ANCC Domain 1- Scientific Foundation
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 (Selegiline) 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 antipsychotics, st johns wort,
l-tryptophan, stimulants (and other sympathomimetics), asthma medications
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 psychiatric 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.
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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
-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, developmental,
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.
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.
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
- 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
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; positive 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
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 (Selegiline) 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 antipsychotics, st johns wort,
l-tryptophan, stimulants (and other sympathomimetics), asthma medications
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 psychiatric 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.
Brainpower
Read More
,Previous
Play
Next
Rewind 10 seconds
Move forward 10 seconds
Unmute
0:00
/
0:15
Full screen
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
-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, developmental,
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.
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.
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
- 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
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; positive 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
