A 62-year-old woman sees the APRN for evaluation of hypertension. According to JNC 8 guidelines for hypertension, what is the threshold for treating hypertension?

Choice A reason: Psychotic symptoms in bipolar disorder can last longer than one month, especially during severe manic or depressive episodes. The duration alone does not differentiate bipolar disorder from schizoaffective disorder.

Choice B reason: In bipolar disorder, psychotic symptoms are mood-congruent and occur exclusively during mood episodes. In contrast, schizoaffective disorder includes psychotic symptoms that persist independently of mood disturbances, which is the key distinguishing feature.

Choice C reason: Schizoaffective disorder can include both depressive and manic or hypomanic episodes. It is not limited to depressive episodes alone. The subtype (depressive type or bipolar type) depends on the nature of the mood episodes.

Choice D reason: Schizoaffective disorder often includes full-blown episodes of major depression. The presence of major depressive episodes is part of the diagnostic criteria for the depressive subtype of schizoaffective disorder.

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.