PSYCHOLOGICAL DISORDERS MODULE 6 NURS 6501

Sample Answer for PSYCHOLOGICAL DISORDERS MODULE 6 NURS 6501 Included After Question

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Possible topics covered in this Knowledge Check include:

  • Generalized anxiety disorder
  • Depression
  • Bipolar disorders
  • Schizophrenia
  • Delirium and dementia
  • Obsessive compulsive disease

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A Sample Answer For the Assignment: PSYCHOLOGICAL DISORDERS MODULE 6 NURS 6501

Title: PSYCHOLOGICAL DISORDERS MODULE 6 NURS 6501

 

Question 1  

Needs Grading 

   
  A ten-year-old boy is brought to clinic by his mother who states that the boy has been listless and not eating. She also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes. Mother states the child has had intermittent fevers that respond to acetaminophen. Maternal history negative for pre, intra, or post-partum problems. Child’s past medical history negative and he easily reached developmental milestones. Physical exam reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern. The APRN orders complete blood count (CBC), and complete metabolic profile (CMP). The CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl. The APRN recognizes that the patient appears to have acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his mother. The diagnosis of acute lymphoblastic leukemia (ALL) was made after extensive testing.   

 

Question 1 of 2: 

PSYCHOLOGICAL DISORDERS MODULE 6 NURS 6501
PSYCHOLOGICAL DISORDERS MODULE 6 NURS 6501

What is ALL?   

     
Selected Answer:   ALL is a malignant bone marrow disease where there is a proliferation of early lymphoid precursors that replace the normal bone marrow hematopoietic cells. It is the most common type of leukemia in the US and cancer in children. The malignant cells (lymphoblasts) get arrested in the early development stages, which is caused by abnormal gene expression following abnormalities in the number of chromosomes or   translocations of chromosomes. When the lymphoblasts proliferate, the number of normal elements in the bone marrow which produce other lines of blood cells decrease.  This explains why most patients usually present with thrombocytopenia, anemia, and neutropenia. In other instances, the lymphoblasts can also infiltrate the beyond the bone marrow, to the lymph nodes, liver, and spleen, causing enlargement.  
Correct Answer:    

Acute lymphoblastic leukemia (ALL) is a malignant (clonal) disease of the bone marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells of the marrow. ALL is the most common type of cancer and leukemia in children in the United States. 

The malignant cells of acute lymphoblastic leukemia (ALL) are lymphoid precursor cells (ie, lymphoblasts) that are arrested in an early stage of development. This arrest is caused by an abnormal expression of genes, often as a result of chromosomal translocations or abnormalities of chromosome number. 

These aberrant lymphoblasts proliferate, reducing the number of the normal marrow elements that produce other blood cell lines (red blood cells, platelets, and neutrophils). Consequently, anemia, thrombocytopenia, and neutropenia occur, although typically to a lesser degree than is seen in acute myeloid leukemia. Lymphoblasts can also infiltrate outside the marrow, particularly in the liver, spleen, and lymph nodes, resulting in enlargement of the latter organs. 

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Question 2  

Needs Grading 

   
  A ten-year-old boy is brought to clinic by his mother who states that the boy has been listless and not eating. She also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes. Mother states the child has had intermittent fevers that respond to acetaminophen. Maternal history negative for pre, intra, or post-partum problems. Child’s past medical history negative and he easily reached developmental milestones. Physical exam reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern. The APRN orders complete blood count (CBC), and complete metabolic profile (CMP). The CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl. The APRN recognizes that the patient appears to have acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his mother. The diagnosis of acute lymphoblastic leukemia (ALL) was made after extensive testing.   

Question 2 of 2: 

 

How does renal failure occur in some patients with ALL?  

 

     
Selected Answer:   In patients with ALL, renal failure occurs as a result of hyperuricemia and this can be at the point of diagnosis or active treatment. Cellular destruction during the metabolism of purine influences an increase in the levels of uric. Since major paths of excretion are through the kidneys, the urates can end up precipitating in the ureters or renal tubules resulting in symptoms of oliguria and subsequent acute renal failure.  

 

Correct Answer:    

Renal failure as a result of hyperuricemia can be associated with ALL, particularly at diagnosis or during active treatment. Uric levels rise as an end product of purine metabolism from cellular destruction. Because the major excretory pathway is through the kidneys, urates can precipitate in renal tubules or ureters and can lead to oliguria and acute renal failure. 

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Question 3  

Needs Grading 

   
  A 12-year-old female with known sickle cell disease (SCD) present to the Emergency Room in sickle cell crisis. The patient is crying with pain and states this is the third acute episode she has had in the last nine months. Both parents are present and appear very anxious and teary eyed. A diagnosis of acute sickle cell crisis was made. Appropriate therapeutic interventions were initiated by the APRN and the patient’s pain level decreased, and she was transferred to the pediatric intensive care unit (PICU) for observation and further management.   

 

Question 1 of 2: 

 

What is the pathophysiology of acute SCD crisis and why is pain the predominate feature of acute crises?   

 

     
Selected Answer:   Vaso-occlusive crises occur in more than half of individuals who have homozygous HbS although frequency tends to vary. Potential triggers of crises may include; dehydration, hypoxemia, and potential changes in body temperature. Most people with HbSS have a chronic low level of pain in joint and bones.  RBCs with a sickle shape are stickier and have high amounts of adhesion molecules. During an inflammatory reaction, leukocytes release mediators which increase the adhesion of molecules to endothelial cells. These processes influence sickled erythrocytes to be arrested as they move into the microvascular compartment. The RBCs become stagnant and sluggish in inflamed vascular vessels increasing their likelihood to sickle, low oxygen tension, and obstruction. The lysed RBCs produce hemoglobin and the free hemoglobin can bind and inactivate nitric oxide, a vasodilator that also inhibits the aggregation of platelets. These processes influence a decrease in the Ph of blood which decreases the affinity of hemoglobin for oxygen increasing the amount of HbS that is deoxygenated in the tension of oxygen, and a predisposition to sickling. As the lungs receive less oxygen, there is a drop in PO2 which further influences sickling. The pain experienced   is caused by the lack of oxygen in major bones and organs and can result in  the death of vital organs  and ischemia.  

 

Correct Answer:    

Approximately half the individuals with homozygous HbS disease experience vaso-occlusive crises. The frequency of crises is extremely variable. Some individuals have as many as 6 or more episodes annually, whereas others may have episodes only at great intervals or none at all. Each individual typically has a consistent pattern for crisis frequency. Triggers of vaso-occlusive crisis include the following: 

  • Hypoxemia: May be due to acute chest syndrome or respiratory complications 
  • Dehydration: Acidosis results in a shift of the oxygen dissociation curve 
  • Changes in body temperature (eg, an increase due to fever or a decrease due to environmental temperature change) 

Many individuals with HbSS experience chronic low-level pain, mainly in bones and joints. Intermittent vaso-occlusive crises may be superimposed, or chronic low-level pain may be the only expression of the disease. 

Sickle RBCs express higher than normal amounts of adhesion molecules and are sticky. During inflammatory reactions, leukocyte release of mediators increases the expression of adhesion molecules on endothelial cells. These reactions further promote sickled erythrocytes to be come arrested during movement through the microvascular. The sluggish and stagnant red cells within the inflamed vascular vessels result in extended exposure to low oxygen tension, sickling, and vascular obstruction. Lysed sickle erythrocytes release hemoglobin and free hemoglobin can bind and inactivate nitic oxide (NO), which is a powerful vasodilator and inhibitor of platelet aggregation. Decreased blood pH reduces hemoglobin affinity for oxygen leading to an increasing fraction of deoxygenated HbS at any oxygen tension and predisposition to sickling. As less oxygen is taken up by hemoglobin in the lungs, the PO2 drops promoting additional sickling. 

