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Assessing Clients With Addictive Disorders

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Assignment : Assessing Clients With Addictive Disorders

Addictive disorders can be particularly challenging for clients. Not only do these disorders typically interfere with a client’s ability to function in daily life, but they also often manifest as negative and sometimes criminal behaviors. Sometime clients with addictive disorders also suffer from other mental health issues, creating even greater struggles for them to overcome. In your role, you have the opportunity to help clients address their addictions and improve outcomes for both the clients and their families. For this Assignment, as you examine the Levy Family video in this week’s Learning Resources, consider how you might assess and treat clients presenting with addiction.

Learning Objectives

Students will:

· Assess clients presenting with addictive disorders

· Analyze therapeutic approaches for treating clients with addictive disorders

· Evaluate outcomes for clients with addictive disorders

To prepare:

· Review this week’s Learning Resources and consider the insights they provide.

· Review the Levy Family video Episodes 1 through 5

The Assignment

In a 2- to 3-page paper, address the following:

· After watching Episode 1, describe:

o What is Mr. Levy’s perception of the problem?

o What is Mrs. Levy’s perception of the problem?

o What can be some of the implications of the problem on the family as a whole?

· After watching Episode 2, describe:

o What did you think of Mr. Levy’s social worker’s ideas?

o What were your thoughts of her supervisor’s questions about her suggested therapies and his advice to Mr. Levy’s supervisor?

· After watching Episode 3, discuss the following:

o What were your thoughts about the way Mr. Levy’s therapist responded to what Mr. Levy had to say?

o What were your impressions of how the therapist worked with Mr. Levy? What did you think about the therapy session as a whole?

o Informed by your knowledge of pathophysiology, explain the physiology of deep breathing (a common technique that we use in helping clients to manage anxiety). Explain how changing breathing mechanics can alter blood chemistry.

o Describe the therapeutic approach his therapist selected. Would you use exposure therapy with Mr. Levy? Why or why not? What evidence exists to support the use of exposure therapy (or the therapeutic approach you would consider if you disagree with exposure therapy)?

· In Episode 4, Mr. Levy tells a very difficult story about Kurt, his platoon officer.

o Discuss how you would have responded to this revelation.

o Describe how this information would inform your therapeutic approach. What would you say/do next?

· In Episode 5, Mr. Levy’s therapist is having issues with his story.

o Imagine that you were providing supervision to this therapist, how would you respond to her concerns?

· Support your approach with evidence-based literature.

Note: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. 

Required Readings ( Need 3+ reference)

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

  • Chapter 7, “Motivational      Interviewing” (pp. 299–312)
  • Chapter 16, “Psychotherapeutic Approaches for      Addictions and Related Disorders” (pp. 565–596)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Albrecht, U., Kirschner, N. E., & Grusser, S. M. (2007). Diagnostic instruments for behavioral addiction: An overview. German Medical Science Psycho-Social-Medicine, 4, 1–11. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736529/

Fisher, M. A. (2016a). The ethical ABCs of conditional confidentiality. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 13–25). Washington, DC: American Psychological Association. doi:10.1037/14860-002

Required Media

Laureate Education (Producer). (2013c). Levy family: Episodes 1 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 2 minutes.

Accessible player  –Downloads– Download Video w/CC Download Audio Download Transcript

Laureate Education (Producer). (2013c). Levy family: Episodes 2 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 2 minutes.

Accessible player  –Downloads– Download Video w/CC Download Audio Download Transcript

Laureate Education (Producer). (2013c). Levy family: Episodes 3 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 6 minutes.

Accessible player  –Downloads– Download Video w/CC Download Audio Download Transcript

Laureate Education (Producer). (2013c). Levy family: Episodes 4 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 5 minutes.

Accessible player  –Downloads– Download Video w/CC Download Audio Download Transcript

Laureate Education (Producer). (2013c). Levy family: Episodes 5 [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 2 minutes.

Accessible player  –Downloads– Download Video w/CC Download Audio Download Transcript

Laureate Education (Producer). (2012c). In their own words [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 23 minutes.

Accessible player  –Downloads– Download Video w/CC Download Audio Download Transcript

Optional Resources

Dronen, S. O. (2012). New research about Facebook addiction. Retrieved from http://www.uib.no/en/news/36380/new-research-about-facebook-addiction 

Substance Abuse and Mental Health Services Administration. (2005). Substance abuse treatment for adults in the criminal justice system. Treatment Improvement Protocol (TIP) Series 44. Rockville, MD: Author. Retrieved from https://store.samhsa.gov/system/files/sma13-4056.pdf

 

Substance Abuse and Mental Health Services Administration. (2013). Substance abuse treatment for persons with co-occurring disorders: A treatment improvement protocol. Treatment Improvement Protocol (TIP) Series 42. Rockville, MD: Author. Retrieved from https://store.samhsa.gov/system/files/sma13-3992.pdf

Physical Examination

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Janet, a 20 year-old college student, is experiencing a five-week history of itchy eyes and nasal congestion with watery nasal discharge. She also complains of a “tickling” cough, especially at night, and she has had episodes of repetitive sneezing. Janet gets frequent “colds” every spring and fall.

Physical Examination
Vital Signs: Temp, 98.8; BP 110/68; Pulse 72; Respirations 18

Skin: Flaking erythematous rash on the flexor surfaces of both arms

Head, Eyes, Ears, Nose, and Throat: Tender over maxillary sinuses; sclera red and slightly swollen with frequent tearing; outer nares with red, irritated skin; internal nares with red, boggy, moist mucosa and one medium-sized polyp on each side; pharynx slightly erythematous, with clear postnasal drainage

Lungs: Clear to auscultation and percussion

Discussion Questions:
1. Provide three differential diagnoses based on Janet’s subjective and objective data and discuss your reasoning for each.

