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: A 48-year-old woman presents to the psychiatric clinic accompanied by her
sister, who is concerned about her behavior over the past three months. The patient
believes that characters on late-night television talk shows are sending her secret,
personalized messages specifically about her life. She describes seeing "flashing
images" during commercial breaks that "only I can interpret." She stays awake
watching TV until 3-4 AM most nights and sleeps until early afternoon. She was
recently fired from her administrative job for chronic absenteeism. What is your first
clinical priority?
A. Prescribe a second-generation antipsychotic immediately to address her psychotic
symptoms
B. Order an immediate CT scan of the brain to rule out a tumor
C. Conduct a comprehensive psychiatric evaluation including detailed sleep history,
substance use screening, medical workup, and mental status exam before
formulating a differential diagnosis [CORRECT]
D. Diagnose schizophrenia and begin long-acting injectable antipsychotic therapy
Correct Answer: C
Rationale: Atypical psychotic presentations in a middle-aged woman require
thorough evaluation before diagnosis. Sleep deprivation, substance use, and medical
causes must be ruled out. Option A and D jump to treatment without adequate
assessment. Option B is premature without neurological red flags.
,Q2: During the mental status examination, the patient is alert and oriented to person,
place, and time. Her speech is coherent but circumstantial when discussing television.
She maintains fixed eye contact and appears suspicious. She denies depressed mood,
anhedonia, or suicidal ideation. She denies euphoria, grandiosity, or racing thoughts.
Her affect is constricted. Her thought process shows ideas of reference but no
loosening of associations. What is the most prominent psychopathology?
A. Formal thought disorder with disorganized speech
B. Mood-congruent psychotic features secondary to major depression
C. Delusional thinking with ideas of reference in the absence of prominent mood
symptoms [CORRECT]
D. Negative symptoms of schizophrenia with flat affect and alogia
Correct Answer: C
Rationale: The patient demonstrates delusional thinking (personalized messages
from TV) and ideas of reference without prominent mood symptoms, formal thought
disorder, or negative symptoms. Option A requires disorganization. Option B requires
mood symptoms. Option D requires more pervasive negative symptomatology.
Q3: The patient's sister reports that the patient has no prior psychiatric history, no
known substance use, and no family history of psychotic disorders. However, she
notes the patient went through a difficult divorce two years ago and has become
increasingly isolated since. She also mentions the patient "always had trouble
sleeping" but it has become much worse over the past six months. What additional
history is most critical to obtain?
A. Detailed sleep history including sleep onset, offset, total sleep time, sleep quality,
and presence of hypnagogic/hypnopompic phenomena [CORRECT]
B. Detailed sexual history to assess for trauma-related disorders
C. Detailed occupational history to assess for work-related stress disorder
, D. Detailed dietary history to assess for nutritional deficiencies
Correct Answer: A
Rationale: Sleep deprivation can induce or exacerbate psychotic symptoms. A
detailed sleep history is essential given her 3-4 AM bedtime pattern and the
established relationship between sleep disturbance and psychosis. Options B, C, and
D may be relevant but are less immediately critical than characterizing the sleep-
psychosis relationship.
Q4: You obtain a sleep history. The patient reports falling asleep around 4 AM,
waking multiple times, and finally rising around 1 PM. She estimates 4-5 hours of
fragmented sleep nightly for the past three months. She denies snoring, witnessed
apneas, restless legs, or cataplexy. She does not nap. She describes vivid, intense
dreams but cannot distinguish them from her TV-related experiences. This pattern is
most consistent with:
A. Narcolepsy with hypnagogic hallucinations
B. Delayed sleep-wake phase disorder with possible sleep deprivation-induced
perceptual disturbances [CORRECT]
C. REM sleep behavior disorder with dream enactment
D. Obstructive sleep apnea with nocturnal hypoxemia
Correct Answer: B
Rationale: The delayed sleep phase (4 AM to 1 PM), chronic sleep restriction (4-5
hours), and dream-reality confusion are consistent with circadian disruption and
sleep deprivation contributing to perceptual disturbances. Option A requires
cataplexy or sleep attacks. Option C requires dream enactment behaviors. Option D
requires snoring/apneas.
