Exam 2

Question 1

*Best treatment for PTSD

Answer 1

-SSRI medications
-Paroxethine and Sertaline
-Short Term Benzodiazephines
-Prazosin for nightmares
-Mood stabilizers and antipsychotics

Question 2

*Symptoms of PTSD

Answer 2

Re-experiencing the the traumatic event example getting flash backs
· Constantly at a high level of stress or startle
· Numbing of responsiveness like avoidance or indifference
· Disturbed sleeping patterns because of nightmares
· Amnesia to certain aspects of the trauma

Question 3

*What is depersonalization and derealization?

Answer 3

-Depersonalization is focus on self. Feeling like your body does not belong to you or feeling like you are outside of your and sometimes feeling like something is wrong with your body
-Derealization is focus on the outside world Feeling like you do not know your surroundings or the world is not real and feeling disconnected from people

Question 4

*What are the different dissociative disorders?

Answer 4

-Dissociative identity disorder is having two or more separate personalities and switching between them
-Depersonalization-derealization disorder
- Dissociative amnesia a persons inability to remember or recall detailed information about their life

Question 5

How are dissociative disorder treated?

Answer 5

First we establish safety and stabilization
· Then we confront and work though traumatic experiences
· Finally we use rehabilitation
· We can also use meds
· * CBT, psychodynamic psychotherapy, exposure therapy,
· modified EMDR therapy, hypnotherapy, neurofeedback,
· ego state therapies, somatic therapies

Question 6

Review Joint Commission regulations on restraints in your ATI

Answer 6

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Question 7

*What is timing for restraints for 5-7 year olds adolescents? Adults?

Answer 7

-8 year or younger limit is 1hr
- 9 to 17 limit is 2hr
-18+ limit is 4hr

Question 8

Provide examples of negative symptoms and positive symptoms

Answer 8

Positive symptoms are symptoms shouldn’t be present. Ex: hallucinations, delusions, paranoia, alteration in speech.

Negative symptoms are the absence of essential human qualities like social discomfort, apathy, Anhedonia (inability to enjoy activities).
It shows the outward expression of the person’s internal emotional state

Question 9

*Major acronyms like SIGECAPS, SOLER, DIGFAST, What do they stand for?

Answer 9

Depression: SIGECAPS
S- Sleep changes
I- Interest (loss)
G- Guilt (worthless)
E- Energy (lack)
C- Cognition/ Concentration
A- Appetite
P- Psychomotor
S- Suicide/Death

SOLER: non verbal communication
S- Sit squarely
O- Open posture
L- Leaning
E- Eye contact
R- Relaxed

DIG FAST: Primary symptoms of a Mania attack
D-Distractibility
I-Indiscretion
G- Grandiosity
F-Flight of Ideas
A- Activity Increase
S-Sleep Deficit
T-Talkativeness

Question 10

Signs of lithium toxicity

Answer 10

N/V, dizziness, diarrhea, and abdominal pain

Question 11

*How to treat lithium toxicity

Answer 11

stomach pumping

Question 12

Lithium Levels

Answer 12

Therapeutic level: 0.8-1.4 mEq/L
Maintenance blood level: 0.4 to 1.3 mEq/L
Toxic Blood level: >1.5 mEq/L

Question 13

*What are the potential long-term effects of lithium use?

Answer 13

Kidney and thyroid gland issues.

Question 14

How often should lithium levels be checked?

Answer 14

Every 3 to 6 months

Question 15

A major side effect of desryl (Trazodone) is priapism. What instructions should you provide patients regarding this serious side effect?

Answer 15

Go to the hospital if the erection lasts longer than four hours

Question 16

What classes do each of these groups of medications fall under
a. sertraline, paroxetine, escitalopram, citalopram, fluoxetine,
b. duloxetine, venlafaxine, desvenlafaxine
c. haloperidol, Chlorpromazine
d. olanzapine, Risperidone, ziprasidone, quetiapine, , Clozaril or clozapine
e. alprazolam, clonazepam, lorazepam diazepam
f. amphetamines, methylphenidate
g. parnate, nardil
h. donepezil
i. bupropion
j. mirtazepine

Answer 16

A. SSRI’s
B. SNRI’s
C. First- Generation (Conventional) Antipsychotics
D. Atypical/ Second Generation Antipsychotics
E.Benzodiazepines (Anxiety)
F. Psychostimulants/CNS Stimulants
G. MAOIs
H. Cholinesterase Inhibitors
I. Atypical Antidepressants
J. Antidepressants

Question 17

A second-generation antipsychotic is a second generation antipsychotic because of the 5HT 2A receptor activity? What does that mean?

