## manufacturing-process

What are the characteristics of a manufacturing process? How are manufacturing processes organized and evaluated? 500word response

Below is the chapter and citation.

Jacobs, F.R. & Chase, R.B. (2014). Operations and supply chain management (14th ed). New York, NY: McGraw-Hill

Understand what a manufacturing process is.

In this chapter we consider processes used to make tangible goods. Manufacturing processes are used to make everything that we buy ranging from the apartment building in which we live to the ink pens with which we write. The high-level view of what is required to make something can be divided into three simple steps. The first step is sourcing the parts we need, followed by actually making the item, and then sending the item to the customer. As discussed in Chapter 1, a supply chain view of this may involve a complex series of players where subcontractors feed suppliers, suppliers feed manufacturing plants, manufacturing plants feed warehouses, and finally warehouses feed retailers. Depending on the item being produced, the supply chain can be very long with subcontractors and manufacturing plants spread out over the globe (such as an automobile or computer manufacturer) or short where parts are sourced and the product is made locally (such as a house builder).

Strategy

Consider Exhibit 7.1, which illustrates the Source step where parts are procured from one or more suppliers, the Make step where manufacturing takes place, and the Deliver step where the product is shipped to the customer. Depending on the strategy of the firm, the capabilities of manufacturing, and the needs of customers, these activities are organized to minimize cost while meeting the competitive priorities necessary to attract customer orders. For example, in the case of consumer products such as televisions or clothes, customers normally want these products “on-demand” for quick delivery from a local department store. As a manufacturer of these products, we build them ahead of time in anticipation of demand and ship them to the retail stores where they are carried in inventory until they are sold. At the other end of the spectrum are custom products, such as military airplanes, that are ordered with very specific uses in mind and that need to be designed and then built to the design. In the case of an airplane, the time needed to respond to a customer order, called the , could easily be years compared to only a few minutes for the television.

The time needed to respond to a customer order.

A key concept in manufacturing processes is the which determines where inventory is positioned to allow processes or entities in the supply chain to operate independently. For example, if a product is stocked at a retailer, the customer pulls

Customer order decoupling point

Where inventory is positioned in the supply chain.

exhibit 7.1 Positioning Inventory in the Supply Chain

148

the item from the shelf and the manufacturer never sees a customer order. Inventory acts as a buffer to separate the customer from the manufacturing process. Selection of decoupling points is a strategic decision that determines customer lead times and can greatly impact inventory investment. The closer this point is to the customer, the quicker the customer can be served. Typically, there is a trade-off where quicker response to customer demand comes at the expense of greater inventory investment because finished goods inventory is more expensive than raw material inventory. An item in finished goods inventory typically contains all the raw materials needed to produce the item. So from a cost view it includes the cost of the material plus the cost to fabricate the finished item.

Make-to-stock Assemble-to-order Make-to-order Engineer-to-order

These terms describe how customers are served by a firm.

Positioning of the customer order decoupling point is important to understanding manufacturing environments. Firms that serve customers from finished goods inventory are known as firms. Those that combine a number of preassembled modules to meet a customer’s specifications are called firms. Those that make the customer’s product from raw materials, parts, and components are firms. An firm will work with the customer to design the product, and then make it from purchased materials, parts, and components. Of course, many firms serve a combination of these environments and a few will have all simultaneously. Depending on the environment and the location of the customer order decoupling point, one would expect inventory concentrated in finished goods, work-in-process (this is inventory in the manufacturing process), manufacturing raw material, or at the supplier as shown in Exhibit 7.1.

Lean manufacturing

To achieve high customer service with minimum levels of inventory investment.

The essential issue in satisfying customers in the make-to-stock environment is to balance the level of finished inventory against the level of service to the customer. Examples of products produced by these firms include televisions, clothing, and packaged food products. If unlimited inventory were possible and free, the task would be trivial. Unfortunately, that is not the case. Providing more inventory increases costs, so a trade-off between the costs of the inventory and the level of customer service must be made. The trade-off can be improved by better estimates (or knowledge) of customer demand, by more rapid transportation alternatives, by speedier production, and by more flexible manufacturing. Many make-to-stock firms invest in programs in order to achieve higher service levels for a given inventory investment. Regardless of the trade-offs involved, the focus in the make-to-stock environment is on providing finished goods where and when the customers want them.

In the assemble-to-order environment, a primary task is to define a customer’s order in terms of alternative components and options since it is these components that are carried in inventory. A good example is the way Dell Computer makes desktop computers. The number of combinations that can be made may be nearly infinite (although some might not be feasible). One of the capabilities required for success in the assemble-to-order environment is an engineering design that enables as much flexibility as possible in combining components, options, and modules into finished products. Similar to make-to-stock, many assemble-to-order companies have applied lean manufacturing principles to dramatically decrease the time required to assemble finished goods. By doing so they are delivering customers’ orders so quickly that they appear to be make-to-stock firms from the perspective of the customer.

LATASHA BELL, A DELL INC. EMPLOYEE, ASSEMBLES A DELL OPTIPLEX DESKTOP COMPUTER AT THE COMPANYS FACILITY IN LEBANON, TENNESSEE, U.S.

When assembling-to-order there are significant advantages from moving the customer order decoupling point from finished goods to components. The number of finished products is usually substantially greater than the number of components that are combined to produce the finished product. Consider, for example, a computer for which there are four processor alternatives, three hard disk drive choices, four DVD alternatives, two speaker systems, and four monitors available. If all combinations of these 17 components are valid, they can be combined into a total of 384 different final configurations. This can be calculated as follows:

149

If Ni is the number of alternatives for component i, the total number of combinations of n components (given all are viable) is:

Total number of combinations=N1×N2×NnOr 384=4×3×4×2×4 for this example.[7.1]



Total number of combinations

=

N

1

×

N

2

×

N

n

Or

384

=

4

×

3

×

4

×

2

×

4

for this example

.

[

7.1

]

It is much easier to manage and forecast the demand for 17 components than for 384 computers.

In the make-to-order and engineer-to-order environments the customer order decoupling point could be in either raw materials at the manufacturing site or possibly even with the supplier inventory. Boeing’s process for making commercial aircraft is an example of make-to-order. The need for engineering resources in the engineer-to-order case is somewhat different than make-to-order since engineering determines what materials will be required and what steps will be required in manufacturing. Depending on how similar the products are it might not even be possible to pre-order parts. Rather than inventory, the emphasis in these environments may be more toward managing capacity of critical resources such as engineering and construction crews. Lockheed Martin’s Satellite division uses an engineer-to-order strategy.

### HOW MANUFACTURING PROCESSES ARE ORGANIZED

LO7–2

Explain how manufacturing processes are organized.

Process selection refers to the strategic decision of selecting which kind of production processes to use to produce a product or provide a service. For example, in the case of Toshiba notebook computers, if the volume is very low, we may just have a worker manually assemble each computer by hand. In contrast, if the volume is higher, setting up an assembly line is appropriate.

The formats by which a facility is arranged are defined by the general pattern of work flow; there are five basic structures (project, workcenter, manufacturing cell, assembly line, and continuous process).

Project layout

For large or massive products produced in a specific location, labor, material, and equipment are moved to the product rather than vice versa.

In a project layout, the product (by virtue of its bulk or weight) remains in a fixed location. Manufacturing equipment is moved to the product rather than vice versa. Construction sites (houses and bridges) and movie shooting lots are examples of this format. Items produced with this type of layout are typically managed using the project management techniques described in Chapter 4. Areas on the site will be designated for various purposes, such as material staging, subassembly construction, site access for heavy equipment, and a management area.

In developing a project layout, visualize the product as the hub of a wheel, with materials and equipment arranged concentrically around the production point in the order of use and movement difficulty. Thus, in building commercial aircraft, for example, rivets that are used throughout construction would be placed close to or in the fuselage; heavy engine parts, which must travel to the fuselage only once, would be placed at a more distant location; and cranes would be set up close to the fuselage because of their constant use.

Workcenter

A process with great flexibility to produce a variety of products, typically at lower volume levels.

PROJECT LAYOUT

In a project layout, a high degree of task ordering is common. To the extent that this task ordering, or precedence, determines production stages, a project layout may be developed by arranging materials according to their assembly priority. This procedure would be expected in making a layout for a large machine tool, such as a stamping machine, where manufacturing follows a rigid sequence; assembly is performed from the ground up, with parts being added to the base in almost a building-block fashion.

A workcenter layout, sometimes referred to as a job shop, is where similar equipment or functions

150

are grouped together, such as all drilling machines in one area and all stamping machines in another. A part being worked on travels, according to the established sequence of operations, from workcenter to workcenter, where the proper machines are located for each operation.

WORKCENTERS

The most common approach to developing this type of layout is to arrange workcenters in a way that optimizes the movement of material. A workcenter sometimes is referred to as a department and is focused on a particular type of operation. Examples include a workcenter for drilling holes, one for performing grinding operations, and a painting area. The workcenters in a low-volume toy factory might consist of shipping and receiving, plastic molding and stamping, metal forming, sewing, and painting. Parts for the toys are fabricated in these workcenters and then sent to the assembly workcenter, where they are put together. In many installations, optimal placement often means placing workcenters with large amounts of interdepartmental traffic adjacent to each other.

Manufacturing cell

Dedicated area where a group of similar products are produced.

A manufacturing cell layout is a dedicated area where products that are similar in processing requirements are produced. These cells are designed to perform a specific set of processes, and the cells are dedicated to a limited range of products. A firm may have many different cells in a production area, each set up to produce a single product or a similar group of products efficiently, but typically at lower volume levels. These cells typically are scheduled to produce “as needed” in response to current customer demand.

Assembly line

An item is produced through a fixed sequence of workstations, designed to achieve a specific production rate.

Manufacturing cells are formed by allocating dissimilar machines to cells that are designed to work on products that have similar shapes and processing requirements. Manufacturing cells are widely used in metal fabricating, computer chip manufacture, and assembly work.

MANUFACTURING CELL

An assembly line is where work processes are arranged according to the progressive steps by which the product is made. These steps are defined so that a specific production rate can be achieved. The path for each part is, in effect, a straight line. Discrete products are made by moving from workstation to workstation at a controlled rate, following the sequence needed to build the product. Examples include the assembly of toys, appliances, and automobiles. These are typically used in high-volume items where the specialized process can be justified.

ASSEMBLY LINE

The assembly line steps are done in areas referred to as “stations,” and typically the stations are linked by some form of material handling device. In addition, usually there is some form of pacing by which the amount of time allowed at each station is managed. Rather than develop the process for designing assembly at this time, we will devote the entire next section of this chapter to the topic of assembly line design since these designs are used so often by manufacturing firms around the world. A continuous or flow process is similar to an assembly line except that the product continuously moves through the process. Often the item being produced by the continuous process is a liquid or chemical that actually “flows” through the system; this is the origin of the term. A gasoline refinery is a good example of a flow process.

