ANCC Practice UPDATED Exam Questions
and CORECT 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 900 mg of lithium daily. The
psychiatric nurse practitioner identifies these symptoms as signs of lithium toxicity. What is the
priority action of the PMHNP?
A. Maintains medication regimen and monitors the symptoms.
B. Tells the patient to stop taking lithium in orders of serum lithium level.
C. Order an electrocardiogram.
D. Take the patient's vital signs. - CORRECT ANSWER B. Tells the patient to stop taking
lithium in orders of serum lithium level.
For 12 years, a 65 year old patient with bipolar affective disorder has been treated with lithium
900 mg daily. When oral hydrochlorothiazide 12.5 mg daily is added for hypertension, the
patient develops nausea, vomiting, ataxia, and muscle weakness, and the patient's serum lithium
level is 2.0 the interaction of the lithium and thiazide diuretic has induced:
A. Hypokalemia.
B. Hyponatremia.
C. Increased Renal clearance of lithium.
D. Reduced renal clearance of lithium. - CORRECT ANSWER D. Reduced renal clearance of
lithium
Mary, a 45-year-old African-American female has been treated on isocarboxazid (Marplan) for
over six years. Mari is going in for a surgical procedure. Which medication is strictly
contraindicated with isocarboxazid?
A. Morphine.
B. NSAIDs.
,C. Methylphenidate.
D. Acetaminophen. - CORRECT ANSWER C. Methylphenidate
The psychiatric mental health nurse practitioner is aware of the following signs to watch out for
in patients taking clozapine (clozaril)
A. Nosebleeds, bleeding gums, and skin rash
B. Mutism, muscle rigidity, and hyperthermia
C. Fever, sore throat, and chills
D. Ataxia, confusion, hypothyroidism - CORRECT ANSWER C. Fever, sore throat, and
chills
A new prescription of carbamazepine is given to a patient who is baseline white blood cell count
is 5000 an absolute neutrophil count is 4000. Laboratory test show that the patient WBC count
has decreased to 2500 and ANC has decreased to 750 after two weeks of therapy. Similar
outcomes are obtained when the laboratory studies are repeated. The patient is not present with
any signs of infection. What is the next action of the PMHNP?
A. Continues a patient on Tegretol and monitor the patient for signs of infection.
B. Tell the patient to stop taking Tegretol and recheck the ANC and WBC.
C. Continues the patient on Tegretol since the WBC is within normal limits.
D. Refer the patient to a primary care provider. - CORRECT ANSWER B. Tell 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?
A. Steven Johnson syndrome
B. Ebstein's anomaly
C. Spina bifida
D. Cleft palate - CORRECT ANSWER C. Spina bifida
,Which mood stabilizer is associated with potential life threatening rash in the Asian population?
A. Carbamazepine (tegretol)
B. Depakote
C. Lithium
D. Lamictal - CORRECT ANSWER A. Carbamazepine (tegretol)
Which of the following physical exam finding would help the PMHNP differentiate anorexia
nervosa from bulimia nervosa?
A. Russel sign
B. Low body mass index
C. Erosion of dental enamel
D. Hypertrophy of salivary glands - CORRECT ANSWER B. Low body mass index
Which of the following medication has a unique mechanism that is both a norepinephrine and
dopamine reuptake inhibitor?
A. Bupropion (Wellbutrin)
B. Sertraline (Zoloft)
C. Clomipramine (Anafranil)
D. Duloxetine (Cymbalta) - CORRECT ANSWER A. Bupropion (Wellbutrin)
Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is
treated on clozapine?
A) 1A2
B) 2D6
, C) 2C9
D) 2C19 - CORRECT ANSWER A) 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?
A. Decreased body fat.
B. Increased liver capacity.
C. Decreased protein binding.
D. Increased in muscle concentration. - CORRECT ANSWER C. Decreased protein binding
Serotonin is a neurotransmitter that is implicated in sleep and mood. What area of the brain has a
large majority of serotonin neurons?
A. Raphe nuclei.
B. Nucleus, accumbens
C. Locus Coeruleus
D. Amygdala. - CORRECT ANSWER A. Raphe nuclei.
A client who is experiencing difficulties with working memory, planning/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
A. Frontal lobe
B. Temporal lobe
C. Parietal lobe
D. Occipital lobe - CORRECT ANSWER A. Frontal lobe
Which of these brain structures puts emotional meaning on a stimulus, forms emotional
memories, and is involved with rage and fear?
