Identify at least 5 possible conditions that may be considered in a differential diagnosis for the patient.

Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test.

In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the Episodic/Focused SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.

Case 1: Nose Focused Exam

Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he’s taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.

Case 2: Focused Throat Exam

Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus over the past two weeks, Lily figured she shouldn’t take her three-day sore throat lightly. Your clinic has treated a few cases similar to Lily’s. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn’t sound congested.

Case 3: Focused Ear Exam

Martha brings her 11-year old grandson, James, to your clinic to have his right ear checked. He has complained to her about a mild earache for the past two days. His grandmother believes that he feels warm but did not verify this with a thermometer. James states that the pain was worse while he was falling asleep and that it was harder for him to hear. When you begin basic assessments, you notice that James has a prominent tan. When you ask him how he’s been spending his summer, James responds that he’s been spending a lot of time in the pool.

To prepare:

With regard to the case study you were assigned:

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

· Consider what history would be necessary to collect from the patient.

· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

· Identify at least 5 possible conditions that may be considered in a differential diagnosis for the patient.

Note: Before you submit your initial post, replace the subject line (“Week 5 Discussion”) with “Review of Case Study ___,” identifying the number of the case study you were assigned.

How does the time course help to distinguish among different causes of ear pain?

No Plegarism please, will be checked with Turnitin.

Will need minimum of 300 words, APA Style, double spaced, times new romans, font 12, and and (3 references with intext citations )

Case and Discussion

A 21-year-old women comes to your office with a 2 day history of right ear pain. She reports that the ear pain began shortly after taking scuba diving lessons. She describes the pain as “a pressure” and also notes “crackling” in the right ear and periodically feeling dizzy.

Please answer questions below in discussion board response.

What other associated symptoms should you ask about?

How does the time course help to distinguish among different causes of ear pain?

How does the age of the patient help with narrowing the diagnostic possibilities?

What diagnostic tests do you want to include to help you with your diagnosis?

Create a differential diagnosis flowsheet for this patient and include the diagnostics as well as the pharmacological management and rationale related to the differentials.

Which of the following prophylactic medications would you order for her migraines?

Question 1: In an outpatient setting, what is the most common reason for a malpractice suit?

a. Failure to treat a condition

b. Failure to diagnose correctly

c. Ordering the wrong medication

d. Failure to manage care

Question 2: How often should the clinician examine the feet of a person with diabetes?

a. Once a year

b. Every 6 months

c. Every 3 months

d. Every visit

Question 3: Which drug for Alzheimer’s disease should be administered beginning at the time of diagnosis?

a. Cholinesterase inhibitors

b. Anxiolytics

c. Antidepressants

d. Atypical antipsychotics

Question 4: Which of the following medications is the treatment of choice for trichomonas?

a. Metranidazole

b. Ceftriaxone

c. Diflucan

d. Doxycycline

Question 5: Most adult poisonings are:

a. intentional and self-inflicted.

b. accidental.

c. caused by someone wishing to do harm to the person.

d. not attributed to any reason.

Question 6: A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate?

a. “It is probably just a cyst, because that is the most common breast mass.”

b. “We will order a mammogram and ultrasound to help establish a diagnosis.”

c. “We will go ahead and schedule you for a biopsy because that is the only way to know for sure.”

d. “Because your lump is painful, it is most likely not cancer.”

Question 7: Which of the following is a specific test for multiple sclerosis (MS)?

a. Magnetic resonance imaging (MRI)

b. Computed tomography (CT) scan

c. A lumbar puncture

d. There is no specific test.

Question 8: After removing a tack from a type 2 diabetic’s heel and evaluating the site for infection, what is the best plan for this patient?

a. Suggest she use a heating pad to improve circulation

b. Refer to a podiatrist for a foot care treatment plan

c. Send her for acupuncture treatments

d. All of the above

Question 9: Which characteristic of delirium helps to distinguish delirium from dementia?

a. Abrupt onset

b. Impaired attention

c. Affective changes

d. Delusions

Question 10: Which clinical feature is the first to be affected in increased intracranial pressure (ICP)?

a. Decrease in level of consciousness (LOC)

b. Headache

c. Nausea

d. Widening pulse pressure

Question 11: Jennifer is an 18-year-old girl who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited range of motion in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation?

a. Posterior dislocations are more common than anterior dislocations.

b. There is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses.

c. Recurrent dislocations are uncommon and would require a greater force to result in injury.

d. Surgery is most commonly the treatment of choice.

Question 12: In the consensus model for Advanced Practice Registered Nurse (APRN) regulation, the “C” of LACE represents?

a. Commitment

b. Consensus

c. Certification

d. Collaboration

Question 13: Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?

a. Decreased C-reactive protein

b. Hyperalbuminemia

c. Morning stiffness

d. Weight gain

Question 14: Which of the following statements is true concerning the musculoskeletal exam?

a. The uninvolved side should be examined initially and compared to the involved side.

b. The part of the body that is causing the patient pain should be examined first.

c. The patient should not be asked to perform active range-of-motion (ROM) exercises whenever possible to avoid causing pain.

d. Radiographs should always be obtained prior to examination so as not to cause further injury to the patient.

