2024 NR546 FINAL EXAM QUESTIONS AND VERIFIED ANSWERS LATEST VERSION (GRADED A+), Exams of Nursing

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2024 NR546 FINAL EXAM QUESTIONS AND

VERIFIED ANSWERS LATEST VERSION

(GRADED A+) | ALREADY PASSED

•Mary was reprimanded by her boss for not listening during their last meeting and making careless mistakes on their current project. Mary apologizes and says she's been feeling very forgetful lately. this is an example of which ADHD symptoms? ----CORRECT ANSWER----------selective attetion Jim is a college student who can't find the motivation to complete his homework or pay attention in class. this is an example of which ADHD symptoms? ----CORRECT ANSWER- ---------lack of sustained attention Layla just started school and her parent's received a call from her teacher about her behavior. The teacher states Layla runs and climbs on the chairs and desks, has trouble playing quietly, and refuses to stay in her seat. this is an example of which ADHD symptoms? ----CORRECT ANSWER----------hyperactivity (ADHD: Lifespan Considerations) •Which symptom decreases markedly with age? ---- CORRECT ANSWER----------hyperactivity (ADHD lifespan consideration) primary symptoms are? ----CORRECT ANSWER---------- inattention, restlessness, cognitive & emotional impulsivity, executive functioning deficits, and self-regulation (ADHD Lifespan) What might adults who struggle with executive functioning difficulties and disorganization also experience? ----CORRECT ANSWER----------occupational stress and anxiety ADHD symptoms may arise from abnormalities within circuits in the_________, which affect ________ ----CORRECT ANSWER----------prefrontal cortex (PFC) , executive function.

ADHD symptoms become noticeable around what age and why? ----CORRECT ANSWER---------- 6 - 7 y/o, possibly due to abnormalities in the prefrontal cortex circuits or errors in the synaptic pruning process. which NT play a role in the symptoms & treatment of ADHD? ----CORRECT ANSWER------ ----norepinephrine & dopamine ADHD symptoms 4 categories ----CORRECT ANSWER----------selective attention, hyperactivity, lack of zsustained attention, impulsivity what is the youngest age ADHD can appear at? ----CORRECT ANSWER----------3 y/o what plays an important role in the development of ADHD? ----CORRECT ANSWER-------- --genetics Describe selective attention? ----CORRECT ANSWER----------lack of attention to detail, careless mistakes, not listening, losing things, diverting attention, forgetful Describe lack of sustained attention? ----CORRECT ANSWER----------poor problem solving, difficulty completing tasks, disorganization, difficulty sustaining mental effort what is impulsivity? ----CORRECT ANSWER----------excessive talking, blurting things out, not waiting one's turn, interrupting what is hyperactivity? ----CORRECT ANSWER----------fidgeting, leaving one's seat, running, climbing, trouble playing quietly •George talks excessively, blurts out answers in class, and has hurt a friend's feelings when he wouldn't wait his turn at recess. this is an example of which ADHD symptoms? ---

• CORRECT ANSWER----------impulsivity

Anxiety and ADHD are regulated by which loop? ----CORRECT ANSWER---------- corticostriatal-thalamocortical (CSTC) loop what NT are associated with inefficient information processing in the prefrontal circuits? ---

• CORRECT ANSWER----------Norepinephrine (NE) and dopamine (DA) •What scheduled drug level are stimulant medications? •Are refills permitted? ----CORRECT ANSWER----------•Stimulants are schedule II- controlled substances •Refills are NOT permitted what diagnostic test must be obtained? ----CORRECT ANSWER----------•Must obtain a thorough health hx first •Assess for cardiac disease and, if present, obtain an EKG •Blood pressure, height, and weight should be monitored regularly •Assess for bipolar disorder before treatment •Treatment efficacy will be noted within the first week of treatment •Can cause or worsen tics •What is the correct protocol for switching patients from one stimulant medication to another? ----CORRECT ANSWER----------•When switching stimulants, discontinue the current medication and start the new medication at a starting dose the next day. •What two forms are stimulant medications available in? ----CORRECT ANSWER---------- •Stimulant medications available to treat ADHD are available as immediate-release or sustained-release formulations •Are short-acting or long-acting stimulants at a higher risk for diversion? •How should these medications be monitored? ----CORRECT ANSWER----------•Short- acting medications are at higher risk for diversion. •Occasional urine drug screens should be obtained to verify the presence of amphetamines and the absence of other substances of abuse Common side effects include? ----CORRECT ANSWER----------restlessness, irritability, anxiety, insomnia, stomachache, headaches, tics, and worsening of aggression symptoms

