Complete Test Deck Flashcards
1
Q
Tolerance is
A
Need more to get the same effect
2
Q
Physical Tolerance
A
Tissue adaptation
3
Q
Cross-Tolerance
A
To other CNS depressants (may occur)
4
Q
Intoxication
A
Due to direct physiological effects of substance on CNS
5
Q
Symptoms of Intoxication include (5):
A
- Perception
- Thinking
- Judgement
- Psychomotor skills
- Interpersonal behavior
6
Q
Effects of Alcohol on Central Nervous System (2):
A
- Respiratory depressant
- Selective anesthetic
7
Q
Minor Withdrawl -
Timeframe
Symptoms
A
6-12 hours after last drink
- Irritability
- Anxiety
- Agitation
- Headache
- Nausea/Vomiting
- Insomnia
8
Q
Withdrawl -
Timeframe
Symptoms
A
24 hours after last drink
- Tremors (shakes)
- Tachycardia
- Increased BP
- Diaphoresis
- GI distress
- Hallucinations - Audio, visual, tactile
9
Q
Major Withdrawl-
Timeframe
Symptoms
A
48-72 hours after last drink
- Seizures
- Delirium Tremens
- Symptoms may last up to 5 days
10
Q
Delirium Tremens (DT’s) defined
A
- Disorientation
- Hallucinations
- Profuse sweating
- Increased BP
- Increased & irregular pulse
- Severe Tremor
- Risk of Seizures
- Mortality Rate 5-25%
11
Q
Disulfiram (Antabuse)
A
Inhibits breakdown of alcohol by enzyme
Antabuse + alcohol = ILL
- Nausea and Vomiting
- Sweating
- Tachycardia
- Hypotensive
- Throbbing headache
NO alcohol in any form
Examples: NO cough medicine, mouthwash, etc.
12
Q
You are working the inpatient psychiatric unit and believe that a client is intoxicated after a visitor has left. What is the best intervention?
A
Obtain a specimen for drug screen
13
Q
Benzo Withdrawal (lots)
A
Muscle Pain Tinnitus Itching Anxiety/Panic Hypersensitivity to sounds Depression Insomnia Hallucinations Sweating Paranoia Balance Problems Shaking Jumpiness Seizures
CAN BE FATAL
14
Q
Physical effects of Opioids
A
Respiratory depression - Opioid death often occurs d/t respiratory depression
- Hypotension
- Decreased biliary, gastric, and pancreatic secretions
- Urinary retention
- Constipation
- Constricted pupils
15
Q
Amphetamines
What side effect of amphetamines may make them popular?
A
ANOREXIA
16
Q
Most widely used drug
A
Cannabis
17
Q
Cannabis Effect:
A
- Sense of well-being
- Alters perceptions
- Increased appetite
- Anti-emetic properties
- Impaired balance and stability
18
Q
Cannabis Effect (-)
A
- Impaired short-term memory
- Impaired decision making
- Impaired concentration
- Amotivational- research disagrees
- Cellular changes in the lungs
- Weakening heart contraction
- Immunosuppression
- Reduced testosterone & sperm count
- Impaired judgment
- Lowered testosterone levels
19
Q
Psychiatric clients are vulnerable to:
A
substance use and abuse
20
Q
Common for clients with schizophrenia and depression to use:
A
drug and alcohol to self-medicate
21
Q
Best Practice Treatment Integrates
A
-Both mental health and substance abuse interventions
22
Q
Co-Ocurring treatment programs
A
Most effective
23
Q
Family Issues:
A
Co-Dependency
24
Q
Co-Dependency - defined
Behaviors
A
Maladaptive coping pattern that results from a prolonged relationship with the person who uses substances
- Over-extending one-self
- Low self-esteem
- People-pleasing
- Poor Boundaries
- Care taking
- Denial
- Painful emotions
25
Domestic Violence
Pattern of -
Perpetuated through-
Pattern of intentional and purposeful behavior that adults and adolescents use to control their intimate partner
Perpetuated through generations of cycle of violence
26
A child has a history of an eating disorder, poor trust of others and has come to the ED after an episode of cutting their wrist. What are your priorities?
**Setting limits on self harm**
27
Child Abuse -
Main priorities
- SAFETY is primary intervention
- Document, document, document
- What is important in documenting the injury?
