Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
Which of the following represents one of the key changes from the DSM-4 to the DSM-5?
A. DSM-4 considered homosexuality a psychiatric illness
This choice is incorrect because DSM-4 had already removed homosexuality as a psychiatric disorder in 1973, long before DSM-4 or DSM-5. Therefore, this does not represent a change between DSM-4 and DSM-5.
B. DSM-5 no longer considers psychosocial and environmental issues when assessing a patient
This choice is incorrect because DSM-5 actually emphasizes consideration of psychosocial and contextual factors in diagnosis, rather than eliminating them. The assessment still incorporates these factors in clinical formulation.
C. DSM-5 uses two axes instead of five
This choice is incorrect because DSM-5 eliminated the multiaxial system, which had five axes in DSM-4, and did not replace it with a two-axis system. The DSM-5 uses a single-axis approach with dimensional assessments.
D. DSM-4 used a multiaxial approach to psychiatric assessment
This choice is correct because DSM-5 removed the multiaxial assessment system that was used in DSM-4, which included five separate axes for diagnosis. This is one of the primary structural changes between the two editions.
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: This choice is incorrect because DSM-4 had already removed homosexuality as a psychiatric disorder in 1973, long before DSM-4 or DSM-5. Therefore, this does not represent a change between DSM-4 and DSM-5.
Choice B reason: This choice is incorrect because DSM-5 actually emphasizes consideration of psychosocial and contextual factors in diagnosis, rather than eliminating them. The assessment still incorporates these factors in clinical formulation.
Choice C reason: This choice is incorrect because DSM-5 eliminated the multiaxial system, which had five axes in DSM-4, and did not replace it with a two-axis system. The DSM-5 uses a single-axis approach with dimensional assessments.
Choice D reason: This choice is correct because DSM-5 removed the multiaxial assessment system that was used in DSM-4, which included five separate axes for diagnosis. This is one of the primary structural changes between the two editions.
Similar Questions
Regarding complementary and alternative treatments, which of the following is considered a mind-body intervention?
A. Reflexology
Reflexology involves applying pressure to specific points on the feet or hands to influence other parts of the body. While it is a complementary therapy, it is considered a body-based or manual therapy rather than a mind-body intervention.
B. Meditation
Meditation is correct because it is a mind-body intervention that emphasizes mental focus, relaxation, and awareness to positively influence physical and emotional health. It directly involves cognitive and emotional processes affecting the body.
C. Acupressure
Acupressure, similar to acupuncture, involves applying pressure to specific points on the body to relieve symptoms. While beneficial for physical symptoms, it is categorized as a manual or energy-based therapy rather than primarily a mind-body approach.
D. Acupuncture
Acupuncture involves inserting needles into specific points on the body to influence energy flow. Like acupressure, it is an energy-based or somatic therapy and does not primarily focus on cognitive or emotional modulation.
Full Explanation
Choice A reason: Reflexology involves applying pressure to specific points on the feet or hands to influence other parts of the body. While it is a complementary therapy, it is considered a body-based or manual therapy rather than a mind-body intervention.
Choice B reason: Meditation is correct because it is a mind-body intervention that emphasizes mental focus, relaxation, and awareness to positively influence physical and emotional health. It directly involves cognitive and emotional processes affecting the body.
Choice C reason: Acupressure, similar to acupuncture, involves applying pressure to specific points on the body to relieve symptoms. While beneficial for physical symptoms, it is categorized as a manual or energy-based therapy rather than primarily a mind-body approach.
Choice D reason: Acupuncture involves inserting needles into specific points on the body to influence energy flow. Like acupressure, it is an energy-based or somatic therapy and does not primarily focus on cognitive or emotional modulation.
The PMHNP works on an inpatient geriatric psychiatric unit. She knows that which of the following features is commonly present in Lewy body dementia?
