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Biology Case Study Forum Post

November 11, 2023/in Uncategorized /by Daniel Jennings

Page 1“Antibiotic Resistance” by Maureen Leonard

by Maureen Leonard Biology Department Mount Mary College, Milwaukee, WI

Antibiotic Resistance: Can We Ever Win?

Part I – Measuring Resistance Katelyn was excited to start her summer job in her microbiology professor’s research laboratory. She had enjoyed Dr. Johnson’s class, and when she saw the ” yer recruiting undergraduate lab assistants for the summer, she had jumped at the opportunity. She was looking forward to making new discoveries in the lab.

On her # rst day, she was supposed to meet with Dr. Johnson to talk about what she would be doing. She knew the lab focused on antibiotic resistance in Staphylococcus aureus, espe- cially MRSA (methicillin-resistant S. aureus ).

She still remembered the scare her family had last year when her little brother, Jimmy, got so sick. He’d been playing in the neighborhood playground and cut his lip when he fell o$ the jungle gym. Of course he always had cuts and scrapes—he was a # ve-year-old boy! % is time though his lip swelled up and he developed a fever. When her mother took him to the doctor, the pediatrician said the cut was infected and had prescribed cephalothin, an antibiotic related to penicillin, and recommended ” ushing the cut regularly to help clear up the infection.

Two days later, Jimmy was in the hospital with a fever of 103°F, coughing up blood and having trouble breathing. % e emergency room doctors told the family that Jimmy had developed pneumonia. % ey started him on IV antibiotics, including ceftriaxone and nafcillin, both also relatives of penicillin.

It was lucky for Jimmy that one of the doctors decided to check for MRSA, because that’s what it was! MRSA is resistant to most of the penicillin derivatives. Most cases of MRSA are hospital-acquired from patients who are already susceptible to infection, but the ER doctor explained that community-acquired MRSA was becoming more common. % e doctor then switched the treatment to vancomycin, a completely di$ erent kind of antibiotic, and Jimmy got better quickly after that.

Katelyn had dropped Jimmy o$ at swimming lessons just before coming to work at the lab. As she waited in the hallway for Dr. Johnson, she hoped that she would be at least a small part of helping other people like Jimmy deal with these scary resistant microbes. She was surprised when the professor burst out of the lab, almost running into her.

“Hi Katelyn, I’m really sorry but I have to run to a meeting right now—they sprung it on me last minute. % ere are a bunch of plates in the incubator right now that need their zones of inhibition measured. I’ll be back in a few hours,” Dr. Johnson said as he rushed down the hallway with a stack of folders.

Katelyn dug out her old lab notebook to look up what she was supposed to do. She found the lab where she and her fellow students had examined the antimicrobial properties of antibiotics using the Kirby-Bauer disk di$ usion tech- nique. Looking at the plates Dr. Johnson had told her about, she saw they had all been “lawned,” or completely coated with microbes to make a thick hazy layer over the agar surface. She could also see paper disks with letters on them, and some of the disks had clear zones around them where the microbe had been inhibited (Fig. 1). Her notebook explained how to measure the zone of inhibition around the disks (Fig. 2).

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ttle brother, Jimmy, got hi li h h f ll $ h j l

We’re looking for undergraduate lab assistants! If yes, e-mail Dr. Johnson to grab a spot today!

(You must have taken Biology 200 Microbiology to apply)

Interested in studying microbial antibiotic resistance?

Do you want to work in a research lab? Are you interested in bacteria?

Have you heard of antibiotic resistance?

Page 2“Antibiotic Resistance” by Maureen Leonard

Plate 1. Plate 2. Plate 3.

S. aureus

CE ME

S. aureus

CE ME

S. aureus

CE ME

MRSA

CE ME

MRSA

CE ME

MRSA

Figure 1. Agar plates of S. aureus or MRSA lawns with antibiotic disks placed on them.

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Page 3“Antibiotic Resistance” by Maureen Leonard

Figure 2. Katelyn’s diagram of how to measure a zone of inhibition from her microbiology lab notebook.

x xi

i 1

Exercise1 Measure the zones of inhibition for each antibiotic on the plates shown in Figure 1 and note the measurements in the spaces in Table 1 below. (Note: % e Kirby-Bauer method is standardized so that no zone of inhibition is scored as a 0, and all others include the disk as part of the zone.)

Key: PE = penicillin, ME = methicillin, CE = cephalothin, and VA = vancomycin

Plate S. aureus MRSA

An average, or mean (x ), is a measure of central tendency in the data, or what value occurs in the middle of the data set. % e mean is calculated by adding up all the values for a given set of data, then dividing by the sample size (n).

Average

Standard deviation measures the spread of the data—as in how variable the data set is. % e standard deviation (s ) is calculated by the following:

Inhibition (clear) zone

Measure in mm

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Page 4“Antibiotic Resistance” by Maureen Leonard

Standard error measures the di$ erence between the sample you have taken and the whole population of values. % e standard error (SE) is calculated as follows:

s (x x) 2

n 1

SE s n

Exercise 2 In Table 2 below calculate and record the averages and standard errors for each antibiotic in S. aureus and MRSA.

S. aureus MRSA

Average SE Average SE

Exercise 3 Now, redraw Tables 1 and 2 into a single, more organized table. Be sure to label the table appropriately.

Standard deviation

Standard error

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Page 5“Antibiotic Resistance” by Maureen Leonard

Exercise 4 Graph the results from Table 2. Be sure to label the # gure and the axes correctly.

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Page 6“Antibiotic Resistance” by Maureen Leonard

Questions 1. What do you think the experimental question is? 2. What hypotheses can you come up with to answer the experimental question? 3. If your hypothesis is correct, what would the plates look like (i.e., what predictions would you make for each

hypothesis)? 4. Is the experiment you just collected data for an appropriate test of the experimental question you came up with

in your answer to Question 1? 5. Which antibiotics where most e$ ective against S. aureus? Against MRSA? 6. When comparing the antibiotics e$ ective against both, were there di$ erences in e$ ectiveness? 7. What other questions do the data shown in Figure 1 make you think of?

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Page 7“Antibiotic Resistance” by Maureen Leonard

Part II – Resistance Among the # rst antibiotics used on a large scale was penicillin, which was discovered in 1929 by Alexander Fleming. It was # nally isolated and synthesized in large quantities in 1943. Penicillin works by interfering with the bacterial cell wall synthesis. Without a cell wall, the bacterial cells cannot maintain their shape in changing osmotic conditions. % is puts signi# cant selective pressure on the microbes to evolve, as they cannot survive the osmotic stress. Any microbe that can resist these drugs will survive and reproduce more, making the population of microbes antibiotic resistant.

% e speci# c mechanism of penicillin is the prevention of cell wall synthesis by the -lactam ring of the antibiotic (Fig. 3), which binds and inhibits an enzyme required by the bacterium in this process.

% e enzyme is called penicillin-binding protein (PBP), even though it is an enzyme involved in cell wall synthesis. Normally enzymes have names that indicate what they do and end in the su, x -ase, like lactase, the enzyme that breaks down lactose. Figure 4 is a representation of PBP and its active site.

Bacterial cell walls are layered structures, where each layer is made of peptidoglycan, a sugar and protein polymer. Each layer is cross-linked to the next, strengthening the wall and allowing the cell to resist osmotic pressure. % e way the enzyme PBP works is to form those cross-bridges by joining strings of amino acids together in the active site, which is a groove in the protein (Fig. 5).

Active site

Figure 4. PBP (penicillin-binding protein) active site is a groove allowing formation of cross-links in the bacterial cell wall.

Figure 5. Cross-link formation in bacterial cell walls by PBP (penicillin-binding protein).

PBP

Peptidoglycan layers

Amino acids

Cross-bridge

Figure 3. % e -lactam ring common to the penicillin family of antibiotics.

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Page 8“Antibiotic Resistance” by Maureen Leonard

% e PBP takes amino acid residues attached to peptidoglycan layers and forms bridges between them within the active site groove. % is cross-linking, or cross-bridging, stabilizes and strengthens the cell wall. -lactam antibiotics interfere with the PBP enzyme by binding to the active site, blocking the site from the amino acids (Fig. 6).

% ere are over 80 natural and semi-synthetic forms of -lactam antibiotics, including cephalothin and methicillin. Vancomycin also interferes with cell wall synthesis, but its mechanism of action is to bind directly to the cell wall components (Figs. 7 and 8).

Figure 6. Inhibition of PBP (penicillin-binding protein) by

-lactam blocking the active site.

Figure 7. PBP (penicillin-binding protein), the enzyme that allows the bacterial cell wall to form cross-bridges, is inhibited by the -lactam family of antibiotics. % is prevents proper cell wall synthesis and the bacterium will succumb to osmotic stress.

a. Normal PBP binding and cross-bridge formation

b. PBP inhibited by -lactam antibiotic

c. Cell wall does not form properly

+ =

PBP

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Page 9“Antibiotic Resistance” by Maureen Leonard

% e # rst MRSA case was discovered in 1961 in a British hospital, and was the result of a mutation in the enzyme normally inhibited by the -lactam ring of methicillin. % e site where the antibiotic would bind no longer allowed access to the ring, so the enzyme continued to function normally. % e microbe acquired a new gene that, when made into protein, was a di$ erent version of PBP, one that couldn’t be inhibited by penicillin.

Questions 1. Describe what is happening in Figures 7 and 8 in a complete sentence of your own words. 2. What are the di$ erences in how -lactam antibiotics and vancomycin work? 3. What other mechanisms might arise to allow resistance to the -lactam antibiotics? 4. Could resistance arise to vancomycin? Why or why not?

Figure 8. Vancomycin inhibits cell wall synthesis a di$ erent way by binding PBP’s substrates and preventing cross-bridging. % is prevents proper cell wall synthesis and the bacterium will succumb to osmotic stress.

a. Normal PBP binding and cross-bridge formation

b. Vancomycin binds PBP substrate

c. Cell wall does not form properly

PBP

Vancomycin

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Biology Lab

November 11, 2023/in Uncategorized /by Daniel Jennings

INCLUDEPICTURE “D:\\Karuna\\ESL01\\8 Nov\\Final Files\\Lab02\\CourseRoot\\images\\lab002banner02.jpg” \* MERGEFORMATINET

Pre-Lab Questions

1. What should you always wear to protect your eyes when you are in the chemistry laboratory?

Safety glasses or safety goggles should always be worn inside a chemistry lab to protect your eyes.

2. Should you add acid to water or water to acid?

Always add acid to water.

3. Where should you dispose of broken glass?

They should be placed in the proper container for the disposal of sharps. They should never be tossed into a regular trash can.

4. What should you do if you spill a chemical on your hand?

You should immediately wash your hands with copious amounts of water and antibacterial soap.

Exercise 1: What Is It?

A chemical laboratory contains special equipment to use while you are performing an experiment. Locate each of the items pictured on the following pages in your lab kit, and place a check mark in the appropriate place when you find it. After you have completed this, sketch a picture and name any additional items that are located in your lab kit, classroom, or home that are likely to be useful for you in completing these labs.

Beaker

50 mL ____x_____

Stir Stick__x_______

250 mL ___x______ Graduated Cylinder

10 mL ____x_____

100 mL __x_______

Test Tube ___x______ Pipette ___x______ Petri Dish ___x______

Include your Drawings Here:

Experiment 1: Neutralization of Acids and Bases

In this experiment, you will learn how to properly neutralize and dispose of acidic and basic solutions.

Materials

5 mL 4.5% Acetic Acid (vinegar), C2H4O2 (1) 10 mL Graduated Cylinder 8 Litmus Test Strips (Neutral) Permanent Marker 2 Pipettes 1 g Sodium Bicarbonate (baking soda), NaHCO3

4 Weigh Boats *Water

*You Must Provide

Procedure

1. Use the permanent marker to label three of the weigh boats as A – C.

2. Measure and pour approximately 5 mL of water into weigh boat “A”.

3. Add 0.5 g sodium bicarbonate to weigh boat “B”.

4. Measure and pour approximately 5 mL of water into weigh boat “B”. Gently pipette the solution up and down until the sodium bicarbonate is fully dissolved in the water.

5. Measure and pour 5 mL acetic acid solution to weigh boat “C”.

6. Use the litmus test strips to determine if the substances in weigh boats A – C are acidic or basic. This is accomplished by briefly dipping an unused strip of the litmus paper in each of the weigh boats. Record your color results in Table 2.

7. Pipette 1 mL of the sodium bicarbonate solution from weigh boat “B” into weigh boat “C”. Gently swirl weigh boat “C” to mix.

8. Develop and record a hypothesis regarding the pH of weigh boat “C”. Record this in the Post-Lab Questions section.

9. Test the pH of weigh boat “C” using new litmus paper. Record your result in Table 3.

10. Repeat Step 9 four more times until all the sodium bicarbonate has been added to weigh boat “C”.

Table 2: Initial Litmus Test Results
Weigh Boat	Chemical Contents	Litmus Results	Additional Observations
A
B
C

Table 3: Neutralization of an Acid
Amount of Base	Litmus Result
1 mL
2 mL
3 mL
4 mL
5 mL

Post-Lab Questions

1. State your hypothesis (developed in Step 8) here. Be sure to include what you think the pH will be, and why.

2. What is a neutralization reaction?

3. When might neutralization reactions be used in a laboratory setting?

4. At what point was the acetic acid in weigh boat “C” neutralized?

5. What do you think would have been the results if a stronger solution of sodium bicarbonate was used? Would it take more or less to neutralize the acid? What about a weaker concentration of sodium bicarbonate?

Pre-lab Questions

1. List the atomic numbers for each of the following elements.

Iron	_________	Oxygen	_________
Calcium	_________	Nitrogen	_________
Potassium	_________	Hydrogen	_________

2. What determines if a bond is polar?

3. Use the periodic table to determine if potassium chloride (KCl) formed through covalent or ionic bonds? Use evidence from the Introduction to support your answer.

4. Research two common, polar molecules and two common nonpolar molecules. Draw their molecular structure and explain how the structure makes each molecule polar or non-polar.

Experiment 1: Slime Time

Inks can be polar or non-polar. Polar solvents pick up polar inks, while non-polar solvents pick up non-polar inks. In this experiment, you will use inks to identify slime and silly putty as polar or non-polar. You will also use paper chromatography to verify the inks are correctly identified as polar or non-polar.

Materials

(1) 250 mL Beaker 5 mL 4% Borax Solution, Na2B4O7·10H2O Dry Erase Marker (1) 10 mL Graduated Cylinder (1) 100 mL Graduated Cylinder Filter Paper (Disk) Filter Paper (Square) 0.5 g Guar Gum Highlighter Permanent Marker 1 Popsicle Stick

Silly Putty® Ruler Wooden Stir Stick Uni-ball® Roller Pen *Distilled or Tap Water *Newspaper *Notebook Paper *Scissors *You Must Provide

Procedure:

Part 1: Making Slime

1. Weigh out 0.5 g of guar gum into a 250 mL beaker.

2. Measure 50.0 mL of distilled water into a 100 mL graduated cylinder and pour it into the 250 mL beaker that contains the guar gum.

3. Rapidly stir the mixture with a wooden stir stick for three minutes, or until the guar gum is dissolved.

4. Measure 4.00 mL of a 4% Borax solution into a 10 mL graduated cylinder and add it to the guar gum and water.

5. Stir the solution until it becomes slime. This will take a few minutes. If the slime remains too runny, add an additional 1.0 mL of the 4.0% Borax solution and continue to stir until the slime is the slightly runny or gooey.

