NR546 MIDTERM EXAM|| 291
QUESTIONS AND ANSWERS (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
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
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
CYP450 - ANSWER-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 - ANSWER-elevated enzyme activity
subtherapeutic drug levels
poor efficacy with standard doses
genotyping - ANSWER-the patient for pharmacogenomic use
QUESTIONS AND ANSWERS (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
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
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
CYP450 - ANSWER-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 - ANSWER-elevated enzyme activity
subtherapeutic drug levels
poor efficacy with standard doses
genotyping - ANSWER-the patient for pharmacogenomic use
