NCLEX Question: 3 Medical Disorders that Present Psychiatric SymptomsWhile satisfying my daily dose of social media, I stumbled upon an NCLEX question that was stirring up nurses across the country. In 24 hours, over 1,000 individuals responded with striking opinions of what they believed was the correct answer.

This brought me back to my undergraduate days, completing hundreds of NCLEX questions each night, only to be defeated by the trickery these questions posed on exam day.

Did I answer the question wrong? Was the professor’s answer, in fact, false? Was the wording poor? Was it all of the above? Take a look at the question:

Identify 3 medical disorders that may present as psychiatric symptoms:

  1. CVA, Parkinson’s Disease, HIV
  2. SLE, Diverticulitis, Asthma
  3. Vitamin C deficiency, Traumatic Brain Injury, Parkinson’s Disease
  4. All of the above

I started breaking this question down by examining symptoms of each medical disorder.

  • CVA: Individuals can suffer from confusion, which is associated with dementia or delirium.
     
  • HIV: Those suffering a longstanding infection can develop HIV encephalopathy and/or AIDS Dementia Complex. Symptoms include confusion, cognitive dysfunction, personality changes, social withdrawal, and in rare cases, psychosis and sleep disturbances. Additionally, patients with cryptococcal meningitis (a complication of HIV/AIDS) can have personality changes and confusion (King, 2015). These symptoms also present in delirium and dementia.
     
  • Parkinson’s Disease: Symptoms can mimic delirium tremens due to alcohol withdrawal. Additionally, bradykinesia is noted to be a common feature associated with Parkinson’s, but can also be associated with depression. Mood alterations, decreased facial expression, and impaired executive function are also evidenced in Parkinson’s and depression.
     
  • SLE: Lupus patients typically complain of chronic fatigue and fibromyalgia-like symptoms, which are both associated with depression and chronic fatigue syndrome. Lupus patients can also display neuropsychiatric symptoms (Popescu & Kao, 2011).
     
  • Diverticulitis: Patients commonly suffer from abdominal pain during acute attacks, also a common complaint reported by those with somatoform disorder. Additionally, research shows individuals can suffer from depression, anxiety, and social withdrawal even after diverticulitis attacks (Adkins, 2014).
     
  • Asthma: During acute exacerbations, individuals commonly complain of chest pain/tightness. These are common symptoms of anxiety and/or panic attacks. Additionally, acute hyperventilation occurring in an asthma or panic attack can cause a decrease in PaCO2, resulting in feelings of dizziness and confusion, leading to respiratory alkalosis.  This state of acute confusion could be confused with delirium (Byrd & Mosenifar, 2015).
     
  • Vitamin C deficiency: Early symptoms include weakness, irritability, fatigue, and lack of energy. All of these symptoms can also be presented in depressed individuals. Later symptoms include decreased immune function, poor wound healing, bleeding gums, and scurvy (Johnson, 2014).
     
  • Traumatic Brain Injury: Symptoms include fatigue, confusion, loss of consciousness, confusion, mood changes, dizziness, loss of balance, nausea, and vomiting. These symptoms can be present in drug/alcohol withdrawal as well as dementia.

 

With all of this information laid out, my choice would be D. all of the above.

AM I READING TOO FAR INTO THE QUESTION?
IS THE QUESTION WORDED POORLY?
Share your thoughts and opinions in the comments below!

References

Adkins, S.  (2015). Diverticulitis Patients Suffer From Psychological and Physical Symptoms Even After Attack, Study. University Herald. Retrieved November 3, 2015 from http://www.universityherald.com/articles/10679/20140731/diverticulitis-patients-psychological-physical-symptoms-illness-california.htm.

Byrd, R.  (2015). Respiratory Alkalosis Clinical Presentation. Retrieved November 3, 2015 from http://emedicine.medscape.com/article/301680-clinical.

Johnson, L.  (2014). Vitamin C (Ascorbic Acid). Retrieved November 4, 2015 from http://www.merckmanuals.com/professional/nutritional-disorders/vitamin-deficiency-dependency-and-toxicity/vitamin-c.

King, A.  (2015).  Cryptococcosis. Retrieved November 3, 2015 from http://emedicine.medscape.com/article/215354-overview.

Popscu, A. & Kao, A.  (2011). Neuropsychiatric Systemic Lupus Erythematosus. Current Neuropharmacology, 9(3): 449–457. Retrieved November 3, 2015 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3151599/