NR546 MIDTERM EXAM EXAM
QUESTIONS AND ANSWERS
WhatsshouldsthesPMHNPsconsiderswhensprescribingschemicalsrestraints?s-sans✔✔-
allergysstatus
-priorsmedshxsforsadversesdrugsreactionssr/tsthesmedssorderedsinstheschemicalsrestraint
-statesregulationssregardingschemicalsrestrainssmustsbesreviewed
AresthesPMHNPsandsothersstaffsliablesifsthesclientshassansallergicsreactionsorsadversessides
effectsstosthesdrugssusedsforschemicalsrestraint?s-sans✔✔No.
Thesclientshassbeenscourt-
orderedstostakesthesprescribedsmedicationssandsthesstandingsordersforschemicalsrestraints
sissapproved.sThesPMHNPsandsothersstaffsaresnotsliablesifsthespatientshassansallergicsreacti
onsorsadversessideseffects.
HowsdoessreviewingsthesgeneticsmakeupsofsasclientshelpsguidesthesPMHNPsinsselectingsm
edicationsforsclients?s-sans✔✔-
Geneticstestingscansassistsbysprovidingsmoresinformationsonshowsclientssmaysrespondstos
certainspsychotropicsmedications
-
providessinformationsonshowsasclientsmaysbreaksdownsandsmetabolizesmedicationssbased
sonsthescytochromesP450ssystem.
TanrıkulusandsErbaşs(2020)sinvestigatedsidenticalstwinsstosdeterminesthespresencesofsansi
nheritedslinksforsschizophreniasandswhysonestwinsmaysdevelopsschizophreniaswhensthesot
hersdoessnot.sWhenstwospeopleshaves100%sidenticalsDNA,swhysdon'tsbothspersonssdevel
opsthesexactsillnesses?sStudiessofsidenticalsDanishstwinssfoundsthatsifsonestwinshadsschizo
phrenia,sthesotherstwinshadsas50%slifetimesrisksofsdevelopingsschizophrenias(Lemvighsetsa
l.,s2020).sWhysisstheresonlyshalfsthesrisk?s-
sans✔✔Bothsenvironmentalsandspsychosocialsstressorsscansimpactsmentalshealth.sAlthou
ghstwinssmayshavesidenticalsgenes,stheirsgenesexpressionsmaysbesdifferent.
Theresmaysbesansenvironmentalsexposuresthatsturnedsasgenes"on"sthatsshouldshavesbeens
"off"sforsonestwinstosdevelopsschizophreniasandsnotsthesother.
centralssulcuss-sans✔✔separatessthesfrontalslobesfromsthesparietalslobe
frontalslobes-sans✔✔associatedswithsmovement,sintelligence,sabstractsthinking
broca'ssareas-sans✔✔speechsproduction
,temporalslobes-sans✔✔involvessobjectsidentificationsandsauditoryssignals
cerebellums-sans✔✔coordination
wernicke'ssareas-sans✔✔speechscomprehension
occipitalslobes-sans✔✔primarysvisualsarea
parietalslobes-sans✔✔keepssussalertstoswhatsissgoingsonsaroundsus
sensoryscortexs-sans✔✔pain,sheat,sandsotherssensations
motorscortexs-sans✔✔movement
hippocampuss-sans✔✔involvedsinsbothsmemorysandsanxiety
nucleussaccumbenss-sans✔✔involvedsinsthesrewardsprocess
thalamuss-sans✔✔involvedsinssensorysorgansandsmotorscommandsprocessing
striatums-sans✔✔involvedsinscomplexsmotorsactions,salsoslinksscognitionstosmotorsactions
limbicssystems-sans✔✔includesscircuitssthatsaresassociatedswithspleasuresandsreward
basalsganglias-sans✔✔groupsofsstructuressinvolvedsinsvoluntarysmotorsmovements
amygdalas-sans✔✔involvedsinsemotionalsregulationsandsperceptionsofsodors
corpusscallosums-
sans✔✔controlssthescommunicationsbetweensthestwosbrainshemispheres
whitesmatters-
sans✔✔containssnervesfiberssthatsconnectsneuronssfromsdifferentsregionssintosfunctionalsc
ircuits
greysmatters-sans✔✔containssnervescellssandsdendrites
brainstissues-sans✔✔madesupsofsgreysmattersandswhitesmatter
dorsalsstriatums-
sans✔✔involvedsinscomplexsmotorsactionssandslinkagesofscognitionstosmotorsactions
-mainsinputsareasforsbasalsganglia
,*activatedswhensanticipatingsorsengagingsinspleasure
Thesfieldsofsepigeneticssissrapidlysgrowingsandscanshelpsexplainshowsgenesexpressionsis:s-
sans✔✔influencedsbysenvironmentalsfactorssandshowsepigeneticsscontributesstosthesmanif
estationsofsmentalsillness
Howsdoessepigeneticssimpactsasperson'ssmentalshealth?s-
sans✔✔internalsorsexternalsfactorssactivatesportionssofsthesgenomesthatsresultsinsthesmani
festationsofsmentalshealthssymptoms
-
activationsissoftensasresultsofsasstressfulsevent,swhich,swhenscombinedswithsthesgeneticsris
k,sresultssinsthesdisease
-genessbeingsonsorsoff
-
occurrencesofssymptomssmaysbesthesresultsofsinheritancesofsansabnormalsgenesorsofsnorm
alsgenessbeings"on"swhenstheysshouldsbes"off."
