ANCC Domain 1- Scientific Foundation
Study online at https://quizlet.com/_bdzlk2
1. Mr. Smith is going in for an elective surgical procedure. He is currently
taking Selegiline. Which medication is he not able to take?
-Morphine
-Codeine
-NSAIDs
-Meperidine: - Meperidine is prohibited when a patient is taking an MAOI (Selegi-
line) due to risk of HTN crisis and death.
Rationale: Meperidine is strictly prohibited when a patient is treated on a monoamine
oxidase inhibitor (MAOI), due to the risk of hypertensive crisis and death.
Hypertensive crisis and death can also occur when MAOIs are taken in conjunction
with certain medications: meperidine (demerol), decongestants, TCAs, atypical an-
tipsychotics, st johns wort, l-tryptophan, stimulants (and other sympathomimetics),
asthma medications
2. 17-year-old female presents to your clinic reporting anhedonia, 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 the treating psychi-
atric mental health nurse practitioner, you decide to prescribe her bupropion
(Wellbutrin).
Of the following, which is a contraindication for bupropion?
- Dysthymia
- Fatigue
- Smoking
- Bulimia: - Bulimia
Rationale: Do not use bupropion if patient is bulimic, either currently or in the past.
Prohibition for use in eating disorders due to increased risk of seizures.
3. 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 Syndrome?
-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
, ANCC Domain 1- Scientific Foundation
Study online at https://quizlet.com/_bdzlk2
-small stature, short palpebral fissure, inner epicanthal folds: -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, devel-
opmental, acquired, or in combination. Genetic causes included chromosomal and
inherited conditions. Many of these genetic disorders have characteristic physical
features that warrant genetic testing for confirmatory diagnosis. Fragile X Syndrome
occurs in about 1 of every 1,000 males and 1 of every 2,000 females. The typical
phenotype includes a large, long head and ears, short stature, hyperextensible
joints, and postpubertal 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 hypogonadism are characteristic of Prader-Willi Syndrome.
Small head, short palpebral fissure, and inner epicanthal folds are characteristic of
fetal alcohol syndrome.
4. A 43-year-old male is treated for Bipolar I on lithium.
Which of the following hematologic changes is associated with lithium?
- Leukopenia
- Agranulocytosis
- Anemia
- Leukocytosis: - Leukocytosis
Rationale: While the mechanism of action is not clear, the use of lithium can raise
white blood cell counts and, therefore, CBC should be monitored in patients treated
on lithium.
5. 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 changes reflect a significant decrease in blood
pressure and an increase in heart rate.
You suspect this is secondary to the alpha 1-adrenergic blockade which is
causing
, ANCC Domain 1- Scientific Foundation
Study online at https://quizlet.com/_bdzlk2
- Decreased sweating
- Orthostatic hypotension
- Respiratory depression
- Dry mouth: - Orthostatic hypotension
Rationale: Orthostatic hypotension, a drop in blood pressure while standing, is a
side effect from alpha 1-adrenergic blockade. This is especially troublesome with
chlorpromazine and clozapine and is best handled by raising doses slowly
6. Which of the following statements reflect the current understanding of
dopamine (DA) pathways and clinical symptoms in schizophrenia?
- Negative symptoms are related to DA deficit in the mesolimbic system;
positive symptoms are related to DA excess in the substantia nigra and ventral
tegmental area
- Negative symptoms are related to DA excess in the mesolimbic system;
positive symptoms are related to DA deficit in the substantia nigra and ventral
tegmental area
- Negative symptoms are related to DA deficit in the mesolimbic system;
positive symptoms are related to DA excess in the substantia nigra and ventral
tegmental area
- Negative symptoms are related to DA deficit in the cerebral cortex; positive
symptoms are related to DA excess in the nucleus accumbens and mesolimbic
system: - Negative symptoms are related to DA deficit in the cerebral cortex; posi-
tive symptoms are related to DA excess in the nucleus accumbens and mesolimbic
system
Rationale: Negative symptoms and cognitive impairment are thought to be related
to hypoactivity of the mesocortical dopaminergic tract, which by association with
the prefrontal and neocortex contributes to motivation, planning, sequencing of
behaviors in time, attention, and social behavior.
Positive symptoms of schizophrenia (hallucinations and delusions) are thought
to be caused by dopamine hyperactivity in the mesolimbic tract, which regulates
memory and emotion. This hyperactivity could result from overactive 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. In schizophrenia, the
primary defect may be in the mesocortical tract, where dopaminergic function is
Study online at https://quizlet.com/_bdzlk2
1. Mr. Smith is going in for an elective surgical procedure. He is currently
taking Selegiline. Which medication is he not able to take?
