A 28-year-old woman presents to the psychiatric-mental health nurse practitioner for evaluation of depression and anxiety. She states that her older sister and her mother have been on antidepressants "for years." She has avoided coming to the "crazy doctor" for "a long time." She is nervous about taking medication because she is worried about side effects. She asks about getting a genetic test to see which medication would work best for her. What is the PMHNP's most appropriate response?
"You don't need a genetic test until you have failed a few medications."
"We can certainly conduct a genetic screening test if you would like."
"Which medications are your mother and sister taking?"
"We can certainly obtain a genetic test; while we wait for results, let's start with a medication that is working for your mother or sister."
The Correct Answer is C
Choice A reason: Waiting to perform a genetic test until after multiple medication failures unnecessarily delays personalized care and may contribute to patient anxiety.
Choice B reason: Offering a genetic test respects the patient’s interest in pharmacogenomics, supports shared decision-making, and can guide individualized treatment to minimize side effects and improve outcomes.
Choice C reason: Knowing family medication history is helpful but does not directly address the patient’s request for genetic testing or guide immediate personalized care.
Choice D reason: Initiating treatment based on family history before obtaining test results may compromise the principle of individualized care and ignores the patient’s expressed interest in genetic testing.
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Related Questions
Correct Answer is D
Explanation
Choice A reason: The Donabedian model focuses on evaluating healthcare quality through structure, process, and outcomes. It is more about system evaluation than employee engagement.
Choice B reason: The Institute of Medicine’s quality aims provide overarching goals for healthcare improvement, such as safety, effectiveness, and patient-centeredness, but do not prescribe methods like “stay interviews.”
Choice C reason: The Plan, Do, Study, Act (PDSA) model is a cyclical framework for implementing and testing change but is not specifically about engaging employees through positive reflection.
Choice D reason: Appreciative inquiry emphasizes identifying what works well in an organization and leveraging strengths. Using “stay interviews” to explore positive experiences aligns directly with this approach, focusing on fostering engagement and morale rather than addressing problems alone.
Correct Answer is D
Explanation
Choice A reason: Lewy body dementia presents with cognitive fluctuations, visual hallucinations, and parkinsonism, but the acute onset of myoclonus and multifocal MRI findings are not typical.
Choice B reason: Alzheimer’s disease presents with gradual cognitive decline rather than sudden onset of ataxia and myoclonus, making it less likely.
Choice C reason: Huntington’s disease is a hereditary neurodegenerative disorder with chorea, psychiatric symptoms, and gradual cognitive decline, not acute multifocal neurologic deficits.
Choice D reason: Sporadic Creutzfeldt-Jakob disease is a prion disease characterized by rapidly progressive dementia, myoclonus, ataxia, and characteristic MRI and EEG findings, matching this patient’s presentation.
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