BUS 520 Professional Development Program Proposal

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Task Force Committee Report: Issue and Solutions

By Larry D. Douglas

BUS 520: Leadership and Organizational Behavior

Professor Kene D. Ewulu PhD

October 29, 2018

 

Task Force Committee Report: Issue and Solutions

The company United Services Automobile Association (USAA) is a privately owned organization founded in 1922 when 25 Army officers met in San Antonio, Texas and decided to issue each other’s vehicles insurance. They could never have imagined that their tiny organization would one day serve millions of members and become one of the only fully integrated financial services organizations in America. USAA has its headquarters in San Antonio, Texas. (USAA Corporate Staff, 2015). USAA is part of the Financial Services and Insurance Industry (Corporate Staff, 2015). So of the products and services that USAA provides are insurance, banking, investments, retirement & IRA’s, real estate, shopping & discounts, health insurance, and ATM locations. Also, some life events that USAA provides is car buying, car selling, military life, and a tax center. USAA as of today has more than 12.4 million members that remain enrolled in a number of its products. We are known for our legendary commitment to our members and our outstanding service, financial strength, and employee well-being. Membership is open to all who are serving or have received an Honorable discharge from the military, and their eligible family members (Corporate Staff, 2015).

The Organization and the Issues to Resolve

The company United Services Automobile Association (USAA) is a Fortune 500 company that is a very diversified group of financial services companies that among the leading provider’s of insurance, investments, banking products, retirement & IRA’s and they bring advice to over 12.4 million current and former members of the United States Military and their families. USAA has been consistently recognized for outstanding service, employee well-being, and financial strength. Members of the United States armed forces, veterans, and their families are all customers of USAA. Some products provided by USAA include savings and checking accounts, credit cards, home, and auto loans. USAA has about 76 sites throughout the United States and approximately 26,267 United States employees (Great Rated Staff, 2015). USAA is currently serving individuals who are currently serving in the United States Air Force, U.S. Army, Coast Guard, Marines, Navy, National Guard, and Reserves. Former military and those who have retired or separated from the U.S. military with a discharge type of Honorable. Family widows, widowers and un-remarried former spouses of USAA members who had USAA auto or property insurance while married and individuals whose parents have or had USAA auto or property insurance. Cadets or Midshipmen Cadets and midshipmen at United States service academies, in advanced Reserve Officer Training Corps (ROTC) or on an ROTC scholarship, plus officer candidates within 24 months of commissioning (Great Rated Staff, 2015). USAA has roots that are well grounded in the military, in which they can bring its methods to finances, and its values to service through an exclusive suite of financial products, tools, and advice.

With all of the changes within the organization when it comes to the directives, they are usually delayed due to the Standard Operating Procedures (SOPS) not being updated and processed in a timely matter. Also, when it comes to training for the new employee’s implementation of participants, the process is rushed, and there are usually more questions than answers after the training has occurred completed. These are just two issues that affect the environment within the USAA company. These reflect some weaknesses in USAA’s culture and leadership and its culture of diversity could have contributed to the issues.

Current Corporate Culture

According to United Services Automobile Association’s when it comes to corporate culture positions to itself internal and external perspectives. When it comes to an internal corporate culture within USAA, it is visible, and it is voluntary. Corporate culture is also all the deliberate inaction that people have with each other within an organization. When it comes to the external corporate culture within USAA, it describes a particular environment in the organization that it services. External changes outside of the company that the company has no control over. One may draw strength from the other when it comes to being within an organization. One supports the other by facilitating each other. The challenge to each other in order to get the most out of there employees and their suppliers (USAA Corporate Staff, 2015).

Areas of Weakness

There is some weakness within USAA when it comes to international growth once the company has reached out to all prior military and their family members, there are no other opportunities to expand. The company has to deal with default issues wh make it comes to its financial services in order to have significant competitive pricing in order for the company to make a profit. USAA has one of the largest electronic footprints within the cybersecurity threat to the company and its customers. In which it will have to stay abreast of all the technological changes in order to protect the integrity of its IT systems. With USAA being a privately owned company they are not required to report their financials with as much scrutiny as publicly owned firms. So it reasons would make it very difficult to ford them to compare their financial health with other companies based on these discrepancies. They include problems that need to be corrected, deficiencies recognized through a comparison with competitors, or deficiencies relative to proposed strategies such as lacking the resources to grow (Abraham, 2012). USAA weaknesses are due to the single market exposure that prevents diversification, and all revenue comes from the United States limiting exposure to the United States Armed Services. Additional this has restricted growth opportunities.

 

Proposed Solutions

As the leader of a task force committee, we will be proposing that whenever the company changes its directives that the company’s Standard Operating Procedures (SOPS) be updated immediately. Moreover, that all employees remain informed that they need to read the updates as soon as possible and in hear For the long-term growth of the USAA company, there is a need for the creation of a strategy that advances diversity to them. Because that is very important that all personnel within the organization be aware of all changes that would affect them. The second thing is that when it comes to training within the organization that should be implemented from the very start after an employee was hired. Some organizations may call this training new hires orientation. Because if new employees are trained right from the onset, they will come into the organization knowing what will be expected of them. So, there will be no sources once the employee began working in their new position. So if the company were to modify these two practices that it would not only keep the company’s employees informed. However, this might increase work productivity and their attitude of its employees. So what we would be presenting to the organization’s leadership is to modify its new employee orientation training with training improvement, organizational communications, and information dissemination improvement. Within the company, the senior leadership should focus on its employees being well trained along with providing the highest level of customer service. Not only when management is around, but more important when they are not around. Always doing the right thing for the customers and their clients would help not only help to grow the company. However, it would help to create a positive work environment not only for other employees but senior management within the company as well. So when everyone works together, it allows all who are involved in completing the mission of the company.

Executive Summary

At United Services Automobile Association (USAA) company, which was formed in 1922 by 25 United States Army officers that met in Texas and decided to ensure each other’s vehicles. The organization was initially named United States Army Automobile Association (USAAA), but two years later the name was changed to United Services Automobile Association in 1924.

Today most of their businesses are conducted over the internet or by using telephones by their employees instead of agents. The two main objectives are to provide a summary to the senior leadership of the company so that they can improve the corporate work environment. So, the key recommendations will be about the organization constant change so that when changes come down, all employees will know why senior leadership is doing what they do when it comes through directives and SOPS are often delayed. Also, that when new training classes are implemented and not rushed through all the participants want to be confused and be left asking too many questions after the training has been finished.

The company will need to improve how training is conducted regarding content, delivery and implementation monitoring along with improving the organizational communications and dissemination of information within the company to all that are involved. Once those two things are done, revisit how the organization manages diversity and establish processes that support greater productivity. Because according to research done by (Saxena, 2014), diversity may be a problem, but it can enhance productivity if properly managed. In order for these to take effect, it should be supported by the senior leadership of the organization. The organization should always value the skills, abilities, and aspirations of each of their employees no matter how big are small that they may be within the organization.

