Exam 5 Flashcards
A client takes imipramine for depression. Which indicates a need for further instruction?
I know my physician prescribed this medication due to being first-line therapy for depression.
A client being prescribed venlafaxine requests more information on this drug. The nurse responds appropriately with which statement?
You should not abruptly discontinue this drug after you begin taking it.
The nurse prepares to administer lithium carbonate to a client. Which lithium level would concern the nurse the most?
1.6
The nurse giving a seminar lecture regarding the safe use of anticonvulsive medication would include what in her lecture? select all that apply
valproic acid, carbamazepine
Signs and symptoms of acute hypertension that can occur with MAOI drugs include which. Select all that apply.
Occipital headache, Stiff neck, Flushing, Diaphoresis
Duloxetine belongs to which drug class?
SNRI
Which would indicate a normal depakene (valproic acid level)?
52
A client taking isocarboxyzid should have which lunch tray?
Cottage cheese, apples, grapes, pears, apple pie, and water.
What is the greatest predictor of suicide?
Client with a previous suicide attempt.
The nurse assisting with electroconvulsive therapy knows to recover the client in which position?
Lateral recumbent
Which of the following would the nurse observe in a client for if suspecting major depression? Select all that apply.
Insomnia, Weight gain, Feelings of hopelessness, Anhedonia
What is an atypical antidepressant sometimes prescribed for smoking cessation or seasonal affective disorder?
Bupropion
Which duration is required by the DSM V for an official diagnosis with major depression?
2 Weeks
Which of the following is the MOST important intervention for a suicidal client?
Begin 1:1 observation of the client
Which is included in caring for a manic client in the acute care psychiatric unit?
Set limits on behaviors
Lithium is contraindicated in which client conditions? Select all that apply.
pregnant in 1st trimester, CHF , sodium-restricted diet
Which ethnicity have possible increased risk of toxicity with drugs such as lithium due to liver metabolism of drugs?
Asian
Which of the following drugs is an SSRI?
Escitalopram
Signs and Symptoms of Serotonin Syndrome include which of the following? Select all that apply
Myoclonus, Shivering, BP 188/122
Which of the following are MAOIs? Select all that apply
Isocarboxyzid, tranylcypromine, phenelzine
What is the most common psychiatric illness world-wide and largest cause of disability?
Major depression
What are the DSM-5 criteria of major depression?
Anhedonia, significant weight change, change in sleep, change in activity, fatigue, guilt or worthlessness, concentration, suicidality
What are the first line meds for depression due to lower side effect profile?
SSRI
What are side effects of SSRI?
Stomach upset, sexual dysfunction, serotonin syndrome
What is the acronym for SSRI Meds
Sad Sera’s Really Irritable(because) Fruit Flies (are such a) PESC!
What gender is most affected by depression
Women
When does depression normally onset?
Mid-Twenties
What factor makes it 3 times more likely for someone to develop major depression?
First-Degree biologic relatives
What meds are SSRIs?
Fluoxetine, fluvoxamine, paroxetine, escitalopram, sertraline, citalopram
What action does SNRIs have?
Blocks reuptake of norepinephrine as well as serotonin
What is the acronym for SNRIs
DVD
What does DVD stand for?
Duloxetine, Venlafaxine, Desvenlafaxine
What sign effects do SNRIs have?
tremors, nausea, headache, dry mouth, blurred vision, increased BP, sexual side effects, nervousness, dizziness
What are some good teaching points for SNRIs?
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.
What is the action of Tricyclic Antidepressants(TCAs)
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.
What questions should you ask the patient if suicide ideation is suspected
Do they have thoughts of suicide, do they have a plan, do they have the means?
Thrombocytopenia, cardiac symptoms, anticholinergic, seizures are side effects of what class of meds?
TCAs
What are some teaching points for TCAs
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
What is the acronym for TCAs?
Ami’s Dinner Included No Protein!
What medications are TCAs?
