Evolution of Skin Pigmentation

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Evolution of Skin Pigmentation

(Evolution of Skin Pigmentation)

Human Evolution Revised April 2018 www.BioInteractive.org Page 1 of 7

Activity Student Handout

Human Skin Color: Evidence for Selection

INTRODUCTION Our closest primate relatives have pale skin under dark fur, but human skin comes in a variety of shades from pinkish white to dark brown. How did this variation arise? Many biological traits have been shaped by natural selection. To determine whether the variation in human skin color is the result of evolution by natural selection, scientists look for patterns revealing an association between different versions of the trait and the environment. Then they look for selective pressures that can explain the association.

In this lesson, you will explore some of the evidence for selection by analyzing data and watching the film The Biology of Skin Color (http://www.hhmi.org/biointeractive/biology-skin-color), featuring anthropologist Dr. Nina Jablonski. In Part 1 of this lesson, you’ll discover the particular environmental factor correlated with the global distribution of skin color variations. In Parts 2 and 3, you’ll come to understand the specific selective pressures that have shaped the evolution of the trait. Finally, in Part 4, you’ll investigate how modern human migration is causing a mismatch between biology and the environment.

PROCEDURE Read the information in Parts 1–4 below, watching segments of the film and pausing as directed. Answer the questions in each section before proceeding to the next.

PART 1: Is There a Connection Between UV Radiation and Skin Color? Watch the film from the beginning to time stamp 5:49 minutes. Pause when Dr. Nina Jablonski asks the question, “Is there a connection between the intensity of UV radiation and skin color?”

In this segment of the film, Dr. Jablonski explains that the sun emits energy over a broad spectrum of wavelengths. In particular, she mentions visible light that you see and ultraviolet (UV) radiation that you can’t see or feel. (Wavelengths you feel as heat are in a portion of the spectrum called infrared.) UV radiation has a shorter wavelength and higher energy than visible light. It has both positive and negative effects on human health, as you will learn in this film. The level of UV radiation reaching Earth’s surface can vary depending on the time of day, the time of year, latitude, altitude, and weather conditions.

The UV Index is a standardized scale that forecasts the intensity of UV radiation at any given time and location in the globe; the higher the number, the greater the intensity. Examine Figure 1 on the next page and answer Questions 1–6.

1. Describe the relationship between the UV Index (the colored bar in Figure 1) and latitude (y-axis).

2. How do you explain the relationship between the UV Index and latitude? (In other words, why does UV intensity change with latitude?)

Human Skin Color: Evidence for Selection

(Evolution of Skin Pigmentation)

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3. Find your approximate location on the map. What is the primary UV Index value of your state on this particular day in September? _________

4. Look at the regions that receive the most-intense UV (light pink). Site a specific piece of evidence from the map that a factor other than latitude was contributing to UV intensity on this day.

5. In the film, Dr. Jablonski explains that melanin, located in the top layer of human skin, absorbs UV radiation, protecting cells from the damaging effects of UV. Genetics determines the type of melanin (i.e., brown/black eumelanin or red/brown pheomelanin) and the amount of melanin present in an individual’s cells. Based on this information, write a hypothesis for where in the world you would expect to find human populations with darker or lighter skin pigmentation (i.e., different amounts of melanin).

6. Explain how scientists could test this hypothesis.

Figure 1. Ultraviolet Radiation Index Across the World. The colors on this map of the world represent Ultraviolet (UV) Index values on a particular day in September 2015. The UV Index is a standardized scale of UV radiation intensity running from 0 (least intense) to 18 (most intense). The y-axis values are degrees of latitude, which range from the equator (0°) to the poles (90° north and −90° south). The x-axis values are degrees of longitude, which range from the prime meridian (0°) to the antimeridian (180° east and −180° west). (Source: European Space Agency, http://www.temis.nl/uvradiati on/UVindex.html.)

Human Skin Color: Evidence for Selection

(Evolution of Skin Pigmentation)

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Activity Student Handout

You will now look at another figure that has to do with skin color. One way to measure skin color is by skin reflectance. Scientists can shine visible light on a portion of skin (typically the inside of the arm) and then measure how much light is reflected back. Dark skin reflects less visible light than does light skin. The lower the reflectance value, therefore, the darker the skin. Examine Figure 2 and answer Questions 7–9.

7. Why do you think that reflectance data are collected from a subject’s inner arm?

8. Describe the relationship between skin reflectance (y-axis) and latitude (x-axis). Consider both the direction and steepness of the lines’ slopes.

9. Do these data support your hypothesis from Question 5? Justify your answer.

Watch the film from time stamp 5:49 minutes to 9:08 minutes. Pause when Dr. Jablonski says, “That suggests that variation in human skin melanin production arose as different populations adapted biologically to different solar conditions around the world.” After watching this segment of the film, answer Question 10.

10. Based on what you know about skin pigmentation so far, suggest a mechanism by which UV intensity could provide a selective pressure on the evolution of human skin color. In other words, propose a hypothesis that links skin color to evolutionary fitness.

Figure 2. Relationship Between Skin Reflectance and Latitude. This figure shows how skin reflectance changes with latitude. Negative latitudes are south of the equator (located at 0°), and positive latitudes are north of the equator. Available reflectance data from multiple sources were combined to form this graph. All combined data were obtained using a reflectometer with an output of 680 nanometers (i.e., a wavelength of visible light) and placed on the subjects’ upper or lower inner arms. (Source: Panel B of Figure 2 in Barsh (2003). Graph originally captioned as “Summary of 102 skin reflectance samples for males as a function of latitude, redrawn from Relethford (1997).” © 2003 Public Library of Science.)

Human Skin Color: Evidence for Selection

(Evolution of Skin Pigmentation)

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PART 2: What Was the Selective Pressure? Watch the film from time stamp 9:08 minutes to 12:19 minutes. Pause when Dr. Jablonski says, “For that reason, though it might cut your life short, it’s unlikely to affect your ability to pass on your genes.” After watching this segment of the film, answer Questions 11–13.

11. What does it mean for a trait, such as light skin coloration, to be under negative selection in equatorial Africa? Relate negative selective pressure to what we know about MC1R allele diversity among African populations.

12. Why does Dr. Jablonski dismiss the hypothesis that protection from skin cancer provided selection for the evolution of darker skin in our human ancestors?

