Mental Health Final Exam | Mental Health Final Exam complete with correct answers

Finals 1. Conduct Disorder (Cruelty to Animals) Demonstrate a persistent pattern of behavior that violates the rights of others or rules/norms of society. In simpler words… CONDUCT DISORDER = BREAKS LAWS!  MAKE SURE THEY ARE AWARE OF THE RULES OF THE UNIT AND ANY CONSEQUENCES OF VIOLATING THOSE RULES Categories include: *Assess Aggression towards people & animals *Destruction property *Deceitfulness or theft *Serious violation of rules 2. Alcohol Abuse It declines as you age! 3. A nurse is caring for a client with bipolar disorder. Client comes to the nurses’ station at 3 am asking the nurse to call the doctor. Which response is the most appropriate? a. You are being unreasonable b. Go back to your room & I will get in touch later c. I can’t call the doctor until later unless it’s an emergency d. You seem upset, can I help you? 4. Benztropine (Cogentin) Why is it given? *To treat Parkinson disease and also to control tremors and stiffness of the muscles due to antipsychotic medications (antipsychotics 1st-gen) Treats EPS symptoms: (usually the 1st choice – can be given PPX *Acute dystonia- severe spasm of the tongue, neck, face, & back (crisis) *Parkinsonism- bradykinesia, rigidity, shuffling gait, tremors, drooling *Akathisia- inability to sit/stand still & continual pacing & agitation. *Tardive dyskinesia- late EPS, involuntary movement of tongue & face, such as lip smacking & tongue fasciculation, involuntary movement of arms, legs, & trunk. 5. A client is sleepwalking. The nurse should include following discharge (SATA) a. Clutter free b. Sleep on the ground floor c. Lock doors & windows d. Alarm on bed e. Hide car keyscDO NOT rearrange furniture 6. A client fell & had an abrasion on the forehead. Who can write an incident report/variance report? Anyone who actually SAW the incident can write it (NOT he said, she said): *CNA, LVN, or RN the person who witnessed the fall (cosigned by the RN) 7. S/S of Acute Grief Grief is the inner emotional response to loss & is exhibited in as many ways as there are individuals. Emotional S/S: anger, restlessness, resentment, withdrawal, hopelessness, & guilt Somatic S/S: chest pain (tightness), palpitations, headaches, nausea, changes in sleep, fatigue 8. S/S of ADHD Inability of a person to control behaviors requiring sustained attention S/S: impulsive, hyperactive, inattention, & not able to focus well 9. Erikson’s Stages of Development Trust vs. Mistrust (Infancy 0-1½ years) *Forming attachment to mother, which lays foundation for later trust in others. Autonomy vs. Shame & Doubt (Early Childhood 1½-3 years) *Gaining some basic control of self & environment (toilet training, exploration) Initiative vs. Guilt (Preschool 3-6 years) *Becoming purposeful & directive Industry vs. Inferiority (School Age 6-12 years) *Developing social, physical, & school skills Identity vs. Role Confusion (Adolescence 12-20 years) *Making transition from childhood to adulthood; developing sense of identity Intimacy vs. Isolation (Early Adulthood 20-25 years) *Establishing intimate bonds of love & friendship Generativity vs. Self-Absorption (Middle Adulthood 35-65 years) *Fulfilling life goals that involve family, career, & society; developing concerns that embrace future generations Integrity vs. Despair (Later Years 65 years-death) *Looking back over one’s life & accepting its meaning 10. Ziprasidone (Geodon) 40 mg b.i.d. Is it a safe dose? – YES! 11. Antipsychotic 2nd-gen (Atypical) The medication affects both dopamine & serotonin, so it can be used for clients who have concurrent depression. **It has a low risk of EPS, diabetes, weight gain, & dyslipidemia Therapeutic Range: *Oral: 100 mg MAX per day (although greater than 80 mg is not recommended) *IM: 40 mg MAX per day 12. Clozapine (Clozaril) 13. Antipsychotic 2nd-gen (Atypical) WBC count: 5,000-10,000 Absolute neutrophil count: 2,000+ AgranulocytosisIf it is increased, what do you do? a. Hold the medication; infectious process – take vitals – assess for fever 14. A young female has experienced partner violence. The client is most likely at risk for the following findings: Self-esteem disturbances 15. Denial 16. A LOT of alcoholics/substance users use this defense mechanism! Pretending the truth is not reality to manage the anxiety of acknowledging what is real. Example: * You have a nurse who is abusing alcohol. She is questioned by her supervisor. *A parent who is informed that his son was killed in combat tells everyone he is coming home for the holidays. *A man reacts to the death of a loved one by saying, “No, I don’t believe you,” to initially protect himself from the overwhelming news. * A woman whose husband died 3 years earlier still keeps his clothes in the closet & talks about him in present tense 17. Projection Blaming others for unacceptable thoughts & feelings Example: *A young adult blames his substance use disorder on his parents’ refusal to buy him a new car. *A woman who has a repressed an attraction toward other women refuses to socialize. She fears another woman will make homosexual advances toward her. 18. Rationalization Creating reasonable & acceptable explanations for unacceptable behavior Example: *A young adult explains he had to drive home