- Pictures if possible
- Body Map to document injuries/locations on body
28
Child of sexual abuse - May exhibit
- Dysfunctional coping
- Substance abuse
- Truancy
May fantasize about revenge
Poor social functioning
Self-neglect
29
Tension Building Stage
Relatively minor incidents-
- Pushing
- Shoving
- Yelling
30
Tension Building Stage
Victim:
Ignores or accepts
31
Tension Building Stage
Abusers:
Rationalize their behavior is acceptable
32
Explosion/Acute Battering Stage
Abuser:
Releases built up tension
| -Brutal beatings minor incidents
33
Explosion/Acute Battering Stage
Victim:
May be seriously hurt
34
Honeymoon Stage
Abusers:
- Feel remorse
- Apologetic
- Makes promises
- Kind, loving behaviors
35
Honeymoon Stage
Victims:
- Believes promises
| - Feels needed and loved
36
Fear of what?
Leaving, staying, both…why?
- Financially
- Don’t know anything else
- Children
- Low self-esteem
37
Why Stay?
- Lack of job and/or education
* Financial dependence on abuser
- Money controlled by partner
- Make decisions based on what is “best” for children
- Cultural or religious beliefs
- Inadequate response from police and/or courts
* Safety more in jeopardy if they leave the abuser
38
A woman comes to the hospital complaining of “pulled” neck muscles. She is noted to have a new bald spot on her scalp. She explains she caught her her hair in the door, pulled it out and this resulted her neck injury. Her partner stays close and is very solicitous (attentive) of her. The nurse should:
Require the partner to remain in the waiting room when the woman is taken into the exam room
39
How Can I Help?
How can healthcare providers help victims?
- If abuse is suspected whether admitted or denied
- Gather relevant information
- Document – Body Map
- Victim may decide to press charges later
- Assist victim to develop safety plan
40
How can healthcare providers help victims?
* *Develop safety plan**
| - Vera House 24 Hour Crisis and Support Lines
41
Rape-
Motivation for rape is:
CONTROL
42
Rape-
Long term impact
- Self blame
- Disruption in daily routine
- Depression
- Sleep disturbances
- Flashbacks
- Erratic mood swings
43
Rape-
Nurses role priority concerns (2):
- Inform client about process
| - Inspect and provide treatment for serious injury
44
Acute Posttraumatic Stress Disorder (PTSD)-
Nursing Assessment (6):
- Quality of sleep
- Flashbacks and intrusive thoughts
- Risk for suicide
- Irritability, angry outbursts
- Hypervigilence/hyperarousal
- Emotional numbing
45
Acute Posttraumatic Stress Disorder (PTSD)-
Factors that interfere with smooth transition from combat zone to civilian life (6):
- Persistence of effects of combat training
- Inability of family and friends to understand the veteran’s experience
- Feelings and support from the veteran’s local community
- Loss of support system
- Finding a new career
- Loss of structure
46
Acute Posttraumatic Stress Disorder (PTSD)-
Nursing Interventions-
What can I do?
Good assessment
- Be aware of signs of abuse
- Collaboration
- Safety plan
- Community Resource
- Encourage diverse ways to express emotions:
* Art Therapy
* Writing
47
Anorexia-
| Reasons for disease (2):
- Refusal to acknowledge seriousness or existence of problem
| - Significantly disturbed perception
48
Bulimia-
| Overview (4):
- Loss of control over eating
- Episodes of binging
- Episodes of purging
* *-Precipitated by emotions-**
49
```
Anorexia and Bulimia-
Biological Factors (3)
```
Genetic vulnerability
- Susceptibility to psychiatric illness
- Increased odds of eating disorder with family history of mood or anxiety disorder
Dysfunction of hypothalamus
Neurochemical changes
- Norepinephrine
- Serotonin
50
Anorexia and Bulimia-
| Deterrents to primary tasks
Anorexia -
- Overprotective parents
- blurred boundaries
Bulimia-
-Isolation between family members
51
Anorexia
Enmeshment in family
Obsessive rituals
Irregular HR
52
Bulimia
Self-guilt/disgust/shame
Irregular HR
Tooth decay from stomach acid
53
Anorexia Treatment Goals
- Safety
- Gradual weight restoration
- Collaborative treatment team efforts
- Target weight about 90% of average for age and height
54
Bulimia Treatment Goals
Safety
Break of binge/purge cycle
Collaborative treatment team efforts
Source of depression - emotionally driven
55
SSRI's used:
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Paroxetine (Paxil, Pexeva)
- Sertraline (Zoloft)
56
A female client is admitted to the psych clinic for treatment of anorexia nervosa. To promote the client's physical health, the nurse should plan to:
**Monitor VS, serum electrolyte levels and acid-base balance**
57
Nursing Priorities with Eating Disorders:
- SAFETY
- Intake
- Weight
- Fluid and electrolytes
58
Nursing Interventions
- Weights
- Supervised eating
* Tube feeding may be necessary*
- Monitored toileting
- Monitor after eating
59
Nursing Interventions -
More practical
- Education
- Listen
- Observation is your friend!
