1. Question :

The drug recommended as primary prevention of osteoporosis in men over seventy years is:

Alendronate (Fosamax)

Ibandronate (Boniva)

Calcium carbonate

Raloxifene (Evista)

Question 2. Question :

Alterations in drug metabolism among Asians may lead to:

Slower metabolism of antidepressants, requiring lower doses

Faster metabolism of neuroleptics, requiring higher doses

Altered metabolism of omeprazole, requiring higher doses

Slower metabolism of alcohol, requiring higher doses

Question 3. Question :

Some research supports that testosterone replacement therapy may be indicated in which of the following diagnoses in men?

Age-related decrease in cognitive functioning

Metabolic syndrome

Decreased muscle mass in aging men

All of the above

Question 4. Question :

The chemicals that promote the spread of pain locally include _.

serotonin

norepinephrine

enkephalin

neurokinin A

Question 5. Question :

The DEA:

Registers manufacturers and prescribes controlled substances

Regulates NP prescribing at the state level

Sanctions providers who prescribe drugs off-label

Provides prescribers with a number they can use for insurance billing

Question 6. Question :

The trial period to determine effective anti-inflammatory activity when starting a patient on aspirin for RA is _.

forty-eight hours

four to six days

four weeks

two months

Question 7. Question :

The route of excretion of a volatile drug will likely be:

The kidneys

The lungs

The bile and feces

The skin

Question 8. Question :

Compelling indications for an ACE inhibitor as treatment for hypertension based on clinical trials include:

Pregnancy

Renal parenchymal disease

Stable angina

Dyslipidemia

Question 9. Question :

The American Diabetic Association has recommended which of the following tests for ongoing management of diabetes?

Fasting blood glucose

Hemoglobin A1c

Thyroid function tests

Electrocardiograms

Question 10. Question :

The angiotensin converting enzyme (ACE) inhibitor lisinopril is a known teratogen. Teratogens cause Type __ ADR.

A

B

C

D

Question 11. Question :

The goals of therapy when prescribing HRT include reducing:

Cardiovascular risk

Risk of stroke or other thromboembolic event

Breast cancer risk

Vasomotor symptoms

Question 12. Question :

Patients who have angina, regardless of class, who are also diabetic should be on:

Nitrates

Beta blockers

ACE inhibitors

Calcium channel blockers

Question 13. Question :

The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is:

Class I

Class II

Class III

Class IV

Question 14. Question :

Patients with allergic rhinitis may benefit from a prescription of:

Fluticasone (Flonase)

Cetirizine (Zyrtec)

OTC cromolyn nasal spray (Nasalcrom)

Any of the above

Question 15. Question :

Kyle has Crohn’s disease and has a documented folate deficiency. Drug therapy for folate deficiency anemia is:

Oral folic acid 1 to 2 mg/day

Oral folic acid 1 gm/day

IM folate weekly for at least six months

Oral folic acid 400 mcg daily

Question 16. Question :

The treatment for vitamin B12 deficiency is:

1,000 mcg daily of oral cobalamin

2 gm/day of oral cobalamin

100 mcg/day vitamin B12 IM

500 mcg/dose nasal cyanocobalamin two sprays once a week

Question 17. Question :

Nonadherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of nonadherence to these drugs is to prescribe a drug that:

Has a short half-life so that missing one dose has limited effect

Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down

Has a tolerability profile with less of the adverse effects that are considered “irritating,” such as nausea and dizziness

Must be taken no more than twice a day

Question 18. Question :

Type II diabetes is a complex disorder involving:

Absence of insulin production by the beta cells

A suboptimal response of insulin-sensitive tissues in the liver

Increased levels of GLP in the postprandial period

Too much fat uptake in the intestine

Question 19. Question :

Metformin is a primary choice of drug to treat hyperglycemia in type II diabetes because it:

Substitutes for insulin usually secreted by the pancreas

Decreases glycogenolysis by the liver

Increases the release of insulin from beta cells

Decreases peripheral glucose utilization

Question 20. Question :

Gender differences between men and women in pharmacokinetics include:

More rapid gastric emptying so that drugs absorbed in the stomach have less exposure to absorption sites

Higher proportion of body fat so that lipophilic drugs have relatively greater volumes of distribution

Increased levels of bile acids so that drugs metabolized in the intestine have higher concentrations

Slower organ blood flow rates so that drugs tend to take longer to be excreted

Question 21. Question :

If not chosen as the first drug in hypertension treatment, which drug class should be added as the second step because it will enhance the effects of most other agents?

ACE inhibitors

Beta blockers

Calcium channel blockers

Diuretics

Question 22. Question :

A nineteen-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including:

Bradykinesia, akathisia, and agitation

Excessive weight gain

Hypertension

Potentially fatal agranulocytosis

Question 23. Question :

Levetiracetam has known drug interactions with:

Oral contraceptives

Carbamazepine

Warfarin

Few, if any, drugs

Question 24. Question :

When the total daily insulin dose is split and given twice daily, which of the following rules may be followed?

Give two-thirds of the total dose in the morning and one-third in the evening.

Give 0.3 units/kg of premixed 70/30 insulin, with one-third in the morning and two-thirds in the evening.

Give 50% of an insulin glargine dose in the morning and 50% in the evening.

Give long-acting insulin in the morning and short-acting insulin at bedtime.

Question 25. Question :

Which of the following factors may adversely affect a patient’s adherence to a therapeutic drug regimen?

Complexity of the drug regimen

Patient’s perception of the potential adverse effects of the drugs

Both A and B

Neither A nor B

Question 26. Question :

The time required for the amount of drug in the body to decrease by 50% is called:

Steady state

Half-life

Phase II metabolism

Reduced bioavailability time

Question 27. Question :

Drugs that are absolutely contraindicated in lactating women include:

Selective serotonin reuptake inhibitors

Antiepileptic drugs such as carbamazepine

Antineoplastic drugs such as methotrexate

All of the above

Question 28. Question :

Tobie presents to clinic with moderate acne. He has been using OTC benzoyl peroxide at home with minimal improvement. A topical antibiotic (clindamycin) and a topical retinoid adapalene (Differin) are prescribed. Education of Tobie would include which one of the following instructions?

