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Question 71

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Passage Numerous studies suggest that physicians make both conscious and unconscious assumptions about their patients, and these assumptions often impact patient care and outcomes.  However, little research has focused on the assumptions patients make about their physicians.Researchers designed an observational study to investigate assumptions made by patients in health care settings.  For this study, three different surgeons were asked to interact with pre-surgery patients whom they had never met using a standardized script.  Each surgeon participated in 30 total interactions over the course of two weeks.  The purpose of the study was to assess how the patient's assumptions regarding the surgeon's status were impacted by the surgeon's race, gender, and attire.According to the script, the surgeon did not introduce him- or herself upon entering the room.  All three surgeons were in their late 40s; one surgeon was a black woman, one was a black man, and one was a white man.  The surgeons wore either surgical scrubs alone or a white coat over their surgical scrubs.  Researchers analyzed how patients addressed or referred to the surgeon to assess assumptions about the surgeon's role as a doctor or a nurse.  The results are presented in Table 1.Table 1  Percentage of Patients Who Assumed the Surgeon Was a Doctor or a Nurse The researchers also retrospectively analyzed minor (non-life-threatening) surgical errors and postoperative patient outcomes for one month prior to the study and during the study timeframe for each surgeon.  The number of minor errors was averaged per surgery, and postoperative patient outcomes were quantified using a multifactor (eg, pain, infection, bleeding, other complications) assessment scale of 1 (worst outcome) to 12 (best outcome) .Table 2  Average Number of Minor Surgical Errors (Per Surgery) and Aggregated Postoperative Patient Outcome Scores -The assertion made in the first paragraph of the passage would be best supported by a study demonstrating that:

A) positive impression management strategies implemented by physicians correspond to increased patient trust.
B) front- and backstage behaviors of hospital patients do not correlate with length of hospital stay.
C) nonverbal communication between patient and physician is a better predictor of patient outcomes than verbal communication.
D) patients are more likely to make assumptions about their physicians based on salient social roles than on attire.

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Question 72

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A patient who has been diagnosed with schizophrenia is prescribed a neuroleptic medication.  Which of the following symptoms, if present, is this medication most likely to improve?

A) Apathy
B) Inability to experience pleasure
C) Emotional flattening
D) Disorganized speech

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Question 73

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Passage Across the lifespan, mental and physical health depends on adequate sleep.  Extensive research suggests that sleep needs and characteristics change throughout an individual's life (Figure 1) . Figure 1  Average hours of rapid eye movement (REM) and non-REM sleep for different age groups across the lifespanChronic sleep deprivation acts as a physiological stressor and can have a multitude of short- and long-term negative health consequences.  Studies show that over 30% of adults get less than the recommended minimum of 7 hours of sleep per night, putting them at greater risk for metabolic disorders (eg, obesity, diabetes) , cardiovascular disease (eg, high blood pressure, stroke) , and emotional disorders (eg, anxiety, depression) .  Sleep deprivation is also associated with impaired cognitive functioning, decreased work performance, and an increased risk of accidents.However, the guideline that adults sleep at least 7 hours per night does not account for the considerable variation in individual sleep needs.  Research suggests that some individuals, known as "long sleepers," require an average daily sleep duration of more than 9 hours, while "short sleepers" require an average daily sleep duration of less than 6 hours.  One study found that biological night duration (established by one's circadian pacemaker or "master clock") appears to be a few hours shorter for short sleepers as compared to long sleepers.  Other studies suggest that short sleepers regularly sleep less than 7 hours without any apparent negative consequences due to one or more genetic mutations, such as a mutation on the DEC2 gene (also known as BHLHE41) , which codes for a transcription factor involved in regulating circadian rhythms. -Based on the description in the passage, should an individual who is a "short sleeper" be diagnosed with a sleep-wake disorder?