•Clients may note a worsening of symptoms when the medication wears off •If this more likely to occur with immediate or sustained-release medications? ---- CORRECT ANSWER----------•Clients may note a worsening of symptoms, or "crash" when the medication wears off, especially with immediate-release (IR) medications •When should clients take stimulant medications? ----CORRECT ANSWER---------- •Medications may cause appetite changes and subsequent weight loss. Take medication with breakfast to decrease anorexia •Methylphenidate ----CORRECT ANSWER----------•Low risk of adverse effects •Examples •Ritalin- available in IR and XR and in beads that can be sprinkled on food •Concerta- IR and DR combined •Daytrana- patch applied in AM remove after 9 hours •Dexmethylphenidate ----CORRECT ANSWER----------•IR and ER forms available

• more potent than Ritalin
• high risk of adverse effects •Amphetamine (adzenys) ----CORRECT ANSWER----------•orally-disintegrating ER for children who cannot swallow pills
• avoid prescribing when MOAI has been used with 14 days •Dextroamphetamine (Adderall)- ----CORRECT ANSWER----------•IR and ER •Often dosed in AM (IR or XR) with a PM or PM PRN (IR) dose if medication effects diminish prior to the end of school, duty, or the workday
• most abused and diverted prescription stimulants •Lisdexamfetamine (Vyvanse)- ----CORRECT ANSWER----------•biologically inactive until metabolized by the body (prodrug)
• less abuse and diversion potential than other stimulants
• higher cost medication Reminder: ----CORRECT ANSWER----------: if a patient is on immediate release medications, the duration of action may be shorter. If the patient complains that their symptoms only improve temporarily but come back throughout the day, they may need an

additional dose (i.e., a morning dose and a dose after lunch- avoid stimulants at night!)immediate-release Stimulant ----CORRECT ANSWER----------schedule II controlled substances no refills permitted Non-stimulant ----CORRECT ANSWER----------low risk of abuse or diversion often prescribed for adults with ADHD Name Stimulant medications ----CORRECT ANSWER----------Methylphenidate (Concerta, Ritalin), dexmethylphenidate (Focalin) ,amphetamine (Adzenys), dextroamphetamine (Adderall), lisdexamfetamine (Vyvanse) Stimulants side effects mnemonic ----CORRECT ANSWER----------RACING (restlessness, appetite suppression, cardiovascular effects, insomnia, narcotic potential, growth restriction) ADHD NT mnemonic ----CORRECT ANSWER----------Dopamine (Drug Addiction, Attention, Movement) Norepinephrine (Fasting, Fired (up), increased Focus) (a-1 receptors ALL over the place, B-1 receptors heart) Two main categories of stimulants? ----CORRECT ANSWER----------1)methylphenidates (Ritalin) 2)amphetamines (Adderall) Methylphenidates NT information? ----CORRECT ANSWER----------are Norepinephrine- dopamine reuptake inhibitors (NDRIs) considered to be milder of the 2 classes. Methylpheidates medications ----CORRECT ANSWER----------(prescribed in it original from Ritalin), Concerta, Daytrana, dexmethylphenidate (focalin), jornay PM

Ritalin ----CORRECT ANSWER----------IR and ER form, sprinkles available for children who have trouble swallowing pills, 5mg-50mg max dose Concerta ----CORRECT ANSWER----------long-lasting formulation, biphasic (immediate & delayed release in one medication, inital dosing 18mg take in AM Daytrana ----CORRECT ANSWER----------transdermal patch, apply in AM and remove after 9 hours (15mg-30mg) Jornay PM ----CORRECT ANSWER---------- Dexmethylphenidate (Focalin) ----CORRECT ANSWER-----------more potent that Ritalin, (IR & ER options), high risk of adverse effects which methylphenidate medication is available in sprinkles if a child is having trouble swallowing pills? ----CORRECT ANSWER----------Ritalin which methylphenidate medication comes in a form of a trandermal patch? ----CORRECT ANSWER----------Daytrana which methylphenidate is biphasic long acting lasting up to 12 hours? ----CORRECT ANSWER----------concerta what class does jornay PM belongings too? ----CORRECT ANSWER---------- methylphenidate which stimulant medication is more potent than ritalin and have a higher risk of adverses effects? ----CORRECT ANSWER----------focalin (dexmethylphenidate) amephetamines ----CORRECT ANSWER----------(think amping up) norepinephrine and dopamine releasing agents that are more stimulating than methylphenidates

