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NR 546 Advanced Pharmacology Psychopharmacology Midterm Exam (2026/2027) PDF | Nursing | Chamberla

HEAL100 Health Care — exam and revision material · Other

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Health Care exam material, 42 pages. Originally published on StudyMerit.

Pages
42
Academic year
2025/2026
Language
English

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MIDTERM STUDY GUIDE CBC – Used to rule out anemia that can cause depressive symptoms and fatigue or rule out infection as a cause of acute mental status changes.  Clozapine requires a routine analysis of absolute neutrophil count and platelet levels. Red blood cells: 4.5-6.0 million/microliter Hemoglobin: 12-18 grams/100 mL Hematocrit: 38%-48% Reticulocytes: 0%-1.5% White blood cells (total): 5,000-10,000/microliter Neutrophils: 55%-70% Eosinophils: 1%-3% Basophils: 0.5%-1% Lymphocytes: 20%-35% Monocytes: 3%-8% Platelets 150,000-300,000/microliter CMP - Used to rule out medical conditions that can cause symptoms such as changes in mood or cognition.  Antipsychotics require CMP analysis to monitor the effects of medication on liver function and glucose levels. Electrolytes Sodium (Na+): 136-145 mEq/L Postassium (K+): 3.5-5.0 mEq/L Chloride (Cl-): 95-105 mEq/L Bicarbonate (HCO3-): 22-28 mEq/L Miscellaneous Calcium, serum (Ca 2+) 8.4-10.2 mg/dl Glucose, serum Fasting: 70-110 mg/dl; 2-h postprandial: <120mg/dl Cholesterol, serum: REC<200 mg/dl Total Protein 6.0-7.8 g/dl Albumin 3.5-5.5 g/dl Kidney Tests Creatinine, serum 0.6-1.2mg/dl Urea nitrogen, serum (BUN) 7-18mg/dl Liver Tests Alanine aminotransferase (ALT), serum: 8-20 U/L Aspartate aminotransferase (AST), serum: 8-20 U/L Bilirubin, serum (adult) Total//Direct: 0.1-1.0 mg/dl // 0.0-0.3 mg/dl Phosphatase (alkaline), serum: 20-70 U/L Thyroid Function Tests – Used to rule out thyroid disorders as a cause for symptoms. Common symptoms related to thyroid disorders include anxiety, Downloaded by Studymerit Dotcom (samuelkaruiki40@gmail.com) lOMoARcPSD|6879242

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restlessness, depression, mood swings, sleeping difficulties, difficulties with concentration, short-term memory lapses, and lack of mental alertness. TSH: 0.4-4.5 mIU/L T3: 100-200 ng/dL T4: 5-11 ug/dL Vitamin B12 - Used to confirm vitamin B12 deficiency as it can affect mood and other brain functions. Common psychiatric symptoms associated with B12 deficiency include depression, mania, psychotic symptoms, and cognitive impairment. 190-950 picograms/mL.  Between 200-300/mL indicates a borderline level with a possible need for additional testing. Vitamin D Level – Vitamin D affects functions such as neurotransmission, neuroprotection, and neuroimmunomodulation. Studies have indicated a high prevalence of vitamin D deficiency in clients with psychiatric disorders such as schizophrenia, depression, seasonal affective disorder, and cognitive impairment. Symptoms of vitamin D deficiency include depression, irritability, anxiety, psychosis, and poor brain development. 20-50 ng/mL. A level less than 12 ng/mL indicates a deficiency.  A vitamin D level can be measured via the 25-hydroxy vitamin D blood test. Toxicology Screen – Used to rule out substance use as a cause for symptoms. Toxicology screenings are also used before starting therapy involving controlled substances, to monitor medication adherence, and in the diagnosis of substance use disorder. Urinalysis – Urinary tract infections are associated with a variety of neuropsychiatric symptoms. When clients present with acute mental status changes, a urinalysis may be used to rule out a urinary tract infection as the cause. Symptom-Directed Treatment Many psychiatric diagnoses share common symptoms, and psychiatric medications are often effective for a variety of symptoms. Psychiatric medication is generally prescribed in a transdiagnostic manner in which symptoms rather than diagnoses guide clinical practice. One caveat associated with symptom-directed treatment involves insurance coverage. Some insurance companies may deny coverage or require prior authorizations for use of certain medications. Providers must be able to present clear rationale for why a specific medication is the best treatment when completing prior authorizations, especially when authorizations require peer to peer review. Downloaded by Studymerit Dotcom (samuelkaruiki40@gmail.com) lOMoARcPSD|6879242

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Social Determinants of Health (SDOH) Social and structural factors have a significant impact on health, quality of life, and life expectancy in relation to mental health. Social and environmental factors can influence genetic determinants of health and illness and affect the risk for mental illness and substance use disorders. SDOH impedes access to care. To effectively address SDOH, changes must be made at both the individual level and at the societal level through adjustments in public policy and social norms. The effects of some SDOH may be modifiable with targeted, evidence-based interventions at the individual and population levels. Psychiatric mental health nurse practitioners (PMHNPs) have a duty to address SDOH to improve the quality of life and health outcomes of clients.  Discrimination, racism, social exclusion, adverse early life experiences, poor education, unemployment, underemployment, job insecurity, poverty, neighborhood deprivation, food insecurity, poor housing quality and housing instability Generalized Anxiety Disorder (GAD) – Characterized by persistent, uncontrollable worry about ordinary everyday situations for at least six months and has three specific symptoms. In addition to worrying, common symptoms of anxiety include restlessness, irritability, difficulty concentrating, muscle tension, fatigue, and sleep disturbances. Patients with anxiety disorders often show increased activation of the amygdala and decreased activation in the prefrontal cortex . Positron emission tomography (PET) scans have also shown reduced serotonin binding in patients with anxiety. Risk factors for developing anxiety include genetic predisposition, being female, recent life stressors, chronic physical illness, and lack of support during childhood. Treatment:  Anxiolytics (buspirone) in 3 divided doses per day. Used as an adjunct to SSRIs/SNRIs  SSRIs/SNRIs (escitalopram, paroxetine, duloxetine, venlafaxine)  Benzodiazepines (alprazolam, clonazepam, lorazepam) – Immediate relief – PRN use  Antihistamines (hydroxyzine) is used as an alternative to benzodiazepines Alogia – Short answers, using few words to communicate Avolition – Lack of initiative, withdrawal from work/school Anosognosia – Functional inability to recognize illness Affective flattening – Lack of emotional response to given situation Downloaded by Studymerit Dotcom (samuelkaruiki40@gmail.com) lOMoARcPSD|6879242

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