ANCC PMHNP Domains 1-5 Comprehensive Resource To Help You Ace 2026-2027 Exams Includes
Frequently Tested Questions With ELABORATED 100% Correct COMPLETE SOLUTIONS
Guaranteed Pass First Attempt!! Current Update!!
- Meperidine is prohibited when a patient is taking an
MAOI (Selegiline) due to risk of HTN crisis and death.
Mr. Smith is going in for an elective surgical procedure.
Rationale: Meperidine is strictly prohibited when a patient
He is currently taking Selegiline. Which medication is he
is treated on a monoamine oxidase inhibitor (MAOI), due
not able to take?
to the risk of hypertensive crisis and death.
-Morphine
-Codeine Hypertensive crisis and death can also occur when MAOIs
-NSAIDs are taken in conjunction with certain medications: meperi-
-Meperidine dine (demerol), decongestants, TCAs, atypical antipsy-
chotics, st johns wort, l-tryptophan, stimulants (and other
sympathomimetics), asthma medications
17-year-old female presents to your clinic reporting anhe-
donia, decreased energy, and hopelessness for the past
2 years. She denies drinking alcohol, smoking, or using
illegal substances. Her physical examination results are
within normal limits and she denies suicidal ideations. As
- Bulimia
the treating psychiatric mental health nurse practitioner,
you decide to prescribe her bupropion (Wellbutrin). Rationale: Do not use bupropion if patient is bulimic, ei-
ther currently or in the past. Prohibition for use in eating
Of the following, which is a contraindication for bupropi-
disorders due to increased risk of seizures.
on?
- Dysthymia
- Fatigue
- Smoking
- Bulimia
While treating a 12-year-old boy for ADHD, the PMHNP
observes which of the following physical features that
raise concerns for genetic evaluation for Fragile X Syn-
drome?
-obesity, small stature, small hands and feet, hypotonia
-café au lait spots on face and arms, neurofibromas
,-long head and ears, short stature, hyperextensible joints
-Most features are large: a broad forehead, elongated
face, large ears, enlarged testicles (macroorchidism)
-Short stature
-hyperextensible joints, low muscle tones, soft fleshy
tones
Rationale: Etiological factors in mental retardation can be
primarily genetic, developmental, acquired, or in com-
bination. Genetic causes included chromosomal and in-
herited conditions. Many of these genetic disorders have
characteristic physical features that warrant genetic test-
ing for confirmatory diagnosis. Fragile X Syndrome occurs
in about 1 of every 1,000 males and 1 of every 2,000 fe-
males. The typical phenotype includes a large, long head
and ears, short stature, hyperextensible joints, and post-
pubertal macroorchidism. The mental retardation ranges
from mild to severe. There is high rate of comorbid ADHD,
learning disorder, and pervasive developmental disorders,
such as autism. Café au lait spots and neurofibromas are
common in von Recklinghausen's disease. Obesity, small
stature, small hands and feet, hypotonia, and hypogo-
nadism are characteristic of Prader-Willi Syndrome. Small
head, short palpebral fissure, and inner epicanthal folds
are characteristic of fetal alcohol syndrome.
A 43-year-old male is treated for Bipolar I on lithium.
- Leukocytosis
Which of the following hematologic changes is associated
with lithium? Rationale: While the mechanism of action is not clear,
- Leukopenia the use of lithium can raise white blood cell counts and,
- Agranulocytosis
, - Anemia therefore, CBC should be monitored in patients treated on
- Leukocytosis lithium.
A 37-year-old patient with schizophrenia is started on a
high dose of chlorpromazine (Thorazine). The next day, he
complains of lightheadedness after standing up. Vital sign
- Orthostatic hypotension
changes reflect a significant decrease in blood pressure
and an increase in heart rate. Rationale: Orthostatic hypotension, a drop in blood pres-
sure while standing, is a side ettect from alpha 1-adren-
You suspect this is secondary to the alpha 1-adrenergic
ergic blockade. This is especially troublesome with chlor-
blockade which is causing
promazine and clozapine and is best handled by raising
- Decreased sweating
doses slowly
- Orthostatic hypotension
- Respiratory depression
- Dry mouth
- Negative symptoms are related to DA deficit in the cere-
bral cortex; positive symptoms are related to DA excess in
the nucleus accumbens and mesolimbic system
Which of the following statements reflect the current
understanding of dopamine (DA) pathways and clinical Rationale: Negative symptoms and cognitive impairment
symptoms in schizophrenia? are thought to be related to hypoactivity of the mesocorti-
cal dopaminergic tract, which by association with the pre-
- Negative symptoms are related to DA deficit in the frontal and neocortex contributes to motivation, planning,
mesolimbic system; positive symptoms are related to DA sequencing of behaviors in time, attention, and social
excess in the substantia nigra and ventral tegmental area behavior.