151

exhibit 7.2 Product–Process Matrix: Framework Describing Layout Strategies

A continuous process is similar to an assembly line in that production follows a predetermined sequence of steps, but the flow is continuous such as with liquids, rather than discrete. Such structures are usually highly automated and, in effect, constitute one integrated “machine” that may operate 24 hours a day to avoid expensive shutdowns and start-ups. Conversion and processing of undifferentiated materials such as petroleum, chemicals, and drugs are good examples.

Continuous process

A process that converts raw materials into finished product in one contiguous process.

The relationship between layout structures is often depicted on a product–process matrix similar to the one shown in Exhibit 7.2. Two dimensions are shown. The first dimension relates to the volume of a particular product or group of standardized products. Standardization is shown on the vertical axis and refers to variations in the product that is produced. These variations are measured in terms of geometric differences, material differences, and so on. Standardized products are highly similar from a manufacturing processing point of view, whereas low standardized products require different processes.

Product–process matrix

A framework depicting when the different production process types are typically used depending on product volume and how standardized the product is.

Exhibit 7.2 shows the processes approximately on a diagonal. In general, it can be argued that it is desirable to design processes along the diagonal. For example, if we produce nonstandard products at relatively low volumes, workcenters should be used. A highly standardized product (commodity) produced at high volumes should be produced using an assembly line or a continuous process, if possible. As a result of the advanced manufacturing technology available today, we see that some of the layout structures span relatively large areas of the product–process matrix. For example, manufacturing cells can be used for a very wide range of applications, and this has become a popular layout structure that often is employed by manufacturing engineers.

Analytics

### Break-Even Analysis

The choice of which specific equipment to use in a process often can be based on an analysis of cost trade-offs. There is often a trade-off between more and less specialized equipment. Less specialized equipment is referred to as “general-purpose,” meaning that it can be used easily in many different ways if it is set up in the proper way. More specialized equipment, referred to as “special-purpose,” is often available as an alternative to a general-purpose machine. For example, if we need to drill holes in a piece of metal, the general-purpose option may be to use a simple hand drill. An alternative special-purpose drill is a drill press. Given the proper setup, the drill press can drill holes much quicker than the hand drill can. The trade-offs involve the cost of the equipment (the manual drill is inexpensive, and the drill press expensive), the setup time (the manual drill is quick, while the drill press takes some time), and the time per unit (the manual drill is slow, and the drill press quick).

152

A standard approach to choosing among alternative processes or equipment is break-even analysis. A break-even chart visually presents alternative profits and losses due to the number of units produced or sold. The choice obviously depends on anticipated demand. The method is most suitable when processes and equipment entail a large initial investment and fixed cost, and when variable costs are reasonably proportional to the number of units produced.

EXAMPLE 7.1: Break-Even Analysis

Suppose a manufacturer has identified the following options for obtaining a machined part: It can buy the part at $200 per unit (including materials); it can make the part on a numerically controlled semiautomatic lathe at$75 per unit (including materials); or it can make the part on a machining center at $15 per unit (including materials). There is negligible fixed cost if the item is purchased; a semiautomatic lathe costs$80,000; and a machining center costs $200,000. To view a tutorial on break-even analysis, visit www.mhhe.com/jacobs14e_tutorial_ch07. The total cost for each option is Purchase cost=$200×DemandProduceusinglathe cost=$80,000+$75×DemandProduceusingmachiningcenter cost=

## manufacturing-process

What are the characteristics of a manufacturing process? How are manufacturing processes organized and evaluated? 500word response

Below is the chapter and citation.

Jacobs, F.R. & Chase, R.B. (2014). Operations and supply chain management (14th ed). New York, NY: McGraw-Hill

Understand what a manufacturing process is.

In this chapter we consider processes used to make tangible goods. Manufacturing processes are used to make everything that we buy ranging from the apartment building in which we live to the ink pens with which we write. The high-level view of what is required to make something can be divided into three simple steps. The first step is sourcing the parts we need, followed by actually making the item, and then sending the item to the customer. As discussed in Chapter 1, a supply chain view of this may involve a complex series of players where subcontractors feed suppliers, suppliers feed manufacturing plants, manufacturing plants feed warehouses, and finally warehouses feed retailers. Depending on the item being produced, the supply chain can be very long with subcontractors and manufacturing plants spread out over the globe (such as an automobile or computer manufacturer) or short where parts are sourced and the product is made locally (such as a house builder).

Strategy

Consider Exhibit 7.1, which illustrates the Source step where parts are procured from one or more suppliers, the Make step where manufacturing takes place, and the Deliver step where the product is shipped to the customer. Depending on the strategy of the firm, the capabilities of manufacturing, and the needs of customers, these activities are organized to minimize cost while meeting the competitive priorities necessary to attract customer orders. For example, in the case of consumer products such as televisions or clothes, customers normally want these products “on-demand” for quick delivery from a local department store. As a manufacturer of these products, we build them ahead of time in anticipation of demand and ship them to the retail stores where they are carried in inventory until they are sold. At the other end of the spectrum are custom products, such as military airplanes, that are ordered with very specific uses in mind and that need to be designed and then built to the design. In the case of an airplane, the time needed to respond to a customer order, called the , could easily be years compared to only a few minutes for the television.

The time needed to respond to a customer order.

A key concept in manufacturing processes is the which determines where inventory is positioned to allow processes or entities in the supply chain to operate independently. For example, if a product is stocked at a retailer, the customer pulls

Customer order decoupling point

Where inventory is positioned in the supply chain.

exhibit 7.1 Positioning Inventory in the Supply Chain

148

the item from the shelf and the manufacturer never sees a customer order. Inventory acts as a buffer to separate the customer from the manufacturing process. Selection of decoupling points is a strategic decision that determines customer lead times and can greatly impact inventory investment. The closer this point is to the customer, the quicker the customer can be served. Typically, there is a trade-off where quicker response to customer demand comes at the expense of greater inventory investment because finished goods inventory is more expensive than raw material inventory. An item in finished goods inventory typically contains all the raw materials needed to produce the item. So from a cost view it includes the cost of the material plus the cost to fabricate the finished item.

Make-to-stock Assemble-to-order Make-to-order Engineer-to-order

These terms describe how customers are served by a firm.

Positioning of the customer order decoupling point is important to understanding manufacturing environments. Firms that serve customers from finished goods inventory are known as firms. Those that combine a number of preassembled modules to meet a customer’s specifications are called firms. Those that make the customer’s product from raw materials, parts, and components are firms. An firm will work with the customer to design the product, and then make it from purchased materials, parts, and components. Of course, many firms serve a combination of these environments and a few will have all simultaneously. Depending on the environment and the location of the customer order decoupling point, one would expect inventory concentrated in finished goods, work-in-process (this is inventory in the manufacturing process), manufacturing raw material, or at the supplier as shown in Exhibit 7.1.

Lean manufacturing

To achieve high customer service with minimum levels of inventory investment.

The essential issue in satisfying customers in the make-to-stock environment is to balance the level of finished inventory against the level of service to the customer. Examples of products produced by these firms include televisions, clothing, and packaged food products. If unlimited inventory were possible and free, the task would be trivial. Unfortunately, that is not the case. Providing more inventory increases costs, so a trade-off between the costs of the inventory and the level of customer service must be made. The trade-off can be improved by better estimates (or knowledge) of customer demand, by more rapid transportation alternatives, by speedier production, and by more flexible manufacturing. Many make-to-stock firms invest in programs in order to achieve higher service levels for a given inventory investment. Regardless of the trade-offs involved, the focus in the make-to-stock environment is on providing finished goods where and when the customers want them.

In the assemble-to-order environment, a primary task is to define a customer’s order in terms of alternative components and options since it is these components that are carried in inventory. A good example is the way Dell Computer makes desktop computers. The number of combinations that can be made may be nearly infinite (although some might not be feasible). One of the capabilities required for success in the assemble-to-order environment is an engineering design that enables as much flexibility as possible in combining components, options, and modules into finished products. Similar to make-to-stock, many assemble-to-order companies have applied lean manufacturing principles to dramatically decrease the time required to assemble finished goods. By doing so they are delivering customers’ orders so quickly that they appear to be make-to-stock firms from the perspective of the customer.

LATASHA BELL, A DELL INC. EMPLOYEE, ASSEMBLES A DELL OPTIPLEX DESKTOP COMPUTER AT THE COMPANYS FACILITY IN LEBANON, TENNESSEE, U.S.

When assembling-to-order there are significant advantages from moving the customer order decoupling point from finished goods to components. The number of finished products is usually substantially greater than the number of components that are combined to produce the finished product. Consider, for example, a computer for which there are four processor alternatives, three hard disk drive choices, four DVD alternatives, two speaker systems, and four monitors available. If all combinations of these 17 components are valid, they can be combined into a total of 384 different final configurations. This can be calculated as follows:

149

If Ni is the number of alternatives for component i, the total number of combinations of n components (given all are viable) is:

Total number of combinations=N1×N2×NnOr 384=4×3×4×2×4 for this example.[7.1]



Total number of combinations

=

N

1

×

N

2

×

N

n

Or

384

=

4

×

3

×

4

×

2

×

4

for this example

.

[

7.1

]

It is much easier to manage and forecast the demand for 17 components than for 384 computers.

In the make-to-order and engineer-to-order environments the customer order decoupling point could be in either raw materials at the manufacturing site or possibly even with the supplier inventory. Boeing’s process for making commercial aircraft is an example of make-to-order. The need for engineering resources in the engineer-to-order case is somewhat different than make-to-order since engineering determines what materials will be required and what steps will be required in manufacturing. Depending on how similar the products are it might not even be possible to pre-order parts. Rather than inventory, the emphasis in these environments may be more toward managing capacity of critical resources such as engineering and construction crews. Lockheed Martin’s Satellite division uses an engineer-to-order strategy.

### HOW MANUFACTURING PROCESSES ARE ORGANIZED

LO7–2

Explain how manufacturing processes are organized.

Process selection refers to the strategic decision of selecting which kind of production processes to use to produce a product or provide a service. For example, in the case of Toshiba notebook computers, if the volume is very low, we may just have a worker manually assemble each computer by hand. In contrast, if the volume is higher, setting up an assembly line is appropriate.

The formats by which a facility is arranged are defined by the general pattern of work flow; there are five basic structures (project, workcenter, manufacturing cell, assembly line, and continuous process).

