Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A 35-year-old man with bipolar I disorder presents with a new-onset manic episode and is successfully treated with medication adjustment. He notes chronic depressive symptoms that, on reflection, long preceded his manic episodes. He describes these symptoms as "feeling down," having decreased energy, and more often than not, having no motivation. He denies other depressive symptoms but feels that these alone have been sufficient to negatively affect his marriage. Which diagnosis best fits his presentation?
A. Bipolar II disorder
Bipolar II disorder involves at least one hypomanic episode and one major depressive episode, but this patient has a history of full manic episodes, not hypomania.
B. Bipolar I disorder, current or most recent episode depressed
While bipolar I disorder with a current or most recent depressive episode captures the depressive phase, it does not account for the chronic depressive symptoms predating manic episodes.
C. Cyclothymic disorder
Cyclothymic disorder involves chronic fluctuating mood states without meeting criteria for full manic or major depressive episodes. This does not match the patient’s manic history.
D. Bipolar I disorder and persistent depressive disorder
Bipolar I disorder with coexisting persistent depressive disorder (dysthymia) accounts for the patient’s chronic depressive symptoms and history of full mania, making it the most accurate diagnosis.
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: Bipolar II disorder involves at least one hypomanic episode and one major depressive episode, but this patient has a history of full manic episodes, not hypomania.
Choice B reason: While bipolar I disorder with a current or most recent depressive episode captures the depressive phase, it does not account for the chronic depressive symptoms predating manic episodes.
Choice C reason: Cyclothymic disorder involves chronic fluctuating mood states without meeting criteria for full manic or major depressive episodes. This does not match the patient’s manic history.
Choice D reason: Bipolar I disorder with coexisting persistent depressive disorder (dysthymia) accounts for the patient’s chronic depressive symptoms and history of full mania, making it the most accurate diagnosis.
Similar Questions
The clock-drawing test (CDT) has become a standard cognitive screening tool around the world. Like all cognitive screening tests, it is designed to detect early brain changes to determine if a person may be experiencing dementia. Which of the following statements most accurately depicts the usefulness of this test?
A. The CDT is affected by level of education and can be used alone for diagnostic purposes or for assessing the severity of cognitive impairment.
While the CDT is somewhat affected by education, it should not be used alone for diagnostic purposes because it is a screening tool, not a definitive test.
B. The CDT serves as an IQ test as well as a test of cognitive functioning.
The CDT does not measure IQ; it is designed to assess multiple domains of cognitive function including executive functioning, visuospatial abilities, and planning.
C. The CDT is easy to administer in a short time, and it assesses multiple domains of cognitive functioning.
The CDT is quick to administer, non-invasive, and provides assessment across multiple cognitive domains, making it valuable for early detection of cognitive impairment.
D. The CDT is an accurate predictor of focal brain degeneration.
The CDT does not specifically predict focal brain degeneration; it is a general screening tool rather than a neuroimaging substitute.
Full Explanation
Choice A reason: While the CDT is somewhat affected by education, it should not be used alone for diagnostic purposes because it is a screening tool, not a definitive test.
Choice B reason: The CDT does not measure IQ; it is designed to assess multiple domains of cognitive function including executive functioning, visuospatial abilities, and planning.
Choice C reason: The CDT is quick to administer, non-invasive, and provides assessment across multiple cognitive domains, making it valuable for early detection of cognitive impairment.
Choice D reason: The CDT does not specifically predict focal brain degeneration; it is a general screening tool rather than a neuroimaging substitute.
A 39-year-old Cambodian man presents to the PMHNP for an evaluation following an event that he refers to as "Khayal." Which culture-bound syndrome should the PMHNP include in the differential diagnosis?
A. Fright, which results in symptoms of depression
Fright syndromes typically involve transient anxiety and sadness but do not include the physical manifestations associated with Khayal.
B. Weakness of the nervous system that results in mood and somatic symptoms
Weakness of the nervous system, such as neurasthenia, is associated with chronic fatigue and somatic complaints but does not reflect the acute episodic presentation of Khayal.
C. A wind attack, similar to a panic attack, that results in tinnitus and neck soreness
Khayal is a Cambodian culture-bound syndrome characterized by a wind attack or sudden anxiety episode with physical symptoms, including tinnitus, palpitations, and neck soreness. It resembles a panic attack culturally contextualized.
D. Thinking too much, resulting in interpersonal and social difficulties
Excessive rumination or “thinking too much” is associated with some African or Caribbean syndromes but does not describe Khayal.
Full Explanation
Choice A reason: Fright syndromes typically involve transient anxiety and sadness but do not include the physical manifestations associated with Khayal.
Choice B reason: Weakness of the nervous system, such as neurasthenia, is associated with chronic fatigue and somatic complaints but does not reflect the acute episodic presentation of Khayal.
Choice C reason: Khayal is a Cambodian culture-bound syndrome characterized by a wind attack or sudden anxiety episode with physical symptoms, including tinnitus, palpitations, and neck soreness. It resembles a panic attack culturally contextualized.
Choice D reason: Excessive rumination or “thinking too much” is associated with some African or Caribbean syndromes but does not describe Khayal.
A 42-year-old woman recently diagnosed with rheumatoid arthritis asks the nurse practitioner about disease-modifying antirheumatic drugs (DMARDs). Which of the following statements about DMARDs is INCORRECT?
A. DMARDs target the underlying disease.
DMARDs act on the underlying inflammatory process in rheumatoid arthritis, modifying disease progression.
B. DMARDs limit joint damage and improve function.
DMARDs slow or prevent joint damage and improve long-term functional outcomes.
C. DMARDs include different classes of medications and are available orally, via subcutaneous injection, or via IV infusion.
DMARDs are a heterogeneous group, including traditional and biologic agents, administered orally, subcutaneously, or intravenously.
D. Patients can begin to experience symptom improvement 3 weeks after DMARD initiation.
Symptom improvement is typically delayed and may take 6–12 weeks or longer after starting DMARD therapy; expecting improvement in 3 weeks is inaccurate.
Full Explanation
Choice A reason: DMARDs act on the underlying inflammatory process in rheumatoid arthritis, modifying disease progression.
Choice B reason: DMARDs slow or prevent joint damage and improve long-term functional outcomes.
Choice C reason: DMARDs are a heterogeneous group, including traditional and biologic agents, administered orally, subcutaneously, or intravenously.
Choice D reason: Symptom improvement is typically delayed and may take 6–12 weeks or longer after starting DMARD therapy; expecting improvement in 3 weeks is inaccurate.