Adult Primary Care for the Advanced Practice Nurse (D118)

Correct Answer: B. It indicates a functional impact of depression.

Explanation:

Depressive symptoms that result in significant impairment in work performance and social relationships are indicative of the functional impact of depression. This impairment suggests that the individual's depression is severe enough to affect their daily life and quality of life, which is a common feature of major depressive disorder (MDD). The functional impact can be used to assess the severity of the disorder and guide treatment decisions.

Why other options are wrong:

A. It suggests they are experiencing a mild form of anxiety.

While anxiety symptoms can overlap with depression, work and social impairments due to depressive symptoms are more directly related to the functional impact of depression, not anxiety. Anxiety alone does not necessarily cause this level of impairment.

C. It implies they have no significant mental health issues.

This is incorrect. Depression is a significant mental health issue that can cause substantial disruptions in work performance and social interactions. The patient's symptoms are clearly affecting their daily life, which contradicts the idea that they have no significant mental health issues.

D. It means they are likely suffering from a personality disorder.

While personality disorders can affect relationships and functioning, the symptoms described here are more likely related to depression. Personality disorders typically involve persistent patterns of behavior and are not typically characterized by the sudden impairment seen in depression.

Correct Answer: D. Anhedonia

Explanation:

Anhedonia, or the inability to feel pleasure, is one of the core symptoms of Major Depressive Disorder (MDD). It refers to a loss of interest or enjoyment in previously enjoyable activities, such as hobbies, social interactions, or work. This symptom is a key diagnostic criterion for MDD and significantly impacts a person's daily life and functioning.

Why other options are wrong:

A. Euphoria

Euphoria refers to an intense feeling of happiness or excitement, which is not characteristic of Major Depressive Disorder. Instead, it is more commonly associated with bipolar disorder during manic episodes.

B. Insomnia

While insomnia is a common symptom of MDD, it is not a primary diagnostic criterion. Sleep disturbances (insomnia or hypersomnia) may accompany depression, but anhedonia and a depressed mood are central to the diagnosis.

C. Hyperactivity

Hyperactivity is not a symptom of MDD. It is more commonly associated with attention-deficit hyperactivity disorder (ADHD) or manic episodes in bipolar disorder. In contrast, MDD often leads to fatigue, slowed movement, and reduced motivation rather than hyperactivity.

Correct answer: B. Sedation.

Explanation:

Sedation is a common side effect of many antidepressant medications, particularly tricyclic antidepressants (TCAs) and certain selective serotonin reuptake inhibitors (SSRIs). This occurs because some antidepressants have histamine-blocking properties, leading to drowsiness and fatigue. This effect can be beneficial for individuals with insomnia but may be undesirable for those who need to remain alert during the day. Adjusting dosage timing or switching to a different medication may help manage sedation.

Why other options are wrong:

A. Weight loss.

While some antidepressants, such as bupropion, may lead to weight loss, many others, including SSRIs and TCAs, are more commonly associated with weight gain. The metabolic effects of antidepressants vary depending on the specific drug and individual patient factors.

C. Improved sleep.

Although some antidepressants can help improve sleep, particularly those with sedative properties, improved sleep is not a guaranteed or universal side effect. Some individuals may experience insomnia or disrupted sleep patterns instead.

D. Increased energy.

While certain antidepressants may lead to increased energy levels over time, this effect is not immediate and varies by drug class. Additionally, some antidepressants can initially cause fatigue before mood and energy levels improve. Increased energy can also pose a risk if it occurs before mood improvement, as it may heighten suicidal tendencies in some individuals.

Correct answer D. Manic or hypomanic episodes

Explanation:

Bipolar Disorder is characterized by the presence of manic or hypomanic episodes, which differentiate it from Major Depressive Disorder (MDD). In Bipolar I Disorder, individuals experience full manic episodes, while in Bipolar II Disorder, hypomanic episodes occur alongside depressive episodes. MDD, on the other hand, is solely defined by depressive episodes without any history of mania or hypomania. The presence of manic or hypomanic episodes is a key diagnostic criterion that distinguishes these two mood disorders.

Why other options are wrong:

A. Depressive episodes

Depressive episodes are present in both Bipolar Disorder and Major Depressive Disorder. While they are a part of the diagnostic criteria for Bipolar Disorder, their presence alone does not differentiate it from MDD.

B. Anxiety episodes

Anxiety is a common comorbidity in both Bipolar Disorder and Major Depressive Disorder, but it is not a defining feature of either disorder. Anxiety disorders exist separately and are not the primary distinguishing factor between these two mood disorders.

