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ANCC Review Questions (PMHNP IQ)
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ANCC Review Questions (PMHNP IQ)What direct-acting dopamine receptor agonist is recommended to be used in
the treatments of neuroleptic malignant syndrome (NMS) fo help lower the
dopamine blockade? - -Bromocriptine (Parlodel) is the recommended direct
acting dopamine receptor agonist to help decrease the dopamine blockade.
Danrolene (Dantrium) is a muscle relaxant. Benzotropine (Cogentin) and
Trihexyphenidyl (Artane) are anticholinergic medications used for
extrapyramidal side effects (EPS).
-Mr. Smith is a 56 year old white male who has been successfully treated on
Selegiline for over 4 years. Mr. Smith is going in for elective surgical
procedure. Which medication is strictly contraindicated with Selegiline? - -
Meperidine is strictly prohibited when a patient is treated on a monoamine
oxidase inhibitor (MAOI) due to the risk of hypertensive crisis and death.
-A WBC of 4,000 in a patient taking Clozapine would prompt the PMHNP to
take which of the following actions? - -Institute twice-weekly complete blood
count with differentials and monitor closely.
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.
-A patient with a diagnosis of schizophrenia has a history of suicidal ideation
and suicide attempts. The PMHNP should consider which antipsychotic
medication that is the only antipsychotic to reduce the risk of suicide in
schizophrenia? - -Clozaril (clozapine) is the only known antipsychotic
medication that had been shown to reduce the risk of suicide in patients
diagnosed with schizophrenia.
-A patient being treated for major depressive disorder and on sertraline
(Zoloft), 150 mg po daily for the past 16 years, presents to the psychiatric
mental health practitioner for an outpatient follow-up visit. During the visit
she states that she has not been feeling well, reporting the flu. She also
states she has not taken her medication in the last five days. Which of the
following symptoms would she be describing if you suspect selective
serotonin reputable inhibitors (SSRIs) discontinuation syndrome? - -A)
Agitation; nausea, dysphoria, and disequilibrium
, The patient has SSRI discontinuation syndrome and would be presenting with
flu-like symptoms. If the patient had serotonin syndrome, she would present
with symptoms of autonomic instability.
-Which of the following statements reflect the current understanding of
dopamine (DA) pathways and clinical symptoms in schizophrenia? - -A)
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 & cognitive impairment are thought to be related to
hypoactivity of the mesocortical dopiminergic tract, which by its association
with the prefrontal cortex and neocortex contributes to motivation, planning,
sequencing of behaviors in time, attention, and social behavior. Positive
symptoms (hallucination and delusions) are thought to be caused by
dopamine hyperactivity in the mesolimbic tract, which regulates emotion.
This hyperactivity could result in overactive modulation of
nueurotransmission from the nucleus accumbens.
-Norepinephrine is a neurotransmitter that is implicated in alertness and
anxiety. What area of the brain has a large majority of norepinephrine
neurons? - -Locus coeruleus
There are two areas in the brain that produce norepinephrine neurons, one is
the locus coeruleus and the other is the medullary reticular formation.
-Which cytochrome (CYP) enzyme is implicated as a tobacco inducer when
an individual is treated on clozapine? - -A) 1A2
When an individual is treated on clozapine and decreases tobacco use, the
clozapine level with increase, as tobacco is an inducer to the clozapine, and
the patient no longer needs the higher dose of clozapine.
-When working with an avoidant patient with a history of trauma, what type
of communication techniques are helpful? - -Techniques to increase arousal
Activation is needed to allow memories stored in the amygdala to be
processed.
-The PMHNP knows that the ego is a part of the personality and is the
logical/rational mind including defense mechanisms. What might this
personality part say? - -"I evaluate"
The ego is the logical and rational mind. The ego monitors the is and would
say "I think. I evaluate."
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