NR546 MIDTERM EXAM QUESTIONS AND ANSWERS.

NR546 MIDTERM EXAM QUESTIONS
AND ANSWERS

What should the PMHNP consider when prescribing chemical restraints? - ANSWER:
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-allergy status
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-prior med hx for adverse drug reactions r/t the meds ordered in the chemical restraint
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-state regulations regarding chemical restrains must be reviewed
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Are the PMHNP and other staff liable if the client has an allergic reaction or adverse
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side effects to the drugs used for chemical restraint? - ANSWER: No.
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The client has been court-ordered to take the prescribed medications and the
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standing order for chemical restraints is approved. The PMHNP and other staff are
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not liable if the patient has an allergic reaction or adverse side effects.
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How does reviewing the genetic makeup of a client help guide the PMHNP in
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selecting medication for clients? - ANSWER: -Genetic testing can assist by providing
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more information on how clients may respond to certain psychotropic medications
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-provides information on how a client may break down and metabolize medications
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based on the cytochrome P450 system.
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Tanrıkulu and Erbaş (2020) investigated identical twins to determine the presence of
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an inherited link for schizophrenia and why one twin may develop schizophrenia
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when the other does not. When two people have 100% identical DNA, why don't both
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persons develop the exact illnesses? Studies of identical Danish twins found that if
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one twin had schizophrenia, the other twin had a 50% lifetime risk of developing
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schizophrenia (Lemvigh et al., 2020). Why is there only half the risk? - ANSWER:
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Both environmental and psychosocial stressors can impact mental health. Although
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twins may have identical genes, their gene expression may be different.
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There may be an environmental exposure that turned a gene "on" that should have
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been "off" for one twin to develop schizophrenia and not the other.
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central sulcus - ANSWER: separates the frontal lobe from the parietal lobe
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frontal lobe - ANSWER: associated with movement, intelligence, abstract thinking
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broca's area - ANSWER: speech production
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temporal lobe - ANSWER: involves object identification and auditory signals
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cerebellum - ANSWER: coordination bb bb bb

,wernicke's area - ANSWER: speech comprehension bb bb bb bb bb




occipital lobe - ANSWER: primary visual area
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parietal lobe - ANSWER: keeps us alert to what is going on around us
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sensory cortex - ANSWER: pain, heat, and other sensations
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motor cortex - ANSWER: movement
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hippocampus - ANSWER: involved in both memory and anxiety bb bb bb bb bb bb bb bb




nucleus accumbens - ANSWER: involved in the reward process
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thalamus - ANSWER: involved in sensory organ and motor command processing
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striatum - ANSWER: involved in complex motor actions, also links cognition to motor
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actions
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limbic system - ANSWER: includes circuits that are associated with pleasure and
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reward
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basal ganglia - ANSWER: group of structures involved in voluntary motor movements
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amygdala - ANSWER: involved in emotional regulation and perception of odors
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corpus callosum - ANSWER: controls the communication between the two brain
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hemispheres
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white matter - ANSWER: contains nerve fibers that connect neurons from different
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regions into functional circuits
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grey matter - ANSWER: contains nerve cells and dendrites
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brain tissue - ANSWER: made up of grey matter and white matter
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dorsal striatum - ANSWER: involved in complex motor actions and linkage of
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cognition to motor actions
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-main input area for basal ganglia
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*activated when anticipating or engaging in pleasure
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The field of epigenetics is rapidly growing and can help explain how gene expression
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is: - ANSWER: influenced by environmental factors and how epigenetics contributes
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to the manifestation of mental illness
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,How does epigenetics impact a person's mental health? - ANSWER: internal or
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external factors activate portions of the genome that result in the manifestation of
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mental health symptoms
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-activation is often a result of a stressful event, which, when combined with the
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genetic risk, results in the disease
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-genes being on or off bb bb bb bb



-occurrence of symptoms may be the result of inheritance of an abnormal gene or of
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normal genes being "on" when they should be "off."
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Types of epigenetic changes: - ANSWER: DNA Methylation
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Histone modification bb



Non-coding RNA bb




The potential legal and ethical issues impacting mental health treatment must also be
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taken into account, including: - ANSWER: -informed consent
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-competence to make healthcare decisions bb bb bb bb



-off-label prescribing bb




Informed consent - ANSWER: Clients have the right to receive enough information to
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make decisions about treatment.
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-must also be informed about potential risks associated with medications.
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-have the right to refuse treatment
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-cannot be forcibly medicated in non-emergencies. However, clients can be forcibly
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medicated if they are violent toward themselves or others and when less restrictive
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methods have failed
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Compliance - ANSWER: A court order may be issued for a client to receive treatment
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against their wishes if they are considered a danger to themselves or others.
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-Examples: clients with schizophrenia or sex offenders bb bb bb bb bb bb



-Guardians can provide consent for clients who have limited cognitive capabilities or
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are incompetent to make decisions
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-PMHNPs are responsible for being knowledgeable about their state laws and abiding
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by them.
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Off-Label Prescribing - ANSWER: Some clients may benefit from the unapproved use
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of a drug for symptom management.
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-Example: many SSRIs used to tx anxiety and OCD but are not FDA approved for use
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in this disorder.
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-potentially raises ethical and legal concerns bb bb bb bb bb



-PMHNP must remain up to date with the latest recommendations for off-label
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prescribing.
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Incidence of mental illness-what factors are increasing the incidence - ANSWER:
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Psychological and sociological factors
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, Lifestyle factors such as a client's smoking status, diet, exercise, history of medication
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adherence, or history of addiction should be considered when prescribing
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psychotropic medications
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Adherence - ANSWER: Persistence bb bb bb



-taking med over intended time period
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Compliance
-taking med as prescribed
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left hemisphere - ANSWER: -speech comprehension
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-word recognition
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-grammar
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-recognition of detail bb bb



-conscious mental processing bb bb




right hemisphere - ANSWER: -prosody of speech
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-emotional modulation bb



-visual-spatial skills bb



-recognition of facial expression bb bb bb



-music
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-holistic processing bb



-unconscious mental processing bb bb




Pharmacokinetics - ANSWER: the study of what happens to a drug from the time of bb bb bb bb bb bb bb bb bb bb bb bb bb bb



administration until the parent drug and all metabolites leave the body
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CYP450 - ANSWER: CYP450 enzymes in the gut wall or liver convert drug substrate
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into a biotransformed product in the bloodstream, responsible for degradating of a
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large # of psychotropic drugs
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-Not all ind. have same genetic form of CYP450 enzymes, determined with
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pharmacogenetic testing
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*Most individuals have "normal" rates of drug metabolism from the major CYP450
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enzymes and are said to be "extensive metabolizers", most drug doses are set for
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these individuals.
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*genetic variants of these enzymes can make poor metabolizers or ultra rapid
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metabolizers
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Five of the most important:
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CYP450 1A2, 2B6, 2D6, 2C9, 2C19, and 3A4.
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ultra rapid metabolizers - ANSWER: elevated enzyme activity
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subtherapeutic drug levels bb bb



poor efficacy with standard doses
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