D449 Psychology and Mental Health - Set 4 - Part 2

Correct Answer: Mild anxiety level

Option a is correct because mild anxiety presents with slight restlessness, fidgeting, mild discomfort, and irritability while the patient retains full cognitive function, can follow directions, concentrate on tasks, and communicate effectively without perceptual disturbances. Option b is incorrect because moderate anxiety would present with more pronounced symptoms including concentration difficulty, reduced perception, elevated heart and respiratory rates, and insomnia, representing greater functional impairment than the mild restlessness and fidgeting described here. Option c is incorrect because severe anxiety involves significantly distorted perception, rapid speech, elevated vital signs, inability to learn or solve problems, and a sense of impending doom, which are far more debilitating than the mild discomfort this patient shows. Option d is incorrect because panic-level anxiety causes complete loss of touch with reality, extreme fright, tremors, possible hallucinations, dilated

Correct Answer: Panic-level anxiety response

Option d is correct because panic-level anxiety is characterized by complete loss of touch with reality, extreme terror, tremors, dilated pupils, inability to follow directions, and a sense of imminent death, all demonstrated in this patient's dramatic presentation. Option a is incorrect because moderate anxiety presents with concentration difficulty, reduced perception, and elevated vital signs but the patient can still take direction, which contrasts sharply with this patient's complete inability to respond to verbal instructions or process surroundings. Option b is incorrect because severe anxiety involves distorted perception, rapid speech, and absent problem-solving ability with impending doom, but patients at the severe level retain some environmental awareness unlike this patient who appears completely disconnected from reality. Option c is incorrect because acute stress disorder specifically follows a traumatic event occurring within three days to one month prior, and

Correct Answer: Provide calm presence and simple directions

Option b is correct because patients in severe anxiety cannot process complex information or engage in problem-solving, so the nurse should remain calm, use short simple statements, reduce environmental stimuli, and provide brief clear directions until anxiety decreases. Option a is incorrect because initiating a lengthy problem-solving discussion is ineffective during severe anxiety because cognitive processing is significantly impaired, and attempting complex conversations will increase frustration and potentially escalate the anxiety response further. Option c is incorrect because cognitive behavioral exercises require identifying thoughts, challenging beliefs, and applying structured techniques demanding concentration and rational processing that is completely absent during severe anxiety when learning ability is suspended entirely. Option d is incorrect because beginning detailed psychoeducation assumes the patient can absorb and process new information, but during severe anxiety

Correct Answer: Moderate anxiety affecting function

Option c is correct because moderate anxiety presents with concentration difficulty, insomnia, and elevated heart and respiratory rates while the patient retains ability to follow directions when prompted, matching the CRIED mnemonic for this level of anxiety. Option a is incorrect because mild anxiety produces only slight restlessness, fidgeting, and mild discomfort without the concentration difficulty, insomnia, and elevated vital signs this patient is experiencing, making the mild classification too low for this clinical presentation. Option b is incorrect because severe anxiety involves distorted perception, rapid speech, complete inability to learn or problem-solve, and a sense of impending doom, which are more intense symptoms than concentration difficulty while still being redirectable as seen here. Option d is incorrect because panic-level anxiety causes total loss of contact with reality, extreme terror, tremors, and possible hallucinations with dilated pupils, which is dramat

Correct Answer: Panic with loss of reality contact

Option a is correct because anxiety follows a predictable escalation pattern, and a patient currently displaying severe symptoms including distorted perception and impending doom is at risk of progressing to panic level, involving complete disconnection from reality. Option b is incorrect because returning to baseline mild anxiety without intervention is unlikely when symptoms have been progressively worsening over the past hour, as untreated anxiety typically continues escalating rather than spontaneously resolving without therapeutic intervention or medication. Option c is incorrect because stabilization at the current severe level without intervention is not the expected trajectory, as the escalating pattern described indicates the patient is moving through anxiety stages and requires intervention to prevent further deterioration to panic. Option d is incorrect because progression to moderate anxiety with improved coping represents de-escalation requiring successful nursing interven