6. Once you are satisfied with the slime, pour it into your hands. Be sure not to drop any of it on to the floor.

7. Manipulate the slime in your hands. Write down observations made about how slime pours, stretches, breaks, etc. in Part 1 of the Data section. CAUTION: Slime is slippery and if dropped it can make the work area slick.

8. Place the slime back into the beaker and WASH YOUR HANDS.

Part 2: Slime and Putty Ink Tests

1. On a piece of notebook paper make one 20 – 25 mm long mark of each of the inks you are testing (permanent marker, highlighter, Dry Erase, and Uni-ball® Roller Pen). Space the marks at least one inch apart. Use a pencil to label each mark with its description.

a. Water soluble inks include those in highlighters and certain pens.

b. Water insoluble inks include those in a permanent pen/markers, newsprint, and a dry-erase markers.

2. While the inks are drying, select a passage or a picture in the newspaper to test with the slime.

3. Develop a hypothesis stating whether or not you believe the slime produced in Part 1 will pick up newsprint ink. Record this hypothesis in the Post-Lab Questions section. Then, break off a small piece of slime that is 3 – 5 cm in diameter. Gently place this piece on top of the newspaper print, then carefully pick it up again.

4. Observe and record in Table 1 whether or not the ink was picked up onto the slime.

5. Break off another small piece of slime. Once the inks from Step 1 have dried gently place the slime on top of the first spot on the notebook paper, then carefully pick it up. Repeat this for each of the inks. Observe and record which inks were picked up (dissolved) by the slime in Table 1.

6. Repeat this ink testing two more times for accuracy.

7. Hypothesize which inks the silly putty will pick up in the Part 2 of the Data section. Then, perform the ink tests with the Silly Putty® according to the procedure outlined in Steps 5 – 6.

Part 3: Chromatography of Ink Samples

Figure 7: Chromatography apparatus for Procedure Part 3.

1. Use a pencil or scissors to poke a small hole in the center of a piece of filter paper (see Figure 7).

2. Spot the filter paper evenly spaced approximately 2 cm from the small hole with the two insoluble inks and the two soluble inks that were used in Part 2, Step 1.

3. Obtain a ½ piece of filter paper. Fold the paper in half several times so that it makes a narrow wick.

4. Insert the wick into the hole of the spotted paper so that it is above the top of the filter paper by approximately 2 cm.

5. Fill a 250 mL beaker ¾ full with water.

6. Set the filter paper on top of the beaker so that the bottom of the wick is in the water. The paper should hang over the edge of the beaker with the spotted side up.

7. Allow water to travel until it is approximately 1 cm from the edge of the filter paper. Remove the filter paper from the beaker.

8. Observe which inks moved from where they were originally spotted. Record your observations in Part 3 of the Data section.

Table 1: Results of Ink Testing for Silly Putty®
Name of Ink	Picked up (dissolved)	Did not pick up
	Trial 1	Trial 2	Trial 3	Trial 1	Trial 2	Trial 3
Newsprint
Highlighter
Uni-ball® Roller Pen
Permanent Marker
Dry Erase Marker

Data

Part 1

· Slime Observations:

Part 2

· Hypothesis for Silly Putty® (Procedure Part 2, Step 7):

Part 3

· Observations of inks following chromatography:

Post-Lab Questions

1. Record your hypothesis regarding the slime’s ability to pick up newsprint ink here.

2. Did the slime pick up water soluble or water insoluble inks? From these results, what can you conclude about the polarity of slime molecules?

3. Explain how you determined your hypothesis about whether or not silly putty would pick up water soluble inks. Was your hypothesis correct?

4. Were the inks you used properly classified as soluble and insoluble? Explain your answer.

Pre-Lab Questions

1. Nitrogen fixation is a natural process by which inert or unreactive forms of nitrogen are transformed into usable nitrogen. Why is this process important to life?

2. Given what you have learned about the hydrogen bonding shared between nucleic acids in DNA, which pair is more stable under increasing heat: adenine and thymine, or cytosine and guanine? Explain why.

3. Which of the following is not an organic molecule; methane (CH4), fructose (C6H12O6), rosane (C20H36), or ammonia (NH3)? How do you know?

Experiment 1: Testing for Proteins

The protein molecules in many foods provide the amino acid building blocks required by our own cells to produce new proteins. To determine whether a sample contains protein, a reagent called Biuret solution is used. Biuret solution contains copper ions. However, the chemical state of the copper ions in Biuret solution causes them to form a chemical complex with the peptide bonds between amino acids (when present), changing the color of the solution. Biuret solution is normally blue, but changes to pink when short peptides are present and to violet when long polypeptides are present.

Figure 6: Biuret solution only is located on the far left side of the image (blue). Note the transition from blue to violet as proteins are added to the solution, causing the solution to transition from blue to violet.

Materials

(2) 250 mL Beakers 25 Drops Biuret Solution, H2NC(O)NHC(O)NH (1) Knox® Gelatin Packet 5 mL 1% Glucose Solution, C6H12O6 (1) 10 mL Graduated Cylinder (1) 100 mL Graduated Cylinder Permanent Marker 5 Pipettes

5 Test Tubes (Plastic) Test Tube Rack 5 mL Unknown Solution *Tap Water *Hot Water *Egg White *You Must Provide

Procedure

1. Label five test tubes 1, 2, 3, 4 and 5.

2. Prepare your testing samples as follows:

a. Mix one egg white with 25 mL water in a 250 mL beaker to create an albumin solution. Pipette 5 mL of this solution into Test Tube 1.

b. Mix the packet of Knox® gelatin with 50 mL hot water in a second 250 mL beaker. Stir until dissolved. Pipette 5 mL of this solution into Test Tube 2.

3. Pipette 5 mL of the 1% glucose solution into Test Tube 3.

4. Use the 10 mL graduated cylinder to measure and pour 5 mL of water into Test Tube 4.

5. Pipette 5 mL of the “Unknown Solution” into Test Tube 5.

6. Record the initial color of each sample in Table 1.

7. Develop a hypothesis regarding what you predict will happen when Biuret solution is added to Tubes 1 – 4. Record your hypothesis in the Post-Lab Question section. Then, pipette five drops of Biuret solution to each test tube (1 – 5). Swirl each tube to mix.

8. Record the final color in Table 1. Note: Protein is present in the sample if a light purple color is observed.

Table 1: Testing for Proteins Results
Sample	Initial Color	Final Color	Protein Present
1 – Albumin Solution
2 – Gelatin Solution
3 – Glucose
4 – Water
5 – Unknown

Post-Lab Questions

1. Record your hypothesis about what will happen when Biuret solution is mixed with the solutions from test tubes 1, 2, 3, and 4 here. Be sure to use scientific reasoning to support your hypothesis.

2. Write a statement to explain the molecular composition of the unknown solution based on the results obtained during testing with each reagent.

3. Diet and nutrition are closely linked to the study of biomolecules. How should you monitor your food intake to insure the cells in your body have the materials necessary to function?

4. The molecule pictured below produced a blue color when tested with Benedict’s reagent, a yellow color when tested with IKI, and a violet color when tested with Biuret reagent. Based on the structure shown below and these chemical results, what kind of biomolecule is this?

Pre-Lab Questions

1. A concentration gradient affects the direction that solutes diffuse. Describe how molecules move with respect to the concentration.

2. How does the size of a solute affect the rate of diffusion? Consider the size and shape of a molecule in your response.

3. Does polarity affect diffusion? Explain your answer using scientific principles.

Experiment 1: Diffusion through a Liquid

In this experiment, you will observe the effect that different molecular weights have on the ability of dye to travel through a viscous medium.

Materials

1 60 mL Corn Syrup Bottle, C12H22O11 Red and Blue Dye Solutions (Blue molecular weight = 793 g/mole; Red molecular weight = 496 g/mole) (1) 9 cm Petri Dish (top & bottom halves)

Ruler *Stopwatch *Tape *You Must Provide

Procedure

1. Use clear tape to secure one half (either the bottom or the top half is fine) of the petri dish over a ruler. Make sure that you can read the measurement markings on the ruler through the petri dish. The dish should be positioned with the open end of the dish facing upwards.

2. Carefully fill the half of the petri dish with corn syrup until the entire surface is covered.

3. Develop a hypothesis discussing which dye you believe will diffuse faster across the corn syrup and why. Record this in the Post-Lab Questions section. Then, place a single drop of blue dye in the middle of the corn syrup. Note the position where the dye fell by reading the location of the outside edge of the dye on ruler.

4. Record the location outside edge of the dye (the distance it has traveled) every ten seconds for a total of two minutes. Record your data in Tables 1 and 2.

5. Repeat Steps 1 – 4 using the red dye, the second half of the petri dish, and fresh corn syrup.

Table 1: Rate of Diffusion in Corn Syrup
Time (sec)	Blue Dye	Red Dye	Time (sec)	Blue Dye	Red Dye
10			70
20			80
30			90
40			100
50			110
60			120

Table 2: Speed of Diffusion of Different Molecular Weight Dyes
Structure	Molecular Weight	Total Distance Traveled (mm)	Speed of Diffusion (mm/hr)*
Blue Dye
Red Dye

*Multiply the total distance diffused by 30 to get the hourly diffusion rate

Post-Lab Questions

1. Record your hypothesis from Step 3 here. Be sure to validate your predictions with scientific reasoning.

2. Which dye diffused the fastest?

3. Does the rate of diffusion correspond with the molecular weight of the dye?

4. Does the rate of diffusion change over time? Why or why not?

5. Examine the graph below. Does it match the data you recorded in Table 2? Explain why, or why not. Submit your own plot if necessary.

Experiment 2: Concentration Gradients and Membrane Permeability

In this experiment, you will dialyze a solution of glucose and starch to observe:

· The directional movement of glucose and starch.

· The effect of a selectively permeable membrane on the diffusion of these molecules.

An indicator is a substance that changes color when in the presence of the substance it indicates. In this experiment, IKI will be used an indicator to test for the presence of starch and glucose.

Materials

(5) 100 mL Beakers 10 mL 1% Glucose Solution, C6H12O6 4 Glucose Test Strips (1) 100 mL Graduated Cylinder 4 mL 1% Iodine-Potassium Iodide, IKI 5 mL Liquid Starch, C6H10O5 3 Pipettes 4 Rubber Bands (Small; contain latex, handle with gloves on if allergic)

*Stopwatch *Water *Scissors *15.0 cm Dialysis Tubing *You Must Provide *Be sure to measure and cut only the length you need for this experiment. Reserve the remainder for later experiments.

Attention!

Do not allow the open end of the dialysis tubing to fall into the beaker. If it does, remove the tube and rinse thoroughly with water before refilling with a starch/glucose solution and replacing it in the beaker.

Note:

· Dialysis tubing can be rinsed and used again if you make a mistake.

· Dialysis tubing must be soaked in water before you will be able to open it up to create the dialysis “bag”. Follow the directions for the experiment, beginning with soaking the tubing in a beaker of water. Then, place the dialysis tubing between your thumb and forefinger and rub the two digits together in a shearing manner. This should open up the “tube” so you can fill it with the different solutions.

Procedure

1. Measure and pour 50 mL of water into a 100 mL beaker. Cut a piece of dialysis tubing 15.0 cm long. Submerge the dialysis tubing in the water for at least 10 minutes.

2. Measure and pour 82 mL water into a second 100 mL beaker. This is the beaker you will put the filled dialysis bag into in Step 9.

3. While the dialysis bag is still soaking, make the glucose/sucrose mixture. Use a graduated pipette to add five mL of glucose solution to a third beaker and label it “Dialysis bag solution”. Use a different graduated pipette to add five mL of starch solution to the same beaker. Mix by pipetting the solution up and down the pipette six times.

4. Using the same pipette that you used to mix the dialysis bag solution, remove two mL of that solution and place it in a clean beaker. This sample will serve as your positive control for glucose and starch.

a. Dip one of the glucose test strips into the two mL of glucose/starch solution in the third beaker. After one minute has passed, record the final color of the glucose test strip in Table 3. This is your positive control for glucose.

b. Use a pipette to transfer approximately 0.5 mL of IKI to into the two mL of glucose/starch solution in the third beaker. After one minute has passed, record the final color of the glucose/starch solution in the beaker in Table 3. This is your positive control for starch.

5. Using a clean pipette, remove two mL of water from the 82 mL of water you placed in a beaker in Step 2 and place it in a clean beaker. This sample will serve as your negative control for glucose and starch.

a. Dip one of the glucose test strips into the two mL of water in the beaker. After one minute has passed, record the final color of the glucose test strip in Table 3. This is your negative control for glucose.

b. Use a pipette to transfer approximately 0.5 mL of IKI to into the two mL of water in the beaker. After one minute has passed, record the final color of the water in the beaker in Table 3. This is your negative control for starch.

Note: The color results of these controls determine the indicator reagent key. You must use these results to interpret the rest of your results.

6. After at least 10 minutes have passed, remove the dialysis tube and close one end by folding over 3.0 cm of one end (bottom). Fold it again and secure with a rubber band (use two rubber bands if necessary).

7. Make sure the closed end will not allow a solution to leak out. You can test this by drying off the outside of the dialysis bag with a cloth or paper towel, adding a small amount of water to the bag, and examining the rubber band seal for leakage. Be sure to remove the water from the inside of the bag before continuing.

8. Using the same pipette which was used to mix the solution in Step 3, transfer eight mL of the solution from the Dialysis Bag Solution beaker to the prepared dialysis bag.

Figure 4: Step 9 reference.

9. Place the filled dialysis tube in beaker filled with 80 mL of water with the open end draped over the edge of the beaker as shown in Figure 4.

10. Allow the solution to sit for 60 minutes. Clean and dry all materials except the beaker with the dialysis bag.

11. After the solution has diffused for 60 minutes, remove the dialysis tube from the beaker and empty the contents into a clean, dry beaker. Label it dialysis bag solution.

12. Test the dialysis bag solution for the presence of glucose and starch. Test for the presence of glucose by dipping one glucose test strip into the dialysis bag directly. Again, wait one minute before reading the results of the test strips. Record your results for the presence of glucose and starch in Table 4. Test for the presence of starch by adding two mL IKI. Record the final color in Table 4 after one minute has passed.

13. Test the solution in the beaker for glucose and starch. Use a pipette to transfer eight mL of the solution in the beaker to a clean beaker. Test for the presence of glucose by dipping one glucose test strip into the beaker. Wait one minute before reading the results of the test strip and record the results in Table 4. Add two mL of IKI to the beaker water and record the final color of the beaker solution in Table 4.

Table 3: Indicator Reagent Data
Indicator	Starch Positive Control (Color)	Starch Negative Control (Color)	Glucose Positive Control (Color)	Glucose Negative Control (Color)
IKI Solution			n/a	n/a
Glucose Test Strip	n/a	n/a

Table 4: Diffusion of Starch and Glucose Over Time
Indicator	Dialysis Bag After 1 Hour	Beaker Water After 1 Hour
IKI Solution
Glucose Test Strip

Post-Lab Questions

1. Why is it necessary to have positive and negative controls in this experiment?

2. Draw a diagram of the experimental set-up. Use arrows to depict the movement of each substance in the dialysis bag and the beaker.