C. Psychotic episodes

Psychotic episodes can occur in both Bipolar Disorder and severe cases of Major Depressive Disorder, particularly in mood disorders with psychotic features. Therefore, they are not exclusive to Bipolar Disorder.

Correct answer: A. To initiate treatment.

Explanation:

The main objective of suicide risk assessment is to identify individuals at risk and take immediate action to ensure their safety. Assessment helps clinicians determine appropriate interventions, such as hospitalization, crisis management, therapy, or medication adjustments. Prompt intervention can prevent self-harm and provide necessary support to individuals experiencing suicidal ideation.

Why other options are wrong:

B. To diagnose depression.

While suicide risk assessment is crucial in managing depression, it does not serve as a diagnostic tool for depression itself. Depression is diagnosed using structured clinical interviews and validated scales such as the PHQ-9 or Hamilton Depression Rating Scale.

C. To determine the severity of depression.

Although suicide risk assessment may provide insight into the severity of depression, its primary function is to assess immediate risk and guide intervention. Depression severity is better assessed through scales specifically designed for that purpose.

D. To predict future suicidal behavior.

Suicide risk assessments are not intended to predict future behavior with certainty but rather to evaluate current risk and implement interventions to reduce the likelihood of suicidal actions. Suicide is complex, and no single tool can reliably predict future suicide attempts.

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: D. The functional impact of depression can lead to significant distress or impairment in various aspects of daily life, including work performance and social interactions.

Explanation:

Depression is a complex mental health condition that affects multiple aspects of life, including emotions, cognition, physical health, and daily functioning. It can lead to difficulties in maintaining work productivity, fulfilling personal responsibilities, and engaging in social activities. Individuals with depression often experience fatigue, difficulty concentrating, and lack of motivation, which can impair decision-making and job performance. Additionally, withdrawal from social interactions and relationships is common, contributing to feelings of isolation and worsening the condition.

Why other options are wrong:

A. The functional impact of depression only affects physical health.

While depression can cause physical symptoms such as fatigue, sleep disturbances, and appetite changes, its impact is not limited to physical health. Emotional, cognitive, and social functioning are also significantly affected.

B. The functional impact of depression is limited to emotional responses.

Although emotional symptoms like sadness, hopelessness, and anxiety are central to depression, the disorder affects many areas of life beyond emotions, including work performance, personal relationships, and daily activities.

C. The functional impact of depression has no effect on daily life.

This is incorrect because depression is one of the leading causes of disability worldwide. It can severely disrupt daily routines, making it difficult for individuals to maintain their responsibilities, relationships, and overall well-being.

Correct answer: B. Preventing future episodes

Explanation:

The primary goal of treatment for Bipolar Disorder is to stabilize mood and prevent future manic or depressive episodes. Frequent mood episodes can severely impact a patient’s ability to function and maintain relationships, so long-term mood stabilization through medication adherence, therapy, and lifestyle management is crucial for improving their quality of life.

Why other options are wrong:

A. Increasing medication dosage.

While medication adjustments may be necessary, increasing dosage alone does not address the underlying need for long-term stabilization and prevention of recurrent episodes.

C. Focusing solely on depressive symptoms.

Bipolar Disorder involves both manic and depressive episodes, so addressing only depressive symptoms can leave the patient vulnerable to manic episodes, potentially worsening the overall course of the illness.

D. Encouraging social withdrawal.

Social support is essential for managing Bipolar Disorder. Withdrawal can worsen depressive symptoms and reduce adherence to treatment.

Correct answer: B. Evaluating the lethality of the method helps determine the potential risk of harm and the urgency of intervention needed.

Explanation:

Assessing the lethality of a suicide method is essential because it directly influences the urgency and type of intervention required. The more lethal the method, the higher the risk of fatality, and therefore, immediate and more intensive intervention, such as hospitalization or securing the environment, may be necessary. This assessment helps guide the clinician in determining the level of risk and appropriate action to prevent harm.

Why other options are wrong:

A. Lethality is assessed to provide a diagnosis of depression.

Lethality is not used to diagnose depression. It is assessed to evaluate the immediate risk to the patient's safety in the context of a suicide plan. The diagnosis of depression is separate and based on clinical criteria, not the lethality of the suicide method.

C. It is only important to assess the patient's mental health history, not the method.

While the patient's mental health history is important, assessing the lethality of the suicide method is crucial for determining the risk of harm. Ignoring the method could lead to underestimating the severity of the risk and result in inadequate intervention.

D. Lethality assessment is irrelevant in suicide prevention strategies.

This statement is incorrect. The lethality of the method is a critical component of suicide prevention strategies. It helps clinicians determine the urgency of the situation and the type of intervention required to protect the patient.