Course Objective 1: Anatomy & Physiology catecholamines = arousal (wake) histamine = sleep promoting adenosine = sleep promoting melatonin = sleep promoting Stress A&P A woman’s health nurse practitioner student notices her patient is experiencing anxiety and fear at the thought of having a pelvic exam. The student recognizes that the portion or region of the brain that is most responsible for initiation and control of emotional response is the limbic system. A student is pulling an all-nighter studying. Cortisol is secreted during this stressful time frame to maximize available glucose for the brain & body by promoting increased insulin secretion.  The PMHNP’s client is extremely anxious and vital signs show the patient is mildly tachycardic and complaining of their heart “beating harder”. This is likely a result of catecholamines on his β1 receptors. β1 receptors when stimulated increase heart rate & force of contraction.  A patient experiencing chronic stress presents with elevated cortisol levels and disrupted sleep patterns. Which physiological pathway is primarily responsible for this response? The hypothalamic-pituitary-adrenal (HPA) axis.  A patient presents with elevated heart rate, dilated pupils, and dry mouth during a stressful event. Later, they report fatigue and increased digestive activity. Which of the following best explains the roles of the autonomic nervous system branches in this response? The sympathetic nervous system initiated the stress response, and the parasympathetic system helped restore homeostasis afterward.  The nurse is administering immunizations per the order of the PNP. The toddler is upset, screaming, fighting the nurse & the parents with great strength, during the injections. The toddler’s adrenal medulla is secreting epinephrine due to stimulation of the sympathetic nervous system. Interleukins (IL-1, Il-6) and interferons (IFN) can be released in acute stress. These chemicals are examples of chemicals released by the immune system during stress or immune reactions. A patient recovering from surgery has elevated cortisol levels due to prolonged stress. The nurse practitioner explains that the body normally regulates cortisol through a negative feedback loop. Which of the following best describes how this feedback mechanism works? Elevated cortisol levels inhibit the release of CRH and ACTH, reducing further cortisol secretion. Cortisol is regulated by a negative feedback loop involving the hypothalamus and pituitary gland. When cortisol levels rise, they signal the hypothalamus to reduce CRH (corticotropin-releasing hormone) and the pituitary to reduce ACTH (adrenocorticotropic hormone), thereby decreasing further cortisol production. This feedback helps maintain hormonal balance and prevents excessive stress responses. The NP is going to prescribe a medication know as an alpha1 (α1) -blocker, or in other words when the medication is taken, some of the α1-receptors will be blocked & be unable to be stimulated. Taking an α1-blocker would result in a(n): decrease in genitourinary tract smooth muscle contraction A patient is admitted to the hospital with signs of acute stress, including elevated heart rate, increased blood glucose, and suppressed immune function. Which three body systems are primarily responsible for coordinating this stress response? Nervous, endocrine, and immune systems.  A patient experiencing chronic stress reports new-onset digestive issues and mood changes. The nurse practitioner explains that the gut microbiota may be contributing to these symptoms. Which of the following best describes how the gut microbiota influences the stress response? It modulates the intestinal barrier and communicates with the brain via the vagus nerve and signaling molecules. Sleep Physiology Rapid eye movement (REM) sleep occurs in cycles approximately every 90 minutes.  The NP explains that the body’s internal clock is regulated by a specific brain structure that responds to light and dark signals. Which of the following best describes this structure and its function? The hypothalamic suprachiasmatic nucleus (SCN), which receives light signals and regulates melatonin release via the pineal gland.  Lifespan physiology question A mother of a 1-month-old infant states that the baby is sleeping about 10 hours a day. Which of the following is the most appropriate response? “That’s less than expected. Most 1-month-olds sleep between 14 to 17 hours in a 24-hour period.”  An 80-year-old patient tells the nurse practitioner, “I feel fine, but I just don’t sleep like I used to. I only get about 6 hours a night.” Which of the following is the most appropriate response? “That’s normal. Sleep patterns often change with age, and many older adults sleep less at night.”  

