The PMHNP is treating a 17-year-old girl who is an inpatient on an eating disorder unit. This patient has type 1 diabetes in addition to bulimia nervosa. Today she complains of dizziness, nausea, confusion, and weakness. What is her most likely diagnosis?
Severe dehydration
Diabetic ketoacidosis
Acute renal failure
Myocardial toxicity
The Correct Answer is B
Choice A reason: Severe dehydration can cause dizziness and weakness, but the presence of confusion and nausea in a type 1 diabetic patient raises concern for metabolic disturbance rather than isolated dehydration.
Choice B reason: Diabetic ketoacidosis (DKA) is characterized by hyperglycemia, ketonemia, dehydration, nausea, vomiting, weakness, and altered mental status. Patients with type 1 diabetes, particularly those with eating disorders, are at increased risk due to insulin omission or inadequate intake.
Choice C reason: Acute renal failure can present with nausea, confusion, and weakness, but there is no information suggesting a sudden change in kidney function or laboratory evidence in this scenario.
Choice D reason: Myocardial toxicity is unlikely in this presentation; while electrolyte disturbances may affect the heart, the immediate constellation of symptoms in a type 1 diabetic points more toward DKA.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: The OCI is a self-report questionnaire and useful for screening, but it is not considered the gold standard for severity assessment.
Choice B reason: The FOCI is a brief assessment tool, helpful in research or clinical settings, but lacks the comprehensive evaluation of Y-BOCS.
Choice C reason: The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the gold standard clinician-administered measure for assessing OCD symptom severity and monitoring treatment response.
Choice D reason: The NIMH Global OCD scale is less commonly used and lacks the specificity and validation of Y-BOCS for clinical severity assessment.
Correct Answer is C
Explanation
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.
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