13. Revisit your hypothesis from Question 10. Based on the information you have now, does this seem like a more or less probable hypothesis than when you first proposed it? Provide evidence to support your reasoning.

Watch the film from time stamp 12:19 minutes to 13:32 minutes. Pause when Dr. Jablonski says, “That is what melanin does.” In this segment of the film, Dr. Jablonski references a paper she had read about the connection between UV exposure and the essential nutrient folate (a B vitamin), which circulates throughout the body in the blood. The paper, published in 1978, describes how the serum (blood) folate concentrations differed between two groups of light-skinned people. You will now look at one of the figures from that paper. Examine Figure 3 and answer Questions 14–17.

Figure 3. Folate Levels in Two Groups of People. In one group (“patients”), 10 individuals were exposed to intense UV light for at least 30–60 minutes once or twice a week for three months. Sixty-four individuals not receiving this treatement (“normals”) served as the control group. The difference between the two groups was statistically significant (p < 0.005). Brackets represent the standard error of the mean, and “ng/mL” means “nanograms per milliliter.” (Republished with permission of the American Assn for the Advancement of Science, from Skin color and nutrient photolysis: an evolutionary hypothesis, Branda, RF and Eaton, JW, 201:4356, 1978; permission conveyed through Copyright Clearance Center, Inc.)

Human Skin Color: Evidence for Selection

(Evolution of Skin Pigmentation)

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14. Describe the relationship between folate levels and UV exposure. Use specific data from the graph to support your answer.

15. Dr. Jablonski describes learning that low folate levels are linked to severe birth defects as a “eureka moment.” Explain what she means by this.

16. Based on this new information, revise your hypothesis to explain the selective pressure on the evolution of human skin color.

17. Can the effects of UV light on folate explain the full variation of human skin color that exists among human populations today? Explain your reasoning.

PART 3: Why Aren’t We All Dark Skinned? Watch the film from time stamp 13:32 minutes to 16:04 minutes. Pause when Dr. Jablonski says, “Support for the idea that the UV–vitamin D connection helped drive the evolution of paler skin comes from the fact that indigenous peoples with diets rich in this essential vitamin have dark pigmentation.”

Unlike many essential nutrients, vitamin D is produced by the human body. One type of UV radiation called UVB starts a chain of reactions that convert 7-dehydrocholesterol—a chemical found in skin—to vitamin D. Vitamin D is essential to the absorption of calcium and phosphorus from the foods we eat to make strong bones. It is also important for reproductive health and for the maintenance of a strong immune system. How much UVB exposure is necessary to synthesize sufficient vitamin D depends largely on two factors: UVB intensity and skin color. In general, at a given UV intensity, a dark-skinned individual must be exposed to UVB five times as long as a light-skinned individual to synthesize the same amount of vitamin D.

Dr. Jablonski and Dr. George Chaplin published a paper in which they theorize whether available UV around the world would enable individuals with different skin colors to synthesize an adequate amount of vitamin D. Figure 4 and Table 1 summarize the results. Analyze Figure 4 and Table 1 and answer Questions 18–21.

Human Skin Color: Evidence for Selection

(Evolution of Skin Pigmentation)

Human Evolution Revised April 2018 www.BioInteractive.org Page 6 of 7

Activity Student Handout

Table 1. Key to Zones in Figure 4.

Skin Pigmentation Wide Diagonals Narrow Diagonals Dots

Light N Y Y

Moderate N N Y

Dark N N N

Note: “Y” means that an individual with that skin pigmentation could synthesize sufficient vitamin D in the region indicated throughout the year. “N” means that the person could not.

18. Based on these data, describe the populations least likely to synthesize sufficient levels of vitamin D. Explain your answer with data from the figure.

19. How do these data support the hypothesis that the evolution of lighter skin colors was driven by selection for vitamin D production?

20. For a person living farther away from the equator, would the risk of vitamin D deficiency be uniform or vary throughout the year? If it would vary, how would it vary? Explain your reasoning.

Figure 4. Comparison of Geographic Areas in Which Mean UVB Intensity Would Not Be Sufficient for Vitamin D Synthesis by Populations with Different Skin Colors. Widely spaced diagonal lines show regions in which UVB radiation, averaged over an entire year, is not sufficient for vitamin D synthesis by people with lightly, moderately, and darkly pigmented skin. Narrowly spaced diagonal lines show regions in which UVB radiation is not sufficient for vitamin D synthesis by people with moderately and darkly pigmented skin. The dotted pattern shows regions in which UVB radiation averaged over the year is not sufficient for vitamin D synthesis in people with darkly pigmented skin. (Reprinted from The Journal of Human Evolution, 39:1, Nina G. Jablonski and George Chaplin, The Evolution of Human Skin Coloration, 57-106, Copyright 2000, with permission from Elsevier.)

Human Skin Color: Evidence for Selection

(Evolution of Skin Pigmentation)

Human Evolution Revised April 2018 www.BioInteractive.org Page 7 of 7

Activity Student Handout

21. Vitamin D and folate levels in the blood are both affected by UV light. Describe the predicted effects of using a tanning booth (which exposes skin to UV light) on the blood levels of these two vitamins.

22. Based on everything that you have learned so far, provide an explanation for how the different shades of skin color from pinkish white to dark brown evolved throughout human history.

PART 4: How Does Recent Migration Affect Our Health? Watch the film from time stamp 16:04 minutes to the end. In this segment of the film, Dr. Jablonski and Dr. Zalfa Abdel-Malek explain that some people are living in environments that are not well matched to their skin colors. One example is vitamin D production. The recommended level of circulating vitamin D is 20 ng/mL (nanograms per milliliter). But, as you learned in Part 3, vitamin D production is affected by UV intensity and skin color.

Figure 5 shows the concentrations of serum 25(OH)D vitamin, which is the main type of vitamin D that circulates in blood. Measurements were taken among people living in the United States and were standardized to negate the effects of weight, age, and other factors. Examine Figure 5 and answer Questions 22 and 23.

23. Describe the trends visible in the data. Which subpopulation (gender, race/ethnicity) is at the greatest risk for vitamin D deficiency? Which subpopulation is at the least risk for vitamin D deficiency?

