ANCC IQ domain 3 Exam
Questions with Complete
Solutions
1. The PMHNP treating a patient for schizophrenia on ziprasidone orders an electrocardiogram. Which
QTc interval result places the patient at greatest risk for torsades de pointes?
- 300-500 milliseconds
- 500-700 milliseconds
- 160-260 milliseconds
- 100-200 milliseconds - Correct Answers: - 500-700 milliseconds
Rationale: A patient with a QTc interval of 500-700 milliseconds is at higher risk of developing torsades
de pointes.
1. A patient with a diagnosis of schizophrenia has a history of suicidal ideation and suicide attempts. The
PMHNP should consider which antipsychotic medication that is the only known antipsychotic to reduce
the risk of suicide in schizophrenia?
- Invega (iloperidone)
- Abilify (aripiprazole)
- Latuda (lurasidone)
- Clozaril (clozapine) - Correct Answers: - Clozaril (clozapine)
Rationale: Clozaril (clozapine) is the only known antipsychotic medication that has been shown to
reduce the risk of suicide in patients diagnosed with schizophrenia.
1. A WBC of 4,000 in a patient taking clozapine would prompt the PMHNP to take which of the following
actions?
- Discontinue clozapine, initiate alternative antipsychotic medication and monitor closely.
- Institute daily complete blood count with differentials and monitor closely.
- Consult with hematologist to determine appropriate antibiotic regimen and monitor closely.
- Institute twice-weekly complete blood count with differentials and monitor closely. - Correct Answers:
- Institute twice-weekly complete blood count with differentials and monitor closely.
,Rationale: The recommended cut-points for discontinuation of clozapine are WBC of 2,000 to 3,000 or
granulocytes of 1,000 to 1,500 for agranulocytosis and severely compromised immune system. At a WBC
of 4,000, the recommendation is to closely monitor CBC with differential twice a week while patient may
continue clozapine in the absence of any other signs or symptoms.
1. When evaluating a woman with major depressive disorder, which of the following would not be a
major consideration in the differential diagnosis?
- Prior episodes of depression
- Any episodes of hypomania
- Any periods without sleep yet no fatigue
- Prior pregnancies - Correct Answers: - Prior pregnancies
Rationale: The primary concern is to rule out bipolar disorder whenever making diagnosis of major
depressive disorder. Asking about any prior episodes of mania, hypomania, and extended periods of 2-3
days with little to no sleep while still not feeling fatigued, or period of heightened energy lasting several
days without fatigue are indicative of possible bipolar disorder. Asking about prior episodes of
depression, mood swings, and chronic irritability is also indicated. Prior pregnancies are not the relevant
information needed, but whether she experienced any episodes of postpartum depression and the
severity of any episodes.
1. Electroconvulsive therapy (ECT) is a treatment of depression. What adverse effect is uncommon for a
patient to experience after receiving ECT treatments?
- Muscle soreness
- Headaches
- Fractures
- Memory disturbance - Correct Answers: - Fractures
Rationale: Headaches, memory disturbance, and muscle soreness are common immediately after ECT
treatment.
1. An 88-year-old nursing home patient presents to the emergency department with recent mental
status changes, including aggression, confusion, and dizziness, over the past two days. The patient
scored a 20 on the MINI-Mental Status Exam (MMSE). In addition to the MMSE, what additional
information is needed to conduct a thorough evaluation?
- Blood chemistry, complete blood count, and urinalysis
- Patient Health Questionnaire (PHQ-9) score
, - Hamilton Depression Scale (HAM-D) score
- Electrocardiography and pharmacogenomics testing - Correct Answers: - Blood chemistry, complete
blood count, and urinalysis
Rationale: A bedside MMSE can be used to document the cognitive impairment and to provide a
baseline form which to measure the patient's clinical course. The laboratory workup of a patient should
include standard tests (i.e., blood chemistries, CBC, urinalysis) and additional studies indicated by the
clinical situation.
1. A client says that because he wished his sister was dead, and your client's sister subsequently was
killed in a motor vehicle accident, the death was caused by the client's wishes. The client also revealed
that he can reach other's minds. This client is most likely suffering from which personality disorder?
- Paranoid personality disorder
- Schizotypal personality disorder
- Schizoid personality disorder
- Delusional personality disorder - Correct Answers: - Schizotypal personality disorder
Rationale: Schizotypal personality disorder is characterized by ideas of reference and magical thinking.
1. In the American Journal of Psychiatry, you read an article that discusses a recent study's evidence that
the nicotine exposure in pregnant women increases the risk for schizophrenia in offspring (i.e., 38%
increased likelihood of schizophrenia in young adults whose mothers smoked heavily while pregnant).
This inspires you to translate this information in practice and teaching roles as a nurse practitioner.
What considerations are needed to translate this in to practice based on the best evidence?
- Determine if any other psychiatric or medical journal articles have commented on the validity or
generalizability of the original stud.
- If the research is published in a peer-reviewed journal such as the American Journal of Psychiatry, it is
sound research.
- Analyze the original and repeat studies for methodical rigor and verify that there were randomized or
non-randomized clinical trials with the same results.
- Ana - Correct Answers: - Analyze the original and repeat studies for methodical rigor and verify that
there were randomized or non-randomized clinical trials with the same results.
Rationale: Research Utilization begins with the idea of putting an innovation to use in practice. The level
of the evidence must be considered. The best of the best evidence comes from reviewing several
randomized clinical trials of the same thing with the same results. Second to that are several non-
randomized trials about the same thing with the same results. Single randomized or non-randomized
trials make up level 2 evidence regarding the effectiveness of an intervention.