The intense pain of an acute crisis is due to lack of oxygen to major organs and bones. The lack of oxygen leads to ischemia and organ death. 

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Question 4  

Needs Grading 

   
  A 12-year-old female with known sickle cell disease (SCD) present to the Emergency Room in sickle cell crisis. The patient is crying with pain and states this is the third acute episode she has had in the last nine months. Both parents are present and appear very anxious and teary eyed. A diagnosis of acute sickle cell crisis was made. Appropriate therapeutic interventions were initiated by the APRN and the patient’s pain level decreased, and she was transferred to the pediatric intensive care unit (PICU) for observation and further management.   

Question 2 of 2: 

 

Discuss the genetic basis for SCD. 

 

     
Selected Answer:   SCD comprises of all genotypes that contain at least one sickle gene where the HbS comprises half of the present hemoglobin such as HbSS (sickle cell anemia), HbS/b+ thalassemia, HbS/ b-0 thalassemia, and HbSC disease. The heterozygous form (carriers) have up to 40% of HbS, no anemia, hematuria, and isosthenuria. SCD causes an illness but the trait does not. However, individuals who inherit two sickle hemoglobin genes from both parents can have SCD  

 

Correct Answer:    

SCD denotes all genotypes containing at least one sickle gene, in which HbS makes up at least half the hemoglobin present. Major sickle genotypes described so far include the following: 

  • HbSS disease or sickle cell anemia (the most common form) – Homozygote for the S globin with usually a severe or moderately severe phenotype and with the shortest survival 
  • HbS/b-0 thalassemia – Double heterozygote for HbS and b-0 thalassemia; clinically indistinguishable from sickle cell anemia (SCA) 
  • HbS/b+ thalassemia – Mild-to-moderate severity with variability in different ethnicities 
  • HbSC disease – Double heterozygote for HbS and HbC characterized by moderate clinical severity 
  • HbS/hereditary persistence of fetal Hb (S/HPHP) – Very mild or asymptomatic phenotype 

Sickle cell trait or the carrier state is the heterozygous form characterized by the presence of around 40% HbS, absence of anemia, inability to concentrate urine (isosthenuria), and hematuria. Under conditions leading to hypoxia, it may become a  pathologic risk factor. Sickle cell disease produces illness, while sickle cell trait usually does not. People who inherit two genes for sickle hemoglobin (one from each parent) have sickle cell disease. With a few exceptions, a child can inherit sickle cell disease only if both parents have one gene for sickle cell hemoglobin 

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Question 5  

Needs Grading 

   
  The parents of a 9-month boy bring the infant to the pediatrician’s office for evaluation of a swollen right knee and excessive bruising. The parents have noticed that the baby began having bruising about a month ago but thought the bruising was due to the child’s attempts to crawl. They became concerned when the baby woke up with a swollen knee. Infant up to date on all immunizations, has not had any medical problems since birth and has met all developmental milestones. Pre-natal, intra-natal, and post-natal history of mother noncontributory. Family history negative for any history of bleeding disorders or other major genetic diseases. Physical exam within normal limits except for obvious bruising on the extremities and right knee. Knee is swollen but no warmth appreciated. Range of motion of knee limited due to the swelling. The pediatrician suspects the child has hemophilia and orders a full bleeding panel workup which confirms the diagnosis of hemophilia A.     

 

Question 1 of 2: 

 

Explain the genetics of hemophilia. 

 

     
Selected Answer:   Deficiencies in factor XI, VIII, and IX   are linked with up to 90% of hemorrhagic bleeding disorders. The most common and widely known are type A and B m which are inherited and have an X-linked recessive pattern. This implies that, the genes associated with both types of hemophilia are located on the X chromosome. In males, only a single of the altered gene is adequate to cause hemophilia. Sons inherit from the mother but will have normal clotting, and a 50% likelihood of having hemophilia. Girls inherit the X chromosome with the dominant gene from fathers thus will not have hemophilia. 

 

Correct Answer:    

Deficiencies in factor VIII, IX, and XI are associated with 90% of hemorrhagic bleeding disorders. Hemophilia A and hemophilia B are inherited in an X-linked recessive pattern. The genes associated with these conditions are located on the X chromosome, which is one of the two sex chromosomes. In males (who have only one X chromosome), one altered copy of the gene in each cell is enough to cause the condition. A son inherits his mother’s other X chromosome, he will have normal blood clotting. A carrier’s son has a 50% chance of having hemophilia. A baby girl will inherit an X chromosome with a dominant gene for normal blood clotting from her father. Therefore, the daughter will not have hemophilia. 

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Question 6  

Needs Grading 

   
  The parents of a 9-month boy bring the infant to the pediatrician’s office for evaluation of a swollen right knee and excessive bruising. The parents have noticed that the baby began having bruising about a month ago but thought the bruising was due to the child’s attempts to crawl. They became concerned when the baby woke up with a swollen knee. Infant up to date on all immunizations, has not had any medical problems since birth and has met all developmental milestones. Pre-natal, intra-natal, and post-natal history of mother noncontributory. Family history negative for any history of bleeding disorders or other major genetic diseases. Physical exam within normal limits except for obvious bruising on the extremities and right knee. Knee is swollen but no warmth appreciated. Range of motion of knee limited due to the swelling. The pediatrician suspects the child has hemophilia and orders a full bleeding panel workup which confirms the diagnosis of hemophilia A.     

Question 2 of 2: 

Briefly describe the pathophysiology of Hemophilia. 

 

     
Selected Answer:   Hemophilia A results from an acquired or inherited genetic mutation   which occurs following the deficiency or dysfunction of factor VIII, or an acquired inhibitor which binds to factor VIII.  One third of genetic cases are caused by de novo mutations that lack in a mother’s X chromosome. When factor VIII is inadequate, there amount of thrombin generated by FIXa and FVIIIa complexes in the intrinsic pathway of coagulation is inadequate. These processes combined with   the effect of tissue-factor pathway inhibitor, causes impaired clotting in case of injury, particularly in individuals with spontaneous bleeding in hemophilia.  

 

Correct Answer:    

Hemophilia A is caused by an inherited or acquired genetic mutation that results in dysfunction or deficiency of factor VIII, or by an acquired inhibitor that binds factor VIII. Of genetic cases, up to approximately one third are the result of de novo mutations not present in the mother’s X chromosome. 

Inadequate factor VIII results in the insufficient generation of thrombin by the FIXa and FVIIIa complex by means of the intrinsic pathway of the coagulation cascade. This mechanism, in combination with the effect of the tissue-factor pathway inhibitor, creates an extraordinary tendency for impaired clotting in response to trauma and, especially in persons with severe hemophilia, with spontaneous bleeding. 

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Question 7  

Needs Grading 

   
  During a routine 16-week pre-natal ultrasound, spina bifida with myelomeningocele was detected in the fetus. The parents continued the pregnancy and labor was induced at 38 weeks with the birth of a female infant with an obvious defect at Lumbar Level 2. The Apgar Score was 7 and 9. The infant was otherwise healthy. The sac was leaking cerebral spinal fluid and the child was immediately taken to the operating room for coverage of the open sac. The infant remained in the neonatal intensive care unit (NICU) for several weeks then discharged home with the parents after a prescribed treatment plan was developed and the parents were educated on how to care for this infant.   

