Adult Primary Care for the Advanced Practice Nurse (D118)

Correct answer A. The presence of manic or hypomanic episodes is a key factor in diagnosing Bipolar Disorder, while Major Depressive Disorder is characterized solely by depressive episodes.

Explanation:

Bipolar Disorder is defined by the presence of manic or hypomanic episodes in addition to depressive episodes. Bipolar I Disorder includes full manic episodes, while Bipolar II Disorder includes hypomanic episodes, which are less severe but still distinguish the condition from Major Depressive Disorder (MDD). In contrast, MDD consists only of depressive episodes, without any history of mania or hypomania. Identifying manic or hypomanic symptoms is crucial in ensuring accurate diagnosis and appropriate treatment, as mood stabilizers or antipsychotics are often necessary for managing Bipolar Disorder, whereas antidepressants alone may worsen the condition.

Why other options are wrong:

B. Bipolar Disorder includes only depressive episodes, while Major Depressive Disorder includes manic episodes.

This is incorrect because Bipolar Disorder is defined by the presence of manic or hypomanic episodes. Major Depressive Disorder, on the other hand, consists only of depressive episodes and does not include manic symptoms.

C. Both disorders include manic episodes, but Bipolar Disorder has more severe symptoms.

This is incorrect because Major Depressive Disorder does not include manic episodes at all. While Bipolar Disorder can have severe symptoms, the key distinction between the two disorders is the presence of mania or hypomania in Bipolar Disorder.

D. Major Depressive Disorder can have manic episodes, but they are less frequent than in Bipolar Disorder.

This is incorrect because the presence of manic episodes would exclude a diagnosis of Major Depressive Disorder. If manic or hypomanic episodes occur, the diagnosis shifts to Bipolar Disorder, as MDD is solely characterized by depressive episodes.

Correct Answer: D. To ensure that the symptoms are not caused by another medical issue.

Explanation:

Ruling out other medical conditions is crucial when diagnosing Major Depressive Disorder (MDD) because many physical health problems can present with similar symptoms such as fatigue, weight changes, and sleep disturbances. Conditions like hypothyroidism, vitamin deficiencies, or neurological disorders can mimic depressive symptoms, so careful evaluation ensures that the symptoms are not due to an underlying medical condition. This helps clinicians make an accurate diagnosis and avoid misdiagnosis or inappropriate treatments.

Why other options are wrong:

A. To determine the best medication for treatment.

This is incorrect. The goal of ruling out other medical conditions is to ensure the correct diagnosis of depression, not directly related to choosing the best medication for treatment. Choosing treatment comes after confirming the diagnosis.

B. To assess the patient's family history.

This is not the main reason to rule out medical conditions. While family history is important in understanding the genetic risk factors for MDD, it is unrelated to the process of ruling out other medical causes for the symptoms.

C. To confirm the presence of Major Depressive Disorder.

While ruling out other conditions helps confirm MDD, this option is incomplete. The primary reason for ruling out medical conditions is to ensure that the symptoms are not due to something else, rather than solely to confirm the presence of MDD.

Correct answer: C. Conduct a thorough mental health assessment and consider referral to a mental health professional.

Explanation:

When a patient with a chronic illness shows signs of depression, it is essential for the healthcare provider to conduct a comprehensive mental health assessment. Depression is common in individuals with chronic illnesses, but it should never be overlooked or attributed solely to the illness. Mental health support, including therapy or counseling, may be necessary, and the patient might benefit from a referral to a mental health professional. Treating both the physical and mental health aspects of a patient's well-being is crucial to improving overall health outcomes and quality of life.

Why other options are wrong:

A. Ignore the symptoms as they are common in chronic illness.

Ignoring the symptoms can lead to further deterioration in the patient's mental health. While depression may be more common in people with chronic illnesses, it should never be dismissed as a normal part of their condition. Untreated depression can worsen physical health problems and reduce the patient’s ability to manage their illness.

B. Suggest they engage in more physical activity without further evaluation.

While physical activity can be beneficial for mental health, simply suggesting more exercise without a thorough assessment could overlook the complexity of depression. It's important to address underlying mental health issues through proper evaluation and treatment before recommending lifestyle changes.

