitioner. The NP tells the patient that because of Federal Law 42 CFR he must:
A. Sign two separate releases of information due to the special protected nature of
chemical dependency information
B. Sign once combined release that does not mention his chemical dependency illness
due to its special protected nature
C. Sign two separate releases due to the special protected nature of psychiatric
information
D. Sign one combined release that designated that he is being treated for both chemical
dependency and psychiatric illnesses - Answers -A. Sign two separate releases of
information due to the special protected nature of chemical dependency information
You see a patient for a routine medication visit. At the end of the session, the patient
asks questions and the session ends up 50 minutes in length. You normally charge for
the 30-minute appointment, but instead you charge for the 1-hour appointment. The 1-
hour appointment included a full body assessment that you did not perform. This is
violation is known as:
A. Up-coding
B. Over-coding
C. Down-coding
D. Super-coding - Answers -A. Up-coding
The nurse practitioner (NP) is on an airplane and the flight attendant asks if there is a
medical professional on the flight. The NP agrees to help. The NP is presented with a
young woman who is suffering from a severe panic attack. The woman is nauseated
and lying on the floor of the plane. The woman has trouble communicating much more
than she is upset, afraid and her husband is a few airplane stops away at an air force
base where she is headed. The woman's pulse is 89 and regular, her respirations are
18 and regular. The woman occasionally pants and vomits some pale brown liquid. You
provide information to the flight medical doctor on call. At the destination, the flight
attendant offers to give you some Alprazolam 0.5mg to give to the patient. You:
,A. Give her the alprazolam to help her calm down until you get to the destination. Then,
she can go to the hospital.
B. Give her the alprazolam so that she calm down a - Answers -D. Do not give the
medication. Instead, wait until the plane lands and a full evaluation can be completed at
the local hospital
A 45 y/o woman with Type 1 Bipolar Disorder experiencing an acute episode of
depression with psychotic features requires a temporary leave of absence from her job
as an administrative assistant to a school principal. The patient has signed a release of
information for the Psychiatric-mental Health Nurse Practitioner to disclose full mental
health records to the principal and the human resources department to facilitate her
gradual return to work. The patient fears that she will lose her job due to her psychiatric
disorder. What is the most appropriate information the Psychiatric-Mental Health Nurse
Practitioner can provide in this situation?
A. Employers cannot discriminate against individuals with a mental health disorder,
which is considered a disability covered by the Americans with Disabilities Act of 1990
B. Employers cannot discriminate against individuals with a mental health disorder,
which is protected as co - Answers -A. Employers cannot discriminate against
individuals with a mental health disorder, which is considered a disability covered by the
Americans with Disabilities Act of 1990
Outcomes measurement is the collecting and reporting of data about the effect of an
intervention. Purposes of outcome measurement include all of the following except:
A. To observe errors in data reporting of an intervention
B. To analyze the effectiveness of an intervention
C. To profile practice patterns of providers
D. To suggest changes in treatment - Answers -A. To observe errors in data reporting of
an intervention
A 37 y/o male with schizophrenia, paranoid type, lives in supervised housing and is
followed by the Assertive Community Treatment Team through a Community Mental
Health Center (CMHC) where the Psychiatric-Mental Health Nurse Practitioner notes
that he has refused to see any primary care provider (PCP) during the past several
years despite efforts by case managers to accompany him to medical visits. He has
gained 30 pounds in past three years on clozapine since his last inpatient
hospitalization. His WBC and ANC counts remain within normal limits, but he has
elevated cholesterol, lipids, and A1C levels. What is the most appropriate intervention to
facilitate care for this patient?
A. Advise the patient that he needs to see a PCP to treat his elevated cholesterol and
blood sugar levels and ask what has prevented him from seeing a PCP when referred in
the past
B. Advise the patient that he needs to see a PCP to treat hi - Answers -C. Explain the
health risks of his elevated cholesterol and blood sugar levels and separately ask the
patient and case manager what has prevented him from seeing PCP when referred in
past
, Your patient is a 40 y/o male who has suffered from depression since he was age 21.
