FNU Pathophysiology Quiz-2

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FNU Pathophysiology Quiz-2

(FNU Pathophysiology Quiz-2)

Question 1

A 70-year-old woman has received a diagnosis of chronic myelogenous leukemia (CML) after a clinical investigation sparked by the presence of leukocytosis in her routine blood work. What clinical course should her care provider tell her to expect?

Answers:

A. “It’s likely that this will give you chronic fatigue and malaise for the rest of your life, but that will probably be the extent of your symptoms.”

B. “Unfortunately, your leukemia will likely enter a crisis mode within a few weeks if we don’t treat it immediately.”

C. “You could remain the chronic stage of CML for several years before it accelerates and culminates in a crisis.”

D. “You can expect your blood results, fatigue, and susceptibility to infection to gradually worsen over a few years.”

Question 2

Following an injury resulting in a small cut from a knife, the first cells to go to the area of the cut would be the

Answers:

A. erythrocytes.

B. basophils.

C. neutrophils.

D. albumin.

Question 3

Which of the following diagnostic findings is likely to result in the most serious brain insult?

Answers:

A. Moderate decrease in brain tissue volume secondary to a brain tumor removal

B. High intracellular concentration of glutamate

C. Increased ICP accompanied by hyperventilation

D. Mean arterial pressure (MAP) that equals intracranial pressure (ICP)

Question 4(FNU Pathophysiology Quiz-2)

Which of the following patients would be most likely to be experiencing an increase in renal erythropoietin production?

Answers:

A. A 70-year-old woman admitted with dehydration secondary to an overdose of her potassium-wasting diuretic

B. A 21-year-old man with acute blood loss secondary to a motor vehicle accident 3 hours prior

C. A 68-year-old man with a long-standing diagnosis of polycythemia vera

D. A 71-year-old smoker admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD)

Question 5

A college student has been experiencing frequent headaches that he describes as throbbing and complaining of difficulty concentrating while studying. Upon cerebral angiography, he is found to have an arteriovenous malformation. Which of the following pathophysiological concepts is likely responsible for his symptoms?

Answers:

A. Localized ischemia with areas of necrosis noted on CT angiography

B. High pressure and local hemorrhage of the venous system

C. Hydrocephalus and protein in the cerebral spinal fluid

D. Increased tissue perfusion at the site of the malformation

Question 6

A group of nursing students were studying for their pathophysiology exam by quizzing each other about disorders of WBCs and lymphoid tissue. When asked what the first chromosomal abnormality that identified cancer was, one student correctly answered Answers:

A. interleukin cells.

B. Philadelphia.

C. PSA.

D. BRCA-1.

Question 7

A 47-year-old woman was diagnosed with amyotrophic lateral sclerosis 3 years ago and has experienced a progressive onset and severity of complications. She has been admitted to a palliative care unit due to her poor prognosis? What assessments and interventions should the nursing staff of the unit prioritize in their care?

Answers:

A. Regular pain assessment and administration of opioid analgesics as needed

B. Cardiac monitoring and administration of inotropic medications

C. Assessment and documentation of cognitive changes, including confusion and restlessness

D. Assessment of swallowing ability and respiratory status

Question 8(FNU Pathophysiology Quiz-2)

A 53-year-old man presents with inability to concentrate, itching in his fingers and toes, elevated blood pressure, and unexplained weight loss. He is diagnosed with primary polycythemia. What will be the primary goal of his treatment?

Answers:

A. To increase the amount of oxygen distributed by his red blood cells

B. To reduce the viscosity of his blood

C. To reduce the mean size of his red cells

D. To control his hypertension

Question 9

During a late night study session, a pathophysiology student reaches out to turn the page of her textbook. Which of the following components of her nervous system contains the highest level of control of her arm and hand action?

Answers:

A. Thalamus

B. Cerebellum

C. Frontal lobe

D. Basal ganglia

Question 10

The family members of an elderly patient are wondering why his “blood counts” are not rising after his last GI bleed. They state, “He has always bounced back after one of these episodes, but this time it isn’t happening. Do you know why?” The nurse will respond based on which of the following pathophysiological principles?

Answers:

A. “Don’t worry about it. We can always give him more blood.”

B. “Due to stress, the red blood cells of older adults are not replaced as promptly as younger people.”

C. “Everything slows down when you get older. You just have to wait and see what happens.”

D. “The doctor may start looking for another cause of his anemia, maybe cancer of the bone.”

Question 11

A 44-year-old female patient presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease. Which of the following diagnoses would the medical team be most justified in suspecting as a cause of the patient’s bleeding?

Answers:

A. Hemophilia B

B. Vitamin K deficiency

C. Excess calcium

D. Idiopathic immune thrombocytopenic purpura (ITP)

Question 12(FNU Pathophysiology Quiz-2)

Your ESRD patient is receiving 2 units of packed red blood cells for anemia (Hgb of 8.2). Twenty minutes into the first transfusion, the nurse observes the patient has a flushed face, hives over upper body trunk, and is complaining of pain in lower back. His vital signs include pulse rate of 110 and BP drop to 95/56.What is the nurse’s priority action? Answers:

A. Recheck the type of blood infusing with the chart documentation of patient’s blood type. B. Discontinue the transfusion and begin an infusion of normal saline.

C. Slow the rate of the blood infusion to 50 mL/hour.

D. Document the assessment as the only action.

Question 13

A 5th grade elementary student asks the school nurse how much blood is in an entire body. The nurse should respond that the average grown-up adult has

Answers:

A. 2 to 4 cups of blood in his or her body.

B. 5 to 6 L of blood throughout his or her body.

C. 3 pints of blood in total.

D. 3 to 4 quarts of blood in his or her body.

Question 14

The geriatrician providing care for a 74-year-old man with diagnosis of Parkinson disease has recently changed the client’s medication regimen. What is the most likely focus of the pharmacologic treatment of the man’s health problem?

Answers:

A. Preventing demyelination of the efferent cerebellar pathways

B. Preventing axonal degradation of motor neurons

C. Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions

D. Increasing the functional ability of the underactive dopaminergic system

Question 15

A student makes the statement to a colleague, “Blood plasma is essentially just a carrier for the formed elements like red blood cells and white blood cells.”What would be the most accurate response to this statement?

