NR 546 MIDTERM EXAM WITH ACTUAL
QUESTIONS AND CORRECT DETAILED
ANSWERS LATEST EXAM 2023-2024 A GRADE
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.
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.
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.
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
,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
-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 - ANSWER-absorption
distribution
metabolism
excretion
Flockhart Table - ANSWER-drug interactions that are mediated by cytochrome P450
enzymes
comprehensive list of drugs and the interactions related to the cytochrome P450
system
Neurotransmitters - ANSWER-chemicals released by neurons to send
communication across synaptic clefts to other neurons
-impact human emotion and behavior
Neurotransmission: - ANSWER-the chemical transmission of information between
neurons and their target cells
-the chemicals, or neurotransmitters, are released from their transport vesicles to
bind with receptor sites to perform their duties, which are excitatory or inhibitory
-neurotransmitter then either returned and stored for future use (reuptake) or
inactivated and dissolved by enzymes
-Types: Classic, Retrograde, Volume
Classic neurotransmission - ANSWER-neurons send electrical impulses from one
part of the cell to another part of the same cell via their axons
-one neuron hurling a chemical messenger, or neurotransmitter, at the receptors of a
second neuron
-electrical impulse converted chemical signal at the synapse in a process known as
excitation-secretion coupling, the first stage of chemical neurotransmission, then
back into electrical impulse in second neuron
-chemical information from the first neuron triggering a cascade of further chemical
messages within the second neuron to change that neuron's molecular and genetic
functioning
Retrograde neurotransmission - ANSWER-postsynaptic neurons "talk back" to their
presynaptic neurons
-second neuron to the first at the synapse between them
,-Chemicals produced specifically as retrograde neurotransmitters at some synapses
include: endocannabinoids, gaseous neurotransmitter nitric oxide (NO), nerve growth
factor (NGF).
Volume neurotransmission - ANSWER-Neurotransmission without a synapse or
nonsynaptic diffusion neurotransmission
-Chemical messengers sent by one neuron to another can spill over to sites distant
to the synapse by diffusion
-neurotransmission can occur at any compatible receptor within the diffusion radius
of the neurotransmitter
-neurotransmission occurs in chemical "puffs"
-sophisticated "chemical soup."
ters that may be responsible for a client's symptoms of depression - ANSWER-
Imbalanced levels of acetylcholine, norepinephrine, serotonin, histamine, or
glutamate can contribute to symptoms of depression
client who is a poor metabolizer: - ANSWER-has a lower concentration of the
necessary enzyme to metabolize a drug, which results in higher blood
concentrations of the drug.
-increase the risk of side effects and adverse reactions
Why is trazodone not used as a front-line antidepressant - ANSWER-Its
antidepressant that has a secondary effect of blocking histamine and adrenergic
receptors
-causes sedation and somnolence and as a result
*often used as an adjunct in therapy when a depressed patient has difficulty sleeping
effect on neurotransmitters and side effects: Selective Serotonin Reuptake Inhibitors
(SSRIs) - ANSWER-Inhibits the reuptake of serotonin, which can cause nausea,
agitation, headache, and sexual dysfunction
effect on neurotransmitters and side effects: Serotonin and Norepinephrine
Reuptake Inhibitors (SNRIs) - ANSWER-Inhibits the reuptake of serotonin and
norepinephrine, which can cause nausea, sweating, insomnia, tremors, sexual
dysfunction
effect on neurotransmitters and side effects: Tricyclic Antidepressants - ANSWER--
Inhibits the reuptake of serotonin and norepinephrine, which can cause sexual
dysfunction
-Blocks norepinephrine receptors, which can cause hypotension and tachycardia
-Blocks histamine receptors, which can cause sedation and weight gain
-Blocks acetylcholine receptors, which can cause dry mouth, constipation, blurred
vision, and urinary retention
effect on neurotransmitters and side effects: Monoamine Oxidase Inhibitors (MAOIs)
- ANSWER-Increases norepinephrine and serotonin by inhibiting the enzyme that
inactivates it, which can cause sedation, dizziness, sexual dysfunction, and
hypertensive crisis
, effect on neurotransmitters and side effects: Benzodiazepines - ANSWER-Increases
the receptor affinity for GABA, which can cause dependence and confusion
effect on neurotransmitters and side effects: Bupropion - ANSWER-Inhibits the
reuptake of norepinephrine and dopamine, which can cause insomnia, dry mouth,
tremors, and seizures
antagonist - ANSWER-causes a conformational change that stabilizes the receptor
in the baseline state and thus is "silent."
