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NURS 6501Advanced Pathophysiology Quiz

  1. QUESTION 1

    1. In qualitative studies, results are reported using words or themes.

     True

     False

    5 points   

    QUESTION 2

    1. A key characteristic of a systematic review is that it contains a meta-analysis.

     True

     False

    5 points   

    QUESTION 3

    1. You are forming a team to do a systematic review of the literature about interventions to treat post-traumatic stress disorder (PTSD). Which of the following would be your first step?
     

    A.

    Critically appraise the literature identified.

     

    B.

    Conduct an exhaustive search of multiple databases to identify the literature.

     

    C.

    Identify an explicit, reproducible methodology.

     

    D.

    Create a clearly stated set of objectives with predefined eligibility criteria for study inclusion.

     

    E.

    Create a dissemination plan for your systematic review.

    5 points   

    QUESTION 4

    1. In quantitative studies, results are reported using words or themes.

     True

     False

    5 points   

    QUESTION 5

    1. Which of the following types of research can be categorized as primary research? Select all that apply. 
     

    A.

    Cohort study

     

    B.

    Literature review

     

    C.

    Grounded theory study

     

    D.

    Randomized controlled trial

     

    E.

    Systematic review

     

    F.

    Controlled trial without randomization

    5 points   

    QUESTION 6

    1. Which of the following is a type of quantitative research study?
     

    A.

    Phenomenology

     

    B.

    Case study

     

    C.

    Randomized controlled trial

     

    D.

    Ethnography

     

    E.

    Participative action research

     

    F.

    Ground theory

    5 points   

    QUESTION 7

    1. Mixed-methods studies are a combination of which two methodologies?
     

    A.

    Quantitative research methodologies and literature reviews

     

    B.

    Quantitative and qualitative research methodologies

     

    C.

    Qualitative research methodologies and systematic reviews

     

    D.

    Literature reviews and qualitative research methodologies

     

    E.

    Quasi-experimental and program evaluation

    5 points   

    QUESTION 8

    1. What kind of study is described in the following excerpt?

    Researchers are interested in studying the impact of living in a family where a child has been diagnosed with cancer. They collaborate with the oncology department at a large children’s hospital to identify and receive consent from families that have a child with a cancer diagnosis. Participants are consented and data is collected and triangulated using one-on-one interviews, focus groups, and surveys. Data is analyzed for thematic analysis.

     

    A.

    Quantitative research

     

    B.

    Qualitative research

     

    C.

    Mixed-methods research

     

    D.

    Systematic reviews

     

    E.

    Literature reviews

     

    F.

    Cohort studies

    5 points   

    QUESTION 9

    1. Randomized controlled trials are which type of research?
     

    A.

    Quantitative research

     

    B.

    Qualitative research

     

    C.

    Mixed-methods research

     

    D.

    Systematic review

     

    E.

    Literature review

     

    F.

    Cohort study

    5 points   

    QUESTION 10

    1. In a systematic review with a meta-analysis, researchers combine the results of each of the individual studies to create a larger sample size (and therefore greater power), then re-run the statistics to capture the true magnitude of the effect. The single-effect measure calculated and reported when the results from all the studies are combined is called what?
     

    A.

    Summary statistic

     

    B.

    Power analysis

     

    C.

    Confidence Interval 

     

    D.

    Chi square

     

    E.

    Pearson’s co-efficient

    5 points   

    QUESTION 11

    1. What types of information would help you identify a research study as quantitative? (Select all that apply.)
     

    A.

    Data is collected using such approaches as interviews, focus groups, and open-ended questions on surveys.

     

    B.

    Data is collected using Likert scales on surveys.

     

    C.

    Results are reported using numbers and statistics.

     

    D.

    Results are reported using themes and words.

    QUESTION 12

    1. Which of the following statements is true of narrative reviews? (Select all that apply.)
     

    A.

    Narrative reviews engage a highly structured and rigorous approach to reviewing research evidence.

     

    B.

    Narrative reviews provide a general background discussion of a particular issue.

     

    C.

    Narrative reviews require a rigorous, systematic approach to searching the databases for evidence.

     

    D.

    Narrative reviews generally review literature that support the author’s point of view on an issue or topic.

     

    E.

    Narrative reviews are a type of primary research.

    5 points   

    QUESTION 13

    1. What type of information would help you identify a research study as qualitative? (Select all that apply.)
     

    A.