Correct Answer: Hypertensive crisis from tyramine

Option b is correct because aged cheese, red wine, and salami are tyramine-rich foods that interact dangerously with MAOIs like phenelzine, causing a rapid and potentially fatal surge in blood pressure presenting with severe headache and agitation. Option a is incorrect because serotonin syndrome results from combining MAOIs with other serotonergic medications or supplements like St. John's Wort and presents with agitation, fever, diaphoresis, and tremors rather than the tyramine-food-triggered hypertensive crisis described here. Option c is incorrect because orthostatic hypotension involves a drop in blood pressure upon standing and causes dizziness or fainting, which is the opposite of the dangerous blood pressure elevation that occurs when MAOI patients consume foods containing high tyramine levels. Option d is incorrect because an allergic reaction would typically present with urticaria, angioedema, or respiratory symptoms rather than the acute severe headache and agitation pa

Correct Answer: A washout period prevents serotonin crisis

Option d is correct because switching from an SSRI to an MAOI requires at least a two-week washout period to allow the previous medication to fully clear the body, preventing the dangerous interaction that can cause life-threatening serotonin syndrome. Option a is incorrect because pharmacy ordering timelines are not the clinical reason for delaying the medication switch, as the true concern is the pharmacological interaction between the residual SSRI and the new MAOI that could trigger a potentially fatal serotonin crisis. Option b is incorrect because insurance preauthorization processes are administrative rather than clinical concerns, and the mandatory waiting period between medications exists specifically to prevent the dangerous overlap of serotonergic effects from both medication classes simultaneously. Option c is incorrect because while baseline bloodwork may be obtained, the primary reason for the delay is the essential washout period allowing complete clearance of the SSRI f

Correct Answer: Avoid OTC drugs without provider approval

Option a is correct because many over-the-counter medications including decongestants, certain cough suppressants, and pain relievers can interact dangerously with MAOIs, potentially triggering a hypertensive crisis that requires immediate medical attention. Option b is incorrect because doubling any cold medication dose while taking an MAOI would dramatically increase the risk of a dangerous drug interaction, as even standard doses of certain over-the-counter preparations can cause severe hypertensive reactions with this medication class. Option c is incorrect because nighttime cold formulations are not inherently safer for MAOI patients, as they often contain the same active ingredients that can cause hypertensive crisis regardless of whether the product is marketed for daytime or nighttime symptom relief. Option d is incorrect because combining cold medicine with extra fluids does not prevent the pharmacological interaction between over-the-counter medications and MAOIs, as the dang

Correct Answer: Increased energy enabling suicide plan

Option c is correct because young adults starting SSRIs are at highest risk for suicide in the first few weeks as the medication increases energy and motivation before fully resolving depressive cognition, potentially enabling a patient to act on previously existing suicidal thoughts. Option a is incorrect because while increased energy could represent therapeutic improvement, the timing within the first two weeks of SSRI therapy in a young adult demands heightened suspicion for suicide risk rather than premature reassurance that the medication is working effectively. Option b is incorrect because although a manic episode is possible, the primary concern in a nineteen-year-old within two weeks of starting an SSRI is the well-documented paradoxical increase in suicide risk that occurs when energy returns before depressive thinking fully resolves. Option d is incorrect because dismissing sudden behavioral changes as normal mood fluctuation in a young adult who recently started antidepres

Correct Answer: Two-week medication-free interval required

Option b is correct because switching from an MAOI to another antidepressant class requires a minimum two-week washout period to allow complete clearance of monoamine oxidase inhibition, preventing the potentially fatal serotonin syndrome that occurs when these medications overlap. Option a is incorrect because while gradual tapering may be appropriate for some medication changes, the critical safety teaching specific to MAOIs is the mandatory washout period, as residual enzyme inhibition persists and can cause dangerous interactions with new serotonergic medications. Option c is incorrect because starting a new antidepressant at double the dose after discontinuing an MAOI would be extremely dangerous, as standard practice involves beginning at the lowest effective dose after the complete washout period has safely elapsed. Option d is incorrect because dietary tyramine restrictions must continue throughout the entire washout period because monoamine oxidase enzyme activity takes approx

