NR546 Midterm Exam Questions and
Complete Solutions 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.
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 - 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
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 pleasure 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 hemispheres
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 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
Complete Solutions 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.
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 - 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
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 pleasure 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 hemispheres
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 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
