Have people Annoyed you by criticizing your drinking?

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Directions:Compete the following chart. An example has been provided for you in the first row. Include in-text citations in the table as well as an APA reference listing below. A minimum of two to three scholarly references should be included
Assessment Tool
Include the full name, description of the tool, and what the tool measures (i.e., opioids, process, withdrawal) Tool Description
Type of tool (paper, pen, structured, unstructured), how it is administered, how many questions, and general scoring information Appropriateness of Use
When/where the tool is appropriate or inappropriate to use, where the tool will most likely be used (i.e., online, in-patient, outpatient, clinic), and what specific population the tool is used for (i.e., adolescents, elderly, pregnant.)
CAGE Questionnaire
A brief 4 item, widely used questionnaire designed to assess alcohol use. CAGE is acronym for:
C=Cut down
A=Annoyed
G=Guilty
E=Eye opener

Paper and pen or orally administered Takes less than 1 minute, Yes or No response
Typically administered by health care professional or clinician and is client’s self- report, scored by tester
CAGE Questionnaire-4 questions
1. Have you ever felt you should Cut down on your drinking?

2. Have people Annoyed you by criticizing your drinking?

3. Have you ever felt bad or Guilty about your drinking?

4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?
Scoring: Item responses on the CAGE are scored as 0 or 1. A higher score is an indication of alcohol problems. A total score of 2 or greater is considered to be clinically ToollTsignificant Ewing, 1984; NIAAA, 2002) Often used in medical settings
Several adaptations of tool available for use including computerized and self- administered versions.
Free, in public domain and translated into many languages

Not used to assess for drugs but adapted CAGE-AID questionnaire can be used for drug use.
Best use is in adult populations

Criticism of the CAGE- not gender-sensitive. Women who are problem drinkers less likely to screen positive than men.
It identifies alcohol-dependent persons, but may not identify binge drinkers.
CAGE asks about “lifetime” experience rather than current drinking. A person who no longer drinks may screen positive unless the clinician directs the questions to focus on a more current time frame (ADAI, 2016).

Create at least three contingency goals in the event the current strategy would fail.

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There are several elements results from the planning stage but for our purposes we will focus on the development of long-term and short-term goals. Long-term goals are set by the owners, leaders or upper management depending on the structure, size or type of organization. They are the big-picture goals and objectives of the company and are directly related to the purpose and vision that the leaders and owners develop. In today’s change dominated business environment long-term goals are set to be accomplished in 2-3 years’ time as opposed to the previous century’s 5-10 years.
Long-term goals are often created through planning and strategizing. It begins with the vision and mission of the business. To understand the concept of vision and mission and its role in the process, you will do the leader’s job and formulate the vision and mission of an organization. In week four the class will examine the vision and mission in the context of planning the goals for the same organization.
Create a vision and mission statement to fit the company described below:
Mohammed Abul and his family own the Long-lasting Boot (LLB) store. LLB is a specialty boot store located in the downtown area in a medium sized Scottsdale, Arizona and sells a broad line of boots to all members of the family including a novelty pet line. The store sells boots for work and recreation as well as a line of expensive cowboy boots for the tourist trade. The business is twenty-five years old. It has a reputation for being the best place to get boots in the community because of the selection, quality, and customer service. They will even work with custom designed boots for people with unusually sized feet or medical problems. The boots in some instances, work boots in particular, are considered expensive by middle class buyers but the construction quality is so long-lasting that it makes the higher prices seem worthwhile. The store is successful but sales are very slow growing at the moment. The family is looking to boost sales by developing a competitive edge for the future.
Hint: Before you begin be sure that you clearly understand the difference between a vision and mission statement as well as the purpose they each serve.
As mentioned last week the planning process begins with an environmental scan of the business and its relationship to vision and mission statements. Using the expanded case study of LLB below and the SWOT tool complete a business environmental scan.

