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 D
Explanation
Choice A reason: Ondansetron is a potent antiemetic that can be effective for nausea and vomiting, but it is typically not the first-line therapy in early pregnancy due to potential, albeit low, risks of fetal malformations. Its use is usually reserved for cases refractory to first-line interventions.
Choice B reason: Metoclopramide can be used for nausea and vomiting in pregnancy, but it carries risks of extrapyramidal side effects and is generally not the first-line recommendation for mild to moderate morning sickness.
Choice C reason: Promethazine is an antihistamine antiemetic that can be used safely in pregnancy but is often reserved for more severe cases or when first-line therapy fails. Sedation is a common side effect.
Choice D reason: Doxylamine, an antihistamine, combined with vitamin B6 (pyridoxine) is considered the first-line treatment for nausea and vomiting in pregnancy. This combination has demonstrated efficacy and safety in early pregnancy, making it the preferred initial therapy for severe morning sickness.
Correct Answer is B
Explanation
Choice A reason: GABA deregulation refers to disruptions in inhibitory neurotransmission, which may contribute to bipolar symptoms but does not specifically explain the progressive sensitization seen with repeated episodes.
Choice B reason: Kindling describes the process by which repeated subthreshold stimulation of neurons eventually leads to spontaneous, autonomous activity. In bipolar disorder, initial episodes are triggered by stressors, but later episodes may occur with decreasing external provocation, reflecting the kindling phenomenon.
Choice C reason: Genetic loading refers to inherited susceptibility to bipolar disorder but does not account for the progressive, self-propagating nature of episodes.
Choice D reason: Voltage-gated channel abnormalities may play a role in neuronal excitability but do not specifically describe the phenomenon of progressive autonomy in episode recurrence seen in bipolar disorder.
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