Sources

Abraham, S. C. (2012). Strategic management for organizations. San Diego, CA: Bridgepoint Education, Inc.

Boone, G., & Kurtz, D. L. (2012). Contemporary business. Hoboken, NJ: John Wiley & Sons, Inc.

Great Rated Staff. (2015). USAA: What you should know. Retrieved from Great Rated website: http://us.greatrated.com/usaa.

USAA Board of Directors. (2018). Retrieved from USAA website: https://www.usaa.com/inet/

wc/about/_usaa_corporate_governance_board_of_directors? Akredirect=true.

USAA Corporate Staff. (2015). Corporate Info & Media. Retrieved from USAA website: https://www.usaa.com/inet/wc/about_usaa_main.

USAA Corporate Staff. (2015). Policies. Retrieved from USAA website: https://www.usaa.com/inet/wc/about_usaa_supplier_guide_policies?akredirect=true.

USAA Corporate Staff. (2015). USAA Career Center: Our Mission and Values. Retrieved from USAA website: https://www.usaajobs.com/about-usaa/mission-and-values.html.

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Intercultural Communication Paper – HRMN 302 From UMUC

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Intercultural Communication Paper (25 points) Outcome 3- Due Week 3

This assignment demonstrates your critical thinking skills as well as your intercultural communication competency.

It consists of two parts:

Part 1:

Complete the INCA survey and develop a one-page reflection summarizing your ideas and your results. (Include your Intercultural Competence Scoresheet)

Part 2:

Select 3 critical incidents and analyze them. Frame your analyses of each incident using the cultural dimensions studied in class. Your analysis should contain at least three scholarly references that pertain directly to the incident (can be pulled from class materials). Your analysis should be complete and supported by the literature not an opinion. You will be evaluated on how well you can forma an argument, that is, present a statement and support it with credible sources.

Complete both parts in a formal written paper using APA format. Use headings to mark each part: Part 1 and Part 2. Use subheadings to indicate the discussion of each critical incident. Please review the requirements for all written assignments on page 3 of the syllabus.

INCA is an acronym for Intercultural Competency Assessment. The purpose of the INCA survey is for you to examine your intercultural awareness and assess your cultural sensitivity. This activity is designed to help you become aware of your own attitude towards cultural diversity. The dimensions of cultural competence measured by the INCA survey are:1) Tolerance of ambiguity, 2) Behavioral flexibility, 3) Communicative awareness, 4) Knowledge discovery, 5) Respect for Otherness, and 6) Empathy.

NOTE: This project and the instrument created was funded by the Council of Europe and the Leonardo da Vinci II Program.  You can read more about this project, if you are interested, here:

http://ec.europa.eu/ewsi/en/resources/detail.cfm?ID_ITEMS=9372

Directions: Complete all of the INCA Survey questions. When you are done, use the INCA survey key to help you analyze your results. Read about the different dimensions of intercultural competency and what they mean.

Note that a total score for the INCA survey is not important for the purpose of this assignment.  (You will not get a total score).

 
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Signature Assignment

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Running head: TRAINING & DECVELOPMENT PROGRAM 1

TRAINING & DECVELOPMENT PROGRAM 19

 

Signature Assignment

Prepare a Training & Development Program

by

Dominique Wells

National University

ODV 606

June 2019

 

Signature Assignment: Prepare a Training & Development Program

Organization and Position Summary

Nike Inc. is an organization that was founded by Bill Bowerman and Phil Knight in 1964 as Blue Ribbon Sports (BRS). The organization’s primary focus has always been discovery and innovation, aiming at the provision of both experiences and products for athletes. Initially, BRS served as a distributor for Onitsuka Tiger, a Japanese shoemaker, a relationship that ended in 1971 when BRS introduced its line of footwear. Consequently, Nike Inc. built itself to become a renowned brand in the United States, dominating about half the athlete market share. Furthermore, through diversified communication to reach as many customers as possible, by the 1980s, Nike had made associations with games and directly introduced its product to its target market. The organization’s mission is to inspire athletes all over the world through its innovations, defining athletes as anyone that has a body. Nike’s vision is to maintain the creativity legacy it has already established as well as to develop business opportunities that offer it a competitive advantage and add value to the organization’s shareholders (Brohi et al., 2016). Thus, innovation is Nike’s vantage point in the industry, which the corporation seeks to exploit to retain its market dominance.

The job that the paper will focus on is the converse sales associate position. The role of the position holders at Nike Inc. is to ensure that the organization can maintain high sales from converse shoes, which have now become part of the company’s production line owing to their increased demand for use in the court, on the stage and in the streets. The position holder is expected to be highly adaptable to change to fit into the organization. They must also be alert and aware of the shoe trends in the market among a range of consumer groups including thinkers, rappers and ordinary individuals to keep Nike Inc. updated on what consumers want and enable the organization to better fulfill the needs of its customers (“Converse Sales Associate at NIKE INC,” 2019). Therefore, the converse sales associate position at Nike Inc. requires the holder to be capable of controlling sales efforts as well as consumer relations. It is also their responsibility to ensure that Nike stores selling converse shoes, deliver excellent customer service, and employ top-notch selling techniques to facilitate product flow and support merchandising.

Needs Assessment

Short-term and Long-term and Goals

Nike’s short-term goals focus on increasing the sales that the organization makes and maintaining its market share. First, the company seeks to maximize sales to increase its profit margin and maintain profitability. Secondly, the organization aims to support high-quality production to continue to retain its status as a choice brand among consumers within the market. Thirdly, Nike is determined to keep up with market trends to ensure that it meets the changing consumer needs and remains relevant to their tastes and preferences. All the efforts described above collectively seek to fulfill the short-term goal of facilitating organizational growth through the exploitation of a Direct to Consumer (DTC) approach that allows the distribution of products straight to the consumers through walk-in stores across the globe and online sales (Brohi et al., 2016). Thus, Nike’s short term goals not only seek to better organizational outcomes but also consumer satisfaction.

Moreover, the organization is looking to widen its profit margin by penetrating new markets, through the maintenance and exploitation of the excellent wholesaler relations available to Nike. Furthermore, the corporation is also looking to expand the independent monitoring programs that are available to it to include both educational institutions and government agencies to increase the publicity of its operations. Moreover, Nike aims at adopting the Occupational Safety and Health Administration (OSHA) United States law in the implementation of quality standards in its footwear factory. The corporation is also looking to fund open forums and university research projects to explore matters surrounding business responsibility and global manufacturing practices like air quality standards and independent monitoring (Mahdi et al., 2015). Hence, Nike’s goals in the short run seek to cover organizational, consumer and workforce needs to make it both an employer and brand of choice.

