NR 546 Week 1-7 Quiz’s| Midterm Exam with Answers and Rationales, Exams of Nursing

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NR 546 Week 1-

Quiz’s| Midterm Exam

with Answers and

Rationales

Week 1 quiz Content Review

All Sections No unread replies.No replies. Week 1 quiz Hello NR546 students, In order to provide feedback on the weekly quizzes, I will provide rationale statements for the quiz questions. You will note that there are more than 5 listed this is because the quiz testbank is larger than 5 questions and the additional information can help you prepare for the final and direct your study.

• The amygdala is associated with anxiety and perception of odors.
• The hippocampus is involved in memory and anxiety. The amygdala is associated with anxiety and perception of odors. The prefrontal cortex is associated with executive function. The thalamus is associated with motor command processing
• The client’s cognitive status can result in an ethical concern if the client is unable to self-determine care or is a danger to self or others. Ability to pay is not an ethical issue.
• basal ganglia are a group of structures involved in voluntary motor movements. Basal ganglia are also involved in cognition and emotion.
• Limbic system is associated with emotion and learning
• hippocampi are associated with long term memory
• Wernicke's area is associated with speech comprehension. Review activity
• the dorsolateral prefrontal cortex (DLPFC) is concerned with higher level functioning. The VLPFC is involved with motor inhibition the IFG contains Broca's area which is associated with speech production understanding grammar. Pliska Ch. 8
• the OFC is involved in decision making and social behavior with a focus on punishment and rewards. The OFC inhibits and activates the amygdala and is activated when a risk assessment is required. Some behaviors associated with the OFC include sex, sugar, pain, social humiliation, money, rewards, fame, and aggression. The amygdala will identify a threat and then the OFC will determine the risk or benefit of an action based on past experience. Pliska Ch. 8, p.
• At this time, 20 % of the world’s population is suffering from a neurologic and/or psychiatric disorder.

• Major current hypothesis for the cause of schizophrenia proposes that glutamate activity at N-methyl-d-aspartate (NMDA) receptors is hypofunctional due to abnormalities in the formation of glutamatergic NMDA synapses during neurodevelopment. Stahl p. 107
• EPSs manifest when dopamine receptor occupancy within the basal ganglia reaches approximately 80% as the dopamine-mediated inhibition of movement is now disinhibited (Refer to pathophysiology and the basal ganglia model of movement)Stahl p.133. See figure 5-
• Risperidone has the highest risk for galactorrhea. Review tuberofundiular pathway Stahl p.
• clozapine is documented to decrease risk of suicide in schizophrenic clients. Stahl p. 181
• "Aripiprazole is associated with the lowest risk weight gain.
• All pines are associated with weight gain. Though not associated with large weight gain, lurasidone is not associated with less weight gain in the same way as aripiprazole. Week 3 lecture "
• Haldol is a first-generation antipsychotic, which can cause a dystonic reaction.
• Although individual effects may vary from patient to patient, in general conventional antipsychotics share the same primary mechanism of action and do not differ much in their therapeutic profiles. There are, however, differences in secondary properties, such as degree of muscarinic, histaminergic, and/or alpha-adrenergic receptor antagonism, which can lead to different side-effect profiles. Stahl p.131 (including table 5-1 and Figure 5-2).
• Nearly all atypical antipsychotics (also known as 2nd generation) have an affinity for blocking serotonin 2A receptors that is e qual to or greater than their affinity for blocking dopamine 2 receptors. The “pines” – clozapine, olanzapine, quetiapine, and asenapine – all bind much more potently to the serotonin 2A receptor than they do to the dopamine 2 receptor. The “dones” – risperidone, paliperidone, ziprasidone, iloperidone, and lurasidone – also bind more potently to the serotonin 2A receptor than to the dopamine 2 receptor or show similar potency at both receptors. Stahl p.141-
• The tuberoinfundibular pathway is associated with hyperprolactinemia Stahl p. 136
• The mesolimbic pathway is associated with positive symptoms. The mesocortical pathway is associated with negative symptoms. The nigrostriatal pathway is part of the extrapyramidal nervous system and associated with extrapyramidal symptoms (EPS). the tuberoinfundibular pathway is associated with hyperprolactinemia
• Clozapine is not a first line treatment, it is used when other antipsychotics fail. Stahl, 182.After failure of two sequential adequate trials of antipsychotic monotherapy, the recommended and evidence- based treatment strategy is to switch to clozapine. Stahl p. 182