Answers:

A. “Not really. Plasma also contributes to the processes of protein synthesis and hematopoiesis.”

B. “Actually, plasma plays a significant role in nutrient and waste transport.”

C. “Actually, plasma is integral to the proper function of the liver and maintenance of acid–base balance.”

D. “That’s not really true. Plasma is crucial in the immune and inflammatory responses.”

Question 16(FNU Pathophysiology Quiz-2)

Several months ago, a 20-year-old male suffered a spinal cord injury brought about by a snowboard trick gone wrong. The lasting effects of his injury include a flaccid bowel and bladder and the inability to obtain an erection. While sensation has been completely preserved in his legs and feet, his motor function is significantly impaired. What type of incomplete spinal cord injury has the man most likely experienced?

Answers:

A. Central cord syndrome

B. Conus medullaris syndrome

C. Brown-Séquard syndrome

D. Anterior cord syndrome

Question 17

A client with a gastrointestinal bleed secondary to alcohol abuse and a hemoglobin level of 5.8 g/dL has been ordered a transfusion of packed red blood cells. The client possesses type B antibodies but lacks type D antigens on his red cells. Transfusion of which of the following blood types would be least likely to produce a transfusion reaction?

Answers:

A. A–

B. A

C. B–

D. B

Question 18

Which of the following clients’ signs and symptoms would allow a clinician to be most justified in ruling out stroke as a cause? An adult

Answers:

A. has vomited and complained of a severe headache.

B. states that his left arm and leg are numb, and gait is consequently unsteady.

C. has experienced a sudden loss of balance and slurred speech.

D. has had a gradual onset of weakness, headache, and visual disturbances over the last 2 days.

Question 19

Amniocentesis has suggested that a couple’s first child will be born with sickle cell disease. The parents are unfamiliar with the health problem, and their caregiver is explaining the complexities. Which of the following statements by the parents would suggest a need for further teaching or clarification?

Answers:

A. “Our baby’s red cells are prone to early destruction because of his or her weak membranes.”

B. “Our son or daughter likely won’t show the effects of sickling until he or she is school-aged because of the different hemoglobin in babies.”

C. “Not all of his or her red cells will be sickled, but low oxygen levels can cause them to become so.”

D. “Sickled cells can block his or her blood vessels, especially in the abdomen, chest, and bones.”

Question 20(FNU Pathophysiology Quiz-2)

During science class, a student asks, “What’s the difference between plasma and serum in the blood?” The nurse responds that the primary difference between plasma and serum is that plasma contains

Answers:

A. hydrogen ions.

B. heparin.

C. white blood cells.

D. fibrinogen.

Question 21

During a flu shot clinic, one of the questions the student nurse asks relates to whether the patient has had Guillain-Barré syndrome in his medical history. The patient asks, “What is that?” How should the nursing student reply?

Answers:

A. “A type of paralysis that affects movement on both sides of the body that may even involve the respiratory muscles”

B. “Influenza-like illness where you had fever and chills for 2 to 3 days after your last flu shot”

C. “A degenerative disease where you have trouble walking without the help of a cane or walker”

D. “Swelling of your arm where you got your flu shot, and maybe your eyes and lips had some swelling as well”

Question 22

A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem?

Answers:

A. Excess acetylcholinesterase production; treatment with thymectomy

B. A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins

C. Cerebellar lesions; surgical and immunosuppressive treatment

D. Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids

Question 23

A baseball player was hit in the head with a bat during practice. In the emergency department, the physician tells the family that he has a “coup”injury. How will the nurse explain this to the family so they can understand?

Answers:

A. “It’s like squeezing an orange so tight that the juice runs out of the top.”

B. “When the bat hit his head, his neck jerked backward causing injury to the spine.”

C. “Your son has a contusion of the brain at the site where the bat hit his head.”

D. “Your son has a huge laceration inside his brain where the bat hit his skull.”

Question 24(FNU Pathophysiology Quiz-2)

Which of the following glycoproteins is responsible for treating such diseases as bone marrow failure following chemotherapy and hematopoietic neoplasms such as leukemia? Answers:

A. Growth factors and cytokines

B. T lymphocytes and natural killer cells

C. Neutrophils and eosinophils

D. Natural killer cells and granulocytes

Question 25

While being on subcutaneous heparin injections for deep vein thrombosis during her latter pregnancy, a patient begins to experience major side effects. Her OB-GYN physician has called in a specialist who thinks that the patient is experiencing heparin-induced thrombocytopenia. The nurse should anticipate which of the following orders?

Answers:

A. Immediately discontinue the heparin therapy

B. Switch to Coumadin 2.5 mg once/day

C. Decrease the dose of heparin from 5000 units b.i.d to 3000 units b.i.d

D. Infuse FFP stat

Question 26

Which of the following individuals would most likely experience global ischemia to his or her brain?

Answers:

A. A woman who is being brought to hospital by ambulance following suspected carbon monoxide poisoning related to a faulty portable heater

B. A male client who has just had an ischemic stroke confirmed by CT of his head

C. A woman who has been admitted to the emergency department with a suspected intracranial bleed

D. A man who has entered cardiogenic shock following a severe myocardial infarction

Question 27

A new mother and father are upset that their 2-day-old infant is requiring phototherapy for hyperbilirubinemia. The pediatrician who has followed the infant since birth is explaining the multiplicity of factors that can contribute to high serum bilirubin levels in neonates. Which of the following factors would the physician be most likely to rule out as a contributor?

Answers:

A. Transitioning of hemoglobin F (HbF) to hemoglobin A (HbA)

B. Hepatic immaturity of the infant

C. Hypoxia

D. The fact that the infant is being breast-fed

Question 28(FNU Pathophysiology Quiz-2)

A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms?

Answers:

A. Viruses are killing some of his B cells and becoming incorporated into the genome of others.

B. The Epstein-Barr virus (EBV) is lysing many of the boy’s neutrophils.

C. The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes.

D. The EBV inhibits the maturation of white cells within his peripheral lymph nodes.

Question 29

A 16-year-old female has been brought to her primary care physician by her mother due to the girl’s persistent sore throat and malaise. Which of the following facts revealed in the girl’s history and examination would lead the physician to rule out infectious mononucleosis?

Answers:

A. Chest auscultation reveals crackles in her lower lung fields bilaterally.

B. Her liver and spleen are both enlarged.

C. Blood work reveals an increased white blood cell count.

D. The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes.

Question 30

A 30-year-old woman who has given birth 12 hours prior is displaying signs and symptoms of disseminated intravascular coagulation (DIC). The client’s husband is confused as to why a disease of coagulation can result in bleeding. Which of the nurse’s following statements best characterizes DIC?

