Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
In bipolar disorder, it is theorized that initial episodes are likely triggered by major life events that cause the brain to become overly sensitive to electrical stimulation. Successive episodes grow increasingly more autonomous due to neuronal misfiring. Which term represents this concept?
A. GABA deregulation
GABA deregulation refers to disruptions in inhibitory neurotransmission, which may contribute to bipolar symptoms but does not specifically explain the progressive sensitization seen with repeated episodes.
B. Kindling
Kindling describes the process by which repeated subthreshold stimulation of neurons eventually leads to spontaneous, autonomous activity. In bipolar disorder, initial episodes are triggered by stressors, but later episodes may occur with decreasing external provocation, reflecting the kindling phenomenon.
C. Genetic loading
Genetic loading refers to inherited susceptibility to bipolar disorder but does not account for the progressive, self-propagating nature of episodes.
D. Voltage-gated channel abnormalities
Voltage-gated channel abnormalities may play a role in neuronal excitability but do not specifically describe the phenomenon of progressive autonomy in episode recurrence seen in bipolar disorder.
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: GABA deregulation refers to disruptions in inhibitory neurotransmission, which may contribute to bipolar symptoms but does not specifically explain the progressive sensitization seen with repeated episodes.
Choice B reason: Kindling describes the process by which repeated subthreshold stimulation of neurons eventually leads to spontaneous, autonomous activity. In bipolar disorder, initial episodes are triggered by stressors, but later episodes may occur with decreasing external provocation, reflecting the kindling phenomenon.
Choice C reason: Genetic loading refers to inherited susceptibility to bipolar disorder but does not account for the progressive, self-propagating nature of episodes.
Choice D reason: Voltage-gated channel abnormalities may play a role in neuronal excitability but do not specifically describe the phenomenon of progressive autonomy in episode recurrence seen in bipolar disorder.
Similar Questions
A 22-year-old woman presents for follow-up and evaluation 2 weeks after the initiation of fluoxetine (Prozac) for a diagnosis of major depressive disorder. At this visit, the PMHNP observes that the client has an elevated mood, her affect is expansive, and she is more talkative. The client says she has plans to write a novel that she believes will "change the face of American politics as we know it." When questioned about her potentially manic symptoms, the client becomes defensive. "I know you think I'm bipolar just because my mom was." She refuses to complete a self-rated mania symptom assessment tool. To further evaluate this client for mania, which of the following assessment tools will the PMHNP use?
A. Observer-Rated Scale for Mania
The Observer-Rated Scale for Mania is designed for nonclinicians and caregivers to rate observed manic behaviors rather than being a structured, clinician-administered assessment. It is less suitable for precise clinical assessment by a PMHNP.
B. Altman Self-Rating Mania Scale
The Altman Self-Rating Mania Scale is a self-report tool that requires patient participation. In this scenario, the patient refuses to complete self-rated assessments, making this tool ineffective.
C. Self-Report Manic Inventory
The Self-Report Manic Inventory is also a self-report measure, requiring patient cooperation to provide accurate symptom reporting. Refusal by the patient prevents its use.
D. Young Mania Rating Scale
The Young Mania Rating Scale (YMRS) is a clinician-administered tool widely used to assess the severity of manic symptoms. It combines direct clinician observation with patient input during the clinical interview. It evaluates mood, motor activity, speech, irritability, grandiosity, sleep, and insight, making it ideal for situations where the patient is unwilling to complete self-report measures.
Full Explanation
Choice A reason: The Observer-Rated Scale for Mania is designed for nonclinicians and caregivers to rate observed manic behaviors rather than being a structured, clinician-administered assessment. It is less suitable for precise clinical assessment by a PMHNP.
Choice B reason: The Altman Self-Rating Mania Scale is a self-report tool that requires patient participation. In this scenario, the patient refuses to complete self-rated assessments, making this tool ineffective.
Choice C reason: The Self-Report Manic Inventory is also a self-report measure, requiring patient cooperation to provide accurate symptom reporting. Refusal by the patient prevents its use.