Question 15: The clinician sees a patient who is 5 feet tall and weighs 150 pounds. How would the clinician classify this patient?

a. Overweight

b. Mild obesity

c. Moderate obesity

d. Morbid obesity

Question 16: S presents in the clinic with pain, tenderness, erythema, and swelling of his left great toe. The clinician suspects acute gout. Which of the following should the clinician suspect in the initial test results for this patient?

a. Elevated uric acid level

b. Elevated blood urea nitrogen (BUN)

c. Decreased urine pH

d. Decreased C-reactive protein (CRP)

Question 17: Which of the following statements is true regarding the treatment of carpal tunnel syndrome?

a. The goal of treatment is to prevent flexion and extension movements of the wrist.

b. Splints are used in carpal tunnel syndrome because they allow for free movement of the fingers and thumb while maintaining the wrist in a neutral position.

c. Corticosteroid injections are discouraged in the treatment of carpal tunnel syndrome because of the risks for median nerve damage, scarring, and infection.

d. All of the above

Question 18: The vegetarian patient with gout asks the clinician about food that he should avoid. The clinician should advise the patient to avoid which of the following foods?

a. Rice

b. Carrots

c. Spinach

d. Potatoes

Question 19: A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her exam?

a. Human papillomavirus (HPV)

b. Endometrial hyperplasia

c. Vagismus

d. Polycystic ovarian syndrome

Question 20: Which patient is more likely to have a cluster headache?

a. A female in her reproductive years

b. A 40-year-old African American male

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

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

Question 21: A sunscreen with a sun-protection factor (SPF) of at least what number will block most harmful ultraviolet (UV) radiation?

a. 4

b. 8 d

c. 10

d. 15

Question 22: Which of the following classes of drugs should be used as first-line therapy for treatment of delirium?

a. Benzodiazepines

b. Antipsychotics

c. Anticonvulsants

d. Antidepressants

Question 23: What is the treatment of choice for a patient diagnosed with testicular cancer?

a. Radical orchidectomy

b. Lumpectomy

c. Radiation implants

d. All of the above

Question 24: Sam, aged 65, is started on L-dopa for his Parkinson’s disease (PD). He asks why this is necessary. You tell him:

a. “L-dopa is neuroprotective.”

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

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

d. “This is the initial monotherapy drug.”

Question 25: A 60-year-old man presents with an enlarged scrotum. The clinician uses a penlight to transilluminate the scrotum. In a patient with a hydrocele, what would the clinician expect to find?

a. The scrotum will be dark.

b. The scrotum will appear light pink or yellow.

c. The scrotum will appear milky white.

d. The internal structures will be clearly visible.

Question 26: A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease (STD) has she most probably been exposed to?

a. Gonorrhea

b. Human papillomavirus (HPV)

c. Chlamydia

d. Trichomonas

Question 27: A 58-year-old woman who had a total abdominal hysterectomy at the age of 45 is diagnosed with atrophic vaginitis. Which of the following is the most appropriate treatment?

a. Conjugated estrogen 0.625 mg/day oral

b. Estradiol 7.5 mcg/24 hr vaginal ring

c. Medroxyprogesterone 10 mg/day oral

d. Conjugated estrogen 0.3 mg + medroxyprogesterone 1.5 mg/day oral

Question 28: When looking under the microscope to diagnose an intravaginal infection, you see a cluster of small and oval to round shapes. What do you suspect they are?

a. Conjugated estrogen 0.625 mg/day oral

b. Estradiol 7.5 mcg/24 hr vaginal ring

c. Medroxyprogesterone 10 mg/day oral

d. Conjugated estrogen 0.3 mg + medroxyprogesterone 1.5 mg/day oral

Question 29: A 22-year-old male is seen in the clinic because he found a hard lump in his testicle when performing testicular self-examination (TSE). Which of the following should be included in the list of differential diagnoses?

a. Testicular cancer

b. Inguinal hernia

c. Varicocele

d. All of the above

Question 30: The clinician should Question: the patient with suspected gout about use of which of these medications that may be a risk factor?

a. Low-dose aspirin

b. Thiazide diuretics

c. Ethambutol

d. All of the above

Question 31: What is usually the first sign or symptom that a patient would present with that would make you suspect herpes zoster?

a. A stabbing type of pain on one small area of the body

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

c. A pain that is worse upon awakening

d. A lesion on the exterior ear canal

Question 32: Which ethical principle reflects respect for all persons and their self-determination?

a. Autonomy

b. Beneficence

c. Justice

d. Veracity

Question 33: Patients with a spontaneous pneumothorax should be counseled that up to what percentage may experience a reoccurrence at some point?

a. 10%

b. 20%

c. 30%

d. 50%

Question 34: John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?

a. Valgus stress test

b. McMurray circumduction test

c. Lachman test

d. Varus stress test

Question 35: Which of the following laboratory findings should the clinician expect in a patient with untreated Graves’ disease?

a. Elevated thyroid-stimulating hormone (TSH)

b. Elevated T4

c. Elevated TRH

d. All of the above

Question 36: Which drug commonly prescribed for burns is active against a wide spectrum of microbial pathogens and is the most frequently used agent for partial- and full-thickness thermal injuries?

a. Clotrimazole cream (Lotrimen)

b. Mafenide acetate (Sulfamylon)

c. Silver nitrate

d. Silver sulfadiazine (Silvadene)

Question 37: During a digital rectal exam (DRE) on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?

a. An enlarged rubbery gland

b. A hard irregular gland

c. A tender gland

d. A boggy gland

Question 38: Janet is a 30-year-old woman who has been recently diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?

a. Gastrocnemius weakness

b. A reduced or absent ankle reflex

c. Numbness in the lateral foot

d. Paresthesia of the perineum and buttocks

Question 39: The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (text revision) (DSM-IV-TR) state that excessive worry or apprehension must be present more days than not for at least:

a. 1 month.

b. 3 months.

c. 6 months.

d. 12 months.