Typessofsepigeneticschanges:s-sans✔✔DNAsMethylation
Histonesmodification
Non-codingsRNA
Thespotentialslegalsandsethicalsissuessimpactingsmentalshealthstreatmentsmustsalsosbestak
ensintosaccount,sincluding:s-sans✔✔-informedsconsent
-competencestosmakeshealthcaresdecisions
-off-labelsprescribing
Informedsconsents-
sans✔✔Clientsshavesthesrightstosreceivesenoughsinformationstosmakesdecisionssaboutstre
atment.s
-mustsalsosbesinformedsaboutspotentialsriskssassociatedswithsmedications.s
-havesthesrightstosrefusestreatment
-cannotsbesforciblysmedicatedsinsnon-
emergencies.sHowever,sclientsscansbesforciblysmedicatedsifstheysaresviolentstowardsthem
selvessorsotherssandswhenslesssrestrictivesmethodsshavesfailed
Compliances-
sans✔✔Ascourtsordersmaysbesissuedsforsasclientstosreceivestreatmentsagainststheirswishess
ifstheysaresconsideredsasdangerstosthemselvessorsothers.
-Examples:sclientsswithsschizophreniasorssexsoffenders
-
Guardiansscansprovidesconsentsforsclientsswhoshaveslimitedscognitivescapabilitiessorsaresi
ncompetentstosmakesdecisions
-
PMHNPssaresresponsiblesforsbeingsknowledgeablesaboutstheirsstateslawssandsabidingsbys
them.
, Off-LabelsPrescribings-
sans✔✔Somesclientssmaysbenefitsfromsthesunapprovedsusesofsasdrugsforssymptomsmana
gement.s
-
Example:smanysSSRIssusedstostxsanxietysandsOCDsbutsaresnotsFDAsapprovedsforsusesinst
hissdisorder.s
-potentiallysraisessethicalsandslegalsconcerns
-PMHNPsmustsremainsupstosdateswithstheslatestsrecommendationssforsoff-
labelsprescribing.
Incidencesofsmentalsillness-whatsfactorssaresincreasingsthesincidences-
sans✔✔Psychologicalsandssociologicalsfactors
Lifestylesfactorsssuchsassasclient'sssmokingsstatus,sdiet,sexercise,shistorysofsmedicationsad
herence,sorshistorysofsaddictionsshouldsbesconsideredswhensprescribingspsychotropicsme
dications
Adherences-sans✔✔Persistence
-takingsmedsoversintendedstimesperiod
Compliance
-takingsmedsassprescribed
leftshemispheres-sans✔✔-speechscomprehension
-wordsrecognition
-grammar
-sequentialsprocessing
-recognitionsofsdetail
-conscioussmentalsprocessing
rightshemispheres-sans✔✔-prosodysofsspeech
-emotionalsmodulation
-visual-spatialsskills
-recognitionsofsfacialsexpression
-music
-abstractsmathematicalsskills
-holisticsprocessing
-unconscioussmentalsprocessing
Pharmacokineticss-
sans✔✔thesstudysofswhatshappensstosasdrugsfromsthestimesofsadministrationsuntilsthespare
ntsdrugsandsallsmetabolitessleavesthesbody
CYP450s-
sans✔✔CYP450senzymessinsthesgutswallsorsliversconvertsdrugssubstratesintosasbiotransfor
QUESTIONS AND ANSWERS
WhatsshouldsthesPMHNPsconsiderswhensprescribingschemicalsrestraints?s-sans✔✔-
allergysstatus
-priorsmedshxsforsadversesdrugsreactionssr/tsthesmedssorderedsinstheschemicalsrestraint
-statesregulationssregardingschemicalsrestrainssmustsbesreviewed
AresthesPMHNPsandsothersstaffsliablesifsthesclientshassansallergicsreactionsorsadversessides
effectsstosthesdrugssusedsforschemicalsrestraint?s-sans✔✔No.