Passage Jake and his classmate Michael both grew up in a high-crime public housing project in a poverty-stricken neighborhood in a large urban area.  Both children lived in single-parent households and had almost no relationship with their fathers.  They performed poorly in school and frequently got in trouble with authority figures.  Neither completed high school and both had been arrested by the time they turned 18.At this point their trajectories begin to diverge.  By age 27, Jake had been in and out of prison three times, had fathered four children by four different women, and was abusing drugs and alcohol daily.  On the other hand, Michael had earned a general equivalency diploma, was a general manager at a factory, was married with a biological son and adopted daughter, and owned a home in the suburbs.Jake and Michael both participated in a study about resilience-the ability to prevail in the face of threats to adequate psychosocial development.  This study recruited 81 adult men who as children had lived in the same public housing project between 1976 and 1980.  The investigators categorized participants into one of two groups based on their adult outcomes-low resilience and high resilience.  All the men reported family difficulties while growing up in crime and poverty.  The low-resilience men (n = 69) were significantly more likely to report drug and alcohol use and current or prior imprisonment, whereas the high-resilience men (n = 12) were all employed, and most were married homeowners.The study's primary finding was that high-resilience men received more social support outside their immediate families while growing up than did low-resilience men.  Results also suggested that high-resilience men tended to have calmer, more optimistic dispositions, whereas low-resilience men were more anxious, disagreeable, and pessimistic. -This study is most likely viewing human development from the perspective of:

Passage On the way home from a routine visit to the pediatrician, Sarah stops with her infant son at the local convenience store.  As she is waiting in line, a man squeezes in closely behind them and sneezes.  As Sarah walks home, she finds that her heart is racing, she feels nauseous, and she is terrified that her child will become severely ill.Soon after, she becomes obsessed with disease and contamination.  She begins to take extensive measures to "decontaminate" herself and her home, including washing her hands dozens of times daily.  These cleaning rituals have the immediate effect of lessening Sarah's anxiety, so she soon spends most of her day performing them.  She seeks treatment from a therapist, who instructs her to gradually expose herself to "contamination" but refrain from her cleaning rituals.  The therapist also teaches Sarah how to recognize and modify her maladaptive thoughts about illness prevention.  Within several weeks, Sarah finds that she can manage her thoughts about disease and contamination without resorting to ritualistic cleaning.A researcher hypothesized that individuals with obsessive-compulsive disorder (OCD) , such as Sarah, would show a more generalized fear response to safe stimuli compared to controls.  Generalized conditioned fear responses occur when individuals react with fear to stimuli that resemble the original conditioned stimulus (eg, someone injured in an accident with a red truck fears all red vehicles) .  The researcher conditioned 100 individuals (50 with OCD and 50 controls) to associate a shock with a visual stimulus.  In phase 1, participants viewed a computer screen that alternated between images of a small ring (1 cm) and a large ring (20 cm) .  The small ring and large ring were displayed for 1 second each, with a blank screen in between for 5 seconds.  A mild electric shock was paired with the large ring, and no shock was paired with the small ring.  This was repeated for 10 trials.  In phase 2, shocks were discontinued, and three intermediate-sized rings were added to the series and presented in increasing size (ie, 1 cm, 5 cm, 10 cm, 15 cm, 20 cm) while the participants' startle response to each ring was measured.  This was repeated for 10 trials. ncbi.nlm.nih.gov/pmc/articles/PMC3932061/ -A conditioned fear response during phase 2 occurs as a result of which type of memory?

Passage The last several decades have seen a significant increase in immigration to the United States.  Today, more than 20% of American children age 17 and younger have at least one foreign-born parent, and about 30% of these children are themselves foreign-born.Immigrant youths in the United States tend to adapt extremely well to their new surroundings.  Researchers report that immigrant students often perform in school as well or better than their US-born classmates.  Studies assessing psychological adjustment reveal similar findings:  Foreign-born students are less likely to abuse alcohol or break the law, and they demonstrate relatively higher levels of self-esteem than their US-born peers.The following quotations are responses from overachieving immigrant middle school students when asked by interviewers to explain their success:Student 1, eighth-grade valedictorian:  "When my mother first came to the United States from China, she spent all her time working, trying to earn a living to support her three children.  I know how much she has sacrificed, and I am so grateful that I am willing to do just about anything for her."Student 2, a straight-A student:  "[In my neighborhood] everyone knows everyone.  They all know what I am up to, so I want to make a good impression and have them think highly of me.  I also want to represent my community well to others."Even though immigrant families are often more prosperous in the United States than they were in their home countries, they still often struggle financially, typically due to parental language barriers.  The impressive adaptations of immigrant students occur despite impoverished circumstances; their parents tend to emphasize the importance of education as a means to attaining prosperity, reminding their children that they immigrated to provide their children with access to better education than was available in their homeland.  Immigrant children tend to internalize their parents' attitude toward educational achievement.Members of ethnic minorities in the United States also stress loyalty to family and community over self, so children feel a strong sense of gratitude and allegiance to their parents.  Immigrant parents with successful children have usually formed close relationships with members of their ethnic community; members of ethnic enclaves tend to demonstrate consensus on values and exert an unusually high level of control over the children's behavior through regular monitoring. L. E. Berk. Child Development © 2006 Pearson -Which of the following best illustrates the diffusion of material culture?

