NR 546 ALL WEEKS complete compilation with accurate verified solutions + rationales ( GUARANTEED SUCCESS )

What is the global burden of disease of mental health, neurological, and substance use disorders?

30%

How many children and adolescents are impacted by mental health disorders worldwide?

20%

How much does lost productivity related to anxiety and depression cost the global economy each year?

$1 trillion USD

The development of mental health conditions are linked to causes such as

genetics, biochemical processes, environment, and lifestyle

When prescribing medications, the PMHNP must consider each client's unique circumstances including

symptoms

age

physical health

previous response to treatment

lifestyle

Treatment for mental health conditions requires

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?

a. drug adverse effects

b. client symptoms

c. treatment history

d. client lifestyle

b. client symptoms

Rational: Client symptoms are the priority data to determine a treatment regimen for mental health disorders. The client's history of treatment success and failures, adverse effects of the drugs, and lifestyle are all considered when determining a treatment plan.

What should the PMHNP consider when prescribing chemical restraints?

-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

How does reviewing the genetic makeup of a client help guide the PMHNP in selecting medication for clients?

-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?

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

separates the frontal lobe from the parietal lobe

frontal lobe

associated with movement, intelligence, abstract thinking

broca's area

speech production

temporal lobe

involves object identification and auditory signals

cerebellum

coordination

wernicke's area

speech comprehension

occipital lobe

primary visual area

parietal lobe

keeps us alert to what is going on around us

sensory cortex

pain, heat, and other sensations

motor cortex

movement

hippocampus

involved in both memory and anxiety

nucleus accumbens

involved in the reward process

thalamus

involved in sensory organ and motor command processing

striatum

involved in complex motor actions, also links cognition to motor actions

limbic system

includes circuits that are associated with pleasure and reward

basal ganglia

group of structures involved in voluntary motor movements

amygdala

involved in emotional regulation and perception of odors

corpus callosum

controls the communication between the two brain hemispheres

white matter

contains nerve fibers that connect neurons from different regions into functional circuits

grey matter

contains nerve cells and dendrites

brain tissue

made up of grey matter and white matter

dorsal striatum

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

Mental health diagnoses contribute significantly to:

the global burden of disease

A strong understanding of the functions of the brain and neurotransmitter roles in illness and treatment is needed to:

appropriately prescribe psychotropic medications

Psychiatric prescribing decisions are based on:

neuroscience and symptom presentation

The field of epigenetics 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

Consideration must also be given to each client's unique circumstances when prescribing medications including their:

-symptoms

-age

-physical health

-lifestyle

The potential legal and ethical issues impacting mental health treatment must also be taken into account, including:

-informed consent

-competence to make healthcare decisions

-off-label prescribing

Sequential Framework of Priorities for providers to address when prescribing antidepressants to treat MDD (improve med adherence)

Diagnosis

Pharmacological Tx

Medication Education

Monitoring Plan

Adherence Reinforcement

Adherence

Persistence

-taking med over intended time period

Compliance

-taking med as prescribed

Client, clinician, and structural factors all contribute to _______

non-adherence

non-adherence factors

Client factors

-concern about side effects

-fear of addiction to meds

-misunderstanding of expected outcomes

Clinician factors

-providing inadequate education about meds

-lack of shared decision making

-lack of follow-up

Structural factors

-med cost

-med access

-stigma associated with mental illness

Sensory memory:

Register of events in the environment, often unconscious, for up to 10 seconds, is forgotten if not moved to short-term memory.s

Short-term memory:

Information lasts seconds to minutes (remembering an unfamiliar phone number), has a limited capacity.

Working memory:

Actively holding information in memory and manipulating it (solving a word problem in your mind) is considered part of executive function.

Long-term memory:

Memories stored for days to years, can be lifelong.

Declarative memory:

Memory for events and facts.

Episodic memory:

Memories of personal experiences about one's own life (what, where, when, and with whom they occurred).

Semantic memory:

Memory for facts, concepts ("What is the capital of Texas?")

Nondeclarative memory:

Involuntary or unconscious long-term memory.

Conditioning memory:

Reacting to a sound that has been associated with pain.

Procedural memory:

Memory for a motor act (tying shoes, walking the same route to work), can be performed "without thinking about it."

the first antidepressant prescription represents the most important occasion to provide patients with:

adequate information on:

-medications

-side-effects

-expectations

-therapy duration

-follow-up

pro-antidepressant adherence checklist

1. Provide a diagnostic framework and illustrate illness' biological determinants

2. Discuss the need for pharmacological treatment (i.e., antidepressant) and patient's expectations

3. Select a specific antidepressant in light of patient's clinical characteristics

4. Provide a short-term treatment monitoring plan

5. Provide a mid-/long-term treatment plan

6. Consider other relevant antidepressant adherence boosters

left hemisphere

-speech comprehension

-word recognition

-grammar

-sequential processing

-recognition of detail

-conscious mental processing

right hemisphere

-prosody of speech

-emotional modulation

-visual-spatial skills

-recognition of facial expression

-music

-abstract mathematical skills

-holistic processing

-unconscious mental processing

Which client factor(s) impact the effect of psychotropic medications and should be considered when prescribing psychotropic medications.