Answers:

A. “The same hormones and bacteria that cause clotting also cause bleeding.”

B. “Massive clotting causes irritation, friction, and bleeding in the small blood vessels.”

C. “So much clotting takes place that there are no available clotting components left, and bleeding ensues.”

D. “Excessive activation of clotting causes an overload of vital organs, resulting in bleeding.”

Question 31

A 20-year-old has been diagnosed with an astrocytic brain tumor located in the brain stem. Which of the following statements by the oncologist treating the client is most accurate?

Answers:

A. “Our treatment plan will depend on whether your tumor is malignant or benign.”

B. “This is likely a result of a combination of heredity and lifestyle.”

C. “The major risk that you face is metastases to your lungs, liver, or bones.”

D. “Your prognosis will depend on whether we can surgically resect your tumor.”

Question 32(FNU Pathophysiology Quiz-2)

A patient diagnosed with low-risk chronic lymphocytic leukemia (CLL) has recently developed thrombocytopenia. One of the medications utilized to treat this would be Answers:

A. cisplatin, a chemotherapeutic.

B. vincristine, a Vinca alkaloid.

C. dexamethasone, a corticosteroid.

D. doxorubicin, a cytotoxic antibiotic.

Question 33

Two nursing students are attempting to differentiate between the presentations of immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP). Which of the students’ following statements best captures an aspect of the two health problems? Answers:

A. “ITP can be either inherited or acquired, and if it’s acquired, it involves an enzyme deficiency.”

B. “Both of them involve low platelet counts, but in TTP, there can be more, not less, hemostasis.

C. “TTP can be treated with plasmapheresis, but ITP is best addressed with transfusion of fresh frozen plasma.”

D. “Both diseases can result from inadequate production of thrombopoietin by megakaryocytes.”

Question 34

A physician is explaining to a 40-year-old male patient the importance of completing his course of antibiotics for the treatment of tuberculosis. The physician explains the damage that could occur to lung tissue by Mycobacterium tuberculosis. Which of the following phenomena would underlie the physician’s explanation?

Answers:

A. Tissue destruction results from neutrophil deactivation.

B. Neutrophils are ineffective against the Mycobacterium tuberculosis antigens.

C. Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas.

D. Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis.

Question 35

A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations?

Answers:

A. Encephalitis

B. Lyme disease

C. Rocky Mountain spotted fever

D. Spinal infection

Question 36(FNU Pathophysiology Quiz-2)

A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies,

Answers:

A. “They are looking for the presence of antibody or complement on the surface of the RBC.”

B. “They will look at your RBCs under a microscope to see if they have an irregular shape (poikilocytosis).”

C. “They will wash your RBCs and then mix the cells with a reagent to see if they clump together.”

D. “They will be looking to see if you have enough ferritin in your blood.”

Question 37

A 29-year-old construction worker got a sliver under his fingernail 4 days ago. The affected finger is now reddened, painful, swollen, and warm to touch. Which of the following hematological processes is most likely occurring in the bone marrow in response to the infection?

Answers:

A. Phagocytosis by myelocytes

B. Increased segmented neutrophil production

C. High circulatory levels of myeloblasts

D. Proliferation of immature neutrophils

Question 38(FNU Pathophysiology Quiz-2)

A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy’s spleen. Which of the following teaching points would be most accurate?

Answers:

A.“We think that his spleen is inhibiting the production of platelets by his bone marrow.”

B.“We believe that your son’s spleen is causing the destruction of many of his blood platelets, putting him at a bleeding risk.”

C.“Your son’s spleen is holding on to too many of his platelets, so they’re not available for clotting.”

D.“Your son’s spleen is inappropriately filtering out the platelets from his blood and keeping them from normal circulation.”

Question 39 A nurse practitioner is providing care for a client with low levels of the plasma protein gamma globulin. The nurse would recognize that the client is at risk of developing which of the following health problems?

Answers:

A. Anemia

B. Blood clots

C. Jaundice

D. Infections

Question 40

A 32-year-old woman presents at her neighborhood health clinic complaining of weakness and a feeling of abdominal fullness. She reports that 6 months earlier she noticed that she had difficulty in maintaining the high level of energy she has relied on during her aerobic workouts over the past few years. Because she felt that she was in overall good health, but knew that women often need additional iron, she added a multiple vitamin with iron and some meat and leafy greens to her diet. She followed her plan carefully but had no increase in energy. Upon examination, her spleen is noted to be enlarged. Which of the following is most likely to be the cause?

Answers:

A. CLL

B. Accelerated CML

C. Infectious mononucleosis

D. Stage A Hodgkin disease

Question 41

A nurse is providing care for several patients on an acute medical unit of a hospital.Which of the following patients would be most likely to benefit from hematopoietic growth factors?

Answers:

A. A 61-year-old female patient with end-stage renal cancer

B. A 55-year-old obese male patient with peripheral neuropathy secondary to diabetes

C. A 51-year-old female patient with liver failure secondary to hepatitis

D. A 44-year-old man with a newly diagnosed brain tumor

Question 42(FNU Pathophysiology Quiz-2)

Misinterpreting her physician’s instructions, a 69-year-old woman with a history of peripheral artery disease has been taking two 325 mg tablets of aspirin daily. How has this most likely affected her hemostatic status?

Answers:

A. The binding of an antibody to platelet factor IV produces immune complexes.

B. The patient’s prostaglandin (TXA2) levels are abnormally high.

C. Irreversible acetylation of platelet cyclooxygenase activity has occurred.

D. She is at risk of developing secondary immune thrombocytopenic purpura (ITP).

Question 43 Which of the following teaching points would be most appropriate with a client who has a recent diagnosis of von Willebrand disease?

Answers:

A. “Make sure that you avoid taking aspirin.”

B. “Your disease affects your platelet function rather than clot formation.”

C. “Clotting factor VIII can help your body compensate for the difficulty in clotting.”

D. “It’s important that you avoid trauma.”

Question 44

A nurse at a long-term care facility provides care for an 85-year-old man who has had recent transient ischemic attacks (TIAs). Which of the following statements best identifies future complications associated with TIAs? TIAs

Answers:

A. are caused by small bleeds that can be a warning sign of an impending stroke.

B. are a relatively benign sign that necessitates monitoring but not treatment.

C. are an accumulation of small deficits that may eventually equal the effects of a full CVA. D. resolve rapidly but may place the client at an increased risk for stroke.

Question 45

Following a motor vehicle accident 3 months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents?