Passage Bipolar disorder (BD) , often characterized by periods of depression and mania, although it is possible to experience mania only, is frequently misdiagnosed.  Some studies suggest that as many as half of all individuals diagnosed with BD actually do not have the disorder.  One possible reason is the similarity in symptoms shared by both mania and borderline personality disorder.  Another potential reason involves recent efforts by pharmaceutical companies to increase awareness of BD symptoms.  As one physician stated:"In the past ten years, we've been bombarded with ads, 'These are the symptoms of BD-they're easily missed-and here is a new drug to treat it.'  I think that when you're constantly being reminded not to overlook something, you start looking for it everywhere, even when it's not there."Other studies report that BD is underdiagnosed, with almost 70% of patients receiving an initial misdiagnosis and almost 35% remaining misdiagnosed for 10 years or more.  This can be partially explained by the fact that people often seek treatment for their depressive symptoms but rarely for their manic symptoms.  In fact, some individuals may not initially realize that their manic episodes are problematic.  Patients may describe these episodes as positive experiences, particularly when compared with depressive episodes:Patient 1:  "During my depression, I'm so tired I stay in bed for days.  I feel totally useless.  But when I'm manic, I am so alive.  I feel like I'm on top of the world-I'm the life of the party, and my mind is running a million miles a minute.  I'm so productive, I don't need much sleep, and I can just go, go, go.  It actually took me a long time to realize that this wasn't normal, this awesome energy was way beyond how people normally feel."Patient 2:  "My mania actually came on over a long period during grad school and I just kept feeling better and better.  It was like I was getting sharper and smarter, and I was doing more research and coming up with all of these brilliant ideas.  I felt totally on top of my game."Because mania is often unrecognized and unreported, recent efforts have been made to encourage a more proactive approach to the self-identification of manic symptoms.  Proper diagnosis is critical for effective life-long treatment and management of BD, as reflected by this patient's experience:Patient 3:  "It was almost 10 years before I could acknowledge that my high-stress lifestyle was triggering my mania and that I needed to make some big changes-and that I needed to stay on my medication, even when I felt much better.  That was really hard for me to get, but I get it now-I have this for life, and I have to treat it every day.  Once I finally got that, I started to be able to accept this as a part of who I am." T. Singh and M. Rajput ©2006 Matrix Medical Communications, and J. A. Scott and F. Sohrabi ©2015 Everyday Health Media. -The data presented in the passage are LEAST likely to have been obtained from which type of study?

Passage A common misconception in medicine is that eating disorders present similarly in males and females.  Research suggests that this is untrue: males meeting diagnostic criteria for eating disorders are more likely than females to have another psychiatric illness, demonstrate a later age of onset, and engage in excessive exercise.  They are less likely to engage in purging behaviors, be diagnosed by clinicians, or seek treatment.  When males do enter treatment, they are generally further along in the course of the illness.The classification of eating disorders in males according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has recently been debated.  Research suggests that one very common manifestation of eating disorder etiology in males, called muscle dysmorphia (MD) , includes an obsession with a larger and more muscular body, which contrasts with the thin, idealized body for females with eating disorders.  Characterized as a subset of body dysmorphic disorder, MD is more recently conceptualized as part of a spectrum of eating disorders; however, it is still classified under the obsessive-compulsive and related disorders umbrella in the DSM-5.One study applied the latest DSM-5 diagnostic criteria for anorexia nervosa (AN) , bulimia nervosa (BN) , binge eating disorder (BED) , and MD to the medical records of male veterans treated in Veterans Administration (VA) hospitals across the United States from 2000 to 2015.  The study (Table 1) found a significant increase in psychiatric comorbidity compared to controls (C) .Table 1  Prevalence of Psychiatric Disorders for Eating Disorder and MD Cases and Controls in a National Sample of Male Veterans Treated at VA Hospitals from 2000 to 2015 -Which of the following hypothetical findings from a follow-up study evaluating eating disorders in males is most consistent with the data presented in Table 1?