2. What additional history questions would be useful in your evaluation of Janet?

3. Discuss the pathophysiological process of your primary diagnosis.

4. Differentiate the types of hypersensitivity mechanisms.

5. As per your analysis, what type of hypersensitivity reaction is Janet experiencing?

teaching plan

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Note: This is an individual assignment. Based on the feedback offered  by the provider, identify the best approach for teaching. Prepare a  presentation to accompany the teaching plan and present the  information to your community. Select one of the following options for  delivery of the presentation:

  1. PowerPoint presentation – no more than 30 minutes
  2. Pamphlet presentation – 1 to 2 pages
  3. Poster  presentation

Appropriate community settings include:

  1. Public health clinic
  2. Community health center
  3. Long-term care facility
  4. Transitional care facility
  5. Home health center
  6. University/School health center
  7. Church community
  8. Adult/Child care center

Before presenting information to the community, seek approval from  an agency administrator or representative.

Upon receiving approval from the agency, include the “Community  Teaching Experience Form” as part of your assignment submission.

While APA style is not required for the body of this assignment,  solid academic writing is expected, and documentation of sources  should be presented using APA formatting guidelines, which can be  found in the APA Style Guide, located in the Student Success Center.

You are required to submit this assignment to Turnitin. Please refer  to the directions in the Student Success Center.

NRS-427V-RS-CommunityTeachingExperienceForm.doc

Creating a Flowchart

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Assignment: Creating a Flowchart

PLEASE SEE ATTACHED FILE FOR SAMPLE DOCUMENT

Workflow analysis aims to determine workflow patterns that maximize the effective use of resources and minimize activities that do not add value. There are a variety of tools that can be used to analyze the workflow of processes and clarify potential avenues for eliminating waste. Flowcharts are a basic and commonly used workflow analysis method that can help highlight areas in need of streamlining.

In this Assignment, you select a common event that occurs regularly in your organization and create a flowchart representing the workflow. You analyze the process you have diagrammed and propose changes for improvement.

To prepare:

  • Identify a common, simple event that frequently occurs in your organization that you would like to evaluate.
  • Consider how you would design a flowchart to represent the current workflow.
  • Consider what metrics you would use to determine the effectiveness of the current workflow and identify areas of waste.

To complete:

Write a 3- to 5-page paper which includes the following:

  • Create a simple flowchart of the activity you selected. (Review the Sample Workflow of Answering a Telephone in an Office document found in this week’s Learning Resources for an example.)
  • Next, in your paper:
    • Explain the process you have diagrammed.
    • For each step or decision point in the process, identify the following:
      • Who does this step? (It can be several people.)
      • What technology is used?
      • What policies and rules are involved in determining how, when, why, or where the step is executed?
      • What information is needed for the execution of this step?
    • Describe the metric that is currently used to measure the soundness of the workflow. Is it effective?
    • Describe any areas where improvements could occur and propose changes that could bring about these improvements in the workflow.
    • Summarize why it is important to be aware of the flow of an activity.
    • McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
      • Chapter 14, “Nursing Informatics: Improving Workflow and Meaningful Use”

        This chapter reviews the reasons for conducting workflow analysis and design. The author explains specific workflow analysis and redesign techniques.

      Huser, V., Rasmussen, L. V., Oberg, R., & Starren, J. B. (2011). Implementation of workflow engine technology to deliver basic clinical decision support functionality. BMC Medical Research Methodology, 11(1), 43–61.

      Retrieved from the Walden Library databases.

       

      In this article, the authors describe an implementation of workflow engine technology to support clinical decision making. The article describes some of the pitfalls of implementation, along with successful and future elements.

      Koppel, R., & Kreda, D. A. (2010). Healthcare IT usability and suitability for clinical needs: Challenges of design, workflow, and contractual relations. Studies in Health Technology and Informatics, 157, 7–14.

      Retrieved from the Walden Library databases.

       

      This article points to many health information technology designs and workflow decisions that limit their value and usage. The authors also examine the structure of the conceptual relationships between HIT vendors and the clinical facilities that purchase HIT.

      U.S. Department of Health & Human Services. (n.d.b). Workflow assessment for health IT toolkit. Retrieved, June 18, 2012, from http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919/workflow_assessment_for_health_it_toolkit/27865

       

      This article supplies a toolkit on the planning, design, implementation, and use of health information technology. The sections of the website provide a definition of workflow, examples of workflow tools, related anecdotes, and research.

       

  • Remember to include a cover page, introduction, and summary for your paper.

academic resources or strategies

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1. Clearly identify and accurately describe in detail at least three academic resources or strategies that can be applied to the Masters Nursing MSN program.  2. Clearly identify and accurately describe in detail at least three professional resources that can be applied to success in the nursing practice in general or in a specialty.                                                                                                                                                                   3. Clearly and thoroughly explain in detail how you intend to use these resources, and how they might benefit you academically and professionally.

Remember to include an introduction paragraph which contains a clear and comprehensive purpose statement which delineates all required criteria, and end the assignment Part with a conclusion paragraph. 

Academic Resource/Strategy 1

Academic Resource/Strategy 2

Academic Resource/Strategy 3

Professional Resource/Strategy 1

Professional Resource/Strategy 2

Professional Resource/Strategy 3

ADDITIONAL RESOURCES/STRATEGIES

postoperative anemia.

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Please answer all 20 questions correctly and get back to me within the next 3 hours

1.   Modifier -P5 indicates that the patient

A. experienced postoperative anemia.
B. is not expected to survive without the operation.
C. received a lower anesthesia dosage.
D. is advanced in age.

2.   Code 99217 is assigned for

A. nursing home services.
B. observation discharge services.
C. established patient visits.
D. new patient office visits.

