A 5-year-old boy dreams that he is riding in a car that starts flying, then turns into a monster. At the end of the dream, he dies. The boy tells his mom, "I became a ghost like Grandpa." Which of the following would be an appropriate statement by the NP to the mother?
"We should get him evaluated to make sure he is not having anxiety related to the death of his grandfather."
"At this age, dreams about death are normal, especially since his grandfather recently died."
"He could be showing early signs of schizophrenia."
"Is there a history of mental illness in your family?"
The Correct Answer is B
Choice A reason: While monitoring for anxiety is important, a single dream in a child of this age is generally developmentally appropriate and not indicative of psychopathology. Immediate evaluation is not required.
Choice B reason: This is correct. Children around age 5 often incorporate recent events, especially deaths, into their dreams as they attempt to process and understand concepts of mortality. This is a normal developmental response.
Choice C reason: Early signs of schizophrenia are rare at age 5, and this child’s behavior is not consistent with early psychotic symptoms.
Choice D reason: Family psychiatric history may provide context but is not relevant for interpreting a typical childhood dream about death.
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Correct Answer is D
Explanation
Choice A reason: Bipolar disorder involves distinct mood episodes (mania or depression) with marked functional changes. This child’s presentation of persistent hyperactivity and impulsivity without episodic mood changes does not fit this diagnosis.
Choice B reason: Specific learning disorder affects academic skill acquisition but does not account for hyperactivity, impulsivity, and behavioral regulation difficulties seen across settings.
Choice C reason: Generalized anxiety disorder can lead to restlessness or distractibility, but the pattern of constant motor hyperactivity, impulsive behaviors, and difficulty remaining seated is more consistent with ADHD.
Choice D reason: ADHD, predominantly hyperactive/impulsive type, is characterized by excessive motor activity, impulsivity, difficulty remaining seated, talking excessively, and inability to inhibit behaviors despite awareness of social norms. The child’s presentation aligns closely with this diagnosis.
Correct Answer is B
Explanation
Choice A reason: Aortic stenosis typically presents with a systolic ejection murmur heard best at the right upper sternal border with radiation to the neck. It is often harsh rather than soft and blowing.
Choice B reason: Mitral valve regurgitation produces a holosystolic, soft, blowing murmur best heard at the apex and radiating to the axilla. A grade 3 murmur is moderately loud without a thrill, consistent with this description.
Choice C reason: Tricuspid stenosis produces a diastolic murmur, often heard at the lower left sternal border, sometimes increasing with inspiration. The murmur in this case is systolic and located at the apex, making TS unlikely.
Choice D reason: Austin-Flint murmur is a diastolic murmur associated with severe aortic regurgitation and is heard at the apex. The murmur described here is systolic, not diastolic, and therefore does not fit this diagnosis.
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