In the long run, Nike seeks to achieve a variety of goals, including increasing the availability of its products to consumers by building new stores in top locations like Japan, North America, and West Europe. The corporation also intends to expand the parameters of its wholesale market to make it a key driver for developing retail business and increasing its percentage contribution to annual company sales. Moreover, Nike seeks to elicit higher levels of customer satisfaction by increasing consumer awareness about the benefits of its products and developing new technologies that will further enhance product quality and usability. Increased consumer awareness about the organization’s products is expected to positively impact sales and strengthen Nike’s direct impact through the regulation of consumer business and the enhanced effectiveness of both retail and wholesale market strategies. Furthermore, the organization hopes that in the future it will be able to increase product pricing owing to brand superiority and increased product demand especially in luxury and specialized product markets (Brohi et al., 2016). All of the mentioned long-term goals that Nike seeks to realize aim at eliciting financial benefits, including increasing annual profits, heightening share growth, and return on investment (ROI) as well as growing shareholder dividends.

Decision to allocate Resources to Converse Sales Associate Position

The converse sales associate job is crucial to the success of Nike in the realization of both its short and long term goals because it is directly affiliated with ensuring that the organization’s products reach the target market in high numbers. Qualifying for a converse sales associate position at Nike Inc. requires that the applicant possess knowledge of daily sales targets and key performance indicators (KPI) as well as contribute to their realization. Additionally, the job requirements of the mentioned position dictate that eligibility is highly dependent on the ability to match both merchandising and operational performance standards and have a basic understanding of the apparel, footwear and accessories being sold (“Converse Sales Associate at NIKE INC,” 2019). Thus, based on the job requirements outlined above it is evident that the converse sales associates in Nike play a functional role in ensuring that the organization realizes its fundamental objectives of meeting consumer needs and maintaining high sales levels. This sets the stage for the realization of the other organizational goals.

Resultantly, training converse sales associate position holders is essential because it can directly contribute to enhancing the organization’s value by facilitating the betterment of its human resources. Nike’s human capital is part of its intangible assets, which research has deemed crucial to creating and sustaining a competitive advantage in the market. Through the implementation of training and development programs for the position holders mentioned above, Nike can increase its productivity and performance as well as enhance its capacity to innovate. According to the American Society for Training and Development (ASTD) organizations that make substantial investments in training and development depict shareholder returns that are 86% more than those of their counterparts that do not incorporate training programs within their operations. Training and developing employees, especially those in Nike’s sales department, is vital because it contributes to the enhancement of their competence, know-how, education, and work relations, all of which are crucial to the successful execution of job tasks aiming at the realization of stipulated organizational goals (Noe, 2017). Thus, Nike’s investment in training and developing converse sales associates is justified as it directly contributes to the realization of its short and long term goals.

 

 

Matching Organization Resources to Human Resource Needs

The rate of goal attainment in Nike increases with the organization’s ability to match its objectives to the needs of its human resources. The process that can be applied to facilitate the realization of increased efficiency of meeting corporate goals through the alignment of organizational needs with those of its human resources begins with the determination of the organization’s current and expected position in the future. Hence, Nike’s first step in matching organizational needs with those of its workforce will require the assessment of the current human resource capacity. Analyzing the existing workforce will result in understanding the talent that is available and the compilation of a skills inventory for all current Nike employees. The evaluation can be facilitated through a variety of means, including requiring employees to evaluate their capabilities through surveys, reviewing past performance records, or combining both approaches (Akhigbe, 2013). The examples of the skills that are crucial to a converse sales associate at Nike Inc. include the ability to identify potential buyers, qualify leads, influence purchases and close deals (Ingram et al., 2015). See Figure 1 in the appendices for an example of a self-evaluating skills inventory.

Next, aligning Nike’s needs with those of its workforce requires the forecast of the needs of the human capital. The process involved will necessitate the determination of whether the corporation will need to grow the number of its human resources or maintain the current staff numbers and enhance their capabilities through training. Additionally, it is necessary for Nike to determine whether the talent pool in the job market can fulfill any of the human capital needs likely to present themselves to the organization in the future. Therefore, the corporation must evaluate both its demand for qualified personnel and their availability to create grounds for the proper management of talent (Akhigbe, 2013). The demand forecasting phase is characterized by a detailed process of establishing reasonable human resource quantity, and quality needs to determine the number of employees required and the nature of talent that may be necessary to acquire. Supply forecasting entails the determination of whether the resources that are currently available can meet the established demands by either exploiting the talent within the organization or in the job market (Cascio, 2015). Thus, the success of the demand and supply forecasting processes is determined by the organization’s capability to match its demand and supply of human resources through the implementation of plans that establish whether Nike will fulfill its future talent needs by outsourcing or insourcing.

Consequently, Nike must also engage in determining the strategies it will use to develop its human resources. Developing talent is crucial to fulfilling the need to align organizational requirements with those of the employees within it. Therefore, the undertaking begins with the recruitment phase characterized by the search for job applicants whose skills match organizational needs. The second stage involves the selection of the right people from a pool of qualified candidates based on the forecasts of supply and demand previously made. Thirdly, hiring follows where the decision to get the final candidates to fill the open positions is made after which the training and development phase begins (Akhigbe, 2013). Training new employees is essential because it informs them of the fundamentals of organizational procedures and encourages skill development to fit corporation needs.

Furthermore, the matter concerning the remuneration of employees must be addressed by offering new hires competitive benefit packages and salaries to maximize their retention in the organization over long periods. Nike must also implement measures that facilitate performance management to determine employee strongholds and weaknesses as well as incentivize excellent performance. Furthermore, the corporation should create an influential organizational culture that focuses on the betterment of employee relations to attract and retain top talent from the job market (Akhigbe, 2013). See an overview of the talent development process in figure 2 in the appendix section.

Lastly, the process of aligning organizational needs with those of its employees requires Nike to review and evaluate the previous measures implemented to manage its human resources and facilitate goal realization. Assessing the entire plan allows the determination of its effectiveness in promoting the attainment of objectives through the evaluation of factors like employee retention, organizational production, and profitability (Akhigbe, 2013). If the measures implemented elicit positive results, the organization can continue to apply them, and if not, they can be altered to suit its needs better.

Employee Orientation Program

The employee orientation process entails the introduction of new members of the workforce to their co-workers, responsibilities, workplaces, and jobs. The process aims to enable new employees to feel comfortable within their new work environment and understand the organization’s policies and procedures to enhance comprehension of what is expected of them (Park et al., 2018). Therefore, for employees to smoothly transition into their new roles, the orientation process must be characterized by the implementation of learning theories to ensure that employees’ responsibilities are clearly communicated to them. Using learning theories to guide the employee orientation process facilitates its structuring to ensure that the workforce that is developed gains commitment and flexibility skills that are crucial to maximizing productivity (Jyoti & Dev, 2015). Hence, for Nike Inc. to optimize the results of the employee orientation program it implements, the corporation must evaluate the effectiveness of the application of various learning theories before selecting one to guide the entire process. Discussed below are some appropriate orientation plans that Nike Inc. can employ to assimilate a new converse sales associates.