3. Which substance(s) crossed the dialysis membrane? Support your response with data-based evidence.

4. Which molecules remained inside of the dialysis bag?

5. Did all of the molecules diffuse out of the bag into the beaker? Why or why not?

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Biology

November 11, 2023/in Uncategorized /by Daniel Jennings

INCLUDEPICTURE “../images/lab014banner02.jpg” \* MERGEFORMAT

Experiment 1: Kidney Filtration

The kidneys function to filter the blood in the body by waste removal. In this experiment, the dialysis bag represents a part of the kidney. The solution containing the Congo Red, yellow food coloring, and water symbolizes blood as it enters the kidney through the renal artery. As the experiment progresses, notice the filtration occurring with the kidney (dialysis tubing) and the resulting substances.

Materials

30 cm Dialysis Tubing 2 Small Rubber Bands Pipette 3 mL Congo Red 3 mL Yellow Food Coloring

(2) 250 mL Beakers 10 mL Graduated Cylinder *Water *You must provide

Procedure

1. Begin by placing the dialysis tubing in a beaker filled with 200 mL water. Submerge the tubing for 10 minutes.

2. Remove the tubing from the water after 10 minutes. Use your forefinger and thumb to rub the sides of the dialysis tubing apart. This will create a tube-like shape. Refill the beaker to 200 mL if the volume has decreased.

3. Secure a small rubber band around the bottom of the dialysis tubing to seal it. Wrap the rubber band around the dialysis tubing as many times as possible. Test that the dialysis tubing will not leak out of the bottom by placing a few drops of water into the tubing. If water leaks out the bottom, the rubber band has not been fastened tight enough. If water does not leak, pour the water out of the tubing into the sink. Set the tubing aside.

4. Grab one 250 mL beaker and fill it with 200 mL of water. Set this aside for now.

5. Use the 10 mL graduated cylinder to measure 3 mL of Congo Red. Pour this into the empty 250 mL beaker. Rinse the graduated cylinder.

6. Use the 10 mL graduated cylinder to measure 3 mL of yellow food coloring. Pour this into the 250 mL beaker with the Congo Red. Rinse the graduated cylinder.

7. Use the 10 mL graduated cylinder to measure 5 mL of water. Pour this into the 250 mL beaker with the Congo Red and yellow food coloring.

8. Take a pipette and mix the solutions in the 250 mL beaker. To do this, place the pipette in the solution and squeeze and release the bulb of the pipette while moving the pipette throughout the solution.

9. Pipette 10 mL of the mixed solution into the dialysis tubing, and complete Table 1 by indicating which solutions are present in each container.

10. When all 10 mL have been placed into the dialysis tubing, seal the top of the dialysis tubing by wrapping place a second rubber band around the top of the dialysis tubing.

11. Place the sealed dialysis tubing into the 250 mL beaker with 200 mL of water.

12. Wait 60 minutes. Look for any diffusion that may have occurred through the dialysis tubing (inbound or outbound). Indicate in Table 2 which solutions are present in each container.

Table 1: Solutions Present in Each Container Before 60 Minute Submersion
Solution	Dialysis Tubing	Beaker
Congo Red
Yellow Food Coloring

Table 2: Solutions Present in Each Container After 60 Minute Submersion
Solution	Dialysis Tubing	Beaker
Congo Red
Yellow Food Coloring

Post-Lab Questions

1. What specific part of the kidney does the dialysis tubing represent? What is this part’s function?

2. What does the yellow food coloring represent at the end of the experiment? What does the Congo Red represent?

3. Why is it important that the kidney filters the blood?

Experiment 2: Urinalysis

As was seen in Experiment 1, urine is the waste product filtered within the kidney. The urine is made up of many waste products as well as excess water. Urine is also a very helpful tool for doctors when diagnosing different conditions in patients. In this experiment, you will perform a urinalysis on four different samples of urine, testing a variety of different components. When all components have been tested, you will determine which of the urine samples are “abnormal” (use Table 3 for reference).

Materials

4 Glass Test Tubes Test Tube Rack 25 mL Simulated Urine Sample A 25 mL Simulated Urine Sample B 25 mL Simulated Urine Sample C 25 mL Simulated Urine Sample D 100 mL Graduated Cylinder 16 Pipettes Permanent Marker

4 pH Test Strips 15 mL Benedict’s Solution 10 mL 3% Hydrogen Peroxide, H2O2 10 mL Biuret Solution Stopwatch *Hot Water Bath (boiling water in a deep bowl) *Hot Pad or Towel *You must provide

Procedure

Testing pH

1. Use the permanent marker to label each test tube as A, B, C and D.

2. Place the test tubes in the test tube rack.

3. Use a pipette to add five mL of Simulated Urine Sample A to the corresponding test tube.

4. Repeat Step 3 with samples B, C, and D. Use a new pipette each time.

5. Dip the reaction pad on one pH test strip into Sample A for 5 – 10 seconds and remove. Wait approximately 30 seconds and compare the resulting color on the pad to the color key (color key provided with the pH strips).

6. Record the pH of each of each sample in Table 4.

Glucose Test

1. Wash test tubes A – D. Re-label the tubes if the letters wash off.

2. Replace the test tubes in the test tube rack.

3. Use a pipette to add five mL of Simulated Urine Sample A to the corresponding test tube.

4. Repeat Step 3 with samples B, C, and D. Use a new pipette each time.

5. Add three mL of Benedict’s Solution to each test tube. Gently swirl each tube to mix the solutions.

6. Create a boiling water bath by retrieving a deep, heat-safe bowl.

7. Pour enough water into a pot or microwaveable bowl to cover the solutions in the test tubes. For example, if the solutions in the tubes are approximately 6.0 cm deep, fill the bowl with at least 6.1 cm of water.

8. Heat the water on a stove or in a microwave until boiling.

9. Use a hot pad or towel to carefully remove the water from the heat source, and place all four tubes into a boiling water bath for three minutes. If you do not want to hold the test tubes vertical for this time, you may place the test tubes in a container but monitor the apparatus to ensure that the tubes do not tip over.

10. Use a hot pad or towel to carefully remove the test tubes from the hot water. Place them in the test tube rack. Record their color change in Table 5. Note: A reducing sugar is present in the sample if a red, yellow or green precipitant forms.

Protein Test

1. Wash test tubes A – D. Re-label the tubes if the letters wash off.

2. Replace the test tubes in the test tube rack.

3. Use a pipette to add five mL of Simulated Urine Sample A to the corresponding test tube.

4. Repeat Step 3 with samples B, C, and D. Use a new pipette each time.

5. Add 25 drops of Biuret solution to each test tube.

6. Take Test Tube A out of the test tube rack and gently swirl the solutions. Watch for a color change as you swirl. Record any color changes in Table 6.

Yeast Test

1. Wash test tubes A – D. Re-label the tubes if the letters wash off.

2. Replace the test tubes in the test tube rack.

3. Use a pipette to add five mL of Simulated Urine Sample A to the corresponding test tube.

4. Repeat Step 3 with samples B, C, and D. Use a new pipette each time.

5. Add two mL of hydrogen peroxide to each test tube.

6. Observe the test tubes and record the presence or absence of bubbles in Table 7.

Ketone Test

1. Wash test tubes A – D. Re-label the tubes if the letters wash off.

2. Replace the test tubes in the test tube rack.

3. Use a pipette to add five mL of Simulated Urine Sample A to the corresponding test tube.

4. Repeat Step 3 with samples B, C, and D. Use a new pipette each time.

5. Using a wafting motion (pull your hand over the tube without bringing the tube directly to your nose; see Appendix for more guidance), notice the odor of each of the samples. Record your observations in Table 8.

Table 3: Urine Test
Test	Normal	Abnormal
pH	4.5 – 7.5	Acidic Urine (below 4.5) – Diabetes, starvation, dehydration, respiratory acidosis. Alkaline Urine (above 7.5) – Kidney disease, kidney failure, urinary tract infection, respiratory alkalosis.
Glucose	None	Glucose present (red or green color after test); diabetes mellitus.
Protein	None	Protein present (violet color after test); kidney disease.
Yeast	None	Yeast present (bubbles form after test); yeast infection in urinary tract.
Ketones	Little or None	Large amount of ketones present (sweet smell of urine); starvation, prolonged vomiting, diabetes, hyperthyroidism, an other metabolic disorders

Table 4: Simulated Urine pH Test
Simulated Urine Sample	pH
A
B
C
D

Table 5: Simulated Urine Glucose Test
Simulated Urine Sample	Color Before Hot Water Bath	Color After Hot Water Bath
A
B
C
D

Table 6: Simulated Urine Protein Test
Simulated Urine Sample	Color Before Biuret Solution	Color After Biuret Solution
A
B
C
D

Table 7: Simulated Urine Yeast Test
Simulated Urine Sample	Bubbles Before Hydrogen Peroxide?	Bubbles After Hydrogen Peroxide?
A
B
C
D

Table 8: Simulated Urine Ketone Test
Simulated Urine Sample	Odor Observation
A
B
C
D

Post-Lab Questions

1. Fill in Tables 9 through 12. Refer to Table 3 to determine if each result was normal or abnormal. If abnormal, include the data which indicates this (e.g., a pH of 3.2 means that glucose is present).

Table 9: Sample A
Test	Test Results
pH
Glucose
Protein
Yeast
Ketones

Table 10: Sample B
Test	Test Results
pH
Glucose
Protein
Yeast
Ketones

Table 11: Sample C
Test	Test Results
pH
Glucose
Protein
Yeast
Ketones

Table 12: Sample D
Test	Test Results
pH
Glucose
Protein
Yeast
Ketones

2. Using the test results from each of the urine samples, along with the Table 3, diagnosis the condition(s), if any, that each of the sample patients is experiencing.

3. If you were a doctor and a patient’s urinalysis came back with high level of glucose, ketones and an acidic pH, what diagnosis would you immediately look into?

4. If you were a doctor and a patient’s urinalysis came back with an alkaline pH and high levels of protein, what diagnosis would you immediately look into?

5. What other conditions can urine be used to test for?

Experiment 4: Fetal Pig Dissection of the Urinary System

Like many other systems, the urinary system of the fetal pig provides a good representation of the anatomy of the human urinary system. The following experiment will guide you through an exploration of some of the structures of this system.

Materials

Fetal Pig Dissection Tray

Dissection Tools Kit String (should still be tied onto pig’s hooves)

Procedure

1. To begin, lay your underpad down and place your dissecting tray on top of it. Lay out your dissecting tools. Be sure you have all of your safety equipment on before beginning.

2. Once prepared, gently open the bag your pig is in. Note: DO NOT destroy this bag or empty out the preserving solution within the bag, you will need it for the whole semester.

3. Lay your pig into the dissecting tray ventral (belly) side up. Slide the tied string over the dissection tray, allowing the belly of the pig to be exposed.

4. Peel back the flaps of the abdominal wall to expose the internal organs of the pig.

5. Gently push (do not remove) the intestines to one side. Leave a portion of the large intestine in place (this will be used to locate the rectum).

6. Locate the kidneys. These look like small, bean shaped organs against the dorsal wall of the body.

7. Looking at the kidney, locate the adrenal gland. This sits near the superior surface of the kidney.

8. Locate the ureter (Figure 8). This stems from the medial surface of the kidney. Near the origination of the ureter, notice the renal vein and the renal artery.

9. Follow the ureters posteriorly until you locate the urinary bladder and the urethra (Figure 9). Notice the elongation of the urinary bladder in the fetal pig. This occurs because the urinary bladder is actually connected to the umbilical cord in a fetus. If the urine generated by the fetus were to pass to the urethra as it does in adults, the amniotic sac would become toxic to the fetus. Instead, the fetus transports waste directly through the allantoic duct and through to the allantois, a small sac created specifically to handle toxic waste in a fetus, which then passes the waste onto the umbilical blood vessels. At birth, this process collapses and urine begins to flow from the urinary bladder into the urethra.

Figure 8: Close view of the kidney and ureter.

10. Return to the kidney. Carefully make a longitudinal incision along the side of the kidney, as if you were cutting a bean in half. Gently lay the kidney open.

11. Inside, the kidney is made up of three different regions: the inner renal pelvis where the ureter begins. The darker tissue extending from the renal pelvis is known as the middle medulla. Within the middle medulla are the renal pyramids which look like triangular or cone-shaped masses. The outer portion of the kidney is called the outer cortex. Locate these three regions within the kidney (Figure 10) .

12. Notice the process in which waste is removed from the body. The process begins with blood flowing in from the renal arteries into the kidneys. As the blood flows through the kidneys, it passes through many small vessels that remove waste, water and other ions. The cleansed blood then flows out of the kidney via the renal veins. The waste removed is collected and then passes through the inner renal pelvis into the ureter, on its way to the urinary bladder. The waste again collects in the urinary bladder until it flows down the urethra and is expelled from the body.

Figure 9: Close view of the urinary bladder.

13. Be sure that you can follow this process within the pig.

14. To finish, locate the bag the pig came in. Gently place the pig back into the bag and tightly secure the bag with a rubber band, or place in the zip-seal bag provided in the dissection box.

15. Replace the pig in a cool environment. Remember, the best place to store the pig is a cool, dark place.

16. After your pig has been put away, clean off your dissecting tray and dissection tools with soap and water. Biological scraps should not be thrown into the garbage. Securely store the biological scraps until the end of the term so they can be properly disposed of at one time.

17. Clean the area in which you worked with soap and water as well. As long as the underpad has not been damaged, keep it for future experiments.

Figure 10: Close view of the dissected kidney.

Post-Lab Questions

1. Label the arrows in Figure 11.

Figure 11: Kidney (sagittal-view)

2. What is the function of the urinary bladder?

3. Would you think the kidneys are highly vascularized? Why or why not?

4. What is the function of the adrenal glands?

5. Explain, in detail, the process by which urine is made.

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NURS6630 Final Exam (2018): Walden University

November 11, 2023/in Assignment Help Nursing, Nursing Exam Help, Nursing Paper Help, Uncategorized /by Daniel Jennings

NURS6630 Final Exam (2018): Walden University

QUESTION 1

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity? (NURS6630 Final Exam (2018): Walden University)

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs

QUESTION 2

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism?

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics

QUESTION 3

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics? (NURS6630 Final Exam (2018): Walden University)

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above.

QUESTION 4

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression?

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent.

QUESTION 5

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient?

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy

QUESTION 6

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax)

QUESTION 7

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe?

A. Strattera B. Concerta C. Daytrana D. Adderall

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD? (NURS6630 Final Exam (2018): Walden University)

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient

QUESTION 9

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient?

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency.

QUESTION 10

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching? (NURS6630 Final Exam (2018): Walden University)

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening.

QUESTION 11

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly?

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.”

QUESTION 12

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile?

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night.

QUESTION 13

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose:

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily. (NURS6630 Final Exam (2018): Walden University)

QUESTION 14

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion?

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue.

QUESTION 15

Which patient will receive a lower dose of guanfacine?

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease

QUESTION 16

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient?

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain

QUESTION 17

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose? (NURS6630 Final Exam (2018): Walden University)

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool.

QUESTION 18

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take? (NURS6630 Final Exam (2018): Walden University)

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime

QUESTION 19

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands?

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness.

QUESTION 20

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority? (NURS6630 Final Exam (2018): Walden University)

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg

QUESTION 21

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take?

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection.

QUESTION 22

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do? (NURS6630 Final Exam (2018): Walden University)

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy.