Course Objective 2: Physiological changes that occur in specific diseases Restless leg syndrome is caused in part due to dopaminergic, adenosine, & GABA neurotransmission dysfunction. Obstructive sleep apnea (OSA) is caused by collapse of the oral airway with cessation of breathing. Insomnia is caused by hyperarousal of the thalamus, amygdala, &anterior cingulate Shift work sleep disorder (SWSD) = characterized by insomnia and excessive sleepiness affecting people whose work hours overlap with the typical sleep period Delayed sleep phase syndrome (DSPS) = a delay in rhythms of sleep and temperature cycles, is caused by mutation of a gene involved in the rhythmicity of neurons of the SCN Parasomnias = abnormal behaviors such as nightmares or sleepwalking that occur during sleep Insomnia = recurring problems in falling or staying asleep Acute and chronic stress patho: In chronic stress, elevated glucocorticoids and insulin levels redistribute stored calories to the abdominal region, where fat tissue can begin generating glucocorticoids locally.  The NP student did not realize how time consuming school would be, so they have been extremely stressed trying to working full-time, studying, and caring for their family. This chronic stress over the past year has impacted the NP student’s ability to learn course content due to  cortisol decreasing hippocampus synaptic plasticity. Selye’s theory suggests that our body has an adaptational response to stressors, for example stress on the neurological system can lead to amyloid and tau deposits which can lead to which disease? Alzheimer’s disease A patient with chronic psychological stress is found to have elevated levels of pro-inflammatory cytokines and signs of cognitive decline. The nurse practitioner explains that stress may be affecting the brain’s immune system. Microglia become activated during stress, increasing cytokine production and potentially compromising the BBB.  The NP student knows that acute stress in a female of child-bearing age can often lead to delayed ovulation  What are the 3 stages of Selye’s General Adaptation Syndrome (GAS)? Alarm; Resistance; Exhaustion Sleep Patho A 48-year-old man has recently been diagnosed with obstructive sleep apnea with an apnea-hypopnea index of 21.2/hr. He presents to the clinic for follow-up because he tried CPAP in the sleep laboratory and felt uncomfortable with it. He asks what the potential risks would be to his health if he chose to forego treatment. What advice should the NP give him?  Untreated obstructive sleep apnea has an increased risk of mortality due to cardiovascular events including myocardial infarction and stroke. Untreated obstructive sleep apnea raises nocturnal blood pressure, and treatment with CPAP can lead to drop in blood pressure. Untreated obstructive sleep apnea is associated with a sevenfold increased risk of automobile accidents. Untreated obstructive sleep apnea has an increased risk of depression.  A 47 year old female presents to the NP complaining of “creepy crawlies” all over legs when she tries to sleep. She feels exhausted as the sensation is preventing her from getting a good night’s rest. The NP suspects restless leg syndrome and knows there is likely dopaminergic dysfunction involved in this disorder. The FNP is a seeing a 25-year-old man who comes to the clinic because of daytime sleepiness for the past 3 months. He is working in a banking office and just dozes off at his desk. His coworkers have woken him up a few at work, and he does not even recall falling asleep. He also says his daytime naps are increasing in frequency. He describes these naps as a “sudden desire to fall asleep, sometimes involuntarily”. He sleeps on average 7-8 hours a night. His lab work shows no abnormalities and no anemia. The FNP had already ordered a sleep study 2 months ago, and that showed no sleep apnea. The FNP suspects his symptoms are related to low levels of which of the following orexin (hypocretin). The presentation is suggestive of narcolepsy, which theories attribute to low levels of orexin or hypocretin, a wake-promoting neurochemical. Chronic, unrelenting stress and sleep deprivation can increase a patient’s cancer risk through which of the following THREE mechanisms: oxidative stress leading to DNA mutations, immune suppression of NK cells,  and increased cytokine release and inflammation. A 48-year-old man with a body mass index of 28.9 kg/m2 is diagnosed with obstructive sleep apnea with 42 apneic events per hour and a minimum oxygen saturation of 78%. Which best describes the pathogenesis of this condition?  Transient episodes of pharyngeal collapse   Nurses who have worked night shifts for over 10 years show an epigenetic age approximately 3 years older than those who have never worked night shifts. This difference is partly due to changes in DNA methylation  

The provider writes an order for Nystatin Oral Suspension 250,000 units by mouth every 6 hours for thrush. Following these orders, how many units would this patient receive in 24 hours?

All of the following would be considered subjective data, EXCEPT:

An older patient who reports a 2- to 3-year history of upper gastrointestinal (GI) symptoms will begin taking ranitidine (Zantac) to manage her symptoms. The patient has completed a health history form. The nurse notes that the patient answered “no” when asked if any medications were being taken. Which action will the nurse take next?

The Genetic Information Nondiscrimination Act (GINA) was enacted to

The nurse is preparing to give a 9-month-old child a bitter-tasting oral medication. The nurse is working with the child’s parents to create a plan to help with administration of this medication. Which of the following would be the most appropriate next step?

The essay about learning disabilities:

A decedent has a triangular face. Which corrective application best restores proportional balance?

What is the additive method of mixing colored illumination?