NUR7375900 PMHNP Acute and chronic management of adult with Psych
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Free NUR7375900 PMHNP Acute and chronic management of adult with Psych Questions
Scenario: A 45-year-old Asian female presents to the clinic. She has a bright red rash on her face, and her lips are peeling. What does the psychiatric mental health nurse practitioner think is causing this rash?
- Valproic acid (Depakote)
- Sunburn
- Allergic skin condition
- Lamotrigine (Lamictal)
Explanation
Explanation:
Correct Answer: (D) Lamotrigine (Lamictal)
The presentation of a bright red rash with peeling lips in a patient on Lamotrigine is a serious clinical red flag for Stevens-Johnson Syndrome (SJS) or Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), both of which are known potentially life-threatening adverse reactions to Lamotrigine. Mucosal involvement such as lip peeling is a hallmark warning sign that distinguishes SJS from a benign drug rash, and this requires immediate discontinuation of the medication and emergent medical evaluation.
Why Other Options are Incorrect:
A. Valproic acid (Depakote) — While valproic acid has its own side effect profile including hair loss, weight gain, and hepatotoxicity, it is not classically associated with the severe mucocutaneous rash presentation described here.
B. Sunburn — Sunburn typically presents with diffuse erythema following sun exposure and does not cause lip peeling or the systemic features associated with SJS.
C. Allergic skin condition — While a general allergic reaction could cause a rash, the combination of facial rash and lip peeling in a patient on Lamotrigine specifically points to a drug-induced mucocutaneous reaction rather than a general allergic condition.
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25%
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50%
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75%
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85%
Explanation
Correct Answer: (C) 75%
Research indicates that approximately 75% of manic patients with bipolar affective disorder are at significant risk for verbal threatening or assault. During manic episodes, patients may experience severe irritability, impulsivity, and grandiosity, which substantially elevates the risk of aggressive verbal and physical behavior, making safety assessment a critical component of clinical management.
Why Other Options are Incorrect:
A. 25% — This significantly underestimates the risk of verbal threatening or assault in manic patients with bipolar disorder.
B. 50% — While closer, this figure still underrepresents the documented risk percentage associated with manic episodes and aggression.
D. 85% — This overestimates the documented percentage cited in research regarding this specific risk in manic patients.
Which of the following best illustrates the defense mechanism "regression"?
- A college student, overwhelmed by exams, begins sleeping with a childhood stuffed animal for comfort.
- A man who cheats on his taxes accuses others of being dishonest.
- A woman who didn't get a job she wanted says the company wasn't good enough for her anyway.
- A person who witnesses a car accident forgets key details of the event.
Explanation
Explanation:
Correct Answer: (A) A college student, overwhelmed by exams, begins sleeping with a childhood stuffed animal for comfort.
Regression is a defense mechanism in which an individual reverts to behaviors characteristic of an earlier developmental stage when faced with stress or anxiety. The college student, overwhelmed by academic pressure, returns to a childhood comfort behavior — sleeping with a stuffed animal — as a way of coping with the current stressor.
Why Other Options are Incorrect:
B. A man who cheats on his taxes accuses others of being dishonest — This describes projection, where one's own unacceptable behavior or feelings are attributed to others.
C. A woman who didn't get a job says the company wasn't good enough for her anyway — This describes rationalization, where a logical-sounding justification is created to protect self-esteem from a painful outcome.
D. A person who witnesses a car accident forgets key details of the event — This describes repression or dissociation, where distressing memories or details are unconsciously excluded from awareness.
Which of the following best describes the clinical presentation of someone experiencing their first true manic episode?
- A mildly elevated mood with occasional irritability that lasts only a few hours, resolved without impairment.
- A week or more of abnormally elevated or irritable mood and increased energy/activity, with symptoms such as decreased need for sleep, grandiosity, pressured speech, racing thoughts, distractibility, and risky behavior or causing marked impairment or hospitalization.
- Persistent depression followed by brief moments of euphoria, without changes in behavior or energy.
- A seasonal pattern of mood swings tied only to external stressors, without psychotic or impulsive episodes.
Explanation
Correct Answer: B) A week or more of abnormally elevated or irritable mood and increased energy/activity, with symptoms such as decreased need for sleep, grandiosity, pressured speech, racing thoughts, distractibility, and risky behavior or causing marked impairment or hospitalization.
According to the DSM-5, a manic episode requires a distinct period of abnormally elevated, expansive, or irritable mood and increased goal-directed activity or energy lasting at least seven days, present most of the day nearly every day. At least three additional symptoms must be present, and the episode must be severe enough to cause marked functional impairment or necessitate hospitalization.
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Somatic
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Geriatric
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Psychotic
Explanation
Correct Answer: (A) Somatic
In older adults, major depressive disorder frequently presents with somatic (physical) complaints such as fatigue, pain, and gastrointestinal issues rather than the classic emotional symptoms like sadness. This leads to under-diagnosis because clinicians often attribute these physical symptoms to medical conditions rather than depression.
Why Other Options are Incorrect:
B. Geriatric "Geriatric" describes the population itself, not a type of complaint or symptom presentation used in diagnosing depression.
C. Psychotic While psychotic features can occur in severe depression, they are not the most commonly under-diagnosed presentation in older adults — somatic complaints are far more prevalent and more likely to be missed.
