N3381 Psychiatric Mental Health Study Guide Exam 2
Discuss prioritizing as you triage your patient admissions when there are limited beds available in the inpatient setting.
Triage is to separate those who need rapid medical treatment from those with more minor injuries. It reduces the burden
on the facilities' finite resources, allowing responders to address the greatest number of casualties. First priority is rescue
and evacuation, medical needs, food and shelter, and physical needs.
After immediate needs are met people need help to reconstruct and normalize their lives, including assistance with
houses,jobs,trauma counseling. The importance for crisis intervention and psychological first aid can not be overlooked. If
they are not assisted early on they are left vulnerable to stress related disorders and chronic impairment.
Create a plan to ensure that your homeless client with a serious mental illness has a better chance of maintaining their
medication regimen being successful in a community setting.
Patients would need to be assigned a case manager who would set them up with a community mental health nurse.
Patients could use the Community Mental Health Center (CMHC) that provides financial support services to those whose
income and medical expenses make them eligible. These facilities can provide medication management to help maintain
their medication regimen. Community mental health nurses could also help patients get set up with Medicaid which
operates under federal guidelines and state regulations and pays mental health care costs for people who have extreme
financial need.
Discuss the concept of medication nonadherence as it relates to your homeless patient with serious mental illness identifying
reasons that contribute and interventions to increase compliance.
Homeless patients are at risk for medication non-adherence for multiple reasons including transportation
To clinics to get medication and have follow-up appointments. This is something that the community
Health nurse can help. Other factors affecting medication adherence include lack of family and
Support and substance use.
Explore and discuss the relationship between emotions, stress and functioning of the immune system.
When stress is prolonged or people are not able to relax, they remain in chronic low levels of stress. The body stays alert
for a prolonged period of time. A sustained increase in the chemicals produced by the stress response (cortisol, adrenaline
and other catecholamines) can have damaging effects on the body including a substantial negative effect on the immune
system, leaving individuals more vulnerable to autoimmune disease.
The Hypothalamus and the limbic system contribute to emotions.
o The Hypothalamus and limbic system contribute to emotions SNS = Fight/Flight | PNS = Rest/Digest
● Increased HR, BP (HTN or increased strain on the circulatory system).
● Release of corticosteroids which suppress the immune system.
● Disturbed GI system (ulcers).
● Increased Cholesterol levels via adrenaline and noradrenaline on the release of free fatty acids. This produces a
clumping together of cholesterol particles, leading to clots and occlusion of the arteries.
● Stress impairs Sleep | Eating | loss of interest | feeling of powerlessness | Irritable | Psychological harm |
emotional difficulties.
Explore and discuss the relationship between mood, anxiety and exercise.
Physical activity deepens breathing and relieves muscle tension. It can elevate the levels of the body’s own endorphins
which induces a sense of well-being. Exercise can dissipate chronic and acute stress. It is recommended 30 minutes, three
times per week.
Discuss cognitive reframing and its impact on negative and irrational thought processes, discuss how reframing distorted thoughts
helps with certain anxiety disorders and identify situations where this therapeutic tool might be most useful.
Cognitive reframing is a strategy therapists use to help clients look at situations from a slightly different perspective. It can
be a helpful way to turn problems or negative thoughts into opportunities for change and growth. Situations it can be used
in include all-or-nothing thinking, blaming and catastrophizing.
Discuss the characteristics of negative thinking in depression the tendency to overgeneralize and identify associated responses,
interventions and supportive measures the nurse could employ.
Depressed people dwell on and exaggerate their perceived faults and failures and are unable to focus on their strengths and
successes. Their thinking is slow and memory and concentration are affected.
Cognitive behavioral therapy (CBT) is a popular and commonly used effective and well-researched therapeutic tool. It is based on both
cognitive and behavioral theory and seeks to modify negative thoughts that lead to dysfunctional emotions and actions. The goal of CBT is
to identify the negative patterns of thought that lead to negative emotions. Once the maladaptive patterns are identified, they can be
replaced with rational thoughts. A particularly useful technique in CBT is to use a four-column format to record the precipitating event or
, N3381 Psychiatric Mental Health Study Guide Exam 2
situation, the resulting automatic thought, the ensuing feeling(s) and behavior(s), and, finally, a challenge to the negative thoughts based
on rational evidence and thoughts. This is sometimes referred to as the ABCs of irrational beliefs.
Compare, contrast, define and give examples of responses that reflect empathy and sympathy.
