NURS 6630 WEEK 7 DISCUSSION CASE 1 2026/2027 |
Volume 2 Case #16 | The Woman Who Liked a Late-
Night TV | Complete Solutions | Pass Guaranteed -
A+ Graded
Part One: Case Presentation & Differential Diagnosis (Late-
night TV Case)
(9 Questions)
Q1: Ms. Elena Vasquez, a 28-year-old woman, presents to your PMHNP clinic
accompanied by her sister. Over the past three weeks, Elena has been staying up
until 3–4 AM watching late-night television, insisting that the news anchors are
sending her "hidden messages" through their hand gestures and eye movements.
She believes a popular late-night host is in love with her and communicates through
coded phrases in his monologue. Her sister notes Elena has barely slept, appears
agitated, and has made several large online purchases she can't afford. Which of the
following is the most critical first step in your evaluation?
A. Prescribe an antipsychotic immediately to address the delusions
B. Order neuroimaging to rule out a brain tumor causing the delusions
C. Conduct a comprehensive psychiatric evaluation including timeline of symptoms,
mood history, substance use, medical history, and mental status exam
D. Refer Elena to a neurologist for EEG to rule out seizure disorder
Correct Answer: C
Rationale: The most critical first step is a comprehensive psychiatric evaluation to
establish a timeline, assess mood symptoms, screen for substance use, and perform a
thorough MSE before making any diagnosis or treatment decisions. The presentation
could represent multiple conditions—bipolar I with psychotic features,
schizoaffective disorder, substance-induced psychosis, or even sleep deprivation
psychosis—and rushing to medication (Option A) or invasive testing (Options B and
D) without a proper clinical assessment is premature and potentially harmful. Option
B might be indicated later if red flags emerge, but it's not the first step. Option D is
not indicated without seizure-specific symptoms.
,Q2: During your mental status examination, Elena describes hearing the TV host's
voice "even when the TV is off," telling her she is "special" and "chosen." She also
reports feeling "on top of the world" with boundless energy, decreased need for
sleep, and racing thoughts for the past two weeks. Her sister confirms Elena maxed
out two credit cards buying designer handbags she doesn't need. Which symptom
cluster best describes her current presentation?
A. Pure psychotic disorder with no mood component
B. Manic episode with mood-congruent psychotic features
C. Major depressive episode with psychotic features
D. Hypnagogic hallucinations without psychopathology
Correct Answer: B
Rationale: Elena meets criteria for a manic episode (elevated mood, decreased need
for sleep, increased energy, racing thoughts, excessive spending/impulsivity) with
mood-congruent psychotic features (grandiose delusions of being "special" and
"chosen," auditory hallucinations reinforcing grandiosity) that align thematically with
her elevated mood state. Option A is incorrect because prominent mood symptoms
are clearly present. Option C is wrong—she's not depressed; she's euphoric and
energized. Option D minimizes the severity; these are true hallucinations and
delusions in the context of a manic episode, not benign sleep-related phenomena.
Q3: Elena's sister mentions that Elena has had two prior episodes over the past five
years where she became "really withdrawn and sad" for 6–8 weeks, sleeping 12 hours
a day, barely eating, and missing work. During those episodes, she never reported
hearing voices or believing TV characters were communicating with her. How does
this history change your differential diagnosis?
A. It confirms schizophrenia because she has had multiple psychotic episodes
B. It supports bipolar I disorder, as the current manic episode with psychosis plus
history of depressive episodes fits the diagnostic pattern
C. It suggests schizoaffective disorder because psychotic symptoms occur outside
mood episodes
, D. It indicates major depressive disorder with psychotic features because depression
was her first presentation
Correct Answer: B
Rationale: The history of prior depressive episodes (withdrawn, hypersomnia,
anhedonia, functional impairment) combined with the current manic episode with
psychotic features strongly supports bipolar I disorder. The prior depressions had
no psychotic features, which is actually consistent with bipolar I (psychosis can occur
during mania but not necessarily during every depressive episode). Option A is
wrong because schizophrenia requires 6 months of continuous symptoms and
functional decline. Option C is incorrect because we have no evidence of psychosis
outside mood episodes—her prior depressions were non-psychotic. Option D
ignores the current clear manic episode.
Q4: You learn from collateral history that Elena has been using cannabis daily for the
past six months, including on the day of her evaluation. She says it "helps her relax"
and "makes the TV messages clearer." Which of the following is the most accurate
statement regarding cannabis and her presentation?
A. Cannabis use definitively rules out a primary psychotic or mood disorder; her
symptoms are entirely substance-induced
B. Cannabis can cause or exacerbate psychotic symptoms, but a primary mood
disorder with psychotic features should still be considered given the full clinical
picture
C. Cannabis only causes anxiety, not psychosis, so her symptoms are unrelated to
substance use
D. Because she used cannabis on the day of evaluation, you must wait 30 days before
making any psychiatric diagnosis
Correct Answer: B
Rationale: While cannabis can induce or worsen psychotic symptoms (especially
high-THC products), the presence of a full manic syndrome with classic symptoms
(decreased sleep, grandiosity, racing thoughts, excessive spending) and a history of
prior depressive episodes suggests a primary mood disorder that may be
Volume 2 Case #16 | The Woman Who Liked a Late-
Night TV | Complete Solutions | Pass Guaranteed -
A+ Graded
Part One: Case Presentation & Differential Diagnosis (Late-
night TV Case)
(9 Questions)
Q1: Ms. Elena Vasquez, a 28-year-old woman, presents to your PMHNP clinic
accompanied by her sister. Over the past three weeks, Elena has been staying up
until 3–4 AM watching late-night television, insisting that the news anchors are
sending her "hidden messages" through their hand gestures and eye movements.