He should see an improvement in his acne within the first two weeks of treatment.

If there is no response in a week, he should double the daily application of adapalene (Differin).

He may see an initial worsening of his acne that will improve in six to eight weeks.

Adapalene may cause bleaching of clothing.

Question 29. Question :

Martin is a sixty-year-old with hypertension. The first-line decongestant to be prescribed would be:

Oral pseudoephedrine

Oral phenylephrine

Nasal oxymetazoline

Nasal azelastine

Question 30. Question :

A woman who is pregnant and has hyperthyroidism is best managed by a specialty team that will most likely treat her with:

Methimazole.

Propylthiouracil.

Radioactive iodine.

Nothing; treatment is best delayed until after her pregnancy ends.

Question 31. Question :

A twenty-four-year-old male received multiple fractures in a motor vehicle accident that required significant amounts of opioid medication to treat his pain. He is at risk for Type __ ADR when he no longer requires the opioids.

A

C

E

G

Question 32. Question :

Second-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they:

Are more effective than first-generation antihistamines

Are less sedating than first-generation antihistamines

Are prescription products and, therefore, are covered by insurance

Can be taken with CNS sedatives, such as alcohol

Question 33. Question :

Steady state is:

The point on the drug concentration curve when absorption exceeds excretion

When the amount of drug in the body remains constant

When the amount of drug in the body stays below the minimum toxic concentration (MTC)

All of the above

Question 34. Question :

Jayla is a nine-year-old who has been diagnosed with migraines for almost two years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would be appropriate?

Prescribe amitriptyline (Elavil) daily, start at a low dose and increase the dose slowly every two weeks until effective in eliminating migraines.

Encourage her mother to give her Excedrin Migraine (aspirin, acetaminophen, and caffeine) at the first sign of a headache to abort the headache.

Prescribe propranolol (Inderal) to be taken daily for at least three months.

Explain that it is rare for a nine-year-old to get migraines and that she needs an MRI to rule out a brain tumor.

Question 35. Question :

Josie is a five-year-old who presents to the clinic with a forty-eight-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down, and her weight is 4 pounds less than her last recorded weight. Besides intravenous (IV) fluids, her exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order for Josie?

Prochlorperazine (Compazine)

Meclizine (Antivert)

Promethazine (Phenergan)

Ondansetron (Zofran)

Question 36. Question :

Long-term use of PPIs may lead to:

Hip fractures in at-risk persons

Vitamin B6 deficiency

Liver cancer

All of the above

Question 37. Question :

Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing with their providers or a pharmacist first?

Patients with kidney stones

Pregnant patients

Patients with heartburn

IN Postmenopausal women

0 of 2.5

Question 38. Question :

Beta blockers treat hypertension because they:

Reduce peripheral resistance.

Vasoconstrict coronary arteries.

Reduce norepinephrine.

Reduce angiotensin II production.

Question 39. Question :

Precautions that should be taken when prescribing controlled substances include:

Faxing the prescription for a Schedule II drug directly to the pharmacy

Using tamper-proof papers for all prescriptions written for controlled drugs

Keeping any presigned prescription pads in a locked drawer in the clinic

Using only numbers to indicate the amount of drug to be prescribed

Question 40. Question :

The tricyclic antidepressants should be prescribed cautiously in patients with:

Eczema

Asthma

Diabetes

Heart disease

Question 41. Question :

An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone?

Beta blockers

Diuretics

Nondihydropyridine calcium channel blockers

Angiotensin II receptor blockers

Question 42. Question :

Metoclopramide improves GERD symptoms by:

Reducing acid secretion

Increasing gastric pH

Increasing lower esophageal tone

Decreasing lower esophageal tone

Question 43. Question :

Patient education regarding prescribed medication includes:

Instructions written at the high school reading level

Discussion of expected ADRs

How to store leftover medication such as antibiotics

Verbal instructions always in English

Question 44. Question :

If a patient with H. pylori positive PUD fails first-line therapy, the second-line treatment is:

A PPI BID plus metronidazole plus tetracycline plus bismuth subsalicylate for fourteen days

Testing H. pylori for resistance to common treatment regimens

A PPI plus clarithromycin plus amoxicillin for fourteen days

A PPI and levofloxacin for fourteen days

Question 45. Question :

A patient with a COPD exacerbation may require:

Doubling of inhaled corticosteroid dose

Systemic corticosteroid burst

Continuous inhaled beta 2 agonists

Leukotriene therapy

Question 46. Question :

Angela is a black woman who has heard that women of African descent do not need to worry about osteoporosis. What education would you provide Angela about her risk?

She is ; black women do not have much risk of developing osteoporosis due to their dark skin.

Black women are at risk of developing osteoporosis due to their lower calcium intake as a group.

If she doesn’t drink alcohol, her risk of developing osteoporosis is low.

If she has not lost more than 10% of her weight lately, her risk is low.

Question 47. Question :

The role of the nurse practitioner in the use of herbal medication is to:

Maintain competence in the prescribing of common herbal remedies.

Recommend common OTC herbs to patients.

Educate patients and guide them to appropriate sources of care.

Encourage patients to not use herbal therapy due to the documented dangers.

Question 48. Question :

Ray has been diagnosed with hypertension, and an ACE inhibitor is determined to be needed. Prior to prescribing this drug, the nurse practitioner should assess for:

Hypokalemia

Impotence

Decreased renal function

Inability to concentrate

Question 49. Question :

Long-acting beta-agonists received a black box warning from the US Food and Drug Administration due to the:

Risk of life-threatening dermatological reactions

Increased incidence of cardiac events when long-acting beta-agonists are used

Increased risk of asthma-related deaths when long-acting beta-agonists are used

Risk for life-threatening alterations in electrolytes

Question 50. Question :

Off-Label prescribing is:

Regulated by the FDA

Illegal by NPs in all states (provinces)

Legal if there is scientific evidence for the use

Regulated by the DEA

Question 51. Question :

Adam has type I diabetes and plays tennis for his university. He exhibits knowledge deficit about his insulin and his diagnosis. He should be taught that:

He should increase his increase his carbohydrate intake during times of exercise intake during times of exercise.