amphetamines medications? ----CORRECT ANSWER----------amphetamines (adzenys), dextroamphetamine (Adderall), lisdexamfetamine (Vyvanse) amphetamines (adzenys), ----CORRECT ANSWER----------orally disintegrating extended release formula for children who can't swallow pills, avoid giving within 14 days of MAOIs dextroamphetamine (Adderall), ----CORRECT ANSWER----------most abuse and diverted, a. Often dosed in morning then in afternoon as needed lisdexamfetamine (Vyvanse) ----CORRECT ANSWER----------a. Biologically inactive until metabolized b. Less abuse and diversion c. Higher cost CNS stimulants can cause what? ----CORRECT ANSWER----------a. CNS stimulants can cause psychotic or manic symptoms with no prior history or may exacerbate behavior disturbance symptoms in patient with pre-existing psychosis b. CNS stimulants may exacerbate comorbid anxiety or substance use Non-stimulants action ----CORRECT ANSWER----------Help with lower distractibility, improve attention, working memory, and impulsivity why would a NP used a non stimulants for ADHD? ----CORRECT ANSWER---------- Commonly used when a client does not respond to stimulant medications what medication class needs to be avoided if a patient is taking nonstimulants? ---- CORRECT ANSWER----------MAOIs What happens if a patient does not taper off their non-stimulant medication? ---- CORRECT ANSWER----------•At risk for hypertension and neurological side effects if they do not taper off the medication

Common side effects of non stimulants? ----CORRECT ANSWER----------•Common SE include nausea, vomiting, diarrhea, fatigue, mood swings, dizziness, worsening of symptoms, changes in HR. and BP, sedation, and dry mouth common non-stimulant medication used to treat ADHD? ----CORRECT ANSWER---------- atomoxetine (Strattera), guanfacine, Clonidine, burpropion (wellburtin) 3 groups of non stimulates meds ----CORRECT ANSWER----------1) noradrenergic, 2) a- 2 agonists 3) NE-dopamine reuptake inhibitors Name an noradrenergic ----CORRECT ANSWER---------- 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, as well as providing information on how a client may break down and metabolize medications based on the cytochrome P450 system. 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

. Both environmental and psychosocial stressors can impact mental health. Although twins may have identical genes, their gene expression may be different. Neuroscience - ANSWER is the study of the structure and function of the brain and is a field which is making great advancements (Pliszka, 2016). A strong foundational understanding of neuroscience and how the structure and function of the brain can result in mental health symptoms is necessary to treat mental illnesses. Some mental disorders such as Alzheimer's disease, schizophrenia, and major depressive disorder are thought to be a result of malformations or malfunctions within the brain. The psychiatric mental health nurse practitioner (PMHNP) must comprehend how medications impact the brain in order to safely and effectively prescribe psychotropic medications. Brain tissue - ANSWER is composed of gray and white matter.

gray matter - ANSWER The cerebellum, cerebrum, brain stem, and the butterfly- shaped portion of the central spinal cord are comprised of gray matter which contains neural cell bodies, axon terminals, dendrites, and all nerve synapses. It is the working area of the brain and the focus of psychiatry and neurology. Gray matter - ANSWER associated with learning. Changes in the gray matter are linked to psychiatric diagnoses including Alzheimer's disease, schizophrenia, and major depressive disorder. White Matter - ANSWER contains nerve fibers that connect neurons from different regions into functional circuits. The myelin that coats neuronal axons is necessary for electrical impulse transmission. Think of the white matter as a transit system. If there are breaks in the system, then people cannot get to their destinations. Within the brain, these breaks affect neural communication, affecting behavior. Damage to the myelin can impair transmission which can impact not only sensory and motor function, but also cognition.