He has tried numerous antidepressant medications and combinations of medications to
no avail. There is a response but no recovery for this patient. He is currently taking
Duloxetine 120 mg 1 PO Q am with a response. You prescribe a new medication to help
with resistant depression, Brexpiprasole (rexulti) 0.5mg 1 PO Q am. He tries samples of
the medication for 1 month and he experiences recovery from depression. When he
takes the prescription to the pharmacy, he finds that his insurance will not cover the cost
of the medication sufficiently. The patient tells you that he just cannot afford the
medication and wants to stop it. What do you do?
A. Refer the patient to a psychiatrist because you cannot help him
B. The patient is not in danger of self-harm and has the right to define his own health.
Continue to research other medications th - Answers -B. The patient is not in danger of
self-harm and has the right to define his own health. Continue to research other
medications that will help him.
A 68 y/o retired African-American widower who served for 30 years as an Army officer
was recently diagnosed with terminal lung cancer. He made plans to die at home with
hospice care. He was hospitalized for a broken hip and succumbed to complications in
the hospital. Despite his request to be addressed as "Mr. Baxter" the hospital staff
persisted in calling him by his first name, "john". Which principle of culturally competent
care foes this violate?
A. autonomy
B. collaboration
C. advocacy
D. Respect - Answers -D. Respect
A colleague emails on the company computer system regarding complaints about
another coworker. In the message, the colleague makes several disparaging remarks
about the other coworker and the difficulty of working with her. You reply:
A. I understand your feelings, just put up with it. You are going to another shift in one
month and will leave the problem behind.
B. Did you talk with her about the issue you have with her? Saying bad things about
your co-worker will not solve the problem or make it better.
C. She is just not doing things the way we were taught. She can't help it if she is not us,
but she could try harder!
D. Really, I cannot believe that you get so upset over that little stuff. Help her
understand where she is making a mistake and teach her how to do things correctly -
Answers -B. Did you talk with her about the issue you have with her? Saying bad things
about your co-worker will not solve the problem or make it better.
The initial advanced practice role for Psychiatric Mental Health nurses was the Clinical
Nurse Specialist (CNS) that worked as a therapist and educator. Later, the Psychiatric
Mental Health Nurse Practitioner role was developed to serve the need of a primary
care psychiatric provider that could perform evaluations and medication management
services in hospitals and other venues. As of 2015, the Consensus Model for Advanced
A newly graduated nurse practitioner (NP) wants to open a private psychiatric practice
in her hometown. She wants to find out about the laws that cover her responsibility and
the legal liability that this practice will encounter for her as an independent psychiatric
nurse practitioner. Her best source of information is:
A. The State Statues on Nursing or Advanced Nursing Practice
B. Her city statutes
C. Local Psychiatric Nurse Practitioners in practice
D. The American Academy of Nurse practitioners - Answers -A. The State Statues on
Nursing or Advanced Nursing Practice
Which of the following best depicts the Psychiatric-Mental Health Nurse Practitioner in a
grassroots mental health advocacy role?
A. Attending a town hall meeting to seek timely police response to rising domestic
violence crisis calls.
B. Working on the campaign of an individual running for the state senate.
C. Assisting with depression screening at a health fair in a local shopping mall
D. Meeting states legislators during RN lobbying day organized by the state nurses'
association - Answers -A. Attending a town hall meeting to seek timely police response
to rising domestic violence crisis calls.
A frail 76 y/o woman with Alzheimer's type dementia in a skilled nursing facility has
been increasingly agitated, combative, and has struck out at other patients in the dining
room and at staff attempting to care for her. What would be the most appropriate initial
intervention by the consulting Psychiatric-Mental Health Nurse Practitioner who receives
a call from the nursing staff requesting medication and restraint orders?