Each brand of insulin is equal in bioavailability, so buy the least expensive.

Alcohol produces hypoglycemia and can help control his diabetes when taken in small amounts.

If he does not want to learn to give himself injections, he may substitute an oral hypoglycemic to control his diabetes.

Question 52. Question :

Prior to starting antidepressants, patients should have laboratory testing to rule out:

IN Hypothyroidism

Anemia

Diabetes mellitus

Low estrogen levels

0 of 2.5

Question 53. Question :

What impact does developmental variation in renal function has on prescribing for infants and children?

Lower doses of renally excreted drugs may be prescribed to infants younger than six months

Higher doses of water-soluble drugs may need to be prescribed due to increased renal excretion

Renal excretion rates have no impact on prescribing

Parents need to be instructed on whether drugs are renally excreted or not

Question 54. Question :

All diabetic patients with hyperlipidemia should be treated with:

3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors

Fibric acid derivatives

Nicotinic acid

Colestipol

Question 55. Question :

Treatment failure in patients with PUD associated with H. pylori may be due to:

Antimicrobial resistance

Ineffective antacid

Overuse of PPIs

All of the above

Question 56. Question :

To improve positive outcomes when prescribing for the elderly, the NP should:

Assess cognitive functioning in the elder

Encourage the patient to take a weekly “drug holiday” to keep drug costs down

Encourage the patient to cut drugs in half with a knife to lower costs

All of the above options are

Question 57. Question :

Erik presents with a golden-crusted lesion at the site of an insect bite consistent with impetigo. His parents have limited finances and request the least expensive treatment. Which medication would be the best choice for treatment?

Mupirocin (Bactroban)

Bacitracin and polymixin B (generic double antibiotic ointment)

Retapamulin (Altabax)

Oral cephalexin (Keflex)

Question 58. Question :

Nonselective beta blockers and alcohol create serious drug interactions with insulin because they:

Increase blood glucose levels.

Produce unexplained diaphoresis.

Interfere with the ability of the body to metabolize glucose.

Mask the signs and symptoms of altered glucose levels.

Question 59. Question :

Infants and young children are at higher risk of ADRs due to:

Immature renal function in school-age children

Lack of safety and efficacy studies in the pediatric population

Children’s skin being thicker than adults, requiring higher dosages of topical medication

Infant boys having a higher proportion of muscle mass, leading to a higher volume of distribution

Question 60. Question :

Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:

Toxic levels of warfarin building up

Decreased response to warfarin

Increased risk for significant drug interactions with warfarin

Less risk of drug interactions with warfarin

Question 61. Question :

Jose is a twelve-year-old overweight child with a total cholesterol level of 180 mg/dL and LDL of 125 mg/dL. Along with diet education and recommending increased physical activity, a treatment plan for Jose would include __ with a reevaluation in six months.

statins

niacin

sterols

bile acid-binding resins

Question 62. Question :

A potentially life-threatening adverse response to ACE inhibitors is angioedema. Which of the following statements is true about this adverse response?

Swelling of the tongue and hoarseness are the most common symptoms.

It appears to be related to a decrease in aldosterone production.

The presence of a dry, hacky cough indicates a high risk for this adverse response.

Because it takes time to build up a blood level, it occurs after being on the drug for about one week.

Question 63. Question :

Amber is a twenty-four-year-old who has had migraines for ten years. She reports a migraine on average of once a month. The migraines are effectively aborted with naratriptan (Amerge). When refilling Amber’s naratriptan education would include which of the following?

Naratriptan will interact with antidepressants, including selective serotonin reuptake inhibitors and St John’s Wort, and she should inform any providers she sees that she has migraines.

Continue to monitor her headaches; if the migraine is consistently happening around her menses, then there is preventive therapy available.

Pregnancy is contraindicated when taking a triptan.

All the given options are correct.

Question 64. Question :

One of the main drug classes used to treat acute pain is NSAIDs. They are used due to which of the following reasons?

They have less risk for liver damage than acetaminophen.

Inflammation is a common cause of acute pain.

They have minimal GI irritation.

Regulation of blood flow to the kidney is not affected by these drugs.

Question 65. Question :

A patient has been prescribed silver sulfadiazine (Silvadene) cream to treat burns on his or her leg. Normal adverse effects of silver sulfadiazine cream include:

Transient leukopenia on days two to four that should resolve

Worsening of burn symptoms briefly before resolution

A red, scaly rash that will resolve with continued use

Hypercalcemia

Question 66. Question :

Sulfonylureas may be added to a treatment regimen for type II diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they:

Increase endogenous insulin secretion.

Have a significant risk for hypoglycemia.

Address the insulin resistance found in type II diabetics.

Improve insulin binding to receptors.

Question 67. Question :

Narcotics are exogenous opiates. They act by __.

inhibiting pain transmission in the spinal cord

attaching to receptors in the afferent neuron to inhibit the release of substance P

blocking neurotransmitters in the midbrain

increasing beta-lipoprotein excretion from the pituitary

Question 68. Question :

Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of __.

serum glucose

stool culture

folate levels

vitamin B12

Question 69. Question :

Henry presents to clinic with a significantly swollen, painful great toe and is diagnosed with gout. Of the following, which would be the best treatment for Henry?

High-dose colchicines

Low-dose colchicines

High-dose aspirin

Acetaminophen with codeine

Question 70. Question :

Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the selective-serotonin reuptake inhibitors. What is the initial dosage adjustment when starting a taper off antidepressants?

Change the dose to every other day dosing for a week.

Reduce the dose by 50% for three to four days.

Reduce the dose by 50% every other day.

Escitalopram (Lexapro) can be stopped abruptly due to its long half-life.

Question 71. Question :

Christy has exercise and mild persistent asthma and is prescribed two puffs of albuterol fifteen minutes before exercise and as needed for wheezing. One puff per day of beclomethasone (Qvar) is also prescribed. Teaching regarding her inhalers includes which one of the following?

She should use one to two puffs of albuterol per day to prevent an attack, with no more than eight puffs per day.

Beclomethasone needs to be used every day to treat her asthma.

She should report any systemic side effects she is experiencing, such as weight gain.