age

smoking

caffiene

perscrined medication

over the counter medications

the chemical transmission of information between neurons and their target cells is called ______________

Neurotransmission

The neurotransmitters that most impact mental health can be classified into four major categories:

1.cholinergics (acetylcholine)

2.monoamines (norepinephrine, dopamine, serotonin, and histamine)

3.amino acids (gamma- amino-butyric acid and glutamate), and 4.neuropeptides

Psychotropic medications often impact neurotransmitters by either enhancing or decreasing the neurotransmitters' ability to bind to receptor sites

True

I am the chief inhibitory neurotransmitter (NT). The opposite of Glu. I decrease neuroexcitability across the brain. I bring the “chill” to the party. I say party because people really like me when I take the edge off stress and help them calm down. Some meds use my benefits to help people sleep for medical procedures. I help people relax, destress, and get some sleep.

GABA (gamma-aminobutyric acid.)

When people don't have enough of GABA they may experience

anxiety or even

schizophrenia.

You can see my effects when people drink alcohol. A few drinks and people are super social and up for just about anything. I’m told these are great benefits, but some people abuse alcohol and medications that target me, such as benzodiazepines. I don’t just calm down those emotions, I slow down everything, even breathing, which can be dangerous. I also affect the executive function and motor coordination, making people more at risk for accidents.

GABA (gamma-aminobutyric acid.)

I am your flight, fight, or fright. That's me, in excess. . I can really help with focus and productivity which is why you see me with a cup of coffee. I can put some "pep in your step" for sure when we get you to your sweet spot.

Norepinephrine (NE)

What happens if you have too much NE due to stress, medications, and caffeine or other stimulants? I can make you -------------,------------, and affect your ability to ------------. You see, I'm very primal and I can't tell if you're stressed about a deadline or need to save yourself from a sabertooth tiger, which to me is more important. That executive function? It's on hold until I'm sure you're out of danger. These many roles apply to both physical and mental health, including mood, cognition, cardiac functioning, sleep, and arousal. Knowing about how I function will help you to better understand symptoms and treatments.

antsy, nervous, and affect your ability to focus.

I affect arousal, motivation, attention, learning, and REM sleep. I work within the parasympathetic nervous system too. I can make you sweat and salivate. Increase me, and I can help with symptoms

acetylcholine

Substances that block me can paralyze you because I am the link between the brain and muscles. When there's not enough of me, I can be involved in Alzheimer's and Parkinson's disease.

acetylcholine

I also have a role in addiction. Dr. Stahl refers to me as “the brain’s own nicotine” when he talks about my role in addiction. I’ve got lots of receptor friends; my best friends are nicotinic and muscarinic receptors.

acetylcholine

some people call me 5HT. I help to regulate mood. I’ve been called the “happy hormone,” but actually I am not a hormone at all; I am a monoamine neurotransmitter. Your body synthesizes me naturally from tryptophan. You know that amino acid in turkey that makes you content and happy after a big turkey meal? That’s me, helping you to feel relaxed, comfortable, and less stressed.

Serotonin

I help to regulate sleep, arousal, libido, aggression, and pain perception too! That's how I work in medications too.

Serotonin

I am one of the key monamine neurotransmitters that regulate mood. First of all, I am associated with executive function, your ability to perform well, be organized, and all those good things including emotional intelligence.

dopamine

I'm also essential to your movement and coordination. Being balanced is very important to me; too much or too little can cause problems.

dopamine

When my levels are low you'll lose pleasure, interest, alertness, and even self-confidence. Low levels are also found in clients who have Parkinson's disease. Too much of me is not always a good thing. I can lead to the hallucinations you see in schizophrenia and psychosis.

dopamine

to much DA can lead to

hallucinations

schizophrenia and

psychosis.

Do you know that great feeling you get when you win something? That's me, at work in your reward center. Some people have trouble with me because my reward properties can lead to all types of addictions. These are just a few examples of how I function. Did I mention I even have my own pathways?

Dopamine (DA)

I am an amino acid and THE excitatory neurotransmitter. I’ve been referred to as the workhorse of the brain because I can affect almost every neuron in the brain. I’m quite the firecracker. You’ll find me working hard all over the brain affecting energy, memory, learning, and neural plasticity. I also work to relay sensory information and regulate spinal and motor reflexes.

Glutamate

When my levels are too high, I've been associated with schizophrenia, epilepsy, and mania. My receptors, NMDA and AMPA, work with me across many regions of the brain. I can really make things happen.

