Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A 25-year-old female pharmaceutical sales representative presents to the PMHNP for an evaluation due to what she calls an increasing level of anxiety about her job, which she has had for approximately 1 year. She works from a home office, and it has become unorganized and cluttered. She frequently forgets deadlines for submitting reports, and as a result she turns them in at the last minute. She has been chastised more than once by her boss for not paying attention to details on these necessary reports. Because she does not report to anyone on a day-to-day basis, she often gets completely overwhelmed by the autonomy of the job, and as a result she completely "shuts down." She knows she should be planning her time better, but she has never been good at time management or planning. During her evaluation, she reports making excellent grades until she got to college. She says she can remember not being able to pay attention to teachers as early as first grade, and her report cards frequently said she talked too much. She often got in trouble at home for not finishing chores because she was easily distracted and forgetful. Today, she says she is getting so overwhelmed and anxious about her job performance that she is thinking about quitting. She says her friends are tired of her complaining and tell her she has it "so good." She wishes someone would just tell her exactly what to do every day so she didn't have to think about anything.
A. Generalized anxiety disorder
Generalized anxiety disorder involves persistent, excessive worry about multiple areas of life but does not explain the chronic pattern of inattention, disorganization, and impulsivity beginning in childhood.
B. Attention deficit hyperactivity disorder
Attention deficit hyperactivity disorder (ADHD), particularly the inattentive subtype, is characterized by difficulty sustaining attention, disorganization, forgetfulness, and chronic performance issues starting in childhood, consistent with this patient’s history.
C. Specific learning disorder
Specific learning disorders primarily involve difficulties with academic skills such as reading, writing, or math, rather than pervasive attentional and executive functioning problems.
D. Bipolar disorder
Bipolar disorder involves episodic mood changes, such as mania or depression, rather than persistent inattention and executive dysfunction across the lifespan.
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: Generalized anxiety disorder involves persistent, excessive worry about multiple areas of life but does not explain the chronic pattern of inattention, disorganization, and impulsivity beginning in childhood.
Choice B reason: Attention deficit hyperactivity disorder (ADHD), particularly the inattentive subtype, is characterized by difficulty sustaining attention, disorganization, forgetfulness, and chronic performance issues starting in childhood, consistent with this patient’s history.
Choice C reason: Specific learning disorders primarily involve difficulties with academic skills such as reading, writing, or math, rather than pervasive attentional and executive functioning problems.
Choice D reason: Bipolar disorder involves episodic mood changes, such as mania or depression, rather than persistent inattention and executive dysfunction across the lifespan.
Similar Questions
A 74-year-old client is diagnosed with COVID and is admitted to an inpatient hospital. Days later, he is more energetic than before his diagnosis. He exhibits flights of ideas, delusions of grandeur, and is ready to leave the hospital because he feels "so incredible." Which of the medications used in the treatment of COVID could have induced mania in this client?
A. Remdesivir
Remdesivir is an antiviral and is not commonly associated with mood disturbances such as mania.
B. Albuterol
Albuterol can cause mild nervousness or tremor but rarely induces full manic episodes.
C. Famotidine
Famotidine is an H2 receptor antagonist and is not associated with mania.
D. Dexamethasone
Dexamethasone is a corticosteroid that can induce psychiatric side effects including mania, agitation, and psychosis, particularly in older adults or those with underlying vulnerabilities.
Full Explanation
Choice A reason: Remdesivir is an antiviral and is not commonly associated with mood disturbances such as mania.
Choice B reason: Albuterol can cause mild nervousness or tremor but rarely induces full manic episodes.
Choice C reason: Famotidine is an H2 receptor antagonist and is not associated with mania.
Choice D reason: Dexamethasone is a corticosteroid that can induce psychiatric side effects including mania, agitation, and psychosis, particularly in older adults or those with underlying vulnerabilities.
A 24-year-old woman presents to the PMHNP for a psychiatric evaluation with a chief complaint of depression. Upon questioning, the client states that during certain periods of time, she has needed little sleep but still felt energetic. She has had "creative spurts” during these periods, during which she has started new projects, such as home decorating and writing a book. Which of the following assessment tools will the PMHNP use to assist in diagnosis?
A. Observer-Rated Scale for Mania
The Observer-Rated Scale for Mania is used by clinicians to assess manic symptoms but is less practical for initial self-reported screening in outpatient settings.
B. Mood Disorders Questionnaire (MDQ)
The Mood Disorders Questionnaire (MDQ) is a self-report screening tool designed to identify symptoms of bipolar disorder, including periods of elevated mood and increased energy, making it appropriate for this patient’s history.
C. Patient Health Questionnaire-9 (PHQ-9)
The PHQ-9 assesses depressive symptoms but does not screen for hypomanic or manic episodes.
D. Young Mania Rating Scale
The Young Mania Rating Scale (YMRS) is used for rating current manic severity but is not a screening tool for past hypomanic or manic episodes.
Full Explanation
Choice A reason: The Observer-Rated Scale for Mania is used by clinicians to assess manic symptoms but is less practical for initial self-reported screening in outpatient settings.
Choice B reason: The Mood Disorders Questionnaire (MDQ) is a self-report screening tool designed to identify symptoms of bipolar disorder, including periods of elevated mood and increased energy, making it appropriate for this patient’s history.
Choice C reason: The PHQ-9 assesses depressive symptoms but does not screen for hypomanic or manic episodes.
Choice D reason: The Young Mania Rating Scale (YMRS) is used for rating current manic severity but is not a screening tool for past hypomanic or manic episodes.
A 37-year-old man presents to the PMHNP based on a referral from his primary care physician, who suspects rapid cycling bipolar I disorder. Which of the following should be ordered to rule out an underlying medical etiology?
A. Dexamethasone suppression test
The dexamethasone suppression test is used primarily to assess for hypercortisolism or Cushing's syndrome, which is less commonly linked to mood cycling.
B. Liver function test
Liver function tests are important for monitoring medication metabolism but are not typically used to identify the etiology of rapid cycling bipolar disorder.
C. CSF 5-HIAA level
CSF 5-HIAA levels can reflect serotonin metabolism but are not standard for evaluating rapid cycling bipolar disorder and are rarely used in clinical practice.
D. Thyroid function tests
Thyroid dysfunction, including hyperthyroidism or hypothyroidism, can present with mood disturbances and contribute to rapid cycling in bipolar disorder; therefore, thyroid function tests are critical to rule out an underlying medical cause.
Full Explanation
Choice A reason: The dexamethasone suppression test is used primarily to assess for hypercortisolism or Cushing's syndrome, which is less commonly linked to mood cycling.
Choice B reason: Liver function tests are important for monitoring medication metabolism but are not typically used to identify the etiology of rapid cycling bipolar disorder.
Choice C reason: CSF 5-HIAA levels can reflect serotonin metabolism but are not standard for evaluating rapid cycling bipolar disorder and are rarely used in clinical practice.
Choice D reason: Thyroid dysfunction, including hyperthyroidism or hypothyroidism, can present with mood disturbances and contribute to rapid cycling in bipolar disorder; therefore, thyroid function tests are critical to rule out an underlying medical cause.