from a party after drinking alcohol because he had to feed his dog. *An employee says, “I didn’t get a raise because the boss doesn’t like me.” *A man who thinks his son was fathered by another man excuses his malicious treatment of the boy y saying, “He is lazy & disobedient,” when that is not the case. 19. Oppositional Defiant Disorder Usually… *Aggressive to others *Vindictive Nursing Diagnosis: Risk for Violence This disorder is characterized by a recurrent pattern of the following antisocial behaviors: *Negativity *Disobedience *Hostility *Defiant behaviors (toward authority) *Stubbornness *Argumentativeness *Limit testing *Unwilling to compromise *Refusal to accept responsibility for misbehavior -Misbehavior is seen at home toward the best known person (mom or dad) -Children who have this disorder DO NOT see themselves as defiant & view their behavior as a response to unreasonable demands -Have low-self esteem, mood lability, & low frustration threshold. **ODD can develop into Conduct Disorder**20. Anorexia Nervosa- treatment plan A nurse observes a client admitted with anorexia nervosa because of rigorous sit-ups & running on patio. What is the priority intervention by the nurse? a. Don’t want to take away the client’s privileges b. Don’t want them to complete the exercise routine c. Talk to the client & you can walk w/the client & talk Do you stop them from doing cardio? No, because their anxiety will increase. You do not tell them to stop. You are basically helping them tone down the exercise when you ask them to walk with you and teach/explain why you are doing this 21. A patient is taking Adderall XR 10 mg. What is the duration? Duration: -Adderall (short-acting): 3-4 hours -Adderall XR (long-acting): 8-12 hours 22. Sleep Disorders: A patient tells a nurse he has not slept well in a year, has never felt good, & doesn’t expect things to improve. Which of the following interventions would the nurse consider (SATA): a. Provide instruction on relaxation techniques before bedtime b. Helps teach factors that influence sleep c. Sleep & wake up around the same time each day, even when days odd 23. Can you have an order for restraints as PRN? NEVER! 24. A patient has insomnia & uses OTC Benadryl. What are the S/E of Benadryl? (SATA) *Urinary retention *Blurred vision *Dry mouth 25. Narcotics for Pain -Morphine -Hydromorphone (Dilaudid) -Hydrocodone (Vicodin) -Codeine REMEMBER: *They must be given on a schedule *They can’t be given early *This is due to safety ANTIDOTE: naloxone (Narcan) 26. If a patient comes to the ER w/constricted pupils, slurred speech, drowsiness, & RR of 8, what should the nurse give the patient? Naloxone (Narcan) IM It reverses the effects of opioids such as respiratory depression, sedation, & hypotension 27. Narcolepsy: Treatment A chronic sleep disorder that causes overwhelming daytime drowsiness. **Make sure they maintain regular sleep and wake cycle** a. Modafinil (Provigil)- see below b. Flurazepam (Dalmane)- treats insomnia c. Clonazepam (Klonopin)- used for anxiety - Encourage short naps, Do not stay up all day, No heavy meals before bedtime, Avoid exercise 4 hours before bedtime Medication: Modafinil (Provigil) *Improves daytime wakefulness in people with uncontrollable sleepiness caused by narcolepsy or sleep apnea. *A/E: anorexia, anxiety, dry mouth, headache, insomnia, nervousness, Stevens-Johnson syndrome 28. You have an 88 y/o female. What stage according to Erikson’s should she be in? Integrity vs. Despair (65+) 29. Can a nurse accept money from a NOpatient? What’s the best response? “I’m here to take care of you, I can’t take money from you.” 30. Priority nursing intervention for Schizoid/Paranoid Personality Disorder They need a lot of isolation. Allow isolation for the patients. Characterized by distrust and suspiciousness; emotional detachment, disinterest… 31. An individual w/borderline personality disorder: Need someone to help them. They are very dependent on them. Characterized by instability of affect, identity, & relationships, as well as splitting behaviors, manipulation, impulsiveness, & fear of abandonment; often tries self-injury & may be suicidal. 32. Bulimia Nervosa Monitor this client during meals and at least 1 hour after meals to binge. -Do not let them go back into their rooms depending on their treatment program. 33. A patient with anorexia nervosa, which objective data will the nurse find? Osteoporosis; decreased bone density 34. Lorazepam (Ativan) Chlordiazepoxide (Librium) Clonazepam (Klonopin) Flunazepam (Dalamane) 35. Benzodiazepine Sedative Hypnotic Anxiolytics (Anxiety Meds) 36. A patient has been admitted to the ER who is diaphoretic & has hand tremors. Last time patient abused alcohol was at 1400. What medication should the nurse anticipate the doctor to order? *Lorazepam (Ativan)- used to treat anxiety (IV use) *Chlordiazepoxide (Librium)- used to treat anxiety & symptoms of alcohol withdrawal * Dalamane is used for sleep. It’s a long acting hypnotic that will produce hangover drowsiness during the next day. Adverse Effects: -CNS depression (sedation, light-headedness, ataxia, & decreased cognitive function) -Anterograde amnesia (difficulty recalling events that occur after dosing) -Acute toxicity *Oral: drowsiness, lethargy, confusion *IV (Ativan): respiratory depression, severe hypotension, cardiac arrest -Paradoxical response (insomnia, excitation, euphoria, anxiety, rage) -Withdrawal effects (anxiety, insomnia, diaphoresis, tremors, lightheadedness) Medication/Food Interactions: -CNS depressants (alcohol, barbiturates, & opioids) can cause respiratory depression. Ativan 2 mg & Librium 50 mg37. Richmond Agitation-Sedation Scale (RASS) A medical scale used to measure the agitation or sedation level of a patient. 