White matter abnormalities are associated with autism and vascular dementia. The central sulcus separates which lobes? - ANSWER frontal lobe from parietal lobe Frontal lobe - ANSWER Associated with movement, intelligence, abstract thinking. etc. Broca's area - ANSWER Speech Temporal lobe - ANSWER Involves object identification and auditory signals Cerebellum - ANSWER coordination and balance 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 This includes circuits that are associated with pleasure and reward, emotion and learning Basal ganglia - ANSWER A 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 What is the global burden of disease of mental health, neurological, and substance use disorders? - ANSWER 30% How many children and adolescents are impacted by mental health disorders worldwide? - ANSWER 20% How much does lost productivity related to anxiety and depression cost the global economy each - ANSWER $1 trillion USD

The development of mental health conditions are linked to causes - ANSWER such as genetics, biochemical processes, environment, and lifestyle. Mental illness is common, and treatment often includes the use of psychotropic medications. When prescribing medications, the psychiatric mental health nurse practitioner (PMHNP) must consider each client's unique circumstances including, but not limited to their: - ANSWER symptoms age physical health previous response to treatment lifestyle Treatment for mental health conditions requires - ANSWER individualized care that incorporates the client's desires and goals. Which is the priority data used to determine a treatment plan for mental health disorders? - ANSWER client symptoms Adherence - ANSWER can be defined as persistence or compliance. Persistence is taking the medication over the intended time period. Compliance is taking the medication as prescribed. According to Dell'Osso et al. (2020), client, clinician, and structural factors all contribute to non-adherence. Client factors that contribute to nonadherence include - ANSWER concern about side effects, fear of addiction to medications, misunderstanding of expected outcomes. Clinician factors that contribute to nonadherence include - ANSWER lack of shared-decision making with the client, providing inadequate education about medications, and lack of follow up. Structural factors that contribute to nonadherence include - ANSWER medication access, medication cost, and stigma associated with mental illness.

Informed Consent - ANSWER Clients have the right to receive enough information to make decisions about treatment. They must also be informed about potential risks associated with medications. Clients have the right to refuse treatment and 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 include clients with schizophrenia or sex offenders. Guardians can also provide consent for clients who have limited cognitive capabilities or are incompetent to make decisions. Ultimately, PMHNPs are responsible for being knowledgeable about their state laws and abiding by them. Off-Label Perscribing - ANSWER Some clients may benefit from the unapproved use of a drug for symptom management. For example, many selective serotonin reuptake inhibitors (SSRIs) are used to treat anxiety and obsessive-compulsive disorder but are not FDA approved for use in this disorder. Off-label prescribing potentially raises ethical and legal concerns; the PMHNP must remain up to date with the latest recommendations for off-label prescribing. What should the PMHNP consider when prescribing chemical restraints for this client? - ANSWER Prescribing considerations include carefully reviewing the client's allergy status and prior medication history for adverse drug reactions related to the medications ordered in the chemical restraint. If the client has a known allergy and was given the medication, the prescriber and staff could be held liable for harm to the client. Also, state regulations regarding chemical restraints must be reviewed, as some states do not allow court-ordered treatment against a client's wishes. 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. Normal and abnormal genes both contribute to - ANSWER disease and drug efficacy. Epigenetics - ANSWER can contribute to the risk of any disorder or disease. Psychiatric disorders can also be due to normal genes that are "on" that should be "off." Mental health diagnoses contribute significantly - ANSWER to the global burden of disease. to appropriately prescribe psychotropic medications. - ANSWER A strong

understanding of the functions of the brain and neurotransmitter roles in illness and treatment is needed Psychiatric prescribing decisions are based - ANSWER on neuroscience and symptom presentation. The field of epigenetics - ANSWER is rapidly growing and can help explain how gene expression is influenced by environmental factors and how epigenetics contributes to the manifestation of mental illness. when prescribing medications including - ANSWER Consideration must also be given to each client's unique their symptoms, age, physical health, and lifestyle. The potential legal and ethical issues impacting mental health treatment must - ANSWER also be

taken into account, including informed consent, competence to make healthcare decisions, and off-label prescribing. Which of the following is a prominent CYP enzyme in the body and what is it responsible for? - ANSWER CYP3A4 - responsible for metabolism of a number of medications Dosing adjustments may be required. What is the direct role of transcription factor? - ANSWER influence gene expression antagonist effect - ANSWER antagonist effect - drug binds to receptor, but does not activate a response Partial agonist - ANSWER drug does not fully activate receptors Inverse agonist - - ANSWER drug causes opposite effect of the agonist. Which is a first messenger? - ANSWER neurotransmitter- G protein linked systems and ion channel linked cascades are triggered by neurotransmitters. Which action explains an agonists effect on ligand-gated ion channels? - ANSWER Agonists cause ligand-gated ion channels to open more frequently. When prescribing psychotropic medications, the PMHNP knows that these medications work within which specific areas? - ANSWER mood dorsolateral prefrontal cortex (DLPFC) - ANSWER is concerned with higher level functioning VLPFC (ventrolateral prefrontal cortex) - ANSWER involved with motor inhibition the IFG contains Broca's area which is associated with speech production understanding grammar. Basal ganglia - ANSWER are a group of structures involved in voluntary motor

movements. Basal ganglia are also involved in cognition and emotion. Psychosis - ANSWER can be an overwhelming experience for clients, making them feel out of control and out of touch with reality. Antipsychotic medications - ANSWER can be effective in reducing the symptoms of psychosis.