D. Increase the dosage of their physical illness medication.

Increasing the medication for the chronic illness without addressing the depressive symptoms may not be effective. Depression can affect a person’s ability to engage in their physical treatment plan, so it is critical to address mental health symptoms directly. Increased dosage of physical illness medication may not resolve the emotional and psychological aspects of the patient's condition.

Correct answer: A. In order to promote your safety, it is important to preventatively plan for how you can handle crises that arise outside of the hospital.

Explanation:

A safety plan is a critical tool in suicide prevention, helping patients identify coping strategies, emergency contacts, and steps to take when experiencing suicidal thoughts. The goal is to empower the patient with proactive measures they can implement in times of crisis, promoting autonomy and safety outside of structured care. A well-developed safety plan can help reduce impulsivity and provide immediate steps to seek help when needed.

Why other options are wrong:

B. The treatment team can't provide for your safety unless you agree not to attempt suicide.

This statement places responsibility solely on the patient rather than acknowledging the collaborative effort between the patient and healthcare providers. A safety plan is not about coercion or forcing a commitment but rather providing practical tools to enhance safety and reduce risk.

C. The safety plan will serve as a legal contract that approves resources for you to use in order to stay safe after discharge.

A safety plan is not a legal contract but rather a personalized set of strategies for managing suicidal thoughts. Unlike "no-suicide contracts," which have been found ineffective, safety plans focus on coping mechanisms and support networks rather than legal agreements.

D. Your insurance company will need this documentation in order to agree to your discharge.

Insurance companies do not require a safety plan for discharge approval. The purpose of a safety plan is to support the patient's well-being, not to satisfy administrative or financial requirements. Linking it to insurance can create unnecessary anxiety and misunderstand the primary function of the plan.

Correct answer: B. Advise the patient to avoid ibuprofen as it is an NSAID that can increase lithium levels.

Explanation:

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can reduce kidney clearance of lithium, leading to increased lithium levels in the blood. Elevated lithium levels can result in toxicity, which may cause symptoms like nausea, tremors, confusion, and even severe neurological effects. Alternative pain relievers like acetaminophen (Tylenol) are generally considered safer for patients on lithium. Patients should always check with their healthcare provider before taking any new medications, including over-the-counter drugs.

Why other options are wrong:

A. Advise the patient to take ibuprofen as it is safe with lithium.

This is incorrect because ibuprofen can increase lithium levels, potentially leading to toxicity. Safer alternatives should be considered.

C. Advise the patient to consult their doctor before taking any medication.

While consulting a doctor is always a good practice, specific guidance on avoiding ibuprofen is essential in this scenario. The patient should be informed about the risks associated with NSAIDs and lithium.

D. Advise the patient to take ibuprofen only if they have a headache.

This option does not address the risk of lithium toxicity. The patient should be advised to use an alternative pain reliever or consult their doctor.

Correct answer B. Decreased perceptual field, diaphoresis, fear of going crazy, and palpitations.

Explanation:

Panic attacks are characterized by sudden and intense episodes of fear that trigger physical and cognitive symptoms. Common symptoms include a decreased perceptual field (tunnel vision), excessive sweating (diaphoresis), palpitations, chest discomfort, dizziness, trembling, shortness of breath, and an overwhelming fear of losing control or "going crazy." These attacks can occur unexpectedly and are often misinterpreted as life-threatening medical conditions, such as heart attacks.

Why other options are wrong:

A. Increased blood pressure, bradycardia, shortness of breath.

While increased blood pressure and shortness of breath can occur during a panic attack, bradycardia (slow heart rate) is not a common symptom. Instead, tachycardia (rapid heart rate) is typically seen.

C. Increased respiratory rate, increased perceptual field, increased concentration ability.

During a panic attack, a person’s perceptual field often narrows, leading to a sense of detachment or tunnel vision. Additionally, concentration is typically impaired due to heightened anxiety.

D. Decreased blood pressure, chest pain, choking feeling.

Although chest pain and a choking sensation are common in panic attacks, blood pressure usually increases rather than decreases. A drop in blood pressure is more associated with vasovagal syncope or shock rather than panic attacks.