In empathy we understand the feelings of others. In sympathy we feel the feelings of others. When a helping person is
feeling sympathy for another, objectivity is lost and the ability to assist the patient in solving a personal problem ceases.
○ Empathy- understanding the feelings of others (Experience)
■ Example: How upsetting this must be for you. Something similar happened to my mother last
year and I had so many mixed emotions.
○ Sympathy- f eel the feelings of others, objectivity is lost, the ability to assist is gone. Associated with the
feelings of pity and commiseration (sometimes is not therapeutic) (feeling S orry for)
■ Example: I know how you feel. My mother was hospitalized last year, and it was awful.
Identify Tricyclic antidepressants (TCA’s) on our Medication classification list and discuss specific common & adverse side effects,
client populations of concern and important related patient teaching.
● amitriptyline (Elavil)
● clomipramine (Anafranil)
● imipramine (Tofranil)
● nortriptyline (Pamelor)
● Doxepin (Sinequan)
● Patient Teaching:
○ Primary SE-sedation, anticholinergic effects, weight gain, cardiotoxicity
○ Caution in patients that are suicidal, toxic in doses equal to 3 weeks supply
○ Baseline EKG required before treatment to monitor for cardiotoxicity
○ Dietary restriction of tyramine must be maintained for 2 weeks after stopping MAOIs**
Identify MAOI’s on our Medication classification list and explore the relationship MAOIs, tyramine and vasoconstriction; discuss
related teaching for your patients on these meds.
● phenelzine (Nardil)
● isocarboxazid (Marplan)
● tranylcypromine (Parnate)
● Selegiline (Emsam Patch)
Primary SE-postural hypotension, insomnia, sexual dysfunction, weight gain (edema), change of HR/rhythm, urinary
Hesitancy, vertigo, weakness
Caution-symptoms of hypertension should be treated immediately
patient teaching-LOW tyramine diet (aged/smoked/fermented foods) and no DECONGESTANTS. Inform doctors if surger
are scheduled.
Compare and contrast anergia, anhedonia and vegetative signs of depression giving examples of each and discuss interventions
and teaching for each.
● Anergia- Reduction in or lack of energy.
● Anhedonia- Inability to find meaning or pleasure in existence.
● Anergia and Anhedonia are the result of decreased levels of Norepinephrine
● Vegetative signs include increased sleep, decreased libido, and appetite. It is caused by a decrease in serotonin or
serotonin circuit dysfunction.
● Interventions listed on page 209 under Table 15-5
Discuss important teaching regarding what to be aware of on initiation and when the medication reaches a therapeutic level for
your client who is started on an antidepressant.
● Increased suicidal ideation and suicide risk
● Watch for increased mood or 180 and giving away prized possessions.
Discuss the signs and symptoms of serotonin syndrome (ss) and identify your assessment questions for your patient who you
suspect may have ss.
Signs of Serotonin syndrome include:
● Hyperactivity or restlessness
● Tachycardia ----->cardiovascular shock
● Fever -----> hyperpyrexia
● Elevated blood pressure
● Altered mental status
, N3381 Psychiatric Mental Health Study Guide Exam 2
● Irrationality
● Mood swings
● Hostility
● Seizures----->status epilepticus
● Myoclonus
● Incoordination
● Tonic rigidity
● GI upset--Abdominal pain, Diarrhea, bloating
● Apnea-->Death
Assessment Questions:
1) Ask about signs and symptoms
2) Ask about other Serotonin enhancing agents the patient may be taking such as an MAOI.
Discuss medication interventions for the patient who is just started on Lithium with severe mania that address control of
symptoms of hyperactivity until Li therapeutic serum level is achieved.
Initially the acute mania treatment can start with a benzodiazepine or an antipsychotic; this will help calm the symptoms
until lithium therapeutic level is achieved. Medications such as antipsychotic meds (olanzapine or haloperidol) and benzos
such as (lorazepam or clonazepam) prevent exhaustion, coronary collapse and death until the Li reaches therapeutic levels.
Compare and contrast the signs and symptoms of Lithium side effects and Lithium toxicity.
● Expected side effects are, fine hand tremors, polyuria, mild thirst, mild nausea and general discomfort as well as weight
gain. Usually seen at levels of 0.4-1 mEq/L
● Early signs of toxicity- include N/V/D, Polyuria, Thirst, Slurred speech, and muscle weakness. Usually seen at levels of <1.5.
● Advanced signs of toxicity include, coarse hand tremors, persistent GI upset, mental confusion, muscle irritability, EEG
changes, and incoordination. Usually seen at levels of 1.5- 2 mEq/L
Discuss prioritizing as you triage your patient admissions when there are limited beds available in the inpatient setting.
