ANCC IQ domain 3
Study online at https://quizlet.com/_a1pund
1. 1. The PMHNP treating a patient for schizophrenia on ziprasidone orders
an electrocardiogram. Which QTc interval result places the patient at greatest
risk for torsades de pointes?
- 300-500 milliseconds
- 500-700 milliseconds
- 160-260 milliseconds
- 100-200 milliseconds: - 500-700 milliseconds
Rationale: A patient with a QTc interval of 500-700 milliseconds is at higher risk of
developing torsades de pointes.
2. 1. A patient with a diagnosis of schizophrenia has a history of suicidal
ideation and suicide attempts. The PMHNP should consider which antipsy-
chotic medication that is the only known antipsychotic to reduce the risk of
suicide in schizophrenia?
- Invega (iloperidone)
- Abilify (aripiprazole)
- Latuda (lurasidone)
- Clozaril (clozapine): - Clozaril (clozapine)
Rationale: Clozaril (clozapine) is the only known antipsychotic medication that has
been shown to reduce the risk of suicide in patients diagnosed with schizophrenia.
3. 1. A WBC of 4,000 in a patient taking clozapine would prompt the PMHNP to
take which of the following actions?
- Discontinue clozapine, initiate alternative antipsychotic medication and
monitor closely.
- Institute daily complete blood count with differentials and monitor closely.
- Consult with hematologist to determine appropriate antibiotic regimen and
monitor closely.
- Institute twice-weekly complete blood count with differentials and monitor
closely.: - Institute twice-weekly complete blood count with differentials and monitor
closely.
Rationale: The recommended cut-points for discontinuation of clozapine are WBC
of 2,000 to 3,000 or granulocytes of 1,000 to 1,500 for agranulocytosis and severely
compromised immune system. At a WBC of 4,000, the recommendation is to closely
monitor CBC with differential twice a week while patient may continue clozapine in
the absence of any other signs or symptoms.
4. 1. When evaluating a woman with major depressive disorder, which of the
following would not be a major consideration in the differential diagnosis?
- Prior episodes of depression
- Any episodes of hypomania
- Any periods without sleep yet no fatigue
, ANCC IQ domain 3
Study online at https://quizlet.com/_a1pund
- Prior pregnancies: - Prior pregnancies
Rationale: The primary concern is to rule out bipolar disorder whenever making
diagnosis of major depressive disorder. Asking about any prior episodes of mania,
hypomania, and extended periods of 2-3 days with little to no sleep while still not
feeling fatigued, or period of heightened energy lasting several days without fatigue
are indicative of possible bipolar disorder. Asking about prior episodes of depression,
mood swings, and chronic irritability is also indicated. Prior pregnancies are not
the relevant information needed, but whether she experienced any episodes of
postpartum depression and the severity of any episodes.
5. 1. Electroconvulsive therapy (ECT) is a treatment of depression. What ad-
verse effect is uncommon for a patient to experience after receiving ECT
treatments?
- Muscle soreness
- Headaches
- Fractures
- Memory disturbance: - Fractures
Rationale: Headaches, memory disturbance, and muscle soreness are common
immediately after ECT treatment.
6. 1. An 88-year-old nursing home patient presents to the emergency depart-
ment with recent mental status changes, including aggression, confusion, and
dizziness, over the past two days. The patient scored a 20 on the MINI-Mental
Status Exam (MMSE). In addition to the MMSE, what additional information is
needed to conduct a thorough evaluation?
- Blood chemistry, complete blood count, and urinalysis
- Patient Health Questionnaire (PHQ-9) score
- Hamilton Depression Scale (HAM-D) score
- Electrocardiography and pharmacogenomics testing: - Blood chemistry, com-
plete blood count, and urinalysis
Rationale: A bedside MMSE can be used to document the cognitive impairment
and to provide a baseline form which to measure the patient's clinical course. The
laboratory workup of a patient should include standard tests (i.e., blood chemistries,
CBC, urinalysis) and additional studies indicated by the clinical situation.
7. 1. A client says that because he wished his sister was dead, and your
client's sister subsequently was killed in a motor vehicle accident, the death
was caused by the client's wishes. The client also revealed that he can reach
other's minds. This client is most likely suffering from which personality
disorder?
