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 C
Explanation
Choice A reason: Although structural imaging may show small variations in multiple regions, reduced thalamic volume alone is not consistently observed or diagnostic in ADHD.
Choice B reason: EEG findings in ADHD typically show increased, not decreased, slow-wave activity (especially theta waves), reflecting cortical underarousal. Therefore, this option is inaccurate.
Choice C reason: Reduced total brain volume is a consistent biological finding in ADHD. Neuroimaging studies show that children and adults with ADHD tend to have smaller total brain volume, particularly in the prefrontal cortex, basal ganglia, and cerebellum. These differences reflect delayed cortical maturation and reduced neural connectivity, which underlie impaired executive functioning, attention control, and impulse regulation.
Choice D reason: ADHD is associated with delayed cortical maturation rather than early maturation. The developmental lag particularly affects the prefrontal regions involved in planning, inhibition, and working memory.
Correct Answer is A
Explanation
Choice A reason: SAM-e (S-adenosylmethionine) can increase the risk of bleeding by enhancing anticoagulant effects when combined with warfarin. Patients on warfarin must avoid SAM-e due to the potential for potentiating anticoagulation and increasing the risk of hemorrhage.
Choice B reason: Omega-3 fatty acids may have mild antiplatelet effects but generally do not significantly interact with warfarin at typical dietary doses. Clinicians monitor coagulation parameters but do not universally require discontinuation.
Choice C reason: Melatonin is primarily used for sleep regulation and has minimal effect on warfarin metabolism. It does not pose a significant bleeding risk.
Choice D reason: Tryptophan is a precursor to serotonin and primarily affects mood and sleep. It has no clinically significant effect on warfarin or coagulation.
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