Triage is to separate those who need rapid medical treatment from those with more minor injuries. It reduces the burden
on the facilities' finite resources, allowing responders to address the greatest number of casualties. First priority is rescue
and evacuation, medical needs, food and shelter, and physical needs.
After immediate needs are met people need help to reconstruct and normalize their lives, including assistance with
houses,jobs,trauma counseling. The importance for crisis intervention and psychological first aid can not be overlooked. If
they are not assisted early on they are left vulnerable to stress related disorders and chronic impairment.
Create a plan to ensure that your homeless client with a serious mental illness has a better chance of maintaining their
medication regimen being successful in a community setting.
Patients would need to be assigned a case manager who would set them up with a community mental health nurse.
Patients could use the Community Mental Health Center (CMHC) that provides financial support services to those whose
income and medical expenses make them eligible. These facilities can provide medication management to help maintain
their medication regimen. Community mental health nurses could also help patients get set up with Medicaid which
operates under federal guidelines and state regulations and pays mental health care costs for people who have extreme
financial need.
Discuss the concept of medication nonadherence as it relates to your homeless patient with serious mental illness identifying
reasons that contribute and interventions to increase compliance.
Homeless patients are at risk for medication non-adherence for multiple reasons including transportation
To clinics to get medication and have follow-up appointments. This is something that the community
Health nurse can help. Other factors affecting medication adherence include lack of family and
Support and substance use.
Explore and discuss the relationship between emotions, stress and functioning of the immune system.
When stress is prolonged or people are not able to relax, they remain in chronic low levels of stress. The body stays alert
for a prolonged period of time. A sustained increase in the chemicals produced by the stress response (cortisol, adrenaline
and other catecholamines) can have damaging effects on the body including a substantial negative effect on the immune
system, leaving individuals more vulnerable to autoimmune disease.
The Hypothalamus and the limbic system contribute to emotions.
o The Hypothalamus and limbic system contribute to emotions SNS = Fight/Flight | PNS = Rest/Digest
● Increased HR, BP (HTN or increased strain on the circulatory system).
● Release of corticosteroids which suppress the immune system.
● Disturbed GI system (ulcers).
● Increased Cholesterol levels via adrenaline and noradrenaline on the release of free fatty acids. This produces a
clumping together of cholesterol particles, leading to clots and occlusion of the arteries.
● Stress impairs Sleep | Eating | loss of interest | feeling of powerlessness | Irritable | Psychological harm |
emotional difficulties.
Explore and discuss the relationship between mood, anxiety and exercise.
Physical activity deepens breathing and relieves muscle tension. It can elevate the levels of the body’s own endorphins
which induces a sense of well-being. Exercise can dissipate chronic and acute stress. It is recommended 30 minutes, three
times per week.
Discuss cognitive reframing and its impact on negative and irrational thought processes, discuss how reframing distorted thoughts
helps with certain anxiety disorders and identify situations where this therapeutic tool might be most useful.
Cognitive reframing is a strategy therapists use to help clients look at situations from a slightly different perspective. It can
be a helpful way to turn problems or negative thoughts into opportunities for change and growth. Situations it can be used
in include all-or-nothing thinking, blaming and catastrophizing.
Discuss the characteristics of negative thinking in depression the tendency to overgeneralize and identify associated responses,
interventions and supportive measures the nurse could employ.
Depressed people dwell on and exaggerate their perceived faults and failures and are unable to focus on their strengths and
successes. Their thinking is slow and memory and concentration are affected.
Cognitive behavioral therapy (CBT) is a popular and commonly used effective and well-researched therapeutic tool. It is based on both
cognitive and behavioral theory and seeks to modify negative thoughts that lead to dysfunctional emotions and actions. The goal of CBT is
to identify the negative patterns of thought that lead to negative emotions. Once the maladaptive patterns are identified, they can be
replaced with rational thoughts. A particularly useful technique in CBT is to use a four-column format to record the precipitating event or
, N3381 Psychiatric Mental Health Study Guide Exam 2
situation, the resulting automatic thought, the ensuing feeling(s) and behavior(s), and, finally, a challenge to the negative thoughts based
on rational evidence and thoughts. This is sometimes referred to as the ABCs of irrational beliefs.
Compare, contrast, define and give examples of responses that reflect empathy and sympathy.