Reinforcement Theory

An orientation plan established based on the provisions of the reinforcement theory would guide employee learning through the principle of shaping behavior by manipulating its consequences (Noe, 2017). Using the mentioned theory would allow the utilization of both rewards and punishments to encourage or extinguish desired and undesired behaviors, respectively. A reinforcement orientation plan would depend on the consequences of employee behavior to shape their future mannerisms in the execution of their job tasks. Thus, the new employees will be expected to determine how to respond to various job circumstances based on the positive response outcomes realized in the past. The facilitators of the orientation process would be required to focus on reinforcing the behavior of new employees either positively or negatively, to depict its value or undesirability, respectively (Anicich & Hirsh, 2017). Therefore, proper guidance of new employees would be crucial to ensuring that they adopt behavior that is beneficial to the organization. See Figure 3 in the appendix section for a visual representation of the implications of reinforcement on behavior.

Goal Theory

The goal theory dictates that the goal-setting process is crucial to performing tasks. If an employee going through the orientation process receives specific and challenging job goals coupled with the right feedback, they are likely to develop high task execution capabilities (Noe, 2017). Therefore, during employee orientation for converse sales associates at Nike Inc., the facilitators of the program must employ appropriate goal mechanisms to increase the motivation of the human resources to attain the set objectives. Among the techniques that can be applied to set goals is the exploitation attention direction through goal setting to encourage employees to acquire behavior that facilitates aim realization rather than the contrary. Also, the energizing effect of objective determination can be used to inspire the delivery of a certain level of effort depending on the intensity of the job task that needs to be completed (Shogren et al., 2017). Through goal setting, employee behavior can be manipulated to enhance productivity levels by appealing to various motivators of skill development.

Additionally, a goal based orientation process can also exploit the task persistence mechanism to regulate the amount of time that new employees spend in developing behavior that is deemed vital for successful task execution. Lastly, the facilitators of the orientation process can also utilize the effective strategy mechanism meant to boost the morale of members of the workforce to seek out different means through which they can realize the pre-determined goals (Shogren et al., 2017). Hence, employing an orientation plan that is based on the goal theory will enable Nike’s organizational leaders to manipulate and shape new employee behavior through different mechanisms to elicit the desired job skills.

Need Theory

The most appropriate need theory to apply in Nike Inc.’s orientation plan is the three needs theory proposed by McClelland. The first need that the program would seek to exploit is the need for the new employees to achieve. Employees prefer to exert effort in the fulfillment of moderately difficult tasks and appreciate the reception of feedback on the jobs they complete. Thus, they are likely to avoid both high and low-risk situations, creating an employee personality type that is motivated by accomplishment. Also, a need-based orientation plan can exploit the employees’ requirement for affiliation, which drives them to spend time to create and nurture social relations. Employee cohesion in the workplace is vital because it establishes grounds for collaboration and teamwork, both of which are crucial to the realization of organizational goals. Furthermore, the need theory also presents the opportunity to manipulate the requirement for power, which encourages the attainment of individual goals. Extreme exploitation of the power need would result in the disregard for teamwork, which is not an aim of the orientation process (Khurana & Joshi, 2017). Therefore, when using the three needs theory to facilitate the orientation, Nike’s organizational leaders must moderate the effects of the need for power among new employees to realize the objectives of orientation that are stipulated above.

Decision-Making Process for Selecting the best Theory

The decision-making process employed to determine the best theory for incorporation in the Nike Inc. employee orientation process entailed the identification of the choice that needed to be made. Following the organization’s need to implement a theory based orientation plan, the requirement to explore various approaches to determine the most appropriate arose. Information was gathered, and the three alternatives discussed above identified. Further research was conducted to determine the components and implications of the three theories after which the goal theory approach was deemed the most applicable in the orientation of converse sales associates at Nike Inc. (Dartmouth, 2019). An orientation plan based on the goal theory would serve the organization best because it would allow the facilitators of the program to emphasize the need for Specific, Measurable, Accurate, Realistic and Time-bound goals among its new sales employees. Additionally, it would highlight the essentiality of goal acceptance and commitment, specificity, difficulty assessment, and feedback delivery on the progress of goal pursuits (Redmond, 2016). Thus, developing the skills of a new converse sales associate at Nike would best be served by exploiting the provisions of the goal theory because the job requires precision in setting and achieving sales objectives.

Training and Development Program

An appropriate training and development program for the converse sales associate position would be characterized by the incorporation of different training methods, including on the job training (OJT), online learning, and interactive learning.

Online Training

Nike’s incorporation of online learning in its training and development program for converse sales associates would eliminate the need for an in-person training facilitator. The e-learning training will enable the organization to provide employees with necessary learning material on a website or an app to ensure that they can access the material from a variety of locations. The online classes will be characterized by the availability of visual content displayed on the screen and, where applicable, the instructor’s written or voiced instructions (Brown, 2017). The online training would meet the organization’s need to teach converse sales associates in different organizational branches across the globe with maximum efficiency and reduced cost implications. Additionally, it would allow the employees the flexibility to determine their pace of participating in the program, enabling them to maximize the benefits of the knowledge acquired depending on the learning style they deem to be the most appropriate. Furthermore, to overcome the downside of the reduced learner engagement because of minimal supervision, the online training will incorporate interactive module exercises, quizzes and exams to ensure that the program participants maximally explore the training content.

Interactive Training

Reinforcing the knowledge acquired from the online learning platform would be necessary to ensure that Nike’s converse sales associates maximally benefit from the training and learn the intended essential skills and expertise. Hence, interactive learning will create an opportunity for them to not only receive training reinforcement from a program facilitator but also their associates. The interactive learning will be characterized by group discussions, quizzes, role-playing, and demonstrations. Incorporating this training method will alleviate the monotony and boredom associated with learning with the hope of maximally impacting the employees’ training (Asheim & Parrilli, 2012). This type of training will fulfill Nike’s needs because it can effectively deal with the negative implications of one-directional learning by empowering program participants to learn from each other. Additionally, it will enable Nike to create learning programs that target specific regions to allow its employees to develop skills that allow them to meet specific consumer needs. Furthermore, it will encourage collaboration and teamwork among employees as well as improve communication skills, serving the purpose of enhancing their knowledge, skills, and abilities, which are crucial to facilitating goal attainment.

On the Job Training (OJT)

Regardless of the inherent similarities that characterize the job descriptions of Nike’s converse sales associates, positions in different outlets and stores are unique because of the variation in customer preferences. On the job training will focus more on the practical aspects of the role, reinforcing the training delivered through interactive and online learning (Jagero, Komba & Mlingi, 2012). Therefore, OJT will be a vital part of Nike’s training and development program to enable the employees hired for the position mentioned above to learn traits that are specific to the successful execution of their duties in different stores. Additionally, it will prove vital to boosting the recollection of the knowledge and skills required to successfully execute job tasks because of the hands-on nature of the learning process that is involved.