Question 40: The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs to manage his pain?

a. You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage.

b. You should start with the lowest dose that is effective in managing your pain in order to avoid developing tolerance to the medication.

c. You should take the maximum recommended dose of NSAIDs so that you will not need to take narcotics to control your pain.

d. It is important to take NSAIDs on an empty stomach in order to increase absorption.

Question 41: A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram (ECG) changes should the clinician expect as a manifestation of the disease?

a. Sinus bradycardia

b. Atrial fibrillation

c. Supraventricular tachycardia

d. U waves

Question 42: Sam is a 25-year-old man who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?

a. Morning stiffness and limited mobility of the lumbar spine

b. Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain

c. Fever, chills, and elevated erythrocyte sedimentation rate

d. Pathologic fractures, severe night pain, weight loss, and fatigue

Question 43: Which type of burn injury results in destruction of epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact?

a. Superficial burns

b. Superficial partial-thickness burns

c. Deep partial-thickness burns

d. Full-thickness burns

Question 44: Immunizations are an example of which type of prevention?

a. Primary

b. Secondary

c. Tertiary

Question 45: If a previously frostbitten area becomes frostbitten again after it has healed, what might occur?

a. Permanent tissue damage may occur, resulting in necrosis to that body part.

b. The area will be super sensitive.

c. The area is prone to a repeat frostbite.

d. The area is as susceptible as any other area.

Question 46: In the United States, what is the second most common connective tissue disease and the most destructive to the joints?

a. Osteoarthritis

b. Systemic lupus erythematosus (SLE)

c. Rheumatoid arthritis (RA)

d. Sjogren’s syndrome

Question 47: A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority?

a. Pregnancy test

b. Pelvic ultrasound .

c. Endometrial biopsy

d. Platelet count

Question 48: A 45-year-old woman is seen in the clinic with complaints of a vaginal discharge. The clinician identifies clue cells on the vaginal smear. Which of the following diagnoses is associated with this finding?

a. Trichomonas

b. Bacterial vaginosis

c. Human papillomavirus (HPV)

d. Herpes simplex virus (HSV)

Question 49: Julie, aged 50, has migraine headaches, frequent asthma attacks, coronary artery disease, and hypertension. Which of the following prophylactic medications would you order for her migraines?

a. Propranolol

b. Timolol

c. Ergotamine

d. Topiramate

Question 50: A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of “my feet feel like they are on fire.” He has a loss of vibratory sense, +1 Achilles reflex, and a tack embedded in his left heel. Which of the following would be an appropriate treatment?

a. Tricyclic antidepressants

b. Capsacin cream

c. Vitamin B12 injections

d. Insulin

What would be the appropriate care for her?

Question 1. Jonathan has been diagnosed with strep throat and needs a prescription for an antibiotic. He says the last time he had penicillin he developed a red, blotchy rash. The appropriate antibiotic to prescribe would be:

Penicillin VK, since his rash does not sound like a serious rash

Amoxicillin

Cefadroxil (Duricef)

Erythromycin

Question 2. Tetracyclines are contraindicated in children younger than 8 years because of:

Risk of developing cartilage problems

Development of significant diarrhea

Risk of kernicterus

Adverse effects on bone growth

Question 3. Lisa is a healthy non-pregnant adult woman who recently had a UTI. She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The answer to give her would be:

“Sixteen ounces per day of cranberry juice cocktail will prevent UTIs.”

“100% cranberry juice or cranberry juice extract may decrease UTIs in some patients.”

“There is no evidence that cranberry juice helps prevent UTIs.”

“Cranberry juice only works to prevent UTIs in children.”

Question 4. Rose is a 3 year old with an upper respiratory infection (URI). Treatment for her URI would include:

Amoxicillin

Diphenhydramine

Pseudoephedrine

Nasal saline spray

Question 5. Patient education for a patient who is prescribed antibiotics for sinusitis includes:

Use of nasal saline washes

Use of inhaled corticosteroids

Avoiding the use of ibuprofen while ill

Use of laxatives to treat constipation

Question 6. Patients who should be cautious about using decongestants for an upper respiratory infection include:

School-age children

Patients with asthma

Patients with cardiac disease

Patients with allergies

Question 7. Janet was recently treated with clindamycin for an infection. She calls the advice nurse because she is having frequent diarrhea that she thinks may have blood in it. What would be the appropriate care for her?

Encourage increased fluids and fiber

Assess for pseudomembranous colitis

Advise her to eat yogurt daily to help restore her gut bacteria

Start her on an antidiarrheal medication

Question 8. To prevent further development of antibacterial resistance it is recommended fluoroquinolones be reserved for treatment of:

Urinary tract infections in young women

Upper respiratory infections in adults

Skin and soft tissue infections in adults

Community-acquired pneumonia in patients with comorbidities

Question 9. Nicole is a 4-year-old female with a febrile urinary tract infection. She is generally healthy and has no drug allergies. Appropriate initial therapy for her UTI would be:

Azithromycin

Trimethoprim/sulfamethoxazole

Ceftriaxone

Ciprofloxacin

Question 10. Sally is a 16-year-old female with a urinary tract infection. She is healthy, afebrile, with no use of antibiotics in the previous 6 months and no drug allergies. An appropriate first-line antibiotic choice for her would be:

Azithromycin

Trimethoprim/sulfamethoxazole

Ceftriaxone

Levofloxacin

Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article.