Project layout

For large or massive products produced in a specific location, labor, material, and equipment are moved to the product rather than vice versa.

In a project layout, the product (by virtue of its bulk or weight) remains in a fixed location. Manufacturing equipment is moved to the product rather than vice versa. Construction sites (houses and bridges) and movie shooting lots are examples of this format. Items produced with this type of layout are typically managed using the project management techniques described in Chapter 4. Areas on the site will be designated for various purposes, such as material staging, subassembly construction, site access for heavy equipment, and a management area.

In developing a project layout, visualize the product as the hub of a wheel, with materials and equipment arranged concentrically around the production point in the order of use and movement difficulty. Thus, in building commercial aircraft, for example, rivets that are used throughout construction would be placed close to or in the fuselage; heavy engine parts, which must travel to the fuselage only once, would be placed at a more distant location; and cranes would be set up close to the fuselage because of their constant use.

Workcenter

A process with great flexibility to produce a variety of products, typically at lower volume levels.

PROJECT LAYOUT

In a project layout, a high degree of task ordering is common. To the extent that this task ordering, or precedence, determines production stages, a project layout may be developed by arranging materials according to their assembly priority. This procedure would be expected in making a layout for a large machine tool, such as a stamping machine, where manufacturing follows a rigid sequence; assembly is performed from the ground up, with parts being added to the base in almost a building-block fashion.

A workcenter layout, sometimes referred to as a job shop, is where similar equipment or functions

150

are grouped together, such as all drilling machines in one area and all stamping machines in another. A part being worked on travels, according to the established sequence of operations, from workcenter to workcenter, where the proper machines are located for each operation.

WORKCENTERS

The most common approach to developing this type of layout is to arrange workcenters in a way that optimizes the movement of material. A workcenter sometimes is referred to as a department and is focused on a particular type of operation. Examples include a workcenter for drilling holes, one for performing grinding operations, and a painting area. The workcenters in a low-volume toy factory might consist of shipping and receiving, plastic molding and stamping, metal forming, sewing, and painting. Parts for the toys are fabricated in these workcenters and then sent to the assembly workcenter, where they are put together. In many installations, optimal placement often means placing workcenters with large amounts of interdepartmental traffic adjacent to each other.

Manufacturing cell

Dedicated area where a group of similar products are produced.

A manufacturing cell layout is a dedicated area where products that are similar in processing requirements are produced. These cells are designed to perform a specific set of processes, and the cells are dedicated to a limited range of products. A firm may have many different cells in a production area, each set up to produce a single product or a similar group of products efficiently, but typically at lower volume levels. These cells typically are scheduled to produce “as needed” in response to current customer demand.

Assembly line

An item is produced through a fixed sequence of workstations, designed to achieve a specific production rate.

Manufacturing cells are formed by allocating dissimilar machines to cells that are designed to work on products that have similar shapes and processing requirements. Manufacturing cells are widely used in metal fabricating, computer chip manufacture, and assembly work.

MANUFACTURING CELL

An assembly line is where work processes are arranged according to the progressive steps by which the product is made. These steps are defined so that a specific production rate can be achieved. The path for each part is, in effect, a straight line. Discrete products are made by moving from workstation to workstation at a controlled rate, following the sequence needed to build the product. Examples include the assembly of toys, appliances, and automobiles. These are typically used in high-volume items where the specialized process can be justified.

ASSEMBLY LINE

The assembly line steps are done in areas referred to as “stations,” and typically the stations are linked by some form of material handling device. In addition, usually there is some form of pacing by which the amount of time allowed at each station is managed. Rather than develop the process for designing assembly at this time, we will devote the entire next section of this chapter to the topic of assembly line design since these designs are used so often by manufacturing firms around the world. A continuous or flow process is similar to an assembly line except that the product continuously moves through the process. Often the item being produced by the continuous process is a liquid or chemical that actually “flows” through the system; this is the origin of the term. A gasoline refinery is a good example of a flow process.

151

exhibit 7.2 Product–Process Matrix: Framework Describing Layout Strategies

A continuous process is similar to an assembly line in that production follows a predetermined sequence of steps, but the flow is continuous such as with liquids, rather than discrete. Such structures are usually highly automated and, in effect, constitute one integrated “machine” that may operate 24 hours a day to avoid expensive shutdowns and start-ups. Conversion and processing of undifferentiated materials such as petroleum, chemicals, and drugs are good examples.

Continuous process

A process that converts raw materials into finished product in one contiguous process.

The relationship between layout structures is often depicted on a product–process matrix similar to the one shown in Exhibit 7.2. Two dimensions are shown. The first dimension relates to the volume of a particular product or group of standardized products. Standardization is shown on the vertical axis and refers to variations in the product that is produced. These variations are measured in terms of geometric differences, material differences, and so on. Standardized products are highly similar from a manufacturing processing point of view, whereas low standardized products require different processes.

Product–process matrix

A framework depicting when the different production process types are typically used depending on product volume and how standardized the product is.

Exhibit 7.2 shows the processes approximately on a diagonal. In general, it can be argued that it is desirable to design processes along the diagonal. For example, if we produce nonstandard products at relatively low volumes, workcenters should be used. A highly standardized product (commodity) produced at high volumes should be produced using an assembly line or a continuous process, if possible. As a result of the advanced manufacturing technology available today, we see that some of the layout structures span relatively large areas of the product–process matrix. For example, manufacturing cells can be used for a very wide range of applications, and this has become a popular layout structure that often is employed by manufacturing engineers.

Analytics

### Break-Even Analysis

The choice of which specific equipment to use in a process often can be based on an analysis of cost trade-offs. There is often a trade-off between more and less specialized equipment. Less specialized equipment is referred to as “general-purpose,” meaning that it can be used easily in many different ways if it is set up in the proper way. More specialized equipment, referred to as “special-purpose,” is often available as an alternative to a general-purpose machine. For example, if we need to drill holes in a piece of metal, the general-purpose option may be to use a simple hand drill. An alternative special-purpose drill is a drill press. Given the proper setup, the drill press can drill holes much quicker than the hand drill can. The trade-offs involve the cost of the equipment (the manual drill is inexpensive, and the drill press expensive), the setup time (the manual drill is quick, while the drill press takes some time), and the time per unit (the manual drill is slow, and the drill press quick).

152

A standard approach to choosing among alternative processes or equipment is break-even analysis. A break-even chart visually presents alternative profits and losses due to the number of units produced or sold. The choice obviously depends on anticipated demand. The method is most suitable when processes and equipment entail a large initial investment and fixed cost, and when variable costs are reasonably proportional to the number of units produced.

EXAMPLE 7.1: Break-Even Analysis

Suppose a manufacturer has identified the following options for obtaining a machined part: It can buy the part at $200 per unit (including materials); it can make the part on a numerically controlled semiautomatic lathe at$75 per unit (including materials); or it can make the part on a machining center at $15 per unit (including materials). There is negligible fixed cost if the item is purchased; a semiautomatic lathe costs$80,000; and a machining center costs $200,000. To view a tutorial on break-even analysis, visit www.mhhe.com/jacobs14e_tutorial_ch07. The total cost for each option is Purchase cost=$200×DemandProduceusinglathe cost=$80,000+$75×DemandProduceusingmachiningcenter cost=

## manufacturing-process

What are the characteristics of a manufacturing process? How are manufacturing processes organized and evaluated? 500word response

Below is the chapter and citation.

Jacobs, F.R. & Chase, R.B. (2014). Operations and supply chain management (14th ed). New York, NY: McGraw-Hill

Understand what a manufacturing process is.

In this chapter we consider processes used to make tangible goods. Manufacturing processes are used to make everything that we buy ranging from the apartment building in which we live to the ink pens with which we write. The high-level view of what is required to make something can be divided into three simple steps. The first step is sourcing the parts we need, followed by actually making the item, and then sending the item to the customer. As discussed in Chapter 1, a supply chain view of this may involve a complex series of players where subcontractors feed suppliers, suppliers feed manufacturing plants, manufacturing plants feed warehouses, and finally warehouses feed retailers. Depending on the item being produced, the supply chain can be very long with subcontractors and manufacturing plants spread out over the globe (such as an automobile or computer manufacturer) or short where parts are sourced and the product is made locally (such as a house builder).

Strategy

Consider Exhibit 7.1, which illustrates the Source step where parts are procured from one or more suppliers, the Make step where manufacturing takes place, and the Deliver step where the product is shipped to the customer. Depending on the strategy of the firm, the capabilities of manufacturing, and the needs of customers, these activities are organized to minimize cost while meeting the competitive priorities necessary to attract customer orders. For example, in the case of consumer products such as televisions or clothes, customers normally want these products “on-demand” for quick delivery from a local department store. As a manufacturer of these products, we build them ahead of time in anticipation of demand and ship them to the retail stores where they are carried in inventory until they are sold. At the other end of the spectrum are custom products, such as military airplanes, that are ordered with very specific uses in mind and that need to be designed and then built to the design. In the case of an airplane, the time needed to respond to a customer order, called the , could easily be years compared to only a few minutes for the television.

The time needed to respond to a customer order.

A key concept in manufacturing processes is the which determines where inventory is positioned to allow processes or entities in the supply chain to operate independently. For example, if a product is stocked at a retailer, the customer pulls

Customer order decoupling point

Where inventory is positioned in the supply chain.

exhibit 7.1 Positioning Inventory in the Supply Chain

148

the item from the shelf and the manufacturer never sees a customer order. Inventory acts as a buffer to separate the customer from the manufacturing process. Selection of decoupling points is a strategic decision that determines customer lead times and can greatly impact inventory investment. The closer this point is to the customer, the quicker the customer can be served. Typically, there is a trade-off where quicker response to customer demand comes at the expense of greater inventory investment because finished goods inventory is more expensive than raw material inventory. An item in finished goods inventory typically contains all the raw materials needed to produce the item. So from a cost view it includes the cost of the material plus the cost to fabricate the finished item.

Make-to-stock Assemble-to-order Make-to-order Engineer-to-order

These terms describe how customers are served by a firm.

Positioning of the customer order decoupling point is important to understanding manufacturing environments. Firms that serve customers from finished goods inventory are known as firms. Those that combine a number of preassembled modules to meet a customer’s specifications are called firms. Those that make the customer’s product from raw materials, parts, and components are firms. An firm will work with the customer to design the product, and then make it from purchased materials, parts, and components. Of course, many firms serve a combination of these environments and a few will have all simultaneously. Depending on the environment and the location of the customer order decoupling point, one would expect inventory concentrated in finished goods, work-in-process (this is inventory in the manufacturing process), manufacturing raw material, or at the supplier as shown in Exhibit 7.1.

