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ACTUAL EXAM PRACTICE SAMPLE MULTIPLE CHOICE Q&A (with rationales) FOR Adult-Gerontology PRIMARY Care Nurse Practitioner Certification (AGPCNP-BC®) ANCC 1. The patient is a 27-year-old woman who presents to your health care facility with a history of depre$17.99
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ACTUAL EXAM PRACTICE SAMPLE MULTIPLE CHOICE Q&A (with rationales) FOR Adult-Gerontology PRIMARY Care Nurse Practitioner Certification (AGPCNP-BC®) ANCC 1. The patient is a 27-year-old woman who presents to your health care facility with a history of depre
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ACTUAL EXAM PRACTICE SAMPLE MULTIPLE
CHOICE Q&A (with rationales) FOR Adult-Gerontology
PRIMARY Care Nurse Practitioner Certification
(AGPCNP-BC®) ANCC
1. The patient is a 27-year-old woman who presents to your health care
facility with a history of depressed mood that has worsened during the...
ACTUAL EXAM PRACTICE SAMPLE MULTIPLE
CHOICE Q&A (with rationales) FOR Adult-Gerontology
PRIMARY Care Nurse Practitioner Certification
(AGPCNP-BC®) ANCC
1. The patient is a 27-year-old woman who presents to your health care
facility with a history of depressed mood that has worsened during the
past few weeks. She gained 8 kg in the past 2 months; she reports that
she is eating when she is not sleeping. She is very stressed and worried
about her job. She has passive thoughts of harming herself but no
definite plan. Her medical history includes anxiety, and she takes 0.5 mg
of alprazolam three times daily. Which medication is the best to treat
this patient?
1. Paroxetine.
2. Fluoxetine.
3. Imipramine.
4. Mirtazapine.
2. Fluoxetine.
Rationale: The patient presents with signs and symptoms of major
depressive disorder. Selective serotonin receptor inhibitors are
considered a first-line agent in treatment for this patient. The patient
,gained 8 kg in the past 2 months; therefore paroxetine (answer 1) is not
recommended for her case because it leads to increased appetite and
causes somnolence. Fluoxetine (answer 2) is the best medication for
this patient because it does not affect weight or appetite. In addition,
fluoxetine could concomitantly relieve her symptoms of anxiety.
Imipramine is a tricyclic antidepressant agent (TCA) that has a warning
that patients with passive suicidal ideas should not receive TCAs
(answer 3). Mirtazapine (answer 4), like paroxetine, could increase
appetite and lead to weight gain.
18. The patient is a 37-year-old African American woman who has a 5-
year history of schizophrenia. She was diagnosed with type 2 diabetes,
obesity, and dyslipidemia in the past 6 months. She takes risperidone,
metformin, atorvastatin, and insulin glargine. She complained of
galactorrhea, which was induced by risperidone. Which medication is
most appropriate for this patient?
1. Olanzapine.
2. Paliperidone.
3. Ziprasidone.
4. Clozapine.
3. Ziprasidone.
Rationale: This patient has metabolic syndrome (weight gain, diabetes,
and dyslipidemia) caused by taking risperidone. Olanzapine (answer 1)
is asso
,ciated with a high incidence of metabolic syndrome. Paliperidone
(answer 2) could metabolize to risperidone, which has a similar
pharmacological profile. It also could induce galactorrhea as
risperidone. Ziprasidone (answer 3) has a low incidence of metabolic
syndrome; therefore it is the best choice for this patient. Clozapine
(answer 4) like olanzapine has a high incidence of metabolic syndrome.
19. The patient is a 47-year-old woman with a 17-year history of
schizophrenia. She has been taking haloperidol, but this was recently
changed to aripiprazole. Today, she comes to the psychiatric clinic with
anxiety and agitation. She feels "uncomfortable in her skin." She reports
that she regularly drinks alcohol. Which medication is most appropriate
to relieve her symptoms?
1. Propranolol.
2. Alprazolam.
3. Benztropine.
4. Dantrolene.
1. Propranolol.
Rationale: The patient has anxiety, agitation, and feels uncomfortable in
her skin. These symptoms resemble akathisia; therefore the best
treatment for this case is a lipophilic beta-blocker such as propranolol
(answer 1). Benzodiazepines (answer 2) might be efficacious for
akathisia, but the patient has a history of alcohol abuse. Benztropine
, (answer 3) is an anticholinergic agent that is effective against dystonia
and parkinsonism symptoms but not akathisia. Dantrolene (answer 4) is
more effective against neuroleptic malignant syndrome.
20. The patient is a 63-year-old white woman with a 25-year history of
schizophrenia who is admitted to the emergency department with
involuntary chewing motions and abnormal blinking for the past 6
months. The patient was on haloperidol 5 mg twice daily, but the dose
was decreased to 2.5 mg twice daily. The symptoms started to decrease,
but the patient still is uncomfortable and she wants to change her
antipsychotic medication. Which medication is the best for her?
1. Risperidone.
2. Clozapine.
3. Thioridazine.
4. Aripiprazole.
2. Clozapine.
Rationale: The patient has involuntary facial muscles, which is called
tardive dyskinesia. Risperidone has fewer extrapyramidal side effects
(EPSs), but it is not the best treatment for tardive dyskinesia (answer 1).
Clozapine (answer 2) is the best choice because of its low-to-
nonexistent incidence of tardive dyskinesia. Thioridazine (answer 3) is a
first-generation antipsychotic agent associated with the development
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