Answers:

A. “If you or the care team notices any spontaneous eye opening, then we will change our treatment plan.”

B. “Your daughter has lost all her cognitive functions as well as all her basic reflexes.”

C. “Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change.”

D. “Your daughter’s condition is an unfortunate combination with total loss of consciousness but continuation of all other normal brain functions.”

Question 46(FNU Pathophysiology Quiz-2)

A couple who is expecting their first child has been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple has approached their caregiver with this request and is seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting it. How can their caregiver best respond to the couple’s enquiry? Stem cells can

Answers:

A. “be used as source of reserve cells for the entire blood production system.”

B. “help treat some cancers and anemias, but they must come from your child himself or herself.”

C. “be used to regenerate damaged organs should the need ever arise.”

D. “help correct autoimmune diseases and some congenital defects.”

Question 47 A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy’s spleen. Which of the following teaching points would be most accurate?

Answers:

A. “Ferritin is a protein–iron complex that allows your red blood cells to make use of the iron that you consume in your diet.”

B. “Ferritin is the activated and usable form of iron that your red blood cells can use to transport oxygen.”

C. “Ferritin is the form of iron that is transported in your blood plasma to red blood cells that need it.”

D. “Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills.”

Question 48

A 13-year-old African American boy comes to the ER complaining of fatigue and a rapid heartbeat. In conversation with the father, it becomes apparent to you that the boy has grown 2 inches in the previous 5 months. What is the first problem the health care team would attempt to rule out?

Answers:

A. Aplastic anemia

B. Sickle cell anemia

C. Thalassemia

D. Iron deficiency anemia

Question 49

In which of the following patients, would diagnostic investigations least likely reveal increased thrombopoietin production?

Answers:

A. A 55-year-old man with dehydration secondary to Crohn disease

B. An 81-year-old woman with diagnoses of rheumatoid arthritis and failure to thrive

C. A 66-year-old woman with a diagnosis of lung cancer with bone metastases

D. A 21-year-old woman awaiting bone marrow transplant for myelogenous leukemia

Question 50(FNU Pathophysiology Quiz-2)

A hospital laboratory technologist is analyzing the complete blood count (CBC) of a patient. Which of the following statements best reflects an aspect of the platelets that would constitute part of the CBC?

Answers:

A. New platelets are released from the bone marrow into circulation.

B. The half-life of a platelet is typically around 8 to 12 days.

C. Platelets originate with granulocyte colony–forming units (CFU).

D. The α-granules of platelets contribute primarily to vasoconstriction.

 
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Construct Measurement: Scale Development

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Construct Measurement: Scale Development

(Construct Measurement: Scale Development)

Posted for Dr Candice_2547InstructionsFor this task, complete the readings for this assignment, and then write a paper in which you complete the following:

Construct measurement involves developing scales to quantify abstract concepts like attitudes or behaviors. Scale development entails creating items, assessing their reliability and validity through statistical analyses and testing, refining the scale based on feedback, and establishing its psychometric properties to ensure accurate and consistent measurement of the construct of interest.

Instructions

For this task, complete the   readings for this assignment, and then write a paper in which you complete   the following:

  1. Write an introduction that        examines the construct, its conceptual definition/s, and related        concepts.
  2. Review the literature and the        existing tools that measure the construct.
  3. Provide justification for        your original scale.
  4. Discuss how you intend to        construct the items, cognizant of the basic principles of item pool        construction, the necessity of SMEs, the unidimensionality or        multidimensionality of the construct, etc.
  5. Write at least 20 sample        items that represent the construct you are planning to measure. You may        construct negatively-worded items, but indicate these in a chart or        table. If the construct you choose has two or more dimensions under it,        write sample items indicating which items fall under which dimension.        (See for example, the Life Position Scale that contained four dimensions        I’m OK etc. at first, but after factor analysis the dimensions reduced        to two—I and You.) These are attached to the assignment
  6. Argue for a specific method        of running an item analysis procedure.
  7. Argue for at least two        specific methods of establishing your scale’s validity (Choose at least        one method for construct validity, and another method for        criterion-related validity. In criterion validation, it is not enough to        simply write that you are planning to employ the method. Be sure to        specify the variable(s) you will correlate your scale with.

Length: 10-15 pages

Your assignment should demonstrate   thoughtful consideration of the ideas and concepts by providing new thoughts   and insights relating directly to this topic. Your response should reflect   scholarly writing and current APA standards.

Due: October 17, 2018 by 4pm EST

 
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Wk 5 Response 2 Nursing Technology

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Wk 5 Response 2 Nursing Technology

(Wk 5 Response 2 Nursing Technology)

Question description

APA format*** 2 paragraphs***at least 4-5 sentences each paragraph***2 References***

Please create a response to my classmates response Below:

My classmates Response is below:

For nurses who have entered the workforce within the last 10 years, paper charting may be something only talked about by older nurses, or utilized begrudgingly during downtime. Since the passage of the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) that promoted the adoption and meaningful use of electronic health records (EHR), EHRs have become synonymous with medical care (McGonigle & Mastrian, 2015). While it may seem that EHRs are efficient and easy to use, the process of adopting these systems is not without challenges.

Resistance to Implementation

Staff resistance to the adoption of an EHR is one of the most challenging aspects of implementing the system in health care facilities. I have even heard grumblings from fellow nurses about finding another job when my facility spoke about initiating the change to EHRs. In fact, “leadership, planning, management, choices, and execution usually are more difficult than dealing with hardware and software choices” (Mooney & Boyle, 2011, p. S5)). It is so important to have buy-in from nursing staff, as they make up a significant portion of health care workforce. In order to combat this resistance, staff nurses should be involved in the transition process from the beginning. If nurses feel that they have stake in the process, they will feel more invested in the outcome and successful on-boarding of the new technology. I suggest having staff nurses participate in early planning meetings, and to train staff nurses to become ‘super users’ within the facility. It will be helpful during implementation for nurses to be assisted by peers versus outside professionals.

Flexibility and Expandability

When choosing an EHR to implement in your workplace, it is so important to plan for the future so that you can ensure that as your facility grows and changes, the EHR can flex with it. For example, in my winter job at a ski resort, electronic charting was implemented only last year. There was a lot of thought that went into the selection process, however, decision-makers did not plan for coordination with Ski Patrol’s electronic charting system. Unfortunately, DocuTap (used by our clinic) does not interoperate with any of the Ski Patrol software currently available. This poses a challenge, as much of the information needed at each place is similar and shared between disciplines. As it stands now, Ski Patrol continues to use paper charting, while the clinic uses DocuTap. We have to copy the information obtained by ski patrol and hand-deliver it to the clinic. To combat this issue, it is imperative that the development team evaluate all software options, as well as the tech support each one offers as this may be a higher start-up cost, but save money in the long-run (Mooney & Boyle, 2011).