24. What is one of the consequences of recent human migrations on human health?

Figure 5. Adjusted mean serum 25(OH)D levels according to race/ethnicity and stratified according to gender (n = 2629). aAdjusted for gender, age, weight, education, income, urban, region; b adjusted for age, weight, education, income, urban, region. (Reproduced with permission from Pediatrics 123, 797-803, Copyright© 2009 by the AAP.)

  • Introduction
  • PROCEDURE
    • PART 1: Is There a Connection Between UV Radiation and Skin Color?
    • PART 2: What Was the Selective Pressure?
    • PART 3: Why Aren’t We All Dark Skinned?
    • PART 4: How Does Recent Migration Affect Our Health?
 
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Discoveries inthe War on Cancer

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Discoveries inthe War on Cancer

(Discoveries inthe War on Cancer)

Individual Assignment 3 – 10 Discoveries inthe War on Cancer

1. Virologists are modifying lentiviruses as vectors for carrying proto-oncogenes into cancer-transformed cells in culture. They are developing this virus for inserting the ras proto-oncogene directly into its correct location in the genome. The correct ras gene will already be linked to human DNA on either side of it and complexed with a recombination enzyme that will insert it into its correct location within the human genome. At the same time, the recombination enzyme will excise the defective oncogenic form of ras. The cells in culture should again come under normal hormonal control and require extra-cellular signals in order to continue dividing.

2. Malignant brain tumors in adults are fast-growing cancers with median survival rates of 15 months, even with aggressive treatment. Researchers have been searching for genetic “signatures” (characteristic groups of cancer-causing genes) that could help in defining the kind of brain tumor the patient has. They hope to be better able to predict the course of the disease and more accurately design the patient’s course of treatment.

3. Tobacco smoking is the leading cause of preventable deaths worldwide. It is a risk factor for lung cancer and several other types of cancer. Results of analysis of the entire human gene collection (the “genome”) support some previous findings that a region of human chromosome number 15 contains one or more genes that are associated with smoking intensity (the number of cigarettes smoked per day) and the closely related trait of nicotine dependency. Scanning people’s genomes for these genes will help them to determine their risk of addiction should they begin smoking tobacco.

4. Immunologists are working with a mutation (HER2) that is expressed on the surface of many breast, bladder, pancreatic, and ovarian cancer cells. They have made antibodies against this mutant surface protein. These antibodies have been covalently bonded to a “gene expression vector” that makes cells light up when incubated with luciferin from fire flies. The vector takes the gene for luciferin into the cancer cells. The researchers have shown that their antibody can accurately find and “light up” cancer cells. Their next step is to bond the antibody to an expression vector that carries the normal HER2 gene into mutant cancer cells.

5. Immunologists are investigating ways to destroy lymphocytes (white blood cells of the immune system) that have become cancerous (lymphomas). A current drug Rituximab contains antibodies that bind to the surfaces of these lymphocytes setting them up for destruction by the cancer patient’s own immune system. They are currently seeking ways to modify the antibody’s structure so that it will attract the cancer patient’s “natural killer” (NK) cells to the lymphocytes. Success of this project will bring a multi-faceted immune response against lymphomas and hasten destruction.

(Discoveries inthe War on Cancer)

6. Biochemists have discovered a protein kinase enzyme named BRAF that is an important link in a molecular pathway that causes a cell to divide. Normally, BRAF responds to signals coming from outside the cell—signals calling for the cell to divide normally under normal conditions. But there is a mutation in BRAF enzymes that causes it activate the cell toward division continually. In this way it gives rise to melanomas and thyroid or ovarian cancers. Biochemists have also found a drug, vemurafenib, which binds selectively to mutant BRAF totally inactivating it. Cells that have inactivated BRAF undergo apoptosis—a process that leads to cell death.

7. Molecular biologists have taken nanoparticle-sized spheres and used them to deliver a cell-killing toxin from bee venom to tumors in mice, substantially reducing tumor growth without harming normal body tissues. Nanoparticles are known to concentrate in solid tumors because blood vessels in tumors show “enhanced permeability and retention effect” or EPR. Hence substances such as nanoparticles escape more readily from the bloodstream into tumors and the generally poor drainage of lymph from tumors further helps trap the particles in tumor tissue.

8. Organic chemists are exploring structural variations of the organic compound avobenzone (1-[4-Methoxyphenyl]-3-[4-tert-butylphenyl] propane-1,3-dione) for inclusion in sunblock products. Avobenzone is known for its ability to absorb a broad spectrum of ultra-violet radiations including UVB light (known to enhance the frequency of basal cell and squamous cell carcinomas [skin cancers]); and UVA rays thought to increase the frequency of melanoma cancers. New variations in the structure of avobenzone are hoped to retain the ability to absorb harmful UV radiation while having an increased stability in the presence of that radiation.

9. Biochemists are analyzing the many, many components of red meat (beef and pork) to determine which component, if any, will cause increased colorectal cancer rates in mice when the component is administered orally. Studies have shown that higher colorectal cancer rates in humans are associated with higher consumption rates of red meat.

10. Molecular biologists have developed a new sequence of human genes called an ankyrin insulator sequence. A new corrected or therapeutic gene is placed within this sequence. Its role is to create an active area on a human chromosome where the new gene can work efficiently no matter what chromosome it lands on.

 
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Weather And Climate Change

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Weather and Climate Change

(Weather and Climate Change)

Introduction

The Earth’s atmosphere is composed of 21% oxygen (O2), 78% Nitrogen (N2), and ~1% other gases (including water vapor, argon, carbon dioxide, hydrogen, and helium). Oxygen is essential for life and is used by most organisms for cellular respiration while carbon dioxide is used by plants and certain bacteria for photosynthesis.

Our atmosphere is composed of five layers:

Troposphere – nearest to the Earth’s surface; layer in which weather occurs (rising and falling air); comprises one half of total atmosphere; air pressure is decreased to 10% of that at sea level.

Concepts to Explore

Atmosphere

Weather

The Water Cycle

Climate

Figure 1: Clouds are visible accumulation of water droplets that accumulate in the Earth’s lowest layer of the atmosphere, the troposphere.

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Weather and Climate Change

Stratosphere – contains the ozone layer (important for UV ray absorption).

Mesosphere – layer which meteors burn up in upon entering the Earth’s atmosphere.

Ionosphere/Thermosphere – locations of auroras (e.g., aurora borealis); layer in which the space shuttle orbits.

