A 40-year-old man reports episodes in which he unexpectedly feels a surge of intense fear that peaks within minutes. During this time he feels dizzy, has shortness of breath, heart palpitations, and feels like he is "going crazy." These episodes seem to come "out of the blue" with no trigger that he can identify. He has had them when he has been napping on the weekend or during a break at work. He is starting to think he is really "going crazy," because he has no medical conditions, doesn't drink or smoke, and says there are no new stressors in his life that could be causing this. What is the most likely diagnosis?
Panic attacks
Panic disorder
Generalized anxiety disorder
Substance/medication-induced panic disorder
The Correct Answer is B
Choice A reason: Panic attacks are the symptomatic episodes themselves, not the diagnosis. A diagnosis of panic disorder requires recurrent, unexpected panic attacks with persistent concern or behavioral changes related to the attacks.
Choice B reason: Panic disorder involves recurrent, unexpected panic attacks with significant concern about future attacks or their implications. This patient demonstrates multiple unprovoked episodes with accompanying worry, consistent with panic disorder.
Choice C reason: Generalized anxiety disorder involves chronic, excessive worry about multiple domains, often with tension and restlessness. The abrupt, episodic, intense fear seen here is characteristic of panic disorder rather than GAD.
Choice D reason: Substance or medication-induced panic disorder requires evidence of exposure to a causative substance. The patient denies use of substances or medications that could trigger these episodes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Ego integrity involves the ability to reflect on one’s life with a sense of fulfillment and acceptance, characteristic of late adulthood according to Erikson’s psychosocial developmental stages.
Choice B reason: Erikson’s stages continue throughout the lifespan; late adulthood involves the stage of ego integrity versus despair.
Choice C reason: Egocentrism refers to a preoccupation with oneself and limited perspective-taking, typically associated with early developmental stages, not late adulthood.
Choice D reason: Advanced ego defense mechanisms describe coping strategies rather than a developmental stage and do not specifically define Erikson’s concept of ego integrity.
Correct Answer is C
Explanation
Choice A reason: SSRIs are not indicated for cluster headaches. These medications are primarily used to treat depression and anxiety and have minimal effect on the pathophysiology of cluster headaches.
Choice B reason: Diazepam, a benzodiazepine, may help with anxiety or insomnia but is not effective in aborting or preventing cluster headaches.
Choice C reason: This is the correct answer. Cluster headaches are severe, unilateral, stabbing headaches often associated with autonomic symptoms like tearing and nasal congestion. Sumatriptan, a selective serotonin 5-HT1B/1D receptor agonist, is the treatment of choice for acute attacks due to its rapid onset and ability to alleviate pain.
Choice D reason: Naproxen, an NSAID, may be effective for tension-type headaches or migraine prophylaxis but is ineffective for acute cluster headache attacks due to the extreme severity and rapid onset of pain.
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