Thesclientshassbeenscourt-
orderedstostakesthesprescribedsmedicationssandsthesstandingsordersforschemicalsrestraints
sissapproved.sThesPMHNPsandsothersstaffsaresnotsliablesifsthespatientshassansallergicsreacti
onsorsadversessideseffects.
HowsdoessreviewingsthesgeneticsmakeupsofsasclientshelpsguidesthesPMHNPsinsselectingsm
edicationsforsclients?s-sans✔✔-
Geneticstestingscansassistsbysprovidingsmoresinformationsonshowsclientssmaysrespondstos
certainspsychotropicsmedications
-
providessinformationsonshowsasclientsmaysbreaksdownsandsmetabolizesmedicationssbased
sonsthescytochromesP450ssystem.
TanrıkulusandsErbaşs(2020)sinvestigatedsidenticalstwinsstosdeterminesthespresencesofsansi
nheritedslinksforsschizophreniasandswhysonestwinsmaysdevelopsschizophreniaswhensthesot
hersdoessnot.sWhenstwospeopleshaves100%sidenticalsDNA,swhysdon'tsbothspersonssdevel
opsthesexactsillnesses?sStudiessofsidenticalsDanishstwinssfoundsthatsifsonestwinshadsschizo
phrenia,sthesotherstwinshadsas50%slifetimesrisksofsdevelopingsschizophrenias(Lemvighsetsa
l.,s2020).sWhysisstheresonlyshalfsthesrisk?s-
sans✔✔Bothsenvironmentalsandspsychosocialsstressorsscansimpactsmentalshealth.sAlthou
ghstwinssmayshavesidenticalsgenes,stheirsgenesexpressionsmaysbesdifferent.
Theresmaysbesansenvironmentalsexposuresthatsturnedsasgenes"on"sthatsshouldshavesbeens
"off"sforsonestwinstosdevelopsschizophreniasandsnotsthesother.
centralssulcuss-sans✔✔separatessthesfrontalslobesfromsthesparietalslobe
frontalslobes-sans✔✔associatedswithsmovement,sintelligence,sabstractsthinking
broca'ssareas-sans✔✔speechsproduction
,temporalslobes-sans✔✔involvessobjectsidentificationsandsauditoryssignals
cerebellums-sans✔✔coordination
wernicke'ssareas-sans✔✔speechscomprehension
occipitalslobes-sans✔✔primarysvisualsarea
parietalslobes-sans✔✔keepssussalertstoswhatsissgoingsonsaroundsus
sensoryscortexs-sans✔✔pain,sheat,sandsotherssensations
motorscortexs-sans✔✔movement
hippocampuss-sans✔✔involvedsinsbothsmemorysandsanxiety
nucleussaccumbenss-sans✔✔involvedsinsthesrewardsprocess
thalamuss-sans✔✔involvedsinssensorysorgansandsmotorscommandsprocessing
striatums-sans✔✔involvedsinscomplexsmotorsactions,salsoslinksscognitionstosmotorsactions
limbicssystems-sans✔✔includesscircuitssthatsaresassociatedswithspleasuresandsreward
basalsganglias-sans✔✔groupsofsstructuressinvolvedsinsvoluntarysmotorsmovements
amygdalas-sans✔✔involvedsinsemotionalsregulationsandsperceptionsofsodors
corpusscallosums-
sans✔✔controlssthescommunicationsbetweensthestwosbrainshemispheres
whitesmatters-
sans✔✔containssnervesfiberssthatsconnectsneuronssfromsdifferentsregionssintosfunctionalsc
ircuits
greysmatters-sans✔✔containssnervescellssandsdendrites
brainstissues-sans✔✔madesupsofsgreysmattersandswhitesmatter
dorsalsstriatums-
sans✔✔involvedsinscomplexsmotorsactionssandslinkagesofscognitionstosmotorsactions
-mainsinputsareasforsbasalsganglia
,*activatedswhensanticipatingsorsengagingsinspleasure
Thesfieldsofsepigeneticssissrapidlysgrowingsandscanshelpsexplainshowsgenesexpressionsis:s-
sans✔✔influencedsbysenvironmentalsfactorssandshowsepigeneticsscontributesstosthesmanif
estationsofsmentalsillness
Howsdoessepigeneticssimpactsasperson'ssmentalshealth?s-
sans✔✔internalsorsexternalsfactorssactivatesportionssofsthesgenomesthatsresultsinsthesmani
festationsofsmentalshealthssymptoms
-
activationsissoftensasresultsofsasstressfulsevent,swhich,swhenscombinedswithsthesgeneticsris
k,sresultssinsthesdisease
-genessbeingsonsorsoff
-
occurrencesofssymptomssmaysbesthesresultsofsinheritancesofsansabnormalsgenesorsofsnorm
alsgenessbeings"on"swhenstheysshouldsbes"off."
