On an inpatient unit, a 31-year-old single woman reports experiencing auditory and visual hallucinations for 1 month, followed by a full major depressive episode for 2 months. The psychotic symptoms and depressive symptoms occurred concurrently for 3 months, until the depressive symptoms resolved with pharmacotherapy and psychotherapy. The psychotic symptoms persisted for 2 more weeks, at which time the patient checked herself into the hospital. Which diagnosis best fits this clinical picture?
Schizoaffective disorder
Bipolar disorder with psychotic features
Major depressive disorder with psychotic features
Schizophrenia and unspecified depressive disorder
The Correct Answer is A
Choice A reason: Schizoaffective disorder is diagnosed when psychotic symptoms occur both during and outside of mood episodes. In this case, the patient had psychosis before, during, and after a major depressive episode, fulfilling the criteria for schizoaffective disorder, depressive type.
Choice B reason: Bipolar disorder with psychotic features requires the presence of manic or mixed episodes, which are not described here. The absence of mania excludes bipolar disorder from consideration.
Choice C reason: Major depressive disorder with psychotic features involves psychosis that occurs exclusively during depressive episodes. Since the patient’s psychotic symptoms persisted beyond the resolution of depression, this diagnosis is not appropriate.
Choice D reason: Schizophrenia requires at least 6 months of continuous symptoms, including 1 month of active-phase symptoms. The timeline here is insufficient for schizophrenia, and the depressive symptoms are not “unspecified”—they meet criteria for a major depressive episode.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Extreme blood loss is characteristic of hypovolemic shock, not septic shock. Hypovolemic shock results from a significant reduction in circulating blood volume due to hemorrhage or fluid loss, but it does not involve the immune-mediated cascade seen in sepsis.
Choice B reason: Septic shock is caused by an overwhelming infection that triggers a dysregulated host response, leading to widespread inflammation, endothelial dysfunction, vasodilation, and impaired tissue perfusion. This cascade is driven by microbial components such as lipopolysaccharides (LPS) binding to toll-like receptors, which activate cytokines like TNF and IL-1, resulting in systemic effects including hypotension and multi-organ dysfunction.
Choice C reason: Acute allergic reactions can lead to anaphylactic shock, which is mediated by IgE and histamine release, not by infectious agents. While both involve vasodilation and hypotension, the underlying mechanisms are distinct.
Choice D reason: Injury to the myocardium is a hallmark of cardiogenic shock, which results from impaired cardiac output due to myocardial infarction or arrhythmias. It does not explain the immune and vascular phenomena seen in septic shock.
Correct Answer is C
Explanation
Choice A reason: Advanced sleep phase type is characterized by falling asleep and waking up earlier than desired. Individuals with this disorder tend to feel sleepy in the early evening and wake up very early in the morning, which is the opposite of the scenario described.
Choice B reason: Irregular sleep-wake type involves a lack of a clearly defined sleep-wake cycle. People with this disorder have fragmented sleep patterns with multiple naps throughout the 24-hour period, not a consistent delay in sleep and wake times.
Choice C reason: Delayed sleep phase type is defined by a consistent pattern of falling asleep and waking up later than desired. This disorder is common in adolescents and young adults and matches the client’s report of delayed sleep onset and waking.
Choice D reason: Non-24 sleep-wake type is typically seen in individuals who are blind and lack light perception. Their circadian rhythm does not align with the 24-hour day, leading to progressively shifting sleep times. This does not match the client’s stable but delayed sleep pattern.
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