Exosphere – upper limit of the Earth’s atmosphere; layer where Earth’s atmosphere merges with outer space.

Weather is the state of the atmosphere at a given time and place and includes temperature, pressure, the type and amount of precipitation, wind, clouds, etc. Weather conditions can change hour to hour, day to day, and season to season.

Our weather is caused by uneven heating of the Earth from the sun. The resulting temperature differentials generate wind that forces warm air to flow to regions of cooler air. This flow can occur both horizontally across the surface of the Earth (e.g., from tropical to polar regions) and vertically, causing clouds, rain, and storms to develop as warm, moist air cools and condenses as it rises.

In addition to driving our weather, the sun’s energy also is responsible for regulating how water moves on, above, and below the Earth’s surface through the water cycle.

The water cycle describes how the amount of water on Earth remains constant over time. Water exists in three different states (in solid form as ice, as liquid water, and in a gas as water vapor) and cycles continuously through these states. The temperature and pressure determine what state water is in.

The water cycle consists of the following processes:

Evaporation of liquid water to a gas (water vapor)

Figure 2: The water cycle – can you name the steps? Refer to Lab 2 for help!

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Weather and Climate Change

Condensation of water vapor to liquid water

Sublimation of solid water (ice) to water vapor (think dry ice)

Precipitation occurs when water vapor condenses to clouds/rain

Transpiration occurs when liquid water moves through plants from roots to leaves, changes to water vapor and is released to the atmosphere through holes (stoma) in the leaves

Surface run-off occurs when water moves from high to low ground

Infiltration occurs when water fills porous spaces in the soil

Percolation occurs when ground water moves in a saturated zone below Earth’s surface

Clouds form at many different altitudes in the troposphere when water vapor in warm air rises and cools. The water vapor condenses on microscopic dust particles in the atmosphere and transforms into either a liquid or solid and is visible as clouds.

Warm air can hold more water vapor than cool air. Thus, clouds often form over the tops of mountains and over large bodies of water, since the air over these formations is typically cooler than the surrounding air.

Figure 3: Clouds.

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Weather and Climate Change

Climate is defined as the long-term average pattern of weather in a given region. Our climate is influenced by five components: the atmosphere, the hydrosphere (mass of liquid water), the cryosphere (mass of solid water; ice), the land surface, and the biosphere (life on Earth).

Climate change refers to the observed accelerated increase in the Earth’s temperature over the past 100 years and its predicted continued increase. The Earth’s average temperature has increased approximately 1 – 1.5 degrees F since 1900 (see figure below) and is projected to rise an additional approximately 3 – 10 degrees F over the next 100 years.

Changes in the Earth’s atmosphere have contributed to global warming. Global warming is due to the accumulation of “greenhouse gases”: carbon dioxide (CO2) from burning fossil fuels (oil, gas, and coal); methane (CH4) from agriculture, landfills, mining operations and gas pipelines; chlorofluorocarbons (CFCs) from refrigerants and aerosols; and nitrous oxide from fertilizers and other chemicals.

Increased temperature results in increased evaporation, accelerated polar ice melting, increased number of extreme temperature days, heavier rains/floods, and more intense storms. These changes will have important implications across public health, infrastructure, energy, economic, and political arenas.

Figure 4: Global Temperature Anomalies. Source: www.nasa.gov

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Weather and Climate Change

Demonstration 1: Modeling the Water Cycle

In this experiment you will observe how entrapped water moves from land to the atmosphere and determine how weather conditions affect this movement.

Procedure

Using a graduated cylinder, carefully pour 20 mL of warm water (60°C) into the canning jar and secure the lid.

Fill the petri dish with ice and place on top of the canning jar’s lid.

Observe the jar every 5 minutes for 30 minutes. After 30 minutes, remove the petri dish and carefully remove the lid and look at the underside.

Materials

100 mL Graduated cylinder

Canning jar

Petri dish

Thermometer

Hot water

Water

Ice cubes

You must provide

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Weather and Climate Change

Experiment 1: Assessing Infiltration

In this experiment, you will observe how entrapped water moves from land to the atmosphere and determine how weather conditions affect this movement.

Procedure:

Record your hypothesis in post-lab question 1. Be sure to indicate how you expect the environment within the bag to change over the course of the experiment.

Measure 200 mL sand into each plastic re-sealable bag.

Measure 200 mL room temperature water into each bag.

Seal each bag, leaving a bit of air in each.

Place 1 bag in a sunny location and 1 bag in a shady location.

Observe the bags after 1 hour, then again after 12 hours. Record your observations in Table 1.

Materials

(2) 9 x 12 in. Bags

250 mL Beaker

400 mL Sand

Water

A sunny location (window sill, outside porch, etc.)

A shady location

You must provide

 
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Exploring Human Genetic Traits

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Exploring Human Genetic Traits

(Exploring Human Genetic Traits)

Human Genetics

Please answer each question fully and in complete sentences. You may use textbook, or PowerPoint slides, and resources indicated in the questions below; if you use other resources, they must be cited properly in a working bibliography (author, article title, journal or book title, date of publication, page numbers)

Topic 8: Multifactorial and Acquired Developmental Traits

Should a woman be held legally responsible if she drinks alcohol, smokes, or abuses drugs during pregnancy and it harms her child (e.g., fetal alcohol syndrome)? If so, should liability apply to all substances that can harm a fetus, or only to those that are illegal? For example, we know that maternal weight gain in pregnancy is associated with an increased risk for diabetes in their children. What evidence or reasoning leads you to this opinion? State your opinion and then give sound reasoning for it.)

Topic 9: Multifactorial and Acquired Cancer Traits

Many genes contribute to lung cancer risk, especially among people who smoke tobacco. These genes include p53, IL1A, IL1B, CYP1A1, EPHX1, TERT, and CRR9. Search for one of these genes online and describe how mutations in the gene may contribute to causing lung cancer, or how polymorphisms in the gene may be associated with increased risk in combination with smoking. Be sure to choose a trustworthy source and cite the source with your answer.

Topic 10: Acquired Microbiome Traits

Malnutrition is common among children in the African nation of Malawi. Researchers hypothesized that the microbiome may play a role in starvation because in some families, some children are malnourished and their siblings are not, even though they eat the same diet. Even identical twins may differ in nutritional status.