-Morphine
-Codeine
-NSAIDs
-Meperidine: - Meperidine is prohibited when a patient is taking an MAOI (Selegi-
line) due to risk of HTN crisis and death.
Rationale: Meperidine is strictly prohibited when a patient is treated on a monoamine
oxidase inhibitor (MAOI), due to the risk of hypertensive crisis and death.
Hypertensive crisis and death can also occur when MAOIs are taken in conjunction
with certain medications: meperidine (demerol), decongestants, TCAs, atypical an-
tipsychotics, st johns wort, l-tryptophan, stimulants (and other sympathomimetics),
asthma medications
2. 17-year-old female presents to your clinic reporting anhedonia, 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 the treating psychi-
atric mental health nurse practitioner, you decide to prescribe her bupropion
(Wellbutrin).
Of the following, which is a contraindication for bupropion?
- Dysthymia
- Fatigue
- Smoking
- Bulimia: - Bulimia
Rationale: Do not use bupropion if patient is bulimic, either currently or in the past.
Prohibition for use in eating disorders due to increased risk of seizures.
3. 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 Syndrome?
-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
, ANCC Domain 1- Scientific Foundation
Study online at https://quizlet.com/_bdzlk2
-small stature, short palpebral fissure, inner epicanthal folds: -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, devel-
opmental, acquired, or in combination. Genetic causes included chromosomal and
inherited conditions. Many of these genetic disorders have characteristic physical
features that warrant genetic testing for confirmatory diagnosis. Fragile X Syndrome
occurs in about 1 of every 1,000 males and 1 of every 2,000 females. The typical
phenotype includes a large, long head and ears, short stature, hyperextensible
joints, and postpubertal 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 hypogonadism are characteristic of Prader-Willi Syndrome.
Small head, short palpebral fissure, and inner epicanthal folds are characteristic of
fetal alcohol syndrome.
4. A 43-year-old male is treated for Bipolar I on lithium.
Which of the following hematologic changes is associated with lithium?
- Leukopenia
- Agranulocytosis
- Anemia
- Leukocytosis: - Leukocytosis
Rationale: While the mechanism of action is not clear, the use of lithium can raise
white blood cell counts and, therefore, CBC should be monitored in patients treated
on lithium.
5. 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 changes reflect a significant decrease in blood
pressure and an increase in heart rate.
You suspect this is secondary to the alpha 1-adrenergic blockade which is
causing
, ANCC Domain 1- Scientific Foundation
Study online at https://quizlet.com/_bdzlk2
- Decreased sweating
- Orthostatic hypotension
- Respiratory depression
- Dry mouth: - Orthostatic hypotension
Rationale: Orthostatic hypotension, a drop in blood pressure while standing, is a
side effect from alpha 1-adrenergic blockade. This is especially troublesome with
chlorpromazine and clozapine and is best handled by raising doses slowly
6. Which of the following statements reflect the current understanding of
dopamine (DA) pathways and clinical symptoms in schizophrenia?
- Negative symptoms are related to DA deficit in the mesolimbic system;
positive symptoms are related to DA excess in the substantia nigra and ventral
tegmental area
- Negative symptoms are related to DA excess in the mesolimbic system;
positive symptoms are related to DA deficit in the substantia nigra and ventral
tegmental area
- Negative symptoms are related to DA deficit in the mesolimbic system;
positive symptoms are related to DA excess in the substantia nigra and ventral
tegmental area
- Negative symptoms are related to DA deficit in the cerebral cortex; positive
symptoms are related to DA excess in the nucleus accumbens and mesolimbic
system: - Negative symptoms are related to DA deficit in the cerebral cortex; posi-
tive symptoms are related to DA excess in the nucleus accumbens and mesolimbic
system
Rationale: Negative symptoms and cognitive impairment are thought to be related
to hypoactivity of the mesocortical dopaminergic tract, which by association with
the prefrontal and neocortex contributes to motivation, planning, sequencing of
behaviors in time, attention, and social behavior.
Positive symptoms of schizophrenia (hallucinations and delusions) are thought
to be caused by dopamine hyperactivity in the mesolimbic tract, which regulates
memory and emotion. This hyperactivity could result from overactive 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. In schizophrenia, the
primary defect may be in the mesocortical tract, where dopaminergic function is