Assignment: Applying Current Literature to Clinical Practice

Literature in psychotherapy differs from other areas of clinical practice. Generally, there are no clinical trials in psychotherapy because it is often neither appropriate nor ethical to have controls in psychotherapy research. This sometimes makes it more difficult to translate research findings into practice. In your role, however, you must be able to synthesize current literature and apply it to your own clients. For this Assignment, you begin practicing this skill by examining current literature on psychodynamic therapy and considering how it might translate into your own clinical practice.

Learning Objective

· Evaluate the application of current literature to clinical practice

To prepare:

· Review and evaluate the psychodynamic therapy article attached in the file and reflect on the insights they provide.

The Assignment

In a 5- to 10-slide PowerPoint presentation, address the following:

· Provide an overview of the article you selected.

· What population is under consideration?

· What was the specific intervention that was used? Is this a new intervention or one that was already used?

· What were the author’s claims?

· Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your own clients. If so, how? If not, why?

· Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article. Support your position with evidence-based literature.

Note: The presentation should be 5-10 slides, not including the title and reference slides. Include presenter notes (no more than ½ page per slide) and use tables and/or diagrams where appropriate. Be sure to support your work with specific citations from the article you selected. Support your approach with evidence-based literature.

BELOW ARE THE ARTICLE TO SELECT FROM

Select one of the following articles on psychodynamic therapy to evaluate in your Assignment:

Aznar-Martinez, B., Perez-Testor, C., Davins, M., & Aramburu, I. (2016). Couple psychoanalytic psychotherapy as the treatment of choice: Indications, challenges, and benefits. Psychoanalytic Psychology, 33(1), 1–20. doi:10.1037/a0038503

Karbelnig, A. M. (2016). “The analyst is present”: Viewing the psychoanalytic process as performance art. Psychoanalytic Psychology, 33(supplement 1), S153–S172. doi:10.1037/a0037332

LaMothe, R. (2015). A future project of psychoanalytic psychotherapy: Revisiting the debate between classical/commitment and analytic therapies. Psychoanalytic Psychology, 32(2), 334–351. doi:10.1037/a0035982

Migone, P. (2013). Psychoanalysis on the Internet: A discussion of its theoretical implications for both online and offline therapeutic technique. Psychoanalytic Psychology, 30(2), 281–299. doi:10.1037/a0031507

Tummala-Narra, P. (2013). Psychoanalytic applications in a diverse society. Psychoanalytic Psychology, 30(3), 471–487. doi:10.1037/a0031375

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

According to the National Alliance on Mental Illness, approximately 100,000 people experience psychosis in the United States each year (NAMI, 2016). In practice, clients may present with delusions, hallucinations, disorganized thinking, disorganized or abnormal motor behavior, as well as other negative symptoms that can be disabling for these individuals. Not only are these symptoms one of the most challenging symptom clusters you will encounter, many are associated with other disorders such as depression, bipolar disorder, and disorders on the schizophrenia spectrum. As a psychiatric mental health nurse practitioner, you must understand the underlying neurobiology of these symptoms to select appropriate therapies and improve outcomes for clients.

This week, as you examine antipsychotic therapies, you explore the assessment and treatment of clients with psychosis and schizophrenia. You also consider ethical and legal implications of these therapies.

Photo Credit: Ingram Publishing/Getty Images

Assignment: Assessing and Treating Clients With Psychosis and Schizophrenia

Psychosis and schizophrenia greatly impact the brain’s normal processes, which interferes with the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life. However, clients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with psychosis and schizophrenia.

Learning Objectives

Students will:

· Assess client factors and history to develop personalized plans of antipsychotic therapy for clients

· Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring antipsychotic therapy

· Evaluate efficacy of treatment plans

· Analyze ethical and legal implications related to prescribing antipsychotic therapy to clients across the lifespan

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

· Chapter 4, “Psychosis and Schizophrenia”

· Chapter 5, “Antipsychotic Agents”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

amisulpride
aripiprazole
asenapine
chlorpromazine
clozapine
flupenthixol
fluphenazine
haloperidol
iloperidone
loxapine
lurasidone
olanzapine
paliperidone
perphenazine
quetiapine
risperidone
sulpiride
thioridazine
thiothixene
trifluoperazine
ziprasidone

Naber, D., & Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and implications for clinicians. CNS Drugs, 23(8), 649-659. doi:10.2165/00023210-200923080-00002

Note: Retrieved from Walden Library databases.

Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.

Note: Retrieved from Walden Library databases.

Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. Retrieved from https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf

Walden University. (2016). ASC success strategies: Studying for and taking a test. Retrieved from http://academicguides.waldenu.edu/ASCsuccess/ASCtesting

Required Media

Laureate Education. (2016j). Case study: Pakistani woman with delusional thought processes [Interactive media file]. Baltimore, MD: Author

Note: This case study will serve as the foundation for this week’s Assignment.