A. Order close observation by staff in quiet area secluded from other patients until you
can evaluate in person
B. Order soft wrist and vest restraints until you can evaluate in person
C. Order short-acting benzodiazepine and close observation until you can evaluate in
person
D. Order low-dose atypical antipsychotic and soft vest restraint until you can evaluate in
person - Answers -A. Order close observation by staff in quiet area secluded from other
patients until you can evaluate in person
You frequently use your iPhone/smart phone to connect with your office, the pharmacy
and patients. These multifunction devices assist you in your practice. What needs to
happen to the protected/private health information on your phone after you conclude a
healthcare interaction?
A. You document an abbreviated note of the phone conversation
B. You document that you had a telephone interaction only
C. You document it briefly, only if it is important
D. You document it fully in the patient record as a patient interaction - Answers -D. You
document it fully in the patient record as a patient interaction
,A Psychiatric-Mental Nurse Practitioner practices in a state requiring a collaborating
psychiatrist. The Psychiatric-Mental Health Nurse Practitioner review all new and
complex cases with the psychiatrist on a monthly basis. A young adult patient with
recurrent depression has been under the care of the Psychiatric-Mental Health Nurse
Practitioner for 3 months when she commits suicide. The family sues for wrongful death.
Who is legally responsible for this patient's care in a court of law?
A. Equal responsibility of Psychiatric-Mental Health Nurse Practitioner and psychiatrist
B. Psychiatrist
C. Primary responsibility of Psychiatric-Mental health Nurse Practitioner and secondary
responsibility of psychiatrist
D. Psychiatric-Mental Health Nurse Practitioner - Answers -D. Psychiatric-Mental Health
Nurse Practitioner
The Nurse Practitioner (NP) is seeing a patient for both psychiatric and chemical
dependency illnesses. The patient wants the NP to send medical records to his General
Practitioner. The NP tells the patient that because of Federal Law 42 CFR he must:
A. Sign two separate releases of information due to the special protected nature of
chemical dependency information
B. Sign once combined release that does not mention his chemical dependency illness
due to its special protected nature
C. Sign two separate releases due to the special protected nature of psychiatric
information
D. Sign one combined release that designated that he is being treated for both chemical
dependency and psychiatric illnesses - Answers -A. Sign two separate releases of
information due to the special protected nature of chemical dependency information
You see a patient for a routine medication visit. At the end of the session, the patient
asks questions and the session ends up 50 minutes in length. You normally charge for
the 30-minute appointment, but instead you charge for the 1-hour appointment. The 1-
hour appointment included a full body assessment that you did not perform. This is
violation is known as:
A. Up-coding
B. Over-coding
C. Down-coding
D. Super-coding - Answers -A. Up-coding
The nurse practitioner (NP) is on an airplane and the flight attendant asks if there is a
medical professional on the flight. The NP agrees to help. The NP is presented with a
young woman who is suffering from a severe panic attack. The woman is nauseated
and lying on the floor of the plane. The woman has trouble communicating much more
than she is upset, afraid and her husband is a few airplane stops away at an air force
base where she is headed. The woman's pulse is 89 and regular, her respirations are
18 and regular. The woman occasionally pants and vomits some pale brown liquid. You
provide information to the flight medical doctor on call. At the destination, the flight
attendant offers to give you some Alprazolam 0.5mg to give to the patient. You:
,A. Give her the alprazolam to help her calm down until you get to the destination. Then,
she can go to the hospital.
B. Give her the alprazolam so that she calm down a - Answers -D. Do not give the
medication. Instead, wait until the plane lands and a full evaluation can be completed at
the local hospital
A 45 y/o woman with Type 1 Bipolar Disorder experiencing an acute episode of
depression with psychotic features requires a temporary leave of absence from her job
as an administrative assistant to a school principal. The patient has signed a release of
information for the Psychiatric-mental Health Nurse Practitioner to disclose full mental
health records to the principal and the human resources department to facilitate her
gradual return to work. The patient fears that she will lose her job due to her psychiatric
disorder. What is the most appropriate information the Psychiatric-Mental Health Nurse
Practitioner can provide in this situation?