QUESTION 23

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP? (NURS6630 Final Exam (2018): Walden University)

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test.

QUESTION 24

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID (NURS6630 Final Exam (2018): Walden University)

QUESTION 25

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient?

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.” (NURS6630 Final Exam (2018): Walden University)

QUESTION 26

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient?

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

Clozapine (Clozaril)

Phenytoin (Dilantin)

QUESTION 27

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work?

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain.

QUESTION 28

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above

QUESTION 29

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain? (NURS6630 Final Exam (2018): Walden University)

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin

QUESTION 30

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select?

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera)

QUESTION 31

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe? (NURS6630 Final Exam (2018): Walden University)

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C

QUESTION 32

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient?

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above (NURS6630 Final Exam (2018): Walden University)

QUESTION 33

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP?

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.”

QUESTION 34

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe?

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone

QUESTION 35

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options?

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.” (NURS6630 Final Exam (2018): Walden University)

QUESTION 36

Which statement best describes a pharmacological approach to treating patients for impulsive aggression?

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive.

QUESTION 37

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient?

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things.

QUESTION 38

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders?

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.”

QUESTION 39

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction?

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption.

QUESTION 40

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state?

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine

QUESTION 41

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options?

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above

QUESTION 42

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation?

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly.

QUESTION 43

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia?

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics

QUESTION 44

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe?

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien)

QUESTION 45

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make?

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane)

QUESTION 46

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP?

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.”

QUESTION 47

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects?

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above

QUESTION 48

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach?

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.”

QUESTION 49

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start?

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms.

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option?

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac)

QUESTION 51

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe?

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin)

QUESTION 52

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication?

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera)

QUESTION 53

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response?

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above.

QUESTION 54

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following?

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents.

QUESTION 55

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider?

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions.

QUESTION 56

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)?

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD.

QUESTION 57

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD?

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only

QUESTION 58

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms:

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia

QUESTION 59

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia?

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil

QUESTION 60

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response?

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.”

QUESTION 61

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors?

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B”

QUESTION 62

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice?

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above

QUESTION 63

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment.

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil.

QUESTION 64

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option?

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro)

QUESTION 65

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff?

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.”

QUESTION 66

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems?

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above

QUESTION 67

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients?

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine.

QUESTION 68

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions?

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal

QUESTION 69

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient?

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres)

QUESTION 70

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following?

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA.

QUESTION 71

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed?

A. Kidney disease stage II B. Obesity C. Cardiovascular disease D. Diabetes type II

QUESTION 72

The PMHNP prescribes an obese patient phentermine (Adipex-p)/topiramate ER (Topamax) (Qsymia), Why is topiramate (Topamax) often prescribed with phentermine (Adipex-P)?

A. Phentermine (Adipex-P) dose can be increased safely when taken with an anticonvulsant. B. Phentermine (Adipex-P) works by suppressing appetite while topiramate (Topamax) acts by inhibiting appetite. C. Topiramate (Topamax) potentiates appetite suppression achieved by phentermine (Adipex-P). D. Topiramate (Topamax) helps prevent the unwanted side effects of phentermine (Adipex-P).

QUESTION 73

The PMHNP is assessing a patient who has expressed suicidal intent and is now stating that he is hearing voices and sees people chasing him. The PMHNP identifies these symptoms to be associated with which of the following?

A. Barbiturate intoxication B. Marijuana intoxication C. “Bath salt” intoxication D. Cocaine intoxication

QUESTION 74

The PMHNP is caring for a patient who openly admitted to drinking a quart of vodka daily. Prior to prescribing this patient disulfiram (Antabuse), it is important for the PMHNP to:

A. Evaluate the patient’s willingness to abstain from alcohol B. Counsel the patient on dietary restrictions C. Obtain liver function tests D. Assess for addiction to opioids

QUESTION 75 An opioid-naive patient is taking MS Contin (morphine sulfate) to treat his pain that is secondary to cancer. Under what circumstances would the PMHNP order naloxone (Narcan) IM/SQ?

A. The patient’s speech is slurred, and he is in and out of sleep. B. The patient’s appetite has decreased from eating 100% of his meal to 50% of his meal. C. The patient complains of not having a bowel movement for 4 days. D. The patient’s vital signs are 98.4F temp, 88 pulse, 104/62 blood pressure, and 8 respirations.

QUESTION 76

When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?

Yes No

NURS 6630 Midterm Exam (2018): Walden University

QUESTION 1

1. A noncompliant patient states, “Why do you want me to put this poison in my body?” Identify the best response made by the psychiatric-mental health nurse practitioner (PMHNP).

“You have to take your medication to become stable.”

“Most medications will increase the number of neurotransmitters that you already have in the brain.”

“Most medications used in treatment are either increasing or decreasing neurotransmitters that your body already has.”

“Why do you believe that your medication is poison?”

QUESTION 2

1. Which statement about neurotransmitters and medications is true?

Natural neurotransmitters such as endorphins have been discovered after the development of medications.

Some medications were developed after the discovery and known action of the neurotransmitters in the brain.

Neurotransmitters receive messages from most medications.

The neurotransmitter serotonin is directly linked to depression. Following this discovery, the antidepressant Prozac was developed.

1 points

QUESTION 3

1. When an unstable patient asks why it is necessary to add medications to his current regimen, the PMHNP’s best response would be:

“In an extreme case such as yours, more than one medication is often needed.”

“Due to the ineffectiveness of your current medication, we need to try something else that can possibly potentiate its effects.

“Medications are often specific to the neurotransmitter(s) they are affecting and, due to more than one neurotransmitter involvement, it is often necessary to use more than one medication to improve symptoms.”

“I understand your concern. We can discontinue your current medication and switch to a different one that may better manage your symptoms.”

1 points

QUESTION 4 ?

1. During gene expression, what must occur prior to a gene being expressed?

Transcription factor must bind to the regulatory region within the cell’s nucleus.

RNA must be converted to mRNA.

The coding region must separate from the regulatory region. This is wrong

RNA polymerase must inhibit the process of changing RNA to mRNA.

1 points

QUESTION 5

1. While genes have potential to modify behavior, behavior can also modify genes. How do genes impact this process?

Genes impact neuron functioning directly.

Changes made to proteins lead to changes in behavior.

Neurons are able to impact protein synthesis.

Genes impact the DNA of a cell, leading to changes in behavior.

1 points

QUESTION 6

1. Though medications have the ability to target neurotransmitters in the synapse, it is not always necessary. The PMHNP understands that this is because:

Neurotransmission that occurs via the axon allows for transport of a neurotransmitter.

Active transport is a different type of energy that allows the transport of certain neurotransmitters.

Neurotransmitters can spread by diffusion.

The postsynaptic neuron can release the neurotransmitter.

1 points

QUESTION 7

1. Why is the cytochrome P450 enzyme system of significance to the PMHNP?

The kidneys play a role with excretion of the medication, and if a patient has kidney damage, the dose must be increased to be effective.

The bioavailability of the medication after it passes through the stomach and liver can be altered. Correct answer

The medication’s chemical composition changes when it comes in contact with the acid in the stomach.

The CYP enzyme system is a steady and predictable process that prescribers must understand to treat conditions effectively.

1 points

QUESTION 8

1. It is important for the PMHNP to recognize differences in pharmacokinetics to safely prescribe and monitor medications. Which of the following statements does the competent PMHNP identify as true?

About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants and antipsychotics.

The term polymorphic refers to the body’s ability to break a medication down several ways, and this patient may require higher doses of certain antidepressants and antipsychotics.

About 1 out of 30 Caucasians requires lower doses of some antidepressants and antipsychotics.

Most enzyme pathways do not have interactions between the newer medications.

1 points

QUESTION 9

1. As it relates to G-protein linked receptors, what does the PMHNP understand about medications that are used in practice?

Most medications that act on G-protein linked receptors have antagonistic traits.

The majority of medications used in practice are full agonists and are used to stimulate the body’s natural neurotransmitters.

Most medications act as partial agonists because they allow the body to use only what is needed.

Medications used in practice may act as inverse agonists if the dosage is too high.

1 points

QUESTION 10

1. The PMHNP is considering prescribing a 49-year-old male clozapine (Clozaril) to treat his schizophrenia and suicidal ideations. The PMHNP is aware that which factor may impact the dose needed to effectively treat his condition:

The patient smokes cigarettes.

The patient has hypertension.

The patient has chronic kidney disease, stage 2.

The patient drinks a cup of coffee a day.

1 points

QUESTION 11

1. A patient is diagnosed with bipolar disorder and is currently taking carbamazepine (Tegretol), aripiprazole (Abilify), and melatonin. The PMHNP has just written an order to discontinue the carbamazepine (Tegretol) for drug-induced thrombocytopenia. The PMHNP is aware that his next best action is to:

Alert staff to possible seizures

Write an order for a different moodstabilizer

Decrease the amount prescribed for aripiprazole (Abilify)

Explain to the patient that it will be more difficult to control his temper

1 points

QUESTION 12

1. A patient recently transferred following a suicide attempt has a history of schizophrenia, depression, and fibromyalgia. He is currently taking Amitriptyline (Elavil), Lisinopril, aspirin, and fluoxetine (Prozac). Which is the best action for the PMHNP to take for this patient?

Review Amitriptyline (Elavil) level

Order a liver function test

Check the patient’s blood pressure and pulse

Order a stat platelet count

1 points

QUESTION 13

1. A patient with schizophrenia is given an inverse agonist that acts on the receptor 5HT and neurotransmitter serotonin. What is the rationale for prescribing a medication such as this?

To promote the availability of serotonin

To decrease serotonin

To indirectly increase the amount of dopamine in the body

To help decrease the amount of serotonin and dopamine

1 points

QUESTION 14

1. The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines would be beneficial?

“I have trouble staying asleep in the middle of the night.”

“My spouse told me that I seem to have trouble remembering things sometimes.”

“I really want to stop smoking, but the cravings are too strong.”

“I feel nervous to go outside and be in large crowds.”

1 points

QUESTION 15

1. Ms. Harlow is a 42-year-old patient who is prescribed a drug that acts on ionotropic receptors. She is curious about the effects of the drug and how it will act on her symptoms. Which statement made by the PMHNP demonstrates proper understanding of Ms. Harlow’s prescription?

“The drug will have an almost immediate effect.”

“The drug can take a while to build up in your system.”

“The drug is slow to release but lasts for a long time.”

“The drug will make a subtle difference in your symptoms.”

1 points

QUESTION 16

1. A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the PMHNP prescribe to the patient?

Benzodiazepine

Mirtazapine (Remeron)

Ketamine

Varenicline (Chantix)

1 points

QUESTION 17

1. The PMHNP is caring for a new patient who has been transferred from another office. When meeting with the new patient, the patient reports, “I feel like I am improving with the stabilizers.” The PMHNP immediately recognizes that the patient is describing which kind of drug? (NURS6630 Final Exam (2018): Walden University)

Full agonists

Antagonists

Partial agonists

Inverse agonists

1 points

QUESTION 18

1. A patient presents with frequent episodes of mania. Which statement describes an appropriate treatment approach for this patient?

“The patient needs to have an inverse agonist.”

“The patient could benefit from an anticonvulsant.”

“The patient’s calcium, sodium, chloride, and potassium levels must be regulated.”

“The patient should have a drug that acts on ligand-gated ion channels.”

1 points

QUESTION 19

1. The PHMNP is caring for a patient who would benefit from nicotine cholinergic, serotonin 3, or glycine receptors. What kind of agent does the PHMNP want to prescribe for this patient?

Ligand-gated ion channels with a pentameric structure

Ligand-gated ion channels with a tetrameric structure

Voltage-sensitive ion channels

Anticonvulsants

1 points

QUESTION 20 ?

1. Which statement made by the patient suggests the patient will need to be treated with antipsychotics that target paranoid psychosis?

“It’s my fault that all of this is happening. I don’t think I could ever forgive myself.”

“I have to talk to the President because I’m the only one who can help him.”

“I’m not sure why that lady is wearing a red jacket since it’s the dogs who need food.”

“I don’t know that I even want to go to that meeting. It doesn’t seem worth it anymore.”

1 points

QUESTION 21

1. A patient has been treated with a number of novel psychotropic drugs. How is it theoretically possible to identify cognitive improvement in the patient using neuropsychological assessment batteries after the pharmacologic therapy? I did not have this question

Obtaining raw normative metrics and using them to assess functionality

Having the patient report on cognitive function based on personal experiences

Monitoring the patient in a controlled setting

Measuring symptoms of psychosis

1 points

QUESTION 22

1. Mr. McCullin is 64 years old with Parkinson’s disease. The PMHNP caring for Mr. McCullin wants to start him on a dopamine agonist to help manage and treat his condition. The PHMNP selects this agent because of which action it has on patients like Mr. McCullin?

Dopamine is terminated through multiple mechanisms.

The D2 autoreceptor regulates release of dopamine from the presynaptic neuron.

MAO-B presents in the mitochondria within the presynaptic neuron.

D2 receptors are the primary binding site for dopamine agonists.

1 points

QUESTION 23

1. Mrs. Trevor is a 44-year-old patient who does not have a diagnosis of schizophrenia but occasionally reports symptoms of psychosis, followed by severe fatigue. Mrs. Trevor inquires about the use of amphetamines to help with her energy levels. Which response made by the PMHNP is most appropriate?

“Amphetamines may help you, as they can alleviate psychotic conditions.”

“Amphetamines can inhibit negative symptoms of schizophrenia, so this might be a good choice for you.”

“Amphetamines can cause hallucinations, so I would advise against this type of prescription.”

“Amphetamines can lead to a dopamine deficiency, so I will not prescribe this for you.”

1 points

QUESTION 24

1. The PMHNP is caring for a patient with schizophrenia and is considering a variety of treatment approaches. The PHMNP selects a viable treatment that is consistent with the “dopamine hypothesis of schizophrenia.” What action does the PMHNP anticipate this treatment having on the patient?

Blocking the release of dopamine facilitates the onset of positive schizophrenia symptoms.

Hyperactivity in the mesolimbic dopamine pathway mediates the positive symptoms of schizophrenia.

Antipsychotic drugs that open D2 receptor pathways can treat schizophrenia.

The neuroanatomy of dopamine neuronal pathways can explain symptoms of schizophrenia.

1 points

QUESTION 25

1. A patient is diagnosed with schizophrenia. What increases the patient’s potential to mediate the cognitive symptoms of the disease?

Achieving underactivity of the mesocorticol projections to the prefrontal cortex

Achieving overactivity of the mesocorticol projections to the ventromedial prefrontal cortex

Achieving underactivity of the mesocortical projections to the ventromedial prefrontal cortex

Achieving overactivity of the mesocorticol projections to the prefrontal cortex

1 points

QUESTION 26

1. The PMNHP is assessing a 29-year-old patient who takes antipsychotics that block D2 receptors. What patient teaching should the PMHNP include related to the possible side effects of this type of drug?

Hypersexuality

Amenorrhea

Dystonia

Tardive dyskinesia

1 points

QUESTION 27

1. The PMHNP is caring for a patient who is taking antipsychotics heard the psychiatrist tell the patient that the patient would be placed on a different antipsychotic agent. Which of the following requires the longest transition time for therapeutic benefit?