3.   Code range 99218–99220 denotes

A. emergency room visits.
B. initial hospital visits.
C. initial observation care.
D. follow-up hospital visits.

4.   A physician performs an invasive surgical procedure. Prior to the start of the procedure, the anesthesiologist administers monitored anesthesia. Which modifier should be appended to the anesthesia code?

A. -G10
B. -G8
C. -G1
D. -G9

5.   When more than one surgery is performed during one anesthesia administration, the coder should

A. report the anesthesia code with the highest base value unit.
B. assign modifier -QS to the second surgery code.
C. assign add-on code 01900 to indicate more than one surgery was performed during a single operative session.
D. add modifier -QY to the first surgery code.

6.   Modifier -P3 indicates that the patient

A. received topical anesthesia.
B. is in a coma.
C. received local anesthesia.
D. has severe systemic disease.

7.   ___ modifiers indicate the number of anesthesia cases being directed at one time.

A. Coordinated time
B. Conversion
C. Calculation
D. Concurrent

8.   A coder adds modifier -P2 to an anesthesia code. This modifier indicates the patient

A. is allergic to lidocaine.
B. received general anesthesia.
C. is handicapped.
D. has mild systemic disease.

9.   The risk of morbidity or mortality would be considered as a part of

A. review of systems.
B. medical decision-making.
C. history of present illness.
D. chief complaint.

10.   A patient who has not been seen by a physician or another physician in the same group within the last three years is a/an _______ patient.

A. established
B. new
C. emergent
D. existing

11.   The dollar rate of each anesthesia unit is called the _______ factor.

A. unit conversion
B. conversion
C. calculation
D. base value unit rate

12.   A patient who has been admitted to a hospital is a/an

A. inpatient.
B. established patient.
C. new patient.
D. ambulatory surgery patient.

13.   A patient undergoes an esophagogastric tamponade with a balloon. How would this procedure be coded?

A. 43460
B. 00500
C. 43460-P1
D. 00500-P1

14.   Codes in the range of 99224–99226 represent services for

A. critical care services.
B. subsequent observations.
C. consultations.
D. initial observations.

15.   Which of the following code ranges are add-on codes reported for prolonged physician services?

A. 99458–99586, 99372
B. 99212–99252, 99344
C. 99673–99873, 99001
D. 99354–99357, 99359

16.   A patient who has been treated by a physician or another physician in the same group within the last three years is a/an _______ patient.

A. emergent
B. new
C. transmitted
D. established

17.   Modifier -QY indicates that

A. anesthesia administration was abruptly terminated due to surgical complications.
B. the surgeon is administering anesthesia.
C. the physician is supplying topical anesthesia only.
D. an anesthesiologist is directing the CRNA during anesthesia administration.

18.   _______ circumstance codes are used in situations that increase the difficulty of administering anesthesia.

A. UNIT administration modification
B. Extenuating
C. ASA relativity
D. Qualifying

19.   Other nursing facility services would be reported with code

A. 99305.
B. 99318.
C. 99525.
D. 99211.

20.   A patient undergoes a pacemaker insertion. She is not expected to survive if she doesn’t have the operation. What code should be reported?

A. 00530-P4
B. 33206-P4
C. 00530-P1
D. 33208-P2

confusion

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Question 1 2 / 2 points

Which statement about confusion is true?

Question options:

a) Confusion is a disease process.

b) Confusion is always temporary.

c) Age is a reliable predictor of confusion.

d) Polypharmacy is a major contributor to confusion in older adults.

Question 2 0 / 2 points

Sondra’s peripheral vestibular disease causes dizziness and vertigo. Which of the following medications will help to decrease edema in the labyrinth of the ear?

Question options:

a) Meclizine

b) Diphenhydramine

c) Diamox

d) Promethazine

Question 3 2 / 2 points

The hallmark of an absence seizure is:

Question options:

a) No activity at all

b) A blank stare

c) Urine is usually voided involuntarily

d) The attack usually lasts several minutes

Question 4 2 / 2 points

How often should drug levels be monitored when a seizure medication has controlled the seizures, and the drug level is adequate?

Question options:

a) Every 3 months

b) Every 6 months

c) Annually

d) Whenever there is a problem

Question 5 2 / 2 points

Which of the following persons fits the classic description of a patient with multiple sclerosis (MS)?

Question options:

a) A teenage male

b) A 65-year-old male

c) A 25-year-old female

d) A 60-year-old female

Question 6 2 / 2 points

Which of the following is a specific test to MS?

Question options:

a) Magnetic resonance imaging (MRI)

b) Computed tomography (CT) scan

c) A lumbar puncture

d) There is no specific test.

Question 7 2 / 2 points

Which drug for Alzheimer’s disease should be administered beginning at the time of diagnosis?

Question options:

a) Cholinesterase inhibitors

b) Anxiolytics

c) Antidepressants

d) Atypical antipsychotics

Question 8 2 / 2 points

Which hematoma occurs along the temporal cranial wall and results from tears in the middle meningeal artery?

Question options:

a) Epidural hematoma

b) Subdural hematoma

c) Subarachnoid hematoma

d) Intraparenchymal hemorrhage

Question 9 2 / 2 points

Which cranial nerve is affected in a patient with a cerebrovascular accident who has difficulty chewing?

Question options:

a) CN V

b) CN VII

c) CN IX

d) CN X

Question 10 2 / 2 points

Which statement best describes a carotid bruit?

Question options:

a) It is felt with the middle three fingers over the carotid artery.

b) A bruit becomes audible when the lumen is narrowed to 1 mm or less.

c) A low-pitched bruit is a medical emergency.

d) The higher the pitch of the bruit, the higher the degree of stenosis.

Question 11 2 / 2 points

Which patient is more likely to have a cluster headache?

Question options:

a) A female in her reproductive years

b) A 40-year-old African American male

c) A 55-year-old female who drinks 10 cups of coffee daily

d) A 45-year-old male awakened at night

Question 12 2 / 2 points

Inattention and a sleep-wake cycle disturbance are the hallmark symptoms of?