38. Clinical Institute Withdrawal Assessment for Alcohol (CIWA) A ten item scale used in the assessment & management of alcohol withdrawal MAX points possible: 67 (severe) Mild alcohol withdrawal: 15 Moderate alcohol withdrawal: 16-20 Severe alcohol withdrawal: 20 39. A high school reports a student’s challenging behavior in the classroom to the school nurse. The diagnosis is Oppositional Defiant Disorder. What type of behavior would this patient demonstrate? a. Looking to blame others b. Mean and nasty 40. With anorexia nervosa, which complication do you expect to find? Low bone density41. A patient is taking Chlorpromazine (Thorazine). What priority intervention should they discuss? Antipsychotic 1st-gen (Conventional) a. Sip water (patients tend to get a dry mouth) b. Chew sugarless gum More client education… -Wearing sunglasses when outdoors -Eating foods high in fiber -Maintaining fluid intake of 2-3 L/day -Voiding just before taking medication 42. A patient asks the nurse what the major difference is between conventional medicine & alternative medicine. What is the nurse’s best response? Conventional medicine helps heal the body through medications & procedures. Alternative medicine is the healing & interaction of the body & mind. 43. Kübler-Ross: 5 Stages of Grief 1. Denial: The client has difficulty believing a terminal diagnosis or loss 2. Anger: Anger is directed toward self, others, or objects 3. Bargaining- The client negotiates for more time or a cure 4. Depression- The client mourns & directly confronts feelings related to the loss 5. Acceptance- The client accepts what is happening & plans for the future. Question does not mention acceptance 44. Priority nursing diagnosis for a patient w/anorexia? Impaired nutrition less than body requirements 45. S/S of Acute Alcohol Withdrawal: a. Increased HR, BP b. Confusion c. Disorientation 46. Normal Lithium level *Early 1.5-2: thirst, polyuria, muscle weakness, fine hand tremors, slurred speech, N/V *Advanced Indications (1.5-2.0): mental confusion, poor coordination, coarse tremors, ongoing GI distress (N/V/D) *Severe Toxicity (2.0-2.5): extreme polyuria, tinnitus, ataxia, seizures, severe hypotension, respiratory complications *(2.5): rapid progression of S/S leading to death Acute stabilization levels: 0.8 – 1.4 Maintenance levels: 0.4 – 1.0 Teaching: Lithium (Eskalith / Lithobid) 1. Mood stabilizer 2. It is a naturally occurring salt 3. DO NOT GIVE LOW SALT or NO SALT DIET  Give REGULAR DIET / no dietary restrictions. If on low salt diet it can increases risk for lithium toxicity 4. Pt can tolerate it and be on it long term and suddenly be toxic 5. Avoid NSAIDS – use ASA instead 6. Works within 7 – 14 days 7. Know blood levels, must be taken routinely a. 1st blood draw – before giving meds b. 2nd blood draw – 12 hours after giving meds c. LABS i. BUN / CR ii. T3, T4, TSH, BNP 8. Causes of Lithium Toxicity a. Change in salt intake / must maintain regular diet b. Fasting – ask them if they belong to a religion that requires fasting on certain days 9. Teaching a. Maintain regular diet b. No fasting c. No laxativesd. Inform MD if diarrhea is present 10. Long-term Risks a. Hypothyroidism b. Impairment of kidney’s ability to concentrate urine 47. A patient will have ECT. What is usually one of the teachings to the patient prior to beginning therapy? Short-term memory loss after ECT. 1. For severe bipolar / depression 2. Usually on pts who have attempted suicide several times and no meds have worked for them 3. Nursing Interventions: a. PRE-OP: i. NPO at midnight or at least 4 – 6 hours before ii. Teach about short term memory loss iii. Teach about procedure iv. Will be given mild muscle relaxant and mild anesthetic v. Teaching about nausea and headache after procedure vi. Tylenol ordered b. DAY OF: i. Given Atropine sulfate to decrease secretions (prevent aspiration), anesthesia (methohexital (Brevita or propofol) and muscle relaxant succinylcholine (Anectine) i. Get consent signed ii. Obtain baseline VS c. POST-OP: i. Orient to time and place ii. Common response is fear iii. Maintain VS and make sure they’re stable iv. Stay by bedside don’t let client get out of bed on their own v. Return of gag reflex – if they’re able to swallow vi. Offer food and fluids when they wake up vii. Memory will return within 4 – 6 hours viii. Family teaching 4. Side Effects: a. Short term memory loss – won’t remember where they are  reorient b. Headache – will give Tylenol 5. Client are NOT intubated / have mouth guard and ambu-bag 6. Safety and reorientation – priority when they wake up 7. 