Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
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.
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: 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.
Similar Questions
A nurse practitioner is treating a 17-year-old boy who sustained an open tibial fracture in a motor vehicle crash. Which of the following is the most appropriate treatment choice for a grade 1 open fracture?
A. Aminoglycosides
Aminoglycosides are primarily used for gram-negative infections and severe open fractures (grade II or III) but are not the first-line choice for a mild, grade 1 open fracture.
B. Cephalosporins
Cephalosporins, particularly first-generation cephalosporins like cefazolin, are the standard prophylactic antibiotics for grade 1 open fractures. They cover common pathogens such as Staphylococcus aureus and reduce the risk of post-traumatic osteomyelitis.
C. High-dose penicillin
High-dose penicillin is reserved for fractures complicated by anaerobic infections (e.g., contaminated wounds with soil) and is not routinely indicated for simple grade 1 open fractures.
D. Sulfamethoxazole and trimethoprim
Sulfamethoxazole and trimethoprim are not standard prophylaxis for open fractures and are not the first-line treatment due to insufficient coverage of typical pathogens encountered in acute open fractures.
Full Explanation
Choice A reason: Aminoglycosides are primarily used for gram-negative infections and severe open fractures (grade II or III) but are not the first-line choice for a mild, grade 1 open fracture.
Choice B reason: Cephalosporins, particularly first-generation cephalosporins like cefazolin, are the standard prophylactic antibiotics for grade 1 open fractures. They cover common pathogens such as Staphylococcus aureus and reduce the risk of post-traumatic osteomyelitis.
Choice C reason: High-dose penicillin is reserved for fractures complicated by anaerobic infections (e.g., contaminated wounds with soil) and is not routinely indicated for simple grade 1 open fractures.
Choice D reason: Sulfamethoxazole and trimethoprim are not standard prophylaxis for open fractures and are not the first-line treatment due to insufficient coverage of typical pathogens encountered in acute open fractures.
A 36-year-old man is evaluated by the PMHNP for a recent incident in which he stayed up for several nights in a row, had much more energy than usual, and believed he was talking to God. He was diagnosed with bipolar disorder. In reviewing his medications, the PMHNP finds he is taking acetaminophen 500 mg BID, bupropion XL (Wellbutrin) 150 mg once daily, Sam-E for pain from an old football injury, and alprazolam 0.5 mg pm for agitation. Which of these should be discontinued immediately?
A. Acetaminophen (Tylenol)
Acetaminophen is not known to exacerbate mania and can be safely continued for mild pain management.
B. Sam-E
Sam-E is a supplement that can have serotonergic activity and potentially precipitate mania in susceptible individuals, but it is not the primary agent of concern compared with bupropion in acute manic presentations.
C. Bupropion (Wellbutrin)
Bupropion is an activating antidepressant that can precipitate or worsen manic episodes in individuals with bipolar disorder. Immediate discontinuation is indicated to prevent further exacerbation of mania.
D. Alprazolam (Xanax)
Alprazolam is a benzodiazepine used for agitation or anxiety and does not contribute to manic symptoms; it may provide symptomatic relief and can be continued as needed.
Full Explanation
Choice A reason: Acetaminophen is not known to exacerbate mania and can be safely continued for mild pain management.
Choice B reason: Sam-E is a supplement that can have serotonergic activity and potentially precipitate mania in susceptible individuals, but it is not the primary agent of concern compared with bupropion in acute manic presentations.
Choice C reason: Bupropion is an activating antidepressant that can precipitate or worsen manic episodes in individuals with bipolar disorder. Immediate discontinuation is indicated to prevent further exacerbation of mania.
Choice D reason: Alprazolam is a benzodiazepine used for agitation or anxiety and does not contribute to manic symptoms; it may provide symptomatic relief and can be continued as needed.
A 62-year-old woman presents to the PMHNP for an evaluation. She is concerned she is developing dementia due to her significant family history. Which of the following would help the PMHNP make a diagnosis of pseudodementia rather than dementia?
A. Patients with pseudodementia are more likely to say "I don't know" when uncertain.
Individuals with pseudodementia, often related to depression, tend to respond to cognitive testing with "I don’t know" when uncertain, showing awareness of deficits. This contrasts with true dementia, where patients often confabulate or attempt to answer despite impaired memory.
B. In patients with dementia, attention and concentration are variable.
In dementia, attention and concentration are consistently impaired, not highly variable. This makes the statement inaccurate for distinguishing pseudodementia.
C. Patients with true dementia are less likely to have language impairment and to confabulate.
True dementia commonly involves language impairment and confabulation. The statement is incorrect in suggesting the opposite.
D. In patients with pseudodementia, intellectual performance is usually global, and impairment is consistently poor.
In pseudodementia, intellectual performance is typically intact outside of depressive episodes, and deficits are inconsistent, making the statement inaccurate.
Full Explanation
Choice A reason: Individuals with pseudodementia, often related to depression, tend to respond to cognitive testing with "I don’t know" when uncertain, showing awareness of deficits. This contrasts with true dementia, where patients often confabulate or attempt to answer despite impaired memory.
Choice B reason: In dementia, attention and concentration are consistently impaired, not highly variable. This makes the statement inaccurate for distinguishing pseudodementia.
Choice C reason: True dementia commonly involves language impairment and confabulation. The statement is incorrect in suggesting the opposite.
Choice D reason: In pseudodementia, intellectual performance is typically intact outside of depressive episodes, and deficits are inconsistent, making the statement inaccurate.