NR546 Midterm Exam

NR546iMidtermiExam
WhatishoulditheiPMHNPiconsideriwheniprescribingichemicalirestraints?i-i
iiiiiiiiiiiiiiiii-allergyistatus
-priorimedihxiforiadverseidrugireactionsir/titheimedsiorderediinitheichemicalirestraint
-stateiregulationsiregardingichemicalirestrainsimustibeireviewed

AreitheiPMHNPiandiotheristaffiliableiifitheiclientihasianiallergicireactionioriadverseisideieffe
ctsitoitheidrugsiusediforichemicalirestraint?i-i
iiiiiiiiiiiiiiiiiNo.
Theiclientihasibeenicourt-
ordereditoitakeitheiprescribedimedicationsianditheistandingiorderiforichemicalirestraintsiisiap
proved.iTheiPMHNPiandiotheristaffiareinotiliableiifitheipatientihasianiallergicireactionioriadv
erseisideieffects.

HowidoesireviewingitheigeneticimakeupiofiaiclientihelpiguideitheiPMHNPiiniselectingimedic
ationiforiclients?i-i
iiiiiiiiiiiiiiiii-
Geneticitestingicaniassistibyiprovidingimoreiinformationionihowiclientsimayiresponditoicertai
nipsychotropicimedications
-
providesiinformationionihowiaiclientimayibreakidowniandimetabolizeimedicationsibasedionit
heicytochromeiP450isystem.

TanrıkuluiandiErbaşi(2020)iinvestigatediidenticalitwinsitoidetermineitheipresenceiofianiinheri
tedilinkiforischizophreniaiandiwhyioneitwinimayidevelopischizophreniaiwhenitheiotheridoesin
ot.iWhenitwoipeopleihavei100%iidenticaliDNA,iwhyidon'tibothipersonsidevelopitheiexactiilln
esses?iStudiesiofiidenticaliDanishitwinsifoundithatiifioneitwinihadischizophrenia,itheiotheritw
inihadiai50%ilifetimeiriskiofidevelopingischizophreniai(Lemvighietial.,i2020).iWhyiisithereio
nlyihalfitheirisk?i-i
iiiiiiiiiiiiiiiiiBothienvironmentaliandipsychosocialistressorsicaniimpactimentalihealth.iAlthoughit
winsimayihaveiidenticaligenes,itheirigeneiexpressionimayibeidifferent.

Thereimayibeianienvironmentaliexposureithatiturnediaigenei"on"ithatishouldihaveibeeni"off"if
orioneitwinitoidevelopischizophreniaiandinotitheiother.

centralisulcusi-i
iiiiiiiiiiiiiiiiiseparatesitheifrontalilobeifromitheiparietalilobe

frontalilobei-i
iiiiiiiiiiiiiiiiiassociatediwithimovement,iintelligence,iabstractithinking

broca'siareai-i
iiiiiiiiiiiiiiiiispeechiproduction

temporalilobei-i
iiiiiiiiiiiiiiiiiinvolvesiobjectiidentificationiandiauditoryisignals



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,cerebellumi-i
iiiiiiiiiiiiiiiiicoordination

wernicke'siareai-i
iiiiiiiiiiiiiiiiispeechicomprehension

occipitalilobei-i
iiiiiiiiiiiiiiiiiprimaryivisualiarea

parietalilobei-i
iiiiiiiiiiiiiiiiikeepsiusialertitoiwhatiisigoingioniaroundius

sensoryicortexi-i
iiiiiiiiiiiiiiiiipain,iheat,iandiotherisensations

motoricortexi-i
iiiiiiiiiiiiiiiiimovement

hippocampusi-i
iiiiiiiiiiiiiiiiiinvolvediinibothimemoryiandianxiety

nucleusiaccumbensi-i
iiiiiiiiiiiiiiiiiinvolvediinitheirewardiprocess

thalamusi-i
iiiiiiiiiiiiiiiiiinvolvediinisensoryiorganiandimotoricommandiprocessing

striatumi-i
iiiiiiiiiiiiiiiiiinvolvediinicompleximotoriactions,ialsoilinksicognitionitoimotoriactions

limbicisystemi-i
iiiiiiiiiiiiiiiiiincludesicircuitsithatiareiassociatediwithipleasureiandireward

basaligangliai-i
iiiiiiiiiiiiiiiiigroupiofistructuresiinvolvediinivoluntaryimotorimovements

amygdalai-i
iiiiiiiiiiiiiiiiiinvolvediiniemotionaliregulationiandiperceptioniofiodors

corpusicallosumi-i
iiiiiiiiiiiiiiiiicontrolsitheicommunicationibetweenitheitwoibrainihemispheres

whiteimatteri-i
iiiiiiiiiiiiiiiiicontainsinerveifibersithaticonnectineuronsifromidifferentiregionsiintoifunctionalicirc
uits

greyimatteri-i
iiiiiiiiiiiiiiiiicontainsinerveicellsiandidendrites

brainitissuei-i

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,iiiiiiiiiiiiiiiiimadeiupiofigreyimatteriandiwhiteimatter

dorsalistriatumi-i
iiiiiiiiiiiiiiiiiinvolvediinicompleximotoriactionsiandilinkageioficognitionitoimotoriactions
-mainiinputiareaiforibasaliganglia
*activatediwhenianticipatingioriengagingiinipleasure