Mohammed Abul and his family own the Long-lasting Boot (LLB) store. LLB is a specialty boot store located in the downtown area in a medium sized Scottsdale, Arizona and sells a broad line of boots to all members of the family including a novelty pet line. The store sells boots for work and recreation as well as a line of expensive cowboy boots for the tourist trade. The business is twenty-five years old. It has a reputation for being the best place to get boots in the community because of the selection, quality, and customer service. They will even work with custom designed boots for people with unusually sized feet or medical problems. The boots in some instances, work boots in particular, are considered expensive by middle class buyers but the construction quality is so long-lasting that it makes the higher prices seem worthwhile. Abul, who is 32 years old and just out of the military after 10 years of service, has returned to find the business at a crossroad.
The store is successful but sales are very slow growing at the moment. The family is looking to boost sales by developing a competitive edge for the future. The business has up till now been successful because of its ability to anticipate changing boot styles. In the past three years sales have remained constant but growth has waned. Despite sales, loyalty reward cards and staying open late revenue has not grown. Yet total sales in the Central City metropolitan area including the suburbs have grown substantially. Volume stores like Wal-Mart and large shoe chain stores like Payless have boot sales that pull in three times the sales of LLB.

Abul and the family are planning for the next three years and want to find ways to increase sales. They have come to you for advice. As their consultant you want to cover the following ideas in your reply:
• What is meant by long-term planning?
• The tools and information needed to evaluate the future goals.
• The conclusions you have drawn from evaluating the information and analysis of the facts of this case.
• The recommendations that you would make.

Learning Activity 2 – Theme 2 & 3
In the planning phase, managers create a detailed action plan aimed at the organizational goals. Strategic management, or what you will learn as strategizing, is what an organization will do or not do to achieve the goals and objectives that lead to meeting the stated mission and vision. Using the vision, mission, and SWOT analysis created in week three and LA1 complete the following:
• Create three long term goals and objectives (3 each) for the business (2 years forward);
• Create three medium term (operational) goals and objectives (3 each) for the business (usually accomplished within the year);
• Create three short term (day, week, month) goals and objectives (3 each) for the business; and
• Create at least three contingency goals in the event the current strategy would fail.

Which of the following patients of a primary care nurse practitioner would not require extra screening for cancer?