She should use the albuterol MDI immediately after her corticosteroid MDI to facilitate bronchodilation.

Question 72. Question :

Asthma exacerbations at home are managed by the patient by:

Increasing the frequency of beta 2 agonists and contacting his or her provider

Doubling inhaled corticosteroid dose

Increasing the frequency of beta 2 agonists

Starting montelukast (Singulair)

Question 73. Question :

A woman with an intact uterus should not be prescribed:

Estrogen/progesterone combination

Intramuscular (IM) medroxyprogesterone (Depo Provera)

Estrogen alone

Androgens

Question 74. Question :

The drug recommended as primary prevention of osteoporosis in women over seventy years old is:

Alendronate (Fosamax)

Ibandronate (Boniva)

Calcium carbonate

Raloxifene (Evista)

Question 75. Question :

Patient education when prescribing the vitamin D3 derivative calcipotriene for psoriasis includes:

Applying calcipotriene thickly to affected psoriatic areas two to three times a day

Applying a maximum of 100 grams of calcipotriene per week

Not using calcipotriene in combination with its topical corticosteroids

Augmenting calcipotriene with the use of coal-tar products

Question 76. Question :

Both ACE inhibitors and some angiotensin-II receptor blockers have been approved in treating:

Hypertension in diabetic patients

Diabetic nephropathy

Both A and B

Neither A nor B

Question 77. Question :

Scott is presenting for follow-up on his lipid panel. He had elevated total cholesterol, elevated triglycerides, and an LDL of 122 mg/dL. He has already implemented diet changes and increased physical activity. He has mildly elevated liver studies. An appropriate next step for therapy would be:

Atorvastatin (Lipitor)

Niacin (Niaspan)

Simvastatin and ezetimibe (Vytorin)

Gemfibrozil (Lopid)

Question 78. Question :

Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include:

“Fruity” breath odor and rapid respiration

Diarrhea, abdominal pain, weight loss, and hypertension

Dizziness, confusion, diaphoresis, and tachycardia

Easy bruising, palpitations, cardiac dysrhythmias, and coma

Question 79. Question :

Incorporating IT into a patient encounter takes skill and tact. During the encounter, the provider can make the patient more comfortable with the IT the provider is using by:

Turning the screen around so the patient can see material being recorded

Not placing the computer screen between the provider and the patient

Both A and B

Neither A nor B

Question 80. Question :

Which one of the below-given instructions can be followed for applying a topical antibiotic or antiviral ointment?

Apply thickly to the infected area, spreading the medication well past the borders of the infection

If the rash worsens, apply a thicker layer of medication to settle down the infection

Wash hands before and after application of topical antimicrobials

None of the above

Question 81. Question :

Sadie is a ninety-year-old patient who requires a new prescription. What changes in drug distribution with aging would influence prescribing for Sadie?

Increased volume of distribution

Decreased lipid solubility

Decreased plasma proteins

Increased muscle-to-fat ratio

Question 82. Question :

First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be:

OTC topical azole (clotrimazole, miconazole)

Oral terbinafine

Oral griseofulvin microsize

Nystatin cream or ointment

Question 83. Question :

Which of the following is true about procainamide and its dosing schedule?

It produces bradycardia and should be used cautiously in patients with cardiac conditions that a slower heart rate might worsen.

GI adverse effects are common, so the drug should be taken with food.

Adherence can be improved by using a sustained-release formulation that can be given once daily.

Doses of this drug should be taken evenly spaced around the clock to keep an even blood level.

Question 84. Question :

A nurse practitioner would prescribe the liquid form of ibuprofen for a six-year-old because:

Drugs given in liquid form are less irritating to the stomach.

A six-year-old may have problems swallowing a pill.

Liquid forms of medication eliminate the concern for first-pass effect.

Liquid ibuprofen does not have to be dosed as often as tablet form.

Question 85. Question :

Kristine would like to start HRT to treat the significant vasomotor symptoms she is experiencing during menopause. Education for a woman considering hormone replacement would include:

Explaining that HRT is totally safe if used for a short term

Telling her to ignore media hype regarding HRT

Discussing the advantages and risks of HRT

Encouraging the patient to use phytoestrogens with the HRT

Question 86. Question :

Xi, a fifty-four-year-old female, has a history of migraine that does not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Which of the following actions would you take for appropriate decision making?

Prescribe Maxalt, but to monitor the use, only give her four tablets with no refills.

Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose.

Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital).

Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan.

Question 87. Question :

The elderly are at high risk of ADRs due to:

Having greater muscle mass than younger adults, leading to higher volume of distribution

The extensive studies that have been conducted on drug safety in this age group

The blood-brain barrier being less permeable, requiring higher doses to achieve therapeutic effect

Age-related decrease in renal function

Question 88. Question :

Jim presents with fungal infection of two of his toenails (onychomycosis). Treatment for fungal infections of the nail includes:

Miconazole cream

Ketoconazole cream

Oral griseofulvin

Mupirocin cream

Question 89. Question :

GLP-1 agonists:

Directly bind to a receptor in the pancreatic beta cell.

Have been approved for monotherapy.

Speed gastric emptying to decrease appetite.

Can be given orally once daily.

Question 90. Question :

Prophylactic use of bisphosphonates is recommended for patients with early osteopenia related to long-term use of which of the following drugs?

Selective estrogen-receptor modulators

Aspirin

Glucocorticoids

Calcium supplements

Question 91. Question :

Inadequate vitamin D intake can contribute to the development of osteoporosis by:

Increasing calcitonin production

Increasing calcium absorption from the intestine

Altering calcium metabolism

Stimulating bone formation

Question 92. Question :

Which of the following statements is true about age and pain?

Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children.

Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs.

Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain.

Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.

Question 93. Question :

Selective estrogen receptor modifiers (SERMs) treat osteoporosis by selectively:

Inhibiting magnesium resorption in the kidneys

Increasing calcium absorption from the gastrointestinal (GI) tract

Acting on the bone to inhibit osteoblast activity

Selectively acting on the estrogen receptors in the bone

Question 94. Question :

When a patient is on selective-serotonin reuptake inhibitors:

The complete blood count must be monitored every three to four months

Therapeutic blood levels must be monitored every six months after a steady state is achieved.

