The parents of a 14-year-old female high school freshman bring her to the PMHNP for an evaluation. They believe she should be doing better in high school due to her "gifted" status. They state that she has a formal IQ score of 125 and that her grades were mostly As through 5th grade. Now, she hands in her papers late and her grades are dropping to mostly Bs and Cs. During her psychiatric evaluation, the girl reports that high school is different from elementary school and junior high because now she has to write papers. She says she often turns them in late due to procrastination and forgetfulness. She reports a long history of inability to sustain attention while in class or doing homework, failure to pay attention to details or finish chores or tasks, significant difficulties with time management, planning, and organization. She is forgetful, often loses things, and is easily distracted. She has no history of restlessness or impulsivity, and she is popular with her peers. What is the most likely diagnosis?
Anxiety disorder
Specific learning disorder
Attention deficit hyperactivity disorder, predominantly inattentive
Disruptive mood dysregulation disorder
The Correct Answer is C
Choice A reason: Anxiety disorder may cause difficulties in concentration and performance, but it does not typically explain the lifelong pattern of inattention, procrastination, and forgetfulness that is consistent across settings and tasks.
Choice B reason: Specific learning disorder affects academic skills such as reading, writing, or mathematics. While it may contribute to academic challenges, it does not fully account for the pervasive inattentiveness, organizational deficits, and difficulty sustaining focus observed in this patient.
Choice C reason: Attention-deficit hyperactivity disorder, predominantly inattentive type, is characterized by a long-standing pattern of inattention without hyperactivity or impulsivity. Symptoms such as forgetfulness, losing items, difficulty sustaining attention, and organizational challenges align with this patient’s presentation, making it the most likely diagnosis.
Choice D reason: Disruptive mood dysregulation disorder is primarily characterized by severe irritability and frequent temper outbursts. The patient does not present with mood dysregulation or behavioral outbursts, making this diagnosis unlikely.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Delayed puberty with features such as lack of secondary sexual characteristics, short stature, and physical anomalies such as extra neck folds may indicate Turner syndrome. Estrogen therapy is essential to induce the development of secondary sexual characteristics and support bone health.
Choice B reason: Testosterone is indicated for male hypogonadism or delayed puberty in boys. It is not appropriate for a female patient with delayed puberty.
Choice C reason: Doing nothing delays sexual development, potentially affects bone health, and does not address underlying endocrine issues. This is not appropriate management.
Choice D reason: Synthetic thyroid addresses hypothyroidism, but this patient presents with delayed puberty and physical features consistent with Turner syndrome rather than thyroid deficiency. Thyroid therapy alone will not initiate puberty.
Correct Answer is C
Explanation
Choice A reason: SSRIs are not indicated for cluster headaches. These medications are primarily used to treat depression and anxiety and have minimal effect on the pathophysiology of cluster headaches.
Choice B reason: Diazepam, a benzodiazepine, may help with anxiety or insomnia but is not effective in aborting or preventing cluster headaches.
Choice C reason: This is the correct answer. Cluster headaches are severe, unilateral, stabbing headaches often associated with autonomic symptoms like tearing and nasal congestion. Sumatriptan, a selective serotonin 5-HT1B/1D receptor agonist, is the treatment of choice for acute attacks due to its rapid onset and ability to alleviate pain.
Choice D reason: Naproxen, an NSAID, may be effective for tension-type headaches or migraine prophylaxis but is ineffective for acute cluster headache attacks due to the extreme severity and rapid onset of pain.
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