-blocks the action of a neurotransmitter
agonists - ANSWER-fully stimulate G-protein-linked receptors
partial agonists - ANSWER-stimulate receptors to a lesser degree than an agonist or
natural neurotransmitter
SSRIs, SNRIs, and tricyclic antidepressants increase ________ levels.
___________ do not impact serotonin levels. - ANSWER-increase serotonin levels.
Benzodiazepines do not impact serotonin levels.
Is nicotine an inducer or an inhibitor of the CYP 1A2 enzyme? - ANSWER-inducer
Nicotine is an inducer of the CYP 1A2 enzyme. Does the PMHNP anticipate Joshua
may need a higher or lower dose of olanzapine to achieve a therapeutic response? -
ANSWER-Higher
-Nicotine is an inducer of the CYP 1A2 enzyme, so it lowers the concentration of
drugs. Therefore, a higher dose of olanzapine may be needed to control his
symptoms.
Ernesto, a 60-year-old, presents to the PMHNP with report of having anxiety,
frequent occurrences of feeling frozen in place and like his heart is pounding out of
his chest, as well as having difficulty sleeping.
The PMHNP suspects the client has an elevated level of which neurotransmitter? -
ANSWER-Norepinephrine
-responsible for the regulation of fight or flight responses and can impact mood and
sleep.
Which of the following is the best medication class for the PMHNP to prescribe for
Ernesto to address his elevated norepinephrine levels? - ANSWER-selective
serotonin reuptake inhibitor would block the reuptake of serotonin, leaving a larger
amount of serotonin available. Increasing the amount of serotonin would help
regulate the feelings of fear and anxiety. Reducing the occurrence of fear would help
reduce the release of norepinephrine.
A serotonin and norepinephrine reuptake inhibitor would prevent the reuptake of
norepinephrine, which would not reduce the level of norepinephrine as needed.
Benzodiazepines increase the levels of GABA and do not impact norepinephrine. A
monoamine oxidase inhibitor would increase levels of norepinephrine.
During a follow up appointment after 4 weeks, the PMHNP should assess for the
need to add which medication to Ernesto's treatment plan? - ANSWER-The nurse
QUESTIONS AND CORRECT DETAILED
ANSWERS LATEST EXAM 2023-2024 A GRADE
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.
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.
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.
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
,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
-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 - ANSWER-absorption
distribution
metabolism
excretion
Flockhart Table - ANSWER-drug interactions that are mediated by cytochrome P450
enzymes
comprehensive list of drugs and the interactions related to the cytochrome P450
system
Neurotransmitters - ANSWER-chemicals released by neurons to send
communication across synaptic clefts to other neurons
-impact human emotion and behavior
Neurotransmission: - ANSWER-the chemical transmission of information between
neurons and their target cells
-the chemicals, or neurotransmitters, are released from their transport vesicles to
bind with receptor sites to perform their duties, which are excitatory or inhibitory
-neurotransmitter then either returned and stored for future use (reuptake) or
inactivated and dissolved by enzymes
-Types: Classic, Retrograde, Volume
Classic neurotransmission - ANSWER-neurons send electrical impulses from one
part of the cell to another part of the same cell via their axons
-one neuron hurling a chemical messenger, or neurotransmitter, at the receptors of a
second neuron
-electrical impulse converted chemical signal at the synapse in a process known as
excitation-secretion coupling, the first stage of chemical neurotransmission, then
back into electrical impulse in second neuron
-chemical information from the first neuron triggering a cascade of further chemical
messages within the second neuron to change that neuron's molecular and genetic
functioning
Retrograde neurotransmission - ANSWER-postsynaptic neurons "talk back" to their
presynaptic neurons
-second neuron to the first at the synapse between them
,-Chemicals produced specifically as retrograde neurotransmitters at some synapses
include: endocannabinoids, gaseous neurotransmitter nitric oxide (NO), nerve growth
factor (NGF).
Volume neurotransmission - ANSWER-Neurotransmission without a synapse or
nonsynaptic diffusion neurotransmission
-Chemical messengers sent by one neuron to another can spill over to sites distant
to the synapse by diffusion
-neurotransmission can occur at any compatible receptor within the diffusion radius
of the neurotransmitter
-neurotransmission occurs in chemical "puffs"
-sophisticated "chemical soup."
ters that may be responsible for a client's symptoms of depression - ANSWER-
Imbalanced levels of acetylcholine, norepinephrine, serotonin, histamine, or
glutamate can contribute to symptoms of depression
client who is a poor metabolizer: - ANSWER-has a lower concentration of the
necessary enzyme to metabolize a drug, which results in higher blood
concentrations of the drug.