Questions with Complete
Solutions
1. The PMHNP treating a patient for schizophrenia on ziprasidone orders an electrocardiogram. Which
QTc interval result places the patient at greatest risk for torsades de pointes?
- 300-500 milliseconds
- 500-700 milliseconds
- 160-260 milliseconds
- 100-200 milliseconds - Correct Answers: - 500-700 milliseconds
Rationale: A patient with a QTc interval of 500-700 milliseconds is at higher risk of developing torsades
de pointes.
1. A patient with a diagnosis of schizophrenia has a history of suicidal ideation and suicide attempts. The
PMHNP should consider which antipsychotic medication that is the only known antipsychotic to reduce
the risk of suicide in schizophrenia?
- Invega (iloperidone)
- Abilify (aripiprazole)
- Latuda (lurasidone)
- Clozaril (clozapine) - Correct Answers: - Clozaril (clozapine)
Rationale: Clozaril (clozapine) is the only known antipsychotic medication that has been shown to
reduce the risk of suicide in patients diagnosed with schizophrenia.
1. A WBC of 4,000 in a patient taking clozapine would prompt the PMHNP to take which of the following
actions?
- Discontinue clozapine, initiate alternative antipsychotic medication and monitor closely.
- Institute daily complete blood count with differentials and monitor closely.
- Consult with hematologist to determine appropriate antibiotic regimen and monitor closely.
- Institute twice-weekly complete blood count with differentials and monitor closely. - Correct Answers:
- Institute twice-weekly complete blood count with differentials and monitor closely.
,Rationale: The recommended cut-points for discontinuation of clozapine are WBC of 2,000 to 3,000 or
granulocytes of 1,000 to 1,500 for agranulocytosis and severely compromised immune system. At a WBC
of 4,000, the recommendation is to closely monitor CBC with differential twice a week while patient may
continue clozapine in the absence of any other signs or symptoms.
1. When evaluating a woman with major depressive disorder, which of the following would not be a
major consideration in the differential diagnosis?
- Prior episodes of depression
- Any episodes of hypomania
- Any periods without sleep yet no fatigue
- Prior pregnancies - Correct Answers: - Prior pregnancies
Rationale: The primary concern is to rule out bipolar disorder whenever making diagnosis of major
depressive disorder. Asking about any prior episodes of mania, hypomania, and extended periods of 2-3
days with little to no sleep while still not feeling fatigued, or period of heightened energy lasting several
days without fatigue are indicative of possible bipolar disorder. Asking about prior episodes of
depression, mood swings, and chronic irritability is also indicated. Prior pregnancies are not the relevant
information needed, but whether she experienced any episodes of postpartum depression and the
severity of any episodes.
1. Electroconvulsive therapy (ECT) is a treatment of depression. What adverse effect is uncommon for a
patient to experience after receiving ECT treatments?
- Muscle soreness
- Headaches
- Fractures
- Memory disturbance - Correct Answers: - Fractures
Rationale: Headaches, memory disturbance, and muscle soreness are common immediately after ECT
treatment.
1. An 88-year-old nursing home patient presents to the emergency department with recent mental
status changes, including aggression, confusion, and dizziness, over the past two days. The patient
scored a 20 on the MINI-Mental Status Exam (MMSE). In addition to the MMSE, what additional
information is needed to conduct a thorough evaluation?
- Blood chemistry, complete blood count, and urinalysis
- Patient Health Questionnaire (PHQ-9) score
, - Hamilton Depression Scale (HAM-D) score
- Electrocardiography and pharmacogenomics testing - Correct Answers: - Blood chemistry, complete
blood count, and urinalysis
Rationale: A bedside MMSE can be used to document the cognitive impairment and to provide a
baseline form which to measure the patient's clinical course. The laboratory workup of a patient should
include standard tests (i.e., blood chemistries, CBC, urinalysis) and additional studies indicated by the
clinical situation.
1. A client says that because he wished his sister was dead, and your client's sister subsequently was
killed in a motor vehicle accident, the death was caused by the client's wishes. The client also revealed
that he can reach other's minds. This client is most likely suffering from which personality disorder?
- Paranoid personality disorder
- Schizotypal personality disorder
- Schizoid personality disorder
- Delusional personality disorder - Correct Answers: - Schizotypal personality disorder
Rationale: Schizotypal personality disorder is characterized by ideas of reference and magical thinking.
1. In the American Journal of Psychiatry, you read an article that discusses a recent study's evidence that
the nicotine exposure in pregnant women increases the risk for schizophrenia in offspring (i.e., 38%
increased likelihood of schizophrenia in young adults whose mothers smoked heavily while pregnant).
This inspires you to translate this information in practice and teaching roles as a nurse practitioner.
What considerations are needed to translate this in to practice based on the best evidence?
- Determine if any other psychiatric or medical journal articles have commented on the validity or
generalizability of the original stud.
- If the research is published in a peer-reviewed journal such as the American Journal of Psychiatry, it is
sound research.
- Analyze the original and repeat studies for methodical rigor and verify that there were randomized or
non-randomized clinical trials with the same results.
- Ana - Correct Answers: - Analyze the original and repeat studies for methodical rigor and verify that
there were randomized or non-randomized clinical trials with the same results.
Rationale: Research Utilization begins with the idea of putting an innovation to use in practice. The level
of the evidence must be considered. The best of the best evidence comes from reviewing several
randomized clinical trials of the same thing with the same results. Second to that are several non-
randomized trials about the same thing with the same results. Single randomized or non-randomized
trials make up level 2 evidence regarding the effectiveness of an intervention.