    Data is collected using such approaches as interviews, focus groups, and open-ended questions on surveys.

     

    B.

    Data is collected using Likert scales on surveys.

     

    C.

    Results are reported using numbers and statistics.

     

    D.

    Results are reported using themes and words.

     

    E.

    Data is collected using surveys with fill-in-the-blank questions.

     

    F.

    Results are reported using a mixture of numbers and themes.

    5 points   

    QUESTION 14

    1. What type of study is described in the following excerpt?

    An interprofessional team wants to test a new intervention to see whether it will improve central-line associated bloodstream infection (CLABSI) rates. Subjects were randomized into either the intervention or the control group by pulling a slip of paper with either a one or a two written on it from a manila envelope (those pulling ones were randomized to the intervention group; those pulling twos were randomized to the control group). When the study began, the intervention group received the intervention and the control group received equal attention. Data was collected and analyzed using the Statistical Package for the Social Sciences (SPSS). Descriptive statistics were used to report the data.

    What type of research article is this?

     

    A.

    Quantitative research

     

    B.

    Qualitative research

     

    C.

    Systematic reviews

     

    D.

    Literature reviews

     

    E.

    Mixed methods

     

    F.

    Program evaluation

    5 points   

    QUESTION 15

    1. What type of literature may a systematic review include to be considered Level 1 evidence on the Melnyk & Fineout-Overholt levels of evidence hierarchy?
     

    A.

    Phenomenology studies

     

    B.

    Grounded theory studies

     

    C.

    Descriptive studies

     

    D.

    Cohort studies

     

    E.

    Controlled trials without randomization

     

    F.

    Randomized controlled trials

    5 points   

    QUESTION 16

    1. The methods used in conducting a systematic review are specific and rigorous. 

     True

     False

    5 points   

    QUESTION 17

    1. When trying to determine what type of research study is described in an article, which two sections of the article will give you the best information to make that determination?
     

    A.

    Abstract and conclusion

     

    B.

    Methods and limitations

     

    C.

    Methods and results

     

    D.

    Introduction and results

     

    E.

    Abstract and discussion

     

    F.

    Literature review and data analysis

    5 points   

    QUESTION 18

    1. Both literature reviews and systematic reviews are types of research evidence reviews.

     True

     False

    5 points   

    QUESTION 19

    1. Order the following types of research evidence reviews in order of rigor from most rigorous to least rigorous:

                                               

    1. Systematic review with meta-analysis
    2. Systematic review without meta-analysis
    3. Integrative review
    4. Narrative review

    5 points   

    QUESTION 20

    1. What type of study is described in the following excerpt?

    Surveys to evaluate nurse satisfaction, medical errors, depression and anxiety, and demographics were given to 5,432 nurses from hospitals of various sizes and geographic locations; some had nurses working 8-hour shifts and 12-hour shifts. Nurses were asked to complete the survey. Upon completion of the survey, nurses were invited to participate in video conference focus groups and one-on-one interviews with a research assistant by video conferencing. Survey results were reported using descriptive statistics, and themes were identified and reported from the data collected in the focus groups and one-on-one interviews.

     

    A.

    Quantitative research

     

    B.

    Qualitative research

     

    C.

    Quasi-experimental research

     

    D.

    Mixed-methods research

     

    E.

    Systematic reviews

     

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Scenario 3: Panic Disorders and Attacks

A 27-year-old female presents to the Emergency Room, with a chief complaint of palpitations, rapid heart rate, sweating, tremors, and inability to catch her breath. The symptoms started about 10 hour ago and have gotten worse. She states she has some chest pain that remains constant no matter what. She also has numbness and tingling around her mouth and lips. She says she knows something “terrible is going to happen”. She denies having any similar episode in the past. Past medical history noncontributory. Social history significant for recent stressor of applying for medical school and taking the Medical College Admission Test (MCAT). She had not received the results prior to the episode but is sure that the failed the test. Says she doesn’t know if anyone else in her family has had similar episodes. Physical exam reveals a thin, anxious appearing female who is profusely sweating despite cool ambient air temperature. BP 176/88, Pulse 136, and respirations 26. Electrocardiogram negative for evidence of myocardial infarction and all lab data within normal limits except for mild respiratory alkalosis. The patient’s symptoms are subsiding and the patient states she is feeling better. The APRN suspects the patient has just experienced a panic attack.  