Researchers followed 317 sets of twins in Malawi, from birth until age 3. In half of the twin pairs, one or both twins developed kwashiorkor, the type of protein malnutrition that swells bellies. The researchers focused on twin pairs in which only one was starving, including both identical and fraternal pairs. At the first sign that one twin was malnourished, both were placed on a diet of healthy “therapeutic food.” Four weeks later, the pair returned to the nutrient-poor village diet. If the malnourished twin became so again, then the researchers compared his or her microbiome to that of the healthy sibling. The goal was to identify bacterial species that impair the ability of a child to extract nutrients from the native diet. [Smith, et al. (2013) Gut microbiomes of Malawian twin pairs discordant for kwashiorkor. Science 339(6119):548-554.]

How might the findings from this study be applied to help prevent or treat malnutrition? Do you think that the study was conducted ethically? Why or why not? Explain how identical twins who follow the same diet can differ in nutritional status.

Topic 11: Multifactorial and Acquired Epigenetic Traits

The environmental epigenetics hypothesis states that early negative experiences, such as neglect, abuse, and extreme stress, increase the risk of developing depression, anxiety disorder, addictions, and/or obesity later in life through effects on gene expression that persist and can be passed on to the next generation. Suggest an experiment to test this hypothesis.

Topic 12: Genetics of Human Populations: Hardy-Weinberg Equilibrium

Population bottlenecks are evident today in Arab communities, Israel, India, Thailand, Scandinavia, some African nations, and especially among indigenous peoples such as Native Americans. Research an indigenous or isolated population and describe a genetic condition that its members have that is rare among other groups of people, and how the population bottleneck occurred.

Topic 13: Human Evolution

Explain why analyzing mitochondrial DNA or Y chromosome DNA cannot provide a complete picture of an individual’s ancestry. How can a female trace her paternal lineage if she does not have a Y chromosome?

Topic 14: Biotechnology in Human Genetic Research

Go to clinicaltrials.gov and search under “gene therapy.” Describe one of the current research trials for correcting a genetic problem. Include information about the genetic condition if available, including: mode of inheritance, age of onset, symptom severity, variability in expression, existing treatments (standard of care), and how the gene therapy is proposed to correct the problem.

 
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NURS6630 Final Exam (2018): Walden University

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 NURS6630 Final Exam (2018): Walden University

 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).

A.

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

B.

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

C.

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

D.

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

QUESTION 2

1.      Which statement about neurotransmitters and medications is true?

A.

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

B.

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

C.

Neurotransmitters receive messages from most medications.

D.

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:

A.

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

B.

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

C.

“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.”

D.

“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?

A.

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

B.

RNA must be converted to mRNA.

C.

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

D.

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?

A.

Genes impact neuron functioning directly.

B.

Changes made to proteins lead to changes in behavior.

C.

Neurons are able to impact protein synthesis.

D.

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:

A.

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

B.

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

C.

Neurotransmitters can spread by diffusion.

D.

The postsynaptic neuron can release the neurotransmitter.

1 points

QUESTION 7

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

A.

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.

B.

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

C.

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

D.

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?

A.

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

B.

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.

C.

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

D.

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?

A.

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

B.

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

C.

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

D.

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:

A.

The patient smokes cigarettes.

B.

The patient has hypertension.

C.

The patient has chronic kidney disease, stage 2.

D.

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:

A.

Alert staff to possible seizures

B.

Write an order for a different moodstabilizer

C.

Decrease the amount prescribed for aripiprazole (Abilify)

D.

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?

A.

Review Amitriptyline (Elavil) level

B.

Order a liver function test

C.

Check the patient’s blood pressure and pulse

D.

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?

A.

To promote the availability of serotonin

B.

To decrease serotonin

C.

To indirectly increase the amount of dopamine in the body

D.

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?

A.

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

B.

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

C.

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

D.

“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?

A.

“The drug will have an almost immediate effect.”

B.

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

C.

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

D.

“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?

A.

Benzodiazepine

B.

Mirtazapine (Remeron)

C.

Ketamine

D.

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)

A.

Full agonists

B.

Antagonists

C.

Partial agonists

D.

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?

A.

“The patient needs to have an inverse agonist.”

B.

“The patient could benefit from an anticonvulsant.”

C.

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

D.

“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?

A.

Ligand-gated ion channels with a pentameric structure

B.

Ligand-gated ion channels with a tetrameric structure

C.

Voltage-sensitive ion channels

D.

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?

A.

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

B.

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

C.

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

D.

“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

A.

Obtaining raw normative metrics and using them to assess functionality

B.

Having the patient report on cognitive function based on personal experiences

C.

Monitoring the patient in a controlled setting

D.

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?

A.

Dopamine is terminated through multiple mechanisms.

B.

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

C.

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

D.

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?

A.

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

B.

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

C.

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

D.

“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?

A.

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

B.

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

C.

Antipsychotic drugs that open D2 receptor pathways can treat schizophrenia.

D.

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?

A.

Achieving underactivity of the mesocorticol projections to the prefrontal cortex

B.

Achieving overactivity of the mesocorticol projections to the ventromedial prefrontal cortex

C.

Achieving underactivity of the mesocortical projections to the ventromedial prefrontal cortex

D.

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?

A.

Hypersexuality

B.

Amenorrhea

C.

Dystonia

D.

Tardive dyskinesia

A.

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

B.

Asenapine to Risperidone

C.

Aripripazole to ziprasidone

D.

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?

A.

Quetiapine

B.

Paliperidone

C.

Lurasidone

D.

Clozapine

1 points

QUESTION 29

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

A.

Muscarinic antagonists are more likely to cause decreased prolactin levels.

B.

D2 antagonists decrease the likelihood of EPS symptoms.

C.

D2 antagonism is linked to antidepressant properties.

D.

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?

A.

An underlying depressive disorder

B.

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

C.

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

D.

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)?

A.

Long-term use of antipsychotics

B.

Genetic disposition

C.

Age

D.

A and C

E.

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?

A.

Those that are potent D2 antagonists

B.

Those that are potent D2 antagonists with 5HT2A antagonism properties

C.

D2 receptors that are blocked in the nigrostriatal pathway

D.

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?

A.

5HT2 antagonism

B.

D2 antagonism

C.

Alpha-2 antagonism

D.

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?

A.

Norepinephrine

B.

Dopamine

C.

Serotonin

D.