A Training Evaluation Plan

An appropriate training evaluation plan for the program developed above would require to assess different types of results including reaction, learning, and behavior outcomes

Reaction Outcomes

The effectiveness of a training program can partly be established by evaluating employee reactions towards it. In this case, an opinion survey will be used to determine employees’ responses to the training program after their participation. The questionnaire will use a Likert scale to ease the quantification of the trainees’ reactions and allow the assessors to have a clear picture of what the trained employees thought of the program. Reaction outcomes must be assessed because they can provide insights on the strengths and weaknesses of the training program and enable the facilitators to make the necessary adjustments for the program to better suit the needs of the next lot of trainees (Noe, 2017). The evaluation of reaction outcomes will establish the suitability of the implemented training program to its audience.

Learning Outcomes

Learning outcomes must be assessed to establish the effectiveness of the training. It will be achieved by requiring the trainees to take quizzes or exams after specified training periods to assess their knowledge retention capacity and the impact of the learning processes on their ability to resolve possible job issues presented (Noe, 2017). These outcomes are the most vital because they will determine whether the developed training program realize its goal of instilling specific and practical sales knowledge among Nike’s converse sales associates.

Skill and Behavioural Outcomes

The best way to assess the skill and behavioral outcomes depicted by the employees on completion of the training process will be through observation. Part of the skills acquired will be evaluated on paper in exams and quizzes, but the physical evaluation of their implementation is also crucial. A supervisor or manager will require to monitor the trained employee’s behavior and skills employed in job execution on completion of the training and compare the findings to the employee’s tendencies before the training. If a positive change is noted, it will depict that the training was beneficial, and the converse will apply upon realization of negative or no changes (Noe, 2017). Skill and behavioral outcomes will help justify the effectiveness of the training and development program as well as explain its continuous use by highlighting its return on investment (ROI).

 

 

 

References

Akhigbe, O. J. (2013). Human resource planning: A key factor in ensuring the effectiveness and efficiency of organization. Journal of Emerging Trends in Economics and Management Sciences, 4(4), 388.

Anicich, E. M., & Hirsh, J. B. (2017). The psychology of middle power: Vertical code-switching, role conflict, and behavioral inhibition. Academy of Management Review, 42(4), 659-682.

Asheim, B., & Parrilli, M. D. (2012). Interactive Learning for Innovation. A Key Driver within Clusters and Innovation Systems, Basingstoke.

Brohi, H., Prithiani, J., Abbas, Z., Bhutto, A., & Chawla, S. (2016). Strategic Marketing Plan of Nike.

Brown, K. G. (Ed.). (2017). The Cambridge Handbook of Workplace Training and Employee Development. Cambridge University Press.

Cascio, W. F. (2015). Managing human resources. McGraw-Hill.

Converse Sales Associate at NIKE INC. (2019). Retrieved from https://jobs.nike.com/job/montabaur/converse-sales-associate/824/10284754

Dartmouth, U. (2019). Decision-making process – UMass Dartmouth. Retrieved from https://www.umassd.edu/fycm/decision-making/process/

Ingram, T. N., LaForge, R. W., Williams, M. R., & Schwepker Jr, C. H. (2015). Sales management: Analysis and decision making. Routledge.

Jagero, N., Komba, H. V., & Mlingi, M. N. (2012). Relationship between on the job training and employee’s performance in courier companies in Dar es Salaam, Tanzania. International journal of humanities and social science, 2(22), 114-120.

Jyoti, J., & Dev, M. (2015). The impact of transformational leadership on employee creativity: the role of learning orientation. Journal of Asia Business Studies, 9(1), 78-98.

Khurana, H., & Joshi, V. (2017). Motivation and Its Impact on Individual Performance: A Comparative Study Based On Mcclelland’s Three Need Model. Clear International Journal of Research in Commerce & Management, 8(7).

Mahdi, A., Abbas, M., Mazar, T. I., & George, S. A. (2015). A Comparative Analysis of Strategies and Business Models of Nike, Inc. and Adidas Group with special reference to Competitive Advantage in the context of a Dynamic and Competitive Environment. International Journal of Business Management and Economic Research, 6(3), 167-177.

Noe, R. (2017). Employee training and development. McGraw-Hill.

Park, C., Jun, J., Lee, T., & Lee, H. (2018). Customer orientation or employee orientation: which matters more? The moderating role of firm size. Journal of Business & Industrial Marketing, 33(7), 1001-1011.

Redmond, B. (2016). 6. Goal Setting Theory – PSYCH 484: Work Attitudes and Job Motivation – Confluence. Retrieved from https://wikispaces.psu.edu/display/PSYCH484/6.+Goal+Setting+Theory

Shogren, K. A., Wehmeyer, M. L., & Palmer, S. B. (2017). Causal agency theory. In Development of Self-Determination Through the Life-Course (pp. 55-67). Springer, Dordrecht.

 

Appendices

Figure 1: Example of Self-Evaluating Sales Inventory

Figure 2: Visual Representation of the Talent Development Process

Figure 3: Visual Representation of the Role of Reinforcement in shaping Employee Behavior

 
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Assignment 2 Avon Case Study

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Assignment 2: Avon Products Case Study

Write a five to seven (5) page paper in which you:

 

  1. Provide a brief description of the status of the company that led to its determination that a change was necessary.
  2. Identify the model for change theory typified in the case study of your choice. Discuss what led you to identify the model that you did.
  3. Illustrate the types of evaluation information that were collected and how they are used to benefit the company.
  4. Speculate about success of the changes within the next five (5) years and how adjustments could be made if the results become less than ideal.
  5. Use at least five (5) quality academic resources in this assignment. Note: Wikipedia and other Websites do not quality as academic resources.

 

Your assignment must follow these formatting requirements:

 

  • Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; references must follow APA or school-specific format. Check with your professor for any additional instructions.
  • Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date.
  • The cover page and the reference page are not included in the required page length.

 

The specific course learning outcomes associated with this assignment are:

 

  • Explore how to identify and develop high-potential talent.
  • Analyze behavior change theories and their impact on talent management processes.
  • Determine the effects of leadership in the management of talent pools and the talent review process.
  • Use technology and information resources to research issues in talent management.
  • Write clearly and concisely about talent management using proper writing mechanics.
 
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Case Study For Organizational Behaviour Class 3 Pages

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Case study

(3 pages single spaced)

Refer to the Hy Dairies, Ltd.” case (at the end of this page) and answer the following three questions.

1. What symptoms exist to suggest that something has gone wrong?

2. What are the root causes that led to these symptoms?

3. What actions should the organization take to correct these problems? Case Study Guidelines:

The purpose of case studies is to help develop your analytical skills.

The three questions above are meant to guide you in the direction of clear, systematic assessment.

In question # 1, you need to consider the symptoms of the case. In other words, what are the observable signs that things have gone wrong? What are the “red flags”?

