Chamberlain University-Illinois NR 546
NR546 Midterm EXAMS REVIEW WITH COMPLETE REAL
EXAM QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (MOST RECENT!!)
Students also studied
C
Terms in this set (291)
What should the PMHNP consider -allergy status
when prescribing chemical -prior med hx for adverse drug reactions r/t the meds ordered
restraints? in the chemical restraint
-state regulations regarding chemical restrains must be
reviewed
Are the PMHNP and other staff liable if No.
the client has an allergic reaction or The client has been court-ordered to take the prescribed
adverse side effects to the drugs used for medications and the standing order for chemical restraints is
chemical restraint? 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 -Genetic testing can assist by providing more information on
a client help guide the PMHNP in how clients may respond to certain psychotropic medications
selecting medication for clients? -provides information on how a client may break down and
metabolize medications based on the cytochrome P450
system.
Tanrıkulu and Erbaş (2020) investigated Both environmental and psychosocial stressors can impact
identical twins to determine the presence of mental health. Although twins may have identical genes, their
an inherited link for schizophrenia and gene expression may be different.
why one twin may develop schizophrenia
when the other does not. When two There may be an environmental exposure that turned a gene
people have 100% identical DNA, why "on" that should have been "off" for one twin to develop
don't both persons develop the exact schizophrenia and not the other.
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?
,central sulcus separates the frontal lobe from the parietal lobe
frontal lobe associated with movement, intelligence, abstract thinking
broca's area speech production
temporal lobe involves object identification and auditory signals
cerebellum coordination
wernicke's area speech comprehension
occipital lobe primary visual area
parietal lobe keeps us alert to what is going on around us
sensory cortex pain, heat, and other sensations
motor cortex movement
hippocampus involved in both memory and anxiety
nucleus accumbens involved in the reward process
thalamus involved in sensory organ and motor command processing
striatum involved in complex motor actions, also links cognition to
motor actions
limbic system includes circuits that are associated with pleasure and reward
basal ganglia group of structures involved in voluntary motor movements
amygdala involved in emotional regulation and perception of odors
corpus callosum controls the communication between the two brain
hemispheres
white matter contains nerve fibers that connect neurons from different
regions into functional circuits
grey matter contains nerve cells and dendrites
brain tissue made up of grey matter and white matter
,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
The field of epigenetics is rapidly growing influenced by environmental factors and how epigenetics
and can help explain how gene expression contributes to the manifestation of mental illness
is:
How does epigenetics impact a person's internal or external factors activate portions of the genome
mental health? 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: DNA Methylation
Histone modification
Non-coding RNA
The potential legal and ethical issues -informed consent
impacting mental health treatment must also -competence to make healthcare decisions
be taken into account, including: -off-label prescribing
Informed consent 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 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 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 Psychological and sociological factors
increasing the incidence
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 Persistence
-taking med over intended time period
Compliance
-taking med as prescribed
left hemisphere -speech comprehension
-word recognition
-grammar
-sequential processing
-recognition of detail
-conscious mental processing
right hemisphere -prosody of speech
-emotional modulation
-visual-spatial skills
-recognition of facial expression
-music
-abstract mathematical skills
-holistic processing
-unconscious mental processing
Pharmacokinetics the study of what happens to a drug from the time of
administration until the parent drug and all metabolites leave
the body
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.
ultra rapid metabolizers elevated enzyme activity
subtherapeutic drug levels
poor efficacy with standard doses
NR546 Midterm EXAMS REVIEW WITH COMPLETE REAL
EXAM QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (MOST RECENT!!)
Students also studied
C
Terms in this set (291)
What should the PMHNP consider -allergy status
when prescribing chemical -prior med hx for adverse drug reactions r/t the meds ordered
restraints? in the chemical restraint
-state regulations regarding chemical restrains must be
reviewed
Are the PMHNP and other staff liable if No.
the client has an allergic reaction or The client has been court-ordered to take the prescribed
adverse side effects to the drugs used for medications and the standing order for chemical restraints is
chemical restraint? 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 -Genetic testing can assist by providing more information on
a client help guide the PMHNP in how clients may respond to certain psychotropic medications
selecting medication for clients? -provides information on how a client may break down and
metabolize medications based on the cytochrome P450
system.
Tanrıkulu and Erbaş (2020) investigated Both environmental and psychosocial stressors can impact
identical twins to determine the presence of mental health. Although twins may have identical genes, their
an inherited link for schizophrenia and gene expression may be different.
why one twin may develop schizophrenia
when the other does not. When two There may be an environmental exposure that turned a gene
people have 100% identical DNA, why "on" that should have been "off" for one twin to develop
don't both persons develop the exact schizophrenia and not the other.
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?
,central sulcus separates the frontal lobe from the parietal lobe
frontal lobe associated with movement, intelligence, abstract thinking
broca's area speech production
temporal lobe involves object identification and auditory signals
cerebellum coordination
wernicke's area speech comprehension
occipital lobe primary visual area
parietal lobe keeps us alert to what is going on around us
sensory cortex pain, heat, and other sensations
motor cortex movement
hippocampus involved in both memory and anxiety
nucleus accumbens involved in the reward process
thalamus involved in sensory organ and motor command processing
striatum involved in complex motor actions, also links cognition to
motor actions
limbic system includes circuits that are associated with pleasure and reward
basal ganglia group of structures involved in voluntary motor movements
amygdala involved in emotional regulation and perception of odors
corpus callosum controls the communication between the two brain
hemispheres
white matter contains nerve fibers that connect neurons from different
regions into functional circuits
grey matter contains nerve cells and dendrites
brain tissue made up of grey matter and white matter
,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
The field of epigenetics is rapidly growing influenced by environmental factors and how epigenetics
and can help explain how gene expression contributes to the manifestation of mental illness
is:
How does epigenetics impact a person's internal or external factors activate portions of the genome
mental health? 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: DNA Methylation
Histone modification
Non-coding RNA
The potential legal and ethical issues -informed consent
impacting mental health treatment must also -competence to make healthcare decisions
be taken into account, including: -off-label prescribing
Informed consent 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 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 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 Psychological and sociological factors
increasing the incidence
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 Persistence
-taking med over intended time period
Compliance
-taking med as prescribed
left hemisphere -speech comprehension
-word recognition
-grammar
-sequential processing
-recognition of detail
-conscious mental processing
right hemisphere -prosody of speech
-emotional modulation
-visual-spatial skills
-recognition of facial expression
-music
-abstract mathematical skills
-holistic processing
-unconscious mental processing
Pharmacokinetics the study of what happens to a drug from the time of
administration until the parent drug and all metabolites leave
the body
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.
ultra rapid metabolizers elevated enzyme activity
subtherapeutic drug levels
poor efficacy with standard doses
