A 47-year-old man only travels by train despite the necessity of frequently traveling long distances for his job. This causes significant difficulty, since the train trips are much longer than the plane rides and he misses important meetings. He has tried flying on several occasions, only to have a panic attack each time, even when the flight was smooth with no turbulence. Which of the following is the correct diagnosis?
Panic disorder
Specific phobia, situational type
Acute stress disorder
Social anxiety disorder
The Correct Answer is B
Choice A reason: Panic disorder involves recurrent, unexpected panic attacks that are not consistently triggered by a specific situation, whereas this patient’s panic occurs reliably in response to flying.
Choice B reason: This is correct. The patient exhibits situationally bound panic in response to flying, consistent with a specific phobia, situational type, causing avoidance and functional impairment.
Choice C reason: Acute stress disorder occurs within 4 weeks of a traumatic event and is time-limited, which does not match the chronic pattern seen here.
Choice D reason: Social anxiety disorder is characterized by fear of social scrutiny; the patient’s panic is specific to flying and not social situations.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Alprazolam is a short-acting benzodiazepine that carries high risk for dependence. Using it as monotherapy without long-term management is not recommended.
Choice B reason: This is the correct answer. SSRIs are first-line long-term treatment for generalized anxiety disorder, and low-dose benzodiazepines such as clonazepam can be used short-term for rapid symptom relief during initiation of SSRIs. This approach balances immediate relief with safe long-term management.
Choice C reason: While starting an SSRI alone is reasonable, it may not provide immediate symptom relief, which the patient is requesting. Short-term adjunctive therapy is often needed initially.
Choice D reason: Psychotherapy alone is effective but does not meet the patient’s request for rapid symptom control. Combining therapy with pharmacologic treatment is more appropriate in this scenario.
Correct Answer is B
Explanation
Choice A reason: Trichotillomania involves hair-pulling, but it is typically focused on the act of pulling as a tension-relieving behavior rather than an appearance-focused compulsion driven by perceived flaws.
Choice B reason: This is the correct answer. Body dysmorphic disorder involves preoccupation with perceived physical flaws, leading to repetitive behaviors (such as tweezing) to "correct" perceived imperfections. The patient’s anxiety about eyebrow asymmetry and time-consuming compulsive behavior aligns with BDD.
Choice C reason: Delusional disorder, somatic type, involves fixed false beliefs about bodily functioning or appearance, but the patient demonstrates insight that the asymmetry is “all in her head,” ruling out delusional disorder.
Choice D reason: Obsessive-compulsive disorder involves intrusive thoughts and compulsions but is not specifically focused on perceived physical flaws, which distinguishes it from BDD in this scenario.
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