- Paranoid personality disorder
- Schizotypal personality disorder
, ANCC IQ domain 3
Study online at https://quizlet.com/_a1pund
- Schizoid personality disorder
- Delusional personality disorder: - Schizotypal personality disorder
Rationale: Schizotypal personality disorder is characterized by ideas of reference
and magical thinking.
8. 1. In the American Journal of Psychiatry, you read an article that discusses
a recent study's evidence that the nicotine exposure in pregnant women
increases the risk for schizophrenia in offspring (i.e., 38% increased likelihood
of schizophrenia in young adults whose mothers smoked heavily while preg-
nant). This inspires you to translate this information in practice and teaching
roles as a nurse practitioner. What considerations are needed to translate this
in to practice based on the best evidence?
- Determine if any other psychiatric or medical journal articles have comment-
ed on the validity or generalizability of the original stud.
- If the research is published in a peer-reviewed journal such as the American
Journal of Psychiatry, it is sound research.
- Analyze the original and repeat studies for methodical rigor and verify
that there were randomized or non-randomized clinical trials with the same
results.
- Analyze the original study only to determine that the research is sound and
meets the criteria for effectiveness of an intervention.: - Analyze the original
and repeat studies for methodical rigor and verify that there were randomized or
non-randomized clinical trials with the same results.
Rationale: Research Utilization begins with the idea of putting an innovation to use in
practice. The level of the evidence must be considered. The best of the best evidence
comes from reviewing several randomized clinical trials of the same thing with the
same results. Second to that are several non-randomized trials about the same thing
with the same results. Single randomized or non-randomized trials make up level 2
evidence regarding the effectiveness of an intervention.
9. 1. In distinguishing borderline personality disorder from chronic post-trau-
matic stress disorder related to childhood sexual abuse and victimization,
which of the following would be more indicative of borderline personality
disorder?
- Irritability or intense outbursts of anger
- Efforts to avoid real or imagined abandonment
- Affect lability often associated with intense fear
- Feeling of detachment or estrangement from others: - Efforts to avoid real or
imagined abandonment
Rationale: One hallmark of borderline personality disorder is the frantic efforts to
avoid real or imagined abandonment and the other is a pervasive pattern of unstable
Study online at https://quizlet.com/_a1pund
1. 1. The PMHNP treating a patient for schizophrenia on ziprasidone orders
an electrocardiogram. Which QTc interval result places the patient at greatest
risk for torsades de pointes?
- 300-500 milliseconds
- 500-700 milliseconds
- 160-260 milliseconds
- 100-200 milliseconds: - 500-700 milliseconds
Rationale: A patient with a QTc interval of 500-700 milliseconds is at higher risk of
developing torsades de pointes.
2. 1. A patient with a diagnosis of schizophrenia has a history of suicidal
ideation and suicide attempts. The PMHNP should consider which antipsy-
chotic medication that is the only known antipsychotic to reduce the risk of
suicide in schizophrenia?
- Invega (iloperidone)
- Abilify (aripiprazole)
- Latuda (lurasidone)
- Clozaril (clozapine): - Clozaril (clozapine)
Rationale: Clozaril (clozapine) is the only known antipsychotic medication that has
been shown to reduce the risk of suicide in patients diagnosed with schizophrenia.
3. 1. A WBC of 4,000 in a patient taking clozapine would prompt the PMHNP to
take which of the following actions?
- Discontinue clozapine, initiate alternative antipsychotic medication and
monitor closely.
- Institute daily complete blood count with differentials and monitor closely.
- Consult with hematologist to determine appropriate antibiotic regimen and
monitor closely.
- Institute twice-weekly complete blood count with differentials and monitor
closely.: - Institute twice-weekly complete blood count with differentials and monitor
closely.
Rationale: The recommended cut-points for discontinuation of clozapine are WBC
of 2,000 to 3,000 or granulocytes of 1,000 to 1,500 for agranulocytosis and severely
compromised immune system. At a WBC of 4,000, the recommendation is to closely
monitor CBC with differential twice a week while patient may continue clozapine in
the absence of any other signs or symptoms.
4. 1. When evaluating a woman with major depressive disorder, which of the
following would not be a major consideration in the differential diagnosis?
