ANCC Domain 1- Scientific Foundation
Exam Graded A+
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 - ANS-- 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.
2 yr. old child with Fetal Alcohol Syndrome (FAS). What s/s might you see? - ANS-small
head, short eyelid opening, flat midface, smooth philtrum, thin upper lip,
underdeveloped jaw, and short nose
Tip: most of their features are smaller in size or underdeveloped
S/S: low birth weight/height, microcephaly (small head), microphthalmia (small eye
openings), short palpebral fissures, midface hypoplasia/flat midface, smooth or short
philtrum, thin upper lip
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 - ANS-- 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
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 - ANS-- 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 74-year-old female presents for an evaluation. The psychiatric nurse practitioner has
the patient complete the mini mental status examination and clock drawing. The patient
is unable to correctly draw the face of the clock.
Which area of the brain is likely to have compromised functioning?
- Left hemisphere
- Right hemisphere
- Wernicke's area
- Corpus callosum - ANS-- Right hemisphere
Rationale: The right hemisphere of the brain is involved with the recognition of facial
expressions, music, and visual images. When the right hemisphere is compromised,
there are disturbances in drawing, such as clock drawing.
"Visualize a musician/artist making faces who lives in the right hemisphere of the world".
A client is suffering from 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 tuberoinfundibular pathway?
- are you experiencing drooling?
- are you experiencing dizziness?
- are you experiencing breast discharge?
- are you experiencing tremors? - ANS--are you experiencing breast discharge?
Rationale: Galactorrhea is caused by dopamine blockade in the tuberoinfundibular
pathway by antipsychotic drugs.
Tuberoinfundibular pathway
o If you decrease the dopamine level (D2 blockade), it can lead to increased prolactin
levels (hyperprolactinemia), "TuberoInfundibular Pathway = This Increases Prolactin"
o Clinically manifests as GGAS:
-gynecomastia (enlarged breast tissue)
-galactorrhea (breast discharge)
, -amenorrhea (lack of menses)
-sexual dysfunction
o **Risperidone has a high risk to cause galactorrhea ("gives rise to a pair of breasts")
o Long-term hyperprolactinemia can be associated with osteoporosis
A week after raising a patient's Risperidone, the patient presents to the clinic with
rigidity, fever, and ALOC. The NP understands it might be:
-Serotonin Syndrome
-NMS
-EPS
-Anticholinergic withdrawal syndrome - ANS--NMS
Rationale: NMS is associated with acute mental status change, muscular rigidity, and
autonomic instability (fever)
-Caused by antipsychotics
"FEVER"- Fever, encephalopathy, vital instability, elevated CPK/WBC/LFT,
Rigidity/Rhabdo (myoglobinuria)
o Extreme muscular rigidity
o Mutism (caused by extreme rigidity)
o Altered level of consciousness
o Hyperthermia/Fever
o Tachycardia
o Diaphoresis
o Elevated CPK- caused by muscle contraction and muscle destruction
o Elevated WBCs (leukocytosis)
o Elevated LFTs (liver function tests such as AST and ALT)
o Myoglobinuria (s/s: cherry-colored urine, caused by rhabdomyolysis: muscle
breakdown)
Arcus senilis when seen before the age of 40 years, is associated with which of the
following disorders?
- Syphilis
- Hypertension
- Hyperlipidemia
- HIV infection - ANS-Hyperlipidemia
Rationale: Arcus senilis is a gray opaque band in the cornea, 1.0 to 1.5 mm wide,
separated from the limbus by a narrow clear zone. Early on only a segment of the
circumference is involved; later the circle is completed.
Exam Graded A+
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 - ANS-- 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.
2 yr. old child with Fetal Alcohol Syndrome (FAS). What s/s might you see? - ANS-small
head, short eyelid opening, flat midface, smooth philtrum, thin upper lip,
underdeveloped jaw, and short nose
Tip: most of their features are smaller in size or underdeveloped
S/S: low birth weight/height, microcephaly (small head), microphthalmia (small eye
openings), short palpebral fissures, midface hypoplasia/flat midface, smooth or short
philtrum, thin upper lip
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 - ANS-- 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
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 - ANS-- 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 74-year-old female presents for an evaluation. The psychiatric nurse practitioner has
the patient complete the mini mental status examination and clock drawing. The patient
is unable to correctly draw the face of the clock.
Which area of the brain is likely to have compromised functioning?
- Left hemisphere
- Right hemisphere
- Wernicke's area
- Corpus callosum - ANS-- Right hemisphere
Rationale: The right hemisphere of the brain is involved with the recognition of facial
expressions, music, and visual images. When the right hemisphere is compromised,
there are disturbances in drawing, such as clock drawing.
"Visualize a musician/artist making faces who lives in the right hemisphere of the world".
A client is suffering from 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 tuberoinfundibular pathway?
- are you experiencing drooling?
- are you experiencing dizziness?
- are you experiencing breast discharge?
- are you experiencing tremors? - ANS--are you experiencing breast discharge?
Rationale: Galactorrhea is caused by dopamine blockade in the tuberoinfundibular
pathway by antipsychotic drugs.
Tuberoinfundibular pathway
o If you decrease the dopamine level (D2 blockade), it can lead to increased prolactin
levels (hyperprolactinemia), "TuberoInfundibular Pathway = This Increases Prolactin"
o Clinically manifests as GGAS:
-gynecomastia (enlarged breast tissue)
-galactorrhea (breast discharge)
, -amenorrhea (lack of menses)
-sexual dysfunction
o **Risperidone has a high risk to cause galactorrhea ("gives rise to a pair of breasts")
o Long-term hyperprolactinemia can be associated with osteoporosis
A week after raising a patient's Risperidone, the patient presents to the clinic with
rigidity, fever, and ALOC. The NP understands it might be:
-Serotonin Syndrome
-NMS
-EPS
-Anticholinergic withdrawal syndrome - ANS--NMS
Rationale: NMS is associated with acute mental status change, muscular rigidity, and
autonomic instability (fever)
-Caused by antipsychotics
"FEVER"- Fever, encephalopathy, vital instability, elevated CPK/WBC/LFT,
Rigidity/Rhabdo (myoglobinuria)
o Extreme muscular rigidity
o Mutism (caused by extreme rigidity)
o Altered level of consciousness
o Hyperthermia/Fever
o Tachycardia
o Diaphoresis
o Elevated CPK- caused by muscle contraction and muscle destruction
o Elevated WBCs (leukocytosis)
o Elevated LFTs (liver function tests such as AST and ALT)
o Myoglobinuria (s/s: cherry-colored urine, caused by rhabdomyolysis: muscle
breakdown)
Arcus senilis when seen before the age of 40 years, is associated with which of the
following disorders?
- Syphilis
- Hypertension
- Hyperlipidemia
- HIV infection - ANS-Hyperlipidemia
Rationale: Arcus senilis is a gray opaque band in the cornea, 1.0 to 1.5 mm wide,
separated from the limbus by a narrow clear zone. Early on only a segment of the
circumference is involved; later the circle is completed.