10 – 12 or 10 – 14 treatments / once a week or twice a week 8. Contraindication – cardiac issues 48. A patient w/antisocial personality disorder is smoking in the bathroom. What nursing intervention is appropriate? Confront the patient about behavior. Be straightforward. Definition: Characterized by disregard for others w/exploitation, repeated unlawful actions, deceit, & failure to accept personal responsibility 49. A patient is DNR. What would be appropriate if the patient goes into cardiac arrest? DNR= Do Not Resuscitate *Manage pain control or comfort care 50. S/S of Thiamine Deficiency: Caused by alcoholism a. Muscle weakness b. Short-term memory lossMyopathy of the ocular muscles, confusion, ataxia, temporary short memory loss, somnolence - if this deficiency continues, the patient gets fatigues, sleepy, and can go into a stupor Korsakoff syndrome (dementia, ataxia, ocular changes, confabulation) 51. A client who is alcohol dependent has thiamine deficiency. Which of the following presenting S/S caused by this deficiency is most life threatening? a. Ataxia b. Stupor c. Somnolence 52. A dementia patient who is wandering around the unit keeps asking when is the bus coming. The priority nursing intervention is: a. Offer distractions to decrease anxiety b. Allow participation in self-care activities c. Reorient the patient to time, place, & situation to reduce confusion 53. Conduct Disorder for Adolescent: Dx: Ineffective coping R/T parental neglect 54. Which short-term outcome is appropriate for this patient’s diagnosis? Verbalizing understanding of the rules/regulations on the hospital unit & consequences of violations of the rules *You have to remember they always looking to blame it on someone else! 55. Any type of patient w/borderline personality disorders have frequent self-inflicted behaviors. What is the nurse’s priority? Remember ADPIE! ASSESS the patient to see if they have any self-inflicted type of behaviors 56. You have a patient who has schizophrenia & the nurse is going to discharge him from the acute psychiatric unit. The patient tells the nurse, “I’m only taking this medication so I can be discharged. As soon as I leave, I won’t be taking them.” What is the most therapeutic response? “It sounds as if you have concerns about taking your medications.” 57. Donepezil (Aricept) Other drugs: a. Cognex b. Aricept c. Namenda d. Exelon Use: Slows down the progression of cognitive disorder, it does not cure. A/E: *Nausea & diarrhea (10% of clients) *Bradycardia Contraindication: Pre-existing asthma or other obstructive pulmonary disorders Medication/Food Interactions: *Concurrent use of NSAIDs- causes GI bleeding *Antihistamines, TCAs, conventional antipsychotics- reduce therapeutic effect Take 3 – 6 months after giving them the medication ( anticholinesteraseInterventions: a. Safety – HIGHEST PRIORITY !! b. High door locks c. No rugs d. Well lit environment e. Sleep light at night f. Bed as low as possible g. Close to nurse’s station h. Medi alert bracelet or necklace ( name, contact info ) / no cards or wallets i. Notify neighbors j. Constant reorientation k. Nutrition – 2nd HIGHEST PRIORITY l. Disabled and cannot get out of bed – put 2 side rails up / never put all 4 side rails up because it’s considered as restraints 58. Namenda For moderate to severe dementia Check liver enzymes 59. Methylphenidate (Daytrana) transdermal patch What diagnosis is it used for? ADHD When do you remove the patch? After 9 hours 60. A patient had a total knee replacement & is on Coumadin. What substance should the nurse ask the patient to avoid? Ginkgo Biloba Why? It increases bleeding! 61. A nurse is collecting data during admission assessment for this unit. A patient is using alternative medicine & OTC. Why does the nurse need to collect data on the OTC? The health care team needs to know what medications you’re taking to help give you the proper treatment. 62. A child w/Oppositional Defiant Disorder is in a group. He’s screaming, yelling, & hollering. He is asked by the group leader to kindly leave the group. He uses profanity. What’s the best intervention? Take the child to a private room to decrease external stimuli REMEMBER: Children/Adolescents diagnosed w/ODD are at risk for violence due to poor impulse control!! 63. What happens to a person who is constantly binging? What’s the best nursing intervention? a. Dental erosion- the acid from emesis breaks down teeth enamel b. High potential for heart arrhythmias 64. A patient is taking Lamotrigine (Lamictal) 25 mg Mood Stabilizing Antiepileptic Drugs A/E: Stevens-Johnson Syndrome (rashes all over the body) What do you do? STOP IMMEDIATELY 65. A client tells the nurse, “ I refuse to take any psychiatric medications or else I’ll die.” This is an example of what symptom? This is an example of a positive symptom in Schizophrenia called persecutory delusion (believing something that is NOT true) 66. A patient is in the ER, status post cutting his arm through suicide attempt. The patient had IV Administer the first scheduled dose of oral antibiotics. Other tasks to delegate to LVN:antibiotics & is going to be discharged home w/oral antibiotics. Which can you delegate to the LVN?  PO meds  NO discharge planning  NO teaching  CANNOT admit a pt 67. A CNA called in sick. There is a patient who is violent, confused, and psychotic. The CNA places the patient in seclusion due to staffing shortage. This is an example of which violation of the patient’s rights? False Imprisonment 68. A patient moved to China a few years ago. What is the most appropriate question to ask? “Do you speak English & do you need a translator? 