-increase the risk of side effects and adverse reactions
Why is trazodone not used as a front-line antidepressant - ANSWER-Its
antidepressant that has a secondary effect of blocking histamine and adrenergic
receptors
-causes sedation and somnolence and as a result
*often used as an adjunct in therapy when a depressed patient has difficulty sleeping
effect on neurotransmitters and side effects: Selective Serotonin Reuptake Inhibitors
(SSRIs) - ANSWER-Inhibits the reuptake of serotonin, which can cause nausea,
agitation, headache, and sexual dysfunction
effect on neurotransmitters and side effects: Serotonin and Norepinephrine
Reuptake Inhibitors (SNRIs) - ANSWER-Inhibits the reuptake of serotonin and
norepinephrine, which can cause nausea, sweating, insomnia, tremors, sexual
dysfunction
effect on neurotransmitters and side effects: Tricyclic Antidepressants - ANSWER--
Inhibits the reuptake of serotonin and norepinephrine, which can cause sexual
dysfunction
-Blocks norepinephrine receptors, which can cause hypotension and tachycardia
-Blocks histamine receptors, which can cause sedation and weight gain
-Blocks acetylcholine receptors, which can cause dry mouth, constipation, blurred
vision, and urinary retention
effect on neurotransmitters and side effects: Monoamine Oxidase Inhibitors (MAOIs)
- ANSWER-Increases norepinephrine and serotonin by inhibiting the enzyme that
inactivates it, which can cause sedation, dizziness, sexual dysfunction, and
hypertensive crisis
, effect on neurotransmitters and side effects: Benzodiazepines - ANSWER-Increases
the receptor affinity for GABA, which can cause dependence and confusion
effect on neurotransmitters and side effects: Bupropion - ANSWER-Inhibits the
reuptake of norepinephrine and dopamine, which can cause insomnia, dry mouth,
tremors, and seizures
antagonist - ANSWER-causes a conformational change that stabilizes the receptor
in the baseline state and thus is "silent."
-blocks the action of a neurotransmitter
agonists - ANSWER-fully stimulate G-protein-linked receptors
partial agonists - ANSWER-stimulate receptors to a lesser degree than an agonist or
natural neurotransmitter
SSRIs, SNRIs, and tricyclic antidepressants increase ________ levels.
___________ do not impact serotonin levels. - ANSWER-increase serotonin levels.
Benzodiazepines do not impact serotonin levels.
Is nicotine an inducer or an inhibitor of the CYP 1A2 enzyme? - ANSWER-inducer
Nicotine is an inducer of the CYP 1A2 enzyme. Does the PMHNP anticipate Joshua
may need a higher or lower dose of olanzapine to achieve a therapeutic response? -
ANSWER-Higher
-Nicotine is an inducer of the CYP 1A2 enzyme, so it lowers the concentration of
drugs. Therefore, a higher dose of olanzapine may be needed to control his
symptoms.
Ernesto, a 60-year-old, presents to the PMHNP with report of having anxiety,
frequent occurrences of feeling frozen in place and like his heart is pounding out of
his chest, as well as having difficulty sleeping.
The PMHNP suspects the client has an elevated level of which neurotransmitter? -
ANSWER-Norepinephrine
-responsible for the regulation of fight or flight responses and can impact mood and
sleep.
Which of the following is the best medication class for the PMHNP to prescribe for
Ernesto to address his elevated norepinephrine levels? - ANSWER-selective
serotonin reuptake inhibitor would block the reuptake of serotonin, leaving a larger
amount of serotonin available. Increasing the amount of serotonin would help
regulate the feelings of fear and anxiety. Reducing the occurrence of fear would help
reduce the release of norepinephrine.
A serotonin and norepinephrine reuptake inhibitor would prevent the reuptake of
norepinephrine, which would not reduce the level of norepinephrine as needed.
Benzodiazepines increase the levels of GABA and do not impact norepinephrine. A
monoamine oxidase inhibitor would increase levels of norepinephrine.
During a follow up appointment after 4 weeks, the PMHNP should assess for the
need to add which medication to Ernesto's treatment plan? - ANSWER-The nurse
