Practice Questions ANCC PMHNP with 100% correct answers

A 46-year-old male with a history of bipolar disorder comes for a regular follow-up appointment with a PMHNP and presents with complaints of severe vomiting, diarrhea, muscle weakness, blurred vision, and ataxia. The patient is currently taking 900mg of lithium daily. The PMHNP identifies these symptoms as signs of lithium toxicity. What is the priority action of the PMHNP? Tells the patient to stop taking lithium and orders a serum lithium level Mary a 45-year-old African American female who has been treated on isocarboxazid (Marplan) for over 6 years. Mary is going in for a surgical procedure. Which medication is strictly contraindicated with isocarboxazid? Methylphenidate The PMHNP is aware of the following signs to watch out for in patients taking clozapine (Clozaril): Fever, sore throat, and chills A new prescription of carbamazepine (Tegretol) is given to a patient whose baseline WBC count is 5,000/uL and ANC is 4,000/uL. Laboratory tests show that the patient's WBC count has decreased to 2,500/uL and ANC has decreased to 750/uL after two weeks of therapy. Similar outcomes are obtained when the lab studies are repeated. The patient does not present with any signs of infection. What is the next action of the PMHNP? Tells the patient to stop taking Tegretol and recheck the ANC and WBC If given during pregnancy sodium valproate (Depakote) can cause which of the following medical problems in the baby? Spina bifida Which mood stabilizer is associated with potential life-threatening rash in the Asian population? Carbamazepine (Tegretol) Which of the following physical exam findings would help the PMHNP differentiate anorexia nervosa from bulimia nervosa? Low body mass index Which of the following medication has a unique mechanism that is both a norepinephrine and dopamine reuptake inhibitor? Bupropion (Wellbutrin) Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is treated with clozapine? 1A2 When treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which of the following reasons? Decreased protein binding For 12 years, a 65-year-old patient with bipolar disorder has been treated with lithium (Eskalith) 900mg daily. When oral HCTZ 12.5mg daily is added for hypertension, the patient develops nausea, vomiting, ataxia, and muscle weakness and the patient's serum lithium level is 2.0 mEq/L. The interaction of the lithium and the thiazide diuretic has induced: Reduced renal clearance of lithium Serotonin is a neurotransmitter that is implicated in sleep and mood. What area of the brain has a large majority of serotonin neurons? Raphe nuclei A client who is experiencing difficulties with working memory, planning, and prioritizing, insight into his problems, and impulse control presents for assessment. In planning his care, the PMHNP should apply his or her knowledge that these symptoms represent problems with the: Frontal lobe Which of these brain structures puts emotional meaning on a stimulus, forms emotional memories, and is involved with rage and fear? Amygdala The anatomical structure of the limbic system that is associated with a reaction to stress is the: Hippocampus A 45-year-old African American male diagnosed with schizophrenia. Arrives at your clinic for a regular medication appointment. He is currently stabilized on chlorpromazine. You notice his face appears mask-like, and he walks with a shuffling gait. Based on this information, what extrapyramidal symptoms side effect would you suspect? Pseudo-Parkinsonism A patient has been treated for the past several years with fluphenazine (Prolixin). You notice that he is drooling and has a tremor and slight piull-rolling movement of the fingers. These are the extrapyramidal symptoms known as: Pseudo-Parkinsonism A patient is diagnosed with schizophrenia. Which of the following would be the appropriate question for the PMHNP to ask when assessing side effects produced by dopamine antagonism in the nigrostriatal pathway? Are you experiencing pill rolling tremors, shuffling gait, and masklike facial expression? The study of what a drug does to the body is called: Pharmacodynamics When studying pharmacodynamics involving receptors, you know that an agonist produces the following effect: Activates a biological response and opens the ion channel Sarah presents for her initial intake appointment with complaints of depression. She is being treated for hypertension and asthma by her primary care provider. Knowing that certain medications can cause or exacerbate depression; you obtain a complete medication history. Which of the following medications is known to exacerbate or cause depression? Propranolol A patient with a known diagnosis of bipolar I disorder presents to your clinic complaining of manic symptoms and insomnia. Your patient has been stable on lithium for the past six months. To determine if a medication change or increase is warranted, it is important to gather more information. You suspect a possible medication-induced manic episode when the patient endorses what? She recently had an acute flare-up of her rheumatoid arthritis and received treatment for one week of stabilization of symptoms. John is a 58-year-old male patient with bipolar I disorder has been stable for 5 years on valproate and Seroquel. He was recently started on Fluticasone (Flonase) by his PCP. As the PMHNP treating John, you are concerned that the addition of the Fluticasone may cause: A manic episode What muscle relaxant is recommended to be used in the treatment of neuroleptic malignant syndrome (NMS)? Dantrolene A week after raising the dose of clomipramine a patient treated for depression presents to the clinic with reports of acute change in mental status, fever, and