Glutamate

Which neurotransmitter(s) may be responsible for a client's symptoms of depression? Select all that apply.

increased levels of acetylcholine

increased levels of serotonin

increased levels of glutamate

decreased levels of norepinephrine

decreased levels of histamine

Imbalanced levels of acetylcholine, norepinephrine, serotonin, histamine, or glutamate can contribute to symptoms of depression.

true

This enzyme system is responsible for metabolizing many psychotropic medications

cytochrome P450

Drug metabolism is influenced by client factors such as ___________, ___________, ____________, or other ________________. In older adults’ drug metabolization is decreased, so dosages may need to be reduced to prevent toxicity. Other drugs and substances such as nicotine or caffeine can be either inducers, which increase the rate of drug metabolism, or inhibitors, which decrease the rate of drug metabolism. Polypharmacy is another factor which is common in the care of clients with psychiatric disorders. Not only do clients with psychiatric disorders often need more than one medication to control symptoms, particularly in those with the diagnosis of schizophrenia or bipolar illness, but they often need subsequent medications to manage side effects.

age, smoking, caffeine intake, or other medications.

A client who is a poor metabolizer has a lower concentration of the necessary enzyme to metabolize a drug, which results in higher blood concentrations of the drug. Higher concentrations of drugs increase the risk of side effects and adverse reactions.

inhibits the reuptake of serotonin, which can cause nausea, agitation, headache, and sexual dysfunction

Selective Serotonin Reuptake Inhibitors

inhibits the reuptake of serotonin and norepinephrine, which can cause nausea, sweating, insomnia, tremors, sexual dysfunction

Serotonin and Norepinephrine Reuptake Inhibitors

inhibits reuptake of serotonin and norepinephrine, which can cause sexual dysfunction

blocks norepinephrine receptors, which can cause hypotension and tachycardia

blocks histamine receptors, which can cause sedation and weight gain

blocks acetylcholine receptors, which can cause dry mouth, constipation, blurred vision, and urinary retention

Tricyclic Antidepressants

increases norepinephrine and serotonin by inhibiting the enzyme that inactivates it, which can cause sedation, dizziness, sexual dysfunction, and hypertensive crisis

Monoamine Oxidase Inhibitors

increases the receptor affinity for GABA, which can cause dependence and confusion

Benzodiazepines

inhibits the reuptake of norepinephrine and dopamine, which can cause insomnia, dry mouth, tremors, and seizuresX

Bupropion

The most common action of psychotropic drugs is to modify the actions of G-protein-linked receptors, which occurs on a spectrum. The agonist spectrum ranges from antagonist, which blocks the action of a neurotransmitter, to agonists, which fully stimulate G-protein-linked receptors. In the middle of the spectrum are partial agonists, which stimulate receptors to a lesser degree than an agonist or natural neurotransmitter (Stahl, 2021). Watch this video Links to an external site.to learn more about the agonist spectrum.

SSRIs, SNRIs, and tricyclic antidepressants _______________ serotonin levels. Benzodiazepines do not impact serotonin levels.

increase

Joshua presents to the PMHNP with symptoms of schizophrenia. Nicotine stains are noted on his mouth and hands. He confirms that he smokes at least 2 to 3 packs of cigarettes a day. The PMHNP prescribes olanzapine for Joshua. Olanzapine is metabolized via CYP 1A2 and 2D6.

Is nicotine an inducer or an inhibitor of the CYP 1A2 enzyme?

Inducer. Nicotine is an inducer of the CYP 1A2 enzyme.

Nicotine is an inducer of the CYP 1A2 enzyme. Does the PMHNP anticipate Joshua may need a higher or lower dose of olanzapine to achieve a therapeutic response?

Nicotine is an inducer of the CYP 1A2 enzyme, so it lowers the concentration of drugs. Therefore, a higher dose of olanzapine may be needed to control his symptoms.

_______________ is responsible for the regulation of fight or flight responses and can impact mood and sleep.

Norepinephrine (pounding heart beat)

________________ impacts sleep, pain perception, and memory; increased levels result in depression

Acetylcholine

_____________ impacts alertness, pain sensation, and inflammatory responses; increased levels result in depression

Histamine

Increased levels of gamma-aminobutyric acid have a _________________ effect

calming effect.

_____________ is the best medication class for the PMHNP to prescribe for Ernesto to address his elevated norepinephrine levels?

A selective serotonin reuptake inhibitor would block the reuptake of serotonin, leaving a larger amount of serotonin available. Increasing the amount of serotonin would help regulate the feelings of fear and anxiety. Reducing the occurrence of fear would help reduce the release of norepinephrine.

antipsychotic meds

primarily used for schizophrenia & psychotic disorders

-also used as adjunctive meds for management of tx-resistant depression & other conditions

-not curative

-decrease/control symptoms/improve quality of life

Schizophrenia

a disturbance that must last for 6 months or longer, including at least one month of positive symptoms or negative symptoms

-neurodevelopmental, brain disorder

-psychological condition involving chronic or repeated episodes of psychosis

cause: combination of genetics and environmental factors

DX: based on clinical interview

Schizophrenia increases the risk of:

suicide

homeless

jail/prison