- Negative symptoms are related to DA excess in the Positive symptoms of schizophrenia (hallucinations and
mesolimbic system; positive symptoms are related to DA delusions) are thought to be caused by dopamine hyper-
deficit in the substantia nigra and ventral tegmental area activity in the mesolimbic tract, which regulates memory
- Negative symptoms are related to DA deficit in the and emotion. This hyperactivity could result from overac-
mesolimbic system; positive symptoms are related to DA tive modulation of neurotransmission from the nucleus
accumbens.
Another explanation for dopaminergic hyperactivity in the
, mesolimbic tract is the hypoactivity of the mesocortical
tract, which normally inhibits dopamine activity in the
mesolimbic tract by some type of feedback mechanism.
excess in the substantia nigra and ventral tegmental area
In schizophrenia, the primary defect may be in the meso-
- Negative symptoms are related to DA deficit in the cere-
cortical tract, where dopaminergic function is diminished,
bral cortex; positive symptoms are related to DA excess in
thereby decreasing the inhibitory ettects on the mesolim-
the nucleus accumbens and mesolimbic system
bic tract. This disinhibition may be responsible for the
overactivity of dopamine in the mesolimbic tract, resulting
in positive symptom cluster.
-decreased size of cerebral ventricles
Which of the following findings on MRI and PET scans
Rationale: Individuals with schizophrenia have enlarged
would be uncommon in individuals with schizophrenia?
cerebral ventricles.
-decreased electrical activity in the frontal lobes There is decreased electrical activity in frontal lobes, de-
-decreased total brain volume creased glutamate and GABA release, and decreased total
-decreased size of cerebral ventricles brain volume.
-decreased glutamate and GABA release
Also, increased dopamine and decreased serotonin.
What direct-acting receptor agonist is recommended to
be used in the treatment of neuroleptic malignant syn- - Bromocriptine (Parlodel)
drome (NMS) to help lower the dopamine receptor block-
ade? Rationale: Parlodel is the recommended direct act-
ing dopamine receptor agonist to help decrease the
- Bromocriptine (Parlodel) dopamine blockade. Dantrium is a muscle relaxant, and
- Benztropine (Cogentin) Cogentin and Artane are anticholinergic medications used
- Trihexyphenidyl (Artane) for extrapyramidal side ettects (EPS).
- Dantrolene (Dantrium)
A 74-year-old female presents for an evaluation. The psy-
- Right hemisphere
chiatric nurse practitioner has the patient complete the
mini mental status examination and clock drawing. The
Frequently Tested Questions With ELABORATED 100% Correct COMPLETE SOLUTIONS
Guaranteed Pass First Attempt!! Current Update!!
- Meperidine is prohibited when a patient is taking an
MAOI (Selegiline) due to risk of HTN crisis and death.
Mr. Smith is going in for an elective surgical procedure.
Rationale: Meperidine is strictly prohibited when a patient
He is currently taking Selegiline. Which medication is he
is treated on a monoamine oxidase inhibitor (MAOI), due
not able to take?
to the risk of hypertensive crisis and death.
-Morphine
-Codeine Hypertensive crisis and death can also occur when MAOIs
-NSAIDs are taken in conjunction with certain medications: meperi-
-Meperidine dine (demerol), decongestants, TCAs, atypical antipsy-
chotics, st johns wort, l-tryptophan, stimulants (and other
sympathomimetics), asthma medications
17-year-old female presents to your clinic reporting anhe-
donia, decreased energy, and hopelessness for the past
2 years. She denies drinking alcohol, smoking, or using
illegal substances. Her physical examination results are
within normal limits and she denies suicidal ideations. As
- Bulimia
the treating psychiatric mental health nurse practitioner,
you decide to prescribe her bupropion (Wellbutrin). Rationale: Do not use bupropion if patient is bulimic, ei-
ther currently or in the past. Prohibition for use in eating
Of the following, which is a contraindication for bupropi-
disorders due to increased risk of seizures.
on?
- Dysthymia
- Fatigue
- Smoking
- Bulimia
While treating a 12-year-old boy for ADHD, the PMHNP
observes which of the following physical features that
raise concerns for genetic evaluation for Fragile X Syn-
drome?
-obesity, small stature, small hands and feet, hypotonia
-café au lait spots on face and arms, neurofibromas
,-long head and ears, short stature, hyperextensible joints
-Most features are large: a broad forehead, elongated
face, large ears, enlarged testicles (macroorchidism)
-Short stature
-hyperextensible joints, low muscle tones, soft fleshy
tones
Rationale: Etiological factors in mental retardation can be
primarily genetic, developmental, acquired, or in com-
bination. Genetic causes included chromosomal and in-
herited conditions. Many of these genetic disorders have
characteristic physical features that warrant genetic test-
ing for confirmatory diagnosis. Fragile X Syndrome occurs
in about 1 of every 1,000 males and 1 of every 2,000 fe-
males. The typical phenotype includes a large, long head
and ears, short stature, hyperextensible joints, and post-
pubertal macroorchidism. The mental retardation ranges
from mild to severe. There is high rate of comorbid ADHD,
learning disorder, and pervasive developmental disorders,
such as autism. Café au lait spots and neurofibromas are
common in von Recklinghausen's disease. Obesity, small
stature, small hands and feet, hypotonia, and hypogo-
nadism are characteristic of Prader-Willi Syndrome. Small
head, short palpebral fissure, and inner epicanthal folds
are characteristic of fetal alcohol syndrome.
