NR546 Midterm Exam
Questions And
Answers
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
-taking med over intended time period
Compliance
-taking med as prescribed
left hemisphere - ANSWER - -speech comprehension
-word recognition
Questions And
Answers
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
-taking med over intended time period
Compliance
-taking med as prescribed
left hemisphere - ANSWER - -speech comprehension
-word recognition