Olanzapine to clozapine

Asenapine to Risperidone

Aripripazole to ziprasidone

Aripripazole to clozapine

1 points

QUESTION 28

1. The PMHNP is assessing a patient who has cirrhosis of the liver and anticipates that the patient will be prescribed an antipsychotic. Which medication does the PMHNP suspect will be ordered for this patient?

Quetiapine

Paliperidone

Lurasidone

Clozapine

1 points

QUESTION 29

1. Which statement made by the PMHNP exemplifies correct teaching of physiological effects in the body?

Muscarinic antagonists are more likely to cause decreased prolactin levels.

D2 antagonists decrease the likelihood of EPS symptoms.

D2 antagonism is linked to antidepressant properties.

D2 partial agonists are associated with increased efficacy in treating positive symptoms of schizophrenia.

1 points

QUESTION 30

1. Mrs. Schwartzman is a 52-year-old patient with schizophrenia and no established history of depression. When meeting with the PMHNP, she presents with apathy and withdrawn social behavior, and she reports a loss of joy from enjoyable activities. What does the PMHNP infer from this encounter with the patient?

An underlying depressive disorder

The recent change of a 2nd generation antipsychotic to a conventional one

The recent change of a 1st generation antipsychotic to a 2nd generation antipsychotic

All of the above

1 points

QUESTION 31

1. The PMHNP is taking a history on a patient who has been on antipsychotics for many years. Which risk factors are most likely to contribute to a person developing tardive dyskinesia (TD)?

Long-term use of antipsychotics

Genetic disposition

Age

A and C

All of the above

1 points

QUESTION 32

1. The student inquires about antipsychotic medications. Which response by the PMHNP describes nthe factors that contribute to reduced risk of extrapyramidal symptoms (EPS) for patients who take antipsychotics?

Those that are potent D2 antagonists

Those that are potent D2 antagonists with 5HT2A antagonism properties

D2 receptors that are blocked in the nigrostriatal pathway

Potent D2 antagonists that block the muscarinic anti-M1 cholinergic receptors

1 points

QUESTION 33

1. Mr. Gordon is a middle-aged patient who is taking antipsychotics. When meeting with the PMHNP, he reports positive responses to the medication, stating, “I really feel as though the effects of my depression are going away.” Which receptor action in antipsychotic medications is believed to be the most beneficial in producing the effects described by Mr. Gordon?

5HT2 antagonism

D2 antagonism

Alpha-2 antagonism

D2 partial agonist

1 points

QUESTION 34

1. A patient who was recently admitted to the psychiatric nursing unit is being treated for bipolar disorder. Which neurotransmitter is the PMHNP most likely to target with pharmaceuticals?

Norepinephrine

Dopamine

Serotonin

A and C

All of the above

1 points

QUESTION 35

1. Ms. Ryerson is a 28-year-old patient with a mood disorder. She recently requested to transfer to a new PMHNP, after not getting along well with her previous provider. The new PHMNP is reviewing Ms. Ryerson’s medical chart prior to their first appointment. Upon review, the PMHNP sees that the former provider last documented “patient had rapid poop out.” What does the PMHNP infer about the patient’s prescription based on this documentation?

The patient has an unsustained response to antidepressants.

The patient has antidepressant-induced hypomania.

The patient has a depletion of monoamine neurotransmitters.

The patient has an adverse effect to atypical antipsychotics.

1 points

QUESTION 36

1. The PMHNP recognizes that which patient would be contraindicated for antidepressant monotherapy? (NURS6630 Final Exam (2018): Walden University)

Patient with a bipolar I designation

Patient with a bipolar II designation

Patient with a bipolar III designation

None of the above

1 points

QUESTION 37

1. Why does the PMHNP avoid treating a patient with cyclothymia, and has major depressive episodes, with antidepressant monotherapy?

The patient may experience paranoid avoidant behavior.

The patient may experience severe depression.

The patient may experience auditory hallucinations.

The patient may experience increased mood cycling.

1 points

QUESTION 38

1. The PMHNP is caring for a patient with the s genotype of SERT. What does the PMHNP understand regarding this patient’s response to selective serotonin reuptake inhibitor (SSRI)/SNRI treatment?

The patient has a higher chance of tolerating SSRI/SNRI treatment.

The patient will have a positive response to SSRI/SNRI treatment.

The patient will develop severe mood cycling in response to treatment.

The patient may be less responsive or tolerant to the treatment.

1 points

QUESTION 39

1. Ms. Boeckh is a 42-year-old patient with major depression. The PMHNP understands that which action of norepinephrine will affect Ms. Boeckh’s serotonin levels?

Norepinephrine potentiates 5HT release through a2 postsynaptic receptors.

Norepinephrine inhibits 5HT release through a2 receptors.

Norepinephrine inhibits α2 receptors on axon terminals.

Norepinephrine potentiates 5HT release through a1 and a2 receptors.

1 points

QUESTION 40

1. Which statement made by the PMHNP correctly describes the relationship between NE neurons and pharmaceutical treatment?

“Drugs inhibit the release of NE.”

“Drugs can mimic the natural functioning of the NE neuron.”

“Drugs are unable to simulate the effects of NE neurons.”

“Drugs prevent the natural functioning of the NE neuron by stopping the presynaptic a2 neuron.”

1 points

QUESTION 41

1. The PMHNP is assessing a patient in the psychiatric emergency room. The patient tells the PMHNP that he does not understand why his depression has not lifted after being on four different antidepressants over the course of a year. Which of the following symptoms can be residual symptoms for patients who do not achieve remission with major depressive disorder?

Insomnia

Suicidal ideation

Problems concentrating

A and C

1 points

QUESTION 42

1. Fluoxetine (Prozac) has been prescribed for a patient. Which of the following statements is true regarding the action of this medication?

Neuronal firing rates are not dysregulated in depression.

Blocking the presynaptic SERT will immediately lead to a great deal of serotonin in many synapses.

Upon the acute administration of a SSRI, 5HT decreases.

The action at the somatodendritic end of the serotonin neuron may best explain the therapeutic action of SSRIs.

1 points

QUESTION 43

1. The nurse educator knows that teaching was effective when one of the students compares fluvoxamine to sertraline and notes which of the following similarities?

Both have a sedative-like, calming effect.

Both contribute to antipsychotic actions.

Both demonstrate favorable findings in treating depression in the elderly.

Both are known for causing severe withdrawal symptoms such as dizziness, restlessness, and akathisia.

1 points

QUESTION 44

1. A 45-year-old female patient with allergic rhinitis and normal blood pressure has had no reduction in depressive symptoms after trying bupropion, paroxetine, and venlafaxine. What precautions are needed in considering monoamine oxidase inhibitors (MAOI) in treating her depression?

Since all MAOIs require dietary restrictions, the patient will need to avoid all cheeses and aged, smoked, or fermented meats.

The patient cannot take any antihistamines.

The patient cannot have two wisdom teeth extracted while on a MAnOI.

The patient will need to minimize dietary intake of foods such as tap and unpasteurized beer, aged cheeses, and soy products/tofu.

1 points

QUESTION 45

1. After sitting in on an interdisciplinary treatment team meeting, the student nurse asks the instructor to explain a system-based approach to the treatment of depression. What is the appropriate response?

Symptoms help create a diagnosis, then symptoms are deconstructed into a list of specific symptoms experienced by a patient.

Symptoms are matched first with the brain circuits that hypothetically mediate them and then with the known neuropharmacological regulation of these circuits by neurotransmitters.

Treatment options that target neuropharmacological mechanisms are selected to eliminate symptoms one by one.

All of the above.

1 points

QUESTION 46

1. A 51-year-old female patient presents with symptoms of depression, including lack of motivation and difficulty sleeping. What risk factors would increase her vulnerability for a diagnosis of depression?

First onset in puberty or early adulthood

Late onset of menses

Premenstrual syndrome

A and C

1 points

QUESTION 47

1. A nurse overhears that a patient has failed single therapy with an SSRI and SNRI. She also learns that the patient has been on dual SSRI/SNRI therapy without adequate symptom control. She approaches the PMHNP and asks what the next treatment option could be in this seemingly treatment-resistant patient. The PMHNP tells the nurse she will treat the patient with the following regimen:

MAOI plus SNRI

SSRI/SNRI plus NDRI

NDRI/SNRI plus mirtazapine

NDRI plus modafinil

1 points

*Q/UESTION 48

1. Mrs. Radcliff is a 42-year-old patient who is considering stopping paroxetine. Why does her PMHNP advise against this abrupt discontinuation of the medicine?

She may experience withdrawal symptoms.

She may experience increased trauma.

Effects of abrupt cessation are unknown.

It can lead to difficulties with concentration.

1 points

QUESTION 49

1. A patient is prescribed fluoxetine but is concerned about the side effects. Which statement demonstrates accurate patient teaching when discussing the side effects associated with fluoxetine?

Weight gain can be problematic.

Sedation is very common.

Induction of mania is rare.

Seizures are not unusual.

1 points

QUESTION 50

1. The PMHNP is caring for a patient with anxiety who develops mild to moderate hepatic impairment. Which action does the PMHNP take regarding the use of venlafaxine?

Stop the venlafaxine

Lower the dose of venlafaxine by 50%

Lower the dose of venlafaxine by 25-40%

Increase the dose of venlafaxine by 50%

1 points

QUESTION 51

1. A 25-year-old female patient is being prescribed milnacipran to treat fibromyalgia, and expresses concern regarding “how she will feel and look” from taking the medicine. Which statement correctly describes the side effects as a result of taking this medication?

It can affect her menstruation.

Suicidality can be common among young adults.

Sedation may be problematic.

Weight gain is unusual.

1 points

QUESTION 52

1. Mr. Ruby is a 33-year-old single father who is requesting pharmacological intervention to treat his fibromyalgia. The PMHNP sees in the medical chart that he has a recent diagnosis of arrhythmia and a BMI of 29. During his assessment, the PMHNP learns that Mr. Ruby works 40-50 hours a week as a contractor and “manages his stress” by smoking 3-4 cigarettes a day and having 8-10 drinks of alcohol each week. Why would duloxetine be contraindicated for Mr. Ruby?

He has fibromyalgia.

He has arrhythmia.

He uses alcohol.

He is overweight.

1 points

QUESTION 53

1. A patient is prescribed sertraline to treat panic disorder. Knowing that sertraline can initially cause anxiety or insomnia, what should the PMHNP do?

Prescribe long-acting benzodiazepine for 2 weeks, then increase the dose.

Prescribe short-acting benzodiazepine for 2 weeks, then discontinue.

Prescribe long-acting benzodiazepine for 2 weeks, then discontinue.

Prescribe short-acting benzodiazepine for 2 weeks, then increase the dose.

1 points

QUESTION 54

1. A patient is prescribed 50 mg of desvenlafaxine to take every other day for major depressive disorder. What does the PMHNP understand about this patient?

The patient has hepatic impairment.

The patient has moderate renal impairment.

The patient has severe renal impairment.

The patient has cardiac impairment.

1 points

QUESTION 55

1. The PMHNP understands that which mechanism contributes to a worse tolerability profile for patients taking tricyclic antidepressants (TCAs)?

Histamine H1 receptor blockade can cause insomnia.

Muscarinic M1 receptor blockade causes blurred vision.

Alpha 1 adrenergic receptor blockade causes weight gain.

Muscarinic M3 receptor blockade causes sedation.

1 points

QUESTION 56

1. A patient who was prescribed an MAO inhibitor is learning about dietary modifications. Which statement made by the PMHNP demonstrates proper teaching of the food-drug interactions for MAO inhibitors?

“You must avoid soy products, such as tofu.”

“You should not consume processed meats.”

“You may consume fermented foods, like sauerkraut.”

“You may continue to drink beers on tap.”

1 points

QUESTION 57

1. A patient who is prescribed MAO inhibitors asks about whether he can continue taking pseudoephedrine to relieve his congestion. Which response by the PMHNP indicates proper understanding of drug-drug interactions?

“Decongestants are fine to continue taking with MAO inhibitors.”

“Decongestants are okay to take with MAO inhibitors in moderation.”

“Decongestants should be avoided due to risk of serotonin syndrome.”

“Decongestants should be avoided due to risk of hypertensive crisis.”

1 points

QUESTION 58

1. Ms. Skidmore presents for a follow-up appointment after being prescribed phenelzine (Nardil), and reports “I take my 45 mg pill, three times a day, just like I’m supposed to.” What does the PMHNP understand about this patient? (NURS6630 Final Exam (2018): Walden University)

Ms. Skidmore is taking the correct dose of phenelzine (Nardil).

Ms. Skidmore is not taking enough of the phenelzine (Nardil); she should be taking three times that amount.

Ms. Skidmore is taking too much of the phenelzine (Nardil); she should be taking the 45 mg in three doses.

Ms. Skidmore is taking too much of the phenelzine (Nardil); she is supposed to take 45 mg every 24 hours.

1 points

QUESTION 59

1. The PMHNP is caring for several patients who present with various symptoms and health issues. For which patient does the PMHNP prescribe pregabalin (Lyrica)?

Patient with PTSD

Patient with partial seizures

Patient with galactose intolerance

Patient with Lapp lactase deficiency

1 points

QUESTION 60

1. Mr. Gutier is 72 years old with anxiety and depressive symptoms. His PMHNP is prescribing lorazepam (Ativan). What does the PMHNP understand regarding this prescription?

The PMHNP will prescribe less than 2-6 mg for Mr. Gutier to take daily.

The PMHNP will require Mr. Gutier to take 2-4 doses of lorazepam (Ativan) per day.

The PMHNP will prescribe more than 2-6 mg for Mr. Gutier to take daily.

The PMHNP will have Mr. Gutier take 6 mg of lorazepam (Ativan) as a PRN.

1 points

QUESTION 61

1. A patient is being prescribed a sedating antidepressant, but is concerned about weight gain. Which medication is most likely to be prescribed to addresses the patient’s concerns?

mirtazapine (Remeron)

doxepin (Silenor)

alprazolam (Xanax)

trazadone (Oleptro)

1 points

QUESTION 62

1. A patient who was diagnosed with bipolar disorder without mania, asks the PMHNP why he is being prescribed a mood stabilizer. What is the appropriate response?

Mood stabilizers are only prescribed to treat manic phases of bipolar depression

Mood stabilizers can consistently treat both mania and bipolar depression

Mood stabilizers can target mania and mania relapse and also reduce symptoms of bipolar depression and relapse of bipolar depression symptoms but no drug has been proven to target all four therapeutic actions

Certain mood stabilizers, such as lithium, are able to consistently target mania and bipolar depression

1 points

QUESTION 63

1. The PMHNP is assessing a patient in the emergency room. The patient shares that he has been on lithium (Lithobid) for many years. What blood tests does the PMHMP order?

Thyroid Stimulating Hormone (TSH)

Complete Blood Count (CBC)

Erythrocyte Sedimentation Rate

Platelet Count

1 points

QUESTION 64

1. A 39-year old female patient presently on lithium would like to try a new medication to treat her bipolar disorder. She has had concerns about side effects from lithium and wants to learn more about Lamotrigine (Lamictal) as a treatment option. The PMHNP conveys some of the unique aspects of this agent, including which of the following? I don’t think I had this question

There is some indication lamotrigine can prevent progression from mild cognitive impairment to Alzheimer’s disease

Lamotrigine may cause rashes, including the life-threatening Stevens-Johnson syndrome

It was one of the first anticonvulsants approved by the FDA to treat bipolar depression

There is a risk for amenorrhea and polycystic ovarian disease in women of childbearing age

1 points

QUESTION 65

1. A nursing student is seeking clarification on the use of anticonvulsants to treat depression and is unclear about most effective outcomes. Which of the following agents does the PMHNP convey as having uncertain outcomes?