Lean manufacturing

To achieve high customer service with minimum levels of inventory investment.

The essential issue in satisfying customers in the make-to-stock environment is to balance the level of finished inventory against the level of service to the customer. Examples of products produced by these firms include televisions, clothing, and packaged food products. If unlimited inventory were possible and free, the task would be trivial. Unfortunately, that is not the case. Providing more inventory increases costs, so a trade-off between the costs of the inventory and the level of customer service must be made. The trade-off can be improved by better estimates (or knowledge) of customer demand, by more rapid transportation alternatives, by speedier production, and by more flexible manufacturing. Many make-to-stock firms invest in programs in order to achieve higher service levels for a given inventory investment. Regardless of the trade-offs involved, the focus in the make-to-stock environment is on providing finished goods where and when the customers want them.

In the assemble-to-order environment, a primary task is to define a customer’s order in terms of alternative components and options since it is these components that are carried in inventory. A good example is the way Dell Computer makes desktop computers. The number of combinations that can be made may be nearly infinite (although some might not be feasible). One of the capabilities required for success in the assemble-to-order environment is an engineering design that enables as much flexibility as possible in combining components, options, and modules into finished products. Similar to make-to-stock, many assemble-to-order companies have applied lean manufacturing principles to dramatically decrease the time required to assemble finished goods. By doing so they are delivering customers’ orders so quickly that they appear to be make-to-stock firms from the perspective of the customer.

LATASHA BELL, A DELL INC. EMPLOYEE, ASSEMBLES A DELL OPTIPLEX DESKTOP COMPUTER AT THE COMPANYS FACILITY IN LEBANON, TENNESSEE, U.S.

When assembling-to-order there are significant advantages from moving the customer order decoupling point from finished goods to components. The number of finished products is usually substantially greater than the number of components that are combined to produce the finished product. Consider, for example, a computer for which there are four processor alternatives, three hard disk drive choices, four DVD alternatives, two speaker systems, and four monitors available. If all combinations of these 17 components are valid, they can be combined into a total of 384 different final configurations. This can be calculated as follows:

149

If Ni is the number of alternatives for component i, the total number of combinations of n components (given all are viable) is:

Total number of combinations=N1×N2×NnOr 384=4×3×4×2×4 for this example.[7.1]



Total number of combinations

=

N

1

×

N

2

×

N

n

Or

384

=

4

×

3

×

4

×

2

×

4

for this example

.

[

7.1

]

It is much easier to manage and forecast the demand for 17 components than for 384 computers.

In the make-to-order and engineer-to-order environments the customer order decoupling point could be in either raw materials at the manufacturing site or possibly even with the supplier inventory. Boeing’s process for making commercial aircraft is an example of make-to-order. The need for engineering resources in the engineer-to-order case is somewhat different than make-to-order since engineering determines what materials will be required and what steps will be required in manufacturing. Depending on how similar the products are it might not even be possible to pre-order parts. Rather than inventory, the emphasis in these environments may be more toward managing capacity of critical resources such as engineering and construction crews. Lockheed Martin’s Satellite division uses an engineer-to-order strategy.

### HOW MANUFACTURING PROCESSES ARE ORGANIZED

LO7–2

Explain how manufacturing processes are organized.

Process selection refers to the strategic decision of selecting which kind of production processes to use to produce a product or provide a service. For example, in the case of Toshiba notebook computers, if the volume is very low, we may just have a worker manually assemble each computer by hand. In contrast, if the volume is higher, setting up an assembly line is appropriate.

The formats by which a facility is arranged are defined by the general pattern of work flow; there are five basic structures (project, workcenter, manufacturing cell, assembly line, and continuous process).

Project layout

For large or massive products produced in a specific location, labor, material, and equipment are moved to the product rather than vice versa.

In a project layout, the product (by virtue of its bulk or weight) remains in a fixed location. Manufacturing equipment is moved to the product rather than vice versa. Construction sites (houses and bridges) and movie shooting lots are examples of this format. Items produced with this type of layout are typically managed using the project management techniques described in Chapter 4. Areas on the site will be designated for various purposes, such as material staging, subassembly construction, site access for heavy equipment, and a management area.

In developing a project layout, visualize the product as the hub of a wheel, with materials and equipment arranged concentrically around the production point in the order of use and movement difficulty. Thus, in building commercial aircraft, for example, rivets that are used throughout construction would be placed close to or in the fuselage; heavy engine parts, which must travel to the fuselage only once, would be placed at a more distant location; and cranes would be set up close to the fuselage because of their constant use.

Workcenter

A process with great flexibility to produce a variety of products, typically at lower volume levels.

PROJECT LAYOUT

In a project layout, a high degree of task ordering is common. To the extent that this task ordering, or precedence, determines production stages, a project layout may be developed by arranging materials according to their assembly priority. This procedure would be expected in making a layout for a large machine tool, such as a stamping machine, where manufacturing follows a rigid sequence; assembly is performed from the ground up, with parts being added to the base in almost a building-block fashion.

A workcenter layout, sometimes referred to as a job shop, is where similar equipment or functions

150

are grouped together, such as all drilling machines in one area and all stamping machines in another. A part being worked on travels, according to the established sequence of operations, from workcenter to workcenter, where the proper machines are located for each operation.

WORKCENTERS

The most common approach to developing this type of layout is to arrange workcenters in a way that optimizes the movement of material. A workcenter sometimes is referred to as a department and is focused on a particular type of operation. Examples include a workcenter for drilling holes, one for performing grinding operations, and a painting area. The workcenters in a low-volume toy factory might consist of shipping and receiving, plastic molding and stamping, metal forming, sewing, and painting. Parts for the toys are fabricated in these workcenters and then sent to the assembly workcenter, where they are put together. In many installations, optimal placement often means placing workcenters with large amounts of interdepartmental traffic adjacent to each other.

Manufacturing cell

Dedicated area where a group of similar products are produced.

A manufacturing cell layout is a dedicated area where products that are similar in processing requirements are produced. These cells are designed to perform a specific set of processes, and the cells are dedicated to a limited range of products. A firm may have many different cells in a production area, each set up to produce a single product or a similar group of products efficiently, but typically at lower volume levels. These cells typically are scheduled to produce “as needed” in response to current customer demand.

Assembly line

An item is produced through a fixed sequence of workstations, designed to achieve a specific production rate.

Manufacturing cells are formed by allocating dissimilar machines to cells that are designed to work on products that have similar shapes and processing requirements. Manufacturing cells are widely used in metal fabricating, computer chip manufacture, and assembly work.

MANUFACTURING CELL

An assembly line is where work processes are arranged according to the progressive steps by which the product is made. These steps are defined so that a specific production rate can be achieved. The path for each part is, in effect, a straight line. Discrete products are made by moving from workstation to workstation at a controlled rate, following the sequence needed to build the product. Examples include the assembly of toys, appliances, and automobiles. These are typically used in high-volume items where the specialized process can be justified.

ASSEMBLY LINE

The assembly line steps are done in areas referred to as “stations,” and typically the stations are linked by some form of material handling device. In addition, usually there is some form of pacing by which the amount of time allowed at each station is managed. Rather than develop the process for designing assembly at this time, we will devote the entire next section of this chapter to the topic of assembly line design since these designs are used so often by manufacturing firms around the world. A continuous or flow process is similar to an assembly line except that the product continuously moves through the process. Often the item being produced by the continuous process is a liquid or chemical that actually “flows” through the system; this is the origin of the term. A gasoline refinery is a good example of a flow process.

151

exhibit 7.2 Product–Process Matrix: Framework Describing Layout Strategies

A continuous process is similar to an assembly line in that production follows a predetermined sequence of steps, but the flow is continuous such as with liquids, rather than discrete. Such structures are usually highly automated and, in effect, constitute one integrated “machine” that may operate 24 hours a day to avoid expensive shutdowns and start-ups. Conversion and processing of undifferentiated materials such as petroleum, chemicals, and drugs are good examples.

Continuous process

A process that converts raw materials into finished product in one contiguous process.

The relationship between layout structures is often depicted on a product–process matrix similar to the one shown in Exhibit 7.2. Two dimensions are shown. The first dimension relates to the volume of a particular product or group of standardized products. Standardization is shown on the vertical axis and refers to variations in the product that is produced. These variations are measured in terms of geometric differences, material differences, and so on. Standardized products are highly similar from a manufacturing processing point of view, whereas low standardized products require different processes.

Product–process matrix

A framework depicting when the different production process types are typically used depending on product volume and how standardized the product is.

Exhibit 7.2 shows the processes approximately on a diagonal. In general, it can be argued that it is desirable to design processes along the diagonal. For example, if we produce nonstandard products at relatively low volumes, workcenters should be used. A highly standardized product (commodity) produced at high volumes should be produced using an assembly line or a continuous process, if possible. As a result of the advanced manufacturing technology available today, we see that some of the layout structures span relatively large areas of the product–process matrix. For example, manufacturing cells can be used for a very wide range of applications, and this has become a popular layout structure that often is employed by manufacturing engineers.

Analytics

### Break-Even Analysis

The choice of which specific equipment to use in a process often can be based on an analysis of cost trade-offs. There is often a trade-off between more and less specialized equipment. Less specialized equipment is referred to as “general-purpose,” meaning that it can be used easily in many different ways if it is set up in the proper way. More specialized equipment, referred to as “special-purpose,” is often available as an alternative to a general-purpose machine. For example, if we need to drill holes in a piece of metal, the general-purpose option may be to use a simple hand drill. An alternative special-purpose drill is a drill press. Given the proper setup, the drill press can drill holes much quicker than the hand drill can. The trade-offs involve the cost of the equipment (the manual drill is inexpensive, and the drill press expensive), the setup time (the manual drill is quick, while the drill press takes some time), and the time per unit (the manual drill is slow, and the drill press quick).

152

A standard approach to choosing among alternative processes or equipment is break-even analysis. A break-even chart visually presents alternative profits and losses due to the number of units produced or sold. The choice obviously depends on anticipated demand. The method is most suitable when processes and equipment entail a large initial investment and fixed cost, and when variable costs are reasonably proportional to the number of units produced.

EXAMPLE 7.1: Break-Even Analysis

Suppose a manufacturer has identified the following options for obtaining a machined part: It can buy the part at $200 per unit (including materials); it can make the part on a numerically controlled semiautomatic lathe at$75 per unit (including materials); or it can make the part on a machining center at $15 per unit (including materials). There is negligible fixed cost if the item is purchased; a semiautomatic lathe costs$80,000; and a machining center costs $200,000. To view a tutorial on break-even analysis, visit www.mhhe.com/jacobs14e_tutorial_ch07. The total cost for each option is Purchase cost=$200×DemandProduceusinglathe cost=$80,000+$75×DemandProduceusingmachiningcenter cost=

## manufacturing-process

What are the characteristics of a manufacturing process? How are manufacturing processes organized and evaluated? 500word response

Below is the chapter and citation.