A and C

E.

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?

A.

The patient has an unsustained response to antidepressants.

B.

The patient has antidepressant-induced hypomania.

C.

The patient has a depletion of monoamine neurotransmitters.

D.

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)

A.

Patient with a bipolar I designation

B.

Patient with a bipolar II designation

C.

Patient with a bipolar III designation

D.

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?

A.

The patient may experience paranoid avoidant behavior.

B.

The patient may experience severe depression.

C.

The patient may experience auditory hallucinations.

D.

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?

A.

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

B.

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

C.

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

D.

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?

A.

Norepinephrine potentiates 5HT release through a2 postsynaptic receptors.

B.

Norepinephrine inhibits 5HT release through a2 receptors.

C.

Norepinephrine inhibits α2 receptors on axon terminals.

D.

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?

A.

“Drugs inhibit the release of NE.”

B.

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

C.

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

D.

“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?

A.

Insomnia

B.

Suicidal ideation

C.

Problems concentrating

D.

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?

A.

Neuronal firing rates are not dysregulated in depression.

B.

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

C.

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

D.

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?

A.

Both have a sedative-like, calming effect.

B.

Both contribute to antipsychotic actions.

C.

Both demonstrate favorable findings in treating depression in the elderly.

D.

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?

A.

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

B.

The patient cannot take any antihistamines.

C.

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

D.

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?

A.

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

B.

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

C.

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

D.

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?

A.

First onset in puberty or early adulthood

B.

Late onset of menses

C.

Premenstrual syndrome

D.

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:

A.

MAOI plus SNRI

B.

SSRI/SNRI plus NDRI

C.

NDRI/SNRI plus mirtazapine

D.

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?

A.

She may experience withdrawal symptoms.

B.

She may experience increased trauma.

C.

Effects of abrupt cessation are unknown.

D.

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?

A.

Weight gain can be problematic.

B.

Sedation is very common.

C.

Induction of mania is rare.

D.

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?

A.

Stop the venlafaxine

B.

Lower the dose of venlafaxine by 50%

C.

Lower the dose of venlafaxine by 25-40%

D.

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?

A.

It can affect her menstruation.

B.

Suicidality can be common among young adults.

C.

Sedation may be problematic.

D.

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?

A.

He has fibromyalgia.

B.

He has arrhythmia.

C.

He uses alcohol.

D.

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?

A.

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

B.

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

C.

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

D.

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?

A.

The patient has hepatic impairment.

B.

The patient has moderate renal impairment.

C.

The patient has severe renal impairment.

D.

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)?

A.

Histamine H1 receptor blockade can cause insomnia.

B.

Muscarinic M1 receptor blockade causes blurred vision.

C.

Alpha 1 adrenergic receptor blockade causes weight gain.

D.

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?

A.

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

B.

“You should not consume processed meats.”

C.

“You may consume fermented foods, like sauerkraut.”

D.

“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?

A.

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

B.

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

C.

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

D.

“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)

A.

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

B.

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

C.

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

D.

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)?

A.

Patient with PTSD

B.

Patient with partial seizures

C.

Patient with galactose intolerance

D.

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?

A.

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

B.

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

C.

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

D.

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?

A.

mirtazapine (Remeron)

B.

doxepin (Silenor)

C.

alprazolam (Xanax)

D.

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?

A.

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

B.

Mood stabilizers can consistently treat both mania and bipolar depression

C.

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

D.

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?

A.

Thyroid Stimulating Hormone (TSH)

B.

Complete Blood Count (CBC)

C.

Erythrocyte Sedimentation Rate

D.

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

A.

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

B.

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

C.

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

D.

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?

A.

Carbamazepine (Tegretol)

B.

Gabapentin (Neurontin)

C.

Valporoic Acid (Depakene)

D.

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)

A.

Omega-3-fatty-acids

B.

Soybean lecithin

C.

Inositol

D.

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?

A.

Valporic Acid (Depakene)

B.

Carbamazepine (Tegretol)

C.

Lithium (Lithobid)

D.

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?

A.

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

B.

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

C.

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

D.

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:

A.

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

B.

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

C.

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

D.

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:

A.

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

B.

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

C.

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

D.

“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.

B.

Alcohol works similar to benzodiazepines

C.

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

D.

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?

a.

Respiratory depression

b.

Sedation and restlessness

c.

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

d.

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:

A.

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

B.

“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.”

C.

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

D.

“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:

A.

Have you ever experienced any type of trauma?

B.

What do you do when you feel fear?

C.

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

D.

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:

A.

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

B.

Beta blockers are linked to reconsolidation.

C.

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

D.

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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Breast Cancer SOAP Note

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Breast Cancer SOAP Note

(Breast Cancer SOAP Note)

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 History:
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 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 and wears sunscreen.

Sexual/Contraceptive History:

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

Travel History:

She has not traveled out of the U.S.

Immunizations: (Information missing)

Review of Systems (ROS)

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, or 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, or nausea. Denies liver or gallbladder problems, 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 with concentrating or behavioral 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.

OBJECTIVE

Vitals:

  • Weight: 130 lb
  • Temp: 96.9 F
  • BP: 116/85
  • Height: 5’9”
  • Pulse: 60
  • Respiration: 15

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

Skin:
Normal for ethnicity, warm. No clubbing, rashes, lesions, or abnormal pigmentation. Good skin turgor.

(Detailed HEENT, Cardiovascular, Respiratory, Chest/Breast, Abdomen, Genital/Urinary, Musculoskeletal, Neurological, and Psychiatric findings remain unchanged).

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 & Imaging Studies:

  • Ultrasound of left breast
  • Mammogram Diagnostic Digital Bilateral
  • Follow-up with OB doctor, perform ultrasound for diagnosis and cancer screening.

Medications & Immunizations:

  • If mastitis is observed, prescribe Dicloxacillin 500mg PO QID antibiotics.

Patient Education:

  • Train the patient on how to perform a breast self-exam.
  • Call the hospital if there is any fluid or increased breast pain in the nipple.
  • Follow up and referrals as needed.

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 signaling in breast cancer. Nature, 534(7605), 55-62.

