Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
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.
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 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.
Similar Questions
A 51-year-old woman is diagnosed with primary osteoarthritis (OA) of the knee. The NP will educate the woman that which of the following could have contributed to or might worsen her OA?
A. Diabetes mellitus, a congenital abnormality, obesity
Diabetes mellitus is a metabolic disorder and is not a primary contributor to OA; congenital abnormalities alone are less commonly a major factor.
B. Overuse of joints, obesity, diabetes mellitus
While overuse and obesity contribute to OA, diabetes mellitus is not considered a key causal factor.
C. Overuse of joints, obesity, aging
OA risk increases with mechanical stress on joints, cumulative overuse, obesity that increases joint load, and aging-related degeneration of cartilage, making this the most accurate combination of contributing factors.
D. Overuse of joints, obesity, a congenital abnormality
Congenital abnormalities can predispose to OA in some cases, but aging is a far more common contributing factor overall.
Full Explanation
Choice A reason: Diabetes mellitus is a metabolic disorder and is not a primary contributor to OA; congenital abnormalities alone are less commonly a major factor.
Choice B reason: While overuse and obesity contribute to OA, diabetes mellitus is not considered a key causal factor.
Choice C reason: OA risk increases with mechanical stress on joints, cumulative overuse, obesity that increases joint load, and aging-related degeneration of cartilage, making this the most accurate combination of contributing factors.
Choice D reason: Congenital abnormalities can predispose to OA in some cases, but aging is a far more common contributing factor overall.
The psychiatric-mental health nurse practitioner has just diagnosed a 23-year-old man with bipolar disorder. He has had one manic episode with suicidal ideation and no depressive episodes to date. Which of the following is the most appropriate at this time?
A. Divalproex (Depakote)
Divalproex is an effective mood stabilizer, especially for rapid cycling or mixed episodes, but lithium is generally first-line for classic mania with suicidal ideation.
B. Lamotrigine (Lamictal)
Lamotrigine is more effective for bipolar depression than mania and is not ideal for initial treatment of a first manic episode.
C. Carbamazepine (Tegretol)
Carbamazepine is an alternative mood stabilizer but has more drug interactions and is not the preferred first-line for initial mania.
D. Lithium (Eskalith)
Lithium is considered first-line treatment for acute mania in bipolar disorder and provides prophylactic benefits; it is particularly indicated for patients with suicidal ideation.
Full Explanation
Choice A reason: Divalproex is an effective mood stabilizer, especially for rapid cycling or mixed episodes, but lithium is generally first-line for classic mania with suicidal ideation.
Choice B reason: Lamotrigine is more effective for bipolar depression than mania and is not ideal for initial treatment of a first manic episode.
Choice C reason: Carbamazepine is an alternative mood stabilizer but has more drug interactions and is not the preferred first-line for initial mania.
Choice D reason: Lithium is considered first-line treatment for acute mania in bipolar disorder and provides prophylactic benefits; it is particularly indicated for patients with suicidal ideation.
Which of the following aspects of bipolar disorder predicts a favorable response to lithium treatment?
A. Rapid cycling
Rapid cycling is associated with a poorer response to lithium, often requiring alternative or adjunctive therapies.
B. Euthymic intervals
Clear euthymic intervals between episodes are associated with classic bipolar disorder, which predicts a favorable response to lithium treatment.
C. Psychotic symptoms
Psychotic symptoms do not reliably predict lithium response; these patients may require additional antipsychotic therapy.
D. Mixed episodes
Mixed episodes often respond less predictably to lithium alone and may need combination therapy.
Full Explanation
Choice A reason: Rapid cycling is associated with a poorer response to lithium, often requiring alternative or adjunctive therapies.
Choice B reason: Clear euthymic intervals between episodes are associated with classic bipolar disorder, which predicts a favorable response to lithium treatment.
Choice C reason: Psychotic symptoms do not reliably predict lithium response; these patients may require additional antipsychotic therapy.
Choice D reason: Mixed episodes often respond less predictably to lithium alone and may need combination therapy.