Answer 17

They also target dopamine D2 receptor

Question 18

Which antipsychotic is most likely to cause agranulocytoses? Why does it matter?

Answer 18

Clozapine

Question 19

What are the As of schizophrenia…ie alogia, anhedonia, anergia etc.?

Answer 19

affective flattening, alogia, anhedonia, asociality, and avolition

Question 20

What are extrapyramidal side effects (EPS)?

Answer 20

Acute Dystonia- Last hours to 5 days and it cause spasm of the tongue, neck, face, & back

Parkinsonism- last 5-30 days and it causes tremors, shuffling gait, drooling, stooped posture, instability

Akathesia- Last 5-60 says and it casues Compulsive, repetitive motions, agitation

Tarditive Dyskinesia- Last months to years and causes lip-smacking, worm-like tongue movement, “fly-catching”.

Question 21

Of the antipsychotic medications, which are more likely to cause weight gain, Galacteria or lactation, QT prolongation, cataracts?

Answer 21

Thioridazine

Question 22

If you have a patient who received a haloperidol injection 24 hours ago, what side effects should you look for?

Answer 22

Chest pain, trouble breathing, fast heartbeat, or chills

Question 23

*What is ECT and when is it used?

Answer 23

-ElectroConvulsive Therapy is a therapy used to treat depression specific Psychotic illness, which involves passing a mild electric current through your brain, causing a short seizure “induce seizure”

-Uses:-
*Severe malnutrition, exhaustion, and dehydration due to lengthy depression or when a person is a danger to themselves or others and medication will take days/week to become effective
Delusional depression
*Schizophrenia with catatonia
*Failure of previous medication trials/medication aren’t working

Question 24

*What is the main side effect of ECT?

Answer 24

Nausea, headaches, fatigue, myalgia, confusion and slight memory loss.

Question 25

*Who is a good candidate for ECT?

Answer 25

A client with depression and other major psychiatric/mental health disorders such as schizophrenia and bipolar disorders

Question 26

How do you prepare patients for ECT?

Answer 26

Explain the procedure
Several test done such as blood urine tests, ECG/EKG, imaging tests on the skull, brain and spine
Fast before the procedure (food 8hr & liquids 2hrs)
Remove all type of accessories
Medication stopped or reduce accordingly to the provider
Anesthesia and other preparations
Electrodes placement

Question 27

*What is Transcranial Magnetic Stimulation (TMS)?

Answer 27

Is a non invasive method to treat depression, it uses MRI- strength magnetic pulses to stimulate focal areas of the cerebral cortex.

Question 28

*When is TMS used and how is it different from ECT?

Answer 28

ECT:
*Is the most effective
Safer than meds with certain medical conditions
Uses electric current
SE: *possibilities of neurological deficits or memory problems
*Seizures are possible
May cause nausea
Suitable for severe cases of depression, *when nothing has worked and there is an immediate risk of suicide

TMS:
Noninvasive
Uses MRI-strength magnetic pulses
SE: *no neurological deficits or memory problems
*Seizures are rarely
May cause headache and lightheadedness
*Suitable for a pt with mild, moderate or severe depression

Question 29

Be prepared to prioritize actions based on presenting actions based on presenting symptoms

Answer 29

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Question 30

How is capacity different from competence?

Answer 30

Capacity involves a person’s ability to make informed decisions and provide informed consent
Competence is a legal term and a process that speaks to determining the capability of a person to act on his or her own behalf or have the mental capacity to participate in legal proceedings

Question 31

You have a patient taking Cymbalta, which vital sign would cause you to hold this medication?
a. Resting HR of 56,
b. B/P 180/100,
c. Temp 100.0,
d. Respiratory Rate 20

Answer 31

B

Question 32

Talking in circles and including more detail than you asked for is …………. speech

Answer 32

Circumstantial Speech

Question 33

Not answering a simple question _____________ speech

Answer 33

Tangential Speech