Amitriptyline, desipramine, imipramine, nortriptyline, protriptyline
An enzyme called monoamine oxidase is involved in removing the neurotransmitters, norepinephrine, serotonin and dopamine from the brain
MAOIs prevent this from happening
Period of 2-6 weeks when changing from another drug to MAOI
“wash out” period
What major side effect is caused if patients on MAOIs do not follow dietary guidelines?
Dangerously high BP
What should patient’s on MAOIs avoid?
tyramine
What is the acronym for MAOIs?
Pepperoni Incudes Tyramine
What medications Pepperoni Includes Tyramine stand for?
Phenelzine, Isocarboxyzid, Tranylcypromine
Occipital headache, palpitation, reck stiffness, nausea, vomiting, sweating, dilated pupils, photophobia, tachy or bradycardia are symptoms of?
Hypertensive Crisis
Side effects of MAOI
insomnia, muscle aches, low BP, dry mouth, sexual side effects, nervousness, dizziness, avoid decongestants
Teaching points for MAOIs
low-tyramine diet, report taking new meds, s/s of hypertensive crisis, monitor suicidal ideation.
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
Serotonin Syndrome
How do you diagnose Serotonin Syndrome
No antipsychotic meds used or increased, symptoms make serotonin levels rise, no other obvious causes of fever or confusion
S/s of Serotonin Syndrome
mental status change, agitation, myoclonus, shivering, diarrhea, hyper-reflexia, Ataxia/incoordination, diaphoresis, fever
Nursing interventions for serotonin syndrom?
discontinue, supportive measures to reduce hypertension, respiratory distress, tachycardia, and hyperthermia, benzodiazepines(diazepram/lorezepam) treat myoclonus and resultant hyperthermia, other meds (pg.688)
What medication is ineffective in treating serotonin syndrome?
Clonazepam
Whats very important to remember for antidepressants?
They give the energy to go through with suicide
What should happen when starting elderly people on antidepressants?
START LOW AND GO SLOW
What affects can antidepressants have on patients with bipolar disorder?
cause Manic episodes
What another form of treatment for major depressive disorder?
Electroconvulsive Therapy(ECT)
procedure in which a small electric current is passed through the brain, stimulating a seizure-like response?
ECT
What does ECT intel?
12 treatments
What medication is given 30 min prior to ECT to reduce secretions?
Atropine
A chronic depressive state for the majority of days for at least 2 years?
dysthymic disorder
depression that occurs usually in the winter months due to natural changes in light, etc.
Seasonal affective disorder(SAD)
What medication is used to treat SAD?
bupropion(wellbutrin)
depression related to hormonal changes after birth
postpartum depression
period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week and present most of the day
Manic episode
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
s/s of a manic episode
DIG FAST
distractibility, indiscretion, grandiosity, flight of ideas, activity increase, sleep deficit, talkativeness.
Dysphoric, decrease in pleasure, fatigue, decreased appetite, constipation, insomnia, decreased libido, suicidal preoccupation, movement retardation
s/s of depressive side of bipolar disorder
chronic fluctuating mood disturbances involving numerous periods of hypomanic symptoms and numerous periods of depressive symptoms
cyclothymic
God standard treatment for bipolar disorder; a salt
lithium
therapeutic range for lithium
0.6-1.5
how often are blood levels tested for patients using lithium
2/3 months
early s/s of lithium toxicity
vomiting, diarrhea, lethargy and muscle twitching
late s/s of lithium toxicity
Ataxia, slurred speech, change in consciousness, seizures, electrolyte imbalances that can lead to cardiac arrest
Whats the therapeutic divalproex sodium levels
50-100
What mediation can cause stevens-johnson syndrome
Lamictal
neural tube defects, craniofacial and cardiovascular anomalies fetal growth restriction, and cognitive impairment
exposure to valproic acid during pregnancy
needed if psychosis is present
atypical antipsychotics
interventions for people in manic episode
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.