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Question 1.
A community health nurse practitioner is teaching a group of female high school students about the importance of regular Papanicolaou (Pap) smears. The nurse recognizes that which of the following items underlies the rationale for this teaching?
The active substitution of normal cells in the cervix correlates to cancer risk.
Undifferentiated stem cells are an early indicator of cervical cancer.
Cancer of the uterine cervix develops incrementally at a cellular level.
Dysplasia in the connective tissue of the cervix is a strong precursor to cancer.
Question 2.
A patient who has a diagnosis of lung cancer is scheduled to begin radiation treatment. The NP providing pretreatment education is explaining some of the potential unwanted effects of the treatment. Which of the following statements by the nurse is most accurate?
“Some patients experience longer-term irritation of skin adjacent to the treatment site.”
“Sometimes you might find that your blood takes longer to clot than normal.”
“The changes that you might see are normally irreversible.”
“The unwanted effects will be limited to the exposed portions of your skin.”
Question 3.
Which of the following patients of a primary care nurse practitioner would not require extra screening for cancer?
A 51-year-old woman whose grandmother died of breast cancer
A 48-year-old man who takes immunosuppressant drugs following a kidney transplant
A 50-year-old male who is obese and has a low-fiber, high-fat diet
A 38-year-old female with Down syndrome and congenital scoliosis
Question 4.
A nurse practitioner is educating a patient with a recent diagnosis of diabetes about the roles that glucose and insulin play in the disease pathology and the fact that glucose must enter the cell in order to provide energy for the patient. The nurse practitioner knows that which of the following processes allows glucose to enter body cells
Osmosis
Facilitated diffusion
Active transport
Diffusion
Question 5.
A student nurse practitioner asks her preceptor about the origins of different tissues, and their cellular origins during the process of development. Which of the following statements by the preceptor best describes the process of cell differentiation?
“Cells of the hematopoietic system produce the appropriate body cells that are required at each stage of development.”
“A single stem cell differentiates into approximately 200 different types of cells.”
“A fertilized ovum undergoes a series of divisions, yielding many different cell types.”
“Cells differentiate into necessary body cells, peaking after conception, and ceasing near the time of birth.”
Question 6.
The nurse practitioner is seeing a client who has an acute exacerbation of Crohn’s disease. The NP recognizes the fact that the disease involves the inflammation and irritation of the intestinal lining. Which of the following types of tissue is most likely involved in the patient’s pathology?
Simple columnar epithelium
Glandular epithelium
Simple cuboidal epthelium
Stratified epithelium
Question 7.
A nurse practitioner employed in a hospitalist notices that a patient is experiencing muscle atrophy following 2 weeks in traction after a motor vehicle accident. Which of the following factors has most likely contributed to the atrophy of the patient’s muscle cells?
High levels of insulin and IGF-1 in the patient’s blood during immobilization
Denervation of the affected muscles during the time of traction
A reduction of skeletal muscle use secondary to the traction treatment
Reduced oxygen consumption and cellular function that ensures muscle cell survival
Question 8.
A 7-year-old boy is admitted to the hospital with a suspected diagnosis of lead toxicity. Which of the following assessment findings is most congruent with the patient’s diagnosis?
Decreased deep tendon reflexes
Hemoglobin 9.9 g/dL
Diffuse muscle pain
White blood cells (WBC) 11,000/mm3
Question 9.
The NP is teaching a group of older adults about the value of including foods containing antioxidants in their diet. Which of the following statements best captures the rationale underlying the NPs advice?
Antioxidants inhibit the actions of reactive oxygen species (ROS).
Antioxidants prevent the formation of superoxide dismutase.
Antioxidants react nonspecifically with molecules.
Antioxidants prevent the occurrence of cell dysplasia.
Question 10.
Which of the following statements most accurately conveys an aspect of cell injury due to impaired calcium homeostasis?
Normal intracellular calcium ion levels are higher than extracellular levels.
Ischemia and certain toxins cause a decrease in cytosolic calcium.
Injured cells tend to accumulate calcium.
Low calcium levels cause an activation of damaging enzymes.
Question 11.
The NP is providing care for a 21-year-old female patient with gas gangrene of a compound fracture in her arm. Which of the following assessment findings would the nurse most reasonably expect to find when caring for a patient with a diagnosis of gas gangrene?
Inflammation of the affected tissue
A positive culture for Staphylococcus
Spreading edema
Impaired alveolar gas exchange
Question 12.
A 45-year-old patient who experienced exposure to radiation during an industrial accident several years prior is being assessed. Which of the following phenomena may underlie the genetic changes that have been noted in the patient?
Base pairs may have been rearranged by the radiation exposure.
Endonucleases may have influenced the DNA structure following exposure.
Two paired bases may have exchanged helical positions after the accident.
The radiation may have produced redundant or degenerate genetic code.
Question 13.
A child possesses a trait that is the result of the interaction of two different genes, neither of which could have produced the trait independently. Which of the following explanations best captures the genetic explanation for this?
The trait is an expression of multiple alleles.
Epistasis has dictated the phenotypic outcome.
The phenomenon is an example of polygenic inheritance.
The outcome is the result of the interaction between collaborative genes.
Question 14.
A group of researchers has identified that the prevalence of two particular genetic disorders share a statistical correlation. Which of the following statements best conveys the genetic rationale for this situation?
There is likely a cause-and-effect relationship between the two genes responsible.
The chromosomes containing each gene are likely closely situated.
