NR546 Midterm Exam
1. -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: What should
the PMHNP consider when prescribing chemical restraints?
2. 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.: 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?
3. -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 medica-
tions based on the cytochrome P450 system.: How does reviewing the genetic
makeup of a client help guide the PMHNP in selecting medication for clients?
4. 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.: Tan
r1kulu and Erba_ (2020) investigated identical twins to determine the presence of a
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?
5. separates the frontal lobe from the parietal lobe: central sulcus
6. associated with movement, intelligence, abstract thinking: frontal lobe
7. speech production: broca's area
8. involves object identification and auditory signals: temporal lobe
9. coordination: cerebellum
10. speech comprehension: wernicke's area
11. primary visual area: occipital lobe
12. keeps us alert to what is going on around us: parietal lobe
13. pain, heat, and other sensations: sensory cortex
14. movement: motor cortex
15. involved in both memory and anxiety: hippocampus
, NR546 Midterm Exam
16. involved in the reward process: nucleus accumbens
17. involved in sensory organ and motor command processing: thalamus
18. involved in complex motor actions, also links cognition to motor actions-
: striatum
19. includes circuits that are associated with pleasure and reward: limbic sys-
tem
20. group of structures involved in voluntary motor movements: basal ganglia
21. involved in emotional regulation and perception of odors: amygdala
22. controls the communication between the two brain hemispheres: corpus
callosum
23. contains nerve fibers that connect neurons from different regions into
functional circuits: white matter
24. contains nerve cells and dendrites: grey matter
25. made up of grey matter and white matter: brain tissue
26. 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: dorsal striatum
27. influenced by environmental factors and how epigenetics contributes to
the manifestation of mental illness: The field of epigenetics is rapidly growing and
can help explain how gene expression is:
28. 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.": How does
epigenetics impact a person's mental health?
29. DNA Methylation
Histone modification
Non-coding RNA: Types of epigenetic changes:
30. -informed consent
-competence to make healthcare decisions
-off-label prescribing: The potential legal and ethical issues impacting mental
health treatment must also be taken into account, including:
31. Clients have the right to receive enough information to make decisions
about treatment.
-must also be informed about potential risks associated with medications.
, NR546 Midterm Exam
-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: Informed consent
32. 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 capa-
bilities or are incompetent to make decisions
-PMHNPs are responsible for being knowledgeable about their state laws and
abiding by them.: Compliance
33. 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.: Off-Label Prescribing
34. 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: Incidence of mental illness-what factors
are increasing the incidence
35. Persistence
-taking med over intended time period
Compliance
-taking med as prescribed: Adherence
36. -speech comprehension
-word recognition
-grammar
-sequential processing
-recognition of detail
-conscious mental processing: left hemisphere
37. -prosody of speech
-emotional modulation
-visual-spatial skills
-recognition of facial expression
-music
, NR546 Midterm Exam
-abstract mathematical skills
-holistic processing
-unconscious mental processing: right hemisphere
38. the study of what happens to a drug from the time of administration until
the parent drug and all metabolites leave the body: Pharmacokinetics
39. 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.: CYP450
40. elevated enzyme activity
subtherapeutic drug levels
poor efficacy with standard doses: ultra rapid metabolizers
41. 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: genotyping
42. 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.: most
common targets of psychotropic drugs
43. absorption
distribution
metabolism
excretion: Pharmacokinetics concepts
44. drug interactions that are mediated by cytochrome P450 enzymes
comprehensive list of drugs and the interactions related to the cytochrome
P450 system: Flockhart Table
1. -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: What should
the PMHNP consider when prescribing chemical restraints?
2. 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.: 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?
3. -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 medica-
tions based on the cytochrome P450 system.: How does reviewing the genetic
makeup of a client help guide the PMHNP in selecting medication for clients?
4. 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.: Tan
r1kulu and Erba_ (2020) investigated identical twins to determine the presence of a
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?
5. separates the frontal lobe from the parietal lobe: central sulcus
6. associated with movement, intelligence, abstract thinking: frontal lobe
7. speech production: broca's area
8. involves object identification and auditory signals: temporal lobe
9. coordination: cerebellum
10. speech comprehension: wernicke's area
11. primary visual area: occipital lobe
12. keeps us alert to what is going on around us: parietal lobe
13. pain, heat, and other sensations: sensory cortex
14. movement: motor cortex
15. involved in both memory and anxiety: hippocampus
, NR546 Midterm Exam
16. involved in the reward process: nucleus accumbens
17. involved in sensory organ and motor command processing: thalamus
18. involved in complex motor actions, also links cognition to motor actions-
: striatum
19. includes circuits that are associated with pleasure and reward: limbic sys-
tem
20. group of structures involved in voluntary motor movements: basal ganglia
21. involved in emotional regulation and perception of odors: amygdala
22. controls the communication between the two brain hemispheres: corpus
callosum
23. contains nerve fibers that connect neurons from different regions into
functional circuits: white matter
24. contains nerve cells and dendrites: grey matter
25. made up of grey matter and white matter: brain tissue
26. 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: dorsal striatum
27. influenced by environmental factors and how epigenetics contributes to
the manifestation of mental illness: The field of epigenetics is rapidly growing and
can help explain how gene expression is:
28. 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.": How does
epigenetics impact a person's mental health?
29. DNA Methylation
Histone modification
Non-coding RNA: Types of epigenetic changes:
30. -informed consent
-competence to make healthcare decisions
-off-label prescribing: The potential legal and ethical issues impacting mental
health treatment must also be taken into account, including:
31. Clients have the right to receive enough information to make decisions
about treatment.
-must also be informed about potential risks associated with medications.
, NR546 Midterm Exam
-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: Informed consent
32. 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 capa-
bilities or are incompetent to make decisions
-PMHNPs are responsible for being knowledgeable about their state laws and
abiding by them.: Compliance
33. 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.: Off-Label Prescribing
34. 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: Incidence of mental illness-what factors
are increasing the incidence
35. Persistence
-taking med over intended time period
Compliance
-taking med as prescribed: Adherence
36. -speech comprehension
-word recognition
-grammar
-sequential processing
-recognition of detail
-conscious mental processing: left hemisphere
37. -prosody of speech
-emotional modulation
-visual-spatial skills
-recognition of facial expression
-music
, NR546 Midterm Exam
-abstract mathematical skills
-holistic processing
-unconscious mental processing: right hemisphere
38. the study of what happens to a drug from the time of administration until
the parent drug and all metabolites leave the body: Pharmacokinetics
39. 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.: CYP450
40. elevated enzyme activity
subtherapeutic drug levels
poor efficacy with standard doses: ultra rapid metabolizers
41. 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: genotyping
42. 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.: most
common targets of psychotropic drugs
43. absorption
distribution
metabolism
excretion: Pharmacokinetics concepts
44. drug interactions that are mediated by cytochrome P450 enzymes
comprehensive list of drugs and the interactions related to the cytochrome
P450 system: Flockhart Table