A. A steadily progressive, gradual decline in reasoning and increased incidence of sleepwalking
This choice is incorrect because Lewy body dementia does involve cognitive decline, but sleepwalking is not a characteristic feature. The hallmark symptoms include fluctuating cognition, visual hallucinations, and parkinsonism.
B. Motor abnormalities with a low incidence of depression and psychosis
This choice is incorrect because Lewy body dementia is associated with both motor abnormalities and a higher risk of psychiatric symptoms, including depression and hallucinations, not a low incidence of these.
C. Recurrent visual hallucinations; affected patients adversely react to antipsychotics
This choice is correct because recurrent visual hallucinations and sensitivity to antipsychotic medications are hallmark features of Lewy body dementia. Patients often have parkinsonian motor symptoms and can deteriorate rapidly when exposed to antipsychotics.
D. A slowly progressive and fatal disorder that manifests with depression, psychosis, personality changes, and dementia
This choice is partially correct in describing some aspects of dementia but is more representative of Alzheimer’s disease or other neurodegenerative disorders. It does not capture the specific hallmark features of Lewy body dementia.
Full Explanation
Choice A reason: This choice is incorrect because Lewy body dementia does involve cognitive decline, but sleepwalking is not a characteristic feature. The hallmark symptoms include fluctuating cognition, visual hallucinations, and parkinsonism.
Choice B reason: This choice is incorrect because Lewy body dementia is associated with both motor abnormalities and a higher risk of psychiatric symptoms, including depression and hallucinations, not a low incidence of these.
Choice C reason: This choice is correct because recurrent visual hallucinations and sensitivity to antipsychotic medications are hallmark features of Lewy body dementia. Patients often have parkinsonian motor symptoms and can deteriorate rapidly when exposed to antipsychotics.
Choice D reason: This choice is partially correct in describing some aspects of dementia but is more representative of Alzheimer’s disease or other neurodegenerative disorders. It does not capture the specific hallmark features of Lewy body dementia.
An urgent care nurse practitioner comes in to examine his patient, a 77-year-old woman who was brought in by her family for altered mental status. He notes that the patient appears restless and does not know where she is. Upon further assessment, he notes that her pupils are sluggish to react to light and are unequal in size. She is unable to sit up at the side of the bed and her blood pressure is 190/88 mm Hg. Which of the following does the NP suspect?
A. Ischemic stroke
Ischemic stroke may present with focal neurological deficits, but the combination of unequal pupils, inability to sit up, and high blood pressure suggests a more global intracranial process rather than a localized ischemic event.
B. Increased intracranial pressure
This choice is correct because the patient’s altered mental status, unequal and sluggish pupils, postural instability, and elevated blood pressure are classic signs of increased intracranial pressure. These findings suggest a critical neurological emergency.
C. Myocardial infarction
Myocardial infarction typically presents with chest pain, shortness of breath, and cardiovascular symptoms rather than altered mental status and pupil abnormalities.
D. Cerebral aneurysm
Cerebral aneurysm rupture can cause acute neurological decline, but unequal pupils and gradually increasing blood pressure are more consistent with generalized intracranial pressure rather than the sudden presentation of a subarachnoid hemorrhage.
Full Explanation
Choice A reason: Ischemic stroke may present with focal neurological deficits, but the combination of unequal pupils, inability to sit up, and high blood pressure suggests a more global intracranial process rather than a localized ischemic event.
Choice B reason: This choice is correct because the patient’s altered mental status, unequal and sluggish pupils, postural instability, and elevated blood pressure are classic signs of increased intracranial pressure. These findings suggest a critical neurological emergency.
Choice C reason: Myocardial infarction typically presents with chest pain, shortness of breath, and cardiovascular symptoms rather than altered mental status and pupil abnormalities.
Choice D reason: Cerebral aneurysm rupture can cause acute neurological decline, but unequal pupils and gradually increasing blood pressure are more consistent with generalized intracranial pressure rather than the sudden presentation of a subarachnoid hemorrhage.