• Clozapine is one of the only antipsychotics that does not cause dystonia. The other medications are not known for causing dystonia.
• Clozapine, though the gold standard, is the last medication you would prescribe, it is for treatment resistant cases due to the serious side effects which include agranulocytosis, myocarditis and seizures.
• Due to agranulocytosis, clozapine requires frequent CBCs. Know the required frequency for lab draws.
• Clozapine is the only antipsychotic documented to reduce suicide risk. (Stahl,181)

Week 5 clinical pearls and rationales

All Sections No unread replies.No replies. No unread replies.No replies.

• SSRIs are first line treatment for depression. Stahl Ch. 7
• sexual dysfunction is common with SSRIs. Stahl Ch. 7
• Rapid cycling is a minimum of 4 episodes/year. Stahl Ch 6 , Figure 6.
• the goal of antidepressant treatment is complete remission of symptom s. Stahl p.
• serotonin is associated with GI side effects due to the presence of 90% of 5HT receptors in the GI tract. See lecture- clinical pearls
• escitalopram is considered the best tolerated SSRI with the fewest CYP interactions. Stahl Ch 7 p.
• Lithium levels can be increased by NSAIDs and ACE inhibitors, decreased by caffeine and mania, and unchanged by amiloride, furosemide, and sulindac. lecture- clinical pearls
• Lithium is effective treatment for manic episodes, to prevent reoccurance and to a lower degree is effective in depressive episodes.
• Lamotrigine is well tolerated except for the propensity to cause a rash. Stahl p.
• monoamine neurotransmitters are norepinephrine, dopamine and serotonin. Stahl p. 237
• lamotrigine is a mood stabilizer. Mood stabilizers are listed here- Stahl p.
• week 5 lecture special populations discusses medication associated pregnancy risks
• Lithium is well established to help prevent suicide in clients with mood disorders. (Stahl,372)
• Lithium has a narrow therapeutic window and requires lab draws. (Stahl,373).

• Impulsive disorders are focused on reward and associated with the mesolimbic pathway. Stahl p.

Week 7 Quiz & Content Review

All Sections No unread replies.No replies. Hello NR546 students, here is the week 7 quiz review:

• The tuberomammillary nucleus (TMN) contains the on switch, the off switch is located in the ventrolateral preoptic nucleus (VLPO). Stahl p. 445
• Guanfacine is an alpha 2 agonist, methylphenidate is a dopamine norepinephrine multimodal; amphetamine is a is a dopamine norepinephrine reuptake inhibiter (DN-RIRe),; Wellbutrin is an amphetamine is a is a dopamine reuptake inhibitor(D-RIRe).. Stahl Ch 12
• Hyperactivity is modulated by the prefrontal cortex. Impulsivity is modulated by the orbitofrontal cortex. Stahl p. 475, Figure 11.
• Children present with hyperactivity, the hyperactive symptoms are going to decline markedly with age, becoming more subjective, less apparent or obvious to others. Adults are not hyperactive but do report on internal restless and difficulty sitting still.
• ADHD symptoms presentation in your course under Explore: Week 7: Medications for ADHD and see core symptoms Fig 11.
• Melatonin and melatonin receptor agonists are effective hypnotics for sleep onset. They do not help with sleep maintenance
• Classic ADHD presents around age 7 due to the abnormalities in the prefrontal cortex circuits. dACC is associated with impulsivity, one of the symptoms of ADHD
• Z drugs are Schedule IV medications. A DEA license is required to prescribe these medications
• Methylphenidate Section. Methylphenidate blocks DAT and NET
• Norepinephrine (NE) and Dopamine (DA) are associated with the symptoms of inefficient information processing in the prefrontal circuits. Rather than a deficiency, Stahl (2013) posits that NE and DA are “out of tune”.
• DA agonists are first line treatment for insomnia related to RLS
• Melatonin, secreted by the pineal gland, regulates circadian rhythms.