Optional Resources

Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A., & … Miller, D. (2011). Concomitant psychotropic medication use during treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical Schizophrenia & Related Psychoses, 5(3), 124-134. doi:10.3371/CSRP.5.3.2

Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E., Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in patients with schizophrenia: Trends in multiple health care systems. American Journal of Health-System Pharmacy, 71(9), 728-738. doi:10.2146/ajhp130471

Lin, L. A., Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for schizophrenia: A health state approach. The Psychiatric Quarterly, 86(1), 107-121. doi:10.1007/s11126-014-9326-2

To prepare for this Assignment:

· Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

The Assignment

Examine Case Study: Pakistani Woman with Delusional Thought Processes. 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

o Which decision did you select?

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

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

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

· Decision #2

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

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

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

· Decision #3

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

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

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

Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement

Discuss why this is a good example of leadership through acts of service in terms of the way the actions of the leader demonstrate integrity and personal character building while also establishing followership and pushing others to grow professionally through emulating his actions

Unit 2

A.

Visit the “Competitive Advantages” page of the Robert K. Greenleaf Center for Servant Leadership website at https://www.greenleaf.org/winning-workplaces/workplace-resources/research-studies/competitive-advantages/ and review the articles indicating ways that servant leadership helps organizations gain competitive advantage. Using that information along with the Topic Materials, discuss how servant leadership contributes to competitive advantage in contemporary organizations. Provide specific industry examples of companies that have thrived as servant leaders.

B.

One of the challenges often faced by nonprofit organizations is financial viability. Consider how the service leadership model can make a nonprofit organization competitive in ways that are not profit driven. In your post, discuss whether or not the value the nonprofit provides to the community and the greater good is professionally appealing enough to make you want to explore as a career opportunity despite the fact that in many cases than the personal and financial gains offered by nonprofits may not match what is available in for-profit organizations.

RESOURCES

Electronic Resource

1. “Servant Leadership” – Serve to Be Great

Read “‘Servant Leadership’ – Serve to Be Great,” located on the Intellisource website (2015).

http://www.intellisource.com/2015/02/servant-leadership-serve-great/

2. 1 Little-Known Advantage Most Investors Miss

Read “1 Little-Known Advantage Most Investors Miss,” by Lomax, located on The Motley Fool website (2014).

http://www.fool.com/investing/general/2014/10/23/1-little-known-advantage-most-investors-miss.aspx

3. At Their Service

Read “At Their Service,” by Drake, located on the Smart CEO website (2013).

https://web.archive.org/web/20160610105450/http://www.smartceo.com/wawas-ceo-servant-leadership/

4. DOs & DON’Ts of Servant Leadership

Read “DOs & DON’Ts of Servant Leadership,” located on the Ritz-Carlton Leadership Center website (2015).

http://ritzcarltonleadershipcenter.com/2015/09/dos-donts-of-servant-leadership/

5. Leadership Expert Simon Sinek on Putting Others First

View “Leadership Expert Simon Sinek on Putting Others First,” located on the YouTube website (2014).

6. Servant Leadership Sustains Competitive US Manufacturing Advantage

Read “Servant Leadership Sustains Competitive US Manufacturing Advantage,” by Martin, located on the Industry Today website (2012).

http://industrytoday.com/article_view.asp?ArticleID=we385

7. Servant Leadership: A Path to High Performance

Read “Servant Leadership: A Path to High Performance,” by Hess, from The Washington Post (2013).

http://www.washingtonpost.com/business/capitalbusiness/servant-leadership-a-path-to-high-performance/2013/04/26/435e58b2-a7b8-11e2-8302-3c7e0ea97057_story.html

Website

1. America’s Worst Charities

The America’s Worst Charities website can be used to conduct research for the topic assignment.

http://www.tampabay.com/topics/specials/worst-charities/

2. Charity Navigator

The Charity Navigator website can be used to conduct research for the topic assignment.

https://www.charitynavigator.org/

3. Charity Watch

The Top Rated Charities page of the Charity Watch website can be used to conduct research for the topic assignment.

https://www.charitywatch.org/top-rated-charities

4. Competitive Advantages

Review the Competitive Advantages page of the Robert K. Greenleaf Center for Servant Leadership website to locate servant leadership articles.

https://www.greenleaf.org/winning-workplaces/workplace-resources/research-studies/competitive-advantages/

5. TopNonprofits

The Top 100 Nonprofits on the Web page of the TopNonprofits website can be used to conduct research for the topic assignment.

https://topnonprofits.com/lists/best-nonprofits-on-the-web/

Unit 3

A.

Think about how your personal values correlate with the principles of servant leadership. How can you draw on values and servant leadership principles to better establish your followership to better serve those you lead professionally and personally?

B.

Suppose you go to work for an organization that you discover does not align with your personal values. You are in a leadership role and you are not in a position to leave the job. How do you ethically represent the company without compromising your own beliefs? What is the deal breaker for you? How does ethically representing the company demonstrate your ability to be a servant leader?

RESOURCES

Electronic Resource

1. As a Servant Leader, You Can Change the World Commencement Address

Read “‘As a Servant Leader, You Can Change the World’ Commencement Address,” by George, located on the Bill George website (2013).

http://www.billgeorge.org/page/as-a-servant-leader-you-can-change-the-world

2. Chick-fil-A Founder Was Embodiment of Servant Leader Philosophy

Read “Chick-fil-A Founder Was Embodiment of Servant Leader Philosophy,” by Oswald, located on the HR Hero website (2014).

http://blogs.hrhero.com/oswaldletters/2014/09/15/chick-fil-a-founder-was-embodiment-of-servant-leader-philosophy/

3. Leading as a Servant

Read “Leading as a Servant,” by Krakowski, from Entrepreneur (2014).

http://www.entrepreneur.com/article/231242

4. Serving More Than the Bottom Line

Read “Serving More Than the Bottom Line,” by Brodsky, located on the Human Resource Executive Online website (2015).

http://www.hreonline.com/HRE/view/story.jhtml?id=534358775

5. The Business of Consciousness

Read “The Business of Consciousness,” by McEllin, located on the Examiner website (2013).

https://www.linkedin.com/pulse/business-consciousness-steve-mcellin-mba

Unit 4

A.