In question #2, you will take what you’ve learned in the course, and your own experiences, to reflect on what might be the underlying root causes to the issues you identified in the first question. This will provide some potential “whys” for the observable symptoms. (I actually don’t have any work experience you can just give examples from random daily life situations. We pretty much learned about organizational behavior, how to cope with other employees by understanding different cultures, personalities, different generations(millennials etc.) and whatnot. How employees need to be more effective and efficient. Motivated….how companies should have the same purpose. Its pretty much common sense. If you have any questions please send me a message)

Based on your considerations for question # 2, you will then formulate suggestions or solutions to the case. This will formulate your response for question # 3.

This three-­‐step process helps develop a logical approach. It helps ensure the analysis isn’t “short-­‐ circuited” by looking at the symptoms and immediately go into making recommendations.

Before allowing you to make recommendations, the process pushes you to consider the underlying root causes. This process can be called the “iceberg effect”

Imagine the problem is an iceberg. It is the tip above the water that is the easiest to see (the symptoms). If you try to solve a problem based on what you see above the water, you will not be developing a solution based on the whole problem. Question

# 2 pushes you down into the problem (below the water’s surface) by having you ask the question, “Why might this be happening?” Your solution, when based on the entire problem (both observable symptoms and root causes), is more likely to be on target.

It is valuable to remember that the responses to case studies are somewhat subjective. It is more important to provide your reasoning and ideas in a concise and thoughtful way than to be absolutely correct.

Your assignment should be approximately 2 -­‐ 3 pages in length, single spaced. Consider the use of formatting such as point form, subheadings, etc to help organize your ideas and recommendations.

Case Study: HY DAIRIES LTD.

Syd Gilman read the latest sales figures with a great deal of satisfaction. The vice-president of marketing at Hy Dairies, Ltd., a large Canadian milk products manufacturer, was pleased to see that the marketing campaign to improve sagging sales of Hy’s gourmet ice cream brand was working. Sales volume and market share of the product had increased significantly over the past two quarters compared with the previous year.

The improved sales of Hy’s gourmet ice cream could be credited to Rochelle Beauport, who was assigned to the gourmet ice cream brand last year. Beauport had joined Hy less than two years ago as an assistant brand manager after leaving a similar job at a food products firm. She was one of the few nonwhite women in marketing management at Hy Dairies and had a promising career with the company. Gilman was pleased with Beauport’s work and tried to let her know this in the annual performance reviews. He now had an excellent opportunity to reward her by offering the recently vacated position of market research coordinator. Although technically only a lateral transfer with a modest salary increase, the marketing research coordinator job would give Beauport broader experience in some high-profile work, which would enhance her career with Hy Dairies. Few people were aware that Gilman’s own career had been boosted by working as marketing research coordinator at Hy several years before.

Rochelle Beauport had also seen the latest sales figures on Hy’s gourmet ice cream and was expecting Gilman’s call to meet with her that morning. Gilman began the conversation by briefly mentioning the favourable sales figures, and then explained that he wanted Beauport to take the marketing research coordinator job. Beauport was shocked by the news. She enjoyed brand management and particularly the challenge involved with controlling a product that directly affected the company’s profitability. Marketing research coordinator was a technical support position—a “backroom” job—far removed from the company’s bottom-line activities. Marketing research was not the route to top management in most organizations, Beauport thought. She had been sidelined.

After a long silence, Beauport managed a weak “Thank you, Mr. Gilman.” She was too bewildered to protest. She wanted to collect her thoughts and reflect on what she had done wrong. Also, she did not know her boss well enough to be openly critical.

Gilman recognized Beauport’s surprise, which he naturally assumed was her positive response to hearing of this wonderful career opportunity. He, too, had been delighted several years earlier about his temporary transfer to marketing research to round out his marketing experience. “This move will be good for both you and Hy Dairies,” said Gilman as he escorted Beauport from his office.

Beauport was preoccupied with several tasks that afternoon, but was able to consider the day’s events that evening. She was one of the top women and few minorities in brand management at Hy Dairies and feared that she was being sidelined because the company didn’t want women or nonwhite people in top management. Her previous employer had made it quite clear that women “couldn’t take the heat” in marketing management and tended to place women in technical support positions after a brief term in lower brand management jobs. Obviously Syd Gilman and Hy Dairies were following the same game plan. Gilman’s comments that the coordinator job would be good for her was just a nice way of saying that Beauport couldn’t go any further in brand management at Hy Dairies.

Beauport now faced the difficult decision of whether to confront Gilman and try to change Hy Dairies’ sexist and possibly racist practices or to leave the company.

 
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Maladaptive Immune Response Mechanisms

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Maladaptive Immune Response Mechanisms

(Maladaptive Immune Response Mechanisms)

Maladaptive Responses to Immune Disorders

Maladaptive responses to disorders are compensatory mechanisms that ultimately have adverse health effects for patients. For instance, a patient’s allergic reaction to peanuts might lead to anaphylactic shock, or a patient struggling with depression might develop a substance-abuse problem. To properly diagnose and treat patients, advanced practice nurses must understand both the pathophysiology of disorders and potential maladaptive responses that some disorders cause.

Consider immune disorders, such as HIV, psoriasis, inflammatory bowel disease, and systemic lupus E. What are resulting maladaptive responses for patients with these disorders?

To prepare:

  • Review Chapter 5 and Chapter 7 in the Huether and McCance text, as well as the Yi, et al, article in the Learning Resources. Reflect on the concept of maladaptive responses to disorders.
  • Select two of the following immune disorders: HIV, psoriasis, inflammatory bowel disease, and/or systemic lupus E (SLE).
  • Think about the pathophysiology of each disorder you selected. Consider the compensatory mechanisms that the disorders trigger. Then, compare the resulting maladaptive and physiological responses of the two disorders.
  • Consider the types of drugs that would be prescribed to patients to treat symptoms associated with these disorders and why.
  • Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Consider how your selected factor might impact the disorder. Then, reflect on how your selected factor might impact the effects of prescribed drugs, as well as any measures you might take to help reduce any negative side effects.

Questions to be addressed in my paper:

  1. A brief description of the pathophysiology of the immune disorders you selected.
  2. Explain how the maladaptive and physiological responses of the two disorders differ.
  3. Then, describe the types of drugs that would be prescribed to patients to treat symptoms associated with these immune disorders and why.
  4. Explain how the factor you selected might impact the pathophysiology of each disorder as well as the effects of prescribed drugs.
  5. Explain any measures you might take to help reduce any negative side effects.
  6. Summary with Conclusion

Maladaptive Immune Response Mechanisms

REMINDERS:

1)      2-3 pages (addressing the 5 questions above excluding the title page and reference page).

2)      Kindly follow APA format for the citation and references! References should be between the period of 2011 and 2016. Please utilize the references at least three below as much as possible and the rest from yours.

3)     Make headings for each question.