The genes causing each disorder are likely in the same section of the same chromosome.
The disorders likely share the same locus.
Question 15.
A researcher is involved in the production of insulin through recombinant DNA technology. Which of the following statements could the researcher best provide as a rationale for her work?
The gene fragment responsible for insulin production can be isolated and reproduced.
Particular bacteria are capable of insulin production.
It is possible to reproduce the chromosome responsible for insulin production.
Recombination of DNA base pairs can result in a gene that will produce insulin.
Question 16.
An infant who is four days postpartum has been diagnosed with a single-gene disorder. The parents of the child have a number of questions about the etiology of the health problem, which the physician is attempting to address in detail. Which of the following teaching points most accurately captures an aspect of single-gene congenital disorders?
Affected genes are present on autosomal chromosomes rather than sex chromosomes.
The majority of single-gene disorders manifest near the time of puberty.
A particular defect can be caused by mutations at one of several different loci.
Single-gene disorders are associated with existing rather than new mutations.
Question 17.
A male patient of a nurse practitioner has an autosomal dominant disorder. The patient and his partner are considering starting a family. Which of the patient’s following statements indicates the patient has an adequate understanding of the genetic basis of this health problem?
“I know there’s no way of accurately determining the chance that my child will inherit the disease.”
“My children who don’t have the disease still run the risk of passing it on to their children.”
“I know that new genetic mutations won’t occur between generations.”
“I know that a single mutant allele is to blame for the health problem.”
Question 18.
A 6-year-old girl with a diagnosis of Marfan syndrome is being assessed at a community health clinic. Which of the following assessments would be the health care professional’s lowest priority?
A test of the child’s visual acuity
A musculoskeletal assessment
Tests of kidney function
Cardiovascular assessment
Question 19.
A new older female patient at a long-term care facility has a diagnosis of type 1 neurofibromatosis (NF-1). As part of the intake assessment protocol for the facility, the clinical educator is teaching the care staff about the diagnosis. Which of the following statements most accurately conveys an aspect of neurofibromatosis?
“The neurofibroma lesions are unsightly for the patient, but they are not painful.
“Her diagnosis puts her at higher risk of developing a malignant neoplasm.”
“She is living with an example of an autosomal recessive disorder.”
“The patient is likely to be photosensitive as a result of the disease.”
Question 20.
As part of an orientation to a genetic counseling practice, a group of medical students is differentiating between autosomal recessive disorders and autosomal dominant disorders. Which of the following statements is true of autosomal recessive disorders?
They can manifest when present in one or both gene pairs.
There is a one in two chance of an affected child in each pregnancy with an affected mother.
They tend to have a more uniform symptomatology than autosomal dominant disorders.
The associated disorders are usually attributable to abnormalities in structural proteins.
Question 21.
Which of the following pregnant women has most likely encountered the greatest increase in the risk that her child will have a fetal anomaly?
A woman with diagnoses of syphilis and cirrhosis of the liver
A woman who has herpes simplex and recently recovered from endocarditis
A woman with chronic obstructive pulmonary syndrome and tuberculosis
A woman with diagnoses of insulin-dependent diabetes mellitus and peripheral neuropathy
Question 22.
A 77-year-old male patient with a diagnosis of stomach cancer has been found to have metastases in his liver. The patient and his family are surprised at this turn of events, stating that they don’t see how he could have developed cancer in his liver. Which of the following facts would underlie the reply that the care team provides?
The parenchymal tissue of the liver is particularly susceptible to secondary malignancies.
The portal circulatory system brings venous blood from the gastrointestinal tract into the liver.
Hepatic stromal tissue shares characteristics with cancerous cells, including lack of anchorage dependence.
The proximity of the liver to the stomach allows for direct spread of cancerous cells due to a lack of contact inhibition.
Question 23.
A woman is surprised to read on the Internet that certain infections can cause cancer and has sought clarification from her nurse practitioner during an office visit. How can the NP best respond to the woman’s query?
“Though it’s not particularly common, it’s true that certain bacteria and viruses can lead to cancer.”
“Most cancers that cannot be attributed to family history or lifestyle are in fact associated with viruses.”
“There are many viruses, but only a very few of them have been shown to cause cancer in humans.”
“This is true; for example, HIV has been shown to cause cancer in some patients.”
Question 24.
The family of a 68-year-old man who is in the end stages of small cell lung cancer is distraught at his visible body wasting that has worsened in recent weeks. Which of the following phenomena best accounts for the patient’s anorexia and cachexia?
Inadequate cellular metabolism of glucose results from tumor factors
High fat losses coupled with preservation of muscle mass exaggerate the appearance of wasting
Products of the tumor itself as well as a hypermetabolic state cause cachexia
Inadequate food intake due to symptoms and treatment results in loss of both muscle and fat
Question 25.
The nurse practitioner working in occupational health has been asked to speak to a group of factory workers about the importance of wearing gloves when working with strong chemicals such as turpentine and paint thinner. Which of the following characteristics of cell membranes underlies the nurse’s teaching?
Cell membranes are impermeable to all but lipid-soluble substances.
Cell membranes have lipids that have a hydrophilic head and a hydrophobic tail.
Cell membranes contain receptors for hormones and biologically active substances.
Transmembrane proteins can pass through the cell membrane into the intracellular environment.

Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis?

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Question 1. 1. The unique clinical presentation of a three-month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis? (Points : 0.4)
“Have you ever given your child any honey or honey-containing products?”
“Is there any family history of neuromuscular diseases?”
“Has your baby ever been directly exposed to any chemical cleaning products?”
“Is there any mold in your home that you know of?”
Question 2. 2. A nurse practitioner is providing care for a 68-year-old female whose anxiety disorder is significantly decreasing her quality of life. Which of the following pharmacologic therapies is most likely to benefit the woman? (Points : 0.4)
A drug that influences gamma-aminobutyric acid (GABA) levels
A selective serotonin reuptake inhibitor (SSRI)
An antipsychotic medication that blocks dopamine receptors
An epinephrine and norepinephrine supplement
Question 3. 3. A 51-year-old has been admitted to a rehabilitation center after hospital treatment for an ischemic stroke. Which of the following aspects of the patient’s history would not be considered to have contributed to his stroke? (Points : 0.4)
He was diagnosed with type 2 diabetes eight years ago
Elevated cholesterol
Blood pressure that is normally 120/80
The patient is an African American Male
History of sickle cell anemia
Question 4. 4. Following a motor vehicle accident three 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? (Points : 0.4)
“Your daughter has lost all her cognitive functions as well as all her basic reflexes.”
“Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change.”
“If you or the care team notice any spontaneous eye opening, then we will change our treatment plan.”
“Your daughter’s condition is an unfortunate combination of total loss of consciousness with continuation of all other normal brain functions.”
Question 5. 5. A patient with a diagnosis of depression has been prescribed a medication that ultimately increases the levels of the neurotransmitter serotonin between neurons. Which of the following processes will accompany the actions of the neurotransmitter in her chemical synapses? (Points : 0.4)
Two-way communication between neurons is permitted, in contrast to the one-way communication in electrical synapses.
Communication between a neuron and the single neuron it is connected with will be facilitated.
The neurotransmitter will cross gap junctions more readily.
More serotonin molecules will cross the synaptic cleft and bond with postsynaptic receptors.
Question 6. 6. A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son’s increasingly frequent, severe headaches. Which of the nurse’s following questions is least likely to yield data that will allow for a confirmation or ruling out of migraines as the cause of his problem? (Points : 0.4)
“Does your son have a family history of migraines?”
“When your son has a headache, does he ever have nausea and vomiting as well?”
“Does your son have any food allergies that have been identified?”
“Is your son generally pain free during the intervals between headaches?”
Question 7. 7. A 60-year-old male patient with a long history of back pain has had little success with a variety of analgesic regimens that his nurse practitioner has prescribed. He has recently been diagnosed formally with a chronic pain disorder. Which of the following teaching points about chronic pain would his nurse practitioner most likely emphasize to the patient? (Points : 0.4)
“If your pain comes and goes, then we won’t characterize it as chronic, and it will require different treatment.”
“You need to remind yourself that this is a purely physical phenomenon that requires physical treatment.”
“Our challenge is to bring you relief but still treat the underlying back problem that your body is telling you about.”
“These pain signals your body is sending likely serve no real, useful, or protective function.”
Question 8. 8. Which of the following statements most accurately characterizes an aspect of the neurobiology of sleep? (Points : 0.4)
The hypothalamus stimulates the anterior and posterior pituitary to modulate sleeping–waking cycles.
The pituitary releases melatonin at predictable points in the circadian rhythm in order to facilitate sleep.
The reticular formation, thalamus, and cerebral cortex interact to integrate the sleep–wake cycle.
Input from the retinas is interpreted by the cerebellum and contributes to maintenance of the circadian rhythm.