Choice D reason: The Young Mania Rating Scale (YMRS) is a clinician-administered tool widely used to assess the severity of manic symptoms. It combines direct clinician observation with patient input during the clinical interview. It evaluates mood, motor activity, speech, irritability, grandiosity, sleep, and insight, making it ideal for situations where the patient is unwilling to complete self-report measures.
A nurse practitioner is treating a 17-year-old boy who sustained an open tibial fracture in a motor vehicle crash. Which of the following is the most appropriate treatment choice for a grade 1 open fracture?
A. Aminoglycosides
Aminoglycosides are primarily used for gram-negative infections and severe open fractures (grade II or III) but are not the first-line choice for a mild, grade 1 open fracture.
B. Cephalosporins
Cephalosporins, particularly first-generation cephalosporins like cefazolin, are the standard prophylactic antibiotics for grade 1 open fractures. They cover common pathogens such as Staphylococcus aureus and reduce the risk of post-traumatic osteomyelitis.
C. High-dose penicillin
High-dose penicillin is reserved for fractures complicated by anaerobic infections (e.g., contaminated wounds with soil) and is not routinely indicated for simple grade 1 open fractures.
D. Sulfamethoxazole and trimethoprim
Sulfamethoxazole and trimethoprim are not standard prophylaxis for open fractures and are not the first-line treatment due to insufficient coverage of typical pathogens encountered in acute open fractures.
Full Explanation
Choice A reason: Aminoglycosides are primarily used for gram-negative infections and severe open fractures (grade II or III) but are not the first-line choice for a mild, grade 1 open fracture.
Choice B reason: Cephalosporins, particularly first-generation cephalosporins like cefazolin, are the standard prophylactic antibiotics for grade 1 open fractures. They cover common pathogens such as Staphylococcus aureus and reduce the risk of post-traumatic osteomyelitis.
Choice C reason: High-dose penicillin is reserved for fractures complicated by anaerobic infections (e.g., contaminated wounds with soil) and is not routinely indicated for simple grade 1 open fractures.
Choice D reason: Sulfamethoxazole and trimethoprim are not standard prophylaxis for open fractures and are not the first-line treatment due to insufficient coverage of typical pathogens encountered in acute open fractures.
A 36-year-old man is evaluated by the PMHNP for a recent incident in which he stayed up for several nights in a row, had much more energy than usual, and believed he was talking to God. He was diagnosed with bipolar disorder. In reviewing his medications, the PMHNP finds he is taking acetaminophen 500 mg BID, bupropion XL (Wellbutrin) 150 mg once daily, Sam-E for pain from an old football injury, and alprazolam 0.5 mg pm for agitation. Which of these should be discontinued immediately?
A. Acetaminophen (Tylenol)
Acetaminophen is not known to exacerbate mania and can be safely continued for mild pain management.
B. Sam-E
Sam-E is a supplement that can have serotonergic activity and potentially precipitate mania in susceptible individuals, but it is not the primary agent of concern compared with bupropion in acute manic presentations.
C. Bupropion (Wellbutrin)
Bupropion is an activating antidepressant that can precipitate or worsen manic episodes in individuals with bipolar disorder. Immediate discontinuation is indicated to prevent further exacerbation of mania.
D. Alprazolam (Xanax)
Alprazolam is a benzodiazepine used for agitation or anxiety and does not contribute to manic symptoms; it may provide symptomatic relief and can be continued as needed.
Full Explanation
Choice A reason: Acetaminophen is not known to exacerbate mania and can be safely continued for mild pain management.
Choice B reason: Sam-E is a supplement that can have serotonergic activity and potentially precipitate mania in susceptible individuals, but it is not the primary agent of concern compared with bupropion in acute manic presentations.
Choice C reason: Bupropion is an activating antidepressant that can precipitate or worsen manic episodes in individuals with bipolar disorder. Immediate discontinuation is indicated to prevent further exacerbation of mania.
Choice D reason: Alprazolam is a benzodiazepine used for agitation or anxiety and does not contribute to manic symptoms; it may provide symptomatic relief and can be continued as needed.