Question options:

a) Dementia

b) Alzheimer’s disease

c) Parkinson’s disease

d) Delirium

Question 13 2 / 2 points

Which type of meningitis is more benign, self-limiting, and caused primarily by a virus?

Question options:

a) Purulent meningitis

b) Chronic meningitis

c) Aseptic meningitis

d) Herpes meningitis

Question 14 2 / 2 points

Which is the most sensitive neuroimaging test to evaluate patients with encephalitis?

Question options:

a) MRI

b) CT

c) Electroencephalogram (EEG)

d) An initial lumbar puncture

Question 15 2 / 2 points

What is usually the first sign or symptom that a patient would present with that would make you suspect herpes zoster?

Question options:

a) A stabbing pain on one small area of the body

b) A vesicular skin lesion on one side of the body

c) A pain that is worse upon awakening

d) A lesion on the exterior ear canal

Question 16 1 / 1 point

Gabby, aged 22, has Bell’s palsy on the right side of her face. Her mouth is distorted, and she is concerned about permanent paralysis and pain. What do you tell her?

Question options:

a) “Most patients have complete recovery in 3 to 6 months.”

b) “Unfortunately, you’ll probably have a small amount of residual damage.”

c) “Don’t worry, I’ll take care of everything.”

d) “You may have a few more episodes over the course of your lifetime but no permanent damage.”

Question 17 2 / 2 points

Sam, aged 65, is started on L-dopa for his Parkinson’s disease (PD). He asks why this is necessary. You tell him:

Question options:

a) “L-dopa is neuroprotective.”

b) “The primary goal of therapy is to replace depleted stores of dopamine.”

c) “This is the only drug that can provide symptomatic benefit.”

d) “This is the initial monotherapy drug.”

Question 18 2 / 2 points

Which of the following signs is seen in a patient with more advanced PD?

Question options:

a) Resting tremor

b) Bradykinesia

c) Rigidity

d) Postural instability

Question 19 2 / 2 points

Which of the following is the most commonly experienced symptom of migraine?

Question options:

a) Light sensitivity

b) Pulsatile pain

c) Sound sensitivity

d) Experiencing an aura

Question 20 2 / 2 points

Which of the following characteristics differentiates peripheral vertigo from central vertigo?

Question options:

a) The duration of central vertigo is shorter than that of peripheral vertigo.

b) There is an auditory-associated symptom with peripheral vertigo and a visual-associated symptom with central vertigo.

c) Central vertigo is positional, and peripheral vertigo is not.

d) The onset of central vertigo is more sudden than that of peripheral vertigo.

Question 21 2 / 2 points

Carotid endarterectomy should be considered only for symptomatic patients with greater than what percentage of stenosis?

Question options:

a) Greater than 25%

b) Greater than 50%

c) Greater than 75%

d) Only for 100% occlusion

Question 22 2 / 2 points

What antiplatelet agent is most widely used for secondary prevention of stroke?

Question options:

a) Aspirin

b) Ticlopidine

c) Clopidogrel

d) Aspirin and clopidogrel

Question 23 2 / 2 points

Which adjunctive diagnostic test should be used in the work-up of a patient with suspected Creutzfeldt-Jakob disease or transient epileptic amnesia?

Question options:

a) MRI

b) CT

c) Cerebrospinal fluid analysis

d) EEG

Question 24 2 / 2 points

Which herbal preparation may cause delirium and should be avoided in an elderly patient?

Question options:

a) Sam-e

b) Saint John’s Wort

c) Melatonin

d) Saw Palmetto

Question 25 0 / 2 points

Which of the following activities is part of the functional activities questionnaire?

Question options:

a) Asking the patient to unravel a Rubik’s cube

b) Determining if the patient can drive on the highway

c) Asking the patient about a news event from the current week

d) Seeing if the patient can keep his or her home clean

Question 26 2 / 2 points

About 90% of all headaches are?

Question options:

a) Tension

b) Migraine

c) Cluster

d) Without pathological cause

Question 27 2 / 2 points

Which statement is true regarding driving and patients with a seizure disorder?

Question options:

a) Once diagnosed with a seizure disorder, patients must never drive again.

b) After being seizure free for 6 months, patients may drive.

c) Each state has different laws governing driving for individuals with a seizure disorder.

d) These persons may drive but never alone.

Question 28 2 / 2 points

Julie has relapsing-remitting muscular sclerosis. She has not had a good response to interferon. Which medication might help given intravenously once a month?

Question options:

a) Glatiramer acetate

b) Natalizumab

c) Fingolimod

d) Glucocorticoids

Question 29 2 / 2 points

The ‘freezing phenomenon’ is a cardinal feature of?

Question options:

a) Parkinson’s disease

b) Alzheimer’s disease

c) A CVA

d) Bell’s palsy

Question 30 2 / 2 points

A ratchet-like rhythmic contraction, especially in the hand, during passive stretching is known as?

Question options:

a) Spinothalamic dysfunction

b) Ratcheting

c) Cogwheeling

d) Hand tremors

Question 31 2 / 2 points

Clinical features of insidious onset, slow progression, and a lack of other findings to explain the symptoms are fairly diagnostic of which condition?

Question options:

a) Guillain-Barré syndrome

b) Parkinson’s disease

c) Alzheimer’s disease

d) Huntington’s disease

Question 32 1 / 1 point

Which condition is characterized by the impaired ability to learn new information along with either a cognitive disturbance in language, function, or perception?

Question options:

a) Guillain-Barré syndrome

b) Parkinson’s disease

c) Alzheimer’s disease

d) Delirium

Question 33 2 / 2 points

A score of 20 to 25 on this test indicates early-stage Alzheimer’s disease:

Question options:

a) SLUMS

b) MoCA

c) FAST

d) MMSE

Question 34 2 / 2 points

Intravenous thrombolytic therapy following an ischemic CVA should be given within how many hours of symptom onset?

