NURS 6630 DISCUSSION TREATMENT FOR COMMON
CONDITION 2026/2027 | Elderly Widow Lost Her Spouse |
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Bereavement, Grief, & Differential Diagnosis (Elderly Widow)
Q1: Mrs. Eleanor Vance, a 78-year-old widow, presents to the clinic six weeks after her
husband's death from congestive heart failure. She reports crying spells, difficulty
sleeping, and loss of appetite. She states, "I just miss him so much. We were married for
52 years." She is able to enjoy memories of their grandchildren and denies feeling like a
burden. Which clinical feature most strongly suggests her presentation is consistent
with normal bereavement rather than major depressive disorder?
A. Her insomnia and appetite loss
B. The fact that she is crying frequently
C. Her ability to experience positive emotions when thinking about her grandchildren
[CORRECT]
D. The recency of her husband's death
Correct Answer: C
Rationale: The best answer is C. In normal grief, the bereaved person typically retains
the capacity for positive emotions and their self-esteem remains intact, whereas major
depression is characterized by pervasive anhedonia and feelings of worthlessness that
color all experiences. While insomnia, crying, and recent loss can occur in both
conditions, the preservation of positive affect is a key distinguishing feature.
Q2: Mrs. Vance returns for follow-up four months after her husband's death. She now
reports persistent low mood every day, an inability to take pleasure in anything including
her grandchildren's visits, and recurrent thoughts that she is a burden to her family. She
has lost 12 pounds and sleeps only 3-4 hours per night. Which screening tool is most
appropriate for assessing the severity of her depressive symptoms in this geriatric
population?
A. The Beck Anxiety Inventory
, B. The Geriatric Depression Scale (GDS-15 or GDS-30) [CORRECT]
C. The PTSD Checklist for DSM-5
D. The Young Mania Rating Scale
Correct Answer: B
Rationale: The best answer is B. The Geriatric Depression Scale was specifically
developed for older adults and excludes somatic symptoms that could be confused
with medical illness, making it ideal for this population. The Beck Anxiety Inventory
screens for anxiety, the PTSD Checklist is for trauma, and the Young Mania Rating Scale
assesses for mania—none of which fit her presentation.
Q3: Before initiating any psychiatric treatment, which of the following medical workups
is most essential to rule out reversible causes of depression in this 78-year-old woman?
A. Brain MRI with contrast
B. Thyroid-stimulating hormone (TSH) and vitamin B12 levels [CORRECT]
C. Lumbar puncture for cerebrospinal fluid analysis
D. Genetic testing for serotonin transporter polymorphisms
Correct Answer: B
Rationale: The best answer is B. Hypothyroidism and vitamin B12 deficiency are
common, reversible medical conditions that can mimic or exacerbate depression in
older adults and should be ruled out with basic laboratory testing before attributing
symptoms solely to psychiatric causes. Brain MRI and lumbar puncture are not first-line
unless focal neurological signs are present, and genetic testing is not standard clinical
practice.
Q4: Mrs. Vance mentions that she has been taking diphenhydramine 50 mg nightly for
sleep since her husband died, and her primary care provider recently started her on a
low-dose benzodiazepine for anxiety. Her current medication list includes: lisinopril,
acetaminophen as needed, diphenhydramine, and lorazepam. Which medication on this
list is most concerning according to the Beers Criteria for potentially inappropriate
medication use in older adults?
A. Lisinopril
B. Acetaminophen
C. Diphenhydramine and lorazepam [CORRECT]
D. None of these medications are concerning
Correct Answer: C
CONDITION 2026/2027 | Elderly Widow Lost Her Spouse |
Complete Solutions | Pass Guaranteed - A+ Graded
Bereavement, Grief, & Differential Diagnosis (Elderly Widow)
Q1: Mrs. Eleanor Vance, a 78-year-old widow, presents to the clinic six weeks after her
husband's death from congestive heart failure. She reports crying spells, difficulty
sleeping, and loss of appetite. She states, "I just miss him so much. We were married for
52 years." She is able to enjoy memories of their grandchildren and denies feeling like a
burden. Which clinical feature most strongly suggests her presentation is consistent
with normal bereavement rather than major depressive disorder?
A. Her insomnia and appetite loss
B. The fact that she is crying frequently
C. Her ability to experience positive emotions when thinking about her grandchildren
[CORRECT]
D. The recency of her husband's death
Correct Answer: C
Rationale: The best answer is C. In normal grief, the bereaved person typically retains
the capacity for positive emotions and their self-esteem remains intact, whereas major
depression is characterized by pervasive anhedonia and feelings of worthlessness that
color all experiences. While insomnia, crying, and recent loss can occur in both
conditions, the preservation of positive affect is a key distinguishing feature.
Q2: Mrs. Vance returns for follow-up four months after her husband's death. She now
reports persistent low mood every day, an inability to take pleasure in anything including
her grandchildren's visits, and recurrent thoughts that she is a burden to her family. She
has lost 12 pounds and sleeps only 3-4 hours per night. Which screening tool is most
appropriate for assessing the severity of her depressive symptoms in this geriatric
population?
A. The Beck Anxiety Inventory
, B. The Geriatric Depression Scale (GDS-15 or GDS-30) [CORRECT]
C. The PTSD Checklist for DSM-5
D. The Young Mania Rating Scale
Correct Answer: B
Rationale: The best answer is B. The Geriatric Depression Scale was specifically
developed for older adults and excludes somatic symptoms that could be confused
with medical illness, making it ideal for this population. The Beck Anxiety Inventory
screens for anxiety, the PTSD Checklist is for trauma, and the Young Mania Rating Scale
assesses for mania—none of which fit her presentation.
Q3: Before initiating any psychiatric treatment, which of the following medical workups
is most essential to rule out reversible causes of depression in this 78-year-old woman?
A. Brain MRI with contrast
B. Thyroid-stimulating hormone (TSH) and vitamin B12 levels [CORRECT]
C. Lumbar puncture for cerebrospinal fluid analysis
D. Genetic testing for serotonin transporter polymorphisms
Correct Answer: B
Rationale: The best answer is B. Hypothyroidism and vitamin B12 deficiency are
common, reversible medical conditions that can mimic or exacerbate depression in
older adults and should be ruled out with basic laboratory testing before attributing
symptoms solely to psychiatric causes. Brain MRI and lumbar puncture are not first-line
unless focal neurological signs are present, and genetic testing is not standard clinical
practice.
Q4: Mrs. Vance mentions that she has been taking diphenhydramine 50 mg nightly for
sleep since her husband died, and her primary care provider recently started her on a
low-dose benzodiazepine for anxiety. Her current medication list includes: lisinopril,
acetaminophen as needed, diphenhydramine, and lorazepam. Which medication on this
list is most concerning according to the Beers Criteria for potentially inappropriate
medication use in older adults?
A. Lisinopril
B. Acetaminophen
C. Diphenhydramine and lorazepam [CORRECT]
D. None of these medications are concerning
Correct Answer: C
