Exam 2 SG

Question 1

Disorders or illnesses that are caused by neurotransmitter malfunction

Answer 1

Dopamine - increase - Schizophrenia
Serotonin - decreased - Depression
Norepinephrine - decrease - Depression
y-Aminobutyric acid (Glutamate )- decrease - Anxiety disorders
Acetylcholine - decrease - Alzheimers

Question 2

Function of Broca’s area (Assessment)

Answer 2

Broca’s area is responsible for speech.
Patients with damaged broca’s area has difficulty understanding syntactically complex or semantically reversible sentences (e.g., “touch your nose after you touch your foot”).

Question 3

Mechanism of action for antipsycotics

Answer 3

Many drugs, such the older neuroleptic antipsychotics, interact with ACh and its receptor sites to produce anticholinergic side effects, which occur when muscarinic acetylcholine receptors are blocked. 
1st generation ( typical ) antipsychotics - blocks D2 receptors - not selective
2nd generation (atypical) antipsychotics - blocks D2 and 5HT2A receptor (dopamine and serotonin ) - somewhat selective

Question 4

1st generation (typical) antipsychotic: mechanism of action

Answer 4

blocks D2 receptors - not selective

Question 5

2nd generation (atypical) antipsychotic: Mechanism of action

Answer 5

blocks D2 and 5HT2A receptor (dopamine and serotonin ) - somewhat selective

Question 6

Effects of GABA

Answer 6

brain’s principal inhibitory neurotransmitter

Turns off nerve cells and slows or stops actions in postsynaptic neurons.

Question 7

Education about donepezil (Aricept)

Answer 7

Donepezil (Aricept) and other similar drugs inhibit the cholinesterase enzyme that breaks down ACh. This increases the amount of available ACh, thereby delaying the onset of symptom

Question 8

Risk factors for mental illness

Answer 8

Genetics

Question 9

Assessment for patient with injury to temporal lobe

Answer 9

Auditory hallucinations
Increased sexual focus 
Decreased motivation 
Alterations in memory
Altered emotional responses
Sensory aphasia
Affect fluctuates dramatically

Question 10

Behavioral changes related to frontal lobe injury

Answer 10

Changes in affect, such as flattening 
Alteration in language production 
Alteration in motor functioning 
Impulsive behavior
Impaired decision making 
Concrete thinking

Question 11

Behavioral changes related to PTSD

Answer 11

pt may experience intense fear, helplessness, or horror
pt can be agitated or behave in disorganized manner.
Pt can have sleep disturbances, irritability or angry outbursts, difficulty concentrating, hypervigilance, and an exaggerated startle response

Question 12

Nursing diagnosis for anxiety

Answer 12

Risk for suicide
•Anxiety
•Death anxiety
•Stress overload
•Self-mutilation
•Hopelessness
•Powerlessness
•Social isolation
•Disturbed sensory perception
•Disturbed thought processes
•Insomnia•Impaired memory
•Deficient knowledge
•Fear
•Fatigue
•Chronic low self-esteem
•Disturbed body image
•Risk-prone health behavior
•Ineffective role performance
•Ineffective coping
•Defensive coping
•Ineffective denia
l•Impaired social interaction
•Compromised family coping
•Interrupted family processes
•Spiritual distress
•Decisional conflict
•Noncompliance
•Posttrauma syndrome
•Risk for posttrauma syndrome

Question 13

Cardiovascular C/M of Anxiety:

Answer 13

Palpitations, racing heart, BP changes. fainting,

Question 14

Respiratory C/M of Anxiety:

Answer 14

Rapid and shallow breathing, pressure in chest, SOB, gasping, lump in throat

Question 15

GI C/M of Anxiety:

Answer 15

Loss/Increased of appetite, abd discomfort, feeling of fullness, nausea, heartburn, diarrhea

Question 16

Neuromuscular C/M of Anxiety:

Answer 16

Hyperreflexia, insominia, tremors, pacing, clumsiness, restlessness, flushing, sweating muscle tension

Question 17

GU C/M of Anxiety:

Answer 17

Decreased libido, increased frequency or urgency of urination

Question 18

Cognitive C/M of Anxiety:

Answer 18

Decreased attention, inability to concentrate, forgetfulness, impaired judgment, thought blocking, fear of injury or death

Question 19

Behavioral C/M of Anxiety:

Answer 19

Rapid speech, muscle tension, fine hand tremors, restlessness, pacing, hyperventilation

Question 20

Affective C/M of Anxiety:

Answer 20

Irritability, impatience, nervousness, fear, uneasiness

Question 21

Nursing intervention for anxiety

Answer 21

Maintain safety for pt and environment
Assess your own level of anxiety and maintain calm
Recognize relief behaviors of pts.
Inform pt importance of limiting caffeine, nicotine, and other CNS stimulants
Teach pt to distunguish between anxiety with identifiable and nonidentifiable sources
Instruct pt in reducing anxiety techniques: progressive relaxation , mindfulness meditatiom, slow deep breathing exercises, focusing on single object in room, listening to soothing music or relaxation tapes, visual imagery or nature- related DVDs, and exercises.
Help pt build coping methods
Help pt identify support groups who will help pt perform personal tasks and activities that current circumstances make difficult
Assist the pt with gaining control of overwhelming feelings and impulses through brief and direct verbal instructions
Help pt structure environment
Assess presence and degree of depression and suicidal ideation
Administer anxiolytic medication
Help pt understand importance of medication regimen

Question 22

Nursing intervention for patient experiencing severe anxiety

Answer 22

requires brief, directive verbal interchanges aimed at increasing feelings of safety and security

Question 23

Education about anxiolytics

Answer 23

Benzodiazepines must be used short term due to tolerance and dependence.
Counsel pt about risk of mixing alcohol with medications and avoid driving or operating machinery.
Teach pt about effects of Kava Kava, St. John’s wort and grapefruit with benzodiazepines.
MAOIs can increase BP with Busipirone

Question 24

Assessing severity of anxiety

Answer 24

ANS excessively stimulated (increase v/s, diaphoresis, urinary urgency & frequency, present diarrhea, dry mouth, decreased appetite and dilated pupils)
muscles rigid and tense
Senses affected
Hearing and pain sensation decreases
Perception field is greatly narrowed
Problem solving is difficult
Selective attention 
Distortion of time
Dissociative tendencies, 
Detachment 
Vigilambulism 
Feels threatened and startled with new stimuli
Activity increases or decreases
Appears and feels depressed
Demonstrates denial
Complains of aches or pains
Agitated or irritable
Need for space increases
Eyes may move around or fixed gaze

Question 25

Discharge criteria for patient with anxiety disorder

Answer 25

Identify situations and events that trigger anxiety and select ways to prevent or manage them.
Describe anxiety symptoms and levels of anxiety.
Discuss the connection between anxiety-provoking situations or events and anxiety symptoms.
Explain relief behaviors openly.
Identify adaptive and positive techniques and strategies that relieve anxiety.
Demonstrate behaviors that represent reduced anxiety symptoms.
Use learned anxiety-reducing strategies.
Demonstrate the ability to problem solve, concentrate, and make decisions.
Verbalize feeling relaxed.
Sleep through the night.
Use appropriate supports from the nursing and medical communities, family, and friends.
Acknowledge the inevitability of the occurrence of anxiety.
Discuss the ability to tolerate manageable levels of anxiety.
Seek help from appropriate sources when anxiety is not manageable, including websites such as www.adaa.org (i.e., the website of Anxiety Disorders of America)
List the medication that are used to control the symptoms as well as the appropriate dosage and scheduled times.
Continue postdischarge anxiety management, including medication and therapy

Question 26

light and dark” side of addiction

Answer 26

Light
Pleasure
“feel good transmitters”: dopamine, serotonin, opioid peptides, and other neurochemical predopaminate
Dark
Withdrawal symptoms
Norepinephrine and corticotropin-releasing factors (CRF) as well as the stress circuits are activated