ANCC Practice Questions Domain 3
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 read other's minds. This client is most likely suffering from which personality disorder? a. Schizotypal Personality Disorder b. Schizoid Personality Disorder c. Paranoid Personality Disorder d. Delusional Personality Disorder
A
A middle-school boy repeatedly lies, steals, bully's peers, instigates fights, and inflicts harm without feeling any regret or remorse. These are characteristics of which disorder? a. Conduct disorder b. Oppositional defiant disorder c. Disruptive behavior disorder d. Antisocial personality disorder
A
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 complete a thorough evaluation? a. Blood chemistry, complete blood count, and urinalysis b. Hamilton depression scale (HAMD) score c. Patient Health Questionnaire (PHQ-9) score d. Electrocardiography and pharmacogenomics testing
A
Electroconvulsive therapy (ECT) is a treatment for depression. What adverse effect is uncommon for a patient to experience after receiving ECT treatments? a. Fractures b. Memory disturbances c. Headaches d. Muscle soreness
A
Following best practice guidelines, which pharmacologic and non-pharmacologic treatments are the best studied and have the highest level of evidence for the treatment of nightmares in adults with nightmares in adults with PTSD? a. Prazosin (Minipress) and image rehearsal therapy b. Quetiapine (Seroquel) and eye-movement desensitization and reprocessing (EMDR) c. Venlafaxine (Effexor) and hypnosis d. Clonidine (Catapres) and progressive muscle relaxation
A
Mr. Jones, a 78-year-old male patient, presents to the PMHNP for a follow-up medication appointment. Mr. Jones' depression has been successfully treated with citalopram 20 mg by mouth daily. During the visit, Mr. Jones complains that in the last 2 or 3 weeks, he has had nausea, fatigue, feeling weak, with a headache and decreased appetite. Which action would be the most appropriate for Mr. Jones? a. Assess for other symptoms of hyponatremia and check a serum sodium level b. Discuss rates of relapse on SSRI and recommend switching his medication to a different antidepressant class c. Discuss rates of relapse on an SSI and increase his medication to citalopram 40 mg by mouth daily d. Discuss SSRI discontinuation syndrome and stress the importance of medication adherence.
A
Sally is a 27-year-old attorney who recently moved to your area. Sally presents with social anxiety disorder, specifically symptoms of performance anxiety. Sally's only other medical condition is exercise-induced asthma, and she is treated on Albuterol. Sally states she was in cognitive behavioral therapy (CBT), without relief, and would like to try a medication. Which is the most suitable initial treatment for Sally? a. Sertraline (Zoloft) b. Inderal (Propranolol) c. Risperidone (Risperdal) d. Clonazepam (Klonopin)
A
When evaluating a woman with major depressive disorder, which of the following would not be a major consideration in the differential diagnosis a. Prior pregnancies b. Any episodes of hypomania c. Prior episodes of depression d. Any periods without sleep yet no fatigue
A
When suspecting a patient has NMS, which laboratory values would help confirm the diagnosis? a. Leukocytosis and elevated creatine phosphokinase b. Leukocytosis and thrombocytosis c. Leukopenia and decreased creatine phosphokinase d. Leukocytosis and thrombocytopenia
A
Which of the following antipsychotic medications has dosage formulations which include oral tablets, orally disintegrating tablets, short-acting injections, and long-acting injections? a. Olanzapine (Zyprexa) b. Ziprasidone (Geodon) c. Paliperidone (Invega) d. Clozapine (Clozaril)
A
You have a 16-year-old patient who suffers from Binge Eating Disorder. She is 5 foot 10 inches tall (70 inches) and has a BMI of 30. You consult the National Guideline Clearing House for the best information on treating the patient. Part of your treatment plan includes: a. Implementing non-diet health at every size therapy in addition to psychotherapy to help with weight stabilization and binge eating b. Treatment with Duloxetine (Cymbalta) long-term at low doses and a reduced calorie diet. It is associated with significant weight loss. c. Urine specific gravity, orthostatic vital signs, and oral temperatures taken on a regular basis. d. Use of Sibutramine (Meridia) 10 mg po QAM and a reduced calorie diet. It is associated with significant weight loss.