Blood glucose must be monitored every three to four months.

There is no laboratory monitoring required.

Question 95. Question :

Patients whose total dose of prednisone exceed 1 gram will most likely need a second prescription for _.

metformin, a biguanide to prevent diabetes

omeprazole, a proton pump inhibitor to prevent peptic ulcer disease

naproxen, an NSAID to treat joint pain

furosemide, a diuretic to treat fluid retention

Question 96. Question :

The ongoing monitoring of patients over the age sixty-five years taking alendronate (Fosamax) or any other bisphosphonate is:

Annual dual energy X-ray absorptiometry (DEXA) scans

Annual vitamin D level

Annual renal function evaluation

Electrolytes every three months

Question 97. Question :

Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to:

Reduce the chance of tardive dyskinesia.

Potentiate the effects of the drug.

Reduce the tolerance that tends to occur.

Increase CNS depression.

Question 98. Question :

Diagnostic criteria for diabetes include:

Fasting blood glucose greater than 140 mg/dl on two occasions

Postprandial blood glucose greater than 140 mg/dl

Fasting blood glucose 100 to 125 mg/dl on two occasions

Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl

Question 99. Question :

Insulin preparations are divided into categories based on onset, duration, and intensity of action following subcutaneous inject. Which of the following insulin preparations has the shortest onset and duration of action?

Insulin lispro

Insulin glulisine

Insulin glargine

Insulin detemir

Question 100. Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her?

Valproate is safe during all trimesters of pregnancy.

She can get pregnant while taking valproate, but she should take adequate folic acid.

Valproate is not safe at any time during pregnancy.

Valproate is a known teratogen but may be taken after the first trimester if necessary.

Adaptive Response

As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.

Consider the following scenarios:

Scenario 1:

Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.

Scenario 2:

Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.

Scenario 3:

Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.

To Prepare

· Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.

· Identify the pathophysiology of the disorders presented in each of the three scenarios, including their associated alterations. Consider the adaptive responses to the alterations.

· Review the examples of “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

· Review the Application Assignment Rubric found under Course Information

To Complete

Write a 2- to 3-page paper excluding the title page, reference page and Mind Map that addresses the following:

· For each of the three scenarios explain the pathophysiology, associated alterations and the patients’ adaptive responses to the alterations caused by the disease processes. You are required to discuss all three scenarios within the paper component of this assignment.

· Construct one mind map on a selected disorder presented in one of the scenarios. Your Mind Map must include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

                                                    Learning Resources

Required Readings

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Chapter 6, “Innate Immunity: Inflammation and Wound Healing”

This chapter examines how the body responds to injury and infection by exploring the first, second, and third lines of defense. It also covers wound healing and alterations of the wound healing process.

Chapter 7, “Adaptive Immunity”

This chapter examines the third line of defense, adaptive immunity. It also covers the roles of antigens and immunogens, the humoral immune response, cell-mediated immunity, and the production of B and T lymphocytes in the immune response.

Chapter 8, “Infection and Defects in Mechanism of Defense”

This chapter covers the epidemiology, clinical presentation, and treatment of disorders resulting from infection, deficiencies in immunity, and hypersensitivity. It also examines the pathophysiology of an important immune disorder—HIV/AIDS.

Chapter 9, “Stress and Disease”

This chapter evaluates the impact of stress on various body systems and the immune system. It also examines coping mechanisms and disorders related to stress.

Chapter 10, “Biology of Cancer”

This chapter explores the developmental process of cancer and factors that impact the onset of cancer at the cellular level. It also describes various treatment options.

Chapter 11, “Cancer Epidemiology”

This chapter reviews genetic, environmental, behavioral, and diet-related risk factors for cancer. It also examines types of cancers that result from risk factors.

Chapter 12, “Cancer in Children and Adolescents”

This chapter focuses on the presentation and prognosis of childhood cancers. It examines the impact of genetic and environmental factors on these cancers.

Chapter 38, “Structure and Function of the Musculoskeletal System”

This chapter covers the structure and function of bones, joints, and skeletal muscle. It also explores effects of aging on the musculoskeletal system.

Chapter 39, “Alterations of Musculoskeletal Function”

This chapter examines the pathophysiology, clinical manifestations, and evaluation and treatment of bone, joints, and skeletal muscle disorders. Additionally, it explores musculoskeletal tumors, osteoarthritis, and rheumatoid arthritis.

Chapter 40, “Alterations of Musculoskeletal Function in Children”

This chapter includes musculoskeletal disorders that affect children, such as congenital defects, bone infection, juvenile idiopathic arthritis, muscular dystrophy, musculoskeletal tumors, and nonaccidental trauma.

Chapter 41, “Structure, Function, and Disorders of the Integument”

This chapter begins with an overview of the structure and function of skin. It then covers effects of aging on skin, as well as disorders of the skin, hair, and nails.

Chapter 42, “Alterations of Integument in Children”

This chapter covers alterations of the integument that affect children. These include acne vulgaris, dermatitis, infections of the skin, insect bites and parasites, vascular disorders, and other skin disorders.

Hammer, G. G. , & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.

Chapter 3, “Disorders of the Immune System”

This chapter explores the anatomy and physiology of the immune system. It also explores the pathophysiology of various immune disorders such as primary immunodeficiency diseases and AIDS.

Chapter 8, “Diseases of the Skin”

This chapter begins with an overview of the anatomy and physiology of skin. It also explores the pathophysiology of various types of skin lesions and inflammatory skin diseases.

Chapter 24, “Inflammatory Rheumatic Disease”

This chapter explores the pathogenesis of inflammation and its role in rheumatic diseases. It also examines the clinical presentation, etiology, pathophysiology, and clinical manifestations of rheumatic diseases such as gout and rheumatoid arthritis.

Required Media

Zimbron, J. (2008). Mind maps—Dementia, endocarditis, and gastro-oesophageal reflux disease (GERD) [PDF]. Retrieved from http://www.medmaps.co.uk/beta/

Gastro-oesophageal reflux disease. [Image]. Used with permission of MedMaps.

This media provides examples of mind maps for dementia, endocarditis, and gastro-oesophageal reflux disease (GERD).