Carbamazepine (Tegretol)

Gabapentin (Neurontin)

Valporoic Acid (Depakene)

All of the above

1 points

QUESTION 66

1. A 46-year old male patient mentions several alternative treatments to Carbamazepine (Tegretol) as a way to manage symptoms of his bipolar depression. Which of the following does the PMHNP indicate would not be an agent to treat bipolar depression? (NURS6630 Final Exam (2018): Walden University)

Omega-3-fatty-acids

Soybean lecithin

Inositol

L-methylfolate

1 points

QUESTION 67

1. The PMHNP is meeting with a new mother who would like to begin taking medication again to treat her bipolar depression; she is breastfeeding her 2-month old daughter. The PMHNP recognizes that which of the following medications is contraindicated for this patient?

Valporic Acid (Depakene)

Carbamazepine (Tegretol)

Lithium (Lithobid)

Lamotrigine (Lamictal)

1 points

QUESTION 68

1. The PMHNP assesses a 10-year old male child in the ER and suspects mania. Which of the following symptoms and recommendations for follow-up evaluation are appropriate?

Irritability, euphoria, anger; the child should be evaluated further for conduct disorder.

Irritability, violent outbursts, hyperactivity; the child should also be evaluated further for ADHD

Irritability, lethargy, anger; the child should be evaluated further for ADHD.

Irritability, acute mania, hyperactivity; the child should be evaluated further for conduct disorder.

1 points

QUESTION 69

1. A patient was diagnosed with GAD 4 weeks ago and was placed on Clonazepam (klonopin) twice a day and citalopram (citalopram (celexa)) once daily. When he asks the PMHNP why it is necessary to wean him off of the Clonazepam (klonopin) the best response is:

Clonazepam (klonopin) may interfere with citalopram (celexa)s targeted areas in the brain

Clonazepam (klonopin) is not recommended for long term use due to possible sedation

Clonazepam (klonopin) was used as an aid to treat your condition while you were adjusting to citalopram (celexa)

Clonazepam (klonopin) and citalopram (celexa) target the same area in the brain and after long-term use they will begin to compete making one more or less effective than the other

1 points

QUESTION 70

1. During assessment a patient states “Why are you asking me about my heart, I am here for my head”, the PMHNP’s best response is:

“Some medications can cause heart issues so it is necessary to rule those out before you begin medication.”

“This is a part of our routine admission and it is important that you give me truthful answers.”

“Chronic conditions such as Lupus can cause an area in your brain to malfunction, specifically your hippocampus.”

“Anxiety can cause cortisol levels to increase and when this happens frequently it puts you at risk for comorbidities such as type 2 diabetes.”

1 points

QUESTION 71

1. The PMHNP understands that the potential of alcohol abuse in the anxious patient is higher for the following reason: A.

Alcohol is legal and is a common way that most people deal with their problems.

Alcohol works similar to benzodiazepines

Up to 30% of people with anxiety use alcohol to self-medicate

Alcohol increases serotonin at the synapse and the patient may temporarily feel happy

1 points

QUESTION 72

1. After ordering flumazenil (Rumazicon) the PMHNP cautions the staff to monitor for which possible effect?

Respiratory depression

Sedation and restlessness

Sweating and nausea (This question was marked wrong but I think the answers are different too)

Bradycardia and tachypnea

1 points

QUESTION 73

1. A patient is prescribed escitalopram (Lexapro) for his anxiety. When he asks why he was given an antidepressant the PMHNP’s best response is:

“SSRIs are used to treat anxiety because serotonin has been proven to help with feelings of fear and worry.”

“Even though you were diagnosed with anxiety there is a very high chance that you also have depression due to the similarities of both diseases.”

“Antidepressants are prescribed prophylactically to prevent symptoms of depression.”

“Escitalopram (Lexapro) is very effective with treating the panic attacks that can occur with anxiety.” (NURS6630 Final Exam (2018): Walden University)

1 points

QUESTION 74 ?

1. The PMHNP evaluates the patient for “fear conditioning” when he asks:

Have you ever experienced any type of trauma?

What do you do when you feel fear?

Does your mother or father have a history of fear and/or worrying?

What makes your fear better?

1 points

QUESTION 75

1. A patient diagnosed with PTSD is prescribed propranolol (Inderal) and the PMHNP understands that he was prescribed this medication for what purpose:

He has uncontrolled high blood pressure and this must be treated before focusing on his PTSD.

Beta blockers are linked to reconsolidation.

This medication will allow the patient to sleep throughout the night.

This medication is linked to the increase of serotonin in the brain.

See the link for Final Exam Only

https://www.homeworkmarket.com/questions/nurs6630-final-exam-2018-walden-university

See the link for Midterm Exam Only

https://www.homeworkmarket.com/questions/nurs-6630-midterm-exam-2018-walden-university-already-graded-a (NURS6630 Final Exam (2018): Walden University)

References

https://academics.waldenu.edu/catalog/courses/nurs/6630

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Diffusion/Osmosis Lab

November 11, 2023/in Uncategorized /by Daniel Jennings

BIOL1408 Introductory Biology Name Lab Unit 6/7: Diffusion & Osmosis date Dr. Flo Oxley

In this lab unit, you will follow your eSciences ACC Lab Manual (posted in Blackboard: “Lab Manual”) to learn about diffusion, osmosis, and how these processes work inside cells to support life.

This document will serve as your guide, sending you to the relevant lab activities and introductory information found in the eSciences lab manual (pages for this unit are 68 – 81), or in the online replication of the eScience lab manual uploaded to Blackboard for those of you who prefer to follow along online.

NOTE: I recommend that you read from this lab guide & report document first, going to the eSciences manual materials only as directed. Students previously using the lab manual have found that the additional background information provided in this document and the step-by-step guidance through the eSciences lab materials to be beneficial.

BACKGROUND INFORMATION: DIFFUSION

Diffusion is the net movement of a solute away from an area of high concentration towards an area of lower concentration. If you have ever watched tea diffusing from a tea bag, you are familiar with the process of diffusion. You have watched the brown molecules leaving the tea bag until eventually the tea become uniformly brown. This is sometimes referred to as solute molecules moving down their concentration gradient.

Notice that I said that it is NET movement of a solute. This means that like all molecules in liquid and gas phases, solute molecules move randomly in all directions. There is no driving force for sending a solute molecule down its concentration gradient other than there is no way to prevent the random movement of molecules. Eventually, the solute molecules will become totally randomized in their distribution throughout the solvent.

What does diffusion have to do with biology? Virtually all movements of molecules into and out of, and around the interior of the cell relies on diffusion of solutes. The removal of waste products from the cell relies on the random movement of these molecules from the inside of the cell to the outside of the cell. Similarly, the uptake of vital nutrients relies on their diffusion from the outside to the inside of the cell. The circulatory system speeds these processes up by sweeping nutrients into the vicinity of cells and sweeping away waste products from the cells to be excreted elsewhere from the body.

Note that the diffusion of oxygen (a vital nutrient) and carbon dioxide (an ever-present waste product of cellular respiration) are a part of this story. Diffusion is critical in the process of providing nutrients and oxygen circulating in the bloodstream to cells. A cell must be close to a capillary, within100 microns from a capillary, in order for these metabolites to diffuse to the cell quickly enough. If it is farther than that from the cell, it will not receive the vital nutrients or be able to relieve its metabolic waste back into the blood stream.

An especially larger cell has a bigger problem with exchanging nutrients and waste products than does a smaller cell, simply because these molecules must diffuse farther in order in infuse the cell’s interior. It is believed that this is the reason that all living cells are microscopically small – they can exchange molecules more quickly with their environment if they are small, or at least have a very narrow diameter that nutrients need to traverse.

To better understand how diffusion works and how it is required to feed cells and to help cells to eliminate wastes, you may want to watch this animations on diffusion: http://www.wisc-online.com/Objects/ViewObject.aspx?ID=AP1903

Diffusion Background Questions

After reading the background information about diffusion in this lab report guide and in your eSciences lab manual (posted on Blackboard, Lab Exercises, Lab 6, Introduction), answer the following questions.

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http://www.wisc-online.com/Objects/ViewObject.aspx?ID=AP1903

1. What causes molecules to be in constant motion?

2. What are three general factors that affect diffusion rates of a solute in a solvent? Thinking about how diffusion is important in the uptake of nutrients and the discharge of waste products by cells, which of the factors affecting diffusion rates is the most operative in the health of cells in your body?

3. Describe the molecular components of the membrane that surrounds all living cells, and discuss how this membrane limits the rate of diffusion of nutrients into the cell and the diffusion of waste products out of the cell.

4. What are two chemical properties of a solute that can prevent it from freely diffusing across a biological membrane?

5. What is the one chemical property of a solute that can prevent it from freely diffusing across a dialysis membrane?

6. Go to http://highered.mcgraw-hill.com/sites/0072495855/student_view0/chapter2/ animation__how_diffusion_works.html to watch an animation about diffusion, and answer the following questions: a. At what point does the diffusion of a solute come to a complete stop?

b. Watching the diffusing molecules in this animation, are they moving in a random or in a directional manner? (Try this: pick one specific molecule and watch its motion: is it moving in one direction or randomly in all directions?)

BACKGROUND INFORMATION: OSMOSIS

Osmosis is similar to diffusion in that it is the random movement of molecules that has a net movement down its concentration gradient. But osmosis differs from diffusion in these ways:

1. Osmosis has to do with movement of solute molecules (water) instead of solute molecules. 2. Osmosis has to do with movement across a semipermeable membrane – one that is permeable to

the solvent molecules (water) and not the solute molecules. a. Biological membranes are permeable to water molecules, but is not permeable to large

and/or polar solute molecules. b. Dialysis membranes are permeable to all molecules that are smaller than the pore sizes of

the dialysis membrane.

In osmosis, water molecules cross the semipermeable membranes until the water content become equalized on both sides of the membrane. At this equilibrium point, the solutions on either side of the membrane are said to be “isotonic” or “isosmotic”.

Until equilibrium is reached, the solution with the greater solute content is said to be “hypertonic” or “hyperosmotic”. Conversely, the solution with the lesser solute content is said to be “Hypotonic” or “hypo-osmotic”. In the meantime, water molecules have net movement in a hypotonic to a hypertonic direction until equilibrium is met.

If you have ever soaked a twisted ankle in a solution of Epsom’s Salt, the same principles applied: the hypertonic Epsom’s Salt solution drew down your inflammation by osmosis. The rate of osmosis is increased when the concentration difference is high. Similarly, if you have ever noticed that the skin on your fingers pucker up after along swim, this is due to osmosis, too. The skin cells took on water because they were hypertonic to the swimming pool water. As the skin cells swelled, the skin puckered to accommodate their increased volume.

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http://highered.mcgraw-hill.com/sites/0072495855/student_view0/chapter2/animation__how_diffusion_works.html

If you have ever had an intravenous solution dripped into your veins, this solution was made up in a solution of sodium and potassium chloride salts and NOT in pure water. The reason for this is that unlike plant cells, your cells do NOT have a cell wall to protect it from overfilling to the point of bursting cells. Plant, fungal, and microbial cells are encased in rigid and strong cell walls to prevent the cells from bursting when exposed to hypotonic solutions.

Osmosis Background Questions

After reading the background information about diffusion in this lab report guide and in your eSciences lab manual (posted on Blackboard, Lab Exercises, Lab 6, Osmosis, Introduction), answer the following questions.

1. In diffusion, solute molecules are observed to move down their concentration gradient in a solution. What is observed to move in the process of osmosis?

2. Fill out the following table to describe solute concentration across a semipermeable membrane:

3. What chemical property might interfere with the ability of water molecules to freely diffuse across a biological membrane? What allows for this free diffusion of water across biological membranes to occur?

4. Go to http://highered.mcgraw-hill.com/sites/0072495855/student_view0/chapter2/ animation__how_osmosis_works.html and watch this animation about osmosis before answering the following questions:

a. Urea is a waste product of cellular metabolism that is excreted by the urinary system through osmosis across the kidney semipermeable membranes. What chemical property of the urea molecule prevents it from freely diffusing across a biological membrane?

b. What effect does a hypertonic solution of urea have on the movement of water across a semipermeable membrane?

c. Your kidneys selectively excrete urea molecules to rid your body of these metabolic waste compounds. Dialysis membranes also allow these small urea molecules to freely diffuse across during kidney dialysis, but not selectively. All small molecules can freely diffuse across a kidney dialysis membrane. Thinking on your own, what effects might kidney dialysis have on your body’s physiology, especially with respect to mineral balance (such as sodium and potassium ions), or circulating hormones?

5. Your cells are protected from overfilling with water to the point of bursting from osmosis by maintaining a constant level of solutes in body fluids. How do plants, fungi, and microbes avoid bursting in hypotonic solutions?

6. Go to http://highered.mcgraw-hill.com/sites/0072495855/student_view0/chapter2/ animation__how_facilitated_diffusion_works.html and after watching this animation, answer the following questions: a. How do biological membranes facilitate the diffusion of polar molecules?

Tonicity of a solution undergoing osmosis

Relative solute concentration (higher, lower, or the same)

Relative water content (higher, lower, or the same)

Hypertonic

Hypotonic

Isotonic

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http://highered.mcgraw-hill.com/sites/0072495855/student_view0/chapter2/animation__how_osmosis_works.html

http://highered.mcgraw-hill.com/sites/0072495855/student_view0/chapter2/animation__how_facilitated_diffusion_works.html

b. What direction do solute molecules diffuse?

Lab 6, Experiment 1. Diffusion Through a Liquid

In this diffusion experiment, you will study the effects of these two factors on diffusion: 1. The viscosity of the medium (Viscosity means the “thickness” of the medium, as in molasses in

January.) 2. The size of the solute molecules (The molecular weight as an indicator of molecular size.)

After following the protocol in your eScience lab manual, enter your data in the following tables and answer the questions that follow.

Table 1: Rate of Diffusion in Corn Syrup

(Pay attention to the units of measurement!)

Time (sec) Blue Dye

distance traveled (mm)

RedDye

distance traveled (mm)

Time(sec) Blue Dye

distance traveled (mm)

RedDye

distance traveled (mm)

0 70 2.4 2.7

10 1.7 2 80 2.4 2.8

20 2.1 2.3 90 2.5 2.8

30 2.2 2.5 100 2.5 2.8

40 2.3 2.6 100 ? ?

50 2.4 2.6 110 2.5 2.9

60 2.4 2.7 120 2.5 2.9

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Table 2: Speed of Diffusion of Different Molecular Weight Dyes

(Pay attention to the units of measurement!)

+ Net distance is the distance after 120 seconds minus the distance at 0 seconds. * To calculate speed, multiply the net distance diffused after 2 minutes by 30 to get the hourly diffusion rate.

Lab 6, Experiment 1 Questions

1. Examine the plot below. How well does it match the data you took in Table 1? Explain your reasoning or submit your own plot if necessary to show how your data differs from these.

Structure Molecular Weight Net Distance Travel led after 2 minutes (mm)+

Speed of Dif fusion (mm/hr)*

Blue Dye 496g 25mm 750 mm

Red Dye 793g 29mm 870 mm

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2. Which dye diffused the fastest: the one with the larger or the smaller size? Is this the expected result? (If not, how can you explain your results?)

