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?
Observer-Rated Scale for Mania
Altman Self-Rating Mania Scale
Self-Report Manic Inventory
Young Mania Rating Scale
The Correct Answer is D
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Hydrocodone is an opioid and is generally not first-line for chronic neuropathic pain, due to dependency risks and limited efficacy for burning neuropathic pain.
Choice B reason: This choice is correct because gabapentin is a first-line treatment for diabetic neuropathic pain. It targets nerve hyperexcitability and reduces burning, tingling, and neuropathic discomfort.
Choice C reason: Acetaminophen is useful for nociceptive pain but is not effective for neuropathic pain caused by diabetic peripheral neuropathy.
Choice D reason: Botulinum toxin is used for muscle spasticity or localized pain syndromes, not generalized diabetic neuropathy.
Correct Answer is C
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.
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