A
Your 37-year-old female patient suffers from schizophrenia. She has been maintained in stable condition for four years on Quetiapine (Seroquel). She tells you that her gynecologist has recommended that she have a total hysterectomy. You asked her if her gynecologist plans to prescribe hormone replacement after the total hysterectomy. She responds "no". You initiate a call to the gynecologist to discuss hormone replacement therapy a. The abrupt loss of estrogen from the ovaries can precipitate deterioration of mental state, hallucinations, delusions, and depression as well as the stress from surgical menopause. b. Consultation with the gynecologist is not needed. The hyperprolactinemia caused by the antipsychotic, Quetiapine, has already reduced estrogen production in the patient's body to a point where it is not an issue after four years on the medication. c. Consultation with the gynecologist is not needed. The patient can adapt to surgical menopause as easily as she would natural menopause. Estrogen waxes and wanes in the body naturally and plays no part in schizophrenia. d. You want to know if the gynecologist will wean the patient off her own estrogen. By suppressing the ovaries, she can be tapered off.
A
A 33-year-old female patient has been diagnosed with bipolar disorder. Before starting this patient on lithium (Eskalith) for mood stabilization, which of the following laboratory tests are appropriate to obtain for this patient? a. Thyroid function tests, creatinine, complete blood count b. Thyroid function tests, creatinine, pregnancy test c. Thyroid function tests, liver function tests, pregnancy test d. Thyroid function tests, creatinine, liver function tests
B
A 34-year-old African American female presents for an initial psychiatric evaluation. On examination, she reports she thinks she has attention deficit disorder because she has a short attention span, poor recent memory, nervousness, and mood lability, and she is sweating more. Which laboratory test should the PMHNP order to rule out an organic etiology of her symptoms? a. CMP b. Thyroid profile c. Cortisol level d. Prolactin level
B
A new patient comes to you on a medication regimen of Adderall XR 30 mg 1 po QAM, Seroquel 300 mg po QHS, Mirtazapine 45 mg po QHS, Diazepam 5 mg TID, Zolpidem 10 mg po QHS and Zolpidem 10 mg po QHS in addition if initial dose does not help the patient to sleep. You confirm the medication regimen with the patient's past records. You diagnose the patient with PTSD, Panic disorder, MDD, ADHD, and alcohol use disorder-moderate by history in recovery. You treat the patient and find that the patient is resistant to changing the past medication regimen. The patient calls you stating that the pharmacy will not refill the Zolpidem at this time. The patient wants you to rewrite the script so that the medication is available. In checking with the pharmacy, you find out that the patient has potentially used 60 tablets of Zolpidem in a 20-day period. Your best action is to: a. Refill the order for the medication. Then, send the patient for a chemical dependency evaluation. The patient is on too many sedative-type medications and is harming himself. b. Discontinue the prescription for the Zolpidem. Talk to the patient about the overuse of Zolpidem and the danger it poses to his health and wellbeing. c. Refill the order for the medication as requested. This medication has not harmed the patient so far. d. Give an order for the Zolpidem. Talk with the patient about the danger of using too much sleeping medication. Then, discontinue the medication.
B
For a patient who has a long history of opiate dependence and is newly in recovery, which of the following is most likely to aid in the treatment process? a. Acamprosate (Campral) b. Buprenorphine (Buprenex) c. Bupropion (Wellbutrin) d. Varenicline (Chantix)
B
In bipolar I disorder, men are more prone than women to have: a. Rapid cycling b. Manic episodes c. Mixed episodes d. Depressive episodes
B
In distinguishing HIV-related depression from HIV dementia, which of the following findings would be indicative of HIV dementia? a. Apathy and inertia b. Incoordination c. Decreased motivation d. Diminished attention and concentration
B
In distinguishing borderline personality disorder from chronic post-traumatic stress disorder related to childhood sexual abuse and victimization, which of the following would be more indicative of borderline personality disorder? a. Feeling of detachment or estrangement from others b. Efforts to avoid real or imagined abandonment c. Affect lability often associate with intense fear d. Irritability or intense outbursts of anger
B
In managing the maintenance phase for Bipolar I Disorder, which of the following statements is not supported by current evidence in the literature? a. Lamotrigine, but not lithium, is superior to placebo in preventing a depressive episode. b. Extended-release formulation of carbamazepine is equivalent to lithium in preventing a manic, hypomanic, or mixed episode. c. Both lamotrigine and lithium are superior to placebo in delaying onset of mood-related episodes. d. Lithium, but not lamotrigine, is superior to placebo in preventing a manic, hypomanic, or mixed episode.
