ANCC IQ Domain 1 answered all correctly answered;
latest updated summer 2022.
2 yr. old child with Fetal Alcohol Syndrome (FAS)
small head, short eye lid opening, flat midface, smooth philtrum, underdeveloped jaw,
thin upper lip, and short nose
Neuroleptic Malignant Syndrome (NMS)
- Acute mental status change, muscular rigidity, and autonomic instability (fever)
Elderly pt c/o tinnitus; the PMHNP would associate which of the following findings with
an acoustic neuroma?
- Unilateral tinnitus (ringing in the ears) may be the first symptom of an acoustic
neuroma
- Sx/sx infection of the ear - perforation of tympanic membrane, inflammation of the
middle ear, and suppuration of the labyrinth
Brain structure is activated in patients with severe anxiety (fear, panic, extreme anxiety)
- Amygdala is important in mediation of fear, anxiety, and panic
Which of the following does not reflect current understanding of neurotransmitter
pathways implicated in anxiety disorders?
-FALSE: decreasing GABA in the mesolimbic cortex diminishes symptoms of anxiety
-TRUE: increasing serotonergic activity in the amygdala diminishes symptoms of
anxiety
-TRUE: decreasing norepinephrine in the locus ceruleus diminishes symptoms of
anxiety
-TRUE: increased levels of CRF in the amygdala, hippocampus and locus ceruleus
increases symptoms of anxiety
-FALSE: decreasing GABA in the mesolimbic cortex diminishes symptoms of anxiety
Rationale: GABA (Gamma-aminobutyric acid) is the most abundant inhibitory
neurotransmitter in the brain. Decreasing GABA would increase anxiety.
Benzodiazepines are used to bind with GABA receptors to potentiate the anxiolytic
(calming) effects of GABA. The other responses are all accurate regarding effect on
anxiety symptoms.
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
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 mentalretardation 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.
Which of the following patients with generalized anxiety disorder is most likely to be a
CYP 2C19 poor metabolizer and have an exaggerated response to diazepam (Valium)
5 mg TID with increased sedation, central nervous system, and cognitive side effects?
-40-year-old Asian male
-30-year-old African American male
20-year-old African American male
50-year-old Caucasian male
-40-year-old Asian male
Rationale: The frequency of poor metabolizers of CYP 2C19 is low among Caucasians
(3%), intermediate among African Americans (18%), and higher in Asian and Japanese
populations (up to 20%).
Which serotonin receptor antagonism makes an antipsychotic "atypical"?
-5HT2A
-5HT1A
-5HT4A
-5HT3A
-5HT2A
Rationale: The mechanism of action that makes an antipsychotic medication "atypical"
is related to the 5HT2A receptor antagonism and D2 receptor antagonism.
-5HT1A
-5HT4A
-5HT3A
Which mood stabilizer is most associated with a potentially life-threatening rash?
-lamotrigine (Lamictal)
Lamotrigine is associated with a rare, serious, and potentially life-threatening rash
(Steven Johnsons syndrome
Which of the following findings would raise concern in a pre-school wellness exam for a
5-year-old girl?
height 43 inches, weight 55 lbs
Rationale: Body Mass Index (BMI) calculated for this height and weight is 21, which is
greater than 95th percentile for her age, placing her in overweight category. Calculation:
Weight (lbs) /Stature (inches) / Stature (inches) x 703 = BMI
BMI = 703 x weight (lbs) = 703 x 55
[Height (in)]2 432
Or Weight (kg)/ Stature (cm)/ Stature (cm) x 10,000 = BMI.
BMI = weight (kg)
[height (m)]2
Further evaluation is indicated: 1) assessment of daily activity level and dietary intake;
2) lab work to rule out medical etiology such as hypothyroidism and diabetes mellitus;
and 3) family history of obesity, diabetes, hypertension, etc. Parental counseling for
child's nutritional and exercise needs to begin addressing childhood obesity and
prevention of secondary medical problems. Other vital signs are within normal limits and
immunizations are complete for a 5-year-old.
