A 35-year-old man with bipolar I disorder presents with a new-onset manic episode and is successfully treated with medication adjustment. He notes chronic depressive symptoms that, on reflection, long preceded his manic episodes. He describes these symptoms as "feeling down," having decreased energy, and more often than not, having no motivation. He denies other depressive symptoms but feels that these alone have been sufficient to negatively affect his marriage. Which diagnosis best fits his presentation?
Bipolar II disorder
Bipolar I disorder, current or most recent episode depressed
Cyclothymic disorder
Bipolar I disorder and persistent depressive disorder
The Correct Answer is D
Choice A reason: Bipolar II disorder involves at least one hypomanic episode and one major depressive episode, but this patient has a history of full manic episodes, not hypomania.
Choice B reason: While bipolar I disorder with a current or most recent depressive episode captures the depressive phase, it does not account for the chronic depressive symptoms predating manic episodes.
Choice C reason: Cyclothymic disorder involves chronic fluctuating mood states without meeting criteria for full manic or major depressive episodes. This does not match the patient’s manic history.
Choice D reason: Bipolar I disorder with coexisting persistent depressive disorder (dysthymia) accounts for the patient’s chronic depressive symptoms and history of full mania, making it the most accurate diagnosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: The hippocampus is central to the formation and retrieval of long-term memories. Impairment in this region leads to significant anterograde and retrograde memory deficits seen in dementia.
Choice B reason: The hypothalamus regulates homeostasis and autonomic functions but does not play a primary role in memory recall.
Choice C reason: The thalamus acts as a relay station for sensory and motor signals and contributes to attention and consciousness but is not the main center for episodic memory retrieval.
Choice D reason: The amygdala is involved in emotion, fear responses, and emotional memory processing, not the recall of specific episodic memories.
Correct Answer is D
Explanation
Choice A reason: Divalproex is an effective mood stabilizer, especially for rapid cycling or mixed episodes, but lithium is generally first-line for classic mania with suicidal ideation.
Choice B reason: Lamotrigine is more effective for bipolar depression than mania and is not ideal for initial treatment of a first manic episode.
Choice C reason: Carbamazepine is an alternative mood stabilizer but has more drug interactions and is not the preferred first-line for initial mania.
Choice D reason: Lithium is considered first-line treatment for acute mania in bipolar disorder and provides prophylactic benefits; it is particularly indicated for patients with suicidal ideation.
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