A PMHNP was assigned to a COVID-19 unit during the pandemic. Her assignment was to assist dying patients in saying goodbye to their loved ones via telephone. She facilitated their phone conversations and watched the patients have their last conversations with their family, often crying in agony. More than 2 months after this assignment, during which she assisted hundreds of patients who died, the PMHNP began having nightmares about these experiences. She had flashbacks of some of the memories, often triggered when she received a phone call or looked at her phone. She began avoiding using her phone. She began having difficulty with concentration and often couldn't remember details of her time on the COVID-19 unit. She often felt detached from reality and the world. What diagnosis is most appropriate?
Major depressive disorder
Generalized anxiety disorder
Acute stress disorder
Posttraumatic stress disorder (PTSD)
The Correct Answer is D
Choice A reason: Major depressive disorder may involve sadness, anhedonia, and fatigue, but it does not fully explain recurrent nightmares, flashbacks, avoidance, and detachment after a trauma, making this diagnosis inappropriate here.
Choice B reason: Generalized anxiety disorder is characterized by excessive, generalized worry and tension over multiple domains. It does not explain trauma-specific flashbacks or avoidance behaviors following a specific event, so it is not appropriate.
Choice C reason: Acute stress disorder occurs within 3 days to 4 weeks after a traumatic event. Since the symptoms persisted beyond 2 months, the time frame exceeds that of acute stress disorder.
Choice D reason: Posttraumatic stress disorder is characterized by intrusive memories, nightmares, flashbacks, avoidance, negative mood, and hyperarousal following trauma. The PMHNP's persistent and trauma-specific symptoms months after exposure are consistent with PTSD.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: This response is vague and lacks educational value. It does not explain the purpose of the Holter monitor or the clinical reasoning behind its use.
Choice B reason: While accurate, this response is overly formal and may be difficult for a patient to understand. It focuses on guidelines rather than the patient’s specific situation and diagnostic needs.
Choice C reason: This response provides a clear, patient-centered explanation. It informs the patient that a standard ECG was inconclusive, and the Holter monitor is necessary to obtain continuous data to accurately diagnose atrial fibrillation, helping the patient understand the rationale and importance.
Choice D reason: This statement is dismissive and minimizes the patient’s concern. It does not explain the clinical purpose of the test and could lead to misunderstanding or anxiety.
Correct Answer is D
Explanation
Choice A reason: T1DM is autoimmune in origin, where immune-mediated destruction of pancreatic beta cells leads to insulin deficiency.
Choice B reason: T1DM often manifests in childhood or adolescence, consistent with onset prior to age 20.
Choice C reason: Destruction of pancreatic beta cells results in lack of insulin production, explaining hyperglycemia in T1DM.
Choice D reason: This is incorrect. First-line treatment for T1DM is insulin therapy, not metformin, which is used for type 2 diabetes.
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