Question 9. 9. Following a spinal cord injury suffered in a motor vehicle accident, a 22-year-old male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which of the following components of his white matter has most likely been damaged? (Points : 0.4)
The inner layer (archilayer)
The middle layer (paleolayer)
The outer layer (neolayer)
The reticular formation
Question 10. 10. A patient with a diagnosis of insomnia is surprised when his physician explains to him that his brain is still highly active during normal sleep. Which of the following statements best captures the character of brain activity during sleep? (Points : 0.4)
“Fewer neurons in your brain are firing when you’re asleep, but they’re more synchronized than when you’re awake.”
“While you’re obviously less aware of stimuli when you’re asleep, your brain is actually more active when you’re asleep than when you’re awake.”
“There are four types of brain activity, and actually all of them occur at different stages of sleep.”
“Your brain alternates between periods of activity and periods of inactivity when you’re asleep, and these correspond to your eye movement.”
Question 11. 11. A patient on an acute medicine unit of a hospital, with a diagnosis of small bowel obstruction, is complaining of intense, diffuse pain in her abdomen. Which of the following physiologic phenomena is most likely contributing to her complaint? (Points : 0.4)
Nociceptive afferents are conducting the sensation of pain along the cranial and spinal nerve pathways of the ANS.
First-order neurons are inappropriately signaling pain to the dorsal root ganglion.
The patient is experiencing neuropathic pain.
The patient’s C fibers are conducting pain in the absence of damaged Ad fibers.
Question 12. 12. Which of the following factors is most responsible for the fact that prefrontal lobotomy is no longer a common treatment for mental illness? (Points : 0.4)
Individuals treated by lobotomy have difficulty interpreting somatic, visual, and auditory information.
Lobotomy inhibits the individual’s ability to add perception and meaning to sensory information.
Severing connections between the brain and its prefrontal areas inhibits problem solving and results in a loss of ambition.
Loss of communication to and from the prefrontal cortex changes, but ultimately exacerbates, symptoms of mental illness.
Question 13. 13. After surviving an ischemic stroke, a 79-year-old male has demonstrated significant changes in his emotional behavior, with his family noting that he now experiences wide mood swings and exaggerated responses of empathy, anger, and sadness to situations. His care team would most likely attribute these responses to ischemic changes in which of the following brain structures?
(Points : 0.4)
The man’s occipital lobe
The patient’s temporal lobe in general and Wernicke area in particular
The man’s parietal lobe
The components of the patient’s limbic system
Question 14. 14. A woman with severe visual and auditory deficits is able to identify individuals by running her fingers lightly over their face. Which of the following sources is most likely to provide the input that allows for the woman’s ability? (Points : 0.4)
Pacinian corpuscles
Ruffini end organs
Meissner corpuscles
Free nerve endings
Question 15. 15. Which of the following individuals would be most likely to experience global ischemia to his or her brain? (Points : 0.4)
A male patient who has just had an ischemic stroke confirmed by CT of his head
A woman who has been admitted to the emergency department with a suspected intracranial bleed
A man who has entered cardiogenic shock following a severe myocardial infarction
A woman who is being brought to the hospital by ambulance following suspected carbon monoxide poisoning related to a faulty portable heater
Question 16. 16. 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 has the highest level of control over her arm and hand action? (Points : 0.4)
Cerebelum
Thalamus
Basal ganglia
Frontal lobe
Question 17. 17. A 17-year-old female is suspected of having narcolepsy. Which of the following aspects of her medical history and sleep analysis would contribute to a confirmation of the diagnosis? (Points : 0.4)
She repeatedly moves her large toe, ankle, and knee during sleep.
She complains of a powerful urge to move her legs when in bed at night.
She has frequently awakened unable to move or speak.
She believes that she experiences auditory hallucinations when she awakens.
Her sleep latency is normally around 1 hour.
Question 18. 18. Which of the following phenomena constitutes a component of axonal transport? (Points : 0.4)