Passage The term "health disparities" describes a systematic incidence of poorer health outcomes for groups that have traditionally experienced social disadvantage (eg, racial and ethnic minorities, lower-income individuals, women) as compared to more advantaged groups (eg, whites, higher-income individuals, men) .  These health disparities are driven by unequal access to health care services and health insurance due to prejudice and discrimination on the part of health care providers and the overall system, and extensive research has focused on these issues.Recent research suggests that another factor might explain health disparities: stereotype threat on the part of the patient.  Stereotype threat can be evoked by verbal or nonverbal cues from health care professionals, such as a physician's use of confusing medical jargon (the standardized language medical personnel use to communicate among themselves) or a nurse's body language while discussing the risks of obesity and alcohol use.  Once triggered, stereotype threat may result in behaviors that compromise one's own health.  For example, a patient may withhold information or feel compelled to describe health-related behaviors in a positive light.  Similarly, if the interaction arouses anxiety, a patient may be less likely to remember the physician's instructions or might dismiss a physician's advice as biased.Stereotype threat can be reduced through training programs that improve employees' communication skills.  Some hospitals in large urban areas have implemented the use of cultural liaisons, individuals who are able to bridge the gap between a minority patient's cultural beliefs and Western medicine.  Cultural liaisons are often present during the nonsensitive portions of the doctor's appointment, and studies suggest they may help to reduce stereotype threat in patients. Adapted from J. Aronson, D. Burgess, S. M. Phelan, and L. Juarez (C) 2013 American Public Health Association -Besides reducing stereotype threat, the presence of a cultural liaison during a doctor's appointment increases:

An individual is distressed by her attraction to her supervisor.  As a result, she acts coldly toward her supervisor and regularly tells her colleagues how much she despises her supervisor.  This response is best characterized as which of the following, according to psychoanalytic theory?

Passage The highly addictive nature of cigarettes can be partly explained by how nicotine, the primary addictive ingredient, is administered.  The fastest route of administration for most drugs is through inhalation; cigarette smoking results in the transmission of nicotine to the brain in about 15 seconds.  In the brain, nicotine activates the nicotinic acetylcholine receptors, which stimulate the brain's reward pathway and produce mild feelings of euphoria.  Those who quit smoking often relapse due to stress, weight gain, and withdrawal symptoms such as cravings and irritability.  Of those who attempt to quit without formal treatment, only 3%-5% remain abstinent after a year.Research suggests that mindfulness meditation-based programs can be an effective strategy to quit smoking.  Mindfulness is an aspect of meditation that involves cultivating a nonjudgmental awareness of the thoughts, emotions, and sensations arising in the present moment.For one study, researchers randomly assigned 88 smokers to either Mindfulness Training (MT) or the Freedom From Smoking (FFS) intervention developed by the American Lung Association.  Both groups participated in 90-minute group training sessions twice a week for four weeks.  The FFS intervention educated participants on the negative health consequences of smoking, coping strategies for cravings, and the development of healthy lifestyle habits.  The MT intervention taught mindfulness meditation techniques as a way of gaining awareness and acceptance of the cognitive, emotional, and physical components of cravings.  The number of cigarettes smoked per day and self-reported abstinence, as verified by exhaled carbon monoxide, were measured at the end of treatment and at a 17-week follow-up for participants in each group (Figure 1) . Figure 1  Percentage of participants in each group abstinent at the end of treatment and at 17-week follow-up (* indicates p < 0.05) -Which of the following conclusions is supported by these data reflecting the relationship between cigarette craving and smoking behavior before and after MT intervention?

