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

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

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

Select two clients you observed or counseled this week during a family therapy session. Note: The two clients you select must have attended the same family session.

Then, address in your Practicum Journal the following:

· Using the Group Therapy Progress Note in this week’s Learning Resources, document the family session. (ALSO SEE ATTACHED Group Therapy Progress Note)

· Describe each client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications.

· Using the DSM-5, explain and justify your diagnosis for each client.

· Explain whether solution-focused or cognitive behavioral therapy would be more effective with this family. Include expected outcomes based on these therapeutic approaches.

· Explain any legal and/or ethical implications related to counseling each client.

· Support your approach with evidence-based literature.

                                                                     Learning Resources

Required Readings

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

• Chapter 12, “Family Therapy” (Review pp.      429–468.)

Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.

• Chapter 10,      “Cognitive-Behavior Family Therapy” (pp. 166–189)
• Chapter 12, “Solution-Focused Therapy” (pp.      225–242)

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

Bond, C., Woods, K., Humphrey, N., Symes, W., & Green, L. (2013). Practitioner review: The effectiveness of solution focused brief therapy with children and families: A systematic and critical evaluation of the literature from 1990–2010. Journal of Child Psychology & Psychiatry, 54(7), 707–723. doi:10.1111/jcpp.12058

Conoley, C., Graham, J., Neu, T., Craig, M., O’Pry, A., Cardin, S., & … Parker, R. (2003). Solution-focused family therapy with three aggressive and oppositional-acting children: An N=1 empirical study. Family Process, 42(3), 361–374. doi:10.1111/j.1545-5300.2003.00361.x

de Castro, S., & Guterman, J. (2008). Solution-focused therapy for families coping with suicide. Journal of Marital & Family Therapy, 34(1), 93–106. doi:10.111/j.1752-0606.2008.00055.x

Patterson, T. (2014). A cognitive behavioral systems approach to family therapy. Journal of Family Psychotherapy, 25(2), 132–144. doi:10.1080/08975353.2014.910023

Perry, A. (2014). Cognitive behavioral therapy with couples and families. Sexual & Relationship Therapy, 29(3), 366–367. doi:10.1080/14681994.2014.909024.

Ramisch, J., McVicker, M., & Sahin, Z. (2009). Helping low-conflict divorced parents establish appropriate boundaries using a variation of the miracle question: An integration of solution-focused therapy and structural family therapy. Journal of Divorce & Remarriage, 50(7), 481–495. doi:10.1080/10502550902970587

Washington, K. T., Wittenberg-Lyles, E., Oliver, D. P., Baldwin, P. K., Tappana, J., Wright, J. H., & Demiris, G. (2014). Rethinking family caregiving: Tailoring cognitive-behavioral therapies to the hospice experience. Health & Social Work, 39(4), 244–250. doi:10.1093/hsw/hlu031