LATEST maryville nurs 663 exam 2 Questions With Answers

Lithium labs - ANSWER- level, NA, Ca, P, EKG, Creatinine, Urinalysis, CBC, TSH bipolar meds: depression - ANSWER- lurasidone (13+), olanzapine + fluoxetine (10+)(symbyax) bipolar acute and mixed mania - ANSWER- aripiprazole, risperidone, olanzapine (13+), quetiapine (acute only), asenapine (10+) classic mood stabilizers - ANSWER- Lamotrigine (excellent medication to use), lithium, Depakote (avoid in females if possible due to PCOS and Pregnancy), Tegretol, Trileptal (no evidence for true Bipolar disorder) anti-depressants - ANSWER- class not used w/bipolar disorder lithium - ANSWER- Anti-manic, antidepressant, anti-suicidal Lithium side effects - ANSWER- Frequent urination, increased thirst, weight gain, sedation lithium toxicity - ANSWER- sudden onset tremors, N/V/D, muscle weakness, slurred speech, confusion, seizures (slowing down, feel really out of it) Persistent Motor or Vocal Tic Disorder - ANSWER- pt in front of you only has one or the other but not both—they usually don't even know it is a tic, it is only meaningful if it's affecting their quality of life Tourette's d/o - ANSWER- Multiple motor and at least one vocal tic (some tics come and go, they don't have them all at the same time to receive the diagnosis) HRT - ANSWER- habit reversal training can be used to manage tics Tics tx - ANSWER- Alpha agonists (clonidine, guanfacine); Haldol is not the first-line txt Developmental Coordination Disorder - ANSWER- a motor disorder characterized by marked impairment in the development of motor coordination; movement isn't consistent w/age Stereotypic Movement Disorder - ANSWER- a motor disorder characterized by repetitive, seemingly driven, and apparently purposeless motor behavior, such as hand waving or head banging, but not include ASD sx Specific Learning Disorders - ANSWER- difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities; dx by other professionals w/specialized training; NP tx comorbid d/o Anorexia nervosa - ANSWER- an eating disorder in which an irrational fear of weight gain leads people to starve themselves; restrictive or binge/purge/exercise Bulimia nervosa - ANSWER- an eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise Binge-eating disorder - ANSWER- significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise Avoidant/restrictive eating disorder - ANSWER- avoiding or restricting foods in childhood. significantly low BMI; no distortion of body image or fear of gaining wt. r/o delusions around food Pica - ANSWER- an abnormal craving or appetite for nonfood substances, such as dirt, paint, or clay that lasts for at least 1 month; decrs incidence with incr age Feeding and Eating Disorders tx - ANSWER- Talk therapy (counseling is needed for the distress) (intensive outpatient, partial inpatient or actual inpatient admission may be needed); most have associated depression and/or anxiety Feeding and Eating Disorders meds - ANSWER- fluoxetine help but not direct tx Vyvanse approved for binge eating but not because of stimulant effects Encopresis - ANSWER- a childhood disorder characterized by repeated defecating in inappropriate places, such as one's clothing Enuresis - ANSWER- involuntary urination Encopresis Treatment - ANSWER- Behavior management: toilet refusal behavior, scheduled toileting time, incentives. Prevention of constipation Counseling Enuresis treatment - ANSWER- 1. First line is behavioral interventions: bed alarms, toileting at bedtime and during the night, bladder training 2. reassurance, resolves spontan, normal 4-5 yo Enuresis meds - ANSWER- Desmopressin nasal spray; Major Depressive Disorder Dx - ANSWER- 5+ for at least a 2-week period; either #1 or 2 req 1. Depressed mood most of the day, nearly every day (can be irritability in children & adolescents) 2. Diminished interest or pleasure in all, or almost all, activities 3. Change appetite/weight; kids not wt goals Insomnia or hypersomnia nearly every day 4. Up or down Psychomotor 5. Fatigue or loss of energy 6. Worthlessness/excessive or inappropriate guilt 7. Diminished ability to think or concentrate, or indecisiveness (don't confuse with ADHD, address mood first) 8. Recurrent thoughts of death, thoughts of suicide, or suicidal plan/intent: if hosp then 2 wk not req. SLAP - ANSWER- Social supports; lethal; access to means; plan and previous attempt Suicide risk: IS PATH WARM - ANSWER- Ideation, substance abuse, purpose to live gone; anxiety, trapped feeling; hopelessness, w/d from soc supports, anger w/rage; reckless, dramatic moods SIGECAPS - ANSWER- Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide bipolar vs unipolar: look at bipolar if - ANSWER- 1. family hx: 1st degree relatives 2. Substance use: chasing high or low 3. Response to SSRI: no resp to multiple tries or evidence of mania with use (not diagnostic) coprolalia - ANSWER- involuntary utterance of obscenities or inappropriate remarks Bipolar I criteria - ANSWER- One manic episode required Mania - ANSWER- elevated, expansive, energetic + 3, (unless irritable mood then requires 4+) 1. SX Lastat least one week-any duration if hosp 2. Inflated self-esteem, grandiosity 3. Decreased need for sleep 4. More talkative, pressure to keep talking