3. Does the rate of diffusion appear to change over time? Formulate an explanation of your observation: why or why not?

4. All your cells receive vital nutrients and rid toxic waste with the help of the circulatory system. What is the critical distance a cell must maintain from a capillary (the point of nutrient / waste exchange) in order to survive? Explain the role diffusion plays in this process.

Lab 6, Experiment 2. Diffusion – Concentration Gradients and Membrane Permeability.

A dialysis membrane is a plastic membrane with microscopic pores that allow only molecules that are smaller than the pore diameter to cross. You will measure osmosis by a net gain or loss in volume of dialysis bags.

You will also use chemical assays to detect solute molecules that cross the membrane. Notice (once again!) that whenever you do an assay, you need to have a negative control and a positive control to validate your results. The negative control would be water, or the solvent system in these assays. Without a negative result in your negative control, you would have to start your experiment all over again because it would indicate that you have started out with a contaminated solvent system. The positive control would be solutions known to have the substance that you are testing for. This would validate that you have performed the assay correctly and that you test reagents are working properly.

After following the protocol in your eScience lab manual, enter your data in the following tables and answer the questions that follow.

NOTE: Be sure to wear protective gloves when handling dialysis tubing. The oils in your skin can clog the pores of the tubing, making the osmosis process slow down. The dialysis tubing appears as a membrane in your kit, but when you soak it in water, the membrane will open up into a tube which you will seal at the ends in Experiment 2 and Experiment 3, as described in your eScience lab manual.

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Table 3: Indicator Reagent Data (Controls)

Table 4: Diffusion of Starch and Glucose in the Beaker Over Time

Lab 6, Experiment 2 Questions

1. Why is it necessary to have negative controls in this experiment? What important information do you get from the two negative controls?

2. Why is it necessary to have positive controls in this experiment? What important information do you get from the two positive controls?

3. Which substance(s) crossed the dialysis membrane? What evidence from your results proves this?

4. Which molecules remained inside of the dialysis bag? What evidence from your results proves this?

5. Did all of the solute molecules diffuse out of the glucose bag and into the beaker? Formulate an explanation for why this did or did not happen.

Indicator Starch Posit ive

Starch Negat ive

Glucose Posit ive

Glucose Negat ive

IKI Solut ion n/a n/a

Glucose Test n/a n/a 80

Indicator Dialysis Bag After

1 Hour

Beaker Water After

1 Hour

IKI Solut ion

Glucose Test Str ip

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6. Is the bag hypotonic with regards to the IKI solution (Lugol’s Iodine solution), or the beaker? What about the starch solution? What evidence from your results proves this?

7. What type of membrane does the dialysis tubing represent in a living cell? In what ways is the biological membrane different from the dialysis membrane?

Lab 7, Experiment 2. Osmosis – Tonicity and the Plant Cell

In this experiment, you will examine whether plant cells change size when soaked in water or in salt solution. After following the protocol in your eScience lab manual, (pp. 85 – 86), enter your data in the following tables and answer the questions that follow.

NOTE: Make sure that you are mixing the NaCl salt as you add water to make sure that it doesn’t lump up so that it dissolves more quickly. It may take some time to dissolve the salt, so you might want to start this process early in the experiment. (Step #10 in the eSciences protocol) Notice also that there is a 1-hour incubation time to allow for osmosis to occur (step #11 in the eSciences protocol). Your data would actually be improved if you let this osmosis step continue for 3-6 hours, so you might want to do set up this experiment before you do the other experiments in this unit.

IMPORTANT: When measuring the displacement of water by the potato strips, make sure that the strips are submerged in the water before taking your measurement – and make sure that only the potato strip is displacing water as you do so. The water displacement is your measurement of the volume of the potato strip, so these precautions are necessary to get an accurate reading.

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Table 5: Water Displacement of Potato Samples

Lab 7, Experiment 2 Questions

1. How long did you incubate your potatoes in the solutions before measuring their final displacement of water?

2. What is actually being measured when looking at the net change in water displacement of the potato samples?

3. Did you observe water flow in or out of the plant cells (potato cells) in each of the samples examined? How do you know this?

4. Different types of potatoes have varying natural sugar concentrations. Explain how this may influence the experiment.

5. Based on the data from this experiment, hypothesize which potato has the highest natural sugar concentration. Explain your reasoning. If the russet potato is put in 100% water solution, then it will grow in size and weight because it takes on water due to osmosis. My reasoning is because this potato took on more water than the others, therefore, it had less water molecules and more sugar and salt than the other potatoes did.

6. How did the physical characteristics of the potato vary before and after the experiment? Did it vary by potato type? What was the texture and rigidity of the potato tissue prior to the experiment? After the experiment? Did it vary by type of potato?

Potato Type

Potato Observat ions

Sample Ini t ia l Displacement

(mL)

Final Displacement

(mL)

Net Displacemen

t (mL)

Sweet Brown skin with br ight

orange inside

A (water)

6 ml 7 ml 1 ml

Sweet Brown skin with br ight

orange inside

(20% NaCl)

7 ml 7 ml 0 ml

Russet brown skin with off

white inside

A (water)

5 ml 7 ml 2 ml

Russet brown skin with off

white inside

(20% NaCl)

5 ml 4 ml -1 ml

! 9

7. Would you expect this experiment work in the same way with other types of plant cells? What about animal cells? Why or why not?

8. From what you know of tonicity, which was more hypertonic: plant cells or water? Which was more hypertonic in the salt solution: plant cells or the 20% sodium chloride solution? Explain your reasoning.

9. If the potato is allowed to dehydrate by sitting in open air, would the potato cells be more likely to absorb more or less water? Explain your reasoning.

10. Osmosis is how excess salts and cellular waste that accumulate in your cells are transferred to the blood stream so that they can be removed from the body. Explain how you think this process works in terms of tonicity.

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UMUC Biology 102/103 Lab 5: Meiosis

November 11, 2023/in Uncategorized /by Daniel Jennings

This contains 100% correct material for UMUC Biology 103 LAB05. However, this is an Answer Key, which means, you should put it in your own words. Here is a sample for the Pre lab questions answered:

Pre-Lab Questions

1. What major events occur during interphase?

The cell functions at its job, and prepares for mitosis by collecting resources and duplicating organelles (G1) and genetic content (S), then creating proteins needed for nuclear division (G2).

2. A person, residing in a location where they are exposed to the sun often, develops a mutation in some of their skin cells resulting in cancer. Consider whether their offspring will be born with the same mutation. Use scientific evidence to support your answer.

It would be highly unlikely that the person’s offspring will be born with same skin cancer mutation because the mutation occurred in the person’s skin cells. Skin cells are somatic cells (body cells) and are not involved in meiosis or reproduction. For the mutation to be passed on to the offspring, a sex cell (sperm or egg) would have to carry the mutation.

The other questions that will be answered:

Experiment 1: Following Chromosomal DNA Movement through Meiosis

Data Tables and Post-Lab Assessment

Trial 1 – Meiotic Division Beads Diagram:

Prophase I

Metaphase I

Anaphase I

Telophase I

Prophase II

Metaphase II

Anaphase II

Telophase I

Cytokinesis

Trial 2 – Meiotic Division Beads Diagram:

Prophase I

Metaphase I

Anaphase I

Telophase I

Prophase II

Metaphase II

Anaphase II

Telophase I

Cytokinesis

Post-Lab Questions

1. What is the ploidy of the DNA at the end of meiosis I? What about at the end of meiosis II

2. How are meiosis I and meiosis II different?

3. Why do you use non-sister chromatids to demonstrate crossing over?

4. What combinations of alleles could result from a crossover between BD and bd chromosomes?

5. How many chromosomes were present when meiosis I started?

6. How many nuclei are present at the end of meiosis II? How many chromosomes are in each?

7. Identify two ways that meiosis contributes to genetic recombination.

8. Why is it necessary to reduce the number of chromosomes in gametes, but not in other cells?

9. Blue whales have 44 chromosomes in every cell. Determine how many chromosomes you would expect to find in the following:

i. Sperm Cell:

ii. Egg Cell:

iii. Daughter Cell from Mitosis:

iv. Daughter Cell from Meiosis II:

10. Research and find a disease that is caused by chromosomal mutations. When does the mutation occur? What chromosomes are affected? What are the consequences?

11. Diagram what would happen if sexual reproduction took place for four generations using diploid (2n) cells.

Experiment 2: The Importance of Cell Cycle Control

Data Tables and Post-Lab Assessment

Post-Lab Questions

1. Record your hypothesis from Step 1 in the Procedure section here.

2. What do your results indicate about cell cycle control?

3. Suppose a person developed a mutation in a somatic cell which diminishes the performance of the body’s natural cell cycle control proteins. This mutation resulted in cancer, but was effectively treated with a cocktail of cancer-fighting techniques. Is it possible for this person’s future children to inherit this cancer-causing mutation? Be specific when you explain why or why not.

4. Why do cells which lack cell cycle control exhibit karyotypes which look physically different than cells with normal cell cycle.

5. What are HeLa cells? Why are HeLa cells appropriate for this experiment?

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I Need Picture For Work And Put My Name On it

November 11, 2023/in Uncategorized /by Daniel Jennings

Materials

*30 cm x 30 cm Aluminum Foil (Cell Wall)

*4 Gelatin Packets, unflavored

*2 Resealable Bags (Cell Membrane)

*Bowl

*Household items to represent the cell structures

*Warm Water

You Must Provide items noted by an *asterisk

Procedure

1. Place four packets of unflavored gelatin in a bowl. Add 4 cups of hot water to the bowl. Do not refrigerate

the mixture yet!

Note: You do not need to heat the water in a microwave. Simply run tap water until it feels warm to the touch.

2. Label each resealable bag as either “Plant Cell” or “Animal Cell”. These will serve as the cell membrane.

3. Construct a cell wall using the aluminum foil. This should be large enough to fit the resealable bag when filled with half of the gelatin and some of the cell structures.

Hint: It is helpful to make this square-shaped.

4. Using your knowledge of the cell structures (rought component of endoplasmic reticulum and free ribosomes, nucleus, mitochondria, endoplasmic reticulum, Golgi bodies, chloroplasts) think of household items which

can represent these structures. Find and collect these items for use in this experiment.

Hint: Colored paper may bleed when placed in gelatin.

5. Open the resealable bag labeled “Plant Cell” and pour half of the liquid gelatin into it.7. Add the items which represent plant cell structures (you must determine which items!) into the gelatin and tightly close the bag. If there is an “organelle” present in both plant and animal cells make sure to leave enough to be included in the animal cell.

6. Place the bag in the aluminum foil cell wall.

7. Open the resealable bag labeled “Animal Cell” and pour the remainder of the gelatin into it.

8. Add the items which represent animal cell structures (you must determine which items!) into the gelatin and tightly close the bag.

9. Place both “cells” into the refrigerator for 24 hours.

10. Return after 24 hours and observe the “cells” you have made. Notice the difference between the animal cell and the plant cell.

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Breast Cancer Soap Note

November 11, 2023/in Uncategorized /by Daniel Jennings

Breast Cancer SOAP note

Name Sharon Broom

Date: January/17/2020.

Age: 45 years old

Gender: Female

Time:12:45

SUBJECTIVE:

Chief Complaint: “I have a sore lump on the left breast.”

History of Present Illness :

Sharon is a 45-year-old female with complaints of a painful lump on her left breast for a month. The patient indicates that she feels unbalanced lumps on her left breast that are painful on the outer and upper corners. The patient observed the areas of the left outer breast worsening in terms of size and pain in the past week. She has experienced the pain of level four out of ten. Her mother was detected to have breast cancer prior to the age of 50. She has had a history of hysterectomy because of irregular periods, menorrhagia. The patient refutes swelling, increased warmth, and redness of the left breast. She repudiates nipple discharge swollen glands, chills, and fever.

History

Past Medical History:

Fibrocystic breast disease, Vitamin D deficiency, Urinary tract infection, Hypothyroidism, Hypocalcemia, and Constipation

Screenings:

Blood Pressure screening (2016 N/A)

Dental Examination (2016 N/A)

Eye Examination (2016 N/A)

Mammogram (2016 BiRad 2)

Pap smear- normal

HPV test- normal

GTPAL: G=1.T=0. P=0. A=0. L=1 (Normal vaginal delivery without complication)

Menstrual Hx: started at the age of 14. Normal PAP outcomes. LMP (cannot recall)-hysterectomy (07.2012)

Post Hospitalizations: Admitted to hospital for hysterectomy for one week

Past Surgical History: Hysterectomy (07. 2012)

Medications:

Armour Thyroid 30mg oral tablet: consume two pills on Monday, Wednesday, and Friday and three pills other days.

Therapy: 15 May 2015

Last Rx: 5 April 2016

Allergies:

Food allergies, Penicillin Triple Sulfa Vaginal CREA

Family History:

The patient’s mother passed away at the age of fifty, with a medical history of breast cancer. Sharon’s father is still alive at the age of seventy, with a medical record of hypertension. The patient has a younger brother aged 35 years and has no medical glitches. The patient has a sixteen-year-old son, who is healthy.

Social History:

The patient is divorced, and she lives with her son. She does not smoke but consumes alcohol irregularly. Sharon takes a regular diet that has no restrictions. She has no worries about weight loss or gains since she exercises two to three times weekly. The patient continually puts on a seatbelt when driving, wears sunscreen.

Sexual/Contraceptive History:

She has not been sexually active for at least a year, but previously, she had a monogamous relation. Birth control: Utilized condoms before. The patient has no fears with sexual performance or feelings.

Travel History:

She has not travelled out of the U.S.

Immunizations:

All her childhood and adulthood vaccinations are up to date

Review of Systems (Subjective):

General. The patient refutes fever, fatigue, or chills.

Skin, hair, nails: Repudiates excessive sweating, change in texture, or pigmentation. Refutes changes in nails, hair, and skin

HEENT: Refutes vertigo or headaches. No complaints of vision loss, tearing, redness, or eye discharge. No criticisms of hearing loss, swallowing difficulty, and ear drainage. Denies rhinorrhea or nasal congestion — no bleeding gums.

Neck: Refutes swollen glands, pain, or lumps. Repudiates discomfort of the neck

Respiratory: Repudiates shortness of breath, wheezing, or cough.

Cardiovascular: No latest EKG. Refutes chest pain, palpitations, dyspnea, and orthopnea

Gastrointestinal: Normal appetite, no diarrhea, indigestion, reflux, vomiting, and nausea. Denies liver or gallbladder problem, jaundice. Regular bowel movement. No abdominal pain.

Genitourinary: Refutes vaginal discharge, itchiness, irritation, and discomfort. Denies pain or burning when urinating, suprapubic or flank pain hematuria, and dysuria. Repudiates hesitation or urgency to urinate.

Breast: Senses uneven lumps on her left breast, extremely aching on the outer, upper corner of her left breast

Musculoskeletal: Refutes pain on joints, muscles, and bones. Refutes constraint to a range of motion, weakness, stiffness and joint swelling

Extremities: No bony defect on the joints, heat or redness

Neuro/Psychiatric: Repudiates any trouble of concentrating or behavioural changes. Denies motor-sensory loss, seizures or fainting. Refutes hallucinations, suicidal ideation, mood swings, and depression.

Hematologic: Repudiates easy bleeding or bruising.

