Mental Health Final WCU Exam 2023 Questions with correct Answers

1st generation antipsychotics names - Answer- Chlorpromazine, haloperidol, fluphenazine, loxapine 1st generation - Answer- EPS, liver impairment, anticholinergic effects, sedation, seizures, sexual dysfunction, skin effects Contraindications to 1st Gen - Answer- Liver issues, Parkinson's disease, severe hypotension, dementia What does 1st Gen antipsychotics do - Answer- Block dopamine Neuromalignant syndrome - Answer- Hyperpyrexia BP fluctuations Tachycardia Tachypnea Decreased level of consciousness EPS stuff - Answer- Akathisia Parkinsonism Acute dystonia Tar dive dyskinesia Benotropine (Cogentin) - Answer- Treats EPS Diphenhydramine (Benadryl) - Answer- Treats EPS 2nd Generation Antipsychotiscs - Answer- Rispridone Clozapine Olanzapine Quetiapine Aripiprazole Side effects of 2nd Antipsychotics - Answer- Fewers EPS Orthostatic hypotension Anticholinergic effects Sleep disturbances Sexual dysfunction Contraindications for EPS - Answer- Risperidone pregnancy risk category C Dementia Diabetes Mellitus What's important about Clozapine - Answer- Agranulocytosis Antidepressants first Generation are also known as - Answer- Tricyclics Antidepressants (TCA's) MonoAmine Oxidase Inhibitors (MAOIs) 1st generation TCA medication - Answer- Amitriptyline Nortriptyline Imipramine Trimipramine TCA side effects - Answer- Orthohypotension Anticholinergic effects Sedation Contraindications to TCAs - Answer- Amitriptyline is pregnancy category C Sieizures What should you not take with TCAs - Answer- MAOIs Alcohol Other anticholinergic medication TCAs can occur during TCAs which can lead to - Answer- suicidal ideations Phenelizine Isocarboxazid Tranylcypromine Selegiline - Answer- Medications of MAOIS Side effects of MAOIs - Answer- CNS stimulation Orthostatic Hypotension HTN crisis Contraindications to MAOIs - Answer- Phenelzine is pregnancy category C When not to take MAOIs - Answer- TCAs SSRIs Ephedrine Amphetamine BP meds Caffeine use during MAOIs - Answer- Reduce caffeine use Antidepressants 2nd Generation - Answer- SSRIs SSRI medications - Answer- Fluoxetine (Prozac) Paroxetine Sertraline Citalopram Escitalopram Side effects of SSRIs - Answer- Weight changes Sexual dysfunction Serotonin Syndrome CNS Stimulation Contraindications to SSRIs - Answer- Fluoxetine Pregnancy Risk C Liver/renal dysfunction Cardiac disease Seizures Diabetes Ulcers GI bleedings Do not take SSRIs with - Answer- MAOIs TCAs St. John's Wort Lithium NSAID How to DC SSRIs - Answer- Taper slowly to withdrawal syndrome SNRIs - Answer- Antidepressant 2nd Generation SNRI medication - Answer- Venlafaxine Duloxetine Desvenlafaxine Side effects of SNRIs - Answer- Hyponatremia Anorexia HTN Sexual dysfunction Contraindications to SNRIs - Answer- Fluoxetine MAOIs St. John's Wort Alcohol NSAIDs Medication Administration for SNRIs - Answer- To DC taper off to avoid withdrawal syndrome Take with food How long for SNRIs to take effective - Answer- 4 weeks Lithium manic episode blood level - Answer- 0.8-1.4 Lithium maintenance blood level - Answer- 0.4-1.0 Early lithium toxicity - Answer- Less than 1.5 Early lithium toxicity manifestations - Answer- NVD Thirst Polyuria Lethargy Slurred speech Fine hand tremors Muscle weakness Advanced lithium toxicity - Answer- 1.5-2.0 Advanced lithium toxicity manfestations - Answer- Worsening NVD Stupor Mental confusion Coarse hand tremors Poor coordination Severe lithium toxicity - Answer- 2.0-2.5 Severe lithium toxicity manifestations - Answer- Extreme polyuria/ diluted urine Tinnitus Giddiness Jerking movements Blurred vision Ataxia Seizures Severe hypotension Stupor/ coma Possible death 2.5 or above lithium levels - Answer- Coma/ death Contraindications to lithium - Answer- Pregnancy Category D Discourage breastfeeding Liver/kidney disease Cardiac disease Hypovolemia Schizophrenia NSAIDs Lithium teachings - Answer- Drink 1.5-3L of H2O Do not take diuretics Maintain normal sodium 2-3 G Take with food Monitor blood levels Long term risks of lithium - Answer- hypothyroidism and impairment of the kidney's ability to concentrate urine Anticonvulsants/antielipetics medications - Answer- Valproate/ valproic acid Carbamazepine Lamotrigine Side effects to anticonvulsants - Answer- CNS effects Nystagmus Double vision Vertigo Staggering gait Headache Contraindications to anticonvulsants - Answer- Pregnancy risk category D Blood disorders Bone marrow disorders Therapeutic Valproate Level - Answer- 50-125 What do you look for with carbamazepine - Answer- Blood issues like leukopenia, anemia, thrombocytopenia Avoid this with carbamazepine - Answer- Grapefruit Monitor for this with anticonvulsants - Answer- Hepatotoxicity Benzodiazepines - Answer- Alprazolam