Passage Religion establishes the beliefs and rituals surrounding the sacred and provides meaning and significance to individuals' lives.  The tenets of any given religion can have a far-reaching impact on the individuals within its faith community.  For example, certain religions promote faith-based lifestyle directives (FBLDs) , which urge believers to follow specific guidelines regarding their own behavior (eg, restrictions on diet and substance use) and their treatment of others (eg, mission work) .  Because these practices typically reflect the religious group's values, FBLDs are often an important expression of faith for the deeply religious.One religious group with health-related FBLDs is the Seventh Day Adventist Church, which formed in the 1860s after early leaders broke away from established Protestant churches.  Since its formal establishment, Seventh Day Adventist Church membership has grown from 3,500 to over 20 million worldwide.  The Seventh Day Adventist Church advocates conservative religious teachings and a holistic approach to health and wellness; members are encouraged to pursue vegetarianism, exercise regularly, and avoid alcohol and tobacco.Although FBLDs impact believers' personal choices and behaviors, they are also often meant to have an impact on others through the creation of social institutions such as schools and hospitals.  For example, early Adventist leaders developed a health care system to serve the needs of the larger community, and members of the modern Adventist Church have continued to try to reduce health disparities worldwide by creating hospitals, clinics, and universities that provide health care and education services to underserved and developing communities.Researchers from a variety of fields have examined health-related religious values and FBLDs.  Epidemiological research has shown that believers from different religions who follow certain FBLDs (eg, abstaining from smoking and alcohol) experience lower rates of chronic illnesses (eg, heart disease and many types of cancer) than the general population.  Sociologists have suggested that as a society increasingly relies on medical professionals, rather than clergy, as legitimate sources of guidance on lifestyle behaviors, membership in religious groups with values that are compatible with medicalization will continue to rise.  Some hypothesize that this phenomenon accounts for the seemingly contradictory increase in membership in certain conservative religious groups with strict FBLDs, despite mainstream society becoming less religious. -Results from a survey of believers indicated a positive correlation between the incorporation of religion into an individual's life and participation in FBLDs.  This illustrates what type of study, and what concept was being assessed?

Passage Research suggests that cognitive changes occur with age.  Though dementia is common, occurring in about 14% of individuals age 71 and older and in almost 34% of individuals 90 and older, a majority of older adults exhibit some degree of "normal" cognitive decline.  The following studies were conducted on 605 older adults (mean age = 78.2) who did not show any signs of dementia and 590 younger adult participants (mean age = 28.8) .Cognition studiesParticipants were asked to solve five puzzles designed to test their ability to apply new information, reason inductively and deductively, and use logic.  Participants were also asked to complete a 20-item vocabulary and grammar test.  The older adults performed significantly worse than the younger adults on the puzzles, but there was no significant difference between the groups on the vocabulary/grammar test.Focus studiesWhen asked to read a short story and then answer a series of questions assessing comprehension (focused condition) , older adults performed equally well as the younger adults.  However, when asked to read a similar story while wearing headphones playing another story that was to be ignored (distraction condition) , older adults performed worse than younger adults when answering questions assessing comprehension of the story they read.Memory studiesWhen asked to memorize 30 neutral items (eg, a key, a pencil, a book) , the images of which were presented serially, younger adults performed significantly better when asked to list the items immediately after seeing them and when asked to list the items after performing a distraction task.  In a second trial, both groups were serially presented with 30 pictures of faces showing positive, negative, or neutral expressions.  The groups were later asked to identify these faces among a set of 100.  Results are shown in Figure 1. Figure 1  Average number of correctly identified faces for older and younger adult groups -The cognition studies and focus studies suggest that aging is correlated with declines in:

Passage The last several decades have seen a significant increase in immigration to the United States.  Today, more than 20% of American children age 17 and younger have at least one foreign-born parent, and about 30% of these children are themselves foreign-born.Immigrant youths in the United States tend to adapt extremely well to their new surroundings.  Researchers report that immigrant students often perform in school as well or better than their US-born classmates.  Studies assessing psychological adjustment reveal similar findings:  Foreign-born students are less likely to abuse alcohol or break the law, and they demonstrate relatively higher levels of self-esteem than their US-born peers.The following quotations are responses from overachieving immigrant middle school students when asked by interviewers to explain their success:Student 1, eighth-grade valedictorian:  "When my mother first came to the United States from China, she spent all her time working, trying to earn a living to support her three children.  I know how much she has sacrificed, and I am so grateful that I am willing to do just about anything for her."Student 2, a straight-A student:  "[In my neighborhood] everyone knows everyone.  They all know what I am up to, so I want to make a good impression and have them think highly of me.  I also want to represent my community well to others."Even though immigrant families are often more prosperous in the United States than they were in their home countries, they still often struggle financially, typically due to parental language barriers.  The impressive adaptations of immigrant students occur despite impoverished circumstances; their parents tend to emphasize the importance of education as a means to attaining prosperity, reminding their children that they immigrated to provide their children with access to better education than was available in their homeland.  Immigrant children tend to internalize their parents' attitude toward educational achievement.Members of ethnic minorities in the United States also stress loyalty to family and community over self, so children feel a strong sense of gratitude and allegiance to their parents.  Immigrant parents with successful children have usually formed close relationships with members of their ethnic community; members of ethnic enclaves tend to demonstrate consensus on values and exert an unusually high level of control over the children's behavior through regular monitoring. L. E. Berk. Child Development © 2006 Pearson -If Student 1 has progressed to identity achievement status, how would the student most likely respond to the question, "Would you change your career choice if a better option came along?"