Jacobs, F.R. & Chase, R.B. (2014). Operations and supply chain management (14th ed). New York, NY: McGraw-Hill

Understand what a manufacturing process is.

In this chapter we consider processes used to make tangible goods. Manufacturing processes are used to make everything that we buy ranging from the apartment building in which we live to the ink pens with which we write. The high-level view of what is required to make something can be divided into three simple steps. The first step is sourcing the parts we need, followed by actually making the item, and then sending the item to the customer. As discussed in Chapter 1, a supply chain view of this may involve a complex series of players where subcontractors feed suppliers, suppliers feed manufacturing plants, manufacturing plants feed warehouses, and finally warehouses feed retailers. Depending on the item being produced, the supply chain can be very long with subcontractors and manufacturing plants spread out over the globe (such as an automobile or computer manufacturer) or short where parts are sourced and the product is made locally (such as a house builder).

Strategy

Consider Exhibit 7.1, which illustrates the Source step where parts are procured from one or more suppliers, the Make step where manufacturing takes place, and the Deliver step where the product is shipped to the customer. Depending on the strategy of the firm, the capabilities of manufacturing, and the needs of customers, these activities are organized to minimize cost while meeting the competitive priorities necessary to attract customer orders. For example, in the case of consumer products such as televisions or clothes, customers normally want these products “on-demand” for quick delivery from a local department store. As a manufacturer of these products, we build them ahead of time in anticipation of demand and ship them to the retail stores where they are carried in inventory until they are sold. At the other end of the spectrum are custom products, such as military airplanes, that are ordered with very specific uses in mind and that need to be designed and then built to the design. In the case of an airplane, the time needed to respond to a customer order, called the , could easily be years compared to only a few minutes for the television.

The time needed to respond to a customer order.

A key concept in manufacturing processes is the which determines where inventory is positioned to allow processes or entities in the supply chain to operate independently. For example, if a product is stocked at a retailer, the customer pulls

Customer order decoupling point

Where inventory is positioned in the supply chain.

exhibit 7.1 Positioning Inventory in the Supply Chain

148

the item from the shelf and the manufacturer never sees a customer order. Inventory acts as a buffer to separate the customer from the manufacturing process. Selection of decoupling points is a strategic decision that determines customer lead times and can greatly impact inventory investment. The closer this point is to the customer, the quicker the customer can be served. Typically, there is a trade-off where quicker response to customer demand comes at the expense of greater inventory investment because finished goods inventory is more expensive than raw material inventory. An item in finished goods inventory typically contains all the raw materials needed to produce the item. So from a cost view it includes the cost of the material plus the cost to fabricate the finished item.

Make-to-stock Assemble-to-order Make-to-order Engineer-to-order

These terms describe how customers are served by a firm.

Positioning of the customer order decoupling point is important to understanding manufacturing environments. Firms that serve customers from finished goods inventory are known as firms. Those that combine a number of preassembled modules to meet a customer’s specifications are called firms. Those that make the customer’s product from raw materials, parts, and components are firms. An firm will work with the customer to design the product, and then make it from purchased materials, parts, and components. Of course, many firms serve a combination of these environments and a few will have all simultaneously. Depending on the environment and the location of the customer order decoupling point, one would expect inventory concentrated in finished goods, work-in-process (this is inventory in the manufacturing process), manufacturing raw material, or at the supplier as shown in Exhibit 7.1.

Lean manufacturing

To achieve high customer service with minimum levels of inventory investment.

The essential issue in satisfying customers in the make-to-stock environment is to balance the level of finished inventory against the level of service to the customer. Examples of products produced by these firms include televisions, clothing, and packaged food products. If unlimited inventory were possible and free, the task would be trivial. Unfortunately, that is not the case. Providing more inventory increases costs, so a trade-off between the costs of the inventory and the level of customer service must be made. The trade-off can be improved by better estimates (or knowledge) of customer demand, by more rapid transportation alternatives, by speedier production, and by more flexible manufacturing. Many make-to-stock firms invest in programs in order to achieve higher service levels for a given inventory investment. Regardless of the trade-offs involved, the focus in the make-to-stock environment is on providing finished goods where and when the customers want them.

In the assemble-to-order environment, a primary task is to define a customer’s order in terms of alternative components and options since it is these components that are carried in inventory. A good example is the way Dell Computer makes desktop computers. The number of combinations that can be made may be nearly infinite (although some might not be feasible). One of the capabilities required for success in the assemble-to-order environment is an engineering design that enables as much flexibility as possible in combining components, options, and modules into finished products. Similar to make-to-stock, many assemble-to-order companies have applied lean manufacturing principles to dramatically decrease the time required to assemble finished goods. By doing so they are delivering customers’ orders so quickly that they appear to be make-to-stock firms from the perspective of the customer.

LATASHA BELL, A DELL INC. EMPLOYEE, ASSEMBLES A DELL OPTIPLEX DESKTOP COMPUTER AT THE COMPANYS FACILITY IN LEBANON, TENNESSEE, U.S.

When assembling-to-order there are significant advantages from moving the customer order decoupling point from finished goods to components. The number of finished products is usually substantially greater than the number of components that are combined to produce the finished product. Consider, for example, a computer for which there are four processor alternatives, three hard disk drive choices, four DVD alternatives, two speaker systems, and four monitors available. If all combinations of these 17 components are valid, they can be combined into a total of 384 different final configurations. This can be calculated as follows:

149

If Ni is the number of alternatives for component i, the total number of combinations of n components (given all are viable) is:

Total number of combinations=N1×N2×NnOr 384=4×3×4×2×4 for this example.[7.1]



Total number of combinations

=

N

1

×

N

2

×

N

n

Or

384

=

4

×

3

×

4

×

2

×

4

for this example

.

[

7.1

]

It is much easier to manage and forecast the demand for 17 components than for 384 computers.

In the make-to-order and engineer-to-order environments the customer order decoupling point could be in either raw materials at the manufacturing site or possibly even with the supplier inventory. Boeing’s process for making commercial aircraft is an example of make-to-order. The need for engineering resources in the engineer-to-order case is somewhat different than make-to-order since engineering determines what materials will be required and what steps will be required in manufacturing. Depending on how similar the products are it might not even be possible to pre-order parts. Rather than inventory, the emphasis in these environments may be more toward managing capacity of critical resources such as engineering and construction crews. Lockheed Martin’s Satellite division uses an engineer-to-order strategy.

### HOW MANUFACTURING PROCESSES ARE ORGANIZED

LO7–2

Explain how manufacturing processes are organized.

Process selection refers to the strategic decision of selecting which kind of production processes to use to produce a product or provide a service. For example, in the case of Toshiba notebook computers, if the volume is very low, we may just have a worker manually assemble each computer by hand. In contrast, if the volume is higher, setting up an assembly line is appropriate.

The formats by which a facility is arranged are defined by the general pattern of work flow; there are five basic structures (project, workcenter, manufacturing cell, assembly line, and continuous process).

Project layout

For large or massive products produced in a specific location, labor, material, and equipment are moved to the product rather than vice versa.

In a project layout, the product (by virtue of its bulk or weight) remains in a fixed location. Manufacturing equipment is moved to the product rather than vice versa. Construction sites (houses and bridges) and movie shooting lots are examples of this format. Items produced with this type of layout are typically managed using the project management techniques described in Chapter 4. Areas on the site will be designated for various purposes, such as material staging, subassembly construction, site access for heavy equipment, and a management area.

In developing a project layout, visualize the product as the hub of a wheel, with materials and equipment arranged concentrically around the production point in the order of use and movement difficulty. Thus, in building commercial aircraft, for example, rivets that are used throughout construction would be placed close to or in the fuselage; heavy engine parts, which must travel to the fuselage only once, would be placed at a more distant location; and cranes would be set up close to the fuselage because of their constant use.

Workcenter

A process with great flexibility to produce a variety of products, typically at lower volume levels.

PROJECT LAYOUT

In a project layout, a high degree of task ordering is common. To the extent that this task ordering, or precedence, determines production stages, a project layout may be developed by arranging materials according to their assembly priority. This procedure would be expected in making a layout for a large machine tool, such as a stamping machine, where manufacturing follows a rigid sequence; assembly is performed from the ground up, with parts being added to the base in almost a building-block fashion.

A workcenter layout, sometimes referred to as a job shop, is where similar equipment or functions

150

are grouped together, such as all drilling machines in one area and all stamping machines in another. A part being worked on travels, according to the established sequence of operations, from workcenter to workcenter, where the proper machines are located for each operation.

WORKCENTERS

The most common approach to developing this type of layout is to arrange workcenters in a way that optimizes the movement of material. A workcenter sometimes is referred to as a department and is focused on a particular type of operation. Examples include a workcenter for drilling holes, one for performing grinding operations, and a painting area. The workcenters in a low-volume toy factory might consist of shipping and receiving, plastic molding and stamping, metal forming, sewing, and painting. Parts for the toys are fabricated in these workcenters and then sent to the assembly workcenter, where they are put together. In many installations, optimal placement often means placing workcenters with large amounts of interdepartmental traffic adjacent to each other.

Manufacturing cell

Dedicated area where a group of similar products are produced.

A manufacturing cell layout is a dedicated area where products that are similar in processing requirements are produced. These cells are designed to perform a specific set of processes, and the cells are dedicated to a limited range of products. A firm may have many different cells in a production area, each set up to produce a single product or a similar group of products efficiently, but typically at lower volume levels. These cells typically are scheduled to produce “as needed” in response to current customer demand.

Assembly line

An item is produced through a fixed sequence of workstations, designed to achieve a specific production rate.

Manufacturing cells are formed by allocating dissimilar machines to cells that are designed to work on products that have similar shapes and processing requirements. Manufacturing cells are widely used in metal fabricating, computer chip manufacture, and assembly work.

MANUFACTURING CELL

An assembly line is where work processes are arranged according to the progressive steps by which the product is made. These steps are defined so that a specific production rate can be achieved. The path for each part is, in effect, a straight line. Discrete products are made by moving from workstation to workstation at a controlled rate, following the sequence needed to build the product. Examples include the assembly of toys, appliances, and automobiles. These are typically used in high-volume items where the specialized process can be justified.