Diazepam Lorazepam Chlordiazepoxide Side effects of Benzos - Answer- Drowsiness, dry mouth, acute toxicity, anterograde amnesia, paradoxical response Paradoxical response - Answer- Anxiety and insomnia Contraindications to benzos - Answer- Pregnancy category D Sleep apnea Respiratory depression Glaucoma Hx of substance abuse Length of benzo - Answer- Short term use Withdrawal symptoms of Benzos - Answer- Anxiety Insomnia Diaphoresis Tremors Delirium Seizures Non Benzos - Answer- Buspirone Diphenhydramine Buspirone - Answer- Not addictive Pregnancy Category B No grapefruit or St. John's Wort, erythromycin, MAOIs Diphenhydramine - Answer- Not addictive May cause anticholinergic symptoms High doses can make you sleepy Cholinesterase inhibitors - Answer- Treats alzheime's disease Cholinesterase inhibitor medications - Answer- Donezpezil Rivastigmine Galatamine Side effects of cholinesterase inhibitors - Answer- Upset GI Bradycardia Syncope Contraindications to cholinesterase inhibitors - Answer- Asthma/COPD NSAIDs Antihistamines TCAs Antipsychotics Medication administration for cholinesterase inhibitors - Answer- Start dose low and slowly increase Taper off dose when DCing CNS Stimulants - Answer- Treats ADHD or ADD CNS Stimulant medications - Answer- Methylphenidate Amphetamine mixture Dextroamphetamine Side effects of CNS Stimulants - Answer- Insomnia Restlessness Weight loss Appetite suppression Cardiac effects Possible psychosis Contraindications to CNS Stimulants - Answer- Substance abuse Cardiovascular issues Severe anxiety Psychosis Pregnancy Category C MAOSIs Caffeine Other CNS Stimulants Medication administration of CNS Stimulants - Answer- Do not crush or chew Give 30-45 minutes before meals Last dose by 4 Full effect can take up to 6 weeks Avoid caffefine Which food choices are best for a patient in a manic episode? - Answer- Cheeseburger PB & J Which nursing charting entry is documentation of a behavioral symptom of mania? - Answer- Pacing halls throughout the day, exhibits poor impulse control A nurse on an inpatient psychiatric unit receives report at 1500 hours. Which client would need to be assessed first? - Answer- A client pacing the halls and experiencing irritability and flight of ideas A client states to a nurse " i feel as though it am the only one in the world feeling so depressed". The nurse responds " I know what you mean". The nurse is obstructing communication in which of the following ways? - Answer- Minimizing feelings A newly admitted diagnosed with bipolar 1 disorder is experiencing a manic episode. Which nursing diagnosis is a priority at this time? - Answer- Risk for violence that is other directed, responds to poor impulse controls A client has been hospitalized for a manic episode. Which behavior would suggest that the treatment has been effective? - Answer- The client is no longer loud and hostile to others Nadia has been diagnoses with bipolar disorders. What is an outcome for Nadia in the continuation of treatment phase of bipolar disorder? - Answer- Patient will adhere to medication regimen Which symptom related to communication is likely to be present in a patient experiencing mania? - Answer- Verbosity A client who is diagnosed with bipolar disorder is admitted to an inpatient mental health unit in the manic phase. What is the priority in the initial plan of care? - Answer- Ensure a calm and quiet environment One of the reasons depression is more common in women than in men include what? - Answer- Hormonal changes Men have a higher risk of completed suicide because - Answer- They use more lethal means to commit suicide The diagnosis of major depressive is made by including the following - Answer- Depressed mood Decreased pleasure in all or most activities Feelings of worthlessness and guilt The nurse is evaluating a client who is suicidal. Which is a priority nursing intervention? - Answer- Assess for plan and ability to carry out plan A manic client begins to make sexual advance towards visitors in the day room. When the nurse firmly states that is inappropriate behaviors and will not be allowed, The client becomes verbally abusive and threatens physical violence to the nurse. Based on the analysis of this situation, which interventions should the nurse implement? - Answer- Escort the client to their room, with the assistance of other staff Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior - Answer- Communicate expected behaviors to the client Assist the client in identifying ways of setting limits on personal behavior Follow through with the consequences of behavior Have the client state the consequences for behaviors that are viewed as unacceptable A nurse is meeting with a physician in the conference room and in approached