Think about the principles of servant leadership and provide two examples of specific ways you can apply them in your current work environment, as member of a community group or organization with which you are involved, or in your personal life. Discuss the specific servant leadership principles you would apply, the methods you would use to apply the principles, and the results you would anticipate seeing as a result of implementing these servant leadership principles.

B.

Conduct research about a biblical figure such as Moses, David, Paul, Joseph, Esther, or Nehemiah to learn about how the biblical leader exemplified servant leadership and see how the principles of servant leadership transcend time and place. Think about the contemporary leader you are researching for the Topic 4 assignment, and discuss the similarities you see between the biblical servant leader and the contemporary servant leader. Provide specific examples to illustrate the similarities you have identified and include discussion about what you think makes the principles of servant leadership applicable regardless of time or place.

RESOURCES

6. ‘Servant’ Leadership Style Is Best for Bosses

Read “‘Servant’ Leadership Style Is Best for Bosses,” by Brooks, located on the Business News Daily website (2015).

http://www.businessnewsdaily.com/7964-best-leadership-style.html

7. 10 Tips on How IT Leaders Can Develop a Service-Oriented Perspective

Read “10 Tips on How IT Leaders Can Develop a Service-Oriented Perspective,” by Tennant, located on the IT Business Edge website (2014).

http://www.itbusinessedge.com/blogs/from-under-the-rug/10-tips-on-how-it-leaders-can-develop-a-service-oriented-perspective.html

8. 9 Ways to Motivate People Using Servant Leadership

Read “9 Ways to Motivate People Using Servant Leadership,” by McCuistion, located on the About Leaders website (2013).

9. Being a Servant Leader in the Age of Technology

Read “Being a Servant Leader in the Age of Technology,” by Hollis, located on the Huffington Post website (2015).

http://www.huffingtonpost.com/richard-b-hollis/being-a-servant-leader-in-the-age-of-technology_b_8016290.html

10. Recognizing Servant-Leaders – Not Drum Majors

Read “Recognizing Servant-Leaders – Not Drum Majors,” located on the Dreams InDeed International website.

https://www.dreamsindeed.org/news/recognizing-servant-leaders-not-drum-majors/

Other

1. Individual and Corporate Servant Leaders

The “Individual and Corporate Servant Leaders” resource can be used as a reference for discussion questions throughout the course and for completion of some course assignments.

Unit 5

A.

Learn about current trends in servant leadership by conducting your own research and locating an article that illustrates how the principles of servant leadership are being employed in the workplace, as part of a volunteer or service effort, or in an individual’s personal life. In the Main Forum, post a short summary and a link to the article. Discuss what you learned from reading the article and whether or not you would consider applying servant leadership in a similar way.

B.

The article “Why Isn’t Servant Leadership More Prevalent?” poses the question, “But if servant leadership is as effective as portrayed in recent research, why isn’t it more prevalent?” Using what you have learned about the principles of servant leadership and your own experiences, address this question. Use examples to support your hypotheses.

RESOURCES

Electronic Resource

1. Simon Sinek: Why Good Leaders Make You Feel Safe

View “Simon Sinek: Why Good Leaders Make You Feel Safe,” located on the TED website (2014).

2. The CEO of Popeye’s Says Becoming a “Servant Leader” Helped Her Turn Around the Struggling Restaurant Chain

Read “The CEO of Popeye’s Says Becoming a ‘Servant Leader’ Helped Her Turn Around the Struggling Restaurant Chain,” by Goudreau, located on the Business Insider website (2015).

http://www.businessinsider.com/popeyes-ceo-servant-leadership-traits-2015-3

3. TheThe Baltimore Ravens’ John Harbaugh Discusses Servant Leadership

View “The Baltimore Ravens’ John Harbaugh Discusses Servant Leadership,” by Smart CEO Magazine, located on the YouTube website (2013).

4. Top Midsize Workplace: AutomationDirect.com

Read “Top Midsize Workplace: AutomationDirect.com,” by Tierney, located on the AJC.com website (2014).

http://www.ajc.com/news/business/top-midsize-workplace-automationdirectcom/nfF67/

5. Why Isn’t Servant Leadership More Prevalent?

Read “Why Isn’t Servant Leadership More Prevalent?” by Heskett, from Forbes.

http://onforb.es/10Vh7qx

Unit 6

A.

Think about Greenleaf’s principles of servant leadership and what you have learned about the biblical foundation of servant leadership. Identify specific principles of servant leadership that, when employed effectively, can proliferate respect for multiculturalism and diversity within the organizations and communities they serve? Provide specific examples to illustrate your ideas.

B.

Research an international servant leader or international servant leadership organization to examine the similarities and differences in the way servant leadership is executed in Western culture and Christianity when compared with other cultures and religions. Summarize the similarities and differences you discovered and discuss which principles of servant leadership you think are universal, regardless of religious and cultural differences. Provide examples to support your opinions.