72% of suicides are…
Men
having thoughts of harming or killing oneself
suicidal ideation
a treat that is more serious than a casual statement of suicidal intent and that is accompanied by other behavior changes
suicide threat
non-fatal, self-inflicted destructive act with explicit or inferred intent to die
suicide attempt
a fatal, self-inflicted destructive act with explicit or inferred intent to die
suicide
Nursing interventions for suicidal client
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
most often occurs in 14-24 indicates an excessive number of suicides occurring in a close proximity in either time or geographical location
cluster suicide
an altered immune response to an antigen( a foreign substance triggering the immune response? that results in harm to the client
hypersensitivity
risk factors for hypersensitivity
previous exposure because antigens must be formed, age, sex, concurrent illnesses, and previous reactions to related substance, having a family member with an allergy
Localized or systemic reactions: igE
type 1 hypersensitivity
an acute systemic type 1 response that may result in shock and death
anaphylaxis
insulin, ragweed, grass, trees, eggs, seafoods, nuts, grains, beans, chocolate, cotton seed oil, thiamine, folic acid, yellow jacket, honey bee, rubber products
substances known to rigger anaphylaxis
s/s of anaphylaxis
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
immediate treatment for anaphylaxis, an adrenergic agonist drug that has both vasocontricting and bronchodilating effects
epinephrine
has been shown to be effective in preventing anaphylactic responses to insect venom
immunotherapy
Nursing actions for anaphylaxis
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
a hemolytic reaction to blood of an incompatible type is characteristic of a type 2 or cytotoxic hypersensitivity
transfusion reactions
People who have an allergy to bananas, kiwi, tomatoes, bells peppers, and avocados may have an allergy to…
Latex
rash on the hands, hives, nasal congestion, conjunctivitis, cough or wheeze
s/s of latex allergy
chronic systemic autoimmune disorder, causes inflammation of connective tissue, primarily in the joints
rheumatoid arthritis
joint deformity, redness warmth pain, stiffness in the morning lasting more than an hour, carpal tunnel, rheumatoid nodules, neck pain, anemia
s/s of rheumatoid arthritis
risk factors for RA
family history, heavy smokers
treatments for RA
rest, exercise, PT, and suppression of inflammatory process, heat and cold, assistive devices
synovectomy, arthrodesis, arthroplasty
surgical treatments for RA
pharm treatment for RA
NSAIDs, Low-dose corticosteriods, DMARDs
What can RA cause that is potentially damaging all organs of the body
Anemia
types of deformity in RA
swan neck, boutonniere, ulnar deviation
chronic inflammatory connective tissue disease of unknown origin that affects almost all body systems, including the musculoskeletal system, characterized by remissions and exacerbations
Systemic Lupus Erythematous
Risk factors for SLE
genetic predisposition, enviromental factors suchs as viruses, bacterial antigens, chemicals, UV, drugs, women, AA, Hispanic, NA, asians
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
s/s of SLE
treatments for SLE
no surgical treatment, NSAIDs, Hydroxychoroquine, corticosteroids
Lupus limited to the skin
Discoid lupus
anti-dna, erythrocyte sedimentation rate, serum complement levels, CBC, Urinalysis, kidney biopsy
lab tests for SLE
family planning with SLE
avoid birth control pills with estrogen, this can exacerbate symptoms
immune-mediated disorder of the CNS in which immune cells attack the myelin sheath around nerve cells, causing decreased transmission of nervous signals
Multiple Sclerosis
s/s of MS
fatigue, paresthesia, lack of coordination, unsteady gait, tremors, bladder and bowel dysfunction, visual disturbances, pain, cognitive dysfunction
Environmental factors, infectious factors, genetic risk factors, diagnosed b/w ages 20-40, women, european descent, smoking
risk factors for MS
Medications for MS
Baclofen, diazepam, dexamethasone, isoniazid, prednisone
Importance of rest in MS
fatigue is common symptoms, prevent exacerbations
Does vit D play a role in MS
people who live further from the equator and are exposed to less sunlight are more likely to develop MS
therapies for MS
ST,OT,PT
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
Tuberculosis
s/s of TB
fatigue, weight loss, diminished appetite, low-grade afternoon fever, night sweats, SOB, hypoxia, dry cough hemoptysis, TB empyema and bronchopleural fistula
immigrants, people with HIV/AIDs, racial and ethical minorities
risk factors for TB
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?