Process Improvement

Once an EHR is implemented and the extra support staff is gone, the challenges do not end. Once nurses begin to use the technology more comfortably, they may identify a process that needs to be changed to make it more user-friendly or to better suit the needs of the staff. In order for staff to continue to use the technology appropriately, they need to feel that their input is valued and that there is the possibility for change and improvement within the software after it is implemented. My suggestion to help with this issue is to have a nurse liaison who has clinical experience within the organization and has an interest in nursing informatics. This individual’s role is to act as a leader by relaying staff concerns to the software company to see if there are changes that can be made to make the software more user-friendly or to more appropriately meet the needs of staff. “What health care needs most are effective leaders who understand innovation and how it spreads, who respect the diversity of change itself, and who can nurture innovation in all its rich and many costumes” (Hyrkas & Harvey, 2010, p. 1). The hospital I work for has a liaison employed by Cerner, the company who manages the software we use. This nurse was a staff nurse in the emergency department, then a clinical nurse educator. This system works very well for us.

Summary

In conclusion, there are several potential challenges to implementing EHRs, including: resistance to implementation, flexibility and expandability, and process improvement. Since the HITECH Act of 2009, EHRs have been initiated in every major medical facility in the country. Though not without obstacles, meaningful use of EHRs contribute to the safe, efficient, and accessibility of medical information.

References

Hyrkäs, K., & Harvey, K. (2010). Leading innovation and change. Journal of Nursing Management, 18(1), 1–3.

McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.

Mooney, B. L., & Boyle, A. M. (2011). 10 steps to successful EHR implementation. Medical Economics, 88(9), S4–6, S8–S11.

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The Health Care Scene: Contemporary Trends

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The Health Care Scene: Contemporary Trends

(The Health Care Scene: Contemporary Trends)

As health care leaders, it is important to understand that health care is quite a dynamic field. Its constant changes are a result of continuing trends in regulation, policy, patient and provider advocacy efforts, as well as increasingly sophisticated technology and industry benchmarking guidelines.

For your assignment you review the possible topics for your Senior Project located in Week Five of your online course or in the “Components of Course Evaluation” section of this guide, and select the topic your training program will address. If you choose not to select a topic from the approved topic list, you must have your original topic approved by your instructor prior to submitting this assignment.

For this assignment, focus on a specific contemporary trend in health care and be sure to include all of the following influences:

  • Changes in client characteristics
  • Regulation of the health care industry
  • Reimbursement patterns and mandates
  • Restructuring of health care organizations
  • Impact of technology
  • Ongoing social and ethical factors

Address the information above as it pertains to your selected topic, in an eight to ten slide (excluding title and reference slides) PowerPoint presentation.

Your presentation should conclude with a summary describing the following concerns:

  • Overall, why should health care managers be aware of this change and trend?
  • What impact does this trend have on the stakeholder groups involved (e.g., patients, providers, administrators, third-party payers, legislators, etc.) for a specific organization specified (e.g., for profit, nonprofit, hospital, outpatient clinic, nursing home, etc.).

The information in this presentation will later be used as part of your Senior Project to set the context for the audience you select for a training program on the contemporary trend identified here.

Your presentation must include detailed speaker’s notes (i.e., at least 150 words) for each slide as well as a minimum of one to two scholarly sources from the University Library and one to two current, scholarly web sources.

Your presentation, and any citations used, must be in APA style as outlined in the Writing Center. Examples of scholarly web sources are available in this week’s recommended websites. These sources will also count toward the required sources for your Senior Project. Your presentation must be engaging and relevant to your audience. Lines of text on a slide will not be sufficient for this assignment. It should contain images, graphics, and/or multimedia that communicate your training program clearly to your audience. For tips on creating an excellent presentation, read this overview.
Approved Topics:

  1. Examine how participative leadership functions in today’s modern health care organization and compare it to other types of leadership styles. Evaluate how each type of leadership style may impact organizational culture, employee performance, and how it may help or hinder the legitimacy of authority.
  2. As an administrator, address the challenges of employee recruitment and retention of health care professionals. Additional subtopics may include trends in the nursing workforce, shortage of primary care physicians, staff turnover, retention, and staffing patterns.
  3. Analyze the dual role of a manager and healthcare professional. Examine challenges that the health professional compared to those of a non-health professional, may face in terms of leadership style, and the impact these challenges have on organizational culture. The benefits of a health professional manager as an organizational resource may also be included. Explore the career trends of health professionals in organizational leadership positions, such as the types of health professional training that leaders tend to have in common, and the typical demographic background of health professional managers.
  4. The health care industry must anticipate and monitor trends that could possibly affect its overall survival. Analyze how regulation of the health care industry impacts a health care organization. Explore some of the possible survival organizational strategies such as, but not limited to, mergers, and affiliations, achieving accreditation status, professional licensure.
  5. Analyze the impact of technology on how health care services are delivered. The impact of technology on employee performance, organizational structure, and management planning may also be considered.
  6. Analyze the impact of any recent social and/or ethical trends on the health care industry. Discuss at least two issues.
 
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Understanding Theory and Evidence

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Understanding Theory and Evidence: Classroom Insights

(Understanding Theory and Evidence)

Prior to completing this assignment, please read chapters 1 and 2 in your textbook, view the Endless Questions (Links to an external site.)Links to an external site. video, and review any relevant Instructor Guidance. You may want to look specifically at the interactive media tools demonstrating information on theory which are provided in the Section 1.5 (within Module 1) of the textbook.  In this assignment you will be addressing the role of theory and evidence – both scholarly and personal – and how they can be utilized in the classroom or other professional settings.

In PART I of the paper, begin by reflecting on the benefits and drawbacks of accepting advice from stories told by previous generations (i.e. “I did that with my kids and they turned out just fine.”).  For example, you may have heard a grandparent suggest that you put a bit of whiskey on an infant’s gums to help with teething. Consider your own thoughts about anecdotal advice such as this and think about why it may be true in some cases, but not in others.

