NR546 Midterm Exam Questions and Correct Answers, With Complete Solution. Updated 2024, 291 Questions and Answers. 100%.
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NR546 Midterm Exam Questions and Correct Answers, With Complete Solution. Updated 2024, 291 Questions and Answers. 100%.
What should the PMHNP consider when prescribing chemical restraints?
-allergy status
-prior med hx for adverse drug reactions r/t the meds ordered in the chemical restraint
...
NR546 Midterm Exam Questions and Correct
Answers, With Complete Solution. Updated 2024,
291 Questions and Answers. 100%.
What should the PMHNP consider when prescribing chemical restraints?
-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?
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?
-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?
Both environmental and psychosocial stressors can impact mental health. Although
twins may have identical genes, their gene expression may be different.
There may be an environmental exposure that turned a gene "on" that should have
been "off" for one twin to develop schizophrenia and not the other.
central sulcus
separates the frontal lobe from the parietal lobe
frontal lobe
associated with movement, intelligence, abstract thinking
broca's area
speech production
temporal lobe
involves object identification and auditory signals
cerebellum
coordination
wernicke's area
,speech comprehension
occipital lobe
primary visual area
parietal lobe
keeps us alert to what is going on around us
sensory cortex
pain, heat, and other sensations
motor cortex
movement
hippocampus
involved in both memory and anxiety
nucleus accumbens
involved in the reward process
thalamus
involved in sensory organ and motor command processing
striatum
involved in complex motor actions, also links cognition to motor actions
limbic system
includes circuits that are associated with pleasure and reward
basal ganglia
group of structures involved in voluntary motor movements
amygdala
involved in emotional regulation and perception of odors
corpus callosum
controls the communication between the two brain hemispheres
white matter
contains nerve fibers that connect neurons from different regions into functional circuits
grey matter
contains nerve cells and dendrites
brain tissue
made up of grey matter and white matter
dorsal striatum
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:
influenced by environmental factors and how epigenetics contributes to the
manifestation of mental illness
How does epigenetics impact a person's mental health?
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:
DNA Methylation
Histone modification
Non-coding RNA
The potential legal and ethical issues impacting mental health treatment must
also be taken into account, including:
-informed consent
-competence to make healthcare decisions
-off-label prescribing
Informed consent
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
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
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
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
Persistence
-taking med over intended time period
Compliance
-taking med as prescribed
left hemisphere
, -speech comprehension
-word recognition
-grammar
-sequential processing
-recognition of detail
-conscious mental processing
right hemisphere
-prosody of speech
-emotional modulation
-visual-spatial skills
-recognition of facial expression
-music
-abstract mathematical skills
-holistic processing
-unconscious mental processing
Pharmacokinetics
the study of what happens to a drug from the time of administration until the parent drug
and all metabolites leave the body
CYP450
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
elevated enzyme activity
subtherapeutic drug levels
poor efficacy with standard doses
genotyping
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
G-protein receptors
-Drug actions at these receptors occur in a spectrum, from full agonist actions, to partial
agonist actions, to antagonism, and even to inverse agonism.
Pharmacokinetics concepts
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