She believes a popular late-night host is in love with her and communicates through
coded phrases in his monologue. Her sister notes Elena has barely slept, appears
agitated, and has made several large online purchases she can't afford. Which of the
following is the most critical first step in your evaluation?
A. Prescribe an antipsychotic immediately to address the delusions
B. Order neuroimaging to rule out a brain tumor causing the delusions
C. Conduct a comprehensive psychiatric evaluation including timeline of symptoms,
mood history, substance use, medical history, and mental status exam
D. Refer Elena to a neurologist for EEG to rule out seizure disorder
Correct Answer: C
Rationale: The most critical first step is a comprehensive psychiatric evaluation to
establish a timeline, assess mood symptoms, screen for substance use, and perform a
thorough MSE before making any diagnosis or treatment decisions. The presentation
could represent multiple conditions—bipolar I with psychotic features,
schizoaffective disorder, substance-induced psychosis, or even sleep deprivation
psychosis—and rushing to medication (Option A) or invasive testing (Options B and
D) without a proper clinical assessment is premature and potentially harmful. Option
B might be indicated later if red flags emerge, but it's not the first step. Option D is
not indicated without seizure-specific symptoms.
,Q2: During your mental status examination, Elena describes hearing the TV host's
voice "even when the TV is off," telling her she is "special" and "chosen." She also
reports feeling "on top of the world" with boundless energy, decreased need for
sleep, and racing thoughts for the past two weeks. Her sister confirms Elena maxed
out two credit cards buying designer handbags she doesn't need. Which symptom
cluster best describes her current presentation?
A. Pure psychotic disorder with no mood component
B. Manic episode with mood-congruent psychotic features
C. Major depressive episode with psychotic features
D. Hypnagogic hallucinations without psychopathology
Correct Answer: B
Rationale: Elena meets criteria for a manic episode (elevated mood, decreased need
for sleep, increased energy, racing thoughts, excessive spending/impulsivity) with
mood-congruent psychotic features (grandiose delusions of being "special" and
"chosen," auditory hallucinations reinforcing grandiosity) that align thematically with
her elevated mood state. Option A is incorrect because prominent mood symptoms
are clearly present. Option C is wrong—she's not depressed; she's euphoric and
energized. Option D minimizes the severity; these are true hallucinations and
delusions in the context of a manic episode, not benign sleep-related phenomena.
Q3: Elena's sister mentions that Elena has had two prior episodes over the past five
years where she became "really withdrawn and sad" for 6–8 weeks, sleeping 12 hours
a day, barely eating, and missing work. During those episodes, she never reported
hearing voices or believing TV characters were communicating with her. How does
this history change your differential diagnosis?
A. It confirms schizophrenia because she has had multiple psychotic episodes
B. It supports bipolar I disorder, as the current manic episode with psychosis plus
history of depressive episodes fits the diagnostic pattern
C. It suggests schizoaffective disorder because psychotic symptoms occur outside
mood episodes
, D. It indicates major depressive disorder with psychotic features because depression
was her first presentation
Correct Answer: B
Rationale: The history of prior depressive episodes (withdrawn, hypersomnia,
anhedonia, functional impairment) combined with the current manic episode with
psychotic features strongly supports bipolar I disorder. The prior depressions had
no psychotic features, which is actually consistent with bipolar I (psychosis can occur
during mania but not necessarily during every depressive episode). Option A is
wrong because schizophrenia requires 6 months of continuous symptoms and
functional decline. Option C is incorrect because we have no evidence of psychosis
outside mood episodes—her prior depressions were non-psychotic. Option D
ignores the current clear manic episode.
Q4: You learn from collateral history that Elena has been using cannabis daily for the
past six months, including on the day of her evaluation. She says it "helps her relax"
and "makes the TV messages clearer." Which of the following is the most accurate
statement regarding cannabis and her presentation?
A. Cannabis use definitively rules out a primary psychotic or mood disorder; her
symptoms are entirely substance-induced
B. Cannabis can cause or exacerbate psychotic symptoms, but a primary mood
disorder with psychotic features should still be considered given the full clinical
picture
C. Cannabis only causes anxiety, not psychosis, so her symptoms are unrelated to
substance use
D. Because she used cannabis on the day of evaluation, you must wait 30 days before
making any psychiatric diagnosis
Correct Answer: B
Rationale: While cannabis can induce or worsen psychotic symptoms (especially
high-THC products), the presence of a full manic syndrome with classic symptoms
(decreased sleep, grandiosity, racing thoughts, excessive spending) and a history of
prior depressive episodes suggests a primary mood disorder that may be