Then, watch the Endless Questions (Links to an external site.)Links to an external site. video analyzing child development research and find one additional scholarly source of your choice (see tips and a link to tutorials below).  Use these resources to address the following:

  • Overview some of the specific research methods described in the video to study happiness. Which seemed the most effective to you and why?
  • Why is it important to utilize developmental theory to explain children’s development?
  • What makes scholarly research different from anecdotal evidence (personal experience) in explaining child and adolescent development?

Mossler, R. (2014). Child and adolescent development (2nd ed.). [Electronic version]. Retrieved from https://content.ashford.edu/

Inside out-endless questions: Critical thinking and research (Links to an external site.)Links to an external site. [Video file]. (2006). Retrieved from https://fod.infobase.com/OnDemandEmbed.aspx?token=70418&wID=100753&plt=FOD&loid=0&w=640&h=480&fWidth=660&fHeight=530

You are required to utilize at least one (1) additional scholarly source not from this week’s required readings and  You mustcite (Links to an external site.)Links to an external site. all of your sources (including the video embedded above) in proper APA style.  If you are unsure how to create an APA style reference page, please visit the Reference Guide (Links to an external site.)Links to an external site. page from the Ashford Writing Center. Aside from the video embedded in the prompt, you are to find one other scholarly through the Ashford Library website to help support your reflections in PART II.  View this great tutorial (Links to an external site.)Links to an external site. provided by the Ashford University Library which will show you how to find scholarly articles and how to assess the scholarly quality of the resource.

 
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Bioethics Case Study

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Bioethics Case Study

(Bioethics Case Study)

1.  Bioethics Case Study: This assignment asks you to examine a current ethical controversy case study. The paper should be in APA  style, and does not need an abstract or cover page. With a minimum of two pages and a maximum of four pages A reference page is needed. In-text citations should be in APA format. Papers will be graded on a 0 to 25-point scale.

Case Study in Primary care:

One hypothetical case study involves Jim a 54, year old patient who has recently diagnose with hypertension and his Creatinine and BUN laboratory results are elevated, if left untreated, will result in kidney failure. The patient refuses to take the medication because he said it will affect his sex life The Nurse Practitioner must work with the patient to respect the fact that he doesn’t want the medication (autonomy), and needs to find a solution that would prevent him from going into kidney failure and other complications, which is in his best interest (beneficence). Although medications are the best choice, forcing the patient to accept the medication will result in probably patient leaving the care (non-maleficence). Finally, the NP needs to consider the impact that the patient’s choices might have on others if he starts to go into preventable kidney failure, he’ll need dialysis, which affects other people who need the same treatment (justice). So before making the final decision the NP must consider all four principles of health care ethics, which will help the NP make the choice that will have the best possible benefits for both the patient and society.

Questions?

  1. What are the skills necessary for the provider to identify, address, and assess this clinical ethical issue?
  2. What are the provider’s obligations when a patient discloses does he not intent to follow the treatment?
  3. What are the ethical considerations in evaluating a patient’s failure to adhere to a prescribed therapy?
  4. Will you terminate care for this patient? What are the implications?

Case Study Rubric(Bioethics Case Study)

Criterion

Outstanding  (25)

Very Good  (22)

   Average (18)

Unacceptable (15)

Score

Completeness

Complete in all respects; reflects all requirements

Complete in most respects; reflects most requirements

Incomplete many respects; reflects few requirements

Incomplete in most respects; does not reflect requirements

Understanding

Demonstrates excellent understanding of the topic(s) and issue(s)

Demonstrates an accomplished understanding of the topic(s) and issue(s)

Demonstrates an acceptable understanding of the topic(s) and issue(s)

Demonstrates an inadequate understanding of the topic(s) and issue(s)

Analysis

Presents an insightful and through analysis  of the issue (s) identified

Presents a thorough analysis of most of the issue(s) identified

Presents a superficial analysis of some of the issue(s) identified

Presents an incomplete analysis of the issue(s) identified.

Evaluation(Bioethics Case Study)

Makes appropriate and powerful connections between the issue(s) identified and the concept(s) studied

Makes appropriate connections between the issue(s) identified and the concept(s) studied

Makes appropriate but somewhat vague connections between the issue(s) identified and the concept(s) studied

Makes little or no connection between the issue(s) identified and the concept(s) studied.

Opinion

Supports opinion with strong arguments and evidence; presents a balanced and critical view; interpretation is both reasonable and objective

Supports opinion with reasons and evidence; presents a fairly balanced view; interpretation is both reasonable and objective

Supports opinion with limited reasons and evidence; presents a somewhat one-sided argument

Supports opinion with few reasons and little evidence; argument is one-sided and not objective.

Recommendations

Presents detailed, realistic, and appropriate recommendations clearly supported by the information presented and concepts studied

Presents specific, realistic and appropriate recommendation supported by the information presented and the concepts studied

Presents realistic or appropriate recommendation supported by the information presented and the concepts studied

Presents realistic or appropriate recommendation with little, if any, support from the information and the concepts studied.

Grammar and Spelling

Minimal spelling and grammar errors

Some spelling and grammar errors

Noticeable spelling and grammar errors

Unacceptable number of spelling and grammar errors

APA guidelines

Uses APA guidelines accurately and consistently to cite sources

Uses APA guidelines with minor violations to cite sources

Reflects incomplete knowledge of APA guidelines

Does not use APA guidelines

 
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Health Promotion Presentation

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Collaborative Learning Community: Health Promotion Presentation

(Health Promotion Presentation)

(Sickle Cell Anemia )

1) As a group, develop a 12-15 slide PowerPoint presentation that addresses a childhood disease or illness (infectious, noncontiguous, or congenital) seen in the adult population.

a) Examples of such diseases include:

i) Sickle cell anemia

ii) Cystic fibrosis

iii) Tay Sachs

iv)  Juvenile diabetes (Type I)

v)  Juvenile rheumatoid arthritis

vi)  Hemophilia, congenital heart disease

b) Examples of vaccine preventable adult diseases include:

i) Diphtheria tetanus

ii) Pertussis

iii) Rubella

iv) Measles

v) Mumps

2) Include the following in the presentation:

a) A clinical description and definition of the disease or illness.

b) Pathophysiology and history of the disease or illness.

c) An explanation of the impact of this disease/condition on adults to the health care system and nursing practice.

d) A description of the impact of this disease or illness during childhood.

e) A description of the impact of this disease in adults. Explain why adults live into adulthood with this childhood condition or why adults would contract this childhood illness during adulthood.

f) A validation of the health problem with demographic and health statistics, including citations of sources.