A. Employers cannot discriminate against individuals with a mental health disorder,
which is considered a disability covered by the Americans with Disabilities Act of 1990
B. Employers cannot discriminate against individuals with a mental health disorder,
which is protected as co - Answers -A. Employers cannot discriminate against
individuals with a mental health disorder, which is considered a disability covered by the
Americans with Disabilities Act of 1990
Outcomes measurement is the collecting and reporting of data about the effect of an
intervention. Purposes of outcome measurement include all of the following except:
A. To observe errors in data reporting of an intervention
B. To analyze the effectiveness of an intervention
C. To profile practice patterns of providers
D. To suggest changes in treatment - Answers -A. To observe errors in data reporting of
an intervention
A 37 y/o male with schizophrenia, paranoid type, lives in supervised housing and is
followed by the Assertive Community Treatment Team through a Community Mental
Health Center (CMHC) where the Psychiatric-Mental Health Nurse Practitioner notes
that he has refused to see any primary care provider (PCP) during the past several
years despite efforts by case managers to accompany him to medical visits. He has
gained 30 pounds in past three years on clozapine since his last inpatient
hospitalization. His WBC and ANC counts remain within normal limits, but he has
elevated cholesterol, lipids, and A1C levels. What is the most appropriate intervention to
facilitate care for this patient?
A. Advise the patient that he needs to see a PCP to treat his elevated cholesterol and
blood sugar levels and ask what has prevented him from seeing a PCP when referred in
the past
B. Advise the patient that he needs to see a PCP to treat hi - Answers -C. Explain the
health risks of his elevated cholesterol and blood sugar levels and separately ask the
patient and case manager what has prevented him from seeing PCP when referred in
past
, Your patient is a 40 y/o male who has suffered from depression since he was age 21.
He has tried numerous antidepressant medications and combinations of medications to
no avail. There is a response but no recovery for this patient. He is currently taking
Duloxetine 120 mg 1 PO Q am with a response. You prescribe a new medication to help
with resistant depression, Brexpiprasole (rexulti) 0.5mg 1 PO Q am. He tries samples of
the medication for 1 month and he experiences recovery from depression. When he
takes the prescription to the pharmacy, he finds that his insurance will not cover the cost
of the medication sufficiently. The patient tells you that he just cannot afford the
medication and wants to stop it. What do you do?
A. Refer the patient to a psychiatrist because you cannot help him
B. The patient is not in danger of self-harm and has the right to define his own health.
Continue to research other medications th - Answers -B. The patient is not in danger of
self-harm and has the right to define his own health. Continue to research other
medications that will help him.
A 68 y/o retired African-American widower who served for 30 years as an Army officer
was recently diagnosed with terminal lung cancer. He made plans to die at home with
hospice care. He was hospitalized for a broken hip and succumbed to complications in
the hospital. Despite his request to be addressed as "Mr. Baxter" the hospital staff
persisted in calling him by his first name, "john". Which principle of culturally competent
care foes this violate?
A. autonomy
B. collaboration
C. advocacy
D. Respect - Answers -D. Respect
A colleague emails on the company computer system regarding complaints about
another coworker. In the message, the colleague makes several disparaging remarks
about the other coworker and the difficulty of working with her. You reply:
A. I understand your feelings, just put up with it. You are going to another shift in one
month and will leave the problem behind.
B. Did you talk with her about the issue you have with her? Saying bad things about
your co-worker will not solve the problem or make it better.
C. She is just not doing things the way we were taught. She can't help it if she is not us,
but she could try harder!
D. Really, I cannot believe that you get so upset over that little stuff. Help her
understand where she is making a mistake and teach her how to do things correctly -
Answers -B. Did you talk with her about the issue you have with her? Saying bad things
about your co-worker will not solve the problem or make it better.
The initial advanced practice role for Psychiatric Mental Health nurses was the Clinical
Nurse Specialist (CNS) that worked as a therapist and educator. Later, the Psychiatric
Mental Health Nurse Practitioner role was developed to serve the need of a primary
care psychiatric provider that could perform evaluations and medication management
services in hospitals and other venues. As of 2015, the Consensus Model for Advanced
