Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select one that doesn't apply.

Correct Answer: A

Rationale: Questions about anxiety management, disordered eating, and alcohol use are relevant to identifying comorbid conditions with major depressive disorder, but the question 'Do rules apply to you?' does not directly address common comorbid mental health conditions associated with major depressive disorder.

Correct Answer: C

Rationale: Characteristics such as age, frequency of outbursts, and occurrence in multiple settings support a diagnosis of disruptive mood dysregulation disorder. While comorbid conditions like autism can coexist with disruptive mood dysregulation disorder, it is not a characteristic that serves to support a diagnosis of this specific disorder.

Correct Answer: A

Rationale: Chronic medical conditions can significantly impact mental health, often serving as triggers for major depressive disorder (MDD). The correct answer is **A: Pain**, as chronic pain is one of the most well-documented and clinically established conditions linked to the development of depression. The relationship between chronic pain and depression is bidirectional and multifaceted. Persistent pain disrupts daily functioning, limits mobility, and reduces quality of life, leading to feelings of hopelessness, helplessness, and social isolation—key contributors to depressive symptoms. Neurobiological mechanisms also play a role; chronic pain alters neurotransmitter systems (e.g., serotonin and norepinephrine) and activates inflammatory pathways, which are also implicated in depression. Studies show that up to 50% of chronic pain patients experience comorbid depression, highlighting the strength of this association. **B: Hypertension** is incorrect because, while it is a common chronic condition, its direct link to MDD is weaker. Hypertension may contribute to stress or anxiety, but it does not inherently involve the same profound disruption to daily life or neurochemical pathways as chronic pain. Some studies suggest a correlation between hypertension and depression, but this is often confounded by lifestyle factors (e.g., poor diet, lack of exercise) rather than a direct causal relationship. **C: Hypothyroidism** is incorrect as a *common* trigger for MDD, though it can mimic depressive symptoms (e.g., fatigue, low mood). However, hypothyroidism is less prevalent than chronic pain, and its depressive-like symptoms are typically resolved with thyroid hormone replacement therapy. While untreated hypothyroidism can contribute to mood disturbances, it is not among the leading chronic conditions *proven* to trigger MDD in the same way chronic pain does. **D: Crohn's disease** is incorrect because, although it is a chronic inflammatory condition that can affect mood, its association with depression is more indirect. The psychological burden of managing a gastrointestinal disorder (e.g., embarrassment, dietary restrictions) may contribute to depression, but the condition itself does not universally or directly trigger MDD to the same extent as chronic pain. The inflammatory component of Crohn's may play a role, but the evidence is not as robust as for pain-related depression. In summary, chronic pain stands out due to its high prevalence, profound impact on daily functioning, and direct neurobiological overlap with depressive mechanisms, making it the most compelling choice among the options provided. The other conditions, while relevant to mental health, lack the same breadth and depth of evidence linking them to MDD.

Correct Answer: A

Rationale: Fluoxetine (Prozac) is a suitable alternative antidepressant for Tammy due to its approval for the treatment of bulimia nervosa. It belongs to the selective serotonin reuptake inhibitor (SSRI) class of antidepressants, similar to citalopram, which Tammy is already taking. Fluoxetine has shown efficacy in treating bulimia nervosa and can be a beneficial choice for individuals with this condition.

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.