 

Question 1 of 2: 

 

What is the underlying pathophysiology of myelomeningocele?  

 

     
Selected Answer:   Defects of the neural tube are caused by teratogenic processes which result in abnormal differentiation and failed closure of the embryonic neural tube. They particularly occur between the 17th -30th day of gestation, at a time when a mother may fail to know if she is pregnant and the size of the fetus corresponds to that of a grain of rice. The most common neural tube defects are myelomeningocele and anencephaly. The latter occurs when the rostral end of the neural tube fails to close and there is an incomplete skull and brain formation. The former is caused by failure of the caudal end of the neural tube to close, leading to an open sac or lesion that contains a dysplastic spinal cord, skin, nerve roots, and meninges. In most cases, there’s always a direct correlation between the anatomic level of a myelomeningocele sac and a patients, sensory, motor, and neurologic deficits.    

 

Correct Answer:    

Neural tube defects are the result of a teratogenic process that causes failed closure and abnormal differentiation of the embryonic neural tube. Neural tube defects occur between the 17th and 30th day of gestation, at a time when the mother may not be aware that she is pregnant, and the fetus is estimated to be about the size of a grain of rice. 

The most common neural tube defects are anencephaly and myelomeningocele. Anencephaly results from failed closure of the rostral end of the neural tube, resulting in incomplete formation of the brain and skull. 

Myelomeningocele results from failed closure of the caudal end of the neural tube, resulting in an open lesion or sac that contains dysplastic spinal cord, nerve roots, meninges, vertebral bodies, and skin. The anatomic level of the myelomeningocele sac roughly correlates with the patient’s neurologic, motor, and sensory deficits. 

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Question 8  

Needs Grading 

   
  During a routine 16-week pre-natal ultrasound, spina bifida with myelomeningocele was detected in the fetus. The parents continued the pregnancy and labor was induced at 38 weeks with the birth of a female infant with an obvious defect at Lumbar Level 2. The Apgar Score was 7 and 9. The infant was otherwise healthy. The sac was leaking cerebral spinal fluid and the child was immediately taken to the operating room for coverage of the open sac. The infant remained in the neonatal intensive care unit (NICU) for several weeks then discharged home with the parents after a prescribed treatment plan was developed and the parents were educated on how to care for this infant.   

Question 2 of 2: 

 

Describe the pathophysiology of hydrocephalus in infants with myelomeningocele.  

 

     
Selected Answer:   The development of a myelomeningocele is linked to an abnormal development of the cranial neural tube. The most significant is the Chiari type II malformation which is primarily characterized by hypoplasia of the cerebellar and different degrees of caudal displacement of the lower brainstem through the foramen magnum to the upper cervical canal. This abnormality impedes the absorption and flow of CSF   resulting in hydrocephalus, that commonly occurs in most infants who have myelomeningocele  

 

Correct Answer:    

Myelomeningocele is associated with abnormal development of the cranial neural tube, which results in several characteristic CNS anomalies. The Chiari type II malformation is characterized by cerebellar hypoplasia and varying degrees of caudal displacement of the lower brainstem into the upper cervical canal through the foramen magnum. This deformity impedes the flow and absorption of cerebrospinal fluid (CSF) and causes hydrocephalus, which occurs in more than 90% of infants with myelomeningocele. 

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Question 9  

Needs Grading 

   
  A preterm infant was delivered at 32 weeks gestation and was taken to the NICU for critical care management. Physical assessment of the chest and heart remarkable for a continuous-machinery type murmur best heard at the left upper sternal border through systole and diastole. The infant had bounding pulses, an active precordium, and a palpable thrill. The infant was diagnosed with a patent ductus arteriosus (PDA).   

 

Question: 

 

Discuss the hemodynamic consequences of a PDA.  

 

     
Selected Answer:   Normally, the ductus arteriosus is patent during the life of a fetus. This is vital for its development as it plays a major role in blood flow to other structures and organs of a fetus. Starting from the 6th week forward the ductus plays a significant role in outflow of the right ventricle and contributes to 60% of the total cardiac output in the entire life of a fetus. Only 5%-10% of the outflow goes through the lungs. Continuous production of prostaglandin E2 (PGE2) helps to maintain its patency, and closure before birth can result in right heart failure. This can be influenced by the use of NSAIDs by a mother leading to a PDA (left to right shunt) where blood goes from the systemic to the pulmonary circulation causing excess of pulmonary blood flow. This gradually reduces pulmonary compliance and engorgement.  

 

Correct Answer:    

The ductus arteriosus is normally patent during fetal life; it is an important structure in fetal development as it contributes to the flow of blood to the rest of the fetal organs and structure. From the 6th week of fetal life onwards, the ductus is responsible for most of the right ventricular outflow, and it contributes to 60% of the total cardiac output throughout the fetal life. Only about 5-10% of its outflow passes through the lungs. 

This patency is promoted by continual production of prostaglandin E2 (PGE2) by the ductus. Closure of the ductus before birth may lead to right heart failure. Prostaglandin antagonism, such as maternal use of nonsteroidal anti-inflammatory medications (NSAIDs), can cause fetal closure of the ductus arteriosus. 

Thus, a patent ductus arteriosus (PDA) produces a left-to-right shunt. In other words, it allows blood to go from the systemic circulation to the pulmonary circulation. Therefore, pulmonary blood flow is excessive (see the image below). Pulmonary engorgement results with decreased pulmonary compliance. The reaction of the pulmonary vasculature to the increased blood flow is unpredictable. 

Prematurity or immaturity of the infant at the time of delivery contributes to the patency of the ductus. Several factors are involved, including immaturity of the smooth muscle within the structure or the inability of the immature lungs to clear the circulating prostaglandins that remain from gestation. These mechanisms are not fully understood. Conditions that contribute to low oxygen tension in the blood, such as immature lungs, coexisting congenital heart defects, and high altitude, are associated with persistent patency of the ductus. 

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Question 10  

Needs Grading 

   
  A 7-year-old male was referred to the school psychologist for disruptive behavior in the classroom. The parents told the psychologist that the boy has been difficult to manage at home as well. His scholastic work has gotten worse over the last 6 months and he is not meeting educational benchmarks. His parents are also worried that he isn’t growing like the other kids in the neighborhood. He has been bullied by other children which is contributing to his behaviors. The psychologist suggests that the parents have some blood work done to check for any abnormalities. The complete blood count (CBC) revealed a hypochromic microcytic anemia. Further testing revealed the child had a venous lead level of 21 mcg/dl (normal is < 10 mcg/dl). The child was diagnosed with lead poisoning and it was discovered he lived in public housing that had not finished stripping lead paint from the walls and woodwork.   

 

Question: 

 

How does lead poisoning account for the child’s symptoms?  