Correct Answer: C. Patients with Panic Disorder may develop substance use disorders as a coping mechanism for their panic symptoms.

Explanation:

Panic Disorder is characterized by sudden, intense episodes of fear (panic attacks) that may include racing heart, shortness of breath, dizziness, and a sense of impending doom. Because these symptoms are distressing, some individuals turn to substance use (e.g., alcohol, benzodiazepines, or other drugs) to self-medicate and alleviate anxiety. Over time, this can lead to substance use disorders (SUDs), dependence, and worsened anxiety symptoms. Additionally, withdrawal from certain substances, such as stimulants or alcohol, can trigger panic attacks, further complicating diagnosis and treatment.

Why other options are wrong:

A. Substance use disorders are a primary cause of Panic Disorder.

While substance use can exacerbate anxiety symptoms or induce panic attacks, Panic Disorder typically develops due to a combination of genetic, psychological, and environmental factors. Substance use may contribute to worsening symptoms but is not always the primary cause.

B. Substance use disorders are unrelated to Panic Disorder.

There is a well-documented link between Panic Disorder and substance use disorders, with many individuals using substances to manage their anxiety. Research suggests that people with Panic Disorder have a higher risk of developing SUDs, and substance withdrawal can trigger panic attacks.

D. Panic Disorder is a type of substance use disorder.

Panic Disorder and substance use disorders are separate clinical conditions. However, they often co-occur, meaning that a person with Panic Disorder may develop SUDs, but Panic Disorder itself is not classified as a substance use disorder.

Correct answer C. Loss of interest or pleasure in regular activities.

Explanation:

Major Depressive Disorder (MDD) is diagnosed based on specific criteria outlined in the DSM-5. A person must experience either a persistent depressed mood or a significant loss of interest or pleasure in most daily activities (anhedonia) for at least two weeks. In addition to this core symptom, at least five other symptoms such as changes in appetite, sleep disturbances, fatigue, or difficulty concentrating must be present. The combination of depressed mood and anhedonia is a hallmark feature of MDD, making option C the correct answer.

Why other options are wrong:

A. Sadness that lasts for at least two years.

Persistent sadness lasting two years is characteristic of Persistent Depressive Disorder (Dysthymia), not Major Depressive Disorder. MDD episodes last for at least two weeks, with severe symptoms that significantly impair daily life.

B. Thoughts of suicide or self-harm.

While suicidal thoughts can be a symptom of MDD, they are not a required criterion for diagnosis. Some individuals with MDD may not experience suicidal ideation but still meet the criteria based on other symptoms.

D. Either delusions or hallucinations.

Psychotic symptoms like delusions or hallucinations can occur in severe cases of MDD with psychotic features, but they are not a core requirement for diagnosing the disorder. Many individuals with MDD do not experience psychosis.

Correct answer C. All the answers

Explanation:

Panic disorder shares symptoms with various medical conditions, making differential diagnosis crucial. Conditions such as temporal lobe epilepsy, asthma, and angina pectoris can present with symptoms like chest pain, shortness of breath, dizziness, and palpitations—hallmarks of panic attacks. Proper assessment, including history, clinical examination, and diagnostic testing, helps distinguish between panic disorder and these medical conditions to ensure appropriate treatment.

Why other options are wrong:

A. Temporal lobe epilepsy

Temporal lobe epilepsy (TLE) can cause episodes of intense fear, déjà vu, and autonomic symptoms that resemble panic attacks. However, TLE episodes are typically associated with neurological symptoms such as auras, automatisms, and postictal confusion, which are not seen in panic disorder.

B. Asthma

Asthma can lead to shortness of breath, chest tightness, and hyperventilation, which may be misinterpreted as a panic attack. However, asthma is triggered by respiratory issues such as allergens or exertion and responds to bronchodilator treatment, unlike panic attacks, which are anxiety-driven.

D. Angina pectoris

Angina pectoris, caused by reduced blood flow to the heart, can present with chest pain, shortness of breath, and palpitations—symptoms also common in panic attacks. However, angina is typically triggered by physical exertion or stress and relieved by rest or nitroglycerin, whereas panic attacks arise spontaneously or due to psychological stressors.