69. A patient who is bipolar is in an acute manic phase. What do you recommend the patient to do? Exercise in the patio 70. A nurse is in the working phase in a therapeutic relationship. The client has a gambling addiction. Which indicated transference behavior? The client clings to the nurse for reassurance & support Transference occurs when the client views a member of the health care team as having characteristics of another person who has been significant to the client’s personal life. 71. For a patient w/primary insomnia, the treatment plan should include: Wake up & sleep on a consistent time. No naps a. Exercise several hours before b. Do not eat a large meal before bedtime c. Decrease stimuli – stop conversations, dim lights, soft music, no TV d. Establish a nighttime routine – sleep and wake up at the same time everyday e. Non-pharmacological sleep enhancers i. Warm milk ii. Chamomile tea iii. Warm bath before bedtime 2. Insomnia a. No naps during the day b. Primary Insomnia i. Medication of choice – Benadryl ( OTC ) / Melatonin 1. Side Effects a. Anticholinergic effects i. Dry mouth ii. Blurred vision iii. Urinary retention iv. Constipation v. Lightheadedness vi. Photophobia vii. Tachycardia Interventions - Quiet room - Start turning everything off 30 mins before sleeping - Go to bed at the same time and get up at the same time - Warm bath or shower - Do not encourage active exercise before bed / Stretching or Yoga is ok- Milk, No alcohol - Aroma therapy – Lavender or Chamomile 72. Haloperidol (Haldol) Fluphenazine (Prolixin) Antipsychotics 1st-gen (Conventional) For Chlorpromazine (Thorazine) remember… *If you go outside, you need to use SPF, wear long sleeves, glasses, and hat. *Gets dry mouth? Give sips of water & chew sugarless gum/candy It blocks dopamine, acetylcholine, histamine & NE receptors in the brain & periphery Conventional antipsychotic – high potency - High incidence of EPS - Lower incidence of sedation & anticholinergic effects - Weight gain - Available in elixir and IM Use: acute/chronic disorders, schizophrenia, bipolar disorder (manic), Tourette’s, & prevention of N/V. Complications: *Agranulocytosis *Anticholinergic effects (dry mouth, photophobia, constipation, tachycardia, blurred vision, urinary retention) *Extrapyramidal Symptoms (EPS)- spasms, rigidity, involuntary movements *Neuroendocrine effects (menstrual irregularities, gynecomastia) *Neuroleptic Malignant Syndrome (high fever, BP fluctuations, muscle rigidity) *Orthostatic hypotension *Sedation *Seizures *Severe Dysrhythmias *Sexual Dysfunction *Skin effects (photosensitivity, contact dermatitis) Contraindications: coma, severe depression, Parkinson’s, severe hypotension, and dementia. Use CAUTIOUSLY in patient’s w/glaucoma, paralytic ileus, prostate enlargement, heart disorders, liver/kidney disease, & seizure disorders Medication/Food Interactions: *Anticholinergic effects- will decrease effects *CNS depressants- additive CNS effects w/opioids, alcohol, & antihistamines *Levodopa- counteracts effects of antipsychotic agents 73. Clozapine (Clozaril) Antipsychotics 2nd-gen (Atypical) For Ziprasidone (Geodon) remember… *Monitor EKG (ECG changes & QT prolongation may lead to torsades de pointes which can lead to death) and GIVE WITH MEALS: (at least 300calories) Work mainly by blocking serotonin receptors, & to a lesser degree, dopamine receptors. Also blocks receptors for NE, histamine, & acetylcholine Use: +/- symptoms of schizophrenia, psychosis, relief of psychotic manifestations Complications: *Weight gain, diabetes, & dyslipidemia *Risk for fatal agranulocytosis (ALWAYS GET WBC COUNT!!) (weekly for 1st 6 months) *Sedation*Orthostatic hypotension *Anticholinergic effects * Decreased seizure threshold * Hyper-salivation * Sedation * Increased risk for metabolic syndrome Medication/Food Interactions: *Immunosuppressive medications- further suppress immune function *CNS depressants- additive CNS effects w/opioids, alcohol, & antihistamines *Levodopa- counteracts effects of antipsychotic agents *TCA’s- prolong QT interval, increasing risk of cardiac dysrhythmias 74. What can you delegate to a CNA? V/S, I/O, & doing rounds on the unit, ADLs, feeding 75. Lamotrigine (Lamictal) Mood Stabilizing Antiepileptic Drugs (AEDs) Use: manic & depressive episodes as well as to prevent relapse, mixed mania, rapid cycling bipolar disorders. NOT FOR ACUTE MANIA Complications: *Double blurred vision, dizziness, headache, N/V *Stevens-Johnson syndrome * SJS – report rashes to MD !!  