Psychosis is a syndrome - ANSWER that can be associated with several different psychiatric disorders. Symptoms of psychosis include - ANSWER hallucinations, delusions, disorganized speech, disorganized behavior, and distortions of reality. This syndrome can affect a person's cognition, affective response, communication, capacity to recognize reality, and ability to relate to others Psychosis - ANSWER is a defining feature for some psychotic disorders while other disorders may have a psychotic component. Psychosis is a defining - ANSWER feature for some psychotic disorders while other disorders may have a psychotic component. Diagnoses Requiring the Presence of Psychosis - ANSWER schizophrenia substance-induced psychotic disorders schizophreniform disorder schizoaffecive disorder delusional disorder brief psychotic disorder psychotic disorder due to a medical condition Diagnoses with Psychosis as a Feature -

ANSWER mania depression cognitive disorders dementia Schizophrenia - ANSWER is one of the most common disorders treated by antipsychotic

medications. The prevalence of schizophrenia is difficult to determine due to the complexity of the diagnosis and other factors. Current estimates place the prevalence of schizophrenia and related psychotic disorders in the U.S. between 0.25% and 0.64% with international estimates of the prevalence of schizophrenia among non-institutionalized persons is 0.33% to 0.75% Positive symptoms - ANSWER H allucinations D elusions T hought disorder H ostility E xcitability Motor symptoms - ANSWER Motor delay Dyscoordination EPS, e.g.,ParkinsonismDyskinesia Active symptoms - ANSWER Depression Anxiety Suicidality Cognition - ANSWER Attention Working memory Verbal memory

Visual memory Executive functioning Processing speed Social conditioning

Negative symptoms - ANSWER Affective flattening Alogia Anhedoni a Amotivati on Asociality Genetics - ANSWER Many genes play a role in the likelihood that an individual will develop schizophrenia as do epigenetic factors. Heritability for schizophrenia may be as high as 79%. Evidence exists that links gene-environment interaction to the diagnosis of schizophrenia Environmental Triggers - ANSWER Regular Cannabis Use Exposure to Early Life Trauma Sexual Abuse Emotional Abuse Emotional Neglect Bullying Neuroanatomy - ANSWER Several areas of the brain are associated with the symptoms of schizophrenia.

When brain circuitry in the prefrontal cortex malfunctions, patients may experience symptoms. Mesocortical and ventromedial prefrontal cortex - ANSWER negative and affective symptoms Dorsolateral: - ANSWER cognitive symptoms Orbitofrontal and connections to the amygdala: - ANSWER aggressive, impulsive symptoms

Dopamine Role in Psychosis - ANSWER Many theories exist regarding the causes of psychosis and schizophrenia. A leading hypothesis is that psychosis and schizophrenia are associated with a dysfunction of the neurotransmitter dopamine (DA) (Stahl, 2021). Dopamine dysfunctions are also involved in other conditions that cause psychosis, such as severe depression, certain medical disorders, and substance abuse. Traditionally, schizophrenia and psychosis symptoms have been associated with a surplus of dopamine, since medications that block dopamine, specifically D2, have been found to reduce the positive symptoms of schizophrenia. Stahl (2021) suggests that it is more likely that schizophrenia symptoms are related to "out of tune" dopamine Medications to treat psychosis are classified as either - ANSWER first generation antipsychotics (FGAs) or second- generation antipsychotics (SGAs). Antipsychotics are prescribed based on their pharmacological properties, side effect profiles, and adverse effects according to the unique symptoms and needs of individuals across the lifespan. Within medication management, medications from this and other classes are used across many diagnoses, making the former naming conventions inaccurate. Selecting medications based on mechanism of action allows for precise, individualized prescribing as specific symptoms are targeted. First generation antipsychotics (FGAs) are also known as - ANSWER typical antipsychotics and are appropriate for acute and chronic management of

schizophrenia and psychosis. First Generation Antipsychotics - ANSWER Desirable Effects Improves Positive Symptoms Acute & Chronic Schizophrenia & Psychosis