 

     
Selected Answer:   The most vulnerable system to lead toxicity is the CNS system where children are more likely to develop toxicity and in adults, the peripheral nervous system is more prone to toxicity. Lead is a major inhibitor of sulfhydryl enzymes that increase the permeability of membranes increasing cerebral edema, ICP, and ischemia of tissues. This is followed by tissue atrophy and irreversible necrosis with subsequent changes in behavior, convulsions, reduced 1Q, coma and eventually death. The main manifestations in children include irritability, a decrease in activity, hyperactivity, temperamental lability and changes in behavior. In other instances, children may have symptoms similar to those of DHD and lower IQ. In very severe cases, children tend to present 3with convulsions, delirium, and encephalopathy. Anemia is caused by impaired heme synthesis, RBCs hemolysis and shortened survival of RBCs as well as it impairs the uptake and utilization of iron. The child’s skeletal system is affected since there is tertiary accumulation of calcium and lead phosphate which interferes with the growth of bones longitudinally   in long bone metastases that decreases the rate of growth 
Correct Answer:    

The neurological system is most vulnerable to lead toxicity.  Children are more likely to develop central nervous system toxicity while the peripheral nervous system is more often affected in adults. Lead inhibits sulfhydryl enzymes, which causes increase membrane permeability which causes increased intracranial pressure (ICP) and cerebral edema, tissue ischemia followed by irreversible necrosis and tissue atrophy with the final outcome of behavioral changes, decreased IQ, convulsions and eventually coma and death. 

The manifestations in children include temperamental lability, irritability, behavioral changes, hyperactivity or decreased activity, loss of developmental milestones and language delay. Lower IQ and ADHD like symptoms may be present. Severe toxicity can cause delirium, convulsions and encephalopathy. Depression and anxiety are more common in patients. Lead causes demyelination of the peripheral nervous system and the abnormalities mostly affect the extensor motor nerves and may result in hand and foot drop. 

Anemia may develop with lead poisoning due to impaired synthesis of heme, hemolysis of red cells and shortened red cell survival. Lead impairs uptake and utilization of iron. 

The skeletal system is affected as lead is accumulated as tertiary lead phosphate and calcium. This interferes with longitudinal bone growth in the metaphases in long bones which decreased growth rate. 

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Question 11  

Needs Grading 

   
  Emergency Medical Services (EMS) was dispatched to a home to evaluate the report of an unresponsive 3-month-old infant. Upon arrival, the EMS found a frantic attempt by the presumed father to resuscitate an infant. The EMS took over and attempted CPR but was unable to restore pulse or respiration. The infant was transported to the Emergency Room where the physician pronounced the child dead of Sudden Infant Death Syndrome (SIDS). The distraught parents were questioned as to the events surrounding the discovery of the baby. Parents state the child was in good health, had taken a full 6-ounce bottle of formula prior to being put down for the evening. The child had been sleeping through the night prior to this. Parents stated the baby had had some “sniffles” a few days before and was taken to the pediatrician who diagnosed the child with a mild upper respiratory tract viral syndrome. No other pertinent history.  

 

Question: 

 

What is thought to be the underlying pathophysiology of SIDS?  

 

     
Selected Answer:   There are multiple hypotheses that describe the pathophysiology of SIDS. The most commonly known is the triple-risk model which suggests   that SIDS is a representation of   factors that intersect such as, a highly vulnerable infant   with intrinsic abnormalities in cardiorespiratory control, extrinsic trigger factors and a crucial period in the development   of homeostatic control mechanisms. Death happens when   the infant  is exposed t triggers and the  normal  defense mechanisms  may be developmentally, structurally, or functionally deficient.  

 

 

Correct Answer:    

Although multiple hypotheses have been proposed as the pathophysiologic mechanisms responsible for SIDS, none have been proven. A triple-risk model suggests that SIDS represents an intersection of factors, including the following: 

  • A vulnerable infant possessing intrinsic abnormalities in cardiorespiratory control 
  • A critical period in the development of homeostatic control mechanisms 
  • Exogenous extrinsic stressors (triggering factors) 

Death occurs when vulnerable infants are subjected to stressors at times when normal defense mechanisms may be structurally, functionally, or developmentally deficient. Epidemiologic data suggest that genetic factors play a role, and many studies have attempted to identify SIDS-associated genes. 

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Question 12  

Needs Grading 

   
  A 4-year-old female is brought to the pediatrician by her mother who states the child has been running a fever to 102.0 F, has “pink eye”, and that her tongue looks very bright red and swollen. The mother states the fever has been present for 5 days, noticed the child had developed a rash and that the child’s legs look “puffy”. No other symptoms noted. Past medical history noncontributory. All immunizations up to date. Physical exam remarkable for current fever of 102.8 F, bilateral conjunctivitis without purulent material, oral mucosa with bright red erythema, dry, with fissuring of the lips. Legs noted to have peripheral edema and are also erythematous. Palmar desquamation noted. There is fine maculopapular rash and + cervical adenopathy. The presumptive diagnosis currently (pending laboratory data) is Kawasaki Disease.  

 

Question 1 of 2: 

 

What is Kawasaki Disease and what is the pathophysiology?  

     
Selected Answer:   Also referred to as mucocutaneous lymph node syndrome, KD refers to an acute febrile illness that occurs in early childhood primarily characterized by vasculitis of medium-sized arteries. The laboratory findings for KD are consistent with leukocytosis, elevated ESR rate, hypoalbuminemia, hypoalbuminemia, elevated C-reactive protein (CRP), among other findings. It has four stages as follows; 

Stage 1- edema of vascular media and endothelial cells.  

Stage 2-occurs within 7-9 days after fever starts, there’s infiltration of neutrophils, and an inflammatory cascade which secret cytokines  

Stage 3- replacement of inflammatory cells by  monocytes and fibroblasts, formation of fibrous connective tissue  in the blood vessel walls, proliferation and thickening of the intima. . 

Stage 4- blood vessels scar, the intima thickens and  the coronary arteries calcify.  

 

Correct Answer:    

Kawasaki disease (KD), also known as mucocutaneous lymph node syndrome and Kawasaki syndrome, is an acute febrile illness of early childhood characterized by vasculitis of the medium-sized arteries. Laboratory findings include elevated erythrocyte sedimentation rate (ESR), elevated C-reactive protein (CRP), hypoalbuminemia, anemia, elevated alanine aminotransferase (ALT), thrombocytosis, leukocytosis, and pyuria. 

The disease has 4 recognized stages: 

Stage 1- endothelial cells and the vascular media become edematous, but the internal elastic lamina remains intact. 

Stage 2-approximately 7-9 days after the onset of fever, an influx of neutrophils occurs, which is quickly followed inflammatory cells that secrete various cytokines that target the endothelial cells and result in a cascade of events that lead to fragmentation of the internal elastic lamina and vascular damage 

Stage 3- the active inflammatory cells are replaced by fibroblasts and monocytes, and fibrous connective tissue begins to form within the vessel wall. The intima proliferates and thickens. 

Stage 4- The vessel wall eventually develops scarring, intimal thickening, and calcification of coronary arteries. 

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Question 13  

Needs Grading 

   
  A 4-year-old female is brought to the pediatrician by her mother who states the child has been running a fever to 102.0 F, has “pink eye”, and that her tongue looks very bright red and swollen. The mother states the fever has been present for 5 days, noticed the child had developed a rash and that the child’s legs look “puffy”. No other symptoms noted. Past medical history noncontributory. All immunizations up to date. Physical exam remarkable for current fever of 102.8 F, bilateral conjunctivitis without purulent material, oral mucosa with bright red erythema, dry, with fissuring of the lips. Legs noted to have peripheral edema and are also erythematous. Palmar desquamation noted. There is fine maculopapular rash and + cervical adenopathy. The presumptive diagnosis currently (pending laboratory data) is Kawasaki Disease.  