RESOURCES:

Readings

  • Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.
    • Chapter 5, “Innate Immunity: Inflammation and Wound Healing”This chapter examines how the body responds to injury and infection by exploring the first, second, and third lines of defense. It also covers wound healing and alterations of the wound-healing process.
    • Chapter 6, “Adaptive Immunity”This chapter examines the third line of defense, adaptive immunity. It also covers the roles of antigens and immunogens, the humoral immune response, cell-mediated immunity, and the production of B and T lymphocytes in the immune response.
    • Chapter 7, “Infection and Defects in Mechanisms of Defense”This chapter covers the epidemiology, clinical presentation, and treatment of disorders resulting from infection, deficiencies in immunity, and hypersensitivity. It also examines the pathophysiology of an important immune disorder: HIV/AIDS.
    • Chapter 8, “Stress and Disease”This chapter evaluates the impact of stress on various body systems and the immune system. It also examines coping mechanisms and disorders related to stress.
    • Chapter 39, “Structure, Function, and Disorders of the Integument”This chapter begins with an overview of the structure and function of skin. It then covers effects of aging on skin, as well as disorders of the skin, hair, and nails.
    • Chapter 40, “Alterations of Integument in Children”This chapter covers alterations of the integument that affect children. These include acne vulgaris, dermatitis, infections of the skin, insect bites and parasites, vascular disorders, and other skin disorders.
  • Poole Arcangelo, V., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
    • Chapter 8, “Principles of Antimicrobial Therapy”This chapter covers factors that impact the selection of an antimicrobial treatment regimen. It also examines the clinical uses, adverse events, and drug interactions of various antimicrobial agents, such as penicillin
    • Chapter 12, “Fungal Infections of the Skin”This chapter explores the pathophysiology of several fungal infections of the skin, as well as related drug treatments. It also examines the importance of patient education when managing these infections.
    • Chapter 14, “Bacterial Infections of the Skin”This chapter begins by examining causes of bacterial infections. It then explores the importance of selecting an appropriate agent for treating bacterial infections.
    • Chapter 32, “Urinary Tract Infection”This chapter covers drugs used to treat urinary tract infections. It also identifies special considerations when treating geriatric patients, pediatric patients, and women.
    • Chapter 35, “Sexually Transmitted Infections”This chapter outlines the causes, pathophysiology, and drug treatment of six sexually transmitted infections, including gonorrhea, syphilis, and human papilloma virus infection (HPV). It also examines the importance of selecting the proper agent and monitoring patient response to treatment.
    • Chapter 48, “Human Immunodeficiency Virus”This chapter presents the causes, pathophysiology, diagnostic criteria, and prevention methods for HIV. It also covers various methods of drug treatment and patient factors to consider when selecting, administering, and managing drug treatments.
  • Yi, H., Shidlo, A., & Sandfort, T. (2011). Assessing maladaptive responses to the stress of being at risk of HIV infection among HIV-negative gay men in New York City. Journal of Sex Research, 48(1), 62–73.
    Retrieved from the Walden Library databases.This study assesses behaviors and attitudes toward HIV based on knowledge about infection and advances in medical treatment. It also examines the impact of maladaptive responses to the stress of HIV risk.
  • Scourfield, A., Waters, L., & Nelson, M. (2011). Drug combinations for HIV: What’s new? Expert Review of Anti-Infective Therapy, 9(11), 1001–1011. Retrieved from http://www.expert-reviews.com/doi/abs/10.1586/eri.11.125 

    This article examines current therapies and strategies for treating HIV patients. It also examines factors that impact the selection of therapy, including drug interactions, personalization of therapy, costs, management of comorbidities, and patient response.

  • Drugs.com. (2012). Retrieved from www.drugs.comThis website presents a comprehensive review of prescription and over-the-counter drugs, including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

Media

  • Laureate Education, Inc. (Executive Producer). (2012b). Antimicrobials. Baltimore, MD: Author.This media presentation outlines principles of antimicrobial therapy.

Optional Resources

 
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Skin Cancer and Evolution

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Skin Cancer and Evolution

(Skin Cancer and Evolution)

Biology Questions On Cancer

1. What are the causes of skin cancer?

2. Why are Caucasians more at risk of skin cancer than other populations?

3. At what age does skin cancer typically occur? Is the incidence of skin cancer greater in youth or old age?

4. Does the amount of UV light reaching the Earth vary in a predictable manner (Figure 6-3)? If so, describe the pattern you observe.

5. What latitude receives the greatest amount of UV light (Figure 6-3)? The least?

6. Based on these data (Figure 6-3), where might you expect to find the most lightly pigmented and most darkly pigmented people on the planet? Be as specific as you can.

7. Provide a rationale to your answer above (i.e., why did you think that more darkly pigmented people would be found in those areas)?

8. Interpret Figure 6-4 and the trend it describes.

A. Is skin reflectance randomly distributed throughout the globe? If not, how would you describe the pattern?

B. Restate your findings in terms of skin color and UV light (instead of skin reflectance and latitude).

C. How closely do these findings match the predictions of your hypothesis (Question 6)?

D. Some populations have skin colors that are darker or lighter than predicted based on their loca­tion. Their data point falls somewhere outside of the line shown in (Figure 6-4). What might ex­plain the skin color of these exceptional populations? Propose a few hypotheses.

E. Hypothesize why different skin colors have evolved.

(Skin Cancer and Evolution)

9. Hypothesize why different skin colors have evolved. Based on what you know, what factor is most likely to exert a selective pressure on skin color?

10. Review your answer to Question 3. Keeping your answer in mind, how strong a selective pressure do you expect skin cancer (UV-induced mutations) to exert on reproductive success?

11. Based on this information, does your hypothesis about the evolution of skin color (Question 9) seem likely? Why or why not? How does skin color meet, or fail to meet, the three requirements of natural selection outlined above?

12. Based on Branda and Eaton’s results (Figure 6-5), what is the apparent effect of UV light exposure on blood folate levels?

13. What is the apparent effect of UV light on folate levels in these test tubes? __________________

14. How is folate linked to natural selection?

15. All other things being equal, which skin tone would you expect to be correlated with higher levels of folate? _________________________________________________________________________

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

17. What would happen to the reproductive success of:

A.light-skinnedperson living in the tropics? _________________________________________

B. light-skinned person living in the polar region? _____________________________________

C.dark-skinned person living in the tropics? _________________________________________

D.  dark-skinned person living in the polar region? _____________________________________

18. Predict the skin tones expected at different latitudes, taking folate needs into consideration. Use the world map (Figure 6-6) to indicate the skin tone expected at each latitude (shade the areas where populations are darkly pigmented).

19. Can folate explain the variation and distribution of light- and dark-skinned individuals around the world?

20. How is vitamin D linked to natural selection?

21. Which skin tone allows someone to maintain the recommended level of vitamin D? ________________

22. Based on this new information, revise your hypothesis to explain the evolution of the variation and distribution of human skin color.

