NR 546 MIDTERM NEWEST
UPGRADED EXAM THIS YEAR WITH
DETAILED QUESTIONS AND
VERIFIED ANSWERS
Question-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.
Question- 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
Question-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.
Question-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.
Question-central sulcus - Answer-separates the frontal lobe from the parietal lobe
Question-frontal lobe - Answer-associated with movement, intelligence, abstract thinking
Question-broca's area - Answer-speech production
,Question-temporal lobe - Answer-involves object identification and auditory signals
Question-cerebellum - Answer-coordination
Question-wernicke's area - Answer-speech comprehension
Question-occipital lobe - Answer-primary visual area
Question-parietal lobe - Answer-keeps us alert to what is going on around us
Question-sensory cortex - Answer-pain, heat, and other sensations
Question-motor cortex - Answer-movement
Question-hippocampus - Answer-involved in both memory and anxiety
Question-nucleus accumbens - Answer-involved in the reward process
Question-thalamus - Answer-involved in sensory organ and motor command processing
Question-striatum - Answer-involved in complex motor actions, also links cognition to motor
actions
Question-limbic system - Answer-includes circuits that are associated with pleasure and reward
Question-basal ganglia - Answer-group of structures involved in voluntary motor movements
Question-amygdala - Answer-involved in emotional regulation and perception of odors
Question-corpus callosum - Answer-controls the communication between the two brain
hemispheres
Question-white matter - Answer-contains nerve fibers that connect neurons from different
regions into functional circuits
Question-grey matter - Answer-contains nerve cells and dendrites
Question-brain tissue - Answer-made up of grey matter and white matter
Question-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
,Question-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
Question-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."
Question-Types of epigenetic changes: - Answer-DNA Methylation
Histone modification
Non-coding RNA
Question-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
Question-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
Question-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.
Question-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.
, Question-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
Question-Adherence - Answer-Persistence
-taking med over intended time period
Compliance
-taking med as prescribed
Question-left hemisphere - Answer--speech comprehension
-word recognition
-grammar
-sequential processing
-recognition of detail
-conscious mental processing
Question-right hemisphere - Answer--prosody of speech
-emotional modulation
-visual-spatial skills
-recognition of facial expression
-music
-abstract mathematical skills
-holistic processing
-unconscious mental processing
Question-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
Question-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.
UPGRADED EXAM THIS YEAR WITH
DETAILED QUESTIONS AND
VERIFIED ANSWERS
Question-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.
Question- 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
Question-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.
Question-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.
Question-central sulcus - Answer-separates the frontal lobe from the parietal lobe
Question-frontal lobe - Answer-associated with movement, intelligence, abstract thinking
Question-broca's area - Answer-speech production
,Question-temporal lobe - Answer-involves object identification and auditory signals
Question-cerebellum - Answer-coordination
Question-wernicke's area - Answer-speech comprehension
Question-occipital lobe - Answer-primary visual area
Question-parietal lobe - Answer-keeps us alert to what is going on around us
Question-sensory cortex - Answer-pain, heat, and other sensations
Question-motor cortex - Answer-movement
Question-hippocampus - Answer-involved in both memory and anxiety
Question-nucleus accumbens - Answer-involved in the reward process
Question-thalamus - Answer-involved in sensory organ and motor command processing
Question-striatum - Answer-involved in complex motor actions, also links cognition to motor
actions
Question-limbic system - Answer-includes circuits that are associated with pleasure and reward
Question-basal ganglia - Answer-group of structures involved in voluntary motor movements
Question-amygdala - Answer-involved in emotional regulation and perception of odors
Question-corpus callosum - Answer-controls the communication between the two brain
hemispheres
Question-white matter - Answer-contains nerve fibers that connect neurons from different
regions into functional circuits
Question-grey matter - Answer-contains nerve cells and dendrites
Question-brain tissue - Answer-made up of grey matter and white matter
Question-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
,Question-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
Question-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."
Question-Types of epigenetic changes: - Answer-DNA Methylation
Histone modification
Non-coding RNA
Question-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
Question-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
Question-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.
Question-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.
, Question-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
Question-Adherence - Answer-Persistence
-taking med over intended time period
Compliance
-taking med as prescribed
Question-left hemisphere - Answer--speech comprehension
-word recognition
-grammar
-sequential processing
-recognition of detail
-conscious mental processing
Question-right hemisphere - Answer--prosody of speech
-emotional modulation
-visual-spatial skills
-recognition of facial expression
-music
-abstract mathematical skills
-holistic processing
-unconscious mental processing
Question-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
Question-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.