Question 2 of 2: 

 

How does Kawasaki Disease cause coronary aneurysms?  

 

     
Selected Answer:   The coronary arteries narrow and are occluded by a thrombus or stenosis. Cardiovascular death might be caused by an MI when a thrombus occludes the coronary aneurysm or when a large coronary aneurysm ruptures, Eventually, the walls of a blood vessels might narrow or be occluded by the thrombus or due to stenosis. There is an increase in the serum platelet count during the period of vascular damage, and this is the point where there is a high risk of death.  

 

Correct Answer:    

The coronary arteries become narrowed or occluded owing to stenosis or a thrombus. Cardiovascular death may occur from a myocardial infarction secondary to thrombosis of a coronary aneurysm or from rupture of a large coronary aneurysm. The vessel wall eventually becomes narrowed or occluded owing to stenosis or a thrombus. The period during of the greatest vascular damage is when a concomitant progressive increase in the serum platelet count occurs, and this is the point of the illness when the risk of death is most significant. 

Response Feedback:   [None Given]  

 

     

Question 14  

Needs Grading 

   
  A 9-year-old boy was brought to the Urgent Care Center by his parents who state that the child had a sudden onset of difficulty catching his breath, has a new cough and is making a “funny sound” when he breathes.  The parents state there is no prior history of this, and the child had not been ill prior to the start of the symptoms. Past medical history noncontributory. No family history of respiratory problems. No known allergies to drugs or food. Physical exam positive for respiratory rate of 26, use of accessory muscles, with suprasternal retractions, heart rate of 132 beats per minute, an audible inspiratory and expiratory wheeze noted, and the pulse oximetry is 89% on room air. After the APRN institutes appropriate urgent treatment, the child’s breathing slowly returned to normal, vital signs normalize, and the pulse oximetry increases to 97%. The APRN suspects the child has asthma and tells the parents that they need to bring the child to a pulmonologist for further evaluation and care.   

 

Question: 

 

What is the underlying pathophysiology of asthma?  

 

     
Selected Answer:   The inflammation of the airways is influenced by interactions between the environment, and this limits the flow of air resulting in structural and functional airway changes in the form of mucus plug formation, bronchospasms, and mucosal edema. Obstruction of the airways results in an increase in resistance to the flow of air and reduced expiratory flow rates. These changes can lead to hyperinflation with overdistension to maintain the patency of the airways hence increasing the expiratory flow rate and increasing the pulmonary mechanics of breathing.  

Hyperinflation is a compensatory mechanism for obstructed airflow and the uneven changes that occur in   resistance of the airflow, uneven air distribution, and changes in   circulation caused by intra-alveolar pressure cause a mismatch in ventilation-perfusion.  

 

Correct Answer:    

Interactions between environmental and genetic factors result in airway inflammation, which limits airflow and leads to functional and structural changes in the airways in the form of bronchospasm, mucosal edema, and mucus plugs. 

Airway obstruction causes increased resistance to airflow and decreased expiratory flow rates. These changes lead to a decreased ability to expel air and may result in hyperinflation. The resulting overdistention helps maintain airway patency, thereby improving expiratory flow; however, it also alters pulmonary mechanics and increases the work of breathing. 

Hyperinflation compensates for the airflow obstruction, but this compensation is limited when the tidal volume approaches the volume of the pulmonary dead space; the result is alveolar hypoventilation. Uneven changes in airflow resistance, the resulting uneven distribution of air, and alterations in circulation from increased intra-alveolar pressure due to hyperinflation all lead to ventilation-perfusion mismatch. 

Response Feedback:   [None Given]  

 

     
  • Question 15  

Needs Grading 

   
  A 24-year-old female with known cystic fibrosis (CF) has been admitted to the hospital for evaluation for possible lung transplant. She was diagnosed with CF when she was 9 months old and has had multiple hospitalizations for pneumonia, respiratory failure, and small bowel obstructions. She currently is oxygen dependent and has been told by her physicians that she has end stage pulmonary disease secondary to CF. The only recourse for her currently is lung transplant.   

 

Question 1 of 2: 

 

What is cystic fibrosis and discuss the pathophysiology. 

 

     
Selected Answer:   CF   is a disease of the exocrine gland function that involves multiple systems but primarily leads to insufficiency of pancreatic enzymes, chronic respiratory infections, and other related complications. In 90% of patients, the pulmonary system is involved and it can ultimately lead to death. It arises from defects of the cystic fibrosis gene, which codes transmembrane conductance regulator (CFTR). Mutations that occur in this gene can lead to abnormalities in the cAMP-regulated chloride transport across epithelial cells on mucosal surfaces. This can cause a decrease in the secretion of  of chloride and  increase  sodium reabsorption   across epithelial cells resulting in thicker and sticker mucus  that promotes inflammation and infection. Heavy mucus secretions in other organs such as the GI tract, pancreas, and sweat glands increases the difficulty to clear.  
Correct Answer:    

Cystic fibrosis (CF) is a disease of exocrine gland function that involves multiple organ systems but chiefly results in chronic respiratory infections, pancreatic enzyme insufficiency, and associated complications in untreated patients. Pulmonary involvement occurs in 90% of patients surviving the neonatal period. End-stage lung disease is the principal cause of death. 

Cystic fibrosis is caused by defects in the cystic fibrosis gene, which codes for a protein transmembrane conductance regulator (CFTR) that functions as a chloride channel and is regulated by cyclic adenosine monophosphate (cAMP). Mutations in the CFTR gene result in abnormalities of cAMP-regulated chloride transport across epithelial cells on mucosal surfaces. 

Defective CFTR results in decreased secretion of chloride and increased reabsorption of sodium and water across epithelial cells. The resultant reduced height of epithelial lining fluid and decreased hydration of mucus results in mucus that is stickier to bacteria, which promotes infection and inflammation. Secretions in the respiratory tract, pancreas, GI tract, sweat glands, and other exocrine tissues have increased viscosity, which makes them difficult to clear. 

Most deaths associated with cystic fibrosis result from progressive and end-stage lung disease. In individuals with cystic fibrosis, the lungs are normal in utero, at birth, and after birth, before the onset of infection and inflammation (except possibly for the presence of dilated submucosal gland ducts in the airways). Shortly after birth, many persons with cystic fibrosis acquire a lung infection, which incites an inflammatory response. Infection becomes established with a distinctive bacterial flora. A repeating cycle of infection and neutrophilic inflammation develops. 

Response Feedback:   [None Given]  

 

     
  • Question 16  

Needs Grading 

   
  A 24-year-old female with known cystic fibrosis (CF) has been admitted to the hospital for evaluation for possible lung transplant. She was diagnosed with CF when she was 9 months old and has had multiple hospitalizations for pneumonia, respiratory failure, and small bowel obstructions. She currently is oxygen dependent and has been told by her physicians that she has end stage pulmonary disease secondary to CF. The only recourse for her currently is lung transplant.   

Question 2 of 2: 

 

What is the reason people with CF are often malnourished?  

     
Selected Answer:   CFTR defects result in a decrease in the secretion of chloride water in the GI tract. During birth, this can cause a meconium ileus and later in life, can result in distal intestinal obstruction syndrome (DIOS). Insufficiency of the pancreas also reduces the absorption of  contents in the intestines and other mechanical problems such as  structures, scarring, and  inflammation  can increase the likelihood of contents in the intestines to sludge with subsequent obstruction, fecal impaction and intussusception.  