Typessofsepigeneticschanges:s-sans✔✔DNAsMethylation
Histonesmodification
Non-codingsRNA
Thespotentialslegalsandsethicalsissuessimpactingsmentalshealthstreatmentsmustsalsosbestak
ensintosaccount,sincluding:s-sans✔✔-informedsconsent
-competencestosmakeshealthcaresdecisions
-off-labelsprescribing
Informedsconsents-
sans✔✔Clientsshavesthesrightstosreceivesenoughsinformationstosmakesdecisionssaboutstre
atment.s
-mustsalsosbesinformedsaboutspotentialsriskssassociatedswithsmedications.s
-havesthesrightstosrefusestreatment
-cannotsbesforciblysmedicatedsinsnon-
emergencies.sHowever,sclientsscansbesforciblysmedicatedsifstheysaresviolentstowardsthem
selvessorsotherssandswhenslesssrestrictivesmethodsshavesfailed
Compliances-
sans✔✔Ascourtsordersmaysbesissuedsforsasclientstosreceivestreatmentsagainststheirswishess
ifstheysaresconsideredsasdangerstosthemselvessorsothers.
-Examples:sclientsswithsschizophreniasorssexsoffenders
-
Guardiansscansprovidesconsentsforsclientsswhoshaveslimitedscognitivescapabilitiessorsaresi
ncompetentstosmakesdecisions
-
PMHNPssaresresponsiblesforsbeingsknowledgeablesaboutstheirsstateslawssandsabidingsbys
them.
, Off-LabelsPrescribings-
sans✔✔Somesclientssmaysbenefitsfromsthesunapprovedsusesofsasdrugsforssymptomsmana
gement.s
-
Example:smanysSSRIssusedstostxsanxietysandsOCDsbutsaresnotsFDAsapprovedsforsusesinst
hissdisorder.s
-potentiallysraisessethicalsandslegalsconcerns
-PMHNPsmustsremainsupstosdateswithstheslatestsrecommendationssforsoff-
labelsprescribing.
Incidencesofsmentalsillness-whatsfactorssaresincreasingsthesincidences-
sans✔✔Psychologicalsandssociologicalsfactors
Lifestylesfactorsssuchsassasclient'sssmokingsstatus,sdiet,sexercise,shistorysofsmedicationsad
herence,sorshistorysofsaddictionsshouldsbesconsideredswhensprescribingspsychotropicsme
dications
Adherences-sans✔✔Persistence
-takingsmedsoversintendedstimesperiod
Compliance
-takingsmedsassprescribed
leftshemispheres-sans✔✔-speechscomprehension
-wordsrecognition
-grammar
-sequentialsprocessing
-recognitionsofsdetail
-conscioussmentalsprocessing
rightshemispheres-sans✔✔-prosodysofsspeech
-emotionalsmodulation
-visual-spatialsskills
-recognitionsofsfacialsexpression
-music
-abstractsmathematicalsskills
-holisticsprocessing
-unconscioussmentalsprocessing
Pharmacokineticss-
sans✔✔thesstudysofswhatshappensstosasdrugsfromsthestimesofsadministrationsuntilsthespare
ntsdrugsandsallsmetabolitessleavesthesbody
CYP450s-
sans✔✔CYP450senzymessinsthesgutswallsorsliversconvertsdrugssubstratesintosasbiotransfor
