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Exam 5-Level 3 > Exam 5 > Flashcards

Exam 5 Flashcards

1
Q

A client takes imipramine for depression. Which indicates a need for further instruction?

A

I know my physician prescribed this medication due to being first-line therapy for depression.

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2
Q

A client being prescribed venlafaxine requests more information on this drug. The nurse responds appropriately with which statement?

A

You should not abruptly discontinue this drug after you begin taking it.

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3
Q

The nurse prepares to administer lithium carbonate to a client. Which lithium level would concern the nurse the most?

A

1.6

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4
Q

The nurse giving a seminar lecture regarding the safe use of anticonvulsive medication would include what in her lecture? select all that apply

A

valproic acid, carbamazepine

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5
Q

Signs and symptoms of acute hypertension that can occur with MAOI drugs include which. Select all that apply.

A

Occipital headache, Stiff neck, Flushing, Diaphoresis

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6
Q

Duloxetine belongs to which drug class?

A

SNRI

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7
Q

Which would indicate a normal depakene (valproic acid level)?

A

52

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8
Q

A client taking isocarboxyzid should have which lunch tray?

A

Cottage cheese, apples, grapes, pears, apple pie, and water.

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9
Q

What is the greatest predictor of suicide?

A

Client with a previous suicide attempt.

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10
Q

The nurse assisting with electroconvulsive therapy knows to recover the client in which position?

A

Lateral recumbent

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11
Q

Which of the following would the nurse observe in a client for if suspecting major depression? Select all that apply.

A

Insomnia, Weight gain, Feelings of hopelessness, Anhedonia

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12
Q

What is an atypical antidepressant sometimes prescribed for smoking cessation or seasonal affective disorder?

A

Bupropion

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13
Q

Which duration is required by the DSM V for an official diagnosis with major depression?

A

2 Weeks

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14
Q

Which of the following is the MOST important intervention for a suicidal client?

A

Begin 1:1 observation of the client

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15
Q

Which is included in caring for a manic client in the acute care psychiatric unit?

A

Set limits on behaviors

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16
Q

Lithium is contraindicated in which client conditions? Select all that apply.

A

pregnant in 1st trimester, CHF , sodium-restricted diet

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17
Q

Which ethnicity have possible increased risk of toxicity with drugs such as lithium due to liver metabolism of drugs?

A

Asian

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18
Q

Which of the following drugs is an SSRI?

A

Escitalopram

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19
Q

Signs and Symptoms of Serotonin Syndrome include which of the following? Select all that apply

A

Myoclonus, Shivering, BP 188/122

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20
Q

Which of the following are MAOIs? Select all that apply

A

Isocarboxyzid, tranylcypromine, phenelzine

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21
Q

What is the most common psychiatric illness world-wide and largest cause of disability?

A

Major depression

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22
Q

What are the DSM-5 criteria of major depression?

A

Anhedonia, significant weight change, change in sleep, change in activity, fatigue, guilt or worthlessness, concentration, suicidality

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23
Q

What are the first line meds for depression due to lower side effect profile?

A

SSRI

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24
Q

What are side effects of SSRI?

A

Stomach upset, sexual dysfunction, serotonin syndrome

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25
Q

What is the acronym for SSRI Meds

A

Sad Sera’s Really Irritable(because) Fruit Flies (are such a) PESC!

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26
Q

What gender is most affected by depression

A

Women

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27
Q

When does depression normally onset?

A

Mid-Twenties

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28
Q

What factor makes it 3 times more likely for someone to develop major depression?

A

First-Degree biologic relatives

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29
Q

What meds are SSRIs?

A

Fluoxetine, fluvoxamine, paroxetine, escitalopram, sertraline, citalopram

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30
Q

What action does SNRIs have?

A

Blocks reuptake of norepinephrine as well as serotonin

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31
Q

What is the acronym for SNRIs

A

DVD

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32
Q

What does DVD stand for?

A

Duloxetine, Venlafaxine, Desvenlafaxine

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33
Q

What sign effects do SNRIs have?

A

tremors, nausea, headache, dry mouth, blurred vision, increased BP, sexual side effects, nervousness, dizziness

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34
Q

What are some good teaching points for SNRIs?

A

Side effects, monitor for increased BP, sugar-free beverages and hard candy for dry mouth, take with food, monitor for suicide(energy increases before mood) other medications are available if do not work.

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35
Q

What is the action of Tricyclic Antidepressants(TCAs)

A

Block reuptake of serotonin and norepinephrine as well as histamine and acetylcholine-older medications and not used as often due to issues with side effects.

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36
Q

What questions should you ask the patient if suicide ideation is suspected

A

Do they have thoughts of suicide, do they have a plan, do they have the means?

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37
Q

Thrombocytopenia, cardiac symptoms, anticholinergic, seizures are side effects of what class of meds?

A

TCAs

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38
Q

What are some teaching points for TCAs

A

how to manage side effects, caution in clients with glaucoma, cardiac disease and diabetes, caution that these drugs are very sedating and can take a fatal overdose, can trigger hallucinations in those with latent schizophrenia

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39
Q

What is the acronym for TCAs?

A

Ami’s Dinner Included No Protein!

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40
Q

What medications are TCAs?

A

Amitriptyline, desipramine, imipramine, nortriptyline, protriptyline

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41
Q

An enzyme called monoamine oxidase is involved in removing the neurotransmitters, norepinephrine, serotonin and dopamine from the brain

A

MAOIs prevent this from happening

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42
Q

Period of 2-6 weeks when changing from another drug to MAOI

A

“wash out” period

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43
Q

What major side effect is caused if patients on MAOIs do not follow dietary guidelines?

A

Dangerously high BP

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44
Q

What should patient’s on MAOIs avoid?

A

tyramine

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45
Q

What is the acronym for MAOIs?

A

Pepperoni Incudes Tyramine

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46
Q

What medications Pepperoni Includes Tyramine stand for?

A

Phenelzine, Isocarboxyzid, Tranylcypromine

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47
Q

Occipital headache, palpitation, reck stiffness, nausea, vomiting, sweating, dilated pupils, photophobia, tachy or bradycardia are symptoms of?

A

Hypertensive Crisis

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48
Q

Side effects of MAOI

A

insomnia, muscle aches, low BP, dry mouth, sexual side effects, nervousness, dizziness, avoid decongestants

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49
Q

Teaching points for MAOIs

A

low-tyramine diet, report taking new meds, s/s of hypertensive crisis, monitor suicidal ideation.

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50
Q

Occurs when there is an inadequate wash-out period between and SSRI and an MAOI of when two or more substances are being ingested that increase serotonin in the CNS

A

Serotonin Syndrome

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51
Q

How do you diagnose Serotonin Syndrome

A

No antipsychotic meds used or increased, symptoms make serotonin levels rise, no other obvious causes of fever or confusion

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52
Q

S/s of Serotonin Syndrome

A

mental status change, agitation, myoclonus, shivering, diarrhea, hyper-reflexia, Ataxia/incoordination, diaphoresis, fever

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53
Q

Nursing interventions for serotonin syndrom?

A

discontinue, supportive measures to reduce hypertension, respiratory distress, tachycardia, and hyperthermia, benzodiazepines(diazepram/lorezepam) treat myoclonus and resultant hyperthermia, other meds (pg.688)

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54
Q

What medication is ineffective in treating serotonin syndrome?

A

Clonazepam

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55
Q

Whats very important to remember for antidepressants?

A

They give the energy to go through with suicide

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56
Q

What should happen when starting elderly people on antidepressants?

A

START LOW AND GO SLOW

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57
Q

What affects can antidepressants have on patients with bipolar disorder?

A

cause Manic episodes

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58
Q

What another form of treatment for major depressive disorder?

A

Electroconvulsive Therapy(ECT)

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59
Q

procedure in which a small electric current is passed through the brain, stimulating a seizure-like response?

A

ECT

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60
Q

What does ECT intel?

A

12 treatments

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61
Q

What medication is given 30 min prior to ECT to reduce secretions?

A

Atropine

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62
Q

A chronic depressive state for the majority of days for at least 2 years?

A

dysthymic disorder

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63
Q

depression that occurs usually in the winter months due to natural changes in light, etc.

A

Seasonal affective disorder(SAD)

64
Q

What medication is used to treat SAD?

A

bupropion(wellbutrin)

65
Q

depression related to hormonal changes after birth

A

postpartum depression

66
Q

period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week and present most of the day

A

Manic episode

67
Q

Inflated sense of self-esteem(grandiosity), decreased need for sleep, more talkative, distractibility, increase in goal oriented activity(psychomotor agitation), excessive involvement in activities that have high painful consequences

A

s/s of a manic episode

68
Q

DIG FAST

A

distractibility, indiscretion, grandiosity, flight of ideas, activity increase, sleep deficit, talkativeness.

69
Q

Dysphoric, decrease in pleasure, fatigue, decreased appetite, constipation, insomnia, decreased libido, suicidal preoccupation, movement retardation

A

s/s of depressive side of bipolar disorder

70
Q

chronic fluctuating mood disturbances involving numerous periods of hypomanic symptoms and numerous periods of depressive symptoms

A

cyclothymic

71
Q

God standard treatment for bipolar disorder; a salt

A

lithium

72
Q

therapeutic range for lithium

A

0.6-1.5

73
Q

how often are blood levels tested for patients using lithium

A

2/3 months

74
Q

early s/s of lithium toxicity

A

vomiting, diarrhea, lethargy and muscle twitching

75
Q

late s/s of lithium toxicity

A

Ataxia, slurred speech, change in consciousness, seizures, electrolyte imbalances that can lead to cardiac arrest

76
Q

Whats the therapeutic divalproex sodium levels

A

50-100

77
Q

What mediation can cause stevens-johnson syndrome

A

Lamictal

78
Q

neural tube defects, craniofacial and cardiovascular anomalies fetal growth restriction, and cognitive impairment

A

exposure to valproic acid during pregnancy

79
Q

needed if psychosis is present

A

atypical antipsychotics

80
Q

interventions for people in manic episode

A

keep noise level low, anticipate situations or activities, assign one person to provide controls and limits, guard vigilantly against suicide, accompany client to room as needed, meet physical and nutritional needs.

81
Q

72% of suicides are…

A

Men

82
Q

having thoughts of harming or killing oneself

A

suicidal ideation

83
Q

a treat that is more serious than a casual statement of suicidal intent and that is accompanied by other behavior changes

A

suicide threat

84
Q

non-fatal, self-inflicted destructive act with explicit or inferred intent to die

A

suicide attempt

85
Q

a fatal, self-inflicted destructive act with explicit or inferred intent to die

A

suicide

86
Q

Nursing interventions for suicidal client

A

take any threat seriously, talk about suicide openly and directly, implement suicide precautions/restrictive status and initiate 1:1 observation, perform physical assessment, search clients room, decide if a no self-harm/ no suicide

87
Q

most often occurs in 14-24 indicates an excessive number of suicides occurring in a close proximity in either time or geographical location

A

cluster suicide

88
Q

an altered immune response to an antigen( a foreign substance triggering the immune response? that results in harm to the client

A

hypersensitivity

89
Q

risk factors for hypersensitivity

A

previous exposure because antigens must be formed, age, sex, concurrent illnesses, and previous reactions to related substance, having a family member with an allergy

90
Q

Localized or systemic reactions: igE

A

type 1 hypersensitivity

91
Q

an acute systemic type 1 response that may result in shock and death

A

anaphylaxis

92
Q

insulin, ragweed, grass, trees, eggs, seafoods, nuts, grains, beans, chocolate, cotton seed oil, thiamine, folic acid, yellow jacket, honey bee, rubber products

A

substances known to rigger anaphylaxis

93
Q

s/s of anaphylaxis

A

sense of foreboding or uneasiness, lightheadedness, itching palms and scalp, hives along with angioedema, swelling can affect the uvula and larynx impairing breathing, client exhibits air hunger, stridor and wheezing, barking cough, vasodilation

94
Q

immediate treatment for anaphylaxis, an adrenergic agonist drug that has both vasocontricting and bronchodilating effects

A

epinephrine

95
Q

has been shown to be effective in preventing anaphylactic responses to insect venom

A

immunotherapy

96
Q

Nursing actions for anaphylaxis

A

ABCs, fowler(high fowler), assess respiratory rate and pattern, administer o2 intubation subq diphenhydramin, insert IV(if cardiac output fails 18g) warm IV fluids, leg elevated, aggressive fluids

97
Q

a hemolytic reaction to blood of an incompatible type is characteristic of a type 2 or cytotoxic hypersensitivity

A

transfusion reactions

98
Q

People who have an allergy to bananas, kiwi, tomatoes, bells peppers, and avocados may have an allergy to…

A

Latex

99
Q

rash on the hands, hives, nasal congestion, conjunctivitis, cough or wheeze

A

s/s of latex allergy

100
Q

chronic systemic autoimmune disorder, causes inflammation of connective tissue, primarily in the joints

A

rheumatoid arthritis

101
Q

joint deformity, redness warmth pain, stiffness in the morning lasting more than an hour, carpal tunnel, rheumatoid nodules, neck pain, anemia

A

s/s of rheumatoid arthritis

102
Q

risk factors for RA

A

family history, heavy smokers

103
Q

treatments for RA

A

rest, exercise, PT, and suppression of inflammatory process, heat and cold, assistive devices

104
Q

synovectomy, arthrodesis, arthroplasty

A

surgical treatments for RA

105
Q

pharm treatment for RA

A

NSAIDs, Low-dose corticosteriods, DMARDs

106
Q

What can RA cause that is potentially damaging all organs of the body

A

Anemia

107
Q

types of deformity in RA

A

swan neck, boutonniere, ulnar deviation

108
Q

chronic inflammatory connective tissue disease of unknown origin that affects almost all body systems, including the musculoskeletal system, characterized by remissions and exacerbations

A

Systemic Lupus Erythematous

109
Q

Risk factors for SLE

A

genetic predisposition, enviromental factors suchs as viruses, bacterial antigens, chemicals, UV, drugs, women, AA, Hispanic, NA, asians

110
Q

painful/swollen joints, muscle pain, unexplained fever, red rash in the face, unusual loss of hair, pale or cyanotic, sensitivity to the sun, edema in legs or eyes, ulcers in the mouth

A

s/s of SLE

111
Q

treatments for SLE

A

no surgical treatment, NSAIDs, Hydroxychoroquine, corticosteroids

112
Q

Lupus limited to the skin

A

Discoid lupus

113
Q

anti-dna, erythrocyte sedimentation rate, serum complement levels, CBC, Urinalysis, kidney biopsy

A

lab tests for SLE

114
Q

family planning with SLE

A

avoid birth control pills with estrogen, this can exacerbate symptoms

115
Q

immune-mediated disorder of the CNS in which immune cells attack the myelin sheath around nerve cells, causing decreased transmission of nervous signals

A

Multiple Sclerosis

116
Q

s/s of MS

A

fatigue, paresthesia, lack of coordination, unsteady gait, tremors, bladder and bowel dysfunction, visual disturbances, pain, cognitive dysfunction

117
Q

Environmental factors, infectious factors, genetic risk factors, diagnosed b/w ages 20-40, women, european descent, smoking

A

risk factors for MS

118
Q

Medications for MS

A

Baclofen, diazepam, dexamethasone, isoniazid, prednisone

119
Q

Importance of rest in MS

A

fatigue is common symptoms, prevent exacerbations

120
Q

Does vit D play a role in MS

A

people who live further from the equator and are exposed to less sunlight are more likely to develop MS

121
Q

therapies for MS

A

ST,OT,PT

122
Q

chronic, recurrent, infections disease caused by mycobacterium tuberculosis, a relatively slow-growing, slender, rod-shaped, acid-fast organism with a waxy outer capsule that increases it’s resistance to destruction, most commonly affects the lungs

A

Tuberculosis

123
Q

s/s of TB

A

fatigue, weight loss, diminished appetite, low-grade afternoon fever, night sweats, SOB, hypoxia, dry cough hemoptysis, TB empyema and bronchopleural fistula

124
Q

immigrants, people with HIV/AIDs, racial and ethical minorities

A

risk factors for TB

125
Q

A behavioral health clinic nurse assesses a 23 yr old client who started taking paroxetine 3 weeks ago. Which statement made by the client is MOST important for the nurse to investigate?

A

I have alot more energy, but I’m feeling just as depressed

126
Q

A nurse is discharging a client who is receiving lithium for treatment of bipolar disorder. It is MOST important for the nurse to provide which instruction?

A

Report excessive urination and increased thirst

127
Q

The nurse at a mental health clinic is performing a suicide risk screening on 4 clients experiencing depression. Which client does the nurse recognize as being most at risk for suicide?

A

Divorced male client with Parkinson disease who was recently laid off from his job.

128
Q

The nurse completes the following drug administration. Which would require an incident report?

A

Client with depression stopped phenelzine(MAOI) yesterday; escitalopram(SSRI) given today

129
Q

A client with bipolar disorder is admitted to the psychiatric unit with acute mania and dehydration. Which prescription does the nurse question?

A

Continue prescribed home dose of 300 mg lithium PO every 8 hours

130
Q

The RN supervises a SN who is caring for a client newly prescribed lithium for the treatment of bipolar disorder. Which action indicated need for further teaching?

A

Shows the client how to carefully check food labels to follow a low sodium diet

131
Q

a client recently diagnosed with a major depressive disorder reports use of herbal supplements. it is MOST important for the nurse to provide education about which supplement reported by the client?

A

st. john’s wort

132
Q

A nurse on BHU is reviewing medications prescriptions for 4 clients. Which combination of medications does the nurse question?

A

a client with depression prescribed escitalopram and selegiline

133
Q

the clinic nurse evaluates a client who was prescribed lithium therapy for bipolar disorder. What client statement would cause the MOST concern?

A

ive had the stomach flu for the past couple of days

134
Q

A client has been on lithium carbonate therapy for 7 days. Which of the following would be MOST important to report to the HCP?

A

diarrhea, vomiting, and tremor

135
Q

The nurse is caring for a client admitted with serotonin syndrome after taking citalopram and tramadol. Which assessment findings does the nurse expect to find?

A

Muscle rigidity, restlessness and agitation, sinus tachycardia

136
Q

The nurse is caring for a client admitted with an acute manic episode of bipolar disorder. The nurse identifies which dinner selection as the MOST appropriate to promote client nutrition?

A

cheeseburger, apple, vanilla milkshake.

137
Q

A nurse is caring for a client who was admitted following a failed suicide attempt. Which. client statement is most concerning?

A

very soon everything will be better

138
Q

testing for TB

A

PPD(Mantoux test) , multiple puncture test

139
Q

Meds for TB

A

isoniazid, rifampin, pyrazinamide, ethambutol fo first 2 months

140
Q

What should the nurse instruct the patient taking rafampin

A

may turn urine or secretions orange

141
Q

Diagnostic tests for TB

A

repeat sputum specimens and chest xrays

142
Q

nursing interventions for TB

A

private room with negative airflow room, standard precautions, N95 for nurse, respiratory isolation, visitors masks, limiting transmissions.

143
Q

ways to limit transmission of TB

A

always cough into tissues, dispose of them in a closed bag, wear a mask if sneezing, disease is not spread by touching inanimate objects

144
Q

a collection of chronic inflammatory conditions of the intestines. client experiences symptom free remissions with sporadic periods of active disease

A

Inflammatory bowel disease

145
Q

affects the mucosa and submucosa of the colon and rectum.

A

Ulcerative Colitis

146
Q

usually in the large bowel, sigmoid or rectum

A

Ulcerative Colitis

147
Q

can affect any portion of the GI tract from the mouth to the anus, but it usually affects the terminal ileum and ascending colon.

A

Inflammatory bowel disease(Crohns)

148
Q

cobblestone appearance, fistulization, abscess formation, malabsorption

A

IBD, Crohns

149
Q

diarrhea with blood and mucus, 6 or fewer stools, rectal inflammation causes fecal urgency, LLQ cramping, Fatigue/anorexia, hemorrhage

A

s/s of ulcerative colitis

150
Q

Persistent diarrhea, abdominal pain and tenderness in RLQ, palpable RLQ mass, fever/fatigue/malaise, Anorectal lesions

A

Crohn’s s/s

151
Q

tissue appearance of UC

A

granular, dull, hyperemic, friable, disease uniform, possibly pseudopolyps

152
Q

tissue appearance of Crohn’s

A

cobblestone, areas of normal issue surrounded by ulceration and fissures.

153
Q

Risk factors for IBD

A

occurs more frequently in US, American jews and european, african americans/whites, immune system, environmental factors, smoking NSAIDS

154
Q

toxic megacolon, perforation, massive hemorrhage, colorectal cancer is a longterm complication

A

UC

155
Q

Obstruction, distulization, abscess, malabsorption, colon cancer

A

Crohn’s

Exam 5-Level 3 (1 decks)

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