stop med and call MD !! (Rashes sometimes on face, back, torso; Blisters on lips or inside mouth / cold sores) Medication/Food Interactions: *Carbamazepine (Tegretol), phenytoin, phenobarbital- decreases effect of Lamictal *Valproic acid (Depakote)- increases half-life of Lamictal *Oral contraceptives- decreases the effectiveness 76. Aripiprazole (Abilify) Antipsychotics 2nd-gen (Atypical) Work mainly by blocking serotonin receptors, & to a lesser degree, dopamine receptors. Also blocks receptors for NE, histamine, & acetylcholine. HAS MINIMAL SEDATION AND HIGHER RISK FOR WEIGHT GAIN. Use: +/- symptoms of schizophrenia, psychosis, relief of psychotic manifestations Complications: headache, sedation, anxiety, insomnia, GI upset S/E: INSOMNIA AND AKATHISIA Medication/Food Interactions: *Immunosuppressive medications- further suppress immune function *CNS depressants- additive CNS effects w/opioids, alcohol, & antihistamines *Levodopa- counteracts effects of antipsychotic agents *TCA’s- prolong QT interval, increasing risk of cardiac dysrhythmias *Barbiturates & phenytoin (Dilantin)- decrease drug levels *Fluconazole (Diflucan)- increases drug levels 77. Amphetamine mixture (Adderall XR) Duration: 8-12 hrs (long acting) Raises the levels of NE, serotonin, & dopamine into the CNS Use: ADHD, conduct disorderAdderall: 3-4 hours Adderall SR: 4-8 hours CNS Stimulants Complications: *CNS stimulation (insomnia, restlessness) *Weight loss *CV effects (dysrhythmias, chest pain, high BP)- can cause sudden death *Development of psychotic manifestations (hallucinations, paranoia) *Withdrawal reaction Contraindications: history of substance use, CV disorders, severe anxiety, psychosis Medication/Food Interactions: *MAOIs- cause hypertensive crisis *Caffeine- increase in CNS stimulant effects *Dilantin & Coumadin- increased serum levels *OTC cold/decongestant medications- increased CNS stimulation 78. Vagus Nerve Stimulation (VNS) -Depression -Anxiety S/E: neck pain, difficulty breathing, voice changes, & difficulty swallowing *VNS provides electrical stimulation through the vagus nerve to the brain through a device that is surgically implanted under the skin on the client’s chest VNS Device Nursing Teaching: *It is performed as an outpatient surgical procedure *VNS device delivers ATC programmed pulsations *Client can turn off VNS device at any time by placing a special external magnet over the site of implant. 1. Implanted to pt’s chest to stimulate vagus nerve 2. For depressive pts who do not react to medications or ECT 3. Complications a. Hoarseness b. Voice changes c. Throat or neck pain d. Dysphagia ( usually improve over time ) Dyspnea especially with exertion ( relieved by exercise 79. Diphenhydramine (Benadryl) Antihistamine Blocks the effects of the naturally occurring chemical histamine in the body. Use: allergies, suppress coughs, motion sickness, induce sleep, mild forms of Parkinson’s disease S/E: *CNS depression (sedation, dizziness) *Dystonic reactions (confusion, rigidity, lip/tongue protrusion) *Hypersensitivity *GI effects (nausea, dry mouth) *Hypotension *Tachycardia *Palpitations *Blurred vision *Urinary retention, dysuria Contraindications: Use CAUTIOUSLY in asthma/COPD, CV disease, renal/liver disease Medication/Food Interactions: *MAOI- increase S/E *Alcohol- increase drowsiness & dizziness80. Naloxone (Narcan) Blocks/reverses the effects of opioid medication (extreme drowsiness, respiratory depression, loss of consciousness) Use: treats narcotic OD S/E: *Hypotension/hypertension *Atrial/ventricular tachycardia *Pulmonary edema *Seizures *N/V Contraindications: Heart disease Medication/Food Interactions: *Alcohol 81. Diazepam (Valium) Enhances inhibitory effects of GABA in CNS Use: GAD, panic disorder, seizures, insomnia, muscle spasms, alcohol withdrawal Complications: *CNS depression (sedation, light-headed, ataxia, decreased cognitive function) *Anterograde amnesia- difficulty recalling events after dosing *Oral toxicity (drowsiness, lethargy, confusion) *IV toxicity (respiratory depression, severe hypotension, cardiac arrest) *Paradoxical response (insomnia, excitation, euphoria, anxiety, rage) *Withdrawal effects (anxiety, insomnia, diaphoresis, tremors, lightheadedness) Contraindications: sleep apnea, respiratory depression, glaucoma, liver disease, substance use disorders Medication/Food Interactions: *CNS depressants (alcohol, barbiturates, opioids) 82. Methadone (Dolophine) Substitution Opioid/Narcotic Use: Reduces withdrawal symptoms in people addicted to heroin, a pain reliever, & drug addiction detoxification/maintenance programs. Oral opioid agonist - Replaces the opioid addiction - Prevents abstinence syndrome - Encourage pt to participate in a 12-step program S/E: *QT prolongation *Constipation *N/V *Respiratory depression *Light-headedness *Dizziness *Sedation *Diaphoresis Contraindications: severe asthma, paralytic ileusMedication/Food Interactions: *Alcohol- increase S/E *Grapefruit juice- increases the blood levels & effects of methadone *Antipsychotics- irregular heart rhythm *Bupropion (Wellbutrin)- causes seizures *NSRIs- irregular heart rhythm *MAOIs- respiratory depression 83. Normal Lab Values: Potassium 3.5-5.0 84. Cognitive Behavior Model: Beck & Ellis 85. What is a cognitive-behavioral model? It is a talk therapy that focuses on feelings, thoughts, & behaviors. It is based on the idea that if we change our thoughts, then we can change the way we experience life eliminating self-destructive behavior. Aaron Beck- became convinced that people/depression generally had stereotypical patterns of negative & self-critical thinking that seemed to distort their ability to think and process info. Focuses on substituting irrational beliefs and eliminating self-defeating behaviors Cognitive-Behavioral Therapy (CBT)- active, directive, time-limited, structured approach used to treat a variety of psych disorders. --Behaviors are largely determined by the way people think about the