- Prior episodes of depression
- Any episodes of hypomania
- Any periods without sleep yet no fatigue
, ANCC IQ domain 3
Study online at https://quizlet.com/_a1pund
- Prior pregnancies: - Prior pregnancies
Rationale: The primary concern is to rule out bipolar disorder whenever making
diagnosis of major depressive disorder. Asking about any prior episodes of mania,
hypomania, and extended periods of 2-3 days with little to no sleep while still not
feeling fatigued, or period of heightened energy lasting several days without fatigue
are indicative of possible bipolar disorder. Asking about prior episodes of depression,
mood swings, and chronic irritability is also indicated. Prior pregnancies are not
the relevant information needed, but whether she experienced any episodes of
postpartum depression and the severity of any episodes.
5. 1. Electroconvulsive therapy (ECT) is a treatment of depression. What ad-
verse effect is uncommon for a patient to experience after receiving ECT
treatments?
- Muscle soreness
- Headaches
- Fractures
- Memory disturbance: - Fractures
Rationale: Headaches, memory disturbance, and muscle soreness are common
immediately after ECT treatment.
6. 1. An 88-year-old nursing home patient presents to the emergency depart-
ment with recent mental status changes, including aggression, confusion, and
dizziness, over the past two days. The patient scored a 20 on the MINI-Mental
Status Exam (MMSE). In addition to the MMSE, what additional information is
needed to conduct a thorough evaluation?
- Blood chemistry, complete blood count, and urinalysis
- Patient Health Questionnaire (PHQ-9) score
- Hamilton Depression Scale (HAM-D) score
- Electrocardiography and pharmacogenomics testing: - Blood chemistry, com-
plete blood count, and urinalysis
Rationale: A bedside MMSE can be used to document the cognitive impairment
and to provide a baseline form which to measure the patient's clinical course. The
laboratory workup of a patient should include standard tests (i.e., blood chemistries,
CBC, urinalysis) and additional studies indicated by the clinical situation.
7. 1. A client says that because he wished his sister was dead, and your
client's sister subsequently was killed in a motor vehicle accident, the death
was caused by the client's wishes. The client also revealed that he can reach
other's minds. This client is most likely suffering from which personality
disorder?
- Paranoid personality disorder
- Schizotypal personality disorder
, ANCC IQ domain 3
Study online at https://quizlet.com/_a1pund
- Schizoid personality disorder
- Delusional personality disorder: - Schizotypal personality disorder
Rationale: Schizotypal personality disorder is characterized by ideas of reference
and magical thinking.
8. 1. In the American Journal of Psychiatry, you read an article that discusses
a recent study's evidence that the nicotine exposure in pregnant women
increases the risk for schizophrenia in offspring (i.e., 38% increased likelihood
of schizophrenia in young adults whose mothers smoked heavily while preg-
nant). This inspires you to translate this information in practice and teaching
roles as a nurse practitioner. What considerations are needed to translate this
in to practice based on the best evidence?
- Determine if any other psychiatric or medical journal articles have comment-
ed on the validity or generalizability of the original stud.
- If the research is published in a peer-reviewed journal such as the American
Journal of Psychiatry, it is sound research.
- Analyze the original and repeat studies for methodical rigor and verify
that there were randomized or non-randomized clinical trials with the same
results.
- Analyze the original study only to determine that the research is sound and
meets the criteria for effectiveness of an intervention.: - Analyze the original
and repeat studies for methodical rigor and verify that there were randomized or
non-randomized clinical trials with the same results.
Rationale: Research Utilization begins with the idea of putting an innovation to use in
practice. The level of the evidence must be considered. The best of the best evidence
comes from reviewing several randomized clinical trials of the same thing with the
same results. Second to that are several non-randomized trials about the same thing
with the same results. Single randomized or non-randomized trials make up level 2
evidence regarding the effectiveness of an intervention.
9. 1. In distinguishing borderline personality disorder from chronic post-trau-
matic stress disorder related to childhood sexual abuse and victimization,
which of the following would be more indicative of borderline personality
disorder?
- Irritability or intense outbursts of anger
- Efforts to avoid real or imagined abandonment
- Affect lability often associated with intense fear
- Feeling of detachment or estrangement from others: - Efforts to avoid real or
imagined abandonment
Rationale: One hallmark of borderline personality disorder is the frantic efforts to
avoid real or imagined abandonment and the other is a pervasive pattern of unstable