Passage Until recently, deviance has generally been conceptualized as negative.  Positive deviance (PD) is used to describe the atypical behaviors exhibited by some individuals that result in superior outcomes when compared with others in the group.  Despite having similar access to limited resources, some people adopt novel strategies to problem-solve much better than their peers.  For example, rural Vietnamese villages in the 1990s had child malnutrition rates approaching 70%.  Despite this, certain villagers were able to nourish their children by developing innovative strategies that defied social norms.  These villagers fed their children plant parts not traditionally consumed (such as the leaves of the sweet potato plant) and fed them three or four times a day (instead of the customary two meals a day) .  In other words, despite a lack of conventionally accepted means, these villagers engaged in alternative behaviors, or PD, to meet the societal goal of providing adequate nourishment to their children.Research into PD has focused on using these innovative individuals to catalyze change in their communities.  A pilot study attempting to spread the techniques of these initial PD villagers within their own community was successful:  Childhood malnutrition dropped by over 80% in two years.  However, the community-based approach to changing health behaviors appears to be crucial:  When an international aid organization attempted to implement a larger program based on these same practices, villagers resisted the imposed changes and it was unsuccessful.Another study assessed how PD can improve outcomes in health care settings.  Patients with difficult-to-manage chronic diseases often hold deeply entrenched beliefs about how to handle their illnesses and ignore alternative strategies.  PD patients, referred to as "bright spotters" in the study, are an exception.  They have successfully managed to control their complex illnesses using innovative approaches such as diet modifications and unique coping mechanisms.  Similar to the pilot study with Vietnamese villagers, preliminary results suggest that peer-led group activities may best allow bright spotters to teach fellow patients how to effectively manage their illnesses. -Which of the following statements is most supported by information in the passage?

Passage Patients undergoing chemotherapy frequently experience a number of side effects in response to the cytotoxic drugs administered during treatment, including nausea and/or vomiting (N/V) , hair loss, fatigue, cognitive dysfunction, anemia, and others.  However, there is ample evidence that learning and cognition may play a role in the development of some of these side effects.  For example, 20%-30% of patients undergoing chemotherapy continue to experience N/V merely in the setting and presence of chemotherapy equipment even after taking antiemetic medication.Three studies were conducted to better understand the acquisition of a learned, anticipatory nausea (AN) response.  Studies 1 and 2 used the classical conditioning principle of overshadowing, in which a powerful stimulus is presented alongside a less salient stimulus during the acquisition phase.  This results in a stronger relationship between the salient stimulus and the response, as compared with the less salient stimulus and response.In Study 1, nausea was induced in 50 healthy volunteers through motion sickness in a rotating chair.  Subjects were divided into two groups and drank specific beverages prior to the rotation:  One group received a different novel-tasting beverage (eg, elderberry, sloe) each day, and the other group drank only water.  Nausea-related symptoms were recorded before and after the rotation.  Results showed that subjects who drank the novel-tasting beverages reported less AN than those who drank water.Study 2 tested the protocol from Study 1 in cancer patients undergoing chemotherapy.  Immediately prior to chemotherapy infusion, one group received a different novel-tasting beverage each day and the other group drank only water.  Results again demonstrated that subjects in the group with different novel-tasting beverages experienced less AN than those who drank water.Study 3 researchers investigated whether patients' pretreatment expectations of developing nausea or medication-induced post-chemotherapy nausea (PN) were a better predictor of subsequent AN.  Before their first round of chemotherapy (session #1) , subjects were surveyed about their degree of certainty of developing nausea.  PN was measured after session #1, and then AN was measured before session #3 (Figure 1) . Figure 1  AN before session #3 J. T. Hickok, J. A. Roscoe, and G. R. Morrow ©2001 Elsevier; U. Stockhorst, P. Enck, and S. Klosterhalfen ©2007 Baishideng Publishing Group. -In a follow-up to Study 2, the control participants returned to the chemotherapy room to fill out surveys every day for a week after their final chemotherapy treatment.  By the end of the week, participants' AN had significantly decreased.  This illustrates which phenomenon?