Question options:

a) 1 hour

b) 3 hours

c) 6 hours

d) 12 hours

Question 35 2 / 2 points

When administered at the beginning of an attack, oxygen therapy may help this kind of headache?

Question options:

a) Tension

b) Migraine

c) Cluster

d) Stress

Question 36 2 / 2 points

The effectiveness of benzodiazepines in treating anxiety disorders suggests that which of the following neurotransmitters plays a role in anxiety?

Question options:

a) Acetylcholine

b) Gamma-aminobutyric acid (GABA)

c) Dopamine

d) Serotonin

Question 37 2 / 2 points

The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision) state that excessive worry or apprehension must be present more days than not for at least:

Question options:

a) 1 month

b) 3 months

c) 6 months

d) 12 months

Question 38 1 / 1 point

A patient presents to the clinician after experiencing four episodes in the last month of sweating, palpitations, chest pain, nausea, and shaking. Each episode lasted about 10 minutes. The patient is now becoming very fearful of future events and has been reluctant to leave the house. The clinician suspects panic disorder but wants to rule out any possible medical causes. Which of the following medical conditions can mimic the symptoms of a panic attack?

Question options:

a) Pheochromocytoma

b) Hyperthyroidism

c) Cardiac arrhythmias

d) All of the above

Question 39 2 / 2 points

Which of the following is considered first-line treatment for panic disorders?

Question options:

a) Benzodiazepines

b) Selective serotonin reuptake inhibitors (SSRIs)

c) Tricyclic antidepressants

d) Cognitive behavioral therapy

Question 40 1 / 1 point

Which of the following symptoms is not part of the diagnostic criteria for post-traumatic stress disorder (PTSD)?

Question options:

a) Hypersomnolence

b) Blunted feelings

c) Loss of interest in significant activities

d) Intrusive recurrent recollections of the event

Question 41 2 / 2 points

Which of the following neuroendocrine abnormalities is implicated in depression?

Question options:

a) Decrease in adrenal size

b) Increased cortisol and corticotrophin-releasing hormone

c) An exaggerated response of thyrotropin (TRH) to infusion of thyroid-releasing hormone

d) Increased inhibitory response of glucocorticoids to dexamethasone

Question 42 2 / 2 points

The clinician has chosen to prescribe an SSRI instead of a tricyclic antidepressant (TCA) for a patient fitting the diagnostic criteria for depression. Which of the following is not true concerning SSRIs in comparison to tricyclic antidepressants?

Question options:

a) SSRIs are more effective than TCAs.

b) SSRIs take less time to work than TCAs.

c) SSRIs have a more favorable side-effect profile than TCAs.

d) SSRIs are not lethal in overdose.

Question 43 2 / 2 points

After discontinuing fluoxetine, how long must a person wait before starting a monoamine oxidase inhibitor?

Question options:

a) 2 weeks

b) 3 weeks

c) 4 weeks

d) 5 weeks

Question 44 2 / 2 points

It is important to educate patients with depression and their family members about reporting signs of increasing depression and suicidal thoughts. This is especially true during which time period?

Question options:

a) Before the initiation of treatment

b) 1 to 2 weeks after the initiation of treatment

c) When switching to a different medication

d) 1 to 2 weeks after tapering off medications

Question 45 2 / 2 points

A patient is experiencing extrapyramidal side effects from his antipsychotic medications. The clinician would most likely take which of the following approaches to treating these side effects?

Question options:

a) Give the patient a “drug holiday” until the symptoms resolve and then restart the medication.

b) Switch the patient to a different antipsychotic.

c) Treat the patient with anticholinergics.

d) Treat the patient with anticonvulsants.

Question 46 1 / 1 point

According to Kübler-Ross, the stages of grief occur in which order?

Question options:

a) Anger, denial, depression, bargaining, acceptance

b) Anger, denial, bargaining, acceptance, depression

c) Denial, anger, depression, bargaining, acceptance

d) Denial, anger, bargaining, depression, acceptance

Question 47 1 / 1 point

The clinician is educating a patient about the effects of marijuana. The patient stated she has been smoking for years and believes the use does not interfere with her life. What is a significant long-term sequelae of marijuana use that the clinician should educate this patient about?

Question options:

a) Memory impairment

b) Sexual dysfunction

c) Dry mouth

d) There are no long-term consequences of marijuana use.

Question 48 2 / 2 points

Cocaine acts as a stimulant by blocking the reuptake of which neurotransmitter?

Question options:

a) GABA

b) Acetylcholine

c) Dopamine

d) Serotonin

Question 49 2 / 2 points

What blood alcohol level corresponds with the signs of stupor and confusion?

Question options:

a) 0.05

b) 0.1

c) 0.2

d) 0.3

Question 50 2 / 2 points

Rapid eye movement (REM) sleep occurs how frequently during non-REM sleep?

Question options:

a) Every 30 minutes

b) Every 60 minutes

c) Every 90 minutes

d) Every 180 minutes

Question 51 2 / 2 points

Which of the following is a laboratory finding commonly found in patients with anorexia nervosa?

Question options:

a) Hypercholesterolemia

b) Hypermagnesmia

c) Leukocytosis

d) Decreased TRH

Question 52 2 / 2 points

Which of the following is the only drug for bulimia approved by the U.S. Food and Drug Administration?

Question options:

a) Sertraline

b) Fluoxetine

c) Citoprolam

d) Imipramine

Question 53 2 / 2 points

Which of the following would be important to monitor in a child receiving methylphenidate for treatment of attention deficit-hyperactivity disorder (ADHD)?

Question options:

a) Liver function

b) Vision

c) Growth parameters

d) Renal function

Question 54 2 / 2 points

It is important for the clinician to discuss the long-term effects of sexual assault with survivors. Which of the following is the most common long-term effect of sexual assault?

