A 27-year-old married woman reports to the PMHNP that she is experiencing significant distress in her marriage because she "hates" going to social events, and her husband's job requires attending regular social gatherings. She avoids these activities because she is "terrified" she will do or say something embarrassing, and she has started pretending she has headaches to get out of going to them. Her husband doesn't understand why she doesn't want to go to these parties, which are typically small gatherings of less than 15 people. She admits that when she does go, they end up being "no big deal." The PMHNP will diagnose this woman with which of the following?
Generalized anxiety disorder
Agoraphobia
Social anxiety disorder
Panic disorder
The Correct Answer is C
Choice A reason: Generalized anxiety disorder involves persistent and excessive worry about a variety of everyday issues rather than specific social situations. This patient’s anxiety is context-specific (social interactions), which does not meet the criteria for generalized anxiety disorder.
Choice B reason: Agoraphobia involves fear or avoidance of places or situations where escape might be difficult, often involving crowds or public spaces. Her avoidance is social in nature, not related to leaving home or public spaces, so this diagnosis does not fit.
Choice C reason: This is the correct answer. Social anxiety disorder (social phobia) is characterized by intense fear or anxiety in social situations due to potential scrutiny or embarrassment. The patient’s avoidance of social events, fear of saying or doing something embarrassing, and relief when she attends indicate classic features of social anxiety disorder.
Choice D reason: Panic disorder is defined by recurrent unexpected panic attacks and persistent concern about having additional attacks. The patient does not report sudden, recurrent panic episodes but rather anticipatory anxiety about social evaluation, making panic disorder an inappropriate diagnosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Ataque de nervios is a culture-bound syndrome observed in Latin American populations, characterized by episodes of crying, trembling, and aggression, usually in response to family stress, not common in Malaysian men.
Choice B reason: Khayal is a Malaysian syndrome associated with anxiety, palpitations, and fear of death, but it does not involve violent outbursts with amnesia.
Choice C reason: Possession syndrome involves a belief of being controlled by spirits, usually with stereotyped behaviors, but does not fit the sudden aggressive episode with amnesia described here.
Choice D reason: This is correct. Amok is a culture-bound syndrome primarily described in Malaysia and other Southeast Asian countries, characterized by sudden outbursts of violent behavior, often in response to perceived insult, followed by amnesia of the event.
Correct Answer is C
Explanation
Choice A reason: Acute lower back pain may complicate patient positioning or increase discomfort but is not an absolute contraindication to lumbar puncture.
Choice B reason: Osteoporosis increases fracture risk but does not directly contraindicate lumbar puncture; precautions can be taken.
Choice C reason: This is the correct answer. Increased intracranial pressure is a contraindication because removing cerebrospinal fluid in the setting of elevated intracranial pressure can precipitate brain herniation, which is life-threatening.
Choice D reason: Decreased cardiac output may increase procedural risk but is not an absolute contraindication to performing a lumbar puncture.
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