Question 1 of 2:

What are panicogens and how do they contribute to the development of panic attack symptoms? 

Panicogens are substances that cause panic or anxiety. They include sever stress, Yohimbine, CCK tetrapeptide (CCK-4), caffeine, m-chlorophenylpiperazine, and benzodiazepine partial inverse agonist FG 7142. These agents cause panic attack by increasing anxiety, nervousness, fear, nausea, palpitations, restlessness, and tremors. For instance, the patient in this scenario had chief complaint of palpitations, rapid heart rate, sweating, and tremors, which re all triggered by the panicogenic agents.

 

Question 2 of 2:

How does the GABA-benzodiazepine (BZ) receptor systems contribute to panic attacks/disorders? 

The GABA-benzodiazepine (BZ) receptor systems contribute to panic attacks because their blockage with antagonists results in severe anxiety that eventually leads to panic attack. However, increasing GABA receptor function with antagonists reduces anxiety and changes of panic disorders.

 

Scenario 4: Social Anxiety Disorder (SAD)

A 21-year-old female college junior makes an appointment to see the APRN in the Student Health Clinic. The student tells the APRN that it has gotten harder and harder for her to attend classes, especially her history class where the class is preparing for the semester’s end presentations. She says she is terrified to speak to the class and is considering dropping the class so she will not have to present. She has a significant impairment in social activities and has resigned from her sorority. She is unable to go to the library to study as she feels everyone is looking at her and mocking her. She admits to having some of these symptoms in high school, but the guidance counselor was able to work with her to decrease some of her symptoms. Past medical history noncontributory except for the milder symptoms exhibited in high school. Family history noncontributory. Social history positive for anxiety related to social situations that has had a negative impact on both her scholarly and social endeavors. The APRN diagnoses the student with social anxiety disorder (SAD).  

Question 1 of 2:

Describe the areas of the brain that are associated with social anxiety disorder. 

The areas of the brain that are mostly associated with social anxiety include brain stem, prefrontal cortex, and amygdale, which play a key role in modulating fear and anxiety. Prefrontal cortex is responsible for pathological anxiety responses related to negative emotions caused by amygdala, while brain stem controls the rate of breathing and any fault may result in social anxiety. In these cases, the patient’s social anxiety possibly originated from the prefrontal cortex which concerns negative emotions. The patient has a significant impairment in social activities and has resigned from her sorority and is also unable to go to the library to study as she feels everyone is looking at her and mocking her, which are all negative social emotions.

 

Question 2 of 2:

How is oxytocin associated with SAD? 

Oxytocin hormone is associated with SAD as it is known to promote positive social interactions such as feelings of love, social bonding, and well-being. The hormone act by reducing the impact of SAD on and individual and enhance emotional health. 

Scenario 5: Generalized Anxiety Disorder (GAD)

A 36-year-old female comes to see the APRN in clinic with a chief complaint of “I’m so and I feel all keyed up all the time”. She states she feels restless, keyed up, and on edge most of the time. She fatigues easily and has difficulty concentrating and says her mind goes blank. She admits to being irritable and snapping at her coworkers which she worries will affect her job. She says the symptoms have been present for about 8 or 9 months. and Increased muscle tension. She has had difficulty falling asleep or stay sleeping. Further questioning revealed that prior to her symptoms, her parents got divorced which has been a great stressor for her. Past medical history noncontributory. Social history positive for a case of “nerves” when she was in high school that seemed to resolve after she graduated from college. No drug or alcohol history. The APRN believes the patient has generalized anxiety disorder (GAD).  

Question 1 of 2:

  Discuss the role of neurotransmitters in the expression of GAD.  

Several neurotransmitters are involved in GAD such as serotonin, glutamate, gamma-amino butyric acid, Cholecystokinnin, Adenosine and many others.  However, some of these neurotransmitters are inhibitory while others are excitatory. Therefore, these neurotransmitters play a key role in up-regulation or down-regulation of GAD. Neurotransmitters in the brain modulate the neural circuitry involved in anxiety. For instance, the dysregulation of GABA, an inhibitory neurotransmitter, especially the GABAvariant, tend to elevate the amygdala activity in the brain, thus causing GAD.

Question 2 of 2:

Explain the structural brain changes that occur in people with GAD. 