Q5: You order baseline laboratory studies and screening. Results show: TSH 1.2
mIU/L (normal), vitamin B12 450 pg/mL (normal), CBC normal, BMP normal, urinalysis
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: A 48-year-old woman presents to the psychiatric clinic accompanied by her
sister, who is concerned about her behavior over the past three months. The patient
believes that characters on late-night television talk shows are sending her secret,
personalized messages specifically about her life. She describes seeing "flashing
images" during commercial breaks that "only I can interpret." She stays awake
watching TV until 3-4 AM most nights and sleeps until early afternoon. She was
recently fired from her administrative job for chronic absenteeism. What is your first
clinical priority?
A. Prescribe a second-generation antipsychotic immediately to address her psychotic
symptoms
B. Order an immediate CT scan of the brain to rule out a tumor
C. Conduct a comprehensive psychiatric evaluation including detailed sleep history,
substance use screening, medical workup, and mental status exam before
formulating a differential diagnosis [CORRECT]
D. Diagnose schizophrenia and begin long-acting injectable antipsychotic therapy
Correct Answer: C
Rationale: Atypical psychotic presentations in a middle-aged woman require
thorough evaluation before diagnosis. Sleep deprivation, substance use, and medical
causes must be ruled out. Option A and D jump to treatment without adequate
assessment. Option B is premature without neurological red flags.
,Q2: During the mental status examination, the patient is alert and oriented to person,
place, and time. Her speech is coherent but circumstantial when discussing television.
She maintains fixed eye contact and appears suspicious. She denies depressed mood,
anhedonia, or suicidal ideation. She denies euphoria, grandiosity, or racing thoughts.
Her affect is constricted. Her thought process shows ideas of reference but no
loosening of associations. What is the most prominent psychopathology?
A. Formal thought disorder with disorganized speech
B. Mood-congruent psychotic features secondary to major depression
C. Delusional thinking with ideas of reference in the absence of prominent mood
symptoms [CORRECT]
D. Negative symptoms of schizophrenia with flat affect and alogia
Correct Answer: C
Rationale: The patient demonstrates delusional thinking (personalized messages
from TV) and ideas of reference without prominent mood symptoms, formal thought
disorder, or negative symptoms. Option A requires disorganization. Option B requires
mood symptoms. Option D requires more pervasive negative symptomatology.
Q3: The patient's sister reports that the patient has no prior psychiatric history, no
known substance use, and no family history of psychotic disorders. However, she
notes the patient went through a difficult divorce two years ago and has become
increasingly isolated since. She also mentions the patient "always had trouble
sleeping" but it has become much worse over the past six months. What additional
history is most critical to obtain?
A. Detailed sleep history including sleep onset, offset, total sleep time, sleep quality,
and presence of hypnagogic/hypnopompic phenomena [CORRECT]
B. Detailed sexual history to assess for trauma-related disorders
C. Detailed occupational history to assess for work-related stress disorder
, D. Detailed dietary history to assess for nutritional deficiencies
Correct Answer: A
Rationale: Sleep deprivation can induce or exacerbate psychotic symptoms. A
detailed sleep history is essential given her 3-4 AM bedtime pattern and the
established relationship between sleep disturbance and psychosis. Options B, C, and
D may be relevant but are less immediately critical than characterizing the sleep-
psychosis relationship.
Q4: You obtain a sleep history. The patient reports falling asleep around 4 AM,
waking multiple times, and finally rising around 1 PM. She estimates 4-5 hours of
fragmented sleep nightly for the past three months. She denies snoring, witnessed
apneas, restless legs, or cataplexy. She does not nap. She describes vivid, intense
dreams but cannot distinguish them from her TV-related experiences. This pattern is
most consistent with:
A. Narcolepsy with hypnagogic hallucinations
B. Delayed sleep-wake phase disorder with possible sleep deprivation-induced
perceptual disturbances [CORRECT]
C. REM sleep behavior disorder with dream enactment
D. Obstructive sleep apnea with nocturnal hypoxemia
Correct Answer: B
Rationale: The delayed sleep phase (4 AM to 1 PM), chronic sleep restriction (4-5
hours), and dream-reality confusion are consistent with circadian disruption and
sleep deprivation contributing to perceptual disturbances. Option A requires
cataplexy or sleep attacks. Option C requires dream enactment behaviors. Option D
requires snoring/apneas.
Q5: You order baseline laboratory studies and screening. Results show: TSH 1.2
mIU/L (normal), vitamin B12 450 pg/mL (normal), CBC normal, BMP normal, urinalysis