A 43-year-old male is treated for Bipolar I on lithium.
- Leukocytosis
Which of the following hematologic changes is associated
with lithium? Rationale: While the mechanism of action is not clear,
- Leukopenia the use of lithium can raise white blood cell counts and,
- Agranulocytosis
, - Anemia therefore, CBC should be monitored in patients treated on
- Leukocytosis lithium.
A 37-year-old patient with schizophrenia is started on a
high dose of chlorpromazine (Thorazine). The next day, he
complains of lightheadedness after standing up. Vital sign
- Orthostatic hypotension
changes reflect a significant decrease in blood pressure
and an increase in heart rate. Rationale: Orthostatic hypotension, a drop in blood pres-
sure while standing, is a side ettect from alpha 1-adren-
You suspect this is secondary to the alpha 1-adrenergic
ergic blockade. This is especially troublesome with chlor-
blockade which is causing
promazine and clozapine and is best handled by raising
- Decreased sweating
doses slowly
- Orthostatic hypotension
- Respiratory depression
- Dry mouth
- Negative symptoms are related to DA deficit in the cere-
bral cortex; positive symptoms are related to DA excess in
the nucleus accumbens and mesolimbic system
Which of the following statements reflect the current
understanding of dopamine (DA) pathways and clinical Rationale: Negative symptoms and cognitive impairment
symptoms in schizophrenia? are thought to be related to hypoactivity of the mesocorti-
cal dopaminergic tract, which by association with the pre-
- Negative symptoms are related to DA deficit in the frontal and neocortex contributes to motivation, planning,
mesolimbic system; positive symptoms are related to DA sequencing of behaviors in time, attention, and social
excess in the substantia nigra and ventral tegmental area behavior.
- Negative symptoms are related to DA excess in the Positive symptoms of schizophrenia (hallucinations and
mesolimbic system; positive symptoms are related to DA delusions) are thought to be caused by dopamine hyper-
deficit in the substantia nigra and ventral tegmental area activity in the mesolimbic tract, which regulates memory
- Negative symptoms are related to DA deficit in the and emotion. This hyperactivity could result from overac-
mesolimbic system; positive symptoms are related to DA tive modulation of neurotransmission from the nucleus
accumbens.
Another explanation for dopaminergic hyperactivity in the
, mesolimbic tract is the hypoactivity of the mesocortical
tract, which normally inhibits dopamine activity in the
mesolimbic tract by some type of feedback mechanism.
excess in the substantia nigra and ventral tegmental area
In schizophrenia, the primary defect may be in the meso-
- Negative symptoms are related to DA deficit in the cere-
cortical tract, where dopaminergic function is diminished,
bral cortex; positive symptoms are related to DA excess in
thereby decreasing the inhibitory ettects on the mesolim-
the nucleus accumbens and mesolimbic system
bic tract. This disinhibition may be responsible for the
overactivity of dopamine in the mesolimbic tract, resulting
in positive symptom cluster.
-decreased size of cerebral ventricles
Which of the following findings on MRI and PET scans
Rationale: Individuals with schizophrenia have enlarged
would be uncommon in individuals with schizophrenia?
cerebral ventricles.
-decreased electrical activity in the frontal lobes There is decreased electrical activity in frontal lobes, de-
-decreased total brain volume creased glutamate and GABA release, and decreased total
-decreased size of cerebral ventricles brain volume.
-decreased glutamate and GABA release
Also, increased dopamine and decreased serotonin.
What direct-acting receptor agonist is recommended to
be used in the treatment of neuroleptic malignant syn- - Bromocriptine (Parlodel)
drome (NMS) to help lower the dopamine receptor block-
ade? Rationale: Parlodel is the recommended direct act-
ing dopamine receptor agonist to help decrease the
- Bromocriptine (Parlodel) dopamine blockade. Dantrium is a muscle relaxant, and
- Benztropine (Cogentin) Cogentin and Artane are anticholinergic medications used
- Trihexyphenidyl (Artane) for extrapyramidal side ettects (EPS).
- Dantrolene (Dantrium)
A 74-year-old female presents for an evaluation. The psy-
- Right hemisphere
chiatric nurse practitioner has the patient complete the
mini mental status examination and clock drawing. The
