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Voorbeeld van de inhoud
ANCCDomain
1-
Scientific
Foundation
Mr.
Smith
is
going
in
for
an
elective
surgical
procedure.
He
is
currently
taking
Selegiline.
Which
medication
is
he
not
able
to
take?
-Morphine
-Codeine
-NSAIDs
-Meperidine
-
Meperidine
is
prohibited
when
a
patient
is
taking
an
MAOI
(Selegiline)
due
to
risk
of
HTN
crisis
and
death.
Rationale:
Meperidine
is
strictly
prohibited
when
a
patient
is
treated
on
a
monoamine
oxidase
inhibitor
(MAOI),
due
to
the
risk
of
hypertensive
crisis
and
death.
Hypertensive
crisis
and
death
can
also
occur
when
MAOIs
are
taken
in
conjunction
with
certain
medications:
meperidine
(demerol),
decongestants,
TCAs,
atypical
antipsychotics,
st
johns
wort,
l-tryptophan,
stimulants
(and
other
sympathomimetics),
asthma
medications
17-year-old
female
presents
to
your
clinic
reporting
anhedonia,
decreased
energy,
and
hopelessness
for
the
past
2
years.
She
denies
drinking
alcohol,
smoking,
or
using
illegal
substances.
Her
physical
examination
results
are
within
normal
limits
and
she
denies
suicidal
ideations.
As
the
treating
psychiatric
mental
health
nurse
practitioner,
you
decide
to
prescribe
her
bupropion
(Wellbutrin).
Of
the
following,
which
is
a
contraindication
for
bupropion?
-
Dysthymia
-
Fatigue
-
Smoking
-
Bulimia
-
Bulimia
Rationale:
Do
not
use
bupropion
if
patient
is
bulimic,
either
currently
or
in
the
past.
Prohibition
for
use
in
eating
disorders
due
to
increased
risk
of
seizures.
Brainpower
Read
More Previous
Play
Next
Rewind
10
seconds
Move
forward
10
seconds
Unmute
0:00
/
0:15
Full
screen
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
-Most
features
are
large:
a
broad
forehead,
elongated
face,
large
ears,
enlarged
testicles
(macroorchidism)
-Short
stature
-hyperextensible
joints,
low
muscle
tones,
soft
fleshy
tones
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
mental
retardation
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.
A
43-year-old
male
is
treated
for
Bipolar
I
on
lithium.
Which
of
the
following
hematologic
changes
is
associated
with
lithium?
-
Leukopenia -
Agranulocytosis
-
Anemia
-
Leukocytosis
-
Leukocytosis
Rationale:
While
the
mechanism
of
action
is
not
clear,
the
use
of
lithium
can
raise
white
blood
cell
counts
and,
therefore,
CBC
should
be
monitored
in
patients
treated
on
lithium.
A
37-year-old
patient
with
schizophrenia
is
started
on
a
high
dose
of
chlorpromazine
(Thorazine).
The
next
day,
he
complains
of
lightheadedness
after
standing
up.
Vital
sign
changes
reflect
a
significant
decrease
in
blood
pressure
and
an
increase
in
heart
rate.
You
suspect
this
is
secondary
to
the
alpha
1-adrenergic
blockade
which
is
causing
-
Decreased
sweating
-
Orthostatic
hypotension
-
Respiratory
depression
-
Dry
mouth
-
Orthostatic
hypotension
Rationale:
Orthostatic
hypotension,
a
drop
in
blood
pressure
while
standing,
is
a
side
effect
from
alpha
1-adrenergic
blockade.
This
is
especially
troublesome
with
chlorpromazine
and
clozapine
and
is
best
handled
by
raising
doses
slowly
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
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