60
For a female patient with anorexia. The nurse plans to include her parents in therapy sessions along with the client. What fact should the nurse remember to be typical of parents of children with anorexia?
**They tend to be overprotective of their children**
61
What medical condition is commonly found is clients with bulimia?
**Diabetes mellitus**
62
ADHD - defined
Persistent pattern of inattention, hyperactivity
and impulsivity more frequent and severe than
others at developmental level
63
ADHD -
Age -
-Symptoms present before age 7*
64
ADHD -
Symptoms:
-Present in more than one setting*
-Cause problems in social and
academic settings
65
ADHD -
Hyperactive Type Symptoms:
- Fidgets
- Talks a lot
- Cannot sit still for long
- Smaller children may run, jump or climb constantly
66
ADHD -
Hyperactive Child Feels:
- Restless
- Impulsive
- Does not wait their turn
- Does not listen to directions
67
AHDH -
Priority with hyperactive child:
**SAFETY**
68
Nursing management with ADHD:
- Consistent
- Structured
- Predictable
69
Nursing Management with ADHD:
```
Ensure Safety!!!
-An unfamiliar setting (i.e.: hospital) may increase
risk for injury
-Environmental Management
-Positive Reinforcement
```
70
ADHD -
Psychostimulant Indications:
- Narcolepsy
- ADHD
- Obesity
71
Pharmacokinetics of Psychostimulants:
Readily absorbed in GI
- Half-life variable
- Ritalin 2-4 hours (then symptomatic again)
72
Psychostimulants -
| Methylphenidates (Names)
- Ritalin
- Ritalin LA
- Metadata CD
- Concerta
- Focalin/Focalin XR
- Daytrana Patch
73
Psychostimulants -
| Amphetamines (Mixed Salts)
- Dextroamphetamine
- Dexadrine
- Adderall
- Vyvanse
74
Psychostimulants for ADHD
What Do We Hope To See?
3 increases
3 decreases
Paradoxical Calming
- Increased attention span
- Increased short term memory
- Increased ability to follow directions
- Decreased disruptive behavior
- Decreased distractibility
- Decreased impulsivity
75
Non-Stimulant Medications
- Strattera
| - Intuniv
76
Alpha-2 Noradrenergic Agonists
- Kapvay/**Clonidine HCL**
- Tenex
- TCA (Tricyclic Antidepressant)
77
Oppositional Defiant Disorder (ODD)
What to look for:
-Disobedience
-Argumentative
-Angry outbursts
-Low frustration tolerance
*****Don’t break the law*****
-Spiteful/Vindictive
-Blames others
-Easily annoyed often in conflict with
adults
78
Conduct Disorder
Repetitive and persistent pattern of
behavior in which rules and the basic
rights of others are violated
BREAK THE LAW
79
Conduct Disorder
- Aggression to people & animals
- Destruction of property
- Serious violation of rules
- Often in trouble with the law
- Lies & Cheats
- Truant
- Run-away
80
Nursing Interventions - ODD and CD
Decreased violence and Increased compliance
- Protect others
- Set limits
- Decrease external stimuli
81
An 11-year-old child diagnosed with conduct disorder is
admitted to the psychiatric unit for treatment.
Which of the following behaviors would the nurse
assess?
**Physical aggressiveness, low stress tolerance
| disregard for the rights of others**
82
An 8 year old boy is disobedient and argumentative.
