During a psychiatric evaluation, the psychiatric-mental health nurse practitioner conducts a psychiatric review of systems (ROS) in which he reviews common psychiatric symptoms that may not have been elicited in the history of present illness (HPI). Which of the following questions is most likely designed to elicit a response for the system "sleeping"?
Have you ever had a period of at least 1 week during which you needed much less sleep than usual?
Have you ever seen visions or heard noises that other people did not hear?
Do you ever lose time, forget important details about yourself, or find evidence that you took part in events that you cannot recall?
Is your sleep often inadequate or poor quality?
The Correct Answer is D
Choice A reason: This question is designed to assess for manic or hypomanic episodes, where decreased need for sleep is a hallmark symptom. While related to sleep, it is more specific to mood disorders and not a general sleep assessment.
Choice B reason: This question targets hallucinations and is part of the psychosis screening. It does not relate to sleep patterns or quality.
Choice C reason: This question assesses for dissociative symptoms, such as amnesia or identity disturbances. It is unrelated to sleep.
Choice D reason: This question directly addresses sleep adequacy and quality, making it the most appropriate for evaluating the sleep domain in a psychiatric ROS. It helps identify insomnia, hypersomnia, or other sleep disturbances.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Buffalo hump, easy bruising, and abdominal striae are hallmark features of Cushing's syndrome, which results from excess cortisol. These findings are not associated with hypothyroidism, which is characterized by a slowing of metabolic processes rather than hypercortisolism.
Choice B reason: Periorbital puffiness, bradycardia, and changes in blood pressure (decreased systolic and increased diastolic) are consistent with hypothyroidism. These symptoms reflect fluid retention, reduced cardiac output, and systemic vascular resistance changes due to low thyroid hormone levels. Bradycardia is a classic cardiovascular manifestation of hypothyroidism due to decreased sympathetic tone.
Choice C reason: Increased systolic blood pressure, decreased diastolic pressure, tachycardia, and moon facies are more indicative of hyperthyroidism or Cushing's syndrome. Tachycardia and widened pulse pressure are not typical in hypothyroidism, which tends to cause bradycardia and narrowed pulse pressure.
Choice D reason: An enlarged thyroid gland and protruding eyeballs (exophthalmos) are features of Graves' disease, a form of hyperthyroidism. Hypothyroidism does not typically present with these findings unless it follows treatment for Graves' disease, in which case ophthalmopathy may persist.
Correct Answer is D
Explanation
Choice A reason: The content of the voice (calling her name) does not determine whether the experience is psychotic. Psychotic hallucinations are typically persistent, intrusive, and occur during full wakefulness. Calling her name alone does not rule in or out psychosis.
Choice B reason: Hearing the voice of a close family member can occur in both psychotic and non-psychotic contexts. Bereavement-related hallucinations often involve familiar voices and are considered normal if they are transient and occur in specific emotional contexts.
Choice C reason: The absence of command hallucinations reduces the risk of harm but does not alone determine whether the experience is psychotic. Non-command hallucinations can still be part of psychosis if they are persistent and occur outside sleep transitions.
Choice D reason: Hypnagogic hallucinations—those occurring as one is falling asleep—are considered normal phenomena and not indicative of psychosis. In the context of recent bereavement and emotional triggers, this experience is consistent with a non-pathological grief response.
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