ASSEMBLY LINE

The assembly line steps are done in areas referred to as “stations,” and typically the stations are linked by some form of material handling device. In addition, usually there is some form of pacing by which the amount of time allowed at each station is managed. Rather than develop the process for designing assembly at this time, we will devote the entire next section of this chapter to the topic of assembly line design since these designs are used so often by manufacturing firms around the world. A continuous or flow process is similar to an assembly line except that the product continuously moves through the process. Often the item being produced by the continuous process is a liquid or chemical that actually “flows” through the system; this is the origin of the term. A gasoline refinery is a good example of a flow process.

151

exhibit 7.2 Product–Process Matrix: Framework Describing Layout Strategies

A continuous process is similar to an assembly line in that production follows a predetermined sequence of steps, but the flow is continuous such as with liquids, rather than discrete. Such structures are usually highly automated and, in effect, constitute one integrated “machine” that may operate 24 hours a day to avoid expensive shutdowns and start-ups. Conversion and processing of undifferentiated materials such as petroleum, chemicals, and drugs are good examples.

Continuous process

A process that converts raw materials into finished product in one contiguous process.

The relationship between layout structures is often depicted on a product–process matrix similar to the one shown in Exhibit 7.2. Two dimensions are shown. The first dimension relates to the volume of a particular product or group of standardized products. Standardization is shown on the vertical axis and refers to variations in the product that is produced. These variations are measured in terms of geometric differences, material differences, and so on. Standardized products are highly similar from a manufacturing processing point of view, whereas low standardized products require different processes.

Product–process matrix

A framework depicting when the different production process types are typically used depending on product volume and how standardized the product is.

Exhibit 7.2 shows the processes approximately on a diagonal. In general, it can be argued that it is desirable to design processes along the diagonal. For example, if we produce nonstandard products at relatively low volumes, workcenters should be used. A highly standardized product (commodity) produced at high volumes should be produced using an assembly line or a continuous process, if possible. As a result of the advanced manufacturing technology available today, we see that some of the layout structures span relatively large areas of the product–process matrix. For example, manufacturing cells can be used for a very wide range of applications, and this has become a popular layout structure that often is employed by manufacturing engineers.

Analytics

### Break-Even Analysis

The choice of which specific equipment to use in a process often can be based on an analysis of cost trade-offs. There is often a trade-off between more and less specialized equipment. Less specialized equipment is referred to as “general-purpose,” meaning that it can be used easily in many different ways if it is set up in the proper way. More specialized equipment, referred to as “special-purpose,” is often available as an alternative to a general-purpose machine. For example, if we need to drill holes in a piece of metal, the general-purpose option may be to use a simple hand drill. An alternative special-purpose drill is a drill press. Given the proper setup, the drill press can drill holes much quicker than the hand drill can. The trade-offs involve the cost of the equipment (the manual drill is inexpensive, and the drill press expensive), the setup time (the manual drill is quick, while the drill press takes some time), and the time per unit (the manual drill is slow, and the drill press quick).

152

A standard approach to choosing among alternative processes or equipment is break-even analysis. A break-even chart visually presents alternative profits and losses due to the number of units produced or sold. The choice obviously depends on anticipated demand. The method is most suitable when processes and equipment entail a large initial investment and fixed cost, and when variable costs are reasonably proportional to the number of units produced.

EXAMPLE 7.1: Break-Even Analysis

Suppose a manufacturer has identified the following options for obtaining a machined part: It can buy the part at $200 per unit (including materials); it can make the part on a numerically controlled semiautomatic lathe at$75 per unit (including materials); or it can make the part on a machining center at $15 per unit (including materials). There is negligible fixed cost if the item is purchased; a semiautomatic lathe costs$80,000; and a machining center costs $200,000. To view a tutorial on break-even analysis, visit www.mhhe.com/jacobs14e_tutorial_ch07. The total cost for each option is Purchase cost=$200×DemandProduceusinglathe cost=$80,000+$75×DemandProduceusingmachiningcenter cost=

## NURS 6630 Final Exam (2018), NURS 6630 Midterm Exam (2018): Walden University (Already graded A)

NURS6630 Final Exam (2018): Walden University

QUESTION 1

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity?

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs

QUESTION 2

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism?

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics

QUESTION 3

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics?

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above.

QUESTION 4

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression?

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent.

QUESTION 5

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient?

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy

QUESTION 6

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax)

QUESTION 7

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe?

A. Strattera B. Concerta C. Daytrana D. Adderall

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD?

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient

QUESTION 9

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient?

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency.

QUESTION 10

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching?

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening.

QUESTION 11

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly?

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.”

QUESTION 12

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile?

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night.

QUESTION 13

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose:

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily.

QUESTION 14

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion?

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue.

QUESTION 15

Which patient will receive a lower dose of guanfacine?

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease

QUESTION 16

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient?

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain

QUESTION 17

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose?

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool.

QUESTION 18

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take?

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime

QUESTION 19

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands?

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness.

QUESTION 20

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority?

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg

QUESTION 21

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take?

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection.

QUESTION 22

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do?

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy.

QUESTION 23

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP?

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test.

QUESTION 24

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID

QUESTION 25

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient?

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.”

QUESTION 26

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient?

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

Clozapine (Clozaril)

Phenytoin (Dilantin)

QUESTION 27

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work?

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain.

QUESTION 28

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above

QUESTION 29

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin

QUESTION 30

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select?

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera)

QUESTION 31

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe?

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C

QUESTION 32

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient?

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above

QUESTION 33

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP?

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.”

QUESTION 34

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe?

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone

QUESTION 35

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options?

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.”

QUESTION 36

Which statement best describes a pharmacological approach to treating patients for impulsive aggression?

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive.

QUESTION 37

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient?

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things.

QUESTION 38

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders?

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.”

QUESTION 39

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction?

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption.

QUESTION 40

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state?

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine

QUESTION 41

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options?

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above

QUESTION 42

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation?

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly.

QUESTION 43

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia?

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics

QUESTION 44

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe?

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien)

QUESTION 45

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make?

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane)

QUESTION 46

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP?

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.”

QUESTION 47

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects?

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above

QUESTION 48

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach?

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.”

QUESTION 49

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start?

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms.

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option?

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac)

QUESTION 51

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe?

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin)

QUESTION 52

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication?

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera)

QUESTION 53

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response?

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above.

QUESTION 54

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following?

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents.

QUESTION 55

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider?

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions.

QUESTION 56

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)?

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD.

QUESTION 57

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD?

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only

QUESTION 58

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms:

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia

QUESTION 59

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia?

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil

QUESTION 60

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response?

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.”

QUESTION 61

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors?

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B”

QUESTION 62

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice?

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above

QUESTION 63

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment.

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil.

QUESTION 64

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option?

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro)

QUESTION 65

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff?

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.”

QUESTION 66

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems?

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above

QUESTION 67

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients?

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine.

QUESTION 68

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions?

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal

QUESTION 69

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient?

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres)

QUESTION 70

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following?

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA.

QUESTION 71

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed

## NURS 6630 Final Exam (2018), NURS 6630 Midterm Exam (2018): Walden University (Already graded A)

NURS6630 Final Exam (2018): Walden University

QUESTION 1

What will the PMHNP most likely prescribe to a patient with psychotic aggression who needs to manage the top-down cortical control and the excessive drive from striatal hyperactivity?

A. Stimulants B. Antidepressants C. Antipsychotics D. SSRIs

QUESTION 2

The PMHNP is selecting a medication treatment option for a patient who is exhibiting psychotic behaviors with poor impulse control and aggression. Of the available treatments, which can help temper some of the adverse effects or symptoms that are normally caused by D2 antagonism?

A. First-generation, conventional antipsychotics B. First-generation, atypical antipsychotics C. Second-generation, conventional antipsychotics D. Second-generation, atypical antipsychotics

QUESTION 3

The PMHNP is discussing dopamine D2 receptor occupancy and its association with aggressive behaviors in patients with the student. Why does the PMHNP prescribe a standard dose of atypical antipsychotics?

A. The doses are based on achieving 100% D2 receptor occupancy. B. The doses are based on achieving a minimum of 80% D2 receptor occupancy. C. The doses are based on achieving 60% D2 receptor occupancy. D. None of the above.

QUESTION 4

Why does the PMHNP avoid prescribing clozapine (Clozaril) as a first-line treatment to the patient with psychosis and aggression?

A. There is too high a risk of serious adverse side effects. B. It can exaggerate the psychotic symptoms. C. Clozapine (Clozaril) should not be used as high-dose monotherapy. D. There is no documentation that clozapine (Clozaril) is effective for patients who are violent.

QUESTION 5

The PMHNP is caring for a patient on risperidone (Risperdal). Which action made by the PMHNP exhibits proper care for this patient?

A. Explaining to the patient that there are no risks of EPS B. Prescribing the patient 12 mg/dail C. Titrating the dose by increasing it every 5–7 days D. Writing a prescription for a higher dose of oral risperidone (Risperdal) to achieve high D2 receptor occupancy

QUESTION 6

The PMHNP wants to prescribe Mr. Barber a mood stabilizer that will target aggressive and impulsive symptoms by decreasing dopaminergic neurotransmission. Which mood stabilizer will the PMHNP select? A. Lithium (Lithane) B. Phenytoin (Dilantin) C. Valproate (Depakote) D. Topiramate (Topamax)

QUESTION 7

The parents of a 7-year-old patient with ADHD are concerned about the effects of stimulants on their child. The parents prefer to start pharmacological treatment with a non-stimulant. Which medication will the PMHNP will most likely prescribe?

A. Strattera B. Concerta C. Daytrana D. Adderall

QUESTION 8

8 The PMHNP understands that slow-dose extended release stimulants are most appropriate for which patient with ADHD?

A. 8-year-old patient B. 24-year-old patient C. 55-year-old patient D. 82-year-old patient

QUESTION 9

A patient is prescribed D-methylphenidate, 10-mg extended-release capsules. What should the PMHNP include when discussing the side effects with the patient?

A. The formulation can have delayed actions when taken with food. B. Sedation can be a common side effect of the drug. C. The medication can affect your blood pressure. D. This drug does not cause any dependency.

QUESTION 10

The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the PMHNP include in the teaching?

A. The second dose should be taken at lunch. B. There are no risks for insomnia. C. There is only one daily dose, to be taken in the morning. D. There will be continued effects into the evening.

QUESTION 11

A young patient is prescribed Vyvanse. During the follow-up appointment, which comment made by the patient makes the PMHNP think that the dosing is being done incorrectly?

