ANCC IQ domain 1
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1. 2 yr. old child with Fetal Alcohol
small head, short eye lid
Syn- drome (FAS)
opening, flat midface,
smooth philtrum, un-
derdeveloped jaw, thin
upper lip, and short nose
2. Neuroleptic Malignant Syndrome (NMS) - Acute mental status
change,
muscular rigidity, and
autonomic instability (fever)
3. Elderly pt c/o tinnitus; the PMHNP - Unilateral tinnitus (ringing
would associate which of the following in the ears) may be the first
find- ings with an acoustic neuroma? symptom of an acoustic
neuroma
- Sx/sx infection of the ear -
perfo- ration of tympanic
membrane, in- flammation
of the middle ear, and
4. Brain structure is activated in patients suppuration of the labyrinth
- Amygdala is important in
medi-
with severe anxiety (fear, panic, extreme ation of fear, anxiety, and
panic
anxiety)
5. Which of the following does not symp- toms of anxiety
reflect current understanding of -TRUE: increased levels of
neurotrans- mitter pathways CRF in
implicated in anxiety disorders? the amygdala,
-FALSE: decreasing GABA in the hippocampus and locus
mesolimbic cortex diminishes symp- ceruleus increases
toms of anxiety symptoms of anxi- ety
-TRUE: increasing serotonergic
activity in the amygdala diminishes
symptoms of anxiety
-TRUE: decreasing norepinephrine
in the locus ceruleus diminishes
1/
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-FALSE: decreasing GABA in
the mesolimbic cortex diminishes
symptoms of anxiety
Rationale: GABA (Gam-
ma-aminobutyric acid) is the most
abundant inhibitory neurotrans- mitter
in the brain. Decreas-
ing GABA would increase anxi- ety.
Benzodiazepines are used to bind with
GABA receptors to po- tentiate the
anxiolytic (calming) effects of GABA.
The other re- sponses are all accurate
regard- ing effect on anxiety
symptoms.
2/
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6. While treating a 12-year-old boy for -long head and ears, short
ADHD, the PMHNP observes which stature, hyperextensible
of the following physical features joints Rationale: Etiological
that raise concerns for genetic factors in mental retardation
evaluation for Fragile X Syndrome? can be primar- ily genetic,
-obesity, small stature, small hands developmental, ac- quired,
and feet, hypotonia or in combination. Ge- netic
-café au lait spots on face and arms, causes included chromo-
neurofibromas somal and inherited
-long head and ears, short stature, hy- conditions.
perextensible joints Many of these genetic
-small stature, short palpebral fissure, disorders have characteristic
inner epicanthal folds physical fea- tures that
warrant genetic testing for
confirmatory diagnosis. Frag-
ile 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, hy- perextensible
joints, and postpu- bertal
macroorchidism. The men-
talretardation ranges from
mild to severe. There is high
rate of co- morbid ADHD,
learning disorder, and
pervasive developmental dis-
orders, such as autism. Café
au lait spots and
neurofibromas are common
in von Recklinghausen's
disease. Obesity, small
7. Which of the following patients with stature, small hands and
generalized anxiety disorder is most feet, hypotonia, and
likely to be a CYP 2C19 poor hypogonadism are charac-
metabo- teristic of Prader-Willi
Syndrome. Small head, short
3/
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palpebral fis- sure, and inner epicanthal -40-year-old Asian male
folds are characteristic of fetal alcohol Rationale: The frequency of
syndrome. poor metabolizers of CYP
2C19 is low
lizer and have an exaggerated response among Caucasians (3%),
inter-
4/
