NR546 – Total PMHNP Psychopharmacology – Comprehensive
Midterm Exam Study Material and Concept Review
What should the PMHNP consider when prescribing chemical restraints? - correct 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? - correct 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? - correct 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? - correct 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 - correct answer separates the frontal lobe from the parietal lobe
frontal lobe - correct answer associated with movement, intelligence, abstract thinking
broca's area - correct answer speech production
temporal lobe - correct answer involves object identification and auditory signals
cerebellum - correct answer coordination
,wernicke's area - correct answer speech comprehension
occipital lobe - correct answer primary visual area
parietal lobe - correct answer keeps us alert to what is going on around us
sensory cortex - correct answer pain, heat, and other sensations
motor cortex - correct answer movement
hippocampus - correct answer involved in both memory and anxiety
nucleus accumbens - correct answer involved in the reward process
thalamus - correct answer involved in sensory organ and motor command processing
striatum - correct answer involved in complex motor actions, also links cognition to motor
actions
limbic system - correct answer includes circuits that are associated with pleasure and reward
basal ganglia - correct answer group of structures involved in voluntary motor movements
amygdala - correct answer involved in emotional regulation and perception of odors
corpus callosum - correct answer controls the communication between the two brain
hemispheres
white matter - correct answer contains nerve fibers that connect neurons from different
regions into functional circuits
grey matter - correct answer contains nerve cells and dendrites
brain tissue - correct answer made up of grey matter and white matter
dorsal striatum - correct 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: - correct
answer influenced by environmental factors and how epigenetics contributes to the
manifestation of mental illness
How does epigenetics impact a person's mental health? - correct 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: - correct 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: - correct answer -informed consent
-competence to make healthcare decisions
-off-label prescribing
Informed consent - correct 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 - correct 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 - correct 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 - correct 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 - correct answer Persistence
-taking med over intended time period
Compliance
-taking med as prescribed
left hemisphere - correct answer -speech comprehension
-word recognition
-grammar
-sequential processing
-recognition of detail
-conscious mental processing
right hemisphere - correct answer -prosody of speech
-emotional modulation
-visual-spatial skills
-recognition of facial expression
-music
-abstract mathematical skills
-holistic processing
-unconscious mental processing
Pharmacokinetics - correct answer the study of what happens to a drug from the time of
administration until the parent drug and all metabolites leave the body
CYP450 - correct 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
Midterm Exam Study Material and Concept Review
What should the PMHNP consider when prescribing chemical restraints? - correct 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? - correct 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? - correct 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? - correct 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 - correct answer separates the frontal lobe from the parietal lobe
frontal lobe - correct answer associated with movement, intelligence, abstract thinking
broca's area - correct answer speech production
temporal lobe - correct answer involves object identification and auditory signals
cerebellum - correct answer coordination
,wernicke's area - correct answer speech comprehension
occipital lobe - correct answer primary visual area
parietal lobe - correct answer keeps us alert to what is going on around us
sensory cortex - correct answer pain, heat, and other sensations
motor cortex - correct answer movement
hippocampus - correct answer involved in both memory and anxiety
nucleus accumbens - correct answer involved in the reward process
thalamus - correct answer involved in sensory organ and motor command processing
striatum - correct answer involved in complex motor actions, also links cognition to motor
actions
limbic system - correct answer includes circuits that are associated with pleasure and reward
basal ganglia - correct answer group of structures involved in voluntary motor movements
amygdala - correct answer involved in emotional regulation and perception of odors
corpus callosum - correct answer controls the communication between the two brain
hemispheres
white matter - correct answer contains nerve fibers that connect neurons from different
regions into functional circuits
grey matter - correct answer contains nerve cells and dendrites
brain tissue - correct answer made up of grey matter and white matter
dorsal striatum - correct 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: - correct
answer influenced by environmental factors and how epigenetics contributes to the
manifestation of mental illness
How does epigenetics impact a person's mental health? - correct 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: - correct 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: - correct answer -informed consent
-competence to make healthcare decisions
-off-label prescribing
Informed consent - correct 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 - correct 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 - correct 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 - correct 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 - correct answer Persistence
-taking med over intended time period
Compliance
-taking med as prescribed
left hemisphere - correct answer -speech comprehension
-word recognition
-grammar
-sequential processing
-recognition of detail
-conscious mental processing
right hemisphere - correct answer -prosody of speech
-emotional modulation
-visual-spatial skills
-recognition of facial expression
-music
-abstract mathematical skills
-holistic processing
-unconscious mental processing
Pharmacokinetics - correct answer the study of what happens to a drug from the time of
administration until the parent drug and all metabolites leave the body
CYP450 - correct 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