3) Evaluate how this disease or illness impacts the adult client in the following areas:

a) Mentally and emotionally.

b) Physically.

c) Sexually.

d) Economically, specifically as it relates to the ability to access health insurance and health care.

e) Susceptibility to engage in substance abuse.

f) Prenatal care and childbearing.

g) Occupational considerations and hazards.

h) Ability to cope with stress.

4) Develop a care plan that addresses the following:

a) Identify expected outcomes for an adult client living with this childhood condition.

b) Develop health screening, health promotion, health interventions, and education for adults with this condition.

c) Identify a comprehensive set of relevant resources, both community and national, for adults with this condition. Provide description of resources.

5) Post the assignment to the main forum as directed by the instructor.

a) Respond to other learners’ posts in a manner that initiates or contributes to discussion.

b) Each person should make at least three substantive comments.

 
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Cultural Considerations:Mental Health

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Cultural Considerations in Mental Health Nursing

(Cultural Considerations:Mental Health)

Question description

Submit an evidence-based practice paper about cultural competency in mental health nursing. An evidence-based practice paper allows you to explore best practice and help improve client outcomes on a psychiatric unit. Your paper should describe how you, as a nurse, will include – or have included – cultural awareness in a client diagnosed with a mental illness. The person you describe could be someone in your clinical setting, someone you have worked with in the past, or a theoretical client.

Remember that culture can also include gender equality, sexual orientation, and other cultures besides race and religion – including cultures unique to one particular family. Your paper should be at least 3 pages (double-spaced, not including the title or reference pages) in APA Format and include:(Cultural Considerations:Mental Health)

  • Assessment: Discuss what you would assess in regard to a client’s culture. For example, are there specific dietary requirements? Are schedule changes necessary to avoid conflicts with religious practices? Who is the spokesperson for the family? What would you assess?
  • Diagnosis: List any mental health nursing diagnoses this person has or may be at risk for. Include at least one cultural diagnosis.
  • Planning: What planning needs to be done to ensure the cultural and emotional safety of the client?
  • Implementation: What are interventions that would ensure the safety of your client in regard to culture? Include at least two interventions. For example, if your client has religious beliefs that affect the ability to take medications, what interventions would you create to ensure the client’s safety? What can you do to make sure the client’s cultural needs are met?
  • Evaluation: How will you evaluate whether your implementation was effective? Make sure the parameters are objective and measurable.
  • In your summary, discuss whether any completed interventions were successful. What could be done differently in the future? If the interventions have not yet been carried out, you might discuss some institutional changes that could be made to ensure cultural safety for all clients in that setting.

Your paper should utilize proper APA guidelines and include at least three scholarly sources to support your paper. A scholarly source is a source that has been peer reviewed and has appropriate authors that are credentialed. For more information on APA, please visit the Online Library.

 
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Regulating Controlled Substances Debate

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Regulating Controlled Substances Debate

(Regulating Controlled Substances Debate)

The debate over regulating controlled substances revolves around balancing public health concerns with individual rights and societal impacts. Proponents argue for strict regulations to curb abuse, reduce addiction rates, and prevent associated criminal activity. They emphasize the need for access to treatment and education. Opponents advocate for less stringent controls, citing personal autonomy, medical necessity, and concerns about government overreach. They argue for harm reduction strategies, such as supervised injection sites, and highlight the potential for unintended consequences of overly restrictive measures, such as driving the market underground. Finding a middle ground involves navigating complex ethical, medical, and legal considerations.

(Regulating Controlled Substances Debate)

For this task, you will debate whether controlled substance should be legalized (if currently illegal to buy or use), or made available as over the counter drugs (if currently only used with a prescription).

For your debate, choose a specific drug from one of the four drug categories listed above (CNS depressants, CNS stimulants, marijuana, or hallucinogens). Present the pros and cons of making such a substance available freely or on a controlled basis. In preparing your debate, be sure to mention the following points:

Identify the psychopharmacological properties of the substance.

Determine how widely the substance is used.

Determine if the substance is addictive.

Indicate any side effects for this substance.

Identify the effects of criminalizing the substance.

Recognize any problems that might be caused or prevented by decriminalizing the substance.

Determine how this substance can be beneficial once it can be legally purchased without a prescription.

Indicate how this drug might be detrimental if it can be legally purchased without a prescription.

Identify any social implications that can emerge if this substance can be legally purchased.

Prepare your debate in transcript form and allow each debater to make a statement. Be sure to allow time for each to make a rebuttal of the other’s statement. Use critical thinking skills to follow the rules for a logical debate. Support the points in the debate with reference to at least three scholarly references. In addition to these specified resources, other appropriate scholarly resources, including older articles, may be included.

Length: 5-7 pages

 
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Psychosocial Problems

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Psychosocial Problems

(Psychosocial Problems)

To prepare: Use a differential diagnosis process and analysis of the Mental Status Exam in “The Case of L” to determine if the case meets the criteria for a clinical diagnosis.

Questions:

  • Provide the full DSM-5 diagnosis. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may need clinical attention).
  • Explain the full diagnosis, matching the symptoms of the case to the criteria for any diagnoses used.
  • Identify 2-3 of the close differentials that you considered for the case and have ruled out. Concisely explain why these conditions were considered but eliminated.
  • Identify the assessments you recommend to validate treatment. Explain the rationale behind choosing the assessment instruments to support, clarify, or track treatment progress for the diagnosis.
  • Explain your recommendations for initial resources and treatment. Use scholarly resources to support your evidence-based treatment recommendations.
  • Explain how you took cultural factors and diversity into account when making the assessment and recommending interventions.
  • Identify client strengths, and explain how you would utilize strengths throughout treatment.
  • Identify specific knowledge or skills you would need to obtain to effectively treat this client, and provide a plan on how you will do so.