B
Lorazepam is the preferred benzodiazepine when managing alcohol withdrawal symptoms if a patient with co-morbid: a. OxyContin abuse b. Hepatic disease c. Seizure disorder d. Folate-deficiency anemia
B
Making an evidence-based decision regarding implementation of an intervention includes current research evidence and all of the following except the: a. Patient's clinical status, circumstances, and preferences b. Generalizability of findings c. Clinician's expertise d. Availability of healthcare resources
B
A pervasive pattern of grandiosity, lack of empathy, and need for admiration suggests the diagnosis of which of the following personality disorders? a. Paranoid b. Borderline c. Schizotypal d. Narcissistic
D
Mr. Ready is a 58-year-old new patient at a community mental health center. He's seen by the PMHNP for depression, anxiety, and co-morbid substance use disorder, which the patient describes as effective in treatment of his symptoms. He does not have a primary care provider and does not know when he last had laboratory values drawn. Ready takes Tylenol p.r.n. for his knee pain, Prilosec OTC 20 mg BID, and has been on his current psychotropic medications for over two years: Buspirone 20 mg BID, Sertraline 200 mg po daily, and Aripiprazole 2 mg daily. What screening labs are appropriate for this patient? a. BMP, LFT, and vitamin D b. Lipid Profile, CMP, CBC, Thyroid Profile, and Vitamins B12 and D c. CBC, CMP, Lipid Profile, and Vitamin B12 d. CBC and CMP
B
The PMHNP evaluates a 3-year-old male and makes the diagnosis of attention deficit disorder Following the FDA's labeling of approved medication for children, which medication can be started in a child at age 3? a. Fluoxetine b. Amphetamines c. Methylphenidate d. Bupropion
B
When evaluating a 5-year-old child with language deficits, which of the following is a key indicator in differentiating autistic disorder from a mixed receptive-expressive language disorder. a. Imaginative play is predominant form of expression b. Language abnormalities such as echolalia are common c. Family history of speech delay or language problems d. Level of intelligence ranges from mild to severe impairment
B
Which lab test should be ordered to rule out a medical cause of dementia symptoms? a. Thiamine b. Vitamin B12 c. Albumin d. Vitamin D3
B
Which of the following atypical antipsychotic medications has U.S. FDA approval for treatment of bipolar depression when combined with fluoxetine (Prozac)? a. Quetiapine (Seroquel) b. Olanzapine (Zyprexa) c. Aripiprazole (Abilify) d. Risperidone (Risperdal)
B
Which of the following findings would raise concern in an annual exam of a 76-year-old woman? a. Fasting glucose 76 mg/dL; Hg 11.8 gm/dL; HCT 38% b. AST 85 u/L; ALT 45 u/L c. Height 65 inches; weight 140 lbs d. Blood pressure 130/86; pulse 82; respirations 25
B
Which of the following interventions does not have evidence-based findings that demonstrate reduced symptoms in individuals with non-combat related PTSD? a. Eye-movement, desensitization, and reprocessing (EMDR) b. Anticonvulsants c. Exposure-based cognitive behavior therapy (CBT) d. Selective Serotonin Reuptake Inhibitors (SSRIs)
B
Which of the following interventions have evidence-based findings to reduce co-morbid substance use in patients with schizophrenia? a. Voucher-based behavioral reinforcement b. Manualized group intervention with motivational enhancement c. Three-session individual motivational enhancement d. Psychosocial support group targeting coping skills
B
Which of the following lab findings would raise the greatest concern when prescribing lithium? a. BUN 20 mg/dL b. Serum creatinine 3.0 mg/dL c. Serum Na+ 120 mEq/L d. Glomerular Filtration Rate (GFR) 115 mL/min
B
You are seeing a client for an initial psychiatric evaluation. The client complains of persistent irritability, racing thoughts, decreased need for sleep, distractibility, episodes of unusually high energy, and auditory hallucinations. The episodes of disturbed mood last approx.. 5 days and the psychotic symptoms occur even if mood is euthymic. The most likely diagnosis is: a. Bipolar I disorder with psychotic features b. Schizoaffective disorder bipolar type c. Bipolar II disorder with psychotic features d. Schizophrenia
B
You are seeing a female patient who is morbidly obese. She also suffers from major depression, anxiety, and antidepressant-induced decreased libido. She has been stabilized on desvenlafaxine (Pristiq) 50 mg 1 po QAM and bupropion (Wellbutrin) 50 mg. She also takes Mononessa (Ortho-cyclen) 1 po QAM and Vitamin D 1000 IU po QAM. She has had trouble maintaining weight loss on a diet support programs, diet medications, and self-directed food reduction plans. She asks you about using Phentermine to help her lose weight. You discuss options with her and decide to: a. Prescribe a one-month course of phentermine (Adipex-P) 37.5 mg po QAM. Have her come back in one month for a checkup. b. Discontinue her current bupropion. Prescribe bupropion and naloxone (Contrave) 90mg/8mg for one week. Have her come back in one week for a checkup. You may have to increase the dosage at one-week intervals. c. Prescribe a one-month course of Phentermine and Topiramate (Qsymia) 7.5/46 for 30 days. Have her return to the clinic in 1 month for a checkup. d. Prescribe a 1-month course of Topiramate (Topamax) 50 mg 1 po QHS. Have the patient come back in 1 month for a checkup. Let the patient know that you may have to increase the dosage at one-month intervals.
