Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A mom brings her 13-year-old daughter to the PMHNP for an evaluation of suspected attention-deficit hyperactivity disorder (ADHD). For an adolescent who presents with distractibility, which of the following additional features would suggest an association with bipolar II disorder rather than ADHD?
A. A report of less need for sleep
Reduced need for sleep is a hallmark feature of hypomanic episodes in bipolar disorder and is not typical of ADHD.
B. Evidence that the symptoms are episodic
Symptoms that occur episodically rather than consistently over time suggest a mood disorder rather than a chronic condition like ADHD.
C. Rapid speech noted on examination
Rapid speech can occur in both ADHD and hypomanic episodes, making it less specific.
D. Complaints of racing thoughts
Racing thoughts are characteristic of hypomanic episodes in bipolar disorder, helping distinguish it from ADHD.
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: Reduced need for sleep is a hallmark feature of hypomanic episodes in bipolar disorder and is not typical of ADHD.
Choice B reason: Symptoms that occur episodically rather than consistently over time suggest a mood disorder rather than a chronic condition like ADHD.
Choice C reason: Rapid speech can occur in both ADHD and hypomanic episodes, making it less specific.
Choice D reason: Racing thoughts are characteristic of hypomanic episodes in bipolar disorder, helping distinguish it from ADHD.
Similar Questions
A 41-year-old Malaysian man is referred to the PMHNP following an incident at work. He says a coworker insulted him, and the next thing he knows the police were called. He does not remember attacking the coworker, but he was arrested for assault. Which culture-bound syndrome should the PMHNP include in the differential diagnosis?
A. Ataque de nervios
Ataque de nervios is common in Latin American cultures and involves intense emotional upset with crying, trembling, and verbal or physical aggression, often in response to a stressor, but usually within a family context.
B. Khayal
Khayal is a Southeast Asian cultural syndrome involving anxiety with physical symptoms like palpitations and dizziness, not violent outbursts.
C. Possession syndrome
Possession syndrome involves acting under the control of a spirit or external entity but is distinct from culturally recognized violent episodes such as amok.
D. Amok
Amok is a culture-bound syndrome observed in Malaysia and other Southeast Asian regions, characterized by sudden, dissociative episodes of violent behavior, often followed by amnesia for the event. This aligns with the patient's presentation.
Full Explanation
Choice A reason: Ataque de nervios is common in Latin American cultures and involves intense emotional upset with crying, trembling, and verbal or physical aggression, often in response to a stressor, but usually within a family context.
Choice B reason: Khayal is a Southeast Asian cultural syndrome involving anxiety with physical symptoms like palpitations and dizziness, not violent outbursts.
Choice C reason: Possession syndrome involves acting under the control of a spirit or external entity but is distinct from culturally recognized violent episodes such as amok.
Choice D reason: Amok is a culture-bound syndrome observed in Malaysia and other Southeast Asian regions, characterized by sudden, dissociative episodes of violent behavior, often followed by amnesia for the event. This aligns with the patient's presentation.
For a 39-year-old woman with a recent diagnosis of psoriatic arthritis who is treatment-naive with mild disease, which of the following would be considered an appropriate first-line therapy?
A. Intra-articular glucocorticoids
Intra-articular glucocorticoids may be used for flare management in specific joints but are not first-line systemic therapy for mild psoriatic arthritis.
B. NSAIDs
NSAIDs are first-line therapy for mild psoriatic arthritis, providing anti-inflammatory and analgesic effects without the risks associated with immunosuppressants.
C. Opioids
Opioids are not recommended for arthritis management due to risk of dependence and do not address inflammation.
D. Pregabalin (Lyrica)
Pregabalin is indicated for neuropathic pain, not inflammatory arthritis, and is not appropriate for first-line treatment of psoriatic arthritis.
Full Explanation
Choice A reason: Intra-articular glucocorticoids may be used for flare management in specific joints but are not first-line systemic therapy for mild psoriatic arthritis.
Choice B reason: NSAIDs are first-line therapy for mild psoriatic arthritis, providing anti-inflammatory and analgesic effects without the risks associated with immunosuppressants.
Choice C reason: Opioids are not recommended for arthritis management due to risk of dependence and do not address inflammation.
Choice D reason: Pregabalin is indicated for neuropathic pain, not inflammatory arthritis, and is not appropriate for first-line treatment of psoriatic arthritis.
The PMHNP is evaluating a new client who reports symptoms of one hypomanic episode and at least one major depressive episode. Which psychiatric condition is most closely associated with these experiences?
A. Bipolar I disorder
Bipolar I disorder requires at least one manic episode, not just hypomania, making this inconsistent with the presentation.
B. Bipolar II disorder
Bipolar II disorder is characterized by at least one hypomanic episode and at least one major depressive episode without a history of full mania, matching the client’s symptoms.
C. Cyclothymic disorder
Cyclothymic disorder involves chronic, milder mood fluctuations but does not meet criteria for full hypomanic or major depressive episodes.
D. Schizoaffective disorder
Schizoaffective disorder includes mood episodes along with psychotic symptoms, which are not reported in this client’s history.
Full Explanation
Choice A reason: Bipolar I disorder requires at least one manic episode, not just hypomania, making this inconsistent with the presentation.
Choice B reason: Bipolar II disorder is characterized by at least one hypomanic episode and at least one major depressive episode without a history of full mania, matching the client’s symptoms.
Choice C reason: Cyclothymic disorder involves chronic, milder mood fluctuations but does not meet criteria for full hypomanic or major depressive episodes.
Choice D reason: Schizoaffective disorder includes mood episodes along with psychotic symptoms, which are not reported in this client’s history.