These questions are based on the following case:(Psychosocial Problems)

The Case of L Presenting Problem Client presented in the emergency room (ER) having been brought in the previous night by her parents. Following an argument with her parents, L cut her right wrist. L’s mother reported that L started screaming rapidly and became physically violent toward her prior to cutting her own wrist. Psychological Data L is a 17-year-old Hispanic female who resides in Pennsylvania with her mother, father, and older sister. She is in 11th grade at the local public school. L appeared to be of average to above-average intelligence, as she was able to respond to numerous questions in an articulate and intelligent manner. She was well versed about world history and current affairs. Her mother confirmed that she has done well in school, maintaining a B+ average and participating in various school activities (e.g., chorus, school paper) until last year. L slowly dropped out of many activities she liked in the past. Her mother noticed about 8 months ago that L had also begun having difficulty doing schoolwork. Erratic behavior arose during episodes when L also became irritable and explosive.(Psychosocial Problems)

During these repeated episodes, she became quite defiant, cut classes, had to be placed in school detention, and had even assaulted the principal. L has numerous friends and believed she can relate to all types of people. She has a boyfriend who adores her, but she said she doesn’t feel the same about him. The school counselor confirmed that L is outgoing, popular, and smart; but during these episodes she became another person, one who is very violent and difficult. Medical History A physical examination by a staff doctor revealed superficial cuts on L’s left and right wrist. The cuts appeared to be a few weeks old. There were cigarette burns on her right wrist that looked to be approximately one week old. In questioning L about the cigarette burns, L responded, “I just wanted to see how it felt—now I know.” Whe 2 a high school education. L’s sister is considerably younger, aged 8. Their relationship is described as unremarkable, although L’s mother noted that the younger sister stays away when L is upset. Marital circumstances are uncertain, although the parents admitted that they are trying to keep the family together for their children, and they are of the Catholic faith. Treatment costs for L have been an additional difficulty for the family, but they said they are very worried about L’s lack of self-control and discipline.

Extended family are far away and mostly still in Guatemala. L’s parents were not aware of any other family members with psychiatric problems. Psychiatric History L was evaluated three times at the community hospital ER during the past 4 years. Hospital evaluations were usually done after suicide attempts or threatening violent behavior toward others.(Psychosocial Problems)

L thought that the clinicians trying to diagnose her only had book skills and no people skills. She assumed that no one will ever know what is wrong with her; she did not plan to tell them because she doesn’t like them. L said she knows she “is not crazy,” but she was convinced that the therapist thought she is crazy or a “bad” kid. “They’re just experimenting with me,” L said. L indicated that she had been prescribed medications to alter her mood, but she couldn’t recall what it was, as she stated, “I don’t need those; nothing is wrong with me.” L’s mother reported that L was involved in outpatient counseling on at least four occasions as well as being placed in a shelter once after school truancy, running away from home, and threatening to assault her. A social worker was even sent for home visits for a 3-month period. Each time, L would abruptly end therapy by becoming verbally abusive or totally noncommunicative toward the therapist and would adamantly refuse to continue therapy. She even admitted to shoving a desk toward a therapist and threatening her with a pencil.(Psychosocial Problems)

When questioned about this behavior, L responded, “Well she told me to express myself and let my true feelings out, so I did.” (L also laughed and glanced at her mother during this exchange.) L’s mother was particularly perplexed and overwhelmed by these behaviors. She stated that her husband is completely frustrated and angry. Both admitted that L’s behavior is part of the considerable strain on their marriage. L denied being under any continued psychiatric care even though it was recommended numerous times. She refused to go, stating, “The therapists are the ones who are crazy.” L was first seen in outpatient counseling 9 years ago after she began to have nightmares and experienced tremendous anxiety after her godmother threatened to kidnap her. Her godmother became obsessed with L when L was 6 years old, first threatening to kidnap her then.

Her godmother had to be institutionalized after exhibiting bizarre behavior. Recently, the godmother started threatening to kidnap L again. Three years ago, L was sent for counseling after she ran away from home after getting a bad report card and also discovering that her parents were considering a divorce.(Psychosocial Problems)

L requested therapy, as she reported that at 8 years of age she was sexually molested by an older man in the community (who is now deceased). She expressed having mixed emotions, because she viewed her perpetrator as her friend. By pretending that nothing 3 happened, she could think of him as a nice old man, and she didn’t have to deal with the thought of something this bad happening to her. L’s mother reported that she herself was raped at 8 years old and that L had knowledge of this. Two years ago, L and the entire family again became involved in outpatient counseling after L’s godmother accused L’s mother of child abuse. L’s mother thought this was largely done out of spite. An investigation by Child Protective Services revealed no abuse. Mental Status (1 day after she had been evaluated at the ER) L presented casually, disheveled, in shorts and a tee shirt, and with minimal makeup. L admitted to being in a nasty mood. There was little eye contact, and conversation was difficult. Thought and speech patterns were clear. Affect was flat. She was oriented to time, place, and person.

L denied feeling depressed. When questioned about her suicide attempt the previous day, she suddenly became quiet and teary eyed. She lowered her head and responded, “You don’t understand, he made me do it. I don’t want to hurt myself.” L denied even remembering cutting her wrist, saying, “He must have done it or made me do it.” L was questioned about the person she was talking about. She related that there has been a male presence in her life since she was 6 years old and that he makes her do things that she doesn’t want to do or things she can’t even remember. This presence showed up after the funeral of her best friend, Michael. L said he communicates with her through her mind. She seemed distressed when speaking about him.

Her mother appeared distressed and fearful as well. L’s mother confirmed that L had trouble sleeping and concentrating at school after the funeral. She did not want to attend Girl Scouts anymore, because the uniform had gotten tight and the male presence was laughing at her. L’s mother remembered how scared she had become on a few occasions when L attempted to run out into traffic.(Psychosocial Problems)

Every time L’s mother yelled at L for doing that, L stated that the male presence explained that this was how she could join her friend Michael. L’s mother took L to a therapist. When L entered the third grade, L’s mother took her out of therapy. L reported that during her awake hours she can’t see this presence, but she can sense him. She said she does see him in her dreams, and his appearances in them have intensified within the past year. In her dreams, he torments children, and he controls people through a haunted mirror and a magic book. He reads and controls thoughts. L described him this way: “He looks in his 40s, but is really ageless. Always dressed in dark colors, but I can’t tell the exact colors he wears. I know his eyes are powerful, but I never really look at his eyes.” L was asked why she never shared this information before. She stated, “Because I would be put in the hospital and medicated—and I told you, I’m not crazy.(Psychosocial Problems)

I know you don’t understand, but I am him and he is me, and he eventually wants to totally control me.” She admitted to acting out impulsively at times, such as throwing things for no reason. L reported that the presence was in the room during this interview. When questioned about why he doesn’t influence her now or make her do something, she replied, “He’s too smart, he wouldn’t do that.” L also mentioned that during the past 4 couple of months another male presence has been with her. This new presence seems to be controlled by and intimidated by the primary presence. The two males communicate with one another about how to hurt the children in her dreams. L ended the session by saying, “I know this sounds weird, but this is what is happening to me. If you tell any other therapist, I’ll deny it, because I don’t want to be put away.”

 
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