A 16-year-old boy with a history of appendicitis presents with abdominal pain, malaise, weight loss, and bloody diarrhea. The nurse practitioner suspects ulcerative colitis (UC). What is the pathophysiology of UC?

Choice A reason: Sickle cell anemia is indeed inherited in an autosomal recessive pattern. Individuals must inherit two copies of the mutated beta globin gene (one from each parent) to manifest the disease. Carriers with one copy are typically asymptomatic but may pass the gene to offspring.

Choice B reason: The condition results from a point mutation in the beta globin gene, specifically a substitution of valine for glutamic acid at the sixth position. This leads to the production of hemoglobin S, which polymerizes under low oxygen conditions, causing red blood cells to assume a sickle shape.

Choice C reason: The sickled red blood cells can obstruct small blood vessels, leading to ischemia and infarction in various tissues, including bones. This can predispose patients to osteomyelitis and bone necrosis, particularly in long bones. Thus, this statement is accurate.

Choice D reason: This statement is false and stigmatizing. Patients with sickle cell anemia experience real and often severe pain due to vaso-occlusive crises. Labeling them as drug-seeking undermines their legitimate need for pain management and contributes to healthcare disparities.

Choice A reason: Nightmare disorder involves vivid, frightening dreams that occur during REM sleep and typically awaken the child, who can recall the dream content. In this case, the child does not fully wake and has no memory of the episode, which is inconsistent with nightmare disorder.

Choice B reason: Sleep terrors, also known as night terrors, are episodes of intense fear, screaming, and autonomic arousal that occur during non-REM sleep, usually within the first few hours of sleep. Children experiencing sleep terrors are difficult to awaken, appear confused, and typically have no memory of the event. This matches the boy’s presentation precisely.

Choice C reason: Insomnia is characterized by difficulty initiating or maintaining sleep, or waking too early. It does not involve screaming, crying, or episodes of confusion during sleep. The boy’s symptoms are not consistent with insomnia.

Choice D reason: REM sleep behavior disorder involves physically acting out dreams due to loss of normal REM atonia. It is more common in older adults and involves purposeful movements rather than screaming or crying. The child’s age and presentation make this diagnosis unlikely.