I have alot more energy, but I’m feeling just as depressed
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?
Report excessive urination and increased thirst
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?
Divorced male client with Parkinson disease who was recently laid off from his job.
The nurse completes the following drug administration. Which would require an incident report?
Client with depression stopped phenelzine(MAOI) yesterday; escitalopram(SSRI) given today
A client with bipolar disorder is admitted to the psychiatric unit with acute mania and dehydration. Which prescription does the nurse question?
Continue prescribed home dose of 300 mg lithium PO every 8 hours
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?
Shows the client how to carefully check food labels to follow a low sodium diet
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?
st. john’s wort
A nurse on BHU is reviewing medications prescriptions for 4 clients. Which combination of medications does the nurse question?
a client with depression prescribed escitalopram and selegiline
the clinic nurse evaluates a client who was prescribed lithium therapy for bipolar disorder. What client statement would cause the MOST concern?
ive had the stomach flu for the past couple of days
A client has been on lithium carbonate therapy for 7 days. Which of the following would be MOST important to report to the HCP?
diarrhea, vomiting, and tremor
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?
Muscle rigidity, restlessness and agitation, sinus tachycardia
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?
cheeseburger, apple, vanilla milkshake.
A nurse is caring for a client who was admitted following a failed suicide attempt. Which. client statement is most concerning?
very soon everything will be better
testing for TB
PPD(Mantoux test) , multiple puncture test
Meds for TB
isoniazid, rifampin, pyrazinamide, ethambutol fo first 2 months
What should the nurse instruct the patient taking rafampin
may turn urine or secretions orange
Diagnostic tests for TB
repeat sputum specimens and chest xrays
nursing interventions for TB
private room with negative airflow room, standard precautions, N95 for nurse, respiratory isolation, visitors masks, limiting transmissions.
ways to limit transmission of TB
always cough into tissues, dispose of them in a closed bag, wear a mask if sneezing, disease is not spread by touching inanimate objects
a collection of chronic inflammatory conditions of the intestines. client experiences symptom free remissions with sporadic periods of active disease
Inflammatory bowel disease
affects the mucosa and submucosa of the colon and rectum.
Ulcerative Colitis
usually in the large bowel, sigmoid or rectum
Ulcerative Colitis
can affect any portion of the GI tract from the mouth to the anus, but it usually affects the terminal ileum and ascending colon.
Inflammatory bowel disease(Crohns)
cobblestone appearance, fistulization, abscess formation, malabsorption
IBD, Crohns
diarrhea with blood and mucus, 6 or fewer stools, rectal inflammation causes fecal urgency, LLQ cramping, Fatigue/anorexia, hemorrhage
s/s of ulcerative colitis
Persistent diarrhea, abdominal pain and tenderness in RLQ, palpable RLQ mass, fever/fatigue/malaise, Anorectal lesions
Crohn’s s/s
tissue appearance of UC
granular, dull, hyperemic, friable, disease uniform, possibly pseudopolyps
tissue appearance of Crohn’s
cobblestone, areas of normal issue surrounded by ulceration and fissures.
Risk factors for IBD
occurs more frequently in US, American jews and european, african americans/whites, immune system, environmental factors, smoking NSAIDS
toxic megacolon, perforation, massive hemorrhage, colorectal cancer is a longterm complication
UC
Obstruction, distulization, abscess, malabsorption, colon cancer
Crohn’s