world & their place in it & cognitions are based on attitudes/assumptions developed from previous experiences. Albert Ellis- Rational-Emotive Behavior Therapy (REBT) --Aim: Eradicate core irrational beliefs by helping people recognize thoughts that aren’t accurate, sensible, or useful (take the form of should, ought, & must) Negative thinking is an A-B-C process… A B C Activating Event --------------- Beliefs -------------- Emotional Consequence 86. Tranylcypromine (Parnate) Phenelzine (Nardil) Isocarboxazid (Marplan) Selegiline (EMSAM) Monoamine Oxidase Inhibitors (MAOIs) Block MAO in the brain increasing the amount of NE, dopamine, & serotonin available for transmission of impulses Use: Depression, bulimia nervosa Complications: *CNS stimulation (anxiety, agitation, hypomania, mania) *Orthostatic hypotension *Hypertensive crisis from tyramine intake *Local rash Contraindications: SSRIs, pheochromocytoma, heart failure, CV & cerebral vascular disease, severe renal insufficiency. Medication/Food Interactions: *Indirect-acting sympathomimetic medications- hypertensive crisis *TCAs- hypertensive crisis *SSRIs- serotonin syndrome *Antihypertensives- additive hypotensive effects *Meperidine (Demerol)- hyperpyrexia *Intake of dietary tyramine (aged cheese, pepperoni, salami,avocados, figs, bananas, smoked fish, protein, dietary supplements, some beers, red wine) *Vasopressors- hypertension Food: Aged cheese – over 60 days Blue, Camembert, Cheddar, Parmesan, Provolone, Romano, Stilton, Swiss; Alcoholic Beverages (Beer, Cognac, Liqueurs, Red wine, Sherry); Fish, (Caviar, Shrimp paste, Fermented, Aged, cured or dried, Smoke / LOX – smoked salmon, Pickled); Fruits (Bananas, Fig, Raisins, Prunes); Preserved meats (Beef or chicken liver, Corned beef, Smoked and processed meats ( bacon, salami, pepperoni, bologna )); Vegetables (Avocados, Chinese pea pods, Fava beans, Fermented bean curd, Olives, Flat Italian beans, Sauerkraut, Pickles, Soybean paste); Other sources (Beverages with caffeine, Cheese-filled desserts, MSG, Protein Supplements); Medications (Vasopressors – Pseudoephedrine / Dextrometorphan, TCAs, SSRIs - Pts will develop hypertensive crisis i. Elevated or labile BP ii. Elevated HR iii. General confusion iv. Seizure v. Headache vi. Monitor BP and avoid tyramine containing foods vii. Hold meds viii. If client has eaten and you see this reaction, it’s a medical emergency b. Contraindicated in: i. Concurrent use of other antidepressants ii. Sympathomimetic drugs iii. Oral decongestants (Sudafed) / anti cold / antihistamine / anti flu iv. 87. Displacement Shifting feeling related to an object, person, or situation to another less threatening object, person, or situation Examples: *A person who is angry about losing his job destroys his child’s favorite toy *A child yells at his teddy bear after being picked on by a school bully. *A child who is unable to acknowledge fear of his father becomes fearful of animals 88. What drink can you give a patient who is experiencing sleep deprivation? Lemon Lime Soda & NO caffeine 89. Last month a patient lost her mother to breast cancer. Which actions show she is experiencing inhibited grief? When she continues to go about her day-to-day activities, making it look like she is not affected. 90. Signs of a patient diagnosed w/ Narcissistic Personality Disorder *Grandiose *Feel as though they have a sense of entitlement 91. Personality Disorders Cluster A (Odd/Eccentric Traits) *Paranoid: Distrust & suspiciousness toward others based on unfounded beliefs that others want to harm, exploit, or deceive that person. *Schizoid: Emotional detachment, disinterest in close relationships, & indifference to praise/criticism; often uncooperative *Schizotypal: Odd beliefs leading to interpersonal difficulties, an eccentric appearance, & magical thinking/perceptual distortions thatare not clear delusions/hallucinations Cluster B (Dramatic, Emotional, Erratic Traits) *Antisocial: Disregard for others w/exploitation, repeated unlawful actions, deceit, & failure to accept personal responsibility.  bedwetting  fire setting  harming/killing animals  no remorse *Borderline: Instability of affect, identity, & relationships, as well as splitting behaviors, manipulation & impulsiveness, & fear of abandonment; often tries to self-injury & may be suicidal. *Histrionic: Emotional attention-seeking behavior, in which the person needs to be the center of attention; often seductive & flirtatious *Narcissistic: Arrogance, grandiose vies of self-importance, the need for consistent admiration, & a lack of empathy for others that strains most relationships; often sensitive to criticism. Cluster C (Anxious/Fearful Traits; Insecurity & Inadequacy) *Avoidant: Social inhibition & avoidance of all situations that require interpersonal contact, despite wanting close relationships, due to extreme fear of rejection; often very anxious in social situations *Dependent: Extreme dependency in a close relationship w/an urgent search to find a replacement when one relationship ends. BELIEVE THEY CANNOT FUNCTION WITHOUT THE HELP OF OTHERS. THEY ALWAYS HAVE TO HAVE SOMEONE WITH THEM. *Obsessive-Compulsive: Perfectionism w/a focus on orderliness & control to the extent that the individual may not be able to accomplish a given task. 92. Worden: 4 Tasks of Mourning Completion of ALL 4 tasks takes about a year. Task I- Accepting the reality of the loss Task II- Using coping mechanisms to experience the emotional pain of the loss. Task III- Changing the environment to accommodate the absence of the deceased. WOMAN MOVES INTO A SMALLER HOME AFTER HUSBAND DIES!! Task IV- Finding a meaningful connection w/the lost entity while learning to live again. 