Question options:

a) Depression

b) Obsessive-compulsive disorder

c) Substance abuse

d) PTSD

Question 55 2 / 2 points

Women are at the highest risk for developing postpartum depression for up to how long after childbirth?

Question options:

a) 2 weeks

b) 1 month

c) 3 months

d) 6 months

Question 56 2 / 2 points

Which is the most prevalent psychiatric condition in the United States?

Question options:

a) Depression

b) Anxiety

c) Substance-related addictions

d) Gambling

Question 57 1 / 1 point

What is recorded as clinical category two of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision)?

Question options:

a) Clinical disorder or focus of clinical attention

b) Personality or environmental problems

c) Environmental and psychosocial stressors

d) Global assessment of functioning

Question 58 2 / 2 points

Which of the following may be used to evaluate a person’s suicide risk?

Question options:

a) CAGE

b) SANE

c) SAD PERSONAS

d) DIGFAST

Question 59 2 / 2 points

Assessing for adherence with prescribed medications and developing a plan for what to do if they are stopped is a major treatment issue for which of the following diagnostic groups?

Question options:

a) ADHD

b) Bipolar

c) Depression

d) Anxiety

Question 60 1 / 1 point

Bipolar disorder requires differential diagnosis from all of the following except?

Question options:

a) Substance abuse and medication effects

b) Medical and neurological disorders

c) Cluster B personality disorders and depression

d) Obsessive-compulsive disorder

Question 61 1 / 1 point

The use of benzodiazepines in the patient with generalized anxiety disorder and comorbid depression can exacerbate depressive symptoms.

Question options:

a) True

b) False

Question 62 1 / 1 point

Depressive episodes associated with bipolar disorder are treated the same as major depressive disorder.

Question options:

a) True

b) False

Question 63 1 / 1 point

Women in abusive relationships have a greater chance of being killed by their batterers when they leave the relationship than women who stay.

Question options:

a) True

b) False

Question 64 1 / 1 point

Adults must show childhood onset of symptoms to receive a diagnosis of ADHD.

Question options:

a) True

b) False

Question 65 1 / 1 point

Parkinson’s disease and dementing illnesses may commonly manifest depressive symptoms.

Question options:

a) True

b) False

Question 66 1 / 1 point

The best predictor of suicide risk is a history of suicide attempts.

Question options:

a) True

b) False

Question 67 1 / 1 point

A no-suicide contract can prevent a suicide attempt.

Question options:

a) True

b) False

Question 68 1 / 1 point

Depression is the most chronic disabling and economically catastrophic medical disorder of the severe mental illnesses.

Question options:

a) True

b) False

Question 69 1 / 1 point

Clozapine (Clozaril) requires laboratory monitoring at specified frequencies with results reported to a national registry.

Question options:

a) True

b) False

Question 70 1 / 1 point

When combined with certain other medications, serotonin-specific antidepressants can have significant liver P450-interaction effects.

Question options:

a) True

b) False

Question 71 1 / 1 point

A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her examination?

Question options:

a) Human papillomavirus (HPV)

b) Endometrial hyperplasia

c) Vagismus

d) Polycystic ovarian syndrome

Question 72 2 / 2 points

A 20-year-old woman is seen in the clinic because her boyfriend was found to have gonorrhea. Which of the following is the treatment of choice for gonorrhea?

Question options:

a) Ceftriaxone

b) Doxycycline

c) Acyclovir

d) Metronidazole

Question 73 1 / 1 point

A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease has she most probably been exposed to?

Question options:

a) Gonorrhea

b) HPV

c) Chlamydia

d) Trichomonas

Question 74 1 / 1 point

A 45-year-old woman is seen in the clinic with complaints of a vaginal discharge. The clinician identifies clue cells on the vaginal smear.Which of the following diagnoses is associated with this finding?

Question options:

a) Trichomonas

b) Bacterial vaginosis

c) HPV

d) Herpes simplex virus

Question 75 2 / 2 points

Which of the following medications is the treatment of choice for trichomonas?

Question options:

a) Metronidazole

b) Ceftriaxone

c) Diflucan

d) Doxycycline

Question 76 1 / 1 point

A 36-year-old woman is seen with complaints of vaginal itching, burning, and discharge. On potassium hydroxide (KOH) wet mount of vaginal discharge, the clinician notices hyphae. Which of the following treatments would be appropriate?

Question options:

a) Fluconazole

b) Estrogen vaginal cream

c) Metronidazole

d) Doxycycline

Question 77 2 / 2 points

Mandy presents with a cauliflower-like wart in her anogenital region. You suspect it was sexually transmitted and document this as a:

Question options:

a) Filiform/digitate wart

b) Dysplastic cervical lesion

c) Condyloma acuminata

d) Koilocytosis

Question 78 0 / 2 points

During a DRE on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?

Question options:

a) An enlarged rubbery gland

b) A hard irregular gland

c) A tender gland

d) A boggy gland

Question 79 2 / 2 points

Of the following types of cellulitis, which is a streptococcal infection of the superficial layers of the skin that does not involve the subcutaneous layers?

Question options:

a) Necrotizing fasciitis

b) Periorbital cellulitis

c) Erysipelas

d) “Flesh-eating” cellulitis

Question 80 2 / 2 points

The forced vital capacity is decreased in:

Question options:

a) Asthma

b) Chronic bronchitis

c) Emphysema

d) Restrictive disease

Question 81 2 / 2 points

The most common cause of CAP is?

Question options:

a) Streptococcus pneumoniae

b) Klebsiella pneumoniae

c) Legionella pneumoniae

d) Pseudomonas aeruginosa

Question 82 2 / 2 points

Which of the following is a possible consequence of sleep apnea?