23. Taking only vitamin D into consideration, what would happen to the reproductive success of:

A. light-skinned person living in the tropics? _________________________________________

B. light-skinned person living in the polar region? _____________________________________

C. dark-skinned person living in the tropics? _________________________________________

D. dark-skinned person living in the polar region? _____________________________________

24. Predict the skin tones expected at different latitudes, taking only vitamin D needs into consider­ation. Use the world map (Figure 6-8) to indicate the skin tone expected at each latitude (shade a region to represent pigmented skin in that population).

25. Can vitamin D alone explain the current world distribution of skin color? ____________________

26. Using principles of natural selection, predict the skin tone expected at different latitudes, taking ul­traviolet exposure, vitamin D, and folate needs into consideration. Use the map (Figure 6-9) to indicate skin tone patterns at different latitudes (shade regions where populations are expected to be darkly pigmented).

27. Are UV light, vitamin D and folate needs sufficient to explain the current world distribution of skin color? ___________________________________________________________________________

28. How might you explain that Inuits, living at northern latitudes, are relatively dark-skinned (much more so than expected for their latitude)? Propose a hypothesis.

29. Conversely, Northern Europeans are slightly lighter-skinned than expected for their latitude. Pro­pose a hypothesis to explain this observation.

 
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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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Week 5 Reflection – Answered

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Week 5 Reflection – Answered

In what ways could an understanding of systems theory and complexity science impact the role of the NP? Take a few minutes to reflect on the NP practice model that is most predominant in advanced practice environments you have observed. Are you satisfied with the demonstrated level of interprofessional collaboration? Briefly consider what appears to be the driving practice model for advanced practice nursing in your state. If your state lags behind in its practice model language, what might you do to facilitate change? (Week 5 Reflection – Answered)

Answer

The Impact of Systems Theory and Complexity Science on Nurse Practitioners (NPs)

Understanding Systems Theory and Complexity Science

Systems theory and complexity science offer valuable insights into how nurse practitioners (NPs) can enhance their practice. Systems theory emphasizes the interconnectedness of various components within a system, which in healthcare translates to recognizing how different elements—patients, healthcare providers, and administrative processes—interact and influence each other. Complexity science, on the other hand, focuses on how complex systems behave in unpredictable and non-linear ways. For NPs, applying these theories can lead to a more holistic approach to patient care, improved decision-making, and better adaptation to changes in the healthcare environment. By understanding that healthcare is a dynamic system with many interacting parts, NPs can better anticipate how changes in one area might affect others, leading to more effective interventions and strategies. (Week 5 Reflection – Answered)

NP Practice Models and Interprofessional Collaboration

In many advanced practice environments, the predominant NP practice model is collaborative, where NPs work closely with physicians, specialists, and other healthcare professionals. This model promotes shared decision-making and leverages the diverse expertise of the healthcare team to provide comprehensive patient care. However, the level of interprofessional collaboration can vary significantly. In some settings, collaboration is robust and well-integrated, while in others, it might be limited by organizational barriers or professional silos. Evaluating the effectiveness of these collaborations is crucial for identifying areas where improvements can be made. For instance, frequent team meetings, clear communication channels, and mutual respect among team members can enhance collaborative efforts and ensure that patient care is optimized. (Week 5 Reflection – Answered)

Driving Practice Models and State-Specific Considerations

The practice model for advanced practice nursing can differ widely from state to state. In states where NP practice is restricted by limited prescriptive authority or collaborative agreement requirements, there may be a need for advocacy and policy change. If your state lags behind in adopting more progressive practice models, several strategies can be employed to facilitate change. Engaging in legislative advocacy, participating in professional organizations, and educating policymakers about the benefits of expanded NP roles can help drive reform. Additionally, demonstrating the positive outcomes of advanced practice models through data and case studies can strengthen the case for policy adjustments. By leveraging systems theory and complexity science, NPs can better navigate the complexities of healthcare systems and advocate for changes that enhance their practice. Understanding and addressing the nuances of interprofessional collaboration and staying informed about state-specific practice models are essential for advancing the role of NPs and improving patient outcomes.

References

Phelan, S. E. (2001). What is complexity science, really?. Emergence, A Journal of Complexity Issues in Organizations and Management, 3(1), 120-136. https://www.tandfonline.com/doi/pdf/10.1207/S15327000EM0301_08

 
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DIABETES AND DRUG TREATMENTS – Answered

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DIABETES AND DRUG TREATMENTS – Answered

Each year, 1.5 million Americans are diagnosed with diabetes (American Diabetes Association, 2019). If left untreated, diabetic patients are at risk for several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations. For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes (DIABETES AND DRUG TREATMENTS – Answered).

To Prepare: Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Select one type of diabetes to focus on for this Discussion. Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment. Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments. Post a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples.

Answer

Understanding Type 1 Diabetes and Its Management

Differences Between Types of Diabetes

Diabetes mellitus encompasses several types, each with distinct characteristics. Type 1 diabetes is an autoimmune disorder where the immune system attacks and destroys the insulin-producing beta cells in the pancreas, resulting in little to no insulin production (American Diabetes Association, 2020). It primarily affects children and young adults, necessitating lifelong insulin therapy. Type 2 diabetes, in contrast, involves insulin resistance and a relative deficiency of insulin production. It is more common in adults, though increasing rates in children are observed due to rising obesity levels. This type is often managed with lifestyle modifications and oral hypoglycemic agents (Centers for Disease Control and Prevention, 2022). Gestational diabetes occurs during pregnancy and usually resolves postpartum, but it increases the risk of type 2 diabetes later for both mother and child (National Institute of Diabetes and Digestive and Kidney Diseases, 2021). Juvenile diabetes typically refers to type 1 diabetes in children and adolescents, emphasizing its early onset and impact.

Focus on Type 1 Diabetes

For managing type 1 diabetes, insulin therapy is essential. Rapid-acting insulins like insulin lispro (Humalog) are commonly used. Proper administration involves preparing the insulin by checking its clarity and expiration date, ensuring it is free from particles, and following the prescribed dosage. Insulin lispro is administered subcutaneously using syringes, insulin pens, or pumps, usually before meals to effectively control postprandial blood glucose levels (American Diabetes Association, 2020).

Dietary considerations are crucial for effective management. Patients should focus on a balanced diet, emphasizing whole grains, lean proteins, fruits, and vegetables while closely monitoring carbohydrate intake. Carbohydrate counting is vital for adjusting insulin doses to maintain stable blood glucose levels (Kerr et al., 2017).

Impact on Patients

In the short term, proper insulin management helps prevent acute complications such as hyperglycemia and hypoglycemia, which can lead to symptoms like fatigue, blurred vision, and frequent urination. Long-term impacts of type 1 diabetes include an increased risk of serious complications such as cardiovascular disease, neuropathy, nephropathy, and retinopathy. Ongoing glucose monitoring and insulin adjustments are critical to minimize these risks and manage the condition effectively (Wang et al., 2021). Despite advancements in treatment, type 1 diabetes requires continuous vigilance and adaptation to maintain optimal health (DIABETES AND DRUG TREATMENTS – Answered).

References

 
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