Passage Patients undergoing chemotherapy frequently experience a number of side effects in response to the cytotoxic drugs administered during treatment, including nausea and/or vomiting (N/V) , hair loss, fatigue, cognitive dysfunction, anemia, and others.  However, there is ample evidence that learning and cognition may play a role in the development of some of these side effects.  For example, 20%-30% of patients undergoing chemotherapy continue to experience N/V merely in the setting and presence of chemotherapy equipment even after taking antiemetic medication.Three studies were conducted to better understand the acquisition of a learned, anticipatory nausea (AN) response.  Studies 1 and 2 used the classical conditioning principle of overshadowing, in which a powerful stimulus is presented alongside a less salient stimulus during the acquisition phase.  This results in a stronger relationship between the salient stimulus and the response, as compared with the less salient stimulus and response.In Study 1, nausea was induced in 50 healthy volunteers through motion sickness in a rotating chair.  Subjects were divided into two groups and drank specific beverages prior to the rotation:  One group received a different novel-tasting beverage (eg, elderberry, sloe) each day, and the other group drank only water.  Nausea-related symptoms were recorded before and after the rotation.  Results showed that subjects who drank the novel-tasting beverages reported less AN than those who drank water.Study 2 tested the protocol from Study 1 in cancer patients undergoing chemotherapy.  Immediately prior to chemotherapy infusion, one group received a different novel-tasting beverage each day and the other group drank only water.  Results again demonstrated that subjects in the group with different novel-tasting beverages experienced less AN than those who drank water.Study 3 researchers investigated whether patients' pretreatment expectations of developing nausea or medication-induced post-chemotherapy nausea (PN) were a better predictor of subsequent AN.  Before their first round of chemotherapy (session #1) , subjects were surveyed about their degree of certainty of developing nausea.  PN was measured after session #1, and then AN was measured before session #3 (Figure 1) . Figure 1  AN before session #3 J. T. Hickok, J. A. Roscoe, and G. R. Morrow ©2001 Elsevier; U. Stockhorst, P. Enck, and S. Klosterhalfen ©2007 Baishideng Publishing Group. -Based on the passage and the principles of taste aversion, which strategy should physicians suggest to their patients undergoing chemotherapy?  On the day of chemotherapy, patients should:

Passage Before memories have been consolidated they are considered "labile," or unstable and easily altered.  Sleep is theorized to be essential to the process of memory consolidation, though the mechanisms for this are still under investigation.  Rapid eye movement (REM) sleep has long been assumed to be the sleep stage most important for overall memory consolidation, but recent research suggests that different types of memory may be consolidated during different sleep stages.  Procedural memories appear to be primarily consolidated during REM sleep while declarative memories appear to be primarily consolidated during slow-wave sleep (SWS) .  Sleep duration, sleep regularity, and timing of sleep all contribute to the proportions of REM and SWS, so these factors also play an important role in memory consolidation processes.An experiment was performed at a large state university to investigate the relationship between sleep and learning in college students.  Researchers screened potential participants with a sleep habits questionnaire.  Those who reported having a regular sleep schedule were included in the study (N = 100) and given a vocabulary knowledge pretest.  Participants were then randomly assigned to 1 of 4 experimental groups, each containing 25 students.  During the learning phase (L) , each student was asked to memorize a set of 10 common toy objects (eg, car, ball, stuffed animal, blocks) and 10 vocabulary definitions that the student had labeled as "unknown" during the pretest.  Images of the toy objects were presented in a sequence, one at a time, for 5 seconds each; the 10 vocabulary definitions were listed on a sheet that students were allowed to study for 10 minutes.  During the testing phase (T) , students were asked to recall the objects in any order and define the vocabulary words (Figure 1) . Figure 1  Experimental design for each of the 4 groupsResults were reported as the average recall accuracy for the objects and vocabulary definitions, by group (Table 1) .  Participants were then given a survey about the techniques they used when attempting to remember the toy objects and vocabulary definitions.  Some students reported associating the definitions and objects with one another.  For instance, one student reported that she related the words "plucky" (meaning brave) and "tocsin" (meaning an alarm) to an image of a toy fire truck, making it easier to recall the toy object and both associated vocabulary definitions.Table 1  Average Recall Accuracy, per Group -In this study, the vocabulary recall task most directly assessed which of the following types of memory?