hyperreflexia. As the treating PMHNP, you know these symptoms are consistent with which of the following? Serotonin syndrome A 24-year-old female attempts suicide by overdose with the MAOI phenelzine. She is stabilized at the hospital. Ten days later she is started on venlafaxine and becomes tachycardic and diaphoretic, and she develops myoclonic jerks. What condition is this? Serotonin syndrome A patient is being treated for psychosis two weeks ago presents with hyperthermia, muscle rigidity, mutism, leukocytosis, and myoglobinuria. These symptoms are identified by the PMHNP as? Neuroleptic malignant syndrome and administers dantrolene During a follow-up assessment, a PMHNP asks the patient to count backwards from 100 by sevens. What aspect of mental status exam is being assessed? Concentration Appraisal of patient's suicidal ideation, plan, method, intent, and access to implement plan would be documented in which part of standard psychiatric evaluation? Mental status exam A 48-year-old Caucasian male patient presents for his therapy session. He is sad about losing his wife recently to COVID-19. He reports feeling thoughts of hurting himself. He has a past history of overdosing on propranolol several years ago. Which of the following places him at higher risk for suicide? Previous suicide attempt Which of the following patient is at a higher risk of suicide? A 68-year-old single Caucasian male with depression (this one has 5 risk factors) A 64-year-old Caucasian male referred for treatment of refractory depression by his PCP reports continued lack of purpose, insomnia, decreased energy, reduced interest in pleasurable activities since losing his wife hit by a drunk driver 3 months ago. Which of the following is an assessment priority? Thoughts of self-harm, plan, intent, access A married female patient has been in therapy with an adult psychiatric and mental health nurse practitioner for 3 months. The patient's husband abuses alcohol and refuses treatment. The night before the next scheduled appointment, the patient telephones the clinical nurse specialist stating that her husband is drunk, violent, and threatening to kill her. The PMHNP's priority intervention is to: Arrange for the woman's safety A client says to the PMHNP, "Some days life is just not worth it. All my wife and I ever do is fight and scream. Things at home would be calmer and simpler if I just wasn't there anymore." The most therapeutic response for the PMHNP to make it: Tell me what you mean by "it would be simpler if you just weren't there anymore." While working with an older male client, the nurse begins to think that the client reminds her of her grandfather and responds as if she was the granddaughter. The nurse is developing which of the following? Countertransference Using the Patient Health Questionnaire (PHQ-9), a patient receives a score of 25. What is the next action of the PMHNP? Initiate an antidepressant and/or therapy A 69-year-old man with a diagnosis of delirium has symptoms of psychosis which include frightening auditory and visual hallucinations and paranoid delusions. Which of the following medications should be chosen first for this man's symptoms? Haloperidol An 81-year-old female with a history of vascular dementia is brought to the hospital for increased agitation and urinary tract infection (UTI). Which of the following features most distinguishes the effects of delirium from dementia? Altered level of consciousness What is the best treatment for AIDS dementia complex? Antiretroviral therapy A community has an unusually high incidence of depression and drug use among the teenage population. The public health nurses decide to address this problem, in part, by modifying the environment and strengthening the capacities of families to prevent the development of new cases of depression and drug use. What is this an example of? Primary prevention A patient who was diagnosed with major depressive disorder comes to the clinic for a refill of sertraline (Zoloft). The PMHNP explains that the medication is prescribed for: Tertiary prevention Your client Sam is being treated for panic disorder with agoraphobia. He currently is being prescribed paroxetine (Paxil CR, 37.5 mg q.d.) and clonazepam (Klonopin, 0.5mg q.d., prn). He has been on clonazepam for 2 years and admits to needing 4 pills to achieve the same effect that 1 pill initially produced. This is possibly an example of which process? Tolerance The PMHNP sees a 12-year-old patient who takes Lisdexamfetamine (Vyvanse) 50mg daily for ADHD. The NP opbserves a tic, which the parents report began after the patient started taking the psychostimulant, and it has been increasing in severity. Both the parents and the school report that the medication is helpful. The PMHNP: Discontinues the psychostimulant, prescribes guanfacine extended release (Intuniv), and monitors the patient A 5-year-old boy shows no interest in playing with other children and ignores adults other than his parents. He spends hours lining up his toy cars or spinning their wheels. He rarely uses speech to communicate, and his parents state that he has never done so. Physical examination indicates that his head is of normal circumference and his gait is normal. Which of the following is the most likely diagnosis for this boy? Autism A mother brings in her 7 -year-old son for a psychiatric follow-up visit with the PMHNP. This is the 4th visit the PMHNP has had with the client, his mother, and his younger sister, Renee, now 7 months old. You notice that she has a decrease in head growth, along with stereotypic motions of the hands, often licking and slapping. Renee has also lost her language skills. What medical condition do you suspect Renee has developed? Rett syndrome