 

Correct Answer:    

Defects in CFTR lead to reduced chloride secretion with water following into the gut. This may result in meconium ileus at birth and in distal intestinal obstruction syndrome (DIOS) later in life. In addition, other pathologic disorders complicate the simple relationship between the apical chloride and water secretion and the disease. The pancreatic insufficiency decreases the absorption of intestinal contents. Mechanical problems associated with inflammation, scarring, and strictures may predispose the patient to sludging of intestinal contents, leading to intestinal obstruction by fecal impaction or to intussusception. Adhesions may form, leading to complete obstruction. A complete obstruction may require resection, leading to loss of absorptive epithelium of the distal ileum. 

Other factors, such as reduced water content of secretions, precipitation of proteins, and plugging of ductules and acini, prevent the pancreatic enzymes from reaching the gut. Autodigestion of the pancreas occasionally leads to pancreatitis. 

Most patients with cystic fibrosis (90-95%) have pancreatic enzyme insufficiency and present with digestive symptoms and/or failure to thrive early in life. Onset of pancreatic insufficiency varies, however, and may occur in patients older than 6 months. Some patients never develop pancreatic insufficiency. 

Patients with pancreatic insufficiency typically present with poor weight gain in association with frequent stools that are malodorous, greasy, and associated with flatulence and colicky pain after feeding. The combination of increased energy intake demand at baseline, the added energy intake demand of chronic disease, difficulty sustaining energy uptake because of malabsorption, and anorexia associated with ongoing lung inflammation leads to poor weight gain. 

Response Feedback:   [None Given]  

 

     

Question 17  

Needs Grading 

   
  A 14-year old girl who was trying out for cheerleading underwent a physical examination by the APRN who notices that the girl had uneven hip height, asymmetry of the shoulder height, shoulder and scapular prominence and rib prominence. The rest of the physical exam was normal and the APRN referred the girl to an orthopaedist for evaluation for possible scoliosis. Radiographs in the orthopaedic office confirms the diagnosis of idiopathic scoliosis. The spinal curve was measured at 26 degrees and it was recommended that the girl be fit for a low-profile back brace.   

 

Question: 

 

What is thought to be the pathophysiology of idiopathic scoliosis?  

     
Selected Answer:   Patients with IS have a posterior column lesion within the central nervous system. This dysfunction often manifests as a decrease in proprioception and vibratory sensation. On the concave side of the curve, muscles, ligaments, and other soft tissues become shortened and when asymmetric forces are applied to the epiphyseal center of the ossification by shortened and tight soft tissue, the vertebral is deformed. This curve increases at times of peak skeletal growth and involve torso twisting, and bending.  

 

Correct Answer:    

It has been suggested that a posterior column lesion within the central nervous system might be present in patients who have idiopathic scoliosis. Such central nervous system (CNS) dysfunction was hypothesized to be manifested as decreased vibratory sensation and proprioception. The earliest pathologic changes occur in the soft tissues. The muscles, ligaments, and other soft tissues become shortened on the concave side of the curve. Vertebral deformity occurs as asymmetric forces are applied to the epiphyseal center of the ossification by shortened and tight soft tissue © 2020 Walden University 13 o the concave side of the curve. True curves involve not only bending but also twisting of the torso, leading to a rib hump seen when the child leans forward. 

The curve increases most rapidly during periods of rapid skeletal growth. If the curve is less than 40 degrees at skeletal maturity, the risk of progression is small. In curves greater than 50 degrees, the spine is biomechanically unstable, and the curve usually progresses. For curves in the thoracic region over 80 degrees, there is marked cardiopulmonary compromise. 

Response Feedback:   [None Given]  

 

     

Question 18  

Needs Grading 

   
  A 2-year-old boy was brought to Urgent Care by his parents who state the boy has been having large amounts of diarrhea, been very irritable and very pale. The parents noticed there was blood in the diarrhea and when the boy’s legs became swollen, they sought care. Past medical history noncontributory and all immunizations up to date.  Social history noncontributory and the child is in day care 5 days a week. No known exposure to other sick children and the only new event the parents could think of is the day care workers took the children to a local petting zoo about a week ago. Physical exam revealed a pale, ill appearing child with swollen legs, tender abdomen, and petechia on the legs and abdomen. The APRN suspects the child may have been exposed to a bacterium at the petting zoo and arranges for the patient to be transferred to the Emergency Room. There the child was found to be in renal failure, have hypertension and was diagnosed with hemolytic uremic syndrome (HUS).   

 

Question: 

 

What is the pathophysiology of HUS?   

     
Selected Answer:   The pathology of HUS   is often preceded by an ES (Escherichia Coli) producing Shiga toxin that causes colitis. Colon inflammation   promotes the systemic absorption of lipopolysaccharide and the toxin from the gut. This toxin bins to polymorphonuclear leukocytes and  reaches the kidney to cause a cascade of events  such as glomerular capillary lysis, separating endothelial cells from the glomerular basement, platelet aggregation and  activation,  and activating the coagulation cascade. The arterioles in the glomerular swell and occlude with clots of fibrin and platelets, the glomerular filtration reduces and the glomerular membrane is damaged. This causes proteinuria and hematuria. Since the blood vessels are narrowed, they injure passing erythrocytes which are removed by the spleen, causing acute hemolytic anemia and subsequent thrombocytopenia.  

 

Correct Answer:    

STEC-HUS is usually preceded by a colitis caused by Shiga toxin– producing Escherichia coli (STEC). Subsequent inflammation of the colon facilitates systemic absorption of the shiga toxin and lipopolysaccharide from the GI tract. The toxin binds to polymorphonuclear leukocytes in the gut and is transported to the kidney, causing a cascade of effects, including lysis of glomerular capillary endothelial cells, separation of endothelial cells from the basement membrane, activation and aggregation of platelets and the activation of the coagulation cascade. The glomerular arterioles become swollen and occluded with platelets and fibrin clots. There is decreased glomerular filtration and the damaged glomerular membrane results in hematuria and proteinuria. Narrow vessels injure passing erythrocytes. The damaged erythrocytes are removed by the spleen, causing acute hemolytic anemia. Severe thrombocytopenia ensues. 

Response Feedback:   [None Given]  

 

     

Question 19  

Needs Grading 

   
  The parents of a 3-year-old boy bring the child to the pediatrician with concerns that their child seems “small for his age”. The parents state that the boy has always been small but did not worry until the child went to day care and they noticed other children of the same age were much bigger. They also note that his teeth were very late in coming in. Normal prenatal, perinatal and postnatal history and no medical history on either side of family regarding issues with growth and development. Physical exam is normal except for short limbs and small teeth. The pediatrician suspects the child has pituitary dwarfism. A complete laboratory and radiographic work up confirmed the diagnosis.   

Question: 

 

What is the pathophysiology of pituitary dwarfism?  

 

     
Selected Answer:   Individuals with pituitary dwarfism have a delayed dentition, short stature and delayed skeletal maturation. The secretion of pituitary GH (growth hormone) is stimulated by growth hormone–releasing hormone (GHRH) in the hypothalamus. However, a deficiency in the GH  can disrupt the GH axis in the pituitary, brain or hypothalamus.  