RESOURCES

Electronic Resource

1. Effective Leadership Within a Multinational Environment

Read “Effective Leadership Within a Multinational Environment,” by Rentfrow, located on the Leadership Advance Online website (2007).

http://www.regent.edu/acad/global/publications/lao/issue_10/rentfrow.htm

e-Library Resource

1. Servant Leadership and World Values

Read “Servant Leadership and World Values,” by Rubio-Sanchez, Bosco, and Melchar, from Global Studies Journal (2013).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=95952547&site=ehost-live&scope=site

Unit 7

A.

In the Topic Materials you read several examples of ways that servant leadership can be displayed through true volunteerism and acts of service to others. Research an historic or current servant leader who is a true volunteer in service to others. In what ways does the person inspire leadership while building his or her own character and integrity? How does this leader exemplify the moral obligation to lead through kindness, compassion, and justice?

B.

Share the servant leadership volunteer opportunity you are completing. Discuss how you think this experience will help you develop your own character and give you experience in leading through exhibiting kindness, compassion, and justice.

RESOURCES

2. When Servant Becomes Leader: The Corazon C. Aquino Success Story as a Beacon for Business Leaders

Read “When Servant Becomes Leader: The Corazon C. Aquino Success Story as a Beacon for Business Leaders,” by Udani and Lorenzo-Molo, from Journal of Business Ethics (2013).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=90254863&site=ehost-live&scope=site

Unit 8

A.

Now that you have participated in your servant leadership opportunity, discuss how the experience affected your understanding of how through serving others one actually leads. Support your ideas with specific examples from your volunteer experience.

B.

Watch the video “Servant Leadership – Joe Schmitt.” Discuss why this is a good example of leadership through acts of service in terms of the way the actions of the leader demonstrate integrity and personal character building while also establishing followership and pushing others to grow professionally through emulating his actions. Discuss how this example embraces both Greenleaf’s principles of servant leadership and the call to service evident in Christianity.

RESOURCES

Electronic Resource

1. Drew Dudley “Everyday Leadership” – TED Talks

View “Drew Dudley ‘Everyday Leadership’ – TED Talks,” located on the YouTube website (2013).

2. Servant Leadership – Joe Schmitt

View “Servant Leadership – Joe Schmitt” located on the YouTube website (2014).

Outbreaks of hepatitis _____ often occur in young children attending day care centers and can be attributed to poor hand washing.

d. Gastric erosions related to high ammonia levels and bile reflux

Question 16

The cardinal sign of pyloric stenosis caused by ulceration or tumors is:

a. Constipation

b. Diarrhea

c. Vomiting

d. Heartburn

Question 17

A 55-year-old male died in a motor vehicle accident. Autopsy revealed an enlarged liver caused by fatty infiltration, testicular atrophy, and mild jaundice secondary to cirrhosis. The most likely cause of his condition is:

a. Bacterial infection

b. Viral infection

c. Alcoholism

d. Drug overdose

Question 18

Manifestations associated with hepatic encephalopathy from chronic liver disease are the result of:

a. hyperbilirubinemia and jaundice.

b. fluid and electrolyte imbalances.

c. impaired ammonia metabolism.

d. decreased cerebral blood flow.

Question 19

The most common disorder associated with upper GI bleeding is:

a. diverticulosis.

b. hemorrhoids.

c. esophageal varices.

d. cancer.

Question 20

A 3-month-old female develops colicky pain, abdominal distention, and diarrhea after drinking cow’s milk. The best explanation for her symptoms is:

a. Deficiency of bile that stimulates digestive secretions and bowel motility

b. Excess of amylase, which increases the breakdown of starch and causes an osmotic diarrhea

c. Overgrowth of bacteria from undigested fat molecules, which leads to gas formation and de creased bowel motility

d. Excess of undigested lactose in her digestive tract, resulting in increased fluid movement into the digestive lumen and increased bowel motility

Question 21

A 55-year-old female has general symptoms of gallstones but is also jaundiced. IV cholangiography would most likely reveal that the gallstones are obstructing the:

a. Intrahepatic bile canaliculi

b. Gallbladder

c. Cystic duct

d. Common bile duct

Question 22

A 1-week-old female is brought to her pediatrician for abdominal distention and unstable temperature. Physical examination reveals bradycardia and apnea. Tests reveal hypoxic injury to the bowel resulting in bacterial invasion and perforation. This condition is referred to as:

a. Infective enteropathy

b. Necrotizing enterocolitis (NEC)

c. Mucoviscidosis

d. Ileus

Question 23

For the patient experiencing esophageal reflux, the nurse would expect which sphincter to be malfunctioning?

a. Pyloric

b. Lower esophageal

c. Upper esophageal

d. Gastric

Question 24

Cholecystitis is inflammation of the gallbladder wall usually caused by:

a. accumulation of bile in the hepatic duct.

b. obstruction of the cystic duct by a gall-stone.

c. accumulation of fat in the wall of the gallbladder.

d. viral infection of the gallbladder.

