A 64-year-old man on the inpatient geriatric psychiatric unit believes he has a rash, even though no evidence has documented it in a medical workup. When he is told that no one can see this rash, he says the reason is because it is “on the inside.” What type of delusion is this?
Bizarre
Referential
Nihilistic
Somatic
The Correct Answer is D
Choice A reason: Bizarre delusions are implausible and not understandable within the context of cultural norms, such as believing aliens implanted a device in one's brain. The belief in an internal rash is not bizarre—it is medically conceivable, though unfounded.
Choice B reason: Referential delusions involve the belief that external events, objects, or people have special meaning or are directed at the individual. This does not apply to the patient's belief about having a rash.
Choice C reason: Nihilistic delusions involve beliefs that one is dead, does not exist, or that the world is ending. These are often seen in severe depression or psychotic states but are unrelated to somatic complaints.
Choice D reason: Somatic delusions involve false beliefs about bodily functions or sensations. The patient’s belief that he has a rash “on the inside” despite no physical evidence is a classic example of a somatic delusion.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: This describes osteoarthritis, not Paget’s disease. Osteoarthritis involves degeneration of joint cartilage and synovial structures, whereas Paget’s disease affects bone remodeling.
Choice B reason: Paget’s disease of bone is characterized by excessive osteoclastic bone resorption followed by disorganized osteoblastic bone formation. The newly formed bone is structurally abnormal—larger, less dense, and more vascular—making it prone to deformity and fracture. This explains the patient’s bowing and neurological symptoms due to nerve compression.
Choice C reason: This describes rheumatoid arthritis, an autoimmune condition affecting the synovium. Paget’s disease is not autoimmune and does not primarily involve joint inflammation.
Choice D reason: While PDB does involve abnormal bone remodeling, it does not lead to decreased skeletal mass. Instead, it results in structurally unsound bone that may be enlarged but weakened.
Correct Answer is B
Explanation
Choice A reason: H2 receptor antagonists such as ranitidine and famotidine are effective for mild GERD symptoms, but they are not considered first-line for moderate to severe GERD. PPIs are preferred due to their superior acid suppression and healing rates for erosive esophagitis.
Choice B reason: The American College of Gastroenterology recommends initiating PPI therapy once daily before the first meal of the day for GERD management. PPIs reduce gastric acid secretion by inhibiting the H+/K+ ATPase pump in parietal cells, providing effective symptom relief and mucosal healing.
Choice C reason: While some PPIs have undergone scrutiny for long-term safety concerns (e.g., risk of kidney disease, osteoporosis, and infections), they have not been widely recalled. Most remain approved and in use under proper clinical guidance.
Choice D reason: H2 receptor agonists do not exist; the correct term is H2 receptor antagonists. Moreover, they are less effective than PPIs for healing erosive GERD and maintaining remission, especially in severe cases.
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