ANCC IQ domain 2 Exam
Questions with Complete
Solutions
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. - Correct Answers: - 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 - Correct Answers: - 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 - Correct Answers: - 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 - Correct Answers: -
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 an - Correct Answers: - 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 - Correct Answers: - 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.
Questions with Complete
Solutions
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. - Correct Answers: - 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 - Correct Answers: - 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 - Correct Answers: - 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 - Correct Answers: -
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 an - Correct Answers: - 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 - Correct Answers: - 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.