B
A WBC of 4,000 in a patient taking clozapine would prompt the PMHNP to take3 which of the following actions? a. Consult with hematologist to determine appropriate antibiotic regimen and monitor closely b. Discontinue clozapine, initiate alternative antipsychotic medication and monitor closely c. Institute twice-weekly complete blood count with differentials and monitor closely d. Institute daily complete blood count with differentials and monitor closely
C
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? a. Latuda (lurasidone) b. Abilify (aripiprazole) c. Clozaril (clozapine) d. Invega (iloperidone)
C
After two weeks of treating a client for psychosis, the client develops symptoms of neuroleptic malignant syndrome (NMS). The following factors enable the PMHNP to differentiate NMS from serotonin syndrome: a. Autonomic instability, diaphoresis, tremors b. Rigidity, hyperreflexia, orthostatic hypotension c. Mutism, leukocytosis, myoglobinuria d. Hyperthermia, leukopenia, tachycardia
C
In distinguishing between dementia and pseudodementia which of the following findings would be expected in a patient with pseudodementia? a. Struggle to perform tasks b. Nocturnal accentuation of dysfunction common c. "Don't know" answers typical d. Attention and concentration usually faulty
C
The PMHNP treating a patient for schizophrenia on ziprasidone orders and EKG. Which QTc interval result places the patient at greatest risk for torsade's de points? a. 160-260 milliseconds b. 300-500 milliseconds c. 500-700 milliseconds d. 100-200 milliseconds
C
When counseling a 52-year-old perimenopausal woman with nocturnal hot flashes, anxiety, depressed mood, low energy, little motivation, diminished sex drive, and work-related stress, what lifestyle changes and complementary therapies would be evidence-based recommendations to consider when this patient does not want to be on hormone replacement or antidepressant medication? a. Yoga, isoflavinoids, and black cohosh b. Walking, St. John's Wort, and black cohosh c. Tai chi, dietary soy, and flaxseed d. Current evidence does not support the efficacy of complementary therapies for perimenopausal or depressive symptoms
C
Which is the only medication that is approved by the U.S. FDA to treat depression in children? a. Paroxetine (Paxil) b. Sertraline (Zoloft) c. Fluoxetine (Prozac) d. Citalopram (Celexa)
C
Which of the following is not characteristic of individuals with antisocial personality disorder (APD)? a. APD is five times more common in first-degree biologic relatives for men b. APD is strongly associated with alcohol and drug abuse c. APD is identified predominantly in European and Western industrialized countries d. APD is correlated with low dopamine levels in the frontal cortex implicated in aggression and impulsivity
C
Your patient suffers from insomnia and bipolar disorder. She tells you that she likes to take her Lurasidone 20 mg (Latuda) at bedtime because it is easier for her to remember. She does not like to gain weight so she eats two 90-calorie packages of ham slices with the Lurasidone before she goes to bed. She complains of not being able to go to sleep very quickly. You respond: a. Improve your sleep hygiene, and continue to eat the ham at bedtime b. I will increase the Lurasidone dosage to 40 mg at bedtime to increase the soporific component c. I recommend that you take in 360 calories of carbohydrates at bedtime to induce sleepiness d. Increase the ham so that you are taking in 360 calories for full absorption
C
An 8-year-old boy is referred to you by his school nurse because he has been complaining of stomach aches every morning in school for the past month. When interviewing the boy's mother, she states that he does not like to go to school, insists on coming home immediately after school, and sleeps with his parents at night. The mother denies any other complaints. Which of the following is the most likely diagnosis? a. Reactive attachment disorder b. Posttraumatic stress disorder c. Social phobia d. Separation anxiety disorder
D
Clozapine is associated with severe neutropenia (absolute neutrophil count (ANC) less than 500/?L). The requirements to prescribe, dispense, and receive Clozapine are incorporated into a single, shared program called the Clozapine Risk Evaluation and Mitigation Strategy (REMS). Who implement the Clozapine Risk Evaluation and Mitigation Strategy (REMS)? a. A Federal Drug Administration (FDA) b. Centers for Disease Control and Prevention (CDC) c. Health and Human Services d. The manufactures of Clozapine (Clozaril)
