Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
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.
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: 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.
Similar Questions
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.
A 22-year-old woman diagnosed with bipolar disorder missed her last two appointments with the PMHNP after she was started on lithium (Eskalith). Her mother brought her to a third appointment. The patient was excited to see the PMHNP, as evidenced by her rapid rate of speech and discussion about the book she was writing. The patient went on to say that God had spoken directly to her and given her a message that only she could give to the world. She said she hadn’t been able to sleep for at least 1 week because she had been so busy working on this book, but she felt “absolutely incredible” despite her lack of sleep. Both the patient and the mother insist she has not stopped taking her medication. The PMHNP orders laboratory studies, including a lithium level. Which level of lithium will be subtherapeutic and indicate a need for an increased dose?
A. 5 mEq/L
A lithium level of 5 mEq/L is critically high and would indicate severe toxicity, not subtherapeutic dosing.
B. 0.5 mEq/L
A lithium level of 0.5 mEq/L is at the low end or below the therapeutic range for acute mania (0.8–1.2 mEq/L), suggesting subtherapeutic dosing and a need for an increased dose.
C. 1.2 mEq/L
A lithium level of 1.2 mEq/L is within the therapeutic range for acute mania and would not indicate underdosing.
D. 15 mEq/L
A lithium level of 15 mEq/L is lethally toxic and requires immediate medical intervention, not dose escalation.
Full Explanation
Choice A reason: A lithium level of 5 mEq/L is critically high and would indicate severe toxicity, not subtherapeutic dosing.
Choice B reason: A lithium level of 0.5 mEq/L is at the low end or below the therapeutic range for acute mania (0.8–1.2 mEq/L), suggesting subtherapeutic dosing and a need for an increased dose.
Choice C reason: A lithium level of 1.2 mEq/L is within the therapeutic range for acute mania and would not indicate underdosing.
Choice D reason: A lithium level of 15 mEq/L is lethally toxic and requires immediate medical intervention, not dose escalation.
The nurse practitioner provides education about treatments to a 45-year-old woman with a diagnosis of chronic low back pain. Which of the following is NOT considered a first-line treatment for chronic low back pain?
A. Exercise therapy
Exercise therapy is a cornerstone of first-line treatment, improving strength, flexibility, and pain outcomes.
B. Cognitive behavioral therapy
Cognitive behavioral therapy addresses the psychosocial aspects of chronic pain and is recommended as first-line management.
C. Spinal manipulation
Spinal manipulation is not universally considered first-line treatment; it is adjunctive and varies in effectiveness depending on provider and patient.
D. Advice to remain active
Encouraging patients to remain active is first-line advice, as immobility can worsen pain and disability.
Full Explanation
Choice A reason: Exercise therapy is a cornerstone of first-line treatment, improving strength, flexibility, and pain outcomes.
Choice B reason: Cognitive behavioral therapy addresses the psychosocial aspects of chronic pain and is recommended as first-line management.
Choice C reason: Spinal manipulation is not universally considered first-line treatment; it is adjunctive and varies in effectiveness depending on provider and patient.
Choice D reason: Encouraging patients to remain active is first-line advice, as immobility can worsen pain and disability.