NR 546 MIDTERM EXAM 2023-2024 ACTUAL EXAM
TEST BANK 300 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES |ALREADY
GRADED A+
What should the PMHNP consider when prescribing chemical restraints? - ANSWER--allergy status
-prior med hx for adverse drug reactions r/t the meds ordered in the chemical restraint
-state regulations regarding chemical restrains must be reviewed
Are the PMHNP and other staff liable if the client has an allergic reaction or adverse side effects to the
drugs used for chemical restraint? - ANSWER-No.
The client has been court-ordered to take the prescribed medications and the standing order for
chemical restraints is approved. The PMHNP and other staff are not liable if the patient has an allergic
reaction or adverse side effects.
How does reviewing the genetic makeup of a client help guide the PMHNP in selecting medication for
clients? - ANSWER--Genetic testing can assist by providing more information on how clients may
respond to certain psychotropic medications
-provides information on how a client may break down and metabolize medications based on the
cytochrome P450 system.
Tanrıkulu and Erbaş (2020) investigated identical twins to determine the presence of an inherited link
for schizophrenia and why one twin may develop schizophrenia when the other does not. When two
people have 100% identical DNA, why don't both persons develop the exact illnesses? Studies of
identical Danish twins found that if one twin had schizophrenia, the other twin had a 50% lifetime risk of
developing schizophrenia (Lemvigh et al., 2020). Why is there only half the risk? - ANSWER-Both
environmental and psychosocial stressors can impact mental health. Although twins may have identical
genes, their gene expression may be different.
dorsal striatum - ANSWER-involved in complex motor actions and linkage of cognition to motor actions
-main input area for basal ganglia
*activated when anticipating or engaging in pleasure
,The field of epigenetics is rapidly growing and can help explain how gene expression is: - ANSWER-
influenced by environmental factors and how epigenetics contributes to the manifestation of mental
illness
How does epigenetics impact a person's mental health? - ANSWER-internal or external factors activate
portions of the genome that result in the manifestation of mental health symptoms
-activation is often a result of a stressful event, which, when combined with the genetic risk, results in
the disease
-genes being on or off
-occurrence of symptoms may be the result of inheritance of an abnormal gene or of normal genes
being "on" when they should be "off."
Types of epigenetic changes: - ANSWER-DNA Methylation
Histone modification
Non-coding RNA
The potential legal and ethical issues impacting mental health treatment must also be taken into
account, including: - ANSWER--informed consent
-competence to make healthcare decisions
-off-label prescribing
Informed consent - ANSWER-Clients have the right to receive enough information to make decisions
about treatment.
-must also be informed about potential risks associated with medications.
-have the right to refuse treatment
-cannot be forcibly medicated in non-emergencies. However, clients can be forcibly medicated if they
are violent toward themselves or others and when less restrictive methods have failed
Compliance - ANSWER-A court order may be issued for a client to receive treatment against their wishes
if they are considered a danger to themselves or others.
-Examples: clients with schizophrenia or sex offenders
,-Guardians can provide consent for clients who have limited cognitive capabilities or are incompetent to
make decisions
-PMHNPs are responsible for being knowledgeable about their state laws and abiding by them.
Off-Label Prescribing - ANSWER-Some clients may benefit from the unapproved use of a drug for
symptom management.
-Example: many SSRIs used to tx anxiety and OCD but are not FDA approved for use in this disorder.
-potentially raises ethical and legal concerns
-PMHNP must remain up to date with the latest recommendations for off-label prescribing.
Incidence of mental illness-what factors are increasing the incidence - ANSWER-Psychological and
sociological factors
Lifestyle factors such as a client's smoking status, diet, exercise, history of medication adherence, or
history of addiction should be considered when prescribing psychotropic medications
Adherence - ANSWER-Persistence
-taking med over intended time period
Compliance
-taking med as prescribed
left hemisphere - ANSWER--speech comprehension
-word recognition
-grammar
-sequential processing
-recognition of detail
-conscious mental processing
right hemisphere - ANSWER--prosody of speech
-emotional modulation
-visual-spatial skills
, -recognition of facial expression
-music
-abstract mathematical skills
-holistic processing
-unconscious mental processing
Pharmacokinetics - ANSWER-the study of what happens to a drug from the time of administration until
the parent drug and all metabolites leave the body
CYP450 - ANSWER-CYP450 enzymes in the gut wall or liver convert drug substrate into a biotransformed
product in the bloodstream, responsible for degradating of a large # of psychotropic drugs
-Not all ind. have same genetic form of CYP450 enzymes, determined with pharmacogenetic testing
*Most individuals have "normal" rates of drug metabolism from the major CYP450 enzymes and are said
to be "extensive metabolizers", most drug doses are set for these individuals.
*genetic variants of these enzymes can make poor metabolizers or ultra rapid metabolizers
Five of the most important:
CYP450 1A2, 2B6, 2D6, 2C9, 2C19, and 3A4.
ultra rapid metabolizers - ANSWER-elevated enzyme activity
subtherapeutic drug levels
poor efficacy with standard doses
genotyping - ANSWER-the patient for pharmacogenomic use
-genes for these CYP450 enzymes can now be readily measured and used to predict which patients
might need to have dosage adjustments
-measurement of genes for drug metabolism
most common targets of psychotropic drugs - ANSWER-G-protein receptors
TEST BANK 300 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES |ALREADY
GRADED A+
What should the PMHNP consider when prescribing chemical restraints? - ANSWER--allergy status
-prior med hx for adverse drug reactions r/t the meds ordered in the chemical restraint
-state regulations regarding chemical restrains must be reviewed
Are the PMHNP and other staff liable if the client has an allergic reaction or adverse side effects to the
drugs used for chemical restraint? - ANSWER-No.