He has an explosive temper and low frustration
tolerance. Other children relate poorly to him. These
behaviors are most consistent with the diagnosis of:
**Oppositional Defiant Disorder**
83
```
P
A
N
D
A
S
```
- Pediatric
- Autoimmune disorder
- Neuropsychiatric
- Disorder
- Associated with Group A
- Streptococcus
84
The parents of a young man with schizophrenia
express feelings of responsibility and guilt
for their son’s problems. How can the nurse
best educate the family?
-Explain the biological nature of
| schizophrenia.
85
Tics Treatment
Medications used in treatment
- Risperdal
- Zyprexa
- Haldol
- Clonidine
86
Tourette's
-Stimulants make worse
87
Enuresis
-Occurs after the age at which the child
| should have attained bladder control
88
Treatment for Encopresis and Enuresis
- Thorough physical assessment
- Calm, matter-of-fact approach
- No fluids before bed
- **Increased fiber and fluids for encopresis**
89
Treatment for Enuresis
Tofranil (imipramine)
| -Side Effect: Urinary retention
90
Levels of Anxiety (4)
Mild
Moderate
Severe
Panic
91
Mild
Alert, perceived at a higher level
| NEEDED for learning
92
Moderate
Narrowed perceptual field
| Can be attentive, if guided
93
Severe Anxiety
Perceptual field greatly decreased
| Selective inattention
94
Panic Anxiety
Overwhelmed
| Disorganized thinking, speech and behavior
95
Mild anxiety ___________
Motivates
96
Very high levels of anxiety ___________
Immobilizes
97
Defense mechanisms are:
Cognitive distortions used to maintain sense of control
98
Phobias are
Displacement of unconscious conflict onto an external object
99
GABA has
a "braking" effect on the Limbic System
100
Agoraphobia
Don't want to leave the house
101
In DSM V OCD and Related Disorders**
Obsessive Compulsive D/O
102
Generalized Anxiety Disorder (GAD)
- Excessive, unrealistic worries 6+ months
- Severe, chronic anxiety that interferes with daily living
- Free-floating anxiety
103
Generalized Anxiety Disorder Sx (4)
- Hypervigilant for potential threats
- Abnormally sensitive to caffeine
- Doom & Gloom
- What if's?
104
Panic Disorder - Psychological - Sudden Onset Sx
- Sensation of smothering
- Derealization
- --Feeling of unreality
- Depersonalization
- --Feeling detached from oneself
- Feeling of impending doom or death
- Fear of losing control
- Fear of going “crazy”
105
Panic Disorder - Somatic - Sudden Onset Sx
-Palpitations, pounding heart, increased HR
- Sweating
-Trembling/shaking
-Sensation of SOB
-Sensation of choking
- Chest pain/discomfort
- Nausea/abdominal distress
-Paresthesias
-Feeling dizzy, unsteady, light-headed,
faint
- Chills or heat sensation
-Pupils dilated
-Face flushed
106
Phobias
```
Marked persistent fear
-Excessive
- Unreasonable
-Cued by anticipation of an object or
situation
```
107
Exposure to a stimulus:
Provokes anxiety response
108
Phobias
- Object or situation is avoided
- Cognitive recognition that the fear is out
of proportion to the stimulus
- Fear arises through a process of
displacement of unconscious conflict to an
external object that is symbolically
related
109
Agoraphobia listed as:
Separate diagnosis under Anxiety Disorders
110
Agoraphobia Fears:
```
Fear or anxiety in a least two of the following
situations:
-Using public transportation
-Being in open spaces
- Being enclosed in places
-Standing in line or being in a crowd
- Being outside of the home alone
```
111
OCD - Obsession
-Repetitive disturbing thoughts for which the only relief is the compulsion
-Intrusive thoughts continue to recur despite
efforts to suppress them
112
OCD - Compulsion
- Repetitive actions which become rituals
- Client realizes ritual is illogical
- --BUT is helpless to stop the ritual
113
OCD - Interrupting the Ritual
* *Increases anxiety = Increased need for ritual**
| - May cause client to “act out”
114
OCD - Initially
* *Allow to complete ritual**
| - Try distraction
115
OCD - When client is more comfortable try to:
Set limits
116
Substance Induced Anxiety Disorder -
| Clinically significant anxiety due to the:
DIRECT EFFECT of physiological response to a substance
117
Conversion Disorder is a:
Physical expression of psychological conflict
118
Conversion Disorder - Defense Mechanisms
- Repression
| - Conversion
119
Conversion Disorder - Symptoms
Typically have a **symbolic meaning to the client**
| **Symptom is SYMBOLIC of the conflict**
120
Somatization Disorder
```
-Multiple physical symptoms
Includes
- Pain
-GI
- Pseudoneurolgic symptoms
```
- Begins around age 30 years old
- Trends over several years
121
Somatization Disorder - Typical Presentation
-**Exaggerated, detailed medical history**
*Multiple medical providers*
-**Without resolution**/satisfaction to their
complaint
* Unconsciously express emotions* through
* *physical symptoms**
122
Behavioral Treatments
* *Diaphragmatic Breathing**
- Should be practiced daily
- Lowers levels of arousal
- Inhibits progression of panic level
- Reduces physical effects of anxiety
- Such as increased HR
* **SELECT ALL THAT APPLY!***
123
Intervening with Anxious Patient
**Goal is to REDUCE – not eliminate – anxiety level
| to enable a full “normal” life**
124
Nursing Interventions During Panic Attack (5)
- Stay with Patient
- Reassure safety
- Maintain calm manner
- Decrease Stimulation
- PRN meds
* **SELECT ALL THAT APPLY!***
125
*Initial* Goal During Panic Attack
-**Reduce IMMEDIATE Anxiety**
126
Nursing Intervention during panic attack
* *Identify TRIGGERS**
| - Trigger identification is important in D/C plan
127
Non-Benzo Meds - Buspar
- No effect on benzo receptor
- No sedation
7-10 days to be effective
--- 3-6 weeks maximum benefit
- Not for prn use
- No cross tolerance with CNS depressants
- Fewer SE’s
- Not addicting, no withdrawal
128
Education with Buspar (MED TEST)
Works with a steady blood-level
* * Takes 7-10 days to begin working**
* *No doubling up on doses if missed doses**
* May increase digoxin to TOXIC LEVEL**
NOT a Prn medication
No MAOI’s
No Demerol
129
Benzos =
High street value $
| -VERY ADDICTING-
130
Benzos - Names (6)
```
Ativan
Valium
Xanax
Klonopin
Versed
Librium
```
131
Benzo - Mechanism of Action
"GABA is to the brain as brakes are to the
| train”
132
Benzo - Common Side Effects
Paradoxical reaction - very important in elderly patients!
- Confusion
- Agitation
- Delirium
- Paradoxical excitement in elderly
133
Benzo Withdrawl
DO NOT STOP ABRUPTLY
- Seizures
- Can be lethal
- Taper
- Do not use with ETOH
Increased chance of CNS depression
134
Benzo use with the elderly
Use with caution
- Elderly
- Debilitated
- COPD - RESPIRATORY DEPRESSION
Paradoxical reaction/excitement
- Confusion
- Agitation
- Delirium
135
Overall Treatment of Anxiety with Benzos
Long term treatment of anxiety
SSRI
-Will be used to for control of panic attacks
Novel Antidepressants
Education for Client
- Use of *****benzodiazepine is short term*****
- Taper benzo when SSRI reaches therapeutic effect
136
Specific Meds for Disorders - Panic (3)
Paxil
Prozac
Zoloft
137
Specific Meds for Disorders - GAD (2)
Effexor
| Paxil
138
Specific Meds for Disorders - OCD (4)
Prozac
Paxil
Zoloft
Luvox - SSRI - Takes a while to kick in
139
Use of Anti-Hypertensives - Beta blockers
Drug - Propranolol
| - Reduces SNS symptoms
140
Use of Anti-Hypertensives - Alpha 2 - receptor agonists
Drug - Clonidine
- Blocks epinephrine (fight or flight)
- Prevents symptoms: racing heart, elevated
blood pressure
141
A client prescribed alprazolam (Xanax) 0.50 mg po QID asks, “Would it hurt if I have a cocktail or two at a party? The nurse’s best response is:
**Drinking any alcohol while taking Xanax can cause a severe dangerous sedating effect.**
142
The nurse realizes the goal of intervention during a panic attack is to:
**Reduce the client’s immediate anxiety**
