NR546 Midterm Exam
Study online at https://quizlet.com/_d1dqm8
1. What should the PMHNP consider when prescribing chemical restraints?: -al-
lergy 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
2. 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.
3. 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.
4. 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.
5. central sulcus: separates the frontal lobe from the parietal lobe
6. frontal lobe: associated with movement, intelligence, abstract thinking
7. broca's area: speech production
8. temporal lobe: involves object identification and auditory signals
9. cerebellum: coordination
10. wernicke's area: speech comprehension
11. occipital lobe: primary visual area
12. parietal lobe: keeps us alert to what is going on around us
, NR546 Midterm Exam
Study online at https://quizlet.com/_d1dqm8
13. sensory cortex: pain, heat, and other sensations
14. motor cortex: movement
15. hippocampus: involved in both memory and anxiety
16. nucleus accumbens: involved in the reward process
17. thalamus: involved in sensory organ and motor command processing
18. striatum: involved in complex motor actions, also links cognition to motor actions
19. limbic system: includes circuits that are associated with pleasure and reward
20. basal ganglia: group of structures involved in voluntary motor movements
21. amygdala: involved in emotional regulation and perception of odors
22. corpus callosum: controls the communication between the two brain hemispheres
23. white matter: contains nerve fibers that connect neurons from different regions into functional circuits
24. grey matter: contains nerve cells and dendrites
25. brain tissue: made up of grey matter and white matter
26. 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
27. 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
28. 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."
29. Types of epigenetic changes:: DNA Methylation
Histone modification
Non-coding RNA
30. 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
, NR546 Midterm Exam
Study online at https://quizlet.com/_d1dqm8
31. Informed consent: Clients have the right to receive enough information to make decisions about treat-
ment.
-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
32. 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.
33. 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.
34. Incidence of mental illness-what factors are increasing the incidence: Psycho-
logical 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
35. Adherence: Persistence
-taking med over intended time period
Compliance
-taking med as prescribed
36. left hemisphere: -speech comprehension
-word recognition
-grammar
-sequential processing
-recognition of detail
-conscious mental processing
, NR546 Midterm Exam
Study online at https://quizlet.com/_d1dqm8
37. right hemisphere: -prosody of speech
-emotional modulation
-visual-spatial skills
-recognition of facial expression
-music
-abstract mathematical skills
-holistic processing
-unconscious mental processing
38. Pharmacokinetics: the study of what happens to a drug from the time of administration until the parent
drug and all metabolites leave the body
39. 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.
40. ultra rapid metabolizers: elevated enzyme activity
subtherapeutic drug levels
poor efficacy with standard doses
41. 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
42. 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.
43. Pharmacokinetics concepts: absorption
distribution
Study online at https://quizlet.com/_d1dqm8
1. What should the PMHNP consider when prescribing chemical restraints?: -al-
lergy 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
2. 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.
3. 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.
4. 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.
5. central sulcus: separates the frontal lobe from the parietal lobe
6. frontal lobe: associated with movement, intelligence, abstract thinking
7. broca's area: speech production
8. temporal lobe: involves object identification and auditory signals
9. cerebellum: coordination
10. wernicke's area: speech comprehension
11. occipital lobe: primary visual area
12. parietal lobe: keeps us alert to what is going on around us
, NR546 Midterm Exam
Study online at https://quizlet.com/_d1dqm8
13. sensory cortex: pain, heat, and other sensations
14. motor cortex: movement
15. hippocampus: involved in both memory and anxiety
16. nucleus accumbens: involved in the reward process
17. thalamus: involved in sensory organ and motor command processing
18. striatum: involved in complex motor actions, also links cognition to motor actions
19. limbic system: includes circuits that are associated with pleasure and reward
20. basal ganglia: group of structures involved in voluntary motor movements
21. amygdala: involved in emotional regulation and perception of odors
22. corpus callosum: controls the communication between the two brain hemispheres
23. white matter: contains nerve fibers that connect neurons from different regions into functional circuits
24. grey matter: contains nerve cells and dendrites
25. brain tissue: made up of grey matter and white matter
26. 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
27. 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
28. 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."
29. Types of epigenetic changes:: DNA Methylation
Histone modification
Non-coding RNA
30. 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
, NR546 Midterm Exam
Study online at https://quizlet.com/_d1dqm8
31. Informed consent: Clients have the right to receive enough information to make decisions about treat-
ment.
-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
32. 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.
33. 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.
34. Incidence of mental illness-what factors are increasing the incidence: Psycho-
logical 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
35. Adherence: Persistence
-taking med over intended time period
Compliance
-taking med as prescribed
36. left hemisphere: -speech comprehension
-word recognition
-grammar
-sequential processing
-recognition of detail
-conscious mental processing
, NR546 Midterm Exam
Study online at https://quizlet.com/_d1dqm8
37. right hemisphere: -prosody of speech
-emotional modulation
-visual-spatial skills
-recognition of facial expression
-music
-abstract mathematical skills
-holistic processing
-unconscious mental processing
38. Pharmacokinetics: the study of what happens to a drug from the time of administration until the parent
drug and all metabolites leave the body
39. 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.
40. ultra rapid metabolizers: elevated enzyme activity
subtherapeutic drug levels
poor efficacy with standard doses
41. 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
42. 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.
43. Pharmacokinetics concepts: absorption
distribution