In people with GAD, brain structural changes occurs a result of alterations of the gray and white matter. The structural changes in gray matter include macrostructural changes such as decreased cortical thickness and volume, as well as through microstructural changes such as increased gray matter mean diffusivity. On the other hand, structural changes in white matter include changes in macrostructural lesions measured by the total white matter hyper-intensity (WMH) burden and through microstructural damage in the white matter tracts.

 

Scenario 6: Post-Traumatic Stress Disorder (PTSD)

A 27-year-old man comes to the Veteran’s Administration Hospital at the insistence of his fiancée who accompanies him to the appointment. She tells the APRN that her fiancée has not “been the same” since he returned from his second tour in Iraq.  He was an infantryman with a local Marine Reserve unit and served 2 tours and was honorably discharged. Since his return, he has had difficulty sleeping, and says he “sleeps with one eye open” and fears sleep. Deep sleep brings vivid nightmares. He grudgingly admits to having experienced several traumatic events during his second tour of duty. He is unwilling to discuss them and will not reveal specific details. He is short tempered and irritable and is afraid to be around people as he doesn’t want to snap at people and alienate them. He startles easily at loud noises, especially the sounds of cars backfiring. He admits to thinking there are threats everywhere and spends an excessive amount of time searching for them but never finding any. He has intrusive memories almost every day and says he really isn’t interested in doing much of anything. He is very worried that these symptoms are irreparably hurting his relationship with his fiancée who he loves very much. The APRN diagnoses him with post-traumatic stress disorder (PTSD). 

Question 1 of 2:

Describe the changes seen in the brain structure in patients with PTSD.

Changes in the brain structure in patients with PTSD emanates from severe emotional trauma that causes lasting alterations in the ventromedial prefrontal cortex region of the brain. Prefrontal cortex is responsible for the regulation of responses triggered by amygdale. PTSD patients show a marked decrease in the volume of the ventromedial prefrontal cortex and the functional ability of this region. For instance, the patient in this scenario grudgingly admits to having experienced several traumatic events during his second tour of duty, indicating alterations in the ventromedial prefrontal cortex region of the brain.

 

Question 2 of 2:

Briefly discuss the role glucocorticoids may have on the development of PTSD 

Glucocorticoids play an important role in the development of PTSD. Notably, moderate secretion of glucocorticoids enhances a patients’ coping mechanism by helping them to process information is a way that reduces the retrieval of fear-evoking memories. However, when there is inadequate production of glucocorticoids such as cortisol, which is a stress hormone, the individuals may have problems to emotionally adapt following a traumatic event as seen in the patient in this scenario. 

Scenario 7: Obsessive-Compulsive Disorder (OCD)

A 17-year-old male high school junior comes to the clinic to establish care. He recently moved from a relatively urban area to a very rural area and has just started his junior year in a new school. The mother states that she has noticed that her son has been frequently washing his hands and avoids contact with any dirty or soiled object. He uses paper towels or napkins over the knob on a door when opening it. According to the mother, this behavior has just appeared since moving. The patient, upon close questioning, admits that he is “grossed out” by some of the boys in the boys’ room since they use the toilet and do not wash their hand afterwards. He is worried about all the germs the boys are carrying around. Past medical history is noncontributory. Social history -lives with parents and 2 siblings in a house in a new town. Is an honors student. Based on these behaviors, The APRN thinks the patient has obsessive-compulsive disorder (OCD).  

Question 1 of 2:

What is primary pathophysiology of OCD? 

Obsessive-compulsive disorder (OCD) is a mental disorder that is characterized by absurd, recurrent, and uncontrollable thoughts that lead to anxiety, followed by repetitive behaviors aimed at reducing anxiety. The primary pathophysiology of OCD is overly persistent and uncontrolled neural activity in SMS, possibly as a result of dopamine-serotonin imbalance. For instance, in the case scenario, the patient admits that he is “grossed out” by some of the boys in the boys’ room since they use the toilet and do not wash their hand afterwards. He is also worried about all the germs the boys are carrying around; indicating that he is has anxiety from the thought that other boys’ hands may be contaminated with germs.

 

Question 2 of 2:

Describe the role the dorsal anterior cingulate cortex (dACC) has in reinforcement of obsessive behaviors. 

In patients with OCD, the dACC acts as a hub that processes negative emotional and reinforcing information and then uses the information to direct motivated behavior. Therefore, it is likely that OCD processes such as anxiety and depression can be reinforced by dACC modulation.

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