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Ethical theory based on “greatest benefit for the greatest number of people”

A 24-year-old woman reports chronic excessive daytime sleepiness, episodes of sudden knee buckling triggered by laughter, and vivid hallucinations as she falls asleep. Overnight polysomnography is unremarkable. You pursue additional diagnostic testing. Which laboratory or diagnostic finding would MOST strongly support a diagnosis of narcolepsy type 1?

A four-year old child is referred to the PMHNP because of parental concerns. The child sits on the floor, and the  APRN notes occasional repetitive motor movements such as rocking back and forth. When in a group of other children, he always plays alone. He interacts minimally with mother, occasionally asking for a toy. He yells at mother several times when mother is not paying attention. Mother reports his preoccupation with sniffing toys, compulsiveness about touching walls and other things with smooth surfaces, but he becomes aggressive if asked to hold a stuffed animal. He will only eat certain foods and throws other foods on the floor if they are given to him.  These examples provide evidence to support a diagnosis of 

The greatest advantage of recommending a methylphenidate preparation over atomoxetine or guanfacine for a child with symptoms of attention deficit hyperactivity disorder is

 A 49-year-old man uses alcohol nightly “to help me sleep.” You are considering prescribing a hypnotic. What is the most appropriate action?

A 54-year-old woman reports unrefreshing sleep and new nighttime symptoms. During evaluation, she states that her partner has witnessed episodes where she stops breathing briefly and then gasps loudly. She also reports waking up with a choking sensation several times in the past month. Based on clinical guidelines, which finding indicates the need for an overnight polysomnography (PSG)?

An APRN consults on a 78-year-old male admitted to the hospital three days ago for chest pain. He was diagnosed with heart failure months ago. He is prescribed medications to manage his condition, including lisinopril 20 mg by mouth daily and metoprolol ER 100 mg by mouth daily. The patient has a great deal of time attending to the APRN’s directions and is generally incoherent when spoken to. Recent memory has been getting worse, and he is unable to state correctly where he is. Nurses report that symptoms improve or worsen during different times of the day. His son reports these symptoms were not present prior to hospitalization. Based on presenting signs and symptoms, what condition would be imperative to consider in the differential diagnosis?

The PMHNP is seeing a 73 year old female patient diagnosed with dementia and taking a cholinesterase inhibitor. She has recently started displaying symptoms of significant agitation and aggression toward her care givers. What is the best initial choice for treatment among the following medications?

A 44-year-old man undergoes PSG (polysomnography) due to daytime fatigue. His apnea–hypopnea index (AHI) is 7 events per hour. Symptoms include loud snoring and concentration problems. According to diagnostic criteria, how should this finding be interpreted?

Which of the following is NOT true of tic disorders?