ANCC IQ domain 3 2021/2022 Rated A+ Questions And Answers With Rationales.

ANCC IQ domain 3 2021/2022 Rated A+ Questions And Answers With Rationales. 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 Correct Ans:- - 500-700 milliseconds Rationale: A patient with a QTc interval of 500-700 milliseconds is at higher risk of developing torsades de pointes. 1. 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 known antipsychotic to reduce the risk of suicide in schizophrenia? - Invega (iloperidone) - Abilify (aripiprazole) - Latuda (lurasidone) - Clozaril (clozapine) Correct Ans:- - 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. 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. Correct Ans:- - 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. 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 - Prior pregnancies Correct Ans:- - 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. 1. Electroconvulsive therapy (ECT) is a treatment of depression. What adverse effect is uncommon for a patient to experience after receiving ECT treatments? - Muscle soreness - Headaches - Fractures - Memory disturbance Correct Ans:- - Fractures Rationale: Headaches, memory disturbance, and muscle soreness are common immediately after ECT treatment. 1. An 88-year-old nursing home patient presents to the emergency department 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 Correct Ans:- - Blood chemistry, complete 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. 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 - Schizoid personality disorder - Delusional personality disorder Correct Ans:- - Schizotypal personality disorder Rationale: Schizotypal personality disorder is characterized by ideas of reference and magical thinking. 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 pregnant). 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 commented 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. Correct Ans:- - 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. 1. In distinguishing borderline personality disorder from chronic post-traumatic 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 Correct Ans:- - 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 and intense personal relationships characterized by alternating between extremes of idealization and devaluation. Affect lability, intense fear, irritability, intense anger, and feelings of detachment or estrangement are seen in both chronic PTSD and borderline personality disorder. 1. Which of the following atypical antipsychotic medications has U.S. Food and Drug Administration (FDA) approval for treatment of bipolar depression when combined with fluoxetine (Prozac)? - Risperidone (Risperdal) - Quetiapine (Seroquel) - Olanzapine (Zyprexa) - Aripiprazole (Abilify) Correct Ans:- - Olanzapine (Zyprexa) Rationale: Olanzapine in combination with fluoxetine (Symbax) is FDA approved for the treatment of bipolar depression. 1. A pervasive pattern of grandiosity, lack of empathy, and need for admiration suggests the diagnosis of which of the following personality disorders? - Schizotypal - Narcissistic - Borderline - Paranoid Correct Ans:- - Narcissistic Rationale: The essential features of narcissistic personality disorder is a pervasive pattern of grandiosity, need for admiration, and lack of empathy that begins by early adulthood and is present in a variety of contexts. 1. Mr. Jones, a 78-year-old male patient, presents to the PMHNP for a follow-up medication appointment. Mr. Jones' depression has been successfully treated with citalopram 20 mg by mouth daily. During the visit, Mr. Jones complains that in the last 2 or 3 weeks, he has had nausea, fatigue, feeling weak, with a headache and decreased appetite. Which action would be the most appropriate for Mr. Jones? - Assess for other symptoms of hyponatremia and check a serum sodium level - Discuss selective serotonin reuptake inhibitor discontinuation syndrome and stress the importance of medication adherence. - Discuss rates of relapse on a selective serotonin reuptake inhibitor and increase his medication to citalopram 40 mg be mouth daily. - Discuss rates of relapse on a selective serotonin reuptake inhibitor and recommend switching his medication to a different antidepressant class. Correct Ans:- - Assess for other symptoms of hyponatremia and check a serum sodium level Rationale: Hyponatremia can occur on selective serotonin reuptake inhibitors, and is more common in elderly patients. This patient is reporting symptoms of moderate hyponatremia and needs to be assessed, and his sodium level needs to be checked.