Question options:

a) Asthma

b) Increased white blood cells

c) Insulin resistance

d) Hyperactivity

Question 83 2 / 2 points

The majority of HSV-1 and HSV-2 infections are asymptomatic so that only which elevated antibody titer shows evidence of previous infection?

Question options:

a) IgA

b) IgE

c) IgG

d) IgM

Question 84 2 / 2 points

A 60-year-old man presents with an enlarged scrotum. The clinician uses a penlight to transilluminate the scrotum. In a patient with a hydrocele, what would the clinician expect to find?

Question options:

a) The scrotum will be dark.

b) The scrotum will appear light pink or yellow.

c) The scrotum will appear milky white.

d) The internal structures will be clearly visible.

Question 85 0 / 2 points

During a DRE on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?

Question options:

a) An enlarged rubbery gland

b) A hard irregular gland

c) A tender gland

d) A boggy gland

Question 86 2 / 2 points

A 78-year-old man is diagnosed with C2 prostate cancer, and he asks the clinician what that means. In order to answer the patient, the clinician must have which of these understandings of the Jewett rating system?

Question options:

a) The cancer involves the seminal vesicles.

b) There is metastatic disease to regional lymph nodes.

c) The cancer is confined to the capsule.

d) There is metastasis to distant organs.

Question 87 1 / 1 point

A 58-year-old patient has been receiving leuprolide as treatment for prostate cancer. The clinician should instruct the patient about which of these side effects?

Question options:

a) Risk of osteoporosis

b) May have hot flushes

c) May have impotence

d) All of the above

Question 88 1 / 1 point

A 22-year-old male is seen in the clinic because he found a hard lump in his testicle when performing testicular self-examination (TSE).Which of the following should be included in the list of differential diagnoses?

Question options:

a) Testicular cancer

b) Inguinal hernia

c) Varicocele

d) All of the above

Question 89 1 / 1 point

What is the treatment of choice for a patient diagnosed with testicular cancer?

Question options:

a) Radical orchidectomy

b) Lumpectomy

c) Radiation implants

d) All of the above

Question 90 1 / 1 point

A patient with testicular cancer is being followed after completing treatment 1 year ago. He has been symptom-free with no evidence of disease. How often should he have a CT scan?

Question options:

a) Every month

b) Every 3 to 4 months

c) Every 6 to 12 months

d) Every year

Question 91 2 / 2 points

Simon presents with alopecia areata with well-circumscribed patches of hair loss on the crown of his head. How do you respond when he asks you the cause?

Question options:

a) “You must be under a lot of stress lately.”

b) “It is hereditary. Did your father experience this also?”

c) “The cause is unknown, but we suspect it is due to an immunologic mechanism.”

d) “We’ll have to do some tests.”

Question 92 2 / 2 points

Which of the following is “a linear crack extending from the epidermis to the dermis?”

Question options:

a) An ulcer

b) A fissure

c) Lichenification

d) An excoriation

Question 93 2 / 2 points

A bulla is:

Question options:

a) A vesicle larger than 1 cm in diameter

b) An elevated solid mass with a hard texture; the shape and borders can be regular or irregular

c) A superficial elevated lesion filled with purulent fluid

d) Thinning of the skin (epidermis and dermis) that appears white or translucent

Question 94 1 / 1 point

A 70-year-old female has fallen 2 weeks ago and developed immediate pain in her left wrist. She thought she just bruised it but is worried because it has not improved. She has used Tylenol® and ice at home, and that has helped slightly. You examine her and find she has moderate swelling and ecchymosis but no overtly obvious deformity. Her ROM is uncomfortable and severely diminished due to the pain. No crepitus is heard or felt. Her fingers are warm; her pulse is strong; and capillary refill is less than 2 seconds.What should you do?

Question options:

a) Make an immediate referral for an orthopedic evaluation without further assessment.

b) Tell her that it takes time for these bruises to improve, so she should be patient.

c) Obtain a wrist x-ray and place her wrist in a splint or prescribe a splint.

d) Send her to the emergency room for reduction of this obvious wrist fracture.

Question 95 1 / 1 point

Osteoarthritis is primarily a noninflammatory condition.

Question options:

a) True

b) False

Question 96 1 / 1 point

The presence of a positive rheumatoid factor is always indicative of rheumatoid arthritis.

Question options:

a) True

b) False

Question 97 2 / 2 points

Which of the following medications can cause hyperglycemia?

Question options:

a) Prednisone

b) Metformin

c) Synthroid

d) Cephalexin

Question 98 2 / 2 points

Which of the following is diagnostic for diabetes mellitus?

Question options:

a) A1C 7.0 on one occasion

b) Fasting blood sugar (FBS) of 100 mg/dL on two occasions

c) Random glucose of 200 mg/dL on two occasions

d) Two-hour post-load plasma glucose of 300 mg/dL on one occasion

Question 99 2 / 2 points

Which of the following medications for type 2 diabetes mellitus should not be prescribed during pregnancy?

Question options:

a) Insulin

b) Metformin

c) Glucotrol

d) Precose

Question 100 1 / 1 point

A 35-year-old woman presents with symptoms of hypoglycemia.There is no history of diabetes mellitus. Which of the following should be included in the differential diagnosis?

Question options:

a) Anxiety disorder

b) Pheochromocytoma

c) Psychosis

d) All of the above

GMO’S AND ORGANIC FOODS

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Nutrition Debate:  GMO’S AND ORGANIC FOODS

answer the FOLLOWING QUESTIONS.  You should submit a minimum of 500 – 900 words response (in totality) for the questions. Deduction will be taken for submitting incomplete answers.

1.  What is a Genetically Modified Food?

2.  Many people blame GMO food consumption on diseases or health conditions ie., allergies, cancer, diabetes.  Please explain the reasoning for this belief.  Do you agree?  Why or why not?