In empathy we understand the feelings of others. In sympathy we feel the feelings of others. When a helping person is
feeling sympathy for another, objectivity is lost and the ability to assist the patient in solving a personal problem ceases.
○ Empathy- understanding the feelings of others (Experience)
■ Example: How upsetting this must be for you. Something similar happened to my mother last
year and I had so many mixed emotions.
○ Sympathy- f eel the feelings of others, objectivity is lost, the ability to assist is gone. Associated with the
feelings of pity and commiseration (sometimes is not therapeutic) (feeling S orry for)
■ Example: I know how you feel. My mother was hospitalized last year, and it was awful.
Identify Tricyclic antidepressants (TCA’s) on our Medication classification list and discuss specific common & adverse side effects,
client populations of concern and important related patient teaching.
● amitriptyline (Elavil)
● clomipramine (Anafranil)
● imipramine (Tofranil)
● nortriptyline (Pamelor)
● Doxepin (Sinequan)
● Patient Teaching:
○ Primary SE-sedation, anticholinergic effects, weight gain, cardiotoxicity
○ Caution in patients that are suicidal, toxic in doses equal to 3 weeks supply
○ Baseline EKG required before treatment to monitor for cardiotoxicity
○ Dietary restriction of tyramine must be maintained for 2 weeks after stopping MAOIs**
Identify MAOI’s on our Medication classification list and explore the relationship MAOIs, tyramine and vasoconstriction; discuss
related teaching for your patients on these meds.
● phenelzine (Nardil)
● isocarboxazid (Marplan)
● tranylcypromine (Parnate)
● Selegiline (Emsam Patch)
Primary SE-postural hypotension, insomnia, sexual dysfunction, weight gain (edema), change of HR/rhythm, urinary
Hesitancy, vertigo, weakness
Caution-symptoms of hypertension should be treated immediately
patient teaching-LOW tyramine diet (aged/smoked/fermented foods) and no DECONGESTANTS. Inform doctors if surger
are scheduled.
Compare and contrast anergia, anhedonia and vegetative signs of depression giving examples of each and discuss interventions
and teaching for each.
● Anergia- Reduction in or lack of energy.
● Anhedonia- Inability to find meaning or pleasure in existence.
● Anergia and Anhedonia are the result of decreased levels of Norepinephrine
● Vegetative signs include increased sleep, decreased libido, and appetite. It is caused by a decrease in serotonin or
serotonin circuit dysfunction.
● Interventions listed on page 209 under Table 15-5
Discuss important teaching regarding what to be aware of on initiation and when the medication reaches a therapeutic level for
your client who is started on an antidepressant.
● Increased suicidal ideation and suicide risk
● Watch for increased mood or 180 and giving away prized possessions.
Discuss the signs and symptoms of serotonin syndrome (ss) and identify your assessment questions for your patient who you
suspect may have ss.
Signs of Serotonin syndrome include:
● Hyperactivity or restlessness
● Tachycardia ----->cardiovascular shock
● Fever -----> hyperpyrexia
● Elevated blood pressure
● Altered mental status
, N3381 Psychiatric Mental Health Study Guide Exam 2
● Irrationality
● Mood swings
● Hostility
● Seizures----->status epilepticus
● Myoclonus
● Incoordination
● Tonic rigidity
● GI upset--Abdominal pain, Diarrhea, bloating
● Apnea-->Death
Assessment Questions:
1) Ask about signs and symptoms
2) Ask about other Serotonin enhancing agents the patient may be taking such as an MAOI.
Discuss medication interventions for the patient who is just started on Lithium with severe mania that address control of
symptoms of hyperactivity until Li therapeutic serum level is achieved.
Initially the acute mania treatment can start with a benzodiazepine or an antipsychotic; this will help calm the symptoms
until lithium therapeutic level is achieved. Medications such as antipsychotic meds (olanzapine or haloperidol) and benzos
such as (lorazepam or clonazepam) prevent exhaustion, coronary collapse and death until the Li reaches therapeutic levels.
Compare and contrast the signs and symptoms of Lithium side effects and Lithium toxicity.
● Expected side effects are, fine hand tremors, polyuria, mild thirst, mild nausea and general discomfort as well as weight
gain. Usually seen at levels of 0.4-1 mEq/L
● Early signs of toxicity- include N/V/D, Polyuria, Thirst, Slurred speech, and muscle weakness. Usually seen at levels of <1.5.
● Advanced signs of toxicity include, coarse hand tremors, persistent GI upset, mental confusion, muscle irritability, EEG
changes, and incoordination. Usually seen at levels of 1.5- 2 mEq/L