Correct Answer: Stay with the patient for one hour

Option d is correct because patients hospitalized for anorexia nervosa require one-on-one supervision during meals and for at least one hour afterward to prevent compensatory behaviors such as self-induced vomiting or excessive exercise following food consumption. Option a is incorrect because allowing immediate restroom access after meals provides an opportunity for purging behavior that can undermine treatment progress and worsen the patient's nutritional status, which contradicts the standard eating disorder protocol for inpatient supervision. Option b is incorrect because simply documenting food intake without post-meal supervision fails to address the critical monitoring period after eating, as patients with anorexia may engage in secretive compensatory behaviors that negate the caloric intake just consumed. Option c is incorrect because asking the patient to wait briefly is vague and insufficient, as the evidence-based standard of care requires a full one-hour supervised per

Correct Answer: Bulimia nervosa with purging

Option a is correct because Russell's sign, calluses on the knuckles from self-induced vomiting, combined with dental erosion, normal body weight, and frequent restroom visits after meals are classic hallmark findings specifically associated with bulimia nervosa. Option b is incorrect because anorexia nervosa restrictive type presents with significantly low body weight, malnutrition, lanugo, amenorrhea, and cold intolerance from caloric restriction, rather than the normal body weight and purging indicators described in this student's presentation. Option c is incorrect because binge eating disorder involves recurrent episodes of uncontrolled eating without compensatory purging behaviors, so the knuckle calluses and dental erosion from repeated vomiting would not be present in a patient with this diagnosis. Option d is incorrect because avoidant restrictive food intake disorder involves limited food variety or quantity due to sensory sensitivity or lack of interest in eating,

Correct Answer: Morning weights before eating are standard

Option c is correct because weighing anorexia patients in the morning before any oral intake provides the most accurate and consistent baseline measurement, preventing fluctuations from food and fluid consumption that would distort the true weight trend assessment. Option a is incorrect because evening weights reflect accumulated food, fluid, and metabolic activity throughout the entire day, producing measurements that vary significantly and do not provide the reliable consistent baseline needed to accurately track nutritional recovery progress. Option b is incorrect because afternoon weights still include partial daily intake and activity variables that reduce measurement accuracy, and the timing alone does not specifically prevent manipulation compared to the standardized morning pre-intake protocol used in eating disorder units. Option d is incorrect because weighing after every meal would be excessive, anxiety-provoking for the patient, and clinically unnecessary, as daily morning

Correct Answer: Body weight at normal range versus low

Option b is correct because the most reliable differentiating feature is body weight, as patients with bulimia nervosa typically maintain a normal body weight while those with anorexia nervosa present with significantly low weight from severe caloric restriction and malnutrition. Option a is incorrect because electrolyte imbalances can occur in both anorexia and bulimia through different mechanisms including starvation, purging, laxative abuse, and diuretic misuse, making this finding common to both conditions and unreliable as a sole differentiating factor. Option c is incorrect because excessive exercise can be a compensatory behavior in both anorexia nervosa and bulimia nervosa, as patients with either disorder may use vigorous physical activity to burn calories, making exercise alone insufficient to distinguish between them. Option d is incorrect because depression and mood changes frequently co-occur with both anorexia nervosa and bulimia nervosa as comorbid conditions or conseque

Correct Answer: Repeated self-induced purging episodes

Option d is correct because repeated self-induced vomiting causes significant loss of potassium and other electrolytes through gastric fluid depletion, leading to hypokalemia below 3.5 milliequivalents per liter that can produce life-threatening cardiac dysrhythmias requiring urgent correction. Option a is incorrect because severe caloric restriction is more characteristic of anorexia nervosa and while it can cause electrolyte disturbances through malnutrition, the acute hypokalemia with cardiac dysrhythmias described here most strongly correlates with active purging behavior in bulimia. Option b is incorrect because excessive water consumption can cause dilutional hyponatremia rather than the potassium-specific depletion seen here, and water intoxication presents differently from the electrolyte pattern created by repeated loss of gastric contents through induced vomiting. Option c is incorrect because binge eating itself does not directly cause potassium depletion, as the electrolyte

