NR546 / NR 546 ACTUAL MIDTERM EXAM 2023 QUESTIONS AND ANSWERS 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 b...
NR546 Midterm Exam Questions And Answers 2023 Update 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 t o 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 medic ations 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 1 00% 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. There may be an environmental exposure that turned a gene "on" that should hav e been "off" for one twin to develop schizophrenia and not the other. central sulcus - Answer -separates the frontal lobe from the parietal lobe frontal lobe - Answer -associated with movement, intelligence, abstract thinking broca's area - Answer -speech production temporal lobe - Answer -involves object identification and auditory signals cerebellum - Answer -coordination wernicke's area - Answer -speech comprehension NR546 MIDTERM EXAM QUESTIONS AND ANSWERS 2023 UPDATE A+ occipital lobe - Answer -primary visual area parietal lobe - Answer -keeps us alert to what is going on around us sensory cortex - Answer -pain, heat, and other sensations motor cortex - Answer -movement hippocampus - Answer -involved in both memory and anxiety nucleus accumbens - Answer -involved in the reward process thalamus - Answer -involved in sensory organ and motor command processing striatum - Answer -involved in complex motor actions, also links cognition to motor actions limbic system - Answer -includes circuits that are associated with plea sure and reward basal ganglia - Answer -group of structures involved in voluntary motor movements amygdala - Answer -involved in emotional regulation and perception of odors corpus callosum - Answer -controls the communication between the two brain hemisph eres white matter - Answer -contains nerve fibers that connect neurons from different regions into functional circuits grey matter - Answer -contains nerve cells and dendrites brain tissue - Answer -made up of grey matter and white matter 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 h ow 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 in heritance 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 als o 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 -Guardi ans 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 con cerns -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 smok ing 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 pro duct 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, 2C1 9, 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 us ed to predict which patients might need to have dosage adjustments -measurement of genes for drug metabolism
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