Anterograde and retrograde axonal transport allow for the communication of nerve impulses between a neuron and the central nervous system (CNS).
Materials can be transported to the nerve terminal by either fast or slow components.
The unidirectional nature of the axonal transport system protects the CNS against potential pathogens.
Axonal transport facilitates the movement of electrical impulses but precludes the transport of molecular materials.
Question 19. 19. A 44-year-old female has been diagnosed with major depression. Which of the following neuroimaging findings is most congruent with the woman’s diagnosis? (Points : 0.4)
Decreased brain activity in the pons and brain stem
Reduced activity and gray matter volume in the prefrontal cortex
Atrophy and decreased blood flow in the amygdala
Enlargement of the lateral and third ventricles and reduction in frontal and temporal volumes
Question 20. 20. A nurse practitioner and social worker are facilitating a family meeting for the children and wife of a 79-year-old man who has been diagnosed with Alzheimer disease. What goal of treatment will the clinicians most likely prioritize in their interactions with the family? (Points : 0.4)
Modest reversal of brain plaque formation and improved symptomatology through cholinesterase inhibitors
Surgical treatment of the ischemic changes that underlie the manifestations of the man’s disease
The use of medications such as donepezil and rivastigmine to slow the progression of the disease
Cognitive and behavioral therapy to counteract the agitation, depression, and suspiciousness associated with Alzheimer disease.
Question 21. 21. A nurse practitioner is providing care for a 40-year-old male who is experiencing chronic insomnia in recent months while going through a divorce and child custody proceedings. The man is requesting a prescription for “sleeping pills” to help him through this time. Which of the following statements forms a valid basis for the nurse practitioner’s plan for treatment? (Points : 0.4)
Sedative and hypnotic drugs will not provide safe relief of the man’s health problem.
The man is suffering from primary insomnia.
Melatonin supplements will be the safest and most effective long-term pharmacological treatment.
Behavioral therapies, counseling, and education may be of some use to the patient.
Question 22. 22. The parents of a 15-year-old boy are frustrated by his persistent inability to fall asleep at a reasonable hour at night, as well as the extreme difficulty that they have in rousing him in the morning. While sleepy after waking, the son claims not to feel drowsy after lunch or in the evening. What is the most likely classification of the boy’s sleep disorder? (Points : 0.4)
Delayed sleep phase syndrome (DSPS)
Non–24-hour sleep–wake syndrome
Advanced sleep phase syndrome (ASPS)
Chronic insomnia
Question 23. 23. A clinician is conducting an assessment of a male patient suspected of having a disorder of motor function. Which of the following assessment findings would suggest a possible upper motor neuron (UMN) lesion? (Points : 0.4)
The patient has decreased deep tendon reflexes.
The patient displays increased muscle tone.
The patient’s muscles appear atrophied.
The patient displays weakness in the distal portions of his limbs.
Question 24. 24. A student is feeling inside her backpack to find her mobile phone, which has fallen to the bottom, and there are a number of items in the bag in addition to the phone. Which of the following components of somatosensory conduction is most likely to provide the detailed sensory information that will help her distinguish her phone from other items? (Points : 0.4)
The primary dorsal root ganglion neuron, the dorsal column neuron, and the thalamic neuron
A slow-conducting pathway that projects into the intralaminar nuclei of the thalamus
The opposite anterolateral pathway that travels to the reticular activating system
A bilateral, multisynaptic, slow-conducting tract
Question 25. 25. A 48-year-old male has a new diagnosis of Guillain-Barré syndrome. Which of the following processes underlies the deficits that accompany the degeneration of myelin in his peripheral nervous system (PNS)? (Points : 0.4)
The destruction of myelin causes fewer Schwann cells to be produced in the patient’s PNS.
The axonal transport system is compromised by the lack of myelin surrounding nerve cells.
Nerve cells lack insulation and impulse conduction is compromised by the destruction of myelin.
A deficit of myelin predisposes the patient to infection by potential pathogens.