Optional Resources

Arthritis Foundation. (2012).

Lupus Foundation of America. (2012).

Please refer to milestone before completing assignment.

Review the feedback you received from your instructor for Milestone 1, and use it to develop this milestone.

Create a proposal for your Design for Change Capstone Project. Open the recommended assignment specific Milestone 2 Design Proposal Template (Links to an external site.)Links to an external site.. Use this to write your paper. You will include the information from Milestone 1, your practice issue and evidence summary worksheets, as you compose this proposal. Your plan is to convince your management team of a practice problem you have uncovered that is significant enough to change current practice.

The format for this proposal will be a paper following the Publication manual of APA 6 th edition.

The paper is to be four- to six-pages excluding the Title page and Reference page.

As you organize your information and evidence, include the following topics.

Introduction: Write an introduction but do not use “Introduction” as a heading in accordance with the rules put forth in the Publication manual of the American Psychological Association (2010, p. 63). Introduce the reader to the plan with evidence-based problem identification and solution.

Change Model Overview: Overview of the ACE Star model (the model we have been discussing this session); define the scope of the EBP; identify the stakeholders, and determine the responsibility of the team members.

Evidence: Conduct internal and external searches of evidence; integrate and summarize the evidence summary worksheet from Milestone 1; develop a recommendation for change.

Translation: develop a hypothetical action plan; include measurable outcomes, reporting to stakeholders; identify next steps and disseminate the findings.

Conclusion: Provide a clear and concise summary, inclusive of the problem issue, the five points of the ACE Star change model; and ways to maintain the change plan.

Citations and References must be included to support the information within each topic area. Refer to the APA manual, Chapter 7, for examples of proper reference format. In-text citations are to be noted for all information contained in your paper that is not your original idea or thought. Ask yourself, “How do I know this?” and then cite the source. Scholarly sources are expected, which means using peer-reviewed journals and credible websites.

Tables and Figures may be added as appropriate to the project. They should be embedded within the body of the paper (see your APA manual for how to format and cite). Creating tables and figures offers visual aids to the reader and enhances understanding of your literature review and design for change.

Submit your paper by 11:59 p.m. MT by Sunday of the end of Week 4.

MILESTONE 1

Capstone Project Milestone 1:

Practice Issue and Evidence Summary Worksheets

For Use May 2018

Student Name: Date: 5/21/18

Directions

1. Refer to the guidelines for specific details on how to complete this assignment.
2. Type your answers directly into the worksheets below.
3. Submit to the Dropbox by the end of Week 3, Sunday at 11:59 p.m. MT.
4. Post questions about this assignment to the Q & A Forum. You may also email questions to the instructor for a private response.

Practice Issue Worksheet

List the topic and include the citation for the systematic review you have selected from our approved list (optional: an additional scholarly source of support):

Support for healthy Breastfeeding mothers with healthy term babies.

McFadden, A., Gavine, A., Renfrew, M. J., Wade, A., Buchanan, P., Taylor, J. L., … MacGillivray, S. (2017). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD001141. doi:10.1002/14651858.CD001141.pub5

What is the nursing practice issue you have identified related to the topic you have chosen?

The nursing practice issue identified is the unavailability of resources that can facilitate the teaching of feeding cues to the mothers and expecting mothers in order to provide the best breastfeeding practices.

Fully describe the scope of the practice issue:

The benefits of breastfeeding for both mother and child is widely accepted across the medical field. The world health organization has made a recommendation that infants should be breastfed until six months exclusively, and even continue for up to two years exclusively as the main part of infant diet. The current level of breastfeeding in most of the countries does not indicate that recommendation. Knowing this, instead of offering brief lactation classes on postpartum units, interactive and in-depth lactation support should be available to all expecting mothers and new mothers.

What is the practice area?

_ Clinical

x_ Education

_ Administration

_ Other (List):

How was the practice issue identified? (check all that apply)

_ Safety/risk management concerns

_ Unsatisfactory patient outcomes

_ Wide variations in practice

_x Significant financial concerns

_ Difference between hospital and community practice

_ Clinical practice issue is a concern

_ Procedure or process is a time waster

_ Clinical practice issue has no scientific base

__ Other:

Describe the rationale for your checked selections:

For this practice issue, I selected significant financial concerns as a reason to why lactation courses are not as prioritized as they should. Providing the resources needed in order to facilitate an interactive in depth course may illuminate a financial concern.

What evidence must be gathered? (check all that apply)

_ Literature search

_ Guidelines

_ Expert Opinion

_ Patient Preferences

x_ Clinical Expertise

_x Financial Analysis

_ Standards (Regulatory, professional, community)

_ Other

Describe the rationale for your checked selections:

I selected financial analysis because in order to supply the resources for these lactation courses, the facilities/hospital’s financial capacity should be considered. Hiring additional staff that offer expertise is essential in offering quality care to the specific population.

Evidence Summary Worksheet

Directions: Please type your answers directly into the worksheet.

Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:

As previously mentioned, though it has been medically recommended for mothers of infants to breast feed for at least 6 months, the number of mothers that actually follow through with breastfeeding, does not reflect its importance. Expecting and new mothers are not offered enough support in regards to education, to ensure breastfeeding compliance. As a result, the benefits of breastfeeding are not being reaped by mother and infants.

Type the complete APA reference for the systematic review article you chose from the list provided. It must be relevant to the practice issue you described above. Include the APA reference for any additional optional supplemental scholarly source related to the review you wish to use.

Renfrew, M. J., McCormick, F. M., Wade, A., Quinn, B., & Dowswell, T. (2012). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev, 5(5).

Identify the objectives of the article:

To determine the categories of breastfeeding support that haven examined in the controlled research, the timing for the intervention and the setting which the research and interventions are used

To determine the efficiency of diverse modes for offering the intervention support for instance, whether the offered intervention is reactive, proactive and over the phone or face to face, and if such intervention has the elements of postnatal and antenatal and their effectiveness.

To evaluate the effectiveness of various caregivers and trainings in situations where there was series of trainings.

To explore the interactions between the rates of breastfeeding background and support effectiveness.

