While conducting a class on anxiety and stress reduction, a nurse describes the symptoms of anxiety (including panic), informing the class that the physical symptoms of a panic attack can mimic what?
Gastrointestinal flu
Appendicitis
Stroke
Heart attack
The Correct Answer is D
Choice A reason: Gastrointestinal influenza (gastroenteritis) is characterized by nausea, vomiting, diarrhea, abdominal cramping, and fever, mediated primarily by gastrointestinal mucosal inflammation secondary to viral infection. While some somatic symptoms of anxiety, such as nausea and abdominal discomfort, may overlap with gastrointestinal disturbance, the hallmark somatic features of a panic attack — which include chest pain, palpitations, dyspnea, diaphoresis, and paresthesias — are not characteristic of gastroenteritis. The clinical overlap between panic attacks and gastroenteritis is minimal and does not represent the primary diagnostic confusion encountered in emergency settings.
Choice B reason: Appendicitis presents with characteristic right lower quadrant pain (McBurney's point tenderness), rebound tenderness, fever, nausea, vomiting, and an elevated white blood cell count indicating an acute inflammatory process. While abdominal discomfort can occasionally accompany severe anxiety, the clinical features of an acute appendiceal inflammation are anatomically and physiologically distinct from the cardiovascular and neurological symptoms of a panic attack. Panic attacks are not associated with the localized somatic signs and systemic inflammatory response that define appendicitis, making this comparison clinically inaccurate.
Choice C reason: While stroke (cerebrovascular accident) can present with neurological symptoms such as numbness, tingling, dizziness, and in some cases, confusion, which may superficially overlap with paresthesias and derealization experienced during a panic attack, the core distinguishing features of stroke — focal neurological deficits, unilateral weakness, facial drooping, aphasia, and vision disturbances — are not characteristic of panic attacks. Additionally, while panic attacks can cause cerebral symptoms due to hyperventilation-induced hypocapnia and cerebral vasoconstriction, the degree of similarity between the 2 presentations does not rise to the level of clinical mimicry seen with myocardial infarction.
Choice D reason: The physical symptoms of a panic attack closely and convincingly mimic those of an acute myocardial infarction, making this the correct and clinically most significant comparison. During a panic attack, activation of the sympathoadrenal axis produces marked cardiovascular and somatic symptoms including chest tightness, chest pain, tachycardia, palpitations, diaphoresis, dyspnea, and a profound sense of impending doom or death. These symptoms are phenomenologically indistinguishable from those of an acute MI in the absence of objective cardiac testing. This overlap is a major reason why a significant proportion of clients experiencing their first panic attack present to emergency departments fearing cardiac arrest, making cardiac pathology the primary differential diagnosis that must be excluded.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Histrionic personality disorder is classified under Cluster B personality disorders and is characterized by a pervasive pattern of excessive emotionality and attention-seeking behavior. Key features include discomfort in situations where one is not the center of attention, theatrical and exaggerated emotional expression, seductive or provocative behavior, rapidly shifting and shallow emotional states, and use of physical appearance to draw attention. While histrionic personality disorder shares some features with narcissistic personality disorder, it is not defined by grandiosity or a global lack of empathy. The primary motivation in HPD is the need for attention, not the need for admiration combined with a sense of entitlement and superiority.
Choice B reason: Schizoid personality disorder is a Cluster A disorder characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings. Affected individuals typically prefer solitary activities, show little desire for close relationships including family, lack interest in sexual experiences, demonstrate emotional coldness and detachment, and appear indifferent to praise or criticism. The clinical picture is one of social withdrawal and emotional aloofness, with no component of grandiosity or inflated self-image. Schizoid personality disorder is diagnostically distinct from narcissistic personality disorder in both symptomatology and underlying interpersonal dynamics.
Choice C reason: Narcissistic personality disorder (NPD) is a Cluster B personality disorder formally defined in the DSM-5 by a pervasive pattern of grandiosity (either in fantasy or behavior), a persistent need for admiration, and a marked lack of empathy. Additional features include a sense of entitlement, exploitation of others, arrogance, envy of others or belief that others envy them, and preoccupation with fantasies of unlimited success, power, or beauty. The triad of grandiosity, need for admiration, and absence of empathy described in the question stem is the core diagnostic triad of NPD, making this the definitively correct answer.
Choice D reason: Obsessive-compulsive personality disorder (OCPD) is a Cluster C disorder characterized by a pervasive preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency. Individuals with OCPD are devoted to work and productivity, rigid and inflexible about ethics and values, unable to delegate tasks, hoarding of objects, and prone to miserly spending. OCPD is distinct from OCD in that the behaviors are ego-syntonic. There is no pattern of grandiosity, entitlement, or empathy deficit in OCPD, clearly distinguishing it from narcissistic personality disorder.
Correct Answer is B
Explanation
Choice A reason: Asking whether a client has ever experienced a blackout (alcohol-induced memory impairment) is a clinically relevant question in the assessment of alcohol use disorder, as blackouts are associated with rapid increases in blood alcohol concentration and are indicative of heavy, episodic drinking patterns. However, this question addresses the severity and pattern of drinking behavior rather than the duration or length of time the client has been using alcohol. It does not directly elicit information about when alcohol use was initiated and therefore does not fulfill the specific intent of the nurse's inquiry regarding the timeline of use.
Choice B reason: Asking the client at what age they started using alcohol is the most direct and clinically appropriate question for determining the length of time the client has been consuming alcohol. By establishing the age of onset and comparing it to the client's current age, the nurse can calculate the duration of alcohol use, which has significant implications for assessing the degree of physiological dependence, tolerance, neurobiological impact, and readiness for intervention. Earlier age of onset is associated with higher rates of alcohol use disorder, greater severity of dependence, and poorer treatment outcomes, making this question foundational in a comprehensive substance use assessment.
Choice C reason: Inquiring about legal problems related to alcohol use, such as driving under the influence (DUI), public intoxication, or alcohol-related assault, provides important information about the psychosocial and behavioral consequences of drinking. Legal consequences are 1 of the diagnostic criteria for alcohol use disorder according to the DSM-5. However, this question assesses the social impact of drinking rather than the chronological duration of use. It does not help the nurse establish a timeline of alcohol use and does not answer the question of how long the adolescent has been consuming alcohol.
Choice D reason: Asking whether the client drinks at certain times, such as only in the evenings, only on weekends, or in response to specific triggers, addresses the pattern and context of alcohol consumption, providing insight into habitual use, situational triggers, and potential psychological dependence. This information contributes to a comprehensive substance use assessment but is not directed at determining the length of time alcohol use has been occurring. The question is exploratory regarding drinking habits rather than duration and does not fulfill the nurse's stated assessment goal.
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