Passage Jake and his classmate Michael both grew up in a high-crime public housing project in a poverty-stricken neighborhood in a large urban area.  Both children lived in single-parent households and had almost no relationship with their fathers.  They performed poorly in school and frequently got in trouble with authority figures.  Neither completed high school and both had been arrested by the time they turned 18.At this point their trajectories begin to diverge.  By age 27, Jake had been in and out of prison three times, had fathered four children by four different women, and was abusing drugs and alcohol daily.  On the other hand, Michael had earned a general equivalency diploma, was a general manager at a factory, was married with a biological son and adopted daughter, and owned a home in the suburbs.Jake and Michael both participated in a study about resilience-the ability to prevail in the face of threats to adequate psychosocial development.  This study recruited 81 adult men who as children had lived in the same public housing project between 1976 and 1980.  The investigators categorized participants into one of two groups based on their adult outcomes-low resilience and high resilience.  All the men reported family difficulties while growing up in crime and poverty.  The low-resilience men (n = 69) were significantly more likely to report drug and alcohol use and current or prior imprisonment, whereas the high-resilience men (n = 12) were all employed, and most were married homeowners.The study's primary finding was that high-resilience men received more social support outside their immediate families while growing up than did low-resilience men.  Results also suggested that high-resilience men tended to have calmer, more optimistic dispositions, whereas low-resilience men were more anxious, disagreeable, and pessimistic. -Michael and his wife share what type of kinship?

Passage During the 1800s, the United States (U.S.) transitioned from a farming society to an industrialized society, which resulted in occupations becoming more specialized and socially labeled as "masculine" or "feminine."  Today, the U.S. is experiencing an equally dramatic transition into what is referred to as a knowledge economy, marked by a decline in manufacturing and manual labor occupations, often referred to as "blue-collar" professions (which are dominated by males) , and a rise in information, technology, and service sector jobs.  Sociologists argue that this has led to shifting roles and expectations for both males and females in the U.S. workforce.As demand for blue-collar occupations has declined in recent decades, demand for "pink-collar" (feminine-typed) occupations has increased, particularly in health care (eg, registered nurses, health aides) , but males appear to avoid pink-collar occupations for various reasons.  Research indicates that socially defined gender roles may dissuade males from even considering pink-collar professions due to a perception that one's job will conflict with one's male status.  Male students-in-training for pink-collar professions (eg, nursing) have a higher rate of attrition than their female classmates, which may be partly due to the unintended messages conveyed by the informal curriculum: that male students do not belong in these professions (eg, a lack of male role models, female-only images in textbooks) .  Of the males who enter pink-collar professions, many find that they are more quickly promoted into managerial roles (believed to be more appropriately masculine) than their equally qualified female counterparts, a phenomenon known as the glass escalator.Data show that females continue to be underrepresented in many high-paying fields, which are predominantly masculine-typed industries such as aeronautics, engineering, medical surgery, business (executive-level) , and computer science/technology.  Data also show that within all job categories, even those considered feminine-typed, females are still paid less than their male peers, a phenomenon sociologists call the gender pay (or wage) gap (Figure 1) .  The gender pay gap persists even when differences in hours worked, job choice, education, and other qualifications are taken into account.  Research suggests that mothers earn less than men and women who are not mothers, a phenomenon termed the "motherhood penalty" by sociologists. Figure 1  Gender pay gap by age P. F. Drucker ©1994 The Atlantic Monthly; B. R. MacWilliams, B. Schmidt, and M. R. Bleich ©2013 Wolters Kluwer Health, Inc. -A feminist theorist would be most interested in which of the following?