A. “I take my pill at breakfast.” B. “I am unable to fall asleep at night.” C. “I feel okay all day long.” D. “I am not taking my pill at lunch.”

QUESTION 12

A 14-year-old patient is prescribed Strattera and asks when the medicine should be taken. What does the PMHNP understand regarding the drug’s dosing profile?

A. The patient should take the medication at lunch. B. The patient will have one or two doses a day. C. The patient will take a pill every 17 hours. D. The dosing should be done in the morning and at night.

QUESTION 13

The PMHNP is meeting with the parents of an 8-year-old patient who is receiving an initial prescription for D-amphetamine. The PMHNP demonstrates appropriate prescribing practices when she prescribes the following dose:

A. The child will be prescribed 2.5 mg. B. The child will be prescribed a 10-mg tablet. C. The child’s dose will increase by 2.5 mg every other week. D. The child will take 10–40 mg, daily.

QUESTION 14

A patient is being prescribed bupropion and is concerned about the side effects. What will the PMHNP tell the patient regarding bupropion?

A. Weight gain is not unusual. B. Sedation may be common. C. It can cause cardiac arrhythmias. D. It may amplify fatigue.

QUESTION 15

Which patient will receive a lower dose of guanfacine?

A. Patient who has congestive heart failure B. Patient who has cerebrovascular disease C. Patient who is pregnant D. Patient with kidney disease

QUESTION 16

An 18-year-old female with a history of frequent headaches and a mood disorder is prescribed topiramate (Topamax), 25 mg by mouth daily. The PMHNP understands that this medication is effective in treating which condition(s) in this patient?

A. Migraines B. Bipolar disorder and depression C. Pregnancy-induced depression D. Upper back pain

QUESTION 17

The PMHNP is treating a patient for fibromyalgia and is considering prescribing milnacipran (Savella). When prescribing this medication, which action is the PMHNP likely to choose?

A. Monitor liver function every 6 months for a year and then yearly thereafter. B. Monitor monthly weight. C. Split the daily dose into two doses after the first day. D. Monitor for occult blood in the stool.

QUESTION 18

The PMHNP is assessing a patient she has been treating with the diagnosis of chronic pain. During the assessment, the patient states that he has recently been having trouble getting to sleep and staying asleep. Based on this information, what action is the PMHNP most likely to take?

A. Order hydroxyzine (Vistaril), 50 mg PRN or as needed B. Order zolpidem (Ambien), 5mg at bedtime C. Order melatonin, 5mg at bedtime D. Order quetiapine (Seroquel), 150 mg at bedtime

QUESTION 19

The PMHNP is assessing a female patient who has been taking lamotrigine (Lamictal) for migraine prophylaxis. After discovering that the patient has reached the maximum dose of this medication, the PMHNP decides to change the patient’s medication to zonisamide (Zonegran). In addition to evaluating this patient’s day-to-day activities, what should the PMHNP ensure that this patient understands?

A. Monthly blood levels must be drawn. B. ECG monitoring must be done once every 3 months. C. White blood cell count must be monitored weekly. D. This medication has unwanted side effects such as sedation, lack of coordination, and drowsiness.

QUESTION 20

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority?

A. Order herpes simplex virus (HSV) antibody testing B. Order a blood urea nitrogen (BUN) and creatinine STAT C. Prescribe lidocaine 5% D. Prescribe hydromorphone (Dilaudid) 2mg

QUESTION 21

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take?

A. Increase the dose of lamotrigine (Lamictal) to 25 mg twice daily. B. Ask if the patient has been taking the medication as prescribed. C. Order gabapentin (Neurontin), 100 mg three times a day, because lamotrigine (Lamictal) is no longer working for this patient. D. Order a complete blood count (CBC) to assess for an infection.

QUESTION 22

An elderly woman with a history of Alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the PMHNP is made aware that the patient continues to experience mild to moderate pain. What is the PMHNP most likely to do?

A. Order an X-ray because it is possible that she dislocated her hip. B. Order ibuprofen (Motrin) because she may need long-term treatment and chronic pain is not uncommon. C. Order naproxen (Naprosyn) because she may have arthritis and chronic pain is not uncommon. D. Order Morphine and physical therapy.

QUESTION 23

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP?

A. Orders liver function tests. B. Educate the patient on avoiding grapefruits when taking this medication. C. Encourage this patient to keep fluids to 1500 ml/day until the swelling subsides. D. Order a BUN/Creatinine test.

QUESTION 24

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do? A. Prescribe Estrin FE 24 birth control B. Prescribe ibuprofen (Motrin), 800 mg every 8 hours as needed for pain C. Prescribe desvenlafaxine (Pristiq), 50 mg daily D. Prescribe risperidone (Risperdal), 2 mg TID

QUESTION 25

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient?

A. “The SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” B. “The SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn.” C. “The SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex.” D. “The SNRI can increase neurotransmission to descending neurons.”

QUESTION 26

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient?

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

Clozapine (Clozaril)

Phenytoin (Dilantin)

QUESTION 27

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work?

A. It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels. B. It will induce synaptic changes, including sprouting. C. It will act on the presynaptic neuron to trigger sodium influx. D. It will inhibit activity of dorsal horn neurons to suppress body input from reaching the brain.

QUESTION 28

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition? A. Venlafaxine (Effexor) B. Armodafinil (Nuvigil) C. Bupropion (Wellbutrin) D. All of the above

QUESTION 29

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

A. Methylphenidate (Ritalin) B. Viloxazine (Vivalan) C. Imipramine (Tofranil) D. Bupropion (Wellbutrin

QUESTION 30

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select?

A. Pregabalin (Lyrica) B. Duloxetine (Cymbalta) C. Modafinil (Provigil) D. Atomoxetine (Strattera)

QUESTION 31

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe?

A. Pregabalin (Lyrica) B. Gabapentin (Neurontin) C. Duloxetine (Cymbalta) D. B and C

QUESTION 32

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient?

A. Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog” B. Targeting the patient’s symptoms with anticonvulsants that inhibit gray matter loss in the dorsolateral prefrontal cortex C. Matching the patient’s symptoms with the malfunctioning brain circuits and neurotransmitters that might mediate those symptoms D. None of the above

QUESTION 33

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP?

A. “SSRIs only increase norepinephrine levels.” B. “SSRIs only increase serotonin levels.” C. “SSRIs increase serotonin and norepinephrine levels.” D. “SSRIs do not increase serotonin or norepinephrine levels.”

QUESTION 34

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe?

A. Antipsychotics B. Lithium C. SSRI D. Naltrexone

QUESTION 35

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options?

A. “Naltrexone may be an appropriate option to discuss.” B. “There are many medicine options that treat kleptomania.” C. “Kevin may need to be prescribed antipsychotics to treat this illness.” D. “Lithium has proven effective for treating kleptomania.”

QUESTION 36

Which statement best describes a pharmacological approach to treating patients for impulsive aggression?

A. Anticonvulsant mood stabilizers can eradicate limbic irritability. B. Atypical antipsychotics can increase subcortical dopaminergic stimulation. C. Stimulants can be used to decrease frontal inhibition. D. Opioid antagonists can be used to reduce drive.

QUESTION 37

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient?

A. It will prevent feelings of euphoria. B. It will amplify impulse control. C. It will block testosterone. D. It will redirect the patient to think about other things.

QUESTION 38

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders?

A. “Compulsive Internet use can be treated similarly to how we treat people with substance use disorders.” B. “Internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences.” C. “When it comes to Internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods.” D. “There are no evidence-based treatments for Internet addiction, but there are behavioral therapies your daughter can try.”

QUESTION 39

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs,” he says. Which statement best describes the neurobiological parallels between food and drug addiction?

A. There is decreased activation of the prefrontal cortex. B. There is increased sensation of the reactive reward system. C. There is reduced activation of regions that process palatability. D. There are amplified reward circuits that activate upon consumption.

QUESTION 40

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state?

A. Histamine 2 receptor antagonist B. Benzodiazepines C. Stimulants D. Caffeine

QUESTION 41

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options?

A. Avoiding prescribing the patient a drug that blocks H1 receptors B. Prescribing the patient a drug that acts on H2 receptors C. Stopping the patient from taking medicine that unblocks H1 receptors D.None of the above

QUESTION 42

The PMHNP is performing a quality assurance peer review of the chart of another PMHNP. Upon review, the PMHNP reviews the chart of an older adult patient in long-term care facility who has chronic insomnia. The chart indicates that the patient has been receiving hypnotics on a nightly basis. What does the PMHNP find problematic about this documentation?

A. Older adult patients are contraindicated to take hypnotics. B. Hypnotics have prolonged half-lives that can cause drug accumulation in the elderly. C. Hypnotics have short half-lives that render themselves ineffective for older adults. D. Hypnotics are not effective for “symptomatically masking” chronic insomnia in the elderly.

QUESTION 43

The PMHNP is caring for a patient with chronic insomnia who is worried about pharmacological treatment because the patient does not want to experience dependence. Which pharmacological treatment approach will the PMHNP likely select for this patient for a limited duration, while searching and correcting the underlying pathology associated with the insomnia?

A. Serotonergic hypnotics B. Antihistamines C. Benzodiazepine hypnotics D. Non-benzodiazepine hypnotics

QUESTION 44

The PMHNP is caring for a patient with chronic insomnia who would benefit from taking hypnotics. The PMHNP wants to prescribe the patient a drug with an ultra-short half-life (1–3 hours). Which drug will the PMHNP prescribe?

A. Flurazepam (Dalmane) B. Estazolam (ProSom) C. Triazolam (Halcion) D. Zolpidem CR (Ambien)

QUESTION 45

The PMHNP is attempting to treat a patient’s chronic insomnia and wishes to start with an initial prescription that has a half-life of approximately 1–2 hours. What is the most appropriate prescription for the PMHNP to make?

A. Triazolam (Halcion) B. Quazepam (Doral) C. Temazepam (Restoril) D. Flurazepam (Dalmane)

QUESTION 46

A patient with chronic insomnia asks the PMHNP if they can first try an over-the-counter (OTC) medication before one that needs to be prescribed to help the patient sleep. Which is the best response by the PMHNP?

A. “There are no over-the-counter medications that will help you sleep.” B. “You can choose from one of the five benzo hypnotics that are approved in the United States.” C. “You will need to ask the pharmacist for a non-benzodiazepine medicine.” D. “You can get melatonin over the counter, which will help with sleep onset.”

QUESTION 47

A patient with chronic insomnia and depression is taking trazodone (Oleptro) but complains of feeling drowsy during the day. What can the PMHNP do to reduce the drug’s daytime sedating effects?