 

Correct Answer:    

Pituitary dwarfism is characterized by short stature, delayed dentition, and delayed skeletal maturation. Most cases of sporadic or isolated growth hormone deficiency have a normal-appearing pituitary gland on MRI, although a small adenohypophysis may be observed, particularly in cases of panhypopituitarism. 

Pituitary growth hormone secretion is stimulated by growth hormone–releasing hormone (GHRH) from the hypothalamus and possibly by another signal, which may be stimulated by certain growth hormone–releasing peptides (GHRPs). Receptors for the GHRPs have been identified, and the natural ligand for these receptors has been determined to be ghrelin. Somatostatin secreted by the hypothalamus inhibits growth hormone secretion. 

Growth hormone deficiency may result from disruption of the growth hormone axis in the higher brain, hypothalamus, or pituitary. This dysfunction can be congenital or acquired. 

Response Feedback:   [None Given]  

 

     

Question 20  

Needs Grading 

   
  A 4-year-old boy was brought to the Emergency Room by his parents with a suspected femur fracture. The parents state the child was playing on the couch when he rolled off and cried out in pain. There were no other injuries noted. Review of the child’s chart revealed this was the 4th Emergency Room visit in the last 15 months for fractures after low impact injury. The parents were suspected of child abuse and Child and Protective Services were consulted. The APRN assessing the child noted that the child had unusually thin and translucent skin, poor dentition, and blue sclera. The APRN suspects the child may have osteogenesis imperfecta (OI). Laboratory results revealed an elevated serum alkaline phosphatase and the diagnosis OI was made based on the clinical picture and elevated alkaline phosphatase.   

 

Question: 

 

What is the pathophysiology of OI?  

     
Selected Answer:   OI is a fragile bone deformity caused by mutations in genes that encode type I procollagen. In other instances, it may result from increased levels of thyroxine.  

 

Correct Answer:    

Osteogenesis imperfecta (OI) is a disorder of bone fragility chiefly caused by mutations in the genes that encode type I procollagen. Severity ranges from mild forms to lethal forms in the perinatal period. Additional genes have been discovered in which mutations can also cause brittle bones. 

Other metabolic abnormalities are associated with OI. Some individuals have increased serum thyroxine levels that suggest hyperthyroidism, which is consistent with reports of excessive sweating, heat intolerance, resting tachycardia and tachypnea. 

Response Feedback:   [None Given]  

 

     

Friday, May 28, 2021 6:48:25 AM EDT 

 

Question 1

4 out of 4 points

Scenario 1: Schizophrenia

A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”.  The boyfriend relates episodes of unexpected rage and crying.

PMH:  noncontributory

FH: positive for a first cousin who “had mental problems”.

SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.

PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.

PSYCHOLOGICAL DISORDERS MODULE 6 NURS 6501

DIAGOSIS: schizophrenia.

Questions

1.     What are known characteristics of schizophrenia and relate those to this patient.  

Selected Answer: Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in hallucinations, delusions, and extremely disordered thinking and behavior that impair daily functioning and can be disabling. Schizophrenia involves a range of problems with thinking (cognition), behavior, and emotions. Signs and symptoms of schizophrenia may vary but usually involve delusions, hallucinations, or disorganized speech and reflect an impaired ability to function.

1-  Delusions: These are false beliefs not based on reality. For example, you think that you are being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you, or a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.

2- Hallucinations: These usually involve seeing or hearing things that do not exist. Nevertheless, the person with schizophrenia has the full force and impact of a normal experience. Hallucinations can be in any sense, but hearing voices is the most common hallucination.

3- Disorganized thinking (speech): Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that cannot be understood, sometimes known as word salad.

4- Extremely disorganized or abnormal motor behavior: This may show in several ways, from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, so it is hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.

5- Negative symptoms: This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (does not make eye contact, does not change facial expressions, or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience a pleasure.

Certain factors seem to increase the risk of developing or triggering schizophrenia, including having a family history of schizophrenia; some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development; taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood.

In summary, Positive symptoms of schizophrenia include hallucinations that may be auditory, olfactory, somatic-tactile, visual, voices commenting, and voices conversing. Delusions are also positive symptoms and include delusion of being controlled, mind-reading, the delusion of reference, grandiosity, guilt, persecution, somatic thought broadcasting, thought insertion, and thought withdrawal. Thought disorder symptoms include distractible speech, incoherence, illogicality, circumstantiality, and derailment. Bizarre behaviors are other positive symptoms of schizophrenia. Those behaviors include aggressiveness and agitated states, clothing appearance, repetitive stereotyping, and social and sexual behavior. This patient exhibited signs of auditory hallucinations, disheveled appearance, and persecution.

Correct Answer:  

Positive symptoms of schizophrenia include hallucinations that may be auditory, olfactory, somatic-tactile, visual, voices commenting, and voices conversing. Delusions are also positive symptoms and include delusion of being controlled, delusion of mind reading, delusion of reference, delusion of grandiosity, guilt, persecution, somatic thought broadcasting, thought insertion and thought withdrawal. Thought disorder symptoms include distractible speech, incoherence, illogicality, circumstantially, and derailment. Bizarre behaviors are other positive symptoms of schizophrenia. Those behaviors include aggressiveness and agitated states, clothing appearance, repetitive stereotyped, and social and sexual behavior. This patient exhibited signs of auditory hallucinations, disheveled appearance, and persecution.

Response Feedback: [None Given]

Question 2

4 out of 4 points

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: PSYCHOLOGICAL DISORDERS MODULE 6 NURS 6501

Scenario 1: Schizophrenia

A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”.  The boyfriend relates episodes of unexpected rage and crying.

PMH:  noncontributory

FH: positive for a first cousin who “had mental problems”.

SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.

PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.

DIAGOSIS: schizophrenia.

Question:

1.     Genetics are sometimes attached to schizophrenia explain this.

Selected Answer: The causes of schizophrenia are not known. There are probably at least two sets of risk factors, genetic and perinatal. In addition, undefined socioenvironmental factors may increase the risk of schizophrenia in international migrants or urban populations of ethnic minorities. Increased paternal age is associated with a greater risk of schizophrenia. The risk of schizophrenia is elevated in biological relatives of persons with schizophrenia but not in adopted relatives. The risk of schizophrenia in first-degree relatives of persons with schizophrenia is 10%. If both parents have schizophrenia, the risk of schizophrenia in their child is 40%. Concordance for schizophrenia is about 10% for dizygotic twins and 40-50% for monozygotic twins. Genome-wide association studies have identified many candidate genes. However, the individual gene variants that have been implicated so far account for only a small fraction of schizophrenia cases, and these findings have not always been replicated in different studies. The genes that have been found mostly change a gene’s expression or a protein’s function in a small way.
Correct Answer:  

The causes of schizophrenia are not known. There are probably at least 2 sets of risk factors, genetic and perinatal. In addition, undefined socioenvironmental factors may increase the risk of schizophrenia in international migrants or urban populations of ethnic minorities. Increased paternal age is associated with a greater risk of schizophrenia. The risk of schizophrenia is elevated in biologic relatives of persons with schizophrenia but not in adopted relatives. The risk of schizophrenia in first-degree relatives of persons with schizophrenia is 10%. If both parents have schizophrenia, the risk of schizophrenia in their child is 40%. Concordance for schizophrenia is about 10% for dizygotic twins and 40-50% for monozygotic twins. Genome-wide association studies have identified many candidate genes, but the individual gene variants that have been implicated so far account for only a small fraction of schizophrenia cases, and these findings have not always been replicated in different studies. The genes that have been found mostly change a gene’s expression or a protein’s function in a small way.