 
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Exploring Anthropology and Culture

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Exploring Anthropology and Culture

(Exploring Anthropology and Culture)

Anthropology Exam

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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Cell Structure Answer Key

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Cell Structure Answer Key

(Cell Structure Answer Key)

UMUC Biology 102 / 103 Lab 3: Cell Structure And Function ANSWER KEY

This contains 100% correct material for UMUC Biology 103 LAB03. 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. Identify the major similarities and differences between prokaryotic and eukaryotic cells. (2 pts)

Prokaryotes tend to be less complex than eukaryotic cells, with fewer organelles and (generally) fewer requirements for survival. Eukaryotes have a nucleus, while prokaryotes do not. Both eukaryotes and prokaryotes have DNA, a cell membrane, and cytoplasm.

2. Where is the DNA housed in a prokaryotic cell? Where is it housed in a eukaryotic cell? (2 pts)

DNA is housed in the nucleus in eukaryotic cells. Prokaryotic cells do not have a nucleus, and thus DNA exists freely in the cytoplasm.

3. Identify three structures which provide support and protection in a eukaryotic cell. (2 pts)

The cell membrane, the cytoplasm, and the cytoskeleton (microtubules, microfilaments, etc.).

Experiment 1: Cell Structure and Function

(Cell Structure Answer Key)

Post-Lab Questions

1.    Label each of the arrows in the following slide image:

2.    What is the difference between the rough and smooth endoplasmic reticulum?

3.    Would an animal cell be able to survive without a mitochondria? Why or why not?

4.    What could you determine about a specimen if you observed a slide image showing the specimen with a cell wall, but no nucleus or mitochondria?

5.    Hypothesize why parts of a plant, such as the leaves, are green, but other parts, such as the roots, are not. Use scientific reasoning to support your hypothesis.

Experiment 2: Osmosis – Direction and Concentration Gradients

Data Tables and Post-Lab Assessment

(Cell Structure Answer Key)

Table 3: Sucrose Concentration vs. Tubing Permeability

Band Color Sucrose % Initial Volume (mL) Final Volume (mL) Net Displacement (mL)
Yellow        
Red        
Blue        
Green        

Hypothesis:

Post-Lab Questions

1.    For each of the tubing pieces, identify whether the solution inside was hypotonic, hypertonic, or isotonic in comparison to the beaker solution in which it was placed.

2.    Which tubing increased the most in volume? Explain why this happened.

3.    What do the results of this experiment this tell you about the relative tonicity between the contents of the tubing and the solution in the beaker?

4.    What would happen if the tubing with the yellow band was placed in a beaker of distilled water?

5.    How are excess salts that accumulate in cells transferred to the blood stream so they can be removed from the body? Be sure to explain how this process works in terms of tonicity.

6.    If you wanted water to flow out of a tubing piece filled with a 50% solution, what would the minimum concentration of the beaker solution need to be? Explain your answer using scientific evidence.

7.    How is this experiment similar to the way a cell membrane works in the body? How is it different? Be specific with your response.

 
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Foundations of Criminal Justice

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Foundations of Criminal Justice

(Foundations of Criminal Justice)

1) A codified law is known as a

A) deviant act.

B) statute.

C) theory.

D) crime.

2) According to John F. Galliher, legal definitions of criminality are arrived at through a __________ process.

A) sociological

B) psychological

C) political

D) mainstream

3) Ron Classen sees crime primarily as

A) a violation of a law.

B) problem behavior.

C) an offense against human relationships.

D) a form of social maladjustment.

4) The pluralistic perspective suggests that behaviors are typically criminalized through

A) general agreement of members of society.

B) a political process.

C) the existence of shared norms and values.

D) none of the above

5) Which of the following jobs probably would not fall within the field of criminalistics?

A) Fingerprint examiner

B) Polygraph operator

C) Forensics examiner

D) Correctional officer

6) A police officer or probation officer is best described as a

A) criminalist.

B) criminologist.

C) criminal justice professional.

D) none of the above

7) __________ definitions focus on criminology’s role in uncovering the underlying

causes of crime.

A) Scientific

B) Causative

C) Disciplinary

D) None of the above

8) According to various professional groups, violence in television, music, video, games, and movies

A) may lead to increased levels of violent behavior among children.

B) may lead to decreased levels of violent behavior among children.

C) may lead to emotional sensitization toward violence in real life.

D) may have no effect on levels of violent behavior among children.

9) Which of the following is not an immediate input provided by the justice system that may enhance or reduce the likelihood of criminal occurrences?

A) Police response time to a crime scene

B) The availability or lack of official assistance

C) The presence or absence of police officers

D) A prison that acts as a “crime school”

(Foundations of Criminal Justice)

10) Which of the following is not considered a property crime by the UCR?

A) Robbery

B) Burglary

C) Arson

D) Theft

11) Which of the following is not a reason why rape victims fail to report their victimization?

A) Fear that the crime is not important enough to report

B) Fear of the perpetrator

C) Fear of participation in the criminal justice system

D) Shame

12) The category of crimes in NIBRS which corresponds most closely to the UCR Part I offenses is

A) Group A offenses

B) Part I crimes

C) NIBRS key crimes

D) None of the above

13) According to Elliott Currie, the __________ is the rate of crime calculated on the basis of crimes that would likely be committed by those who are incapacitated by the criminal justice system.

A) actual crime rate

B) criminality index

C) latent crime rate

D) clearance rate

14) The NCVS divides larceny into the categories of __________ larceny.

A) household and personal

B) grand and petty

C) violent and nonviolent

D) felony and misdemeanor

15) Which of the following is not a finding of the National Youth Survey?

A) Violent offenders begin lives of crime earlier than originally believed.

B) Females are involved in a smaller proportion of crime than previously thought.

C) There is a consistent progression from less serious to more serious acts of

delinquency over time.

D) Race differentials in crime are smaller than traditional data sources indicated.

16) The first step in any research is to

A) develop a research design.

B) choose a data collection technique.

C) review the findings.

D) identify a problem.

17) A __________ is especially valuable when aspects of the social setting are beyond the control of the researcher.

A) one-group pretest-posttest design

B) case study

C) controlled experiment

D) quasi-experimental design

18) The study of one particular criminal organization is an example of the __________ data-gathering strategy.

A) survey research

B) case study

C) participant observation

D) secondary analysis

19) The degree of dispersion of scores around the mean is known as the

A) standard deviation.

B) median.

C) correlation.

D) significance test.

20) A __________ correlation exists between sample size and the degree of confidence we can have in our results.