Correct Answer: Systematic desensitization therapy

Option a is correct because systematic desensitization uses a gradual hierarchy of feared situations paired with relaxation techniques, allowing the phobic patient to slowly build tolerance without overwhelming distress, which is the standard evidence-based treatment for phobias. Option b is incorrect because flooding involves immediate and prolonged exposure to the most feared stimulus, which contradicts the patient's expressed terror about sudden exposure and may cause extreme distress that worsens avoidance behavior rather than building therapeutic tolerance. Option c is incorrect because long-term psychoanalytic therapy focuses on uncovering unconscious conflicts through extended exploration of past experiences and is not the recommended first-line treatment for specific phobias like agoraphobia that respond well to behavioral approaches. Option d is incorrect because medication management alone does not address the underlying avoidance patterns and fear responses in agoraphob

Correct Answer: Acute stress disorder response

Option c is correct because acute stress disorder occurs between three days and one month following a traumatic event, and this patient presenting fourteen days after the accident with intrusive memories, hypervigilance, avoidance, and startle response falls precisely within this diagnostic timeframe. Option a is incorrect because generalized anxiety disorder involves persistent excessive worry about multiple life domains lasting at least six months and is not specifically triggered by a single traumatic event with the distinct symptom cluster of intrusions, avoidance, and hyperarousal. Option b is incorrect because post-traumatic stress disorder requires symptoms persisting beyond one month following the traumatic event, and at fourteen days post-accident this patient's symptom duration does not yet meet the temporal diagnostic criteria for this diagnosis. Option d is incorrect because adjustment disorder with anxiety involves emotional distress disproportionate to a stressor but

Correct Answer: CBT with gradual exposure therapy

Option d is correct because cognitive behavioral therapy combined with gradual exposure therapy is the evidence-based treatment approach for PTSD, helping patients process traumatic memories at their own pace while developing coping strategies to manage flashbacks and emotional responses. Option a is incorrect because medication management alone with anxiolytics or antidepressants addresses symptom relief but does not provide the therapeutic processing of traumatic memories needed for lasting recovery, making pharmacotherapy most effective as an adjunct to structured psychotherapy. Option b is incorrect because forcing immediate detailed recounting of the traumatic event can retraumatize the patient and worsen symptoms, as evidence-based trauma therapy emphasizes allowing patients to discuss their experiences at their own pace within a safe therapeutic framework. Option c is incorrect because social isolation would reinforce the patient's existing withdrawal pattern and worsen PTS

Correct Answer: Dissociative stress response features

Option b is correct because emotional numbness, derealization, and inability to remember important aspects of the traumatic event are recognized dissociative features of acute stress disorder that serve as psychological defense mechanisms to protect the mind from overwhelming trauma. Option a is incorrect because malingering involves intentionally fabricating or exaggerating symptoms for external gain such as financial compensation or avoiding responsibility, whereas dissociative symptoms in acute stress disorder are involuntary psychological responses to genuine traumatic experiences. Option c is incorrect because a psychotic break involves hallucinations, delusions, and disorganized thinking that represent a fundamental loss of contact with reality, which differs from the dissociative symptoms of derealization and amnesia that occur as specific trauma responses in acute stress disorder. Option d is incorrect because normal grief processing follows predictable stages related to loss a

Correct Answer: Allow discussion at patient's own pace

Option a is correct because allowing the patient to process the traumatic experience at their own pace respects psychological readiness, promotes trust in the therapeutic relationship, and is the recommended approach to support early trauma recovery without risking retraumatization. Option b is incorrect because requiring immediate detailed narration of the traumatic event can overwhelm the patient's coping capacity and potentially worsen acute stress symptoms, as forced recounting before psychological readiness has been shown to increase rather than decrease trauma-related distress. Option c is incorrect because long-term benzodiazepine prescriptions are not recommended for acute trauma responses, as short-term anxiolytic use may be appropriate but extended benzodiazepine therapy can interfere with natural trauma processing and create dependence issues. Option d is incorrect because advising complete avoidance of all trauma reminders reinforces the avoidance pattern that is a cor