Response Feedback: [None Given]

Question 3

4 out of 4 points

Scenario 1: Schizophrenia

A 22-year-old female student was brought to her college student health department by her boyfriend. He was concerned about the changes in her behavior. The boyfriend noted that she has been hearing voices, and seeing things that are not there. She also thinks that there are people that want to harm her. She told her family that she cannot finish college as the voices told her to quit because she is “dumb”.  The boyfriend relates episodes of unexpected rage and crying.

PMH:  noncontributory

FH: positive for a first cousin who “had mental problems”.

SH: Denies current drug abuse but states he smoked marijuana every day during junior and senior years of high school. Admits to drinking heavily on weekends at various fraternity houses.

PE: thin, anxious disheveled female who, during conversations, stops talking, tilts her head and appears to be listening to something. There is poor eye contact and conversation is disjointed.

DIAGOSIS: schizophrenia.

Question:

What roles do neurotransmitters play in the development of schizophrenia?

Selected Answer: Abnormalities of the dopaminergic system are thought to exist in schizophrenia. The first observable effective antipsychotic drugs, chlorpromazine, and reserpine, were structurally different, but they shared antidopaminergic properties. Drugs that diminish the firing rates of mesolimbic dopamine. D2 neurons are antipsychotic, and drugs that stimulate these neurons (e.g., amphetamines) exacerbate psychotic symptoms. Hypodopaminergic activity in the mesocortical system, leading to negative symptoms, and hyperdopaminergic activity in the mesolimbic system, leading to positive symptoms, may coexist. The newer antipsychotic drugs block dopamine D2 and serotonin (5- hydroxytryptamine [5-HT]) receptors. Clozapine, probably the most effective antipsychotic agent, is a particularly weak dopamine D2 antagonist. Thus, other neurotransmitter systems, such as norepinephrine, serotonin, and gamma-aminobutyric acid (GABA), are undoubtedly involved.
Correct Answer:  

Abnormalities of the dopaminergic system are thought to exist in schizophrenia. The first observable effective antipsychotic drugs, chlorpromazine and reserpine, were structurally different from each other, but they shared antidopaminergic properties. Drugs that diminish the firing rates of mesolimbic dopamine D2 neurons are antipsychotic, and drugs that stimulate these neurons (eg, amphetamines) exacerbate psychotic symptoms. Hypodopaminergic activity in the mesocortical system, leading to negative symptoms, and hyperdopaminergic activity in the mesolimbic system, leading to positive symptoms, may coexist. The newer antipsychotic drugs block both dopamine D2 and serotonin (5- hydroxytryptamine [5-HT]) receptors. Clozapine, probably the most effective antipsychotic agent, is a particularly weak dopamine D2 antagonist. Thus, other neurotransmitter systems, such as norepinephrine, serotonin, and gamma-aminobutyric acid (GABA), are undoubtedly involved.

 

Response Feedback: [None Given]

 

Grading Rubric

Performance Category 100% or highest level of performance

100%

16 points

Very good or high level of performance

88%

14 points

Acceptable level of performance

81%

13 points

Inadequate demonstration of expectations

68%

11 points

Deficient level of performance

56%

9 points

 

Failing level

of performance

55% or less

0 points

 Total Points Possible= 50           16 Points    14 Points 13 Points        11 Points           9 Points          0 Points
Scholarliness

Demonstrates achievement of scholarly inquiry for professional and academic topics.

Presentation of information was exceptional and included all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information was good, but was superficial in places and included all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information was minimally demonstrated in all of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
 

Presentation of information is unsatisfactory in one of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
 

Presentation of information is unsatisfactory in two of the following elements:

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information.
Presentation of information is unsatisfactory in three or more of the following elements

  • Provides evidence of scholarly inquiry relevant to required TD topic(s).
  • Presents specific information from scholarly sources to develop a comprehensive presentation of facts.
  • Uses at least one outside scholarly reference that is relevant, less than 5 years old (use of older references requires instructor permission) and reliable for the required topic.*
  • Uses in-text citation and full reference at end of posting when presenting another person’s thoughts as quotes or paraphrase of information
 16 Points  14 Points  13 Points 11 Points 9 Points  0 Points
Application of Course Knowledge

Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations

Presentation of information was exceptional and included all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information was good, but was superficial in places and included all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information was minimally demonstrated in the all of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in one of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from and scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in two of the following elements:

  • Applies principles, knowledge and information from scholarly resources to the required topic.
  • Applies facts, principles or concepts learned from scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
Presentation of information is unsatisfactory in three of the following elements

  • Applies principles, knowledge and information and scholarly resources to the required topic.
  • Applies facts, principles or concepts learned scholarly resources to a professional experience.
  • Application of information is comprehensive and specific to the required topic.
   10 Points 9 Points  6 Points  0 Points
Interactive Dialogue

Initial post should be a minimum of 300 words (references do not count toward word count)

The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count)

Responses are substantive and relate to the topic.

Demonstrated all of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 3 of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 2 of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
Demonstrated 1 or less of the following:

  • Initial post must be a minimum of 300 words.
  • The peer and instructor responses must be a minimum of 150 words each.
  • Responses are substantive
  • Responses are related to the topic of discussion.
  8 Points 7 Points  6 Points         5 Points          4 Points  0 Points
Grammar, Syntax, APA

Points deducted for improper grammar, syntax and APA style of writing.

The source of information is the APA Manual 6th Edition

Error is defined to be a unique APA error. Same type of error is only counted as one error.

The following was present:

  • 0-3 errors in APA format

AND

  • Responses have 0-3 grammatical, spelling or punctuation errors

AND

  • Writing style is generally clear, focused on topic,and facilitates communication.
The following was present:

  • 4-6 errors in APA format.

AND/OR

  • Responses have 4-5 grammatical, spelling or punctuation errors

AND/OR

  • Writing style is somewhat focused on topic.
The following was present:

  • 7-9 errors in APA format.

AND/OR

  • Responses have 6-7 grammatical, spelling or punctuation errors

AND/OR

  • Writing style is slightly focused on topic making discussion difficult to understand.
 

The following was present:

  • 10- 12 errors in APA format

AND/OR

  • Responses have 8-9 grammatical, spelling and punctuation errors

AND/OR

  • Writing style is not focused on topic, making discussion difficult to understand.
 

The following was present:

  • 13 – 15 errors in APA format

AND/OR

  • Responses have 8-10 grammatical, spelling or punctuation errors

AND/OR

  • Writing style is not focused on topic, making discussion difficult to understand.

AND/OR

  • The student continues to make repeated mistakes in any of the above areas after written correction by the instructor.
The following was present:

  • 16 to greater errors in APA format.

AND/OR

  • Responses have more than 10 grammatical, spelling or punctuation errors.

AND/OR

  • Writing style does not facilitate communication
  0 Points Deducted 5 Points Lost
Participation

Requirements

Demonstrated the following:

  • Initial, peer, and faculty postings were made on 3 separate days
Failed to demonstrate the following:

  • Initial, peer, and faculty postings were made on 3 separate days
  0 Points Lost 5 Points Lost
Due Date Requirements Demonstrated all of the following:

  • The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT.

A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT.

Demonstrates one or less of the following.

  • The initial posting to the graded threaded discussion topic is posted within the course no later than Wednesday, 11:59 pm MT.

A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT.