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Exam 3 Flashcards

1
Q

A client reports she went to dinner and a movie last night. She resides in a nursing home.

a. ) confabulation
b. ) illusion
b. ) agnosia
d. ) agraphia

A

A - confabulation a defense mechanism

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2
Q

A client with dementia is waiting an ER assessment. She is touching all item in the exam room

a. ) hypermetamorphosis
b. ) hypervigilance
c. ) hyperorality
d. ) hypervanity

A

A - hypermetamorphosis

All s&s of dementia though

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3
Q

The client that has a diagnosis of pneumonia reports seeing rats in the hospital room today

a. ) dementia
b. ) delirium
c. ) Depression
d. ) Dystonia

A

B - delirium

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4
Q

A client gets confused and irritated each evening and tries to elope form the facility

a. ) preservation
b. ) sundowning
c. ) aphasia
d. ) agnosia

A

B -sundowning

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5
Q

A client is provided cereal breakfast. She is given a spoon and she appears to brush her hair

a. ) agnosia
b. ) amnesia
c. ) aphasia
d. ) apraxia

A

A - Agnosia

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6
Q

A client is experiencing a steady decline in mental and physical functioning

a. ) delirium
b. ) dementia
c. ) autism
d. ) ADD

A

B - Dementia

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7
Q

Addiction

A

Continued use of substances despite adverse consequences

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8
Q

Use

A

Ingestion, smoking, sniffing, or injection of mind altering substances

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9
Q

Abuse

A

Use for purposes of intoxication or beyond intended use

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10
Q

Withdrawlal

A

Symptoms occurring when substance no longer used

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11
Q

Detoxification

A

Process for safe withdrawal

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12
Q

Relapse

A

Recurrence

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13
Q

What neurotransmitter pathway is activated in the brain when abusing substances

A

Dopamine pathways - reward seeking

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14
Q

What is the most abused drug?

A

Alcohol

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15
Q

What is the second most abused drug?

A

Marijuana

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16
Q

Comorbid mental disorders to substance abuse

A

Psychotic
Anxiety
Mood disorder

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17
Q

Alcohol is a CNS ___. So what drugs would you want to avoid?

A

Alcohol is a CNS depressant

Avoid other drugs that ca cause sedation

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18
Q

BAL 0.05

A

Or 1-2 drinks

Impaired judgement, giddiness, mood changes

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19
Q

BAL 0.10

A

Or 5-6 drinks

Difficultly driving and coordinating movements

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20
Q

BAL 0.20

A

Or 10-20 drinks

Motor functions severely impaired, resulting in ataxia; emotional lability

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21
Q

BAL 0.30

A

Or 15-20 drinks

Stupor, disorientation and confusion

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22
Q

BAL 0.40

A

Or 20-24 drinks

Coma

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23
Q

BAL 0.50

A

25 drinks

Respiratory failure

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24
Q

Assessment of substance abuse

A

What your using
How often are you using
How long have you been using
When was the first use

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25
Alcohol can impair what organs?
Liver | Cardiac function
26
Wernicke encephalopathy
ACUTE Thaimine deficit Vision impairment, ataxia, hypotension, confusion
27
Korsakoff's amnestic syndrome
CHRONIC Heart, vascular, nervous system problems Difficultly acquiring new info and retrieving memories
28
Wernicke-Korsakoff Syndrome
Amnesia | Confabulation
29
Alcohol withdrawal syndrome happens:
Usually within 12 hours after abrupt d/c
30
Symptoms of alcohol withdrawal syndrome:
Delirium tremen Seizures Elevated temp, pulse, and BP
31
A pt. is withdrawal from alcohol and starts having seizure activity. How would the nurse stage the withdrawal?
Stage 3 - Severe
32
Pt is withdrawal from alcohol and has a HR of 115. How would the nurse stage the withdrawal?
Stage 2 - Moderate
33
Pt is withdrawal from alcohol and has visual and auditory hallucinations. How would the nurse stage the withdrawal?
Stage 2 - Moderate
34
CAGE assessment
Screening for substance abuse problems C - ever need to CUT down drinking A - do you ever feel ANNOYED when people tell you to stop drinking G - do you ever feel GUILTY about drinking E - Do you need an EYE opener in the morning (Drink)
35
What is the first symptoms the nurse would notice on a pt. that is withdrawing form alcohol?
Elevation of heart rate, temp, and BP
36
Delirium Tremens
``` Hyperarousal Disoriented Hallucinations Tremors MOST SERIOUS: seizures ```
37
CIWA protocol
Clinical institute withdrawal of alcohol | Rating scale for symptoms: N/V, Tremors, Anxiety, Sweats, Agitation
38
Meds for alcohol withdrawal
Benzos Antidepressants Sleep meds Antipsychotics
39
Relapse Px meds for alcohol:
Disulfiram | Naltrexone
40
What is important teaching for a pt. taking Disulfiram?
Do not drink anything with alcohol in it. Will make you very sick. You will vomit. Ex. mouth wash, hand sanitizer, cough syrups
41
Naltrexone
Help reduce craving for alcohol and opioids
42
Do not admin Naltrexone unless pt. is clean for __-__ days
Do not admin Naltrexone unless pt. is clean for 7-10 days
43
Naltrexone is contraindicated in what kind of pt.?
Pregnant | Use cautiously in: acute hepatitis, liver failure, depression, SI, and breast feeding
44
Do not admin Disulfiram until the pt. is clean from alcohol for at least __ hour
Do not admin Disulfiram until the pt. is clean from alcohol for at least 12 hour
45
Alcohol nutrition teaching
Increase protein Increase thaimine Increase Folic Acid
46
Cocaine increases what neurotransmitters?
Increases: Dopamine, norepinephrine, serotonin
47
Cocaine rush
lasts 10-20 min followed by intense letdown effect: | Irritability, depression, tiredness, and craving more drug
48
Cocaine withdrawal with long term use
Long term depletion of norepinephrine > " crash" and sleeping 12-18 hr.
49
Amphetamines block reuptake of what neurotransmitters?
Amphetamines block reuptake of norepinephrine and dopamine
50
MDMA (Ecstasy) increases what neurotransmitter?
MDMA (Ecstasy) increases serotonin and dopamine
51
Methamphetamines increases what neurotransmitter?
Methamphetamines increases dopamine
52
The term "binge and crash" is used for pt. that are addicted to this class of drugs?
Pt. that abuse methamphetamines "binge and crash"
53
Date rape drug
Rohypnol GHB
54
Marijuana binds to ___ receptors in the brain and blocks reuptake of ___ neurotransmitter?
Marijuana binds to mu receptors in the brain and blocks reuptake of dopamine neurotransmitter?
55
Severe reactions of Hallucinogens
``` Paranoia Fear of losing one's mind Depersonalization illusion Delusions Hallucination ```
56
Most abused opioid
Heroin
57
Naloxone
Emergency Tx of opioid intoxication or overdose
58
Maintenance therapy for drug withdrawal
Methadone therapy and behavioral therapy and counseling
59
Inhalants are CNS ___
Inhalants are CNS depressants
60
Severe risk with inhalant drugs
Severe risk for sudden sniffing death
61
Long term use of inhalant drugs can cause chronic __ __
Long term use of inhalant drugs can cause chronic neurological syndromes
62
Steroid can cause what symptoms?
Increases irritability and aggression
63
Mild withdrawal symptoms
``` Yawning Rhinorrhea Perspiration Restlessness Lacrimation Sleep disturbance Increased craving Anxiety Dysphoria ```
64
Moderate withdrawal Symptoms
``` Dilated pupils Bone and muscle aches Sensation of "goose flesh" Hot/cold flashes Irritability Increase anxiety and craving ```
65
Severe withdrawal symptoms
``` N/V Stomach cramps Diarrhea Insomnia Weight loss Twitching Increased BP, HR, RR Depression Anxiety Dysphoria ```
66
Withdrawal Assessment
``` Behaviors and substance use Hx Denial of prob Motivation for change Countertransference Codependence (Enabling) ```
67
Intense fear of gaining weight or becoming fat
Anorexia Nervosa
68
Two types of Anorexia Nervosa
Restricting | Binging and purging
69
Onset of Anorexia Nervosa
Early adolescence | Then becomes chronic with relapses
70
Interoceptive awarenes
Awareness to sensory cues to hunger
71
F and E complications of purging
Hypokalemia Hypochloremia Hypomagnesemia Increased BUN
72
Med for Anorexia Nervosa
Fluoxetine (SSRI)
73
Interventions for Anorexia Nervosa
``` Journaling Understanding feelings Restructuring distortions Movement and dance therapy Imagery and relaxation Interpersonal therapy Pt. and family education ```
74
Criteria for hospitalization for Anorexia Nervosa
``` Acute weight loss < 85% HR near 40 Temp <36.1 BP < 80/50 Hypokalemia Hypophosphatemia Hypomagnesemia Poor motivation to recover SI Severe depression Failure to comply with Tx ```
75
Dichotomous/All-or-Nothing Thinking
“I’ve gained 2 lb, so I’ll be up by 100 lb soon.”
76
Magnification
“I binged last night, so I can’t go out with anyone.”
77
Selective Abstraction
“I can only be happy 10 lb lighter.”
78
Overgeneralization
“I didn’t eat anything yesterday and did okay, so I don’t think not eating for a week or two will harm me.”
79
Catastrophizing
“I purged last night for the first time in 4 months—I’ll never recover.”
80
Risk factor survey for Anorexia Nervosa
McKnight Risk Factor Survey
81
Bulimia Nervosa
Binging and purging in secret | Normal weight
82
Bulimia Nervosa diagnostic criteria
Episodes occurring at least once a week for at least 3 months
83
Difference between Bulimia Nervosa and Anorexia Nervose
Anorexia Nervosa: Severe weight loss and amenorrhea Bulimia Nervosa - normal weight
84
Characteristics of Bulimia Nervosa
Impulsivity Boundary probs Limit-setting difficulties
85
Meds for Bulimia Nervosa
SSRIs
86
Assessment for Bulimia Nervosa
Eating patterns # of times/day they binge or purge Sleep patterns Exercise
87
Interventions for Bulimia and Anorexia Nervosa
Strict I and Os Supervision of bathroom visits Sleep management SSRIs
88
Binge eating disorder cirteria
Binge eating distress about binge Eating until uncomfortably full Feelings of guilt or depression afterward
89
True/False: Prevalence of sleep wake disorders increase with age
True
90
parasomnia disorders
Sleep walking | Night terrors
91
Circadian disorder
Jeg lag | Work-Shift
92
Sleep wake transition disorders
Trouble starting sleep | sleep talking
93
When sleeping what neurotransmitters are involved?
``` GABA Adenosine Histamine Hypocretin Melatonin Cortisol ```
94
Sleep latency
Bedtime to the beginning of sleep
95
Sleep architecture
pattern of NREM and REM sleep
96
Sleep efficiency
Ratio of total sleep time to nocturnal time in bed
97
Cycle of sleep
1 > 2 > 3 > 4 > 3 > 2 > REM > 2 > 3 > 4 > 3 > 2 > REM
98
Where is the biological clock located?
Hypothalamus
99
When does restorative function happen when sleeping?
Stages 3 and 4
100
When does vivid dreaming happen when sleeping?
REM
101
How long does it take for NREM to start after falling asleep?
90 min
102
Fragmented sleep
Body response when deprived of REM and slow wave sleep debt
103
Deprivation of REM sleep can lead to:
Rebound effect
104
Insomnia diagnostic criteria
Daytime fatigue Difficulty with concentration Poor mood No indication of other disorders
105
Insomnia often causes relapses is what mental disorders?
PTSD and depression
106
What is one major cause of insomnia?
Depression
107
What meds are used for pt with insomnia?
Benzos Nonbenzos: Zaleplon (Sonata) and Ezopiclone (Lunesta) Melatonin: Ramelteon Antidepressants: Trazadone, amitriptyline, doxepin, mirazapine OTC: Antihistamines
108
What nonpharm interventions can the nurse do for a pt. with insomnia?
Sleep hygiene
109
Diagnosis tool for sleep apnea
polysomnography
110
Primary Hypersomnia
Excessive sleepiness for at least 1 month with daytime sleep episodes OR sleeping extended periods at night
111
How long does a pt. with Primary Hypersomnia sleep?
8-12 hours
112
Symptoms of Primary Hypersomnia
``` 8-12 hours of sleep Difficulty awakening Poor concentration and memory Excessive daytime sleepiness Napping ```
113
Diagnosis tool for Primary Hypersomnia
Polysomnography | Multiple sleep latency tests
114
Meds for Primary Hypersomnia
``` Dextroamphetamine and amphetamine mix Modafinil Methylphenidate Pemoline Caffeine Stimulants to help daytime sleepiness ```
115
Narcolepsy
Irresistible urge to sleep at any time of the day regardless of amount of previous sleep
116
Cataplexy
Bilateral loss of muscle tone | Symptom of narcolepsy
117
Symptoms of Narcolepsy
Daytime sleepiness Hypnagogic hallucinations Sleep paralysis Cataplexy
118
Meds for Narcolepsy
CNS stimulants | TCAs - cataplexy
119
Restless Leg Syndrome
urge to move legs | worsens at times of rest
120
Chronotherapy
timed interventions, manipulates the sleep schedule by progressively delaying bedtime until acceptable time
121
Chronopharmacotherapy
Resets the biologic clock by using medications to induce sleep
122
Luminotherapy
(light therapy) | Used to manipulate the circadian system
123
Meds for Restless leg syndrome
Pramipexole Rotigotine Cabergoline Gabapentin***
124
Prazosin is helpful when Tx what sleep disorder?
Nightmare disorder | also PTSD
125
Disorders of arousal meds:
Benzos
126
Exhibitionism
The behavior involves exposing one’s genitals to strangers, with occasional masturbation
127
Fetishism
An object such as women’s undergarments or foot apparel is used for sexual arousal. Fetishism usually begins in adolescence and continues throughout life.
128
Frotteurism
Sexually arousing urges, fantasies, and behaviors occur when touching or rubbing one’s genitals against the breasts, genitals, or thighs of a NONconsenting person. begins in early adolescence or young adulthood and diminishes with age.
129
Pedophilia
Sexual activity occurs with a child usually 13 yrs of age or younger by an individual at least 16 yrs of age or 5 yrs older than the child. AGAINST THE LAW
130
Sexual masochism
This behavior involves the act of being humiliated, beaten, bound, or made to suffer. Self-induced masochistic acts include use of electric shock, pin sticking, restraints, and mutilation
131
Sexual sadism
Sexual excitement occurs when causing physical or psychological suffering to another individual. various forms of physical punishment, use of restraints, rape, burning, stabbing, strangulation, torture, and murder.
132
Transvestic fetishism
This behavior applies generally to the heterosexual man who cross-dresses for the purpose of sexual excitement.
133
Voyeurism
This behavior involves “peeping,” for the purpose of sexual excitement, at unsuspecting people who are nude, undressing, or engaged in sexual activity. AGAINST THE LAW
134
zoophilia
sexual activities involving animals
135
necrophilia
sexual activities involving dead bodies
136
coprophilia
sexual activities involving feces
137
urophilia
sexual activities involving urine
138
partialism
sexual activities involving body parts
139
telephone scatalogia
sexual activities involving obscene telephone calls
140
A client has been diagnosed with erectile dysfunction. The nurse would expect the client to be placed on which of the following medications?
PDE5 Meds: sildenafil, vardenafil, tadalafil, and avanafil
141
Which of the following is a characteristic of Anorexia Nervosa? a. ) Uncontrollable binging w/o compensatory behaviors b. ) intense fear of weight gain c. ) inappropriate compensatory behaviors c. ) recurrent episodes of uncontrollable binging
B - intense fear of weight gain
142
Autism spectrum disorder (ASD)
Neurodevelopment delays with or w/o intellectual disabilities
143
Nurse is caring for a pt with autism spectrum disorder. What skill can the nurse expect the pt. to lack?
Social skills | May be intelligent and have appropriate language
144
What type of repetitive behaviors might be exhibited in a pt. with autism spectrum disorder
Rocking | Hand flapping
145
Interventions for autism spectrum disorder
``` Education of self-care skills Physical safety Admin antipsychotics for behavioral difficulties Focus on building strengths Positive reinforcement Structured environment Redirect Ignore repetitive behavior ```
146
ADHD commonly diagnosed at what age?
3-17
147
ADHD
Persistent pattern of inattention, hyperactivity and impulsiveity
148
ADHD is Tx with what kind of meds?
``` Psychostimulants Atomexetine Bupropion TCAs Alpha agonists ```
149
Pt. has ADHD and is taking psychostimulants for Tx. The pt came in last year for annual check up. This year the nurse will want to check for what SE of psychostimulants?
Assess height and weight | Psychostimulants can cause growth stunt
150
When should the psychostimulants be given?
Preferably in the morning w/ meals | A minimum of 6 hours before bedtime
151
Atomexetine used to Tx ADHD
SNRI | Taken in conjunction with psychostimulants
152
Assessments for alpha agonist used to Tx ADHD
Monitor BP Stay hydrated Avoid extreme high temps.
153
Where should a kid with ADHD do their homework? a. ) At the kitchen table b. ) A room with music playing quietly c. ) on the couch d. ) in a room by themselves
In a room by themselves - quiet and no distractions
154
Environment for ADHD
Predictable environment with decreased stimuli | One task at a time
155
Motor Tics
Quick jerky movements of the eyes, face, neck, and shoulders
156
Phonic tics
Repetitive throat clearings, grunting, or other noises or complex sounds such as words, or parts of words, or possibly obscenities
157
Tourette disorder
Multiple motor and phonic tics OCD also frequently occurs Affects boys more than girls Onset: 7 yr.
158
What meds are used to Tx Tourette disorder
Antipsychotics - aripiprazole (2nd gen) | Alpha agonists - clonidine
159
True/False: Phonic tic come before motor tics
False - motor tics first
160
Schoolphobia
manifestation of anxiety
161
OCD Tx with what kind of meds?
SSRI
162
Enuresis
Bed wetting after potty training; regression
163
Encopresis
Fecal soiling after potty training; regression Fecal deposition in inappropriate places Test for Hirschsprung disease (colon died)
164
Desmopressin
Used for Tx of Enuresis | Does not cure disorder; acute control
165
Sexual maturation
4 areas: biosexual identity, gender identity, sex role identity, and sexual orientation
166
Biosexual identity
anatomic and physiologic states of being male and female
167
Gender identity
the conviction of belonging to a male or female gener
168
Sex role identity
outward expression of gender, including behaviors, feelings, and attitudes
169
Sexual orientation
a person's sexual attraction to those f the opposite sex, same sex, or both sexes
170
Sexual desire
the ability, interest, or willingness to recieve or a motivational state to seek sexual stimulation
171
Masters and Johnson Classic Human sexual response cycle
``` 4 phases: Excitement Plateau Orgasmic Resolution ```
172
Kaplan model of sexual response
3 phases: Desire Excitement Orgasm
173
Anorgasmia
Inability to achieve an orgasm
174
Orgasmic disorder
The inability to reach orgasm by any means
175
Senate focus
Method for partners to learn what each finds arousing and learn to communicate those preferences
176
Premature ejaculation
Inability to control ejaculation before or shortly after penetration
177
Erectile Dysfunction
refers to the inability to acheive or maintain an erection sufficient for satisfactory completion of the sexual activity
178
Dyspareunia
genital pain associated with sexual intercourse
179
Vaginismus
Spastic involuntary constriction of the parineal and out vaginal muscles
180
Gender dysphoria
an incongruence between an individuals experience/expressed gender and assigned gender
181
Egocentrism
concept of imaginary audience and personal fable (they are special and unique)
182
Attachment
the emotional bond between an infant and his/her parental figure
183
Attachment disorganization
consequence of extreme insecurity that results from feared or actual seperation from the attached figure.
184
Temperament
person's characteristic intensity, activity level, threshold of responsiveness
185
Easy temperament
positive mood, regular patterns of eating and sleeping, positive approach to new situations, and low emotional intensity
186
Difficult temperament
irregular sleep and eating patterns, negative response to new stimuli, slow adaptation, negative mood, and high emotional intensity
187
Slow to warm up temperament
negative, mildly emotional response to new situations that is expressed with intensity and initially slow adaptation but evolves into a positive response
188
What is the key diagnostic criteria for delirium?
Impaired consciousness
189
Aphasia
Alteration in language ability
190
Apraxia
Impaired ability to execute motor activities despite intact motor functions
191
Agnosia
Failure to recognize or identify objects despite intact sensory function
192
Disturbance of executive functioning
Ability to think abstractly, plan, initiate, sequence, monitor, and stop complex behavior
193
Hallmarks of alzheimer's disease
Beta-amyloid plaques | Neurofibrillary tangles
194
What neurotransmitter is reduced in a pt. with alzheimer's disease?
ACh - acetylcholine
195
Catastrophic reactions
overreactions or extreme anxiety reactions to everyday situations
196
Meds for Alzheimer's Disease
``` Acetylcholinesterase inhibitors - inhibit enzymes that breakdown ACh Donepezil Galantamine Mementine Rivastigmine ```
197
What mental impairment in that occurs usually in older adults is an EMERGENCY?
Delirium
198
What major med can cause delirium?
Steroids
199
What physical disorder can cause delirium?
UTI** Hypoglycemia Hypoxia
200
True/False: The nurse should inform the family member of an Alzheimer's pt. that things will only get worse
True but word it better lol
201
Sleep wake disturbance that occurs in Alzheimer's
Sun downing
202
What is an intervention the hospital can implement for pt. with alzheimer's trying to leave the hospital consitently
Put locks higher than eye level
203
Erikson's Stage: Trust vs. mistrust
Infancy Is my world safe Feeding/comfort
204
Erikson's Stage: Autnomy vs. shame/doubt
Early Childhood 2-3 years Can I do things by myself or need I always rely on others? Toilet training/Dressing
205
Erikson's Stage: Initiative vs. guilt
Preschool 3-5 years Am I good or bad? exploration/play
206
Erikson's Stage: Industry vs. Inferiority
School Age 6-11 How can I be good? School/activities
207
Erikson's Stage: Identity vs. Role Confusion
Adolescence 12-18 Who am I and where am I going? Social relationships/Identity
208
Erikson's Stage: Intimacy vs. Isolation
Young adult 19-40 Am I loved and wanted? Intimate relationships
209
Erikson's Stage: Generatively vs. Stagnation
Middle Adulthood 40-65 Will I provide something of real value Work and parenthood
210
Erikson's Stage: Ego identity vs. despair
Maturity 65 + Have I lived a full life? Reflection on life
211
Nuclear Family
2+ people living together and related by blood/marriage/adoption
212
Extended family
Several nuclear families
213
Calgary Family Model
Structure Development Functional Four stages: engagement, assessment, intervention, and termination
214
Minuchin Family Model
Family structure Subsystems Boundaries
215
Bowen Family System Model
``` Differentiation of self Triangles Family projection Emotional process Multigenerational transmission process Sibiling position Emotional cutoff ```
216
Examples of using coercion and threats
Threatening to leave, commit suicide, hurt her | Make her drop charges or do illegal things
217
Examples of using intimidation
Making her afraid by using looks, actions, gestures | Smashing things, destroying property, abusing pets. displaying weapons
218
Examples of using economic abuse
Preventing her from getting/keeping a job Making her ask for money Taking her money Not letting her have access to money
219
Examples of using male priviledge
Treating her like a servant Master of the castle Making all big decisions
220
Examples of emotional abuse
``` Putting her down Making her feel bad Calling names Playing mind games Humiliating her Making her feel guilty ```
221
Examples of using isolation
Controlling what she does, reads, or sees, where she goes, limiting outside involvement
222
Examples of using children
Making her feel guilty about the children Using children to rely messages Threatening to take the children away
223
Examples of minimizing, denying, and blaming
Making light of the abuse and not taking her concerns about it seriously Saying the abuse doesn't happen Saying she caused it
224
Stalking
Repeated unwanted contact, attention, and harassment
225
Sexual assualt
Include any form on nonconsenting sexual activity, ranging from fondling to penetration
226
Child maltretment
Includes all type of abuse or neglect of a child under 18
227
Intergenerational transmission of violence
Theory suggests that children who witness or experience violence in their homes often perpetuate violent behavior

Psych (19 decks)

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