by a depressed and withdrawn client. Which response by the nurse is most appropriate? - Answer- Ask the client how she can help Four individuals have given information regarding their suicide plan. Which plan evidences the greatest lethality? - Answer- Jumping from a bridge at night A college student who failed 2 test cried for hours and then tried to phone a parent but got no answer. The student then gave away 2 expensive sweaters and asked to be left alone for a few hours. Which behavior provides the strongest clue of an impending suicide attempt? - Answer- Giving away sweater A nurse assess a patient who reports a 3 week history of depression and periods of uncontrolled crying. The patient says " my buns ness is bankrupt, and i was served with divorce papers." Which subsequent statement by the patient alerts the nurse to a concealed suicidal plan? - Answer- I have a plan that will fix everything Most critical questions for the nurse to ask an adolescent who has threatened to take an overdose of pills - Answer- Do you have access to a medications A client with chronic ongoing stress complains of physical symptoms. The nurse caring for him is aware that the most common chronic problem cause by stress in what? - Answer- Headaches Stress reduction is likely to result in what? - Answer- Reduced pain, lower blood pressure and decreased GI problems What would a client experience during a progressive relaxation session? - Answer- Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed A patient nervously states " financial problems are stressing my marriage, I've heard rumors about cutbacks at work, i am afraid I might get laid off" the patients pulse is 112 BPM, RR 26, BO is 166/88. What nursing intervention will the nurse implement? - Answer- Direct the patient in slow and deep breathing via use or a positive, repeated word A 32 year old male client is experiencing severe anxiety over a recent failed relationship. What nursing intervention should be given the highest priority - Answer- Take the client to a quiet environment A nurse is closely monitoring a newly admitted client who is anxious. At what anxiety level might this client become assaultive and a potential threat to himself and others - Answer- Panic What is the most appropriate therapeutic intervention when helping a patient resolve their agoraphobia? - Answer- Discuss their feelings or sensations rather that the scenario A client is experiencing sudden, moderate level anxiety. The nurse would anticipate that the psychiatrist would most likely prescribe which medication - Answer- Alprazolam A nurse assesses severe anxiety in a client. Which symptom would the nurse expect to see as as response of the sympathetic nervous system to anxiety? - Answer- Tachycardia A nurse is caring for a 22 year old client with schizophrenia. When the patient's father shows up during visitation hours, the client lies in bed, curls up in a ball and sucks his thumb. Which of the following defense mechanisms is the client exhibiting? - Answer- Regression An 18 year old male hosted a party at his parents house while they were out of town. When they returned they were mad by how messy the house was. Ed apologized and gave them a gift card to Applebee's. What defense mechanism is being shown? - Answer- Undoing According to the attachment theory, relationship disorders are related to trauma associated with - Answer- Caregivers/ parents Lorazepam is prescribed for a client who has a generalized anxiety disorder. Which of the following instructions is most important for the nurse to give the client? - Answer- Prolonged used can result in dependence What is a nurses responsibility when a child is suspected of being abused or neglected - Answer- Reporting of suspected abuse or neglect is required by law During an initial interview with parents, a nurse suspects child abuse. What behavior displayed by the parents would lead to the nurse being suspicious? - Answer- Overconcern Which interventions is least appropriate for a nurse to use with a rape victim - Answer- Allow to client to shower and brush her teeth before an examination Top 4 reasons men suffer ptsd - Answer- Rape Combat exposure Childhood neglect Childhood physical abuse Top 4 reasons women suffer ptsd - Answer- Rape Sexual molestation Physical attack Being threatened with a weapon Causes that lead to ptsd - Answer- Assault Domestic abuse Prison Rape Terrorism War Activities that might lead to ptsd - Answer- Crash Natural disaster Civilians in war Assault Ptsd symptoms - Answer- Anxiety and emotions Intrusive memories Avoidance and numbing Anxiety and emotions - Answer- Extreme cases: suicidal or violent Easily startled Substance abuse & destructive behaviors Guilt and shame Anger and irritability