93. Primary Prevention of Abuse Consists of measures taken to prevent occurrence of abuse. Examples of Primary Prevention: *Identifying individuals & families at high risk *Provide health teaching *Coordinating supportive services to prevent crises. Specific Strategies: 1) Reducing stress 2) Reducing the influence of risk factors 3) Increasing social support 4) Increasing coping skills 5) Increasing self-esteem 94. 3 types of prevention 1. Primary – promotes health and prevents mental health problemsfrom occurring 2. Secondary – focuses on early detection of mental illness 3. Tertiary – Rehabilitation and prevention of further problems in pts previously diagnosed 95. Pt 16 y/o weighed 98 lbs and dropped to 89lbs – priority intervention Ask her which foods she would feel most comfortable eating 96. Pt recently lost mother to breast cancer – which situation is pt at risk for delayed or inhibited grief? When a patient’s family expects the pt to maintain day to day activities 97. Phases of Crisis Phase 1:  Increased feelings of anxiety  Problem-solving techniques and use of defense mechanisms in an effort to lower anxiety Phase 2:  Functioning becomes disorganized  Trial-and-error attempts to resolve anxiety Phase 3:  Severe and panic levels of anxiety  Withdrawal and flight Phase 4:  Powerlessness and being overwhelmed Dissociative symptoms, depression, confusion, and/or violence against others or self 98. . What is the mechanism that is going on beneath eating disorders? Control and manipulation 99. You go into your client’s room who has antisocial personality disorder and you notice that they have food that they shouldn’t have, how do you deal with it? Confront them in a nonjudgmental and not disrespectful way, present the rules in a clear way and take it away 100. You have a patient with paranoid personality disorder and there is only an option of placing this patient in a 2 bedroom room or 4 bedroom room, which one would you put them in? 2 bedroom is the better situation 101. Do people who are drunk out of their mind feel pain? No; You need to do a thorough head to toe assessment, make sure they do not have any injuries, unexplained bumps, bruises, or broken bones 102. C.A.M – Complimentary Alternative Medicine 1. Guided Imagery 2. Melatonin 3. Western Medicine - more medications 4. Eastern Medicine – mind, body, & spirit a. Accupuncture / Accupressure b. Yoga / Meditation c. Massage Therapy d. Reiki 103. You are in the psych hospital connected to a medical hospital, the mental health facility is Patient that walked in voluntarily with UTIfull, which client would you place in the med/surg floor? 104. You have a float nurse and is in the mental health facility. Which patient would you give to this nurse? OCD Patient 105. What is it called when a patient does not like to be in large groups because they feel as if they are being judged? Cluster C: Avoidance 106. Who can watch a client in restraints? Someone who can do vitals; CNA, LVN, RN 107. What medication would you give if a client is not reacting well to prolixin (EPS)? Artane, Benadryl, and Cogentin 108. You are trying to teach your patient about ECT for the next day, you notice the longer you sit there, the more agitated, anxious, and nervous the client gets. Do you still continue to teach? NO, because they cannot listen and remember if their anxiety is increasing; stop teaching, remain with client, stay calm and try to teach later. 109. Which of the following clients will you see first? Freaking out- can’t catch breath; feels like they are choking 110. Disorder that starts in childhood that becomes antisocial Conduct Disorder 111. What is the first thing you do when you meet a patient? - Focus on their perspective of what’s going on - Establish rapport 112. Interventions for paranoid personality disorder pt - Talk to them in a private area - Use clear, concise language 113. Alcohol withdrawal - First s/s seen within 4-12 hours after last drink - Peak within 24-48 hours after last drink - Delirium tremors within 48-72 hours 114. Conversion disorder - Physical symptom – psychological basis - Rule out all pathology before diagnosis - La Belle indifference is the key finding 115. S/S of grief - Hypersomnia, crying, isolation, lack of appetite - Physically; what do you think they may be feeling? o Hyperventilation, nausea, vomiting, collapse, labile or elevated vitals o Someone in acute grief: pressure on chest, feel like their heart is breaking - Normal grieving period after someone dies is 1 year116. Prolonged or dysfunctional grief - 12 months or more have passed - Unable to do basic ADL’s - Affects every day living - Unable to move on (keep setting place at table, only sleep on one side of bed, set out clothing every day) 117. Pt with agoraphobia - Encourage independence 118. Isolative client – short term goal - Client will interact with staff or peers by end of shift