Provide a statement of the questions being addressed in the work and how these relate to your practice issue:

Offering the support for the breastfeeding to women both antenatal and postnatal results in the increase of the exclusivity and duration of breastfeeding, hence better health for mother and child. The practice issue identified, suggests that the resources and the availability of staff may be an issue. Financially, many facilities may not deem these interventions as those that require priority, thus dwarfing the availability interactive lactation support courses.

Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.

In order to gain success, these courses should be instructed by qualified personnel who are able to provide in depth expertise. The program should provide progressive arranged visits with women on the based on the time that they’re available. The program should be tailored to the setting and need of the group.

Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome. Consider the relevance to your project proposal for the Milestone 2 project paper. (If an optional supplemental source is also used, include a statement of relevance to it as well.)

The main findings are that the support offered by both the professional and lay persons had positive impact on the outcome of breastfeeding.

Factors like the face to face breastfeeding support and personalized trainings encourage the duration and exclusivity of breastfeeding in new mothers.

Outline evidence-based solutions that you will consider for your project.

Evidence-based solutions that increase the rate of breastfeeding includes; patient centered care of mothers who are experiencing issues with breast feeding, giving support in the settings that have high rate of initiation, and education provided by experts that enables mothers both antenatal and postnatal to have access to all the information they need to provide the best care for their infants. Also, the support strategy should include face to face interactions for higher chances of success for the breastfeeding women.

Discuss any limitations to the studies that you believe impacts your ability to utilize the research in your project.

The studies were limited to 100 studies, and 73 studies were limited to 29 countries which is even less than 50% of the countries across the globe. Statistics cannot rely on such figure as representatives.

Mood disorders can impact every facet of a child’s life, making the most basic activities difficult for clients and their families. This was the case for 13-year-old Kara, who was struggling at home and at school. For more than 8 years, Kara suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues. As a psychiatric mental health nurse practitioner working with pediatric clients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies.

This week, as you examine antidepressant therapies, you explore the assessment and treatment of pediatric clients with mood disorders. You also consider ethical and legal implications of these therapies.

Assignment: Assessing and Treating Pediatric Clients With Mood DisorderWhen pediatric clients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.

Note: This Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.

Learning Objectives

Students will:

Assess client factors and history to develop personalized plans of antidepressant therapy for pediatric clients

Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric clients requiring antidepressant therapy

Evaluate efficacy of treatment plans

Analyze ethical and legal implications related to prescribing antidepressant therapy to pediatric clients

Assignment: Assessing and Treating Pediatric Clients With Mood Disorders

When pediatric clients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.

Note: This Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.

Learning Objectives

Students will:

Assess client factors and history to develop personalized plans of antidepressant therapy for pediatric clients

Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric clients requiring antidepressant therapy

Evaluate efficacy of treatment plans

Analyze ethical and legal implications related to prescribing antidepressant therapy to pediatric clients

Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

Decision #1

Which decision did you select?

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

Decision #2

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

Decision #3

Why did you select this decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

you can do a new assignment or edit this. use the same format .NOTE Plagiarism must be less than 20 % for this to be accepted . reference not counted . thx

The assessing and Treating Pediatric Clients with Mood Disorders Introduction Depression is the most common mental disorder for young people, and it is associated with educational underachievement, self-harm, and suicidality. The depression rate among children this day is so disturbing. The effect of depression is devastating since it leads to a variety of physical and emotionally problems. 1 Depression can reduce the child ability to function at academically (American Psychiatric Association, 2018).

We can categorize depression in children into two types, the 1st is major depression in this type of depression the child will be in depression for less than a month and the child might experience it again sometime in life. Dysthymia depression is a less form of severe chronic depression that last for two years in total (American Psychological Association, 2016). This is the most serious and considered the leading cause of suicide death, and disability in adolescent in this age group (WHO, 2014) Selective serotonin reuptake inhibitors (SSRIs) is antidepressant and helps children and adolescent to get back into a stable mood from mood disorder. It is important to monitor children at a closely at the first four weeks of administering this medication, this help identify a change in behavior.Some sign to watch for include sleeplessness, withdrawal from social gathering or unnecessary agitation (Anxiety and Depression Association of America, 2016).

2 This paper is my opportunity to examine An African American Child Suffering From Depression. What is, what treatment options are available and the effects of the stigma of MDD on the African American child and family. 3 African Americans are no different when its comes to prevalence of mental health conditions when compared to the rest of the population. Poverty level affects mental health status. 1 African Americans living below the poverty level, as compared to those over twice the poverty level, are 3 times more likely to report psychological distress Decision Selected # 1 I will choose Zoloft 25mg as my first choice of medication Reason for Selection: I have work with a diverse group of patient in including African American in the course of my experience working in children in hospitals unit several years .I have to start with Zoloft 25mg. most provider I worked with will not want to give much medication because of this age group. 1 Zoloft is considered “off-label meaning it is not approve by the Food and Drug Administration (FDA) to treat depression in children and adolescents; randomized controlled trials (RCTs) approved it because the benefits. 1 According to the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP, 2016), Zoloft is safes and is the best option to treat mood disorders in children in this age group.

Expected Results In the 1st two weeks of therapy, we expect some progress as the child is expected to exhibit that there is evident in physical symptoms like increase in appetite, and sleep. We should also expected increase is the child concentration within a month, and an increase peer group interactions, and expected to withdraw less from peers. If all things work as expected and absent of adverse reaction, will continue with the treatment (IACAPAP, 2016), Differences between Expected outcome and Actual outcome After two weeks, he patient is expected to come back for a visit to be evaluated for the medication effectiveness. If the goal of the medication is met, and there is no symptom for side effect, then the medication and the dosage will remain the same until the next appointment. If expected result is not not met and there is no sign or symptom of adverse effect, the medication will be increased to Zoloft 50mg. I have to be aware that, the difference between the expected outcome and actual outcome is the dosage being low or higher than the needed therapeutic level for the patient (National Alliance on Mental Illness, 2017).