Question 25

A 6-month-old male infant is brought to the ER after the sudden development of abdominal pain, irritability, and vomiting followed by passing of “currant jelly” stool. Ultrasound reveals intestinal obstruction in which the ileum collapsed through the ileocecal valve and invaginated into the large intestine. This type of obstruction is referred to as:

a. Prolapse

b. Pyloric stenosis

c. Intussusception

d. Imperforation

Question 26

A 22-year-old male underwent brain surgery to remove a tumor. Following surgery, he experienced a peptic ulcer. His ulcer is referred to as a(n) _____ ulcer.

a. Infectious

b. Cushing

c. Ischemic

d. Curling

Question 27

Chronic gastritis is classified according to the:

a. severity.

b. location of lesions.

c. patient’s age.

d. signs and symptoms.

Question 28

Reflux esophagitis is defined as a(n):

a. Immune response to gastroesophageal reflux

b. Inflammatory response to gastroesophageal reflux

c. Congenital anomaly

d. Secretory response to hiatal hernia

Question 29

The cardinal signs of small bowel obstruction are:

a. Vomiting and distention

b. Diarrhea and excessive thirst

c. Dehydration and epigastric pain

d. Abdominal pain and rectal bleeding

Question 30

The nurse assessing the patient with biliary atresia would expect to find which primary clinical manifestation?

a. Anemia

b. Jaundice

c. Hypobilirubinemia

d. Ascites

Question 31

A 20-year-old male was recently diagnosed with lactose intolerance. He eats an ice cream cone and develops diarrhea. His diarrhea can be classified as _____ diarrhea.

a. Motility

b. Hypotonic

c. Secretory

d. Osmotic

Question 32

Which of the following symptoms would help a health care provider distinguish between ulcerative colitis and Crohn disease?

a. Pattern of remission/exacerbations

b. Abdominal pain

c. Malabsorption

d. Diarrhea

Question 33

A 45-year-old male complains of heartburn after eating and difficulty swallowing. He probably has:

a. Pyloric stenosis

b. Hiatal hernia

c. Gastric cancer

d. Achalasia

Question 34

The exocrine portion of the pancreas contains:

a. alpha cells.

b. beta cells.

c. acinar cells.

d. islets of Langerhans.

Question 35

Outbreaks of hepatitis _____ often occur in young children attending day care centers and can be attributed to poor hand washing.

a. A

b. B

c. C

d. D

Many phthalates affect the _______________.

Question 1

Which of the following groups of chemicals was widely used as insulating fluid in electrical equipment?
[removed]

Dioxins

[removed]

Polybrominated diphenyl ethers (PBDEs)

[removed]

Polychlorinated biphenyls (PCBs)

1 points

Question 2

Occupational asthma is known to be caused by synthetic organic chemicals, dusts, and _______________.
[removed]

alpha radiation

[removed]

certain bacteria

[removed]

certain metals

1 points

Question 3

Which of the following products are made using processes that involve perfluorochemicals (PFCs)?
[removed]

Consumer electronics

[removed]

Flexible plastic containers

[removed]

Non-stick coatings

1 points

Question 4

The effect of _______________ in inducing _______________ appears to have no threshold.
[removed]

lead / neurotoxicity

[removed]

methylmercury / decrement in IQ

[removed]

particulates / fibrosis

1 points

Question 5

In the United States today, young children get most of their exposure to the lead in lead paint by __________.
[removed]

ingesting chips of paint

[removed]

ingesting dust that contains lead

[removed]

inhaling airborne lead

1 points

Question 6

Which of the following is the most common medium for people’s exposures to solvents?
[removed]

Dust

[removed]

Groundwater

[removed]

Meat or fish

1 points

Question 7

_______________ are the major cause of stratospheric ozone depletion.
[removed]

Chlorofluorocarbons (CFCs)

[removed]

Perfluorochemicals (PFCs)

[removed]

Polybrominated diphenyl ethers (PBDEs)

1 points

Question 8

In the human body, carbon monoxide (CO) _______________.
[removed]

binds to hemoglobin, displacing oxygen

[removed]

compromises the body’s defenses against airborne particulates

[removed]

concentrates in the thyroid, causing thyroid cancer

1 points

Question 9

_______________ are widely used to degrease metals—for example, in the manufacture of electronic components.
[removed]

Perfluorochemicals (PFCs)

[removed]

Phthalates

[removed]

Solvents

1 points

Question 10

Hearing loss is associated not only with exposure to noise, but also with exposure to _________.
[removed]

air fresheners

[removed]

household pesticides

[removed]

secondhand smoke

1 points

Question 11

Which of the following pollutants is a key contributor to acid deposition?
[removed]

Carbon dioxide

[removed]

Carbon monoxide

[removed]

Ozone

[removed]

Sulfur dioxide

1 points

Question 12

When automobiles burn gasoline, they:
[removed]

emit ozone, which reacts with volatile organic compounds (VOCs) to form photochemical smog.

[removed]

emit VOCs, which react with NOx and other chemicals to form photochemical smog.

[removed]

increase ozone at ground level, contributing to depletion of ozone in the stratosphere.

1 points

Question 13

Many phthalates affect the _______________.
[removed]

central nervous system

[removed]

endocrine system

[removed]

respiratory system

1 points

Question 14

Sick building syndrome is a set of __________.
[removed]

construction features of a building that make people feel ill

[removed]

indoor air pollutants associated with construction materials

[removed]

symptoms that people experience when they spend time in a building

1 points

Question 15

Some likely human health impacts of polybrominated diphenyl ethers (PBDEs) are suggested by their chemical structure, which is similar to that of _______________.
[removed]

human growth hormone

[removed]

neurotransmitters

[removed]

thyroid hormones