Theifieldiofiepigeneticsiisirapidlyigrowingiandicanihelpiexplainihowigeneiexpressioniis:i-i
iiiiiiiiiiiiiiiiiinfluencedibyienvironmentalifactorsiandihowiepigeneticsicontributesitoitheimanifest
ationiofimentaliillness

Howidoesiepigeneticsiimpactiaiperson'simentalihealth?i-i
iiiiiiiiiiiiiiiiiinternalioriexternalifactorsiactivateiportionsiofitheigenomeithatiresultiinitheimanifest
ationiofimentalihealthisymptoms
-
activationiisiofteniairesultiofiaistressfulievent,iwhich,iwhenicombinediwithitheigeneticirisk,ire
sultsiinitheidisease
-genesibeingioniorioff
-
occurrenceiofisymptomsimayibeitheiresultiofiinheritanceiofianiabnormaligeneioriofinormalige
nesibeingi"on"iwhenitheyishouldibei"off."

Typesiofiepigeneticichanges:i-i
iiiiiiiiiiiiiiiiiDNAiMethylation
Histoneimodification
Non-codingiRNA

Theipotentialilegaliandiethicaliissuesiimpactingimentalihealthitreatmentimustialsoibeitakeniint
oiaccount,iincluding:i-i
iiiiiiiiiiiiiiiii-informediconsent
-competenceitoimakeihealthcareidecisions
-off-labeliprescribing

Informediconsenti-i
iiiiiiiiiiiiiiiiiClientsihaveitheirightitoireceiveienoughiinformationitoimakeidecisionsiaboutitreatm
ent.i
-mustialsoibeiinformediaboutipotentialirisksiassociatediwithimedications.i
-haveitheirightitoirefuseitreatment
-cannotibeiforciblyimedicatediininon-
emergencies.iHowever,iclientsicanibeiforciblyimedicatediifitheyiareiviolentitowardithemselve
sioriothersiandiwhenilessirestrictiveimethodsihaveifailed

Compliancei-i
iiiiiiiiiiiiiiiiiAicourtiorderimayibeiissuediforiaiclientitoireceiveitreatmentiagainstitheiriwishesiifit
heyiareiconsiderediaidangeritoithemselvesioriothers.
-Examples:iclientsiwithischizophreniaiorisexioffenders
-
Guardiansicaniprovideiconsentiforiclientsiwhoihaveilimitedicognitiveicapabilitiesioriareiinco
mpetentitoimakeidecisions


3i|iP a g e

, -
PMHNPsiareiresponsibleiforibeingiknowledgeableiaboutitheiristateilawsiandiabidingibyithem.

Off-LabeliPrescribingi-i
iiiiiiiiiiiiiiiiiSomeiclientsimayibenefitifromitheiunapprovediuseiofiaidrugiforisymptomimanagem
ent.i
-
Example:imanyiSSRIsiuseditoitxianxietyiandiOCDibutiareinotiFDAiapprovediforiuseiinithisidi
sorder.i
-potentiallyiraisesiethicaliandilegaliconcerns
-PMHNPimustiremainiupitoidateiwithitheilatestirecommendationsiforioff-labeliprescribing.

Incidenceiofimentaliillness-whatifactorsiareiincreasingitheiincidencei-i
iiiiiiiiiiiiiiiiiPsychologicaliandisociologicalifactors

Lifestyleifactorsisuchiasiaiclient'sismokingistatus,idiet,iexercise,ihistoryiofimedicationiadhere
nce,iorihistoryiofiaddictionishouldibeiconsiderediwheniprescribingipsychotropicimedications

Adherencei-i
iiiiiiiiiiiiiiiiiPersistence
-takingimedioveriintendeditimeiperiod
Compliance
-takingimediasiprescribed

leftihemispherei-i
iiiiiiiiiiiiiiiii-speechicomprehension
-wordirecognition
-grammar
-sequentialiprocessing
-recognitioniofidetail
-consciousimentaliprocessing

rightihemispherei-i
iiiiiiiiiiiiiiiii-prosodyiofispeech
-emotionalimodulation
-visual-spatialiskills
-recognitioniofifacialiexpression
-music
-abstractimathematicaliskills
-holisticiprocessing
-unconsciousimentaliprocessing

Pharmacokineticsi-i
iiiiiiiiiiiiiiiiitheistudyiofiwhatihappensitoiaidrugifromitheitimeiofiadministrationiuntilitheiparenti
drugiandiallimetabolitesileaveitheibody

CYP450i-i
iiiiiiiiiiiiiiiiiCYP450ienzymesiinitheigutiwalliorilivericonvertidrugisubstrateiintoiaibiotransforme
diproductiinitheibloodstream,iresponsibleiforidegradatingiofiailargei#iofipsychotropicidrugs


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