Decision Selected # 2 Reason for Selection: Decision one within four weeks follow-up, my expected outcome has not been achieved. The child is still presented with depressive symptoms. The patient and parent denies any side effect of Zoloft., but the child is still showing signs of major depressive disorder (MDD). I will increase Zoloft to 50mg to attain medication therapeutic effect. 1 This will be done after addressing the effect with patient and family and documented after discussing the risks, benefits and education about MDD and the planned of treatment by increasing the dosage, goals for this client remain the same. We will continue to monitor any side effects, like suicidality risk (National Alliance on Mental Illness, 2017).

Expected Results My client should be able to verbalize some positive changes like reduce in depressive symptoms of Zoloft 50mg. If the higher dose help in reducing depression with no side effect of medication. 1 I will now encourage patient and reassure parents.This improvement should include participating in groups, peers interaction , improve sleep, appetite and academic improvement (American Psychiatric Association, 2018).

4 Differences between Expected outcome and Actual outcome There should be appositive noticeable change with therapeutic of Zoloft 50mg, a decrease in depression symptoms with and no adverse reaction that indicate otherwise that patient is tolerating the therapeutic medication adjustment well. 1 Since at this level, there is no difference between the expected result and the actual result therefore the patient will continue with the Zoloft 50mg. Patient should be monitoring continue, and the next schedule appointment.

Decision Point Three Maintain current dose of Zoloft 50mg orally daily Reason for Selection When the patient shows improvement, we have to keep schedule medication especially when there is no side effect of medication. My patient has shown great degree of improvement, and there is no side effect to this patient with the dose of Zoloft 50mg. 1 The monitoring of the side effect will include suicidal thought (National Alliance on Mental Illness, 2017).

Expected Results Treatment of depression, and monitoring is a continues process. 1Patient improvement should daily, and the signs of depression will be eliminated gradually with dosage of Zoloft 50mg. Patient peer interaction, sleep, appetite, should gradually improve.

Differences between Expected Results and Actual Results Choosing Zoloft 50mg on my African American child patient seems to be working, with no problem. Patient is responding well to therapy. I will continue patient with current dose. With this gradual improvement, I have no reasons to change medication or dosage. I will schedule an appointment and the dose might be increase if depression increases. 1 The expected result would be in treating any side effect to the medication so that maximum therapeutic effects can be achieved. The actual result is that there is an achievement in medication therapeutic effect that is needed by the patient (National Alliance on Mental Illness, 2017).

5 Ethical Considerations Suicidal ideation or behavior is only one reason for which close monitoring is important for children started on antidepressant therapy (Mitchell et al., 2014). Therefore, providers who are considering the use of antidepressants in children, adolescents, and young adults must first balance the risk of suicidality with the clinical need for an antidepressant (Mitchell et al., 2014). 1 The ethic consideration can be classified as an accumulation of reasoning and principle of treatment of depression.The suicidal tendency in the used of antidepressant medication has led the FDA to require that all antidepressant medicine should be labeled by pharmaceutical companies with the caution of suicidal on the label (Sondheimer, 2010). Any child that is below the age of 18years old cannot take decision on depression treatment without the parent approval according to FDA regulation (Sondheimer,2010). Therefore, it is paramount to educate the parent of the treatment given to the child as well the consent of the parent.In case of danger, the consent advice of the parent may be ignored (Sondheimer, 2010).The Zoloft is “off-label” so a greater precaution and parent approval needs to be obtain before dispensing.

6 This lack of knowledge leads many to believe that a mental health condition is a personal weakness or some sort of punishment from God. Many African Americans also have trouble recognizing the signs and symptoms of mental health conditions, leading to underestimating the effects and impact of mental health conditions. 3 Faith and spirituality can help in the recovery process but should not be the only option you pursue. If spirituality is an important part of your life, your spiritual practices can be a strong part of your treatment plan. Your spiritual leaders and faith community can provide support and reduce isolation.

7 Conclusion The FDA advises that doctors prescribe the smallest quantity of pills possible to help reduce the risk of deliberate or accidental overdose. A careful monitoring by parents, caregivers and health care professionals is important for any child or teenager taking an antidepressant for depression or any other condition. 1 Food and Drug Administration (FDA or USFDA) has a rule and regulation set for the treatment of behavioral disorder in children, the guideline which must be follow to the letter (National Alliance on Mental Illness, 2017). Supervising and safe monitoring of the child is very important during therapy (National Alliance on Mental Illness, 2017). 1 The legality guiding the treatment of a child with psychiatric problem has increase because of increase national awareness. As a psychiatric nurse, I strive to increase my knowledge of the legal and ethical implications of prescribing psychotropic medications for children.and adolescents with major depression and anxiety disorders. 3 African Americans are no different when its comes to prevalence of mental health conditions when compared to the rest of the population, depression one of the mental health issues in African American community.

1 References American Psychiatric Association (2018). Practice guideline for the treatment of patients with the major depressive disorder (3rd ed., pp. 152). Arlington (VA): 1 American Psychiatric Association (APA). 2 Retrieved from https://www.guideline.gov/summaries/summary/24158?

1 American Psychological Association. (2016). 1 Psychotropic Medications for Children and Adolescents. Retrieved from:

1 http://www.apa.org/pi/families/resources/child-medications.pdf.

Anxiety and Depression Association of America. (2016). 1 Anxiety and Depression in Children. Retrieved from:https://adaa.org/living-with-anxiety/children/anxiety-and-depression International Association for Child and Adolescent Psychiatry and Allied Professions.

The focus of the Week 3 discussion is on two important elements of quantitative research studies- design and sampling. The approach or design, quantitative or qualitative, also applies to EBP projects. Both quantitative and qualitative have different designs or traditions that fall under these two broad categories.

Select a single-study quantitative research study article related to your specialty track and provide the permalink to the article. Then discuss each of the following items.

Identify whether the research study design is experimental, quasiexperimental, or nonexperimental. Provide the rationale for your answer.

Identify the appropriate representation for the research study article you selected using the nomenclature of X for intervention, O for observation and data collection, and R for random a assignment to a research study group.

Identify the type of sampling (probability vs. nonprobability) that was used in the research study article you selected.

Identify one advantage and one disadvantage to the sampling type used (probability vs. nonprobability).

Identify whether there was random assignment to research study groups in the research study article you have selected.

If random assignment to groups was used, how does this strengthen the research study design?