Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A 22-year-old Asian man has been diagnosed with a seizure disorder. Prior to initiating treatment with an anticonvulsant, what should his nurse practitioner consider?
A. Obtain a complete blood count (CBC), thyroid studies, and HbA1c
CBC, thyroid studies, and HbA1c are not standard pre-treatment requirements for anticonvulsants unless indicated by comorbid conditions.
B. Obtain a CSF analysis, urinalysis, electrolyte level, glucose level
CSF analysis and urinalysis are typically reserved for diagnostic workup of seizures, not pre-treatment pharmacogenomic risk assessment.
C. Obtain a pharmacogenomic profile to determine if he has one of the HLA alleles that make him more susceptible to Stevens-Johnson syndrome
Certain anticonvulsants, such as carbamazepine, carry a risk of severe cutaneous reactions like Stevens-Johnson syndrome. Individuals of Asian descent may carry HLA alleles (e.g., HLA-B*1502) that increase susceptibility. Screening reduces risk.
D. Refer to a psychiatrist to rule out factitious disorder
Referral to psychiatry is unnecessary unless there is suspicion of non-epileptic seizures; it is not a standard consideration prior to anticonvulsant initiation.
This question is an excerpt from Nurse Dive's nursing test bank - Mental Health Northern Kentucky University Proctored Exam 6. Take the full exam now
Full Explanation
Choice A reason: CBC, thyroid studies, and HbA1c are not standard pre-treatment requirements for anticonvulsants unless indicated by comorbid conditions.
Choice B reason: CSF analysis and urinalysis are typically reserved for diagnostic workup of seizures, not pre-treatment pharmacogenomic risk assessment.
Choice C reason: Certain anticonvulsants, such as carbamazepine, carry a risk of severe cutaneous reactions like Stevens-Johnson syndrome. Individuals of Asian descent may carry HLA alleles (e.g., HLA-B*1502) that increase susceptibility. Screening reduces risk.
Choice D reason: Referral to psychiatry is unnecessary unless there is suspicion of non-epileptic seizures; it is not a standard consideration prior to anticonvulsant initiation.
Similar Questions
The nurse practitioner (NP) is working in an urgent care clinic which advertises treatment for "broken bones." Which is not a correct definition of each classification of fracture?
A. Transverse: Diagonal break across the bone
A transverse fracture is a horizontal break across the bone, not diagonal. A diagonal break is an oblique fracture.
B. Greenstick: Bone cracks through one side only
A greenstick fracture occurs when the bone bends and cracks on one side without breaking completely, consistent with the definition provided.
C. Comminuted: Bone is crushed into many pieces
Comminuted fractures involve the bone being crushed into multiple fragments, accurately described.
D. Segmental: The same bone is fractured in two places, so there is a "floating" segment of bone
Segmental fractures involve the same bone being broken in two or more distinct places, leaving a floating segment between breaks, consistent with the description.
Full Explanation
Choice A reason: A transverse fracture is a horizontal break across the bone, not diagonal. A diagonal break is an oblique fracture.
Choice B reason: A greenstick fracture occurs when the bone bends and cracks on one side without breaking completely, consistent with the definition provided.
Choice C reason: Comminuted fractures involve the bone being crushed into multiple fragments, accurately described.
Choice D reason: Segmental fractures involve the same bone being broken in two or more distinct places, leaving a floating segment between breaks, consistent with the description.
In bipolar disorder, it is theorized that initial episodes are likely triggered by major life events that cause the brain to become overly sensitive to electrical stimulation. Successive episodes grow increasingly more autonomous due to neuronal misfiring. Which term represents this concept?
A. GABA deregulation
GABA deregulation refers to disruptions in inhibitory neurotransmission, which may contribute to bipolar symptoms but does not specifically explain the progressive sensitization seen with repeated episodes.
B. Kindling
Kindling describes the process by which repeated subthreshold stimulation of neurons eventually leads to spontaneous, autonomous activity. In bipolar disorder, initial episodes are triggered by stressors, but later episodes may occur with decreasing external provocation, reflecting the kindling phenomenon.
C. Genetic loading
Genetic loading refers to inherited susceptibility to bipolar disorder but does not account for the progressive, self-propagating nature of episodes.
D. Voltage-gated channel abnormalities
Voltage-gated channel abnormalities may play a role in neuronal excitability but do not specifically describe the phenomenon of progressive autonomy in episode recurrence seen in bipolar disorder.
Full Explanation
Choice A reason: GABA deregulation refers to disruptions in inhibitory neurotransmission, which may contribute to bipolar symptoms but does not specifically explain the progressive sensitization seen with repeated episodes.
Choice B reason: Kindling describes the process by which repeated subthreshold stimulation of neurons eventually leads to spontaneous, autonomous activity. In bipolar disorder, initial episodes are triggered by stressors, but later episodes may occur with decreasing external provocation, reflecting the kindling phenomenon.
Choice C reason: Genetic loading refers to inherited susceptibility to bipolar disorder but does not account for the progressive, self-propagating nature of episodes.
Choice D reason: Voltage-gated channel abnormalities may play a role in neuronal excitability but do not specifically describe the phenomenon of progressive autonomy in episode recurrence seen in bipolar disorder.
A 22-year-old woman presents for follow-up and evaluation 2 weeks after the initiation of fluoxetine (Prozac) for a diagnosis of major depressive disorder. At this visit, the PMHNP observes that the client has an elevated mood, her affect is expansive, and she is more talkative. The client says she has plans to write a novel that she believes will "change the face of American politics as we know it." When questioned about her potentially manic symptoms, the client becomes defensive. "I know you think I'm bipolar just because my mom was." She refuses to complete a self-rated mania symptom assessment tool. To further evaluate this client for mania, which of the following assessment tools will the PMHNP use?
A. Observer-Rated Scale for Mania
The Observer-Rated Scale for Mania is designed for nonclinicians and caregivers to rate observed manic behaviors rather than being a structured, clinician-administered assessment. It is less suitable for precise clinical assessment by a PMHNP.
B. Altman Self-Rating Mania Scale
The Altman Self-Rating Mania Scale is a self-report tool that requires patient participation. In this scenario, the patient refuses to complete self-rated assessments, making this tool ineffective.
C. Self-Report Manic Inventory
The Self-Report Manic Inventory is also a self-report measure, requiring patient cooperation to provide accurate symptom reporting. Refusal by the patient prevents its use.
D. Young Mania Rating Scale
The Young Mania Rating Scale (YMRS) is a clinician-administered tool widely used to assess the severity of manic symptoms. It combines direct clinician observation with patient input during the clinical interview. It evaluates mood, motor activity, speech, irritability, grandiosity, sleep, and insight, making it ideal for situations where the patient is unwilling to complete self-report measures.
Full Explanation
Choice A reason: The Observer-Rated Scale for Mania is designed for nonclinicians and caregivers to rate observed manic behaviors rather than being a structured, clinician-administered assessment. It is less suitable for precise clinical assessment by a PMHNP.
Choice B reason: The Altman Self-Rating Mania Scale is a self-report tool that requires patient participation. In this scenario, the patient refuses to complete self-rated assessments, making this tool ineffective.
Choice C reason: The Self-Report Manic Inventory is also a self-report measure, requiring patient cooperation to provide accurate symptom reporting. Refusal by the patient prevents its use.
Choice D reason: The Young Mania Rating Scale (YMRS) is a clinician-administered tool widely used to assess the severity of manic symptoms. It combines direct clinician observation with patient input during the clinical interview. It evaluates mood, motor activity, speech, irritability, grandiosity, sleep, and insight, making it ideal for situations where the patient is unwilling to complete self-report measures.