-Completed immunizations: MMR, Varicella, DTap, IPV, PCV, Hib, HepB
Blood pressure 92/52
Pulse 102, respirations 30
Which of the following findings on MRI and PET scans would be uncommon in
individuals with schizophrenia?
-decreased electrical activity in the frontal lobes
-decreased total brain volume
-decreased size of cerebral ventricles
-decreased glutamate and GABA release
-decreased size of cerebral ventricles
Rationale: Individuals with schizophrenia have enlarged cerebral ventricles. There is
decreased electrical activity in frontal lobes, decreased glutamate and GABA release,
and decreased total brain volume.
A client is suffering from schizophrenia. Which of the FF 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?
Rationale: Galactorrhea is caused from dopamine blockade in the tuberoinfundibular
pathway by antipsychotic drugs.
-are you experiencing tremors?
-are you experiencing breast discharge?
Rationale: Galactorrhea is caused from dopamine blockade in the tuberoinfundibular
pathway by antipsychotic drugs.
You have a 17-year-old female patient who suffers with bipolar disorder. The patient
has a history of impulsive acting out and promiscuity. You make a decision to add Folic
acid 0.8 mg to her medication regimen of Lamotrigine (Lamictal) 200 mg PO QHS and
Quetiapine XR (Seroquel XR) 50 mg PO QHS. Why is it important?
- The folic acid is important to help her with her hypotension induced by the Quetiapine
XR (Seroquel XR) 50 mg PO QHS.
- The folic acid supports neural tube development during the first month that a woman is
pregnant.
- The folic acid is important for the continuing development of the patient's
neuroendocrine system.
- The folic acid is important to help her with the sleepiness induced by her bipolar
medications.
- The folic acid supports neural tube development during the first month that a woman is
pregnant.
Rationale: The patient's acting out behaviors may include sexual acting out. This could
lead to pregnancy. The United States Preventive Services Task Force (USPSTF)
recommends that all women planning or capable of pregnancy take a daily supplement
containing 0.4 to 0.8 mg (400 to 800 mcg) of folic acid. This recommendation is an A
level recommendation. The purpose is to lower the number of neural tube defects in
fetuses.
1. 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 neocortex contributes to motivation, planning, sequencing of behaviors in
time, attention, and social behavior. Positive symptoms of schizophrenia (hallucinations
and delusions) are thought to be caused by dopamine hyperactivity in the mesolimbic
tract, which regulates memory and emotion. This hyperactivity could result from
overactive modulation of neurotransmission from the nucleus accumbens. Another
explanation for dopaminergic hyperactivity in the mesolimbic tract is the hypoactivity of
the mesocortical tract, which normally inhibits dopamine activity in the mesolimbic tract
by some type of feedback mechanism. In schizophrenia, the primary defect may be in
the mesocortical tract, where dopaminergic function is diminished, thereby decreasing
the inhibitory effects on the mesolimbic tract. This disinhibition may be responsible for
the overactivity of dopamine in the mesolimbic tract, resulting in positive symptom
cluster.
Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when an individual
is treated on clozapine?
- 2D6
- 2C19
- 1A2
- 2C9
- 1A2
Rationale: When an individual is treated on clozapine and decreases tobacco use, the
clozapine level will increase, as the tobacco is an inducer to the clozapine, and the
patient no longer needs the higher dose of clozapine.
When patients enter the hospital, they may have to stop smoking abruptly if the hospital
has a 'no smoking' policy. Abrupt smoking cessation can affect the metabolism of drugs.
Cigarette smoking induces the activity of human cytochromes P450 (CYP) 1A2 and
2B6. These enzymes metabolise several clinically important drugs, including clozapine,
olanzapine and methadone.
Decreased CYP1A2 activity after smoking cessation increases the risk of adverse drug
reactions, with reports of increased toxicity from clozapine and olanzapine. Predicting
the required dose reduction of drugs metabolised by CYP1A2 after smoking cessation is
challenging. Therapeutic drug monitoring should be used when possible.
Nicotine replacement therapy does not influence CYP1A2 activity