A. Hippocampus.
and CORECT 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 900 mg of lithium daily. The
psychiatric nurse practitioner identifies these symptoms as signs of lithium toxicity. What is the
priority action of the PMHNP?
A. Maintains medication regimen and monitors the symptoms.
B. Tells the patient to stop taking lithium in orders of serum lithium level.
C. Order an electrocardiogram.
D. Take the patient's vital signs. - CORRECT ANSWER B. Tells the patient to stop taking
lithium in orders of serum lithium level.
For 12 years, a 65 year old patient with bipolar affective disorder has been treated with lithium
900 mg daily. When oral hydrochlorothiazide 12.5 mg daily is added for hypertension, the
patient develops nausea, vomiting, ataxia, and muscle weakness, and the patient's serum lithium
level is 2.0 the interaction of the lithium and thiazide diuretic has induced:
A. Hypokalemia.
B. Hyponatremia.
C. Increased Renal clearance of lithium.
D. Reduced renal clearance of lithium. - CORRECT ANSWER D. Reduced renal clearance of
lithium
Mary, a 45-year-old African-American female has been treated on isocarboxazid (Marplan) for
over six years. Mari is going in for a surgical procedure. Which medication is strictly
contraindicated with isocarboxazid?
A. Morphine.
B. NSAIDs.
,C. Methylphenidate.
D. Acetaminophen. - CORRECT ANSWER C. Methylphenidate
The psychiatric mental health nurse practitioner is aware of the following signs to watch out for
in patients taking clozapine (clozaril)
A. Nosebleeds, bleeding gums, and skin rash
B. Mutism, muscle rigidity, and hyperthermia
C. Fever, sore throat, and chills
D. Ataxia, confusion, hypothyroidism - CORRECT ANSWER C. Fever, sore throat, and
chills
A new prescription of carbamazepine is given to a patient who is baseline white blood cell count
is 5000 an absolute neutrophil count is 4000. Laboratory test show that the patient WBC count
has decreased to 2500 and ANC has decreased to 750 after two weeks of therapy. Similar
outcomes are obtained when the laboratory studies are repeated. The patient is not present with
any signs of infection. What is the next action of the PMHNP?
A. Continues a patient on Tegretol and monitor the patient for signs of infection.
B. Tell the patient to stop taking Tegretol and recheck the ANC and WBC.
C. Continues the patient on Tegretol since the WBC is within normal limits.
D. Refer the patient to a primary care provider. - CORRECT ANSWER B. Tell 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?
A. Steven Johnson syndrome
B. Ebstein's anomaly
C. Spina bifida
D. Cleft palate - CORRECT ANSWER C. Spina bifida
,Which mood stabilizer is associated with potential life threatening rash in the Asian population?
A. Carbamazepine (tegretol)
B. Depakote
C. Lithium
D. Lamictal - CORRECT ANSWER A. Carbamazepine (tegretol)
Which of the following physical exam finding would help the PMHNP differentiate anorexia
nervosa from bulimia nervosa?
A. Russel sign
B. Low body mass index
C. Erosion of dental enamel
D. Hypertrophy of salivary glands - CORRECT ANSWER B. Low body mass index
Which of the following medication has a unique mechanism that is both a norepinephrine and
dopamine reuptake inhibitor?
A. Bupropion (Wellbutrin)
B. Sertraline (Zoloft)
C. Clomipramine (Anafranil)
D. Duloxetine (Cymbalta) - CORRECT ANSWER A. Bupropion (Wellbutrin)
Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual is
treated on clozapine?
A) 1A2
B) 2D6
, C) 2C9
D) 2C19 - CORRECT ANSWER A) 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?
A. Decreased body fat.
B. Increased liver capacity.
C. Decreased protein binding.
D. Increased in muscle concentration. - CORRECT ANSWER C. Decreased protein binding
Serotonin is a neurotransmitter that is implicated in sleep and mood. What area of the brain has a
large majority of serotonin neurons?
A. Raphe nuclei.
B. Nucleus, accumbens
C. Locus Coeruleus
D. Amygdala. - CORRECT ANSWER A. Raphe nuclei.
A client who is experiencing difficulties with working memory, planning/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
A. Frontal lobe
B. Temporal lobe
C. Parietal lobe
D. Occipital lobe - CORRECT ANSWER A. Frontal lobe
Which of these brain structures puts emotional meaning on a stimulus, forms emotional
memories, and is involved with rage and fear?
A. Hippocampus.