Endocrine: Denies kidney problems, thyroid problems, and a history of diabetes. Denies tenderness or thyroid enlargement, no inexplicable weight loss, or gain.

Objectives

Weight: 130 lb Temp: 96.9 F BP: 116/85

Height: 5.9” Pulse:60 Resp: 15

Constitutional: refutes night sweats, irritability, weakness, weight change, insomnia, anorexia, fatigue, chills, and fever

Mental status: Well-dressed patient who looks like her declared age. Seems to be hydrated and well-nourished and does not look to be intensely unwell. She is mild distress, oriented and alert.

Skin: the palms colour are normal for her ethnicity; they are warm. No clubbing observed — similar pigmentation. Great skin turgor. No nevi or rashes observed — scalp with no lesions. Hair texture is average. Nail beds pink; great capillary refill < 2 seconds. Moist mucus membranes and pink in the mouth.

HEENT:

Head : Head midline and erect. Smooth with no deformities, symmetric, atraumatic and normocephalic. Symmetric facial features. Hair of midline texture.

Eyes : Conjunctiva sclera white, pink. The lens and cornea are clear. Pupils are of equal size, regular and round, equally sensitive to the light like constricting and dilating, and bilateral accommodation. Intact peripheral visual fields. Intact extraocular movements. Present red reflex.

Ears : the obes do not have tenderness, lesions, or masses — clear bilateral ear canals. Tympanic membranes have good cone of light, intact and pearly grey. Hearing intact. Right perspicacity to whispered voice. Light reflex and bony landmarks envisaged bilaterally.

Nose : No polyps or discharge, mucosa moist and pink. Patent bilaterally and septum midline. No tenderness of sinus with palpation. The right and left nostrils differentiate dissimilar smells.

Throat : No tonsillar exudate or edema. Posterior oropharynx with no erythema. Midline uvula. Mucous membranes moist and pink with no ulceration. Gingiva firm and pink. Good dentition. Tongue midline, no tenderness or ulcers present.

Neck: No carotid bruits, trachea midline, the neck is supple.

Lymph Nodes: No lymphadenopathy on lymph nodes in the axillae and neck.

Cardiovascular: No overall cyanosis or edema. Heart sounds of S1 and S2 are audible with no gallops, rubs, or murmurs. No noticeable cyanosis or JVD. Equal pulses, bilateral in all extremes. No heaves, lifts, or thrills sensed on palpation.

Respiratory: Respirations regular rhythm and rate, equally bilateral, and non-laboured. No unilateral lag, struggle of breathing or extreme depth. Diminished lungs at the bilateral bases; clear to auscultation. No perceptible adventitious breath sounds, rhonchi, rales (crackles), or wheezes.

Chest/breast: No chest wall abnormalities. No reduced chest expansion or chest pain; symmetrical chest expansion. No barrel chest, localized rigidity or deformities. Percussion: no rise, fremitus, hyper resonance, or dullness. Palpation: no crepitus, tenderness, or abnormal tactile fremitus.

No skin changes, dimpling, symmetrical appreciated. Normal nipples. Multiple nodules on the left breast. Palpated-Superior tender mass, fluctuant, and lateral quadrant. Inferior tender mass, quadrant fluctuant and lateral.

Abdomen: Soft abdomen. No deep palpation, light or rigidity, tenderness or pain on other areas. Positive bowel sounds on auscultation in the quadrants. No venous hum, renal bruits, aortic or friction rubs. No ecchymosis, pulsations, ascites and masses. No splenomegaly or hepatomegaly.

Genital/Urinary: No protests of itching or vaginal discharge. No pain or burning during urination, suprapubic pain, flank, hematuria, or dysuria. No urgency or hesitation on urination. No bleeding during intercourse, discomfort, or pain.

Peripheral Vascular: Refutes bleeding or easy bruising.

Musculoskeletal:

Motor: Great tone and muscle bulk. Strength 5/5 all over. Gait steady. Intact point-to-point movements, Cerebellar Rapid alternating movements (RAMs).

Sensory: Romberg negative. Intact 2-point discrimination, vibration, position sense, light touch, and pinprick.

Reflexes: 2+ (brisk) plantar, Achilles, patellar, deep tendon reflexes of brachioradialis, triceps and biceps.

Psychiatric: appropriate behaviour for her age

Neurological: cooperative, oriented, alert, awake. Clear speech. Oriented to time, place as well as a person. Coherent thoughts. (Mertins, et al., 2016).

LABS&IMAGING

The latest mammography showed no evidence of mammographic malignancy. (BiRad2)

ASSESSMENT

Working diagnosis

Fibrocystic breast disease

Differential diagnosis

Mastitis, Fibroadenoma and breast cancer

Rationale

She has all progression and characteristics conforming with the disease.

Several breast lumps on the breasts; cyclic deviations, which deteriorate during menstruation. Mobile, tender, dominant lumps, Bilateral nodularity

PLAN

Labs and imagining studies:

US breast left, Mammogram Diagnostic Digital Bilat

Continuation with OB doctor as planned, the performance of ultrasound in the period of diagnosis and cancer.

Medications, immunizations therapies:

If mastitis will be observed, consume dicloxacillin 500mg PO QID antibiotics.

Education:

· Train the patient on how to do a breast self-exam.

· Call hospital is presence any fluid or augmented breast pain in nipple.

· Follow up and referrals

Reference

Mertins, P., Mani, D. R., Ruggles, K. V., Gillette, M. A., Clauser, K. R., Wang, P., … & Kawaler, E. (2016). Proteogenomics connects somatic mutations to signalling in breast cancer. Nature, 534(7605), 55-62.

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Anthropology Exam

November 11, 2023/in Uncategorized /by Daniel Jennings

Beginning Thoughts on Anthropology, Culture & Cultural Diversity

1.)What ideas or images that come to mind if someone says “Anthropology” or “anthropologist”? What has shaped your ideas about what Anthropology is or what Anthropologists do?

2.)What IS Anthropology? And what are the four sub-fields of Anthropology?

3.)Some contemporary archaeologists focus on studying modern human waste….including e-waste. If someone were to study YOUR waste (trash) …and e-waste what would they learn about you? Your diet? Your lifestyle?

4.) What are some cultural adaptations human beings have to better allow them to survive in their environment? Are there negative effects of these adaptations? If so, do the benefits outweigh those negative effects?

5.)American anthropologist Ralph Linton once said “The last thing a fish would ever notice would be water.” (Ralph Linton, 1936) How is this relevant and applicable to a discussion on “culture”?

6.) Polish anthropologist, Bronislaw Malinowski who is credited with inventing the anthropological method of intensive fieldwork, wrote in his journal about his fieldwork in the Trobriand Islands.In his diary he wrote” Imagine yourself suddenly set down surrounded by all your gear, alone on a tropical beach close to a native village, while the launch or dinghy which has brought you sails away out of sight.” What is Malinowski describing? Have you ever had an analogous experience in Philadelphia (or elsewhere)?

7.)Clifford Geertz, one of the most influential American anthropologists in the last 40 years, said “The locus of study is not the object of study. Anthropologists don’t study villages (tribes, neighborhoods…) they study in villages.” What do you think he meant? (And what happens if you substitute college for village?)

8.) If I were to ask you to provide a “socio-cultural analysis” of this classroom…where would you begin? Can you identify 10 ways that you might consider “diversity” within this classroom? (on campus, in the city, in the U.S. or in the world?)

9.) How do you think about diversity? i.e.as a problem? A challenge? An asset? Explain

10.) What do you think is bigger…a nation-state or a culture? Briefly explain.

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Biology

November 11, 2023/in Uncategorized /by Daniel Jennings

INCLUDEPICTURE “../images/lab007banner02.jpg” \* MERGEFORMAT

Experiment 2: The Neuromuscular Junction

Each skeletal muscle is connected to the nervous system be motor end units. When the neurotransmitter acetylcholine is release at this site, the muscle fiber depolarizes. Calcium ions are released from stores in the sarcoplasmic reticulum. The presence of Ca2+ triggers the ratcheting of actin and myosin filaments and the contraction of the myofiber as all of the myofibrils contract simultaneously.

Materials

Neuromuscular Junction Digital Slide Images Neuromuscular Junction (Longitudinal Section) Digital Slide Images

Procedure

1. Examine the digital slide images of the neuromuscular junction.

Neuromuscular junction 100X.

Neuromuscular Junction (Longitudinal Section) 1000X.

Post-Lab Questions

1. Identify the axon, terminal branches, and muscle fibers in the slide image below. If possible, trace the fiber to its terminus.

2. Are there few or many nuclei at the end plate?

3. What is a motor unit?

4. How is a greater force generated (in terms or motor unit recruitment)?

5. What types of sensors are present within the muscle to identify how much force is generated?

Experiment 3: Muscle Fatigue

Muscle contractions are essential for muscles to function properly. The inability of a muscle to maintain tension is muscle fatigue. Failure to contract may occur because of the accumulation of lactic acid, a lack of ATP, or decreased blood flow. In this exercise, you will investigate the correlation between repeated movements and muscle fatigue.

Materials

Rubber Band

Stopwatch

Note: If you suffer from a medical condition that does not permit you to perform this activity, please ask a partner to volunteer for you.

Procedure

1. Hypothesize how many times you can stretch a rubber band between your thumb and pinky finger in 20 seconds. Record your predictions in the table below.

2. Using your dominant hand, count the number of times you can completely stretch a rubber band between the thumb and pinky finger in 20 seconds. Be sure to stretch the rubber band as far as possible each time and do not take a break in between trials.

3. Record your count for each trial in Table 1.

Table 1: Experimental Counts
	Trial 1	Trial 2	Trial 3	Trial 4	Trial 5
Predicted Value
Actual Value

Post-Lab Questions

1. How did the predicted results compare to the actual results?

2. Did you notice any changes in the number of repetitions you could perform, or how your hand felt after each of the trials?

3. Explain the actions that were occurring at the cellular level to produce this movement. Include sources of energy and any possible effect of muscle fatigue.

4. Hypothesize what would happen if blood flow was restricted to the hand when this experiment is performed.

Experiment 4: Gross Anatomy of the Muscular System

Muscle actions are often described as a departure of the from the anatomical position of the body. In performing the next exercise, you will understand how muscles act to affect motion.

Materials

*Participant (can be yourself) *Heavy Object (approximately 5 pounds)

*You must provide

Procedure

1. Begin by examining muscles found in the upper limbs. First, extend your forearm so you have a clear view of your hand. What muscle is required to perform this extension? Extend your fingers out so they are straight and splayed apart. Then, retract your fingers into a tight fist. Repeat this motion several times, observing the wrist and hand muscles as the flex and relax. What muscles are used to complete this action? Record your observations in Table 2.

Note: It is helpful to palpate the area being flexed to better identify which muscles are being used.

2. Moving up the limb, extend your forearm out until it is parallel to the ground. Have a partner press down on your forearm. Flex your forearm to provide resistance as your partner pushes down. Observe the forearm and identify which muscles are being used. Record your observations in Table 2.

3. The partner should stop pushing down on your forearm, but keep it extended. Curl the forearm upward, creating a bend at the elbow. Observe which muscles are being used to complete this action, and record your observations in Table 2.

4. Find a heavy object, and pick it up. Keeping your arm straight, raise the object out to the side until it is parallel to the ground. What muscles does this require? Continue holding the object, and extend your arm back behind you. What muscles does this activate? Record your observations in Table 2.

Note: Be sure the heavy object is not too heavy before you lift it. This item should be approximately 5 – 10 pounds. This object should never be raised above your head!

5. Move down to the lower limbs, and determine what motions are needed to view the lower limb muscles in action. For example, you may want to walk, jump, sit, point your toes, etc. Engage at leave seven different muscles and indicate what motion was used to engage each muscle in Table 2.

Table 2: Gross Anatomy Data
Movement	Muscle(s) Activated	Action(s) of Muscle(s)
1. Forearm Extended (Step 1)
2. Fingers Extended and Splayed (Step 1)
3. Fingers Retracted (Step 1)
4. Forearm Pressed Down Upon (Step 2)
5. Elbow Bent (Step 3)
6. Arm Raised to Side with Heavy Object (Step 4)
7. Arm Extended Back with Heavy Object (Step 4)
8. (lower limbs; student selects action…)
9. (lower limbs; student selects action…)
10. (lower limbs; student selects action…)
11. (lower limbs; student selects action…)
12. (lower limbs; student selects action…)
13. (lower limbs; student selects action…)
14. (lower limbs; student selects action…)

Post-Lab Questions

1. Label the human muscle diagram.

2. Which muscle(s) were used to extend your arm backwards?

3. Which muscle(s) were used to extend and splay your fingers outward?

Experiment 5: ATP and Muscle Fatigue

Muscles require energy to contract. Energy is released when biomolecules such as sugars and fats are broken down, and is stored in the form of ATP. ATP enables muscle contraction, but can only be stored in relatively small amounts. For this reason, the body must continually metabolize new ATP molecules.

Muscle fatigue occurs if the local ATP reservoir for a muscle becomes depleted. This is a common result of strenuous exercise in which ATP is consumed at a faster rate than it is produced. At this point, muscles may fail to contract and the intensity of an exercise must decrease. In this experiment, you will test how long it takes your muscles to fatigue.

Materials Stopwatch *Participant *Sturdy Wall to Stand Against

*You must provide

Procedure

1. To begin, find a wall that is strong enough for you to push against. A temporary wall (such as a partition panel) is not suitable.

2. Find the stopwatch and adjust the settings so it is ready to operate.

3. Stand with your back pressed up against the wall, and lower yourself into a “wall-sit”. To do this:

a. Align the backs of your heels, hips, and shoulders with the wall.

b. Keeping your back pressed against the wall, take a few small steps forward (your upper half will lower as you walk your feet out).

c. Lower yourself into a sitting position, keeping your back flat against the wall, until your knees form a 90 degree angle.

d. Steady this position by focusing the majority of your weight in your heels. Do not allow your lower back to pull away from the wall.

4. Start the stopwatch and time how long you are able to hold the wall-sit position. The amount of time will vary, but will likely fall within approximately 30 – 120 seconds. When you are tired, check the time on the stopwatch, and move out of the position by slowly lowering your body down to the floor or standing up.

5. Record how long you were able to hold the wall-sit in Table 3.

6. Allow your muscles to rest for approximately two minutes, reset the stopwatch, and repeat Steps 3 – 5.

7. Again, allow your muscles to rest for approximately two minutes, reset the stopwatch, and repeat Steps 3 – 5. You should have three trials of data.

Table 3: Muscle Fatigue Data
Trial	Time (seconds)
Trial 1
Trial 2
Trial 3

Post-Lab Questions

1. What happened to the time intervals between Trial 1 and Trial 3? What caused this change?

2. Identify three muscles which were engaged during the wall-sit.

3. Explain the biochemical reasoning behind muscle fatigue.

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Materials

*30 cm x 30 cm Aluminum Foil (Cell Wall)

*4 Gelatin Packets, unflavored

*2 Resealable Bags (Cell Membrane)

*Bowl

*Household items to represent the cell structures

*Warm Water

You Must Provide items noted by an *asterisk

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Materials

*30 cm x 30 cm Aluminum Foil (Cell Wall)

*4 Gelatin Packets, unflavored

*2 Resealable Bags (Cell Membrane)

*Bowl

*Household items to represent the cell structures

*Warm Water

You Must Provide items noted by an *asterisk

Procedure

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