A. Prescribe the patient an antihistamine to reverse the sedating effects B. Increasing the patient’s dose and administer it first thing in the morning C. Give the medicine at night and lower the dose D. None of the above

QUESTION 48

The PMHNP is teaching a patient with a sleep disorder about taking diphenhydramine (Benadryl). The patient is concerned about the side effects of the drug. What can the PMHNP teach the patient about this treatment approach?

A. “It can cause diarrhea.” B. “It can cause blurred vision.” C. “It can cause increased salivation.” D. “It can cause heightened cognitive effects.”

QUESTION 49

Parents of a 12-year-old boy want to consider attention deficit hyperactivity disorder (ADHD) medication for their son. Which medication would the PMHNP start?

Methylphenidate Amphetamine salts Atomoxetine All of the above could potentially treat their son’s symptoms.

QUESTION 50

An adult patient presents with a history of alcohol addiction and attention deficit hyperactivity disorder (ADHD). Given these comorbidities, the PMHNP determines which of the following medications may be the best treatment option?

A. Methylphenidate (Ritalin, Concerta) B. Amphetamine C. Atomoxetine (Strattera) D. Fluoxetine (Prozac)

QUESTION 51

An 8-year-old patient presents with severe hyperactivity, described as “ants in his pants.” Based on self-report from the patient, his parents, and his teacher; attention deficit hyperactivity disorder (ADHD) is suspected. What medication is the PMNHP most likely to prescribe?

A. Methylphenidate (Ritalin, Concerta) B. Clonidine (Catapres) C. Bupropion (Wellbutrin) D. Desipramine (Norpramin)

QUESTION 52

A 9-year-old female patient presents with symptoms of both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder. In evaluating her symptoms, the PMHNP determines that which of the following medications may be beneficial in augmenting stimulant medication?

A. Bupropion (Wellbutrin) B. Methylphenidate (Ritalin, Concerta) C. Guanfacine ER (Intuniv) D. Atomoxetine (Strattera)

QUESTION 53

A PMHNP supervisor is discussing with a nursing student how stimulants and noradrenergic agents assist with ADHD symptoms. What is the appropriate response?

A. They both increase signal strength output dopamine (DA) and norepinephrine (NE). B. Dopamine (DA) and norepinephrine (NE) are increased in the prefrontal cortex. C. Noradrenergic agents correct reductions in dopamine (DA) in the reward pathway leading to increased ability to maintain attention to repetitive or boring tasks and resist distractions. D. All of the above.

QUESTION 54

A 43-year-old male patient is seeking clarification about treating attention deficit hyperactivity disorder (ADHD) in adults and how it differs from treating children, since his son is on medication to treat ADHD. The PMHNP conveys a major difference is which of the following?

A. Stimulant prescription is more common in adults. B. Comorbid conditions are more common in children, impacting the use of stimulants in children. C. Atomoxetine (Strattera) use is not advised in children. D. Comorbidities are more common in adults, impacting the prescription of additional agents.

QUESTION 55

A 26-year-old female patient with nicotine dependence and a history of anxiety presents with symptoms of attention deficit hyperactivity disorder (ADHD). Based on the assessment, what does the PMHNP consider?

A. ADHD is often not the focus of treatment in adults with comorbid conditions. B. ADHD should always be treated first when comorbid conditions exist. C. Nicotine has no reported impact on ADHD symptoms. D. Symptoms are often easy to treat with stimulants, given the lack of comorbidity with other conditions.

QUESTION 56

Which of the following is a true statement regarding the use of stimulants to treat attention deficit hyperactivity disorder (ADHD)?

A. In adults with both ADHD and anxiety, treating the anxiety with selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or benzodiazepines and the ADHD with stimulants is most effective in treating both conditions. B. Signal strength output is increased by dialing up the release of dopamine (DA) and norepinephrine (NE). C. In conditions where excessive DA activation is present, such as psychosis or mania, comorbid ADHD should never be treated with stimulants. D. High dose and pulsatile delivery of stimulants that are short acting are preferred to treat ADHD.

QUESTION 57

The PMHNP is providing a workshop for pediatric nurses, and a question is posed about noradrenergic agents to treat ADHD. Which of the following noradrenergic agents have norepinephrine reuptake inhibitor (NRI) properties that can treat ADHD?

A. Desipramine (Norpramin) B. Methylphenidate (Ritalin, Concerta) C. Atomoxetine (Strattera) D. Both “A” & “C” E. “C” only

QUESTION 58

A 71-year-old male patient comes to an appointment with his 65-year-old wife. They are both having concerns related to her memory and ability to recognize faces. The PMNHP is considering prescribing memantine (Namenda) based on the following symptoms:

A. Amnesia, aphasia, apnea B. Aphasia, apraxia, diplopia C. Amnesia, apraxia, agnosia D. Aphasia, agnosia, arthralgia

QUESTION 59

The PMHNP evaluates a patient presenting with symptoms of dementia. Before the PMHNP considers treatment options, the patient must be assessed for other possible causes of dementia. Which of the following answers addresses both possible other causes of dementia and a rational treatment option for Dementia?

A. Possible other causes: hypothyroidism, Cushing’s syndrome, multiple sclerosis Possible treatment option: memantine B. Possible other causes: hypothyroidism, adrenal insufficiency, hyperparathyroidism Possible treatment option: donepezil C. Possible other causes: hypothyroidism, adrenal insufficiency, niacin deficiency Possible treatment option: risperidone D. Possible other causes: hypothyroidism, Cushing’s syndrome, lupus erythematosus Possible treatment option: donepezil

QUESTION 60

A group of nursing students seeks further clarification from the PMHNP on how cholinesterase inhibitors are beneficial for Alzheimer’s disease patients. What is the appropriate response?

A. Acetylcholine (ACh) destruction is inhibited by blocking the enzyme acetylcholinesterase. B. Effectiveness of these agents occurs in all stages of Alzheimer’s disease. C. By increasing acetylcholine, the decline in some patients may be less rapid. D. Both “A” & “C.”

QUESTION 61

The PMHNP is assessing a patient who presents with elevated levels of brain amyloid as noted by positron emission tomography (PET). What other factors will the PMHNP consider before prescribing medication for this patient, and what medication would the PMHNP want to avoid given these other factors?

A. ApoE4 genotype and avoid antihistamines if possible B. Type 2 diabetes and avoid olanzapine C. Anxiety and avoid methylphenidate D. Both “A” & “B”

QUESTION 62

A 72-year-old male patient is in the early stages of Alzheimer’s disease. The PMHNP determines that improving memory is a key consideration in selecting a medication. Which of the following would be an appropriate choice?

A. Rivastigmine (Exelon) B. Donepezil (Aricept) C. Galantamine (Razadyne) D. All of the above

QUESTION 63

A 63-year-old patient presents with the following symptoms. The PMHNP determines which set of symptoms warrant prescribing a medication? Select the answer that is matched with an appropriate treatment.

A. Reduced ability to remember names is most problematic, and an appropriate treatment option is memantine. B. Impairment in the ability to learn and retain new information is most problematic, and an appropriate treatment option would be donepezil. C. Reduced ability to find the correct word is most problematic, and an appropriate treatment option would be memantine. D. Reduced ability to remember where objects are most problematic, and an appropriate treatment option would be donepezil.

QUESTION 64

A 75-year-old male patient diagnosed with Alzheimer’s disease presents with agitation and aggressive behavior. The PMHNP determines which of the following to be the best treatment option?

A. Immunotherapy B. Donepezil (Aricept) C. Haloperidol (Haldol) D. Citalopram (Celexa) or Escitalopram (Lexapro)

QUESTION 65

The PMHNP has been asked to provide an in-service training to include attention to the use of antipsychotics to treat Alzheimer’s. What does the PMHNP convey to staff?

A. The use of antipsychotics may cause increased cardiovascular events and mortality. B. A good option in treating agitation and psychosis in Alzheimer’s patients is haloperidol (Haldol). C. Antipsychotics are often used as “chemical straightjackets” to over-tranquilize patients. D. Both “A” & “C.”

QUESTION 66

An 80-year-old female patient diagnosed with Stage II Alzheimer’s has a history of irritable bowel syndrome. Which cholinergic drug may be the best choice for treatment given the patient’s gastrointestinal problems?

A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. All of the above

QUESTION 67

The PMHNP understands that bupropion (Wellbutrin) is an effective way to assist patients with smoking cessation. Why is this medication effective for these patients?

A. Bupropion (Wellbutrin) releases the dopamine that the patient would normally receive through smoking. B. Bupropion (Wellbutrin) assists patients with their cravings by changing the way that tobacco tastes. C. Bupropion (Wellbutrin) blocks dopamine reuptake, enabling more availability of dopamine. D. Bupropion (Wellbutrin) works on the mesolimbic neurons to increase the availability of dopamine.

QUESTION 68

Naltrexone (Revia), an opioid antagonist, is a medication that is used for which of the following conditions?

A. Alcoholism B. Chronic pain C. Abuse of inhalants D. Mild to moderate heroin withdrawal

QUESTION 69

A patient addicted to heroin is receiving treatment for detoxification. He begins to experience tachycardia, tremors, and diaphoresis. What medication will the PMHNP prescribe for this patient?

A. Phenobarbital (Luminal) B. Methadone (Dolophine) C. Naloxone (Narcan) D. Clonidine (Catapres)

QUESTION 70

A patient diagnosed with obsessive compulsive disorder has been taking a high-dose SSRI and is participating in therapy twice a week. He reports an inability to carry out responsibilities due to consistent interferences of his obsessions and compulsions. The PMHNP knows that the next step would be which of the following?

A. Decrease his SSRI and add buspirone (Buspar). B. Decrease his SSRI and add an MAOI. C. Decrease his SSRI steadily until it can be discontinued then try an antipsychotic to manage his symptoms. D. Keep his SSRI dosage the same and add a low-dose TCA.

QUESTION 71

The PMHNP is assessing a patient who will be receiving phentermine (Adipex-P)/topiramate (Topamax) (Qsymia). Which of the following conditions/diseases will require further evaluation before this medication can be prescribed

Research the range of contemporary issues teenagers face today. In a 500-750-word paper, choose one issue (besides teen pregnancy) and discuss its effect on adolescent behavior and overall well-being. Include the following in your submission:

Describe the contemporary issue and explain what external stressors are associated with this issue.
Outline assessment strategies to screen for this issue and external stressors during an assessment for an adolescent patient. Describe what additional assessment questions you would need to ask and define the ethical parameters regarding what you can and cannot share with the parent or guardian.
Discuss support options for adolescents encountering external stressors. Include specific support options for the contemporary issue you presented.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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## Eventually the final outcome needs to once more restate the view-point..

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