Which of the following is the most common cause of Stevens-Johnson Syndrome (SJS)?
- Viral infections such as influenza
- Adverse reactions to medications, particularly anticonvulsants and antibiotics
- Autoimmune disorders like lupus
- Exposure to extreme temperatures or radiation
Explanation
Explanation:
Correct Answer: (B) Adverse reactions to medications, particularly anticonvulsants and antibiotics
Stevens-Johnson Syndrome is most commonly caused by adverse drug reactions. The medications most frequently implicated include anticonvulsants such as lamotrigine, carbamazepine, and phenytoin, as well as antibiotics such as sulfonamides (e.g., trimethoprim-sulfamethoxazole) and allopurinol. SJS is a severe mucocutaneous reaction characterized by widespread epidermal detachment and mucous membrane involvement, requiring immediate hospitalization.
Why Other Options are Incorrect:
A. Viral infections such as influenza — While some infections (particularly Mycoplasma pneumoniae and herpes simplex virus) can trigger SJS, medications are the most common cause overall.
C. Autoimmune disorders like lupus — Autoimmune conditions are not primary causes of SJS, though they may complicate the clinical picture.
D. Exposure to extreme temperatures or radiation — Temperature extremes and radiation can cause skin reactions but are not recognized causes of Stevens-Johnson Syndrome.
Which of the following statements best defines major depression with psychotic features according to DSM-5?
- A subtype of depression characterized by at least five depressive symptoms for two weeks, plus delusions and/or hallucinations that occur only during the depressive episode, not before or after.
- A chronic mood disorder with mild depressive symptoms and intermittent psychosis over a period of at least two years.
- Major depressive episodes accompanied by psychosis that persists even during periods of euthymia (no mood symptoms).
- A depressive disorder with psychotic-like thoughts (e.g., feeling worthless) without any true hallucinations or delusions, mainly driven by severe guilt.
Explanation
Correct Answer: A) A subtype of depression characterized by at least five depressive symptoms for two weeks, plus delusions and/or hallucinations that occur only during the depressive episode, not before or after.
Major depressive disorder with psychotic features is specified when a major depressive episode is accompanied by delusions or hallucinations. Critically, these psychotic symptoms are mood-congruent or mood-incongruent but occur exclusively during the depressive episode. This distinction is important for differentiating it from schizoaffective disorder or schizophrenia, where psychosis persists beyond mood episodes.
Which of the following is an example of the defense mechanism "projection" as described by Freud?
- A student who forgets an exam date insists the teacher never announced it.
- A person who is angry at their boss insists that their boss is actually angry at them.
- After being scolded by a parent, a child begins sucking their thumb again.
- A person refuses to accept that their partner has ended the relationship.
Explanation
Explanation:
Correct Answer: (B) A person who is angry at their boss insists that their boss is actually angry at them.
Projection is a defense mechanism in which an individual attributes their own unacceptable thoughts, feelings, or impulses to another person. In this example, the person who feels anger toward their boss cannot consciously accept this feeling, so they project it outward — perceiving the boss as the one who is angry, rather than themselves.
Why Other Options are Incorrect:
A. A student who forgets an exam date insists the teacher never announced it — This describes rationalization or denial, where the student creates a justification to avoid personal responsibility.
C. After being scolded by a parent, a child begins sucking their thumb again — This describes regression, where an individual reverts to earlier, more childlike behaviors in response to stress.
D. A person refuses to accept that their partner has ended the relationship — This describes denial, where an individual refuses to acknowledge a painful reality.
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Weight gain, anxiety, malnutrition
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Weight loss, anxiety, anorexia
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Weight is stable, anxiety, malnutrition
Explanation
Correct Answer: (B) Weight loss, anxiety, anorexia Cocaine is a central nervous system stimulant that suppresses appetite and dramatically increases metabolic rate. Clients with cocaine use disorder characteristically experience significant weight loss and anorexia due to appetite suppression, along with anxiety, agitation, paranoia, tachycardia, and elevated blood pressure from the stimulant effects of the drug.
Why Other Options are Incorrect:
A. Weight gain, anxiety, malnutrition — Weight gain is not associated with cocaine use disorder. Cocaine suppresses appetite and increases metabolic demands, consistently leading to weight loss rather than weight gain.
C. Weight is stable, anxiety, malnutrition — Weight stability is not expected in cocaine use disorder. The stimulant and appetite-suppressing effects of cocaine reliably produce weight loss. Stable weight does not reflect the physiological impact of active cocaine use.
Explain signs and symptoms of Serotonin syndrome.
Explanation
Correct Answer:
Serotonin syndrome presents with three hallmark categories:
Mental/Cognitive: Agitation, anxiety, confusion, and restlessness occurring rapidly after initiation or dose increase of a serotonergic agent.
Neuromuscular: Tremor, clonus (rhythmic muscle contractions), hyperreflexia, myoclonus, and incoordination. Clonus — particularly ocular and lower extremity — is the most distinguishing neuromuscular feature of SS compared to NMS.
Autonomic: Hyperthermia, tachycardia, diaphoresis, hypertension, and diarrhea.
Onset is rapid, typically within 24 hours of serotonergic drug use, overdose, or drug interaction. Severe cases can progress to hyperthermia above 41°C, rhabdomyolysis, seizures, renal failure, and death.
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