The client has been court-ordered to take the prescribed medications and the standing order for
chemical restraints is approved. The PMHNP and other staff are not liable if the patient has an allergic
reaction or adverse side effects.
How does reviewing the genetic makeup of a client help guide the PMHNP in selecting medication for
clients? - ANSWER--Genetic testing can assist by providing more information on how clients may
respond to certain psychotropic medications
-provides information on how a client may break down and metabolize medications based on the
cytochrome P450 system.
Tanrıkulu and Erbaş (2020) investigated identical twins to determine the presence of an inherited link
for schizophrenia and why one twin may develop schizophrenia when the other does not. When two
people have 100% identical DNA, why don't both persons develop the exact illnesses? Studies of
identical Danish twins found that if one twin had schizophrenia, the other twin had a 50% lifetime risk of
developing schizophrenia (Lemvigh et al., 2020). Why is there only half the risk? - ANSWER-Both
environmental and psychosocial stressors can impact mental health. Although twins may have identical
genes, their gene expression may be different.
dorsal striatum - ANSWER-involved in complex motor actions and linkage of cognition to motor actions
-main input area for basal ganglia
*activated when anticipating or engaging in pleasure
,The field of epigenetics is rapidly growing and can help explain how gene expression is: - ANSWER-
influenced by environmental factors and how epigenetics contributes to the manifestation of mental
illness
How does epigenetics impact a person's mental health? - ANSWER-internal or external factors activate
portions of the genome that result in the manifestation of mental health symptoms
-activation is often a result of a stressful event, which, when combined with the genetic risk, results in
the disease
-genes being on or off
-occurrence of symptoms may be the result of inheritance of an abnormal gene or of normal genes
being "on" when they should be "off."
Types of epigenetic changes: - ANSWER-DNA Methylation
Histone modification
Non-coding RNA
The potential legal and ethical issues impacting mental health treatment must also be taken into
account, including: - ANSWER--informed consent
-competence to make healthcare decisions
-off-label prescribing
Informed consent - ANSWER-Clients have the right to receive enough information to make decisions
about treatment.
-must also be informed about potential risks associated with medications.
-have the right to refuse treatment
-cannot be forcibly medicated in non-emergencies. However, clients can be forcibly medicated if they
are violent toward themselves or others and when less restrictive methods have failed
Compliance - ANSWER-A court order may be issued for a client to receive treatment against their wishes
if they are considered a danger to themselves or others.
-Examples: clients with schizophrenia or sex offenders
,-Guardians can provide consent for clients who have limited cognitive capabilities or are incompetent to
make decisions
-PMHNPs are responsible for being knowledgeable about their state laws and abiding by them.
Off-Label Prescribing - ANSWER-Some clients may benefit from the unapproved use of a drug for
symptom management.
-Example: many SSRIs used to tx anxiety and OCD but are not FDA approved for use in this disorder.
-potentially raises ethical and legal concerns
-PMHNP must remain up to date with the latest recommendations for off-label prescribing.
Incidence of mental illness-what factors are increasing the incidence - ANSWER-Psychological and
sociological factors
Lifestyle factors such as a client's smoking status, diet, exercise, history of medication adherence, or
history of addiction should be considered when prescribing psychotropic medications
Adherence - ANSWER-Persistence
-taking med over intended time period
Compliance
-taking med as prescribed
left hemisphere - ANSWER--speech comprehension
-word recognition
-grammar
-sequential processing
-recognition of detail
-conscious mental processing
right hemisphere - ANSWER--prosody of speech
-emotional modulation
-visual-spatial skills
, -recognition of facial expression
-music
-abstract mathematical skills
-holistic processing
-unconscious mental processing
Pharmacokinetics - ANSWER-the study of what happens to a drug from the time of administration until
the parent drug and all metabolites leave the body
CYP450 - ANSWER-CYP450 enzymes in the gut wall or liver convert drug substrate into a biotransformed
product in the bloodstream, responsible for degradating of a large # of psychotropic drugs
-Not all ind. have same genetic form of CYP450 enzymes, determined with pharmacogenetic testing
*Most individuals have "normal" rates of drug metabolism from the major CYP450 enzymes and are said
to be "extensive metabolizers", most drug doses are set for these individuals.
*genetic variants of these enzymes can make poor metabolizers or ultra rapid metabolizers
Five of the most important:
CYP450 1A2, 2B6, 2D6, 2C9, 2C19, and 3A4.
ultra rapid metabolizers - ANSWER-elevated enzyme activity
subtherapeutic drug levels
poor efficacy with standard doses
genotyping - ANSWER-the patient for pharmacogenomic use
-genes for these CYP450 enzymes can now be readily measured and used to predict which patients
might need to have dosage adjustments
-measurement of genes for drug metabolism
most common targets of psychotropic drugs - ANSWER-G-protein receptors