A) positive

B) curvilinear

C) negative

D) inverse

21) In which year was the Magna Carta signed?

A) 450 B.C.

B) 1215

C) 1066

D) 1700 B.C.

22) Which of the following was not one of the three types of crimes outlined by Beccaria?

A) Crimes that involved no victims other than society

B) Crimes that ran contrary to the social order

C) Crimes that injured citizens or their property

D) Crimes that threatened the security of the state

23) Which of the following categories of punishment might include the loss of the right to vote?

A) chronic

B) compulsive

C) indelible

D) restrictive

24) The argument that crime is not a result of poverty or social conditions and

therefore cannot be affected by social programs was made by

A) Lawrence Cohen.

B) David Fogel.

C) Ronald V. Clarke.

D) James Q. Wilson.

25) Research by __________ found that a small number of chronic recidivists were responsible for a large majority of serious violent crime.

A) Marvin Wolfgang

B) Marcus Felson

C) Jack Katz

D) Ronald V. Clarke

 
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Health Law and Ethical Dilemmas

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Health Law and Ethical Dilemmas

Health And Law

Health Law and Ethical Dilemmas

The Legal and Regulatory Environment of Health Care

Textbook: Fremgen, B. F. (2014). Medical law and ethics (5th ed.). Upper Saddle River, NJ: Pearson.

Instructions: Please ensure to substantiate your response with scholarly sources and also a personal account of your own experience in the work place. Cite and reference work! Must be 150 to 175 word count.

1. Please highlight two things you found most interesting about Chapter 1. See attached

1a. Read the Jeanette M case; based on the case address your opinion and thoughts to the comments below.

What reactions do you have to the ideas they presented? Include examples from the course readings or your own experience to support your perspective, and raise questions to continue the dialogue

Monica: In the case of Jeanette M. I don’t believe there is an ethical problem. If anything there may be a legal problem for the receptionist because she should have gotten more information regarding Jeanette’s condition. An elderly woman with shortness of breath should have been recommended to the ER. However, Jeanette is also partially at fault because she took no action to save herself sooner. She should have went to the ER on her own as soon as she became exhausted. I would say that the doctor had no part in her death and both the receptionist and Jeanette were at fault (if I had to place blame). If the receptionist had taken the extra time to learn more about Jeanette, she may have referred her to the ER saving Jeanette’s life, maybe. Being that she was elderly, suffering from pneumonia and congestive heart failure, there may have been nothing they could have done.

BeaJae: I agree, on an ethical level had the receptionist given the doctor the message when it was first received Jeanette M could have had a response well before 5:00 P.M. It may or may not have saved her but at least the call would have been answered in a timely manner. I don’t believe that anyone is at fault for the death of Jeanette M and as a receptionist, the order of which the conversation had taken place was adequate because she is only a receptionist, the doctor would have to make the call on what Jeanette is to do as far as getting treatment. In a busy workplace anywhere a lot of things tend to go unanswered due to being understaffed, overworked, or misjudging a situation but in many of them someone is held to blame for the mishap. In this case i believe that there is no one to blame in the death of Jeanette only a delay in reporting the call.

2. Please highlight one thing you found most interesting about Chapter 2. See Chapter 2 attached

2a. Read the Case of Jacob and the diseased and share your thoughts

3. Please highlight one thing you found most interesting about Chapter 8. See Chapter 8 attached.

3a. Read the case of Janet K. and Epilepsy and share your thoughts

4. Read and share your thoughts about the Legislative Process page on the United States House of Representatives website. http://www.house.gov/content/learn/legislative_process/

5. Read and share your thoughts on the article “Why Is Health Care Regulation so Complex? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730786/

Based on the article above, address your opinion and thoughts to the comment below:

What reactions do you have to the ideas they presented? Include examples from the course readings or your own experience to support your perspective, and raise questions to continue the dialogue

5a. Kwan: This article provided a great summary of health care regulation in the U.S. and how it is managed by different levels of government: local, state, and federal. My personal experience working in medical billing and medical front office had been quite challenging at first as I had to learn HIPAA, ICD-9 (at the time), and Medicare/Medicaid compliance. Kind of a crash course if no one has had any official training or education on these subjects. However, I am glad to have experienced it first hand and now I am enjoying the work as a student. Students that learn about health care regulation and compliance at UOP are definitely going to be ahead starting a career in this industry if they aren’t working in it now – so lucky! This article provides examples from a physician and a pharmaceutical company’s perspective on how they require the necessary and legal regulations in order to provide treatment (physician) and sell the drug (pharmaceutical company). As for becoming a physician, it really makes people appreciate the hard work (time, money, and education) they put in in order to practice. Not only do they have to:

– attend a medical school that has received accreditation by a private body

– take a national examination administered by another nongovernmental organization

– obtain licensure from a state medical board

– complete a hospital residency that is funded and governed by the federal Medicare program

– achieve certification from a private specialty board

– AND obtain clinical privileges at a hospital that may operate as either a private or public entity

..but they have to complete regulatory and compliance tasks throughout their career in order to continue to practice (Field, 2008). This helps us as consumers know that we are getting treatment from well-educated medical professionals that meet the necessary standards of law.

Field, R. I. (2008). Why Is Health Care Regulation So Complex? Pharmacy and Therapeutics, 33(10), 607-608.

 

6. Read and share your thoughts on the Laws & Regulations page on the U.S. Department of Health &

Human Services website. http://www.hhs.gov/regulations/

7. Health Care Governance in the US:

Who should be responsible for governing health care delivery in the United States? What should the role of the government be, if any?

8. Government and Health Care

What function does each federal branch of government serve in relation to health care delivery?

Do you think they do a good job?

9. Read and share your thoughts on the Regulations overburden health care article. http://www.edermatologynews.com/single-view/regulations-overburden-health-care/f7bb02a29855cd0ec55a043e1ce29e02.html

10. Complete the Health Care Laws Matrix below. Cite/ reference with proper APA style.

· Explain how health care laws are created.

· Evaluate the impact of local, state, and federal laws on the health care industry.

· Health Care Laws

Health Law and Ethical Dilemmas

Identify 2 health care laws Describe the health care law (25- to 45- words) Identify why the health care law was created (45- to 90- words) Describe how the health care law impacts the health care industry (90- to 175- words)
1.

 
2.

 
 
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