3.  Should manufacturers be required to label products containing GMO Foods?  Why or Why not – please defend your answer.

4.  Do you purchase organic Foods?  Why or Why not?

5.  Many people assume that organic foods and beverages are superior to foods produced using conventional methods.  Do you feel this way?  Why or Why not – defend your answer.

Case Study

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Case Study I A 45-year-old female presents to your clinic today with complaints of back pain and “just not feeling good”.  Regarding her back, she states that her back pain is a chronic condition that she has suffered with for about the last 10 years. She has not suffered any specific injury to her back. She denies weakness of the lower extremities, denies bowel or bladder changes or dysfunction, denies radiation of pain to the lower extremities and no numbness or tingling of the lower extremities. She describes the pain as a constant dull ache and tightness across the low back. She states she started a workout program about 3 weeks, and she is working out with a friend that is a body builder. She states her friend suggested taking Creatine to help build muscle and Coenzyme Q10 as an antioxidant so she started those medications at the same time she began working out. She states she also takes Kava Kava for her anxiety and garlic to help lower her blood pressure. Past medication history includes: Type II diabetes since age 27, High blood pressure, Recurrent DVT’s Her other medications include: Glyburide 3 mg daily with breakfast, Lisinopril 20 mg daily and Coumadin 6 mg daily 1. What are your findings following reviewing this medication list? Explain concerns in detail. 2. Is there additional information you would obtain? If so, please discuss rationale. 3. What are your recommendations for managing this patient’s medications? 4. What are the components for educating the patient? 5. If your plan is to prescribe a medication/s, create a prescription and discuss, what are the important components necessary on the packaging or on the label? Please answer each question concisely. You do not need to write a long paragraph to prove your points. You need to provide a cover page and 1 reference page. Support answers with peer reviewed journals. Articles cannot be older than 5 years. Remember all paragraphs need to be cited properly, and the paper must be written in APA 6th format. A minimum of 3 references are required for this case study.

“Nurse Manager Skills Inventory

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Rate yourself using the results from the “Nurse Manager Skills Inventory”:

http://www.aone.org/resources/nurse-manager-skills-inventory.pdf

Write a reflection of 750-1,000 words in which you identify your strengths and weaknesses related to the four content areas below:

  1. Personal and professional accountability
  2. Career planning
  3. Personal journey disciplines
  4. Reflective practice reference behaviors/tenets

Discuss how you will use your current leadership skill set to advocate for change in your workplace.

Identify one personal goal for your leadership growth and discuss your implementation plan to achieve that goal.

While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Rubrics

 

1
Unsatisfactory
0.00%

2
Less than Satisfactory
75.00%

3
Satisfactory
79.00%

4
Good
89.00%

5
Excellent
100.00%

80.0 %Content

30.0 %Identification of strengths and weaknesses related to the four content areas listed.

Provides strengths and/or weaknesses based on some of the listed content areas.

Lists strengths and weaknesses based on each of the listed content areas, but does not draw on evidence from the given Web site.

Lists strengths and weaknesses based on each of the listed content areas, and draws on evidence from the given Web site for some of the content areas.

Lists strengths and weaknesses based on each of the listed content areas, and draws on evidence from the given Web site.

Lists and analyzes strengths and weaknesses based on each of the listed content areas, and draws on evidence from the given Web site.

25.0 %Discussion of use of current leadership skills to advocate change in the workplace.

Fails to mention either change in the workplace and/or personal skill set.

Discusses one change that can be made in the workplace, without providing examples or evidence. Makes brief mention of personal skill set, but does not effectively demonstrate how it can be used to effect change.

Discusses one change that can be made in the workplace, without providing examples or evidence. Evaluates how personal skill set can be used to effect change in workplace.

Discusses one change that can be made in the workplace, while giving a clear and relevant example for why the change is necessary. Evaluates how personal skill set can be used to effect change in workplace.

Discusses specific changes that can be made in the workplace are discussed, while giving clear and relevant examples for why changes are necessary. Evaluates how personal skill set can be used to effect change in workplace.

25.0 %Reflection on personal goal for leadership growth and development of implementation plan to reach goal.

Pinpoints a goal for leadership growth, but does not provide a plan for attaining the goal.

Pinpoints a goal for leadership growth, but the plan for attaining goal is not aligned to the final outcome.

Provides a surface-level reflection on areas of growth. Pinpoints at least one specific goal for leadership growth, but provides an oversimplified plan for attaining goal.

Reflects on areas for growth. Pinpoints at least one specific goal for leadership growth, and outlines a clear implementation plan to meet the goal.

Provides a thoughtful reflection on areas for growth. Pinpoints at least one specific goal for leadership growth, and outlines a well-organized and realistic implementation plan to meet the goal.

15.0 %Organization and Effectiveness

5.0 %Thesis Development and Purpose

Paper lacks any discernible overall purpose or organizing claim.

Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear.

Thesis and/or main claim are apparent and appropriate to purpose.

Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.

15.0 %Organization and Effectiveness

5.0 %Paragraph Development and Transitions

Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. Organization is disjointed.

Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident.

Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other.

A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to purpose.

There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.

15.0 %Organization and Effectiveness

5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use)

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present.

Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

Writer is clearly in command of standard, written, academic English.

5.0 %Format

2.0 %Paper Format (1- inch margins; 12-point-font; double-spaced; Times New Roman, Arial, or Courier)

Template is not used appropriately or documentation format is rarely followed correctly.

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

Template is used, and formatting is correct, although some minor errors may be present.

Template is fully used; There are virtually no errors in formatting style.

All format elements are correct.

5.0 %Format

3.0 %Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment)

No reference page is included. No citations are used.

Reference page is present. Citations are inconsistently used.

Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present.

Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and GCU style is usually correct.

In-text citations and a reference page are complete. The documentation of cited sources is free of error.

100 %Total Weightage