D
In distinguishing between cortical and subcortical dementias, which of the following findings would be indicative of subcortical dementia? a. Late dysarthria b. Early aphasia c. Euthymic mood d. Early gait disturbances
D
A 20-year-old male with no previous psychiatric history arrives at the emergency room with his college roommate. The roommate reports that the patient has been acting erratic for the past month, talking to people who do not exist, walking around naked, and accusing the roommate of spying on him. The patient's vital signs are WNL and his neur9ological examination does not show any abnormalities. The most important first laboratory test would be which of the following? a. Complete blood count b. Non contrast CT scan of the brain c. Liver function tests d. Toxicology test
D
A PMHNP treating a 32-year-old woman after hospitalization for postpartum psychosis after the birth of her first child needs to consider which as the most important risk factor when monitoring her response to treatment? a. As many as two thirds of patients have a second episode of an underlying affective disorder during the year after the baby's birth b. Incidence of postpartum psychosis is about 1 to 2 per 1,000 childbirths and 50 t 60 percent of affected women have just had their first child c. Subsequent pregnancies are associated with increased risk of another episode, as high as 50 percent d. Data suggest that an episode of postpartum psychosis is essentially an episode of a mood disorder and is usually an indicator of bipolar disorder
D
A patient being treated for major depressive disorder and on sertraline (Zoloft), 150 mg po daily for the past 16 months, presents to the psychiatric mental health nurse practitioner for an outpatient follow-up visit. During the visit, the patient states she has not been feeling well, reporting the flu. She also states she has not taken her medication in the last five days. Which of the following symptoms would she be describing if you suspect SSRI discontinuation syndrome? a. Agitation, diaphoresis, tremor, and ataxia b. Restlessness, tremor, fever, and shivering c. Restlessness, headache, increased heart rate, and diarrhea d. Agitation, nausea, dysphoria, and disequilibrium
D
A patient presents for a clinic appointment and tells the PMHNP, "My depression is a little better, but I read about acupuncture, and I want to add this to my treatment." What is the PMHNP's best response to this patient? a. Integrative therapies have no effectiveness in improving depressive symptoms, ad if your depression has not improved ad you have not achieved remission of your symptoms, I recommend that we increase your antidepressant b. Acupuncture is one of many integrative therapies, but it has the least effectiveness in improving depression c. Integrative therapies such as acupuncture are not well studied, and I cannot recommend that you add this to your current treatment d. Acupuncture has been found to help some individuals with depression. While the data is limited, if this is something you would like to consider, let's talk about where you might find a reputable practitioner for acupuncture treatments
D
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? a. If the research is published in a peer-reviewed journal such as the American Journal of Psychiatry, it is sound research b. Analyze the original study only to determine that the research is sound and meets the criteria for effectiveness of an intervention c. Determine if any other psychiatric or medical journal articles have commented on the validity or generalizability of the original study d. Analyze the original and repeat studies for methodical rigor and verify that there were randomized and non-randomized clinical trials with the same results.
D
Risk reduction for a 22-year-old patient with schizophrenia taking olanzapine includes patient education on daily exercise, balanced nutrition, and baseline and periodic monitoring of BP, weight, BMI, and: a. Fasting lipid panel, EKG, liver enzymes b. Fasting glucose, fasting lipid panel, electrolytes c. Waist circumference, fasting lipid panel, EKG, prolactin level d. Waist circumference, fasting glucose, fasting lipid profile.
D