Exam 6 Psychiatric Mental Health NP Flashcards
What nursing skill did the Technology Informatics Guiding Education Reform (TIGER) initiative seek to improve?
Computer and information literacy
The Technology Informatics Guiding Education Reform (TIGER) initiative developed
a 10-year plan for nursing’s path toward computer and information literacy. It involved more than 1,100 nursing content experts, and it took three years to complete. This initiative successfully defined the basic technology competencies and required curriculum for nurse practitioner education.
The TIGER initiative declared that it is a nurse practitioner’s responsibility to
understand and shape the landscape of health care technology in order to improve access, quality, and the patient experience.
Core symptoms of major depressive disorders in children are
irritability, somatic complaints, and social withdrawal.
Less common symptoms of major depressive disorders in children include
psychosis, motor retardation, hypersomnia, and increased appetite
To assess a patient’s potential to harm others in addition to themselves, nurse practitioners should ask the following questions:
Are there others who you think may be responsible for what you are experiencing?
Are you having thoughts of harming others? Who?
Are there other people you want to die with you?
Are there others who you think would be unable to go on without you?
For patients who present with thoughts about wanting to harm themselves, nurse practitioners could consider asking:
How close have you come to acting on those thoughts?
How likely do you think it is that you will act on them in the future?
What do you envision happening if you actually killed yourself?
Have you made a specific plan to harm yourself?
Are guns or other weapons available to you?
Have you made particular preparations for your death?
When clients are involuntarily admitted to an inpatient psychiatric facility,
they are admitted against their will, they are unable to come and go as they please, and the amount of time they can be kept against their wishes varies by state. These are examples of civil liberties that are withdrawn during the involuntary admission process.
If a client is voluntarily admitted to an inpatient psychiatric facility, they desire and agree to treatment and confinement within the structure of a hospital setting. The client maintains
all civil liberties, and they are able to leave as they please as long as they are not a danger to themselves or others or gravely disabled.
Clients are able to make phone calls, have visitors, and refuse medication. These civil liberties are maintained
even when admitted to an inpatient psychiatric unit involuntarily.
Prozac (fluoxetine) is an SSRI antidepressant and can produce a false positive for
methamphetamine.
Zoloft (sertraline) can produce a false positive for
benzodiazepines
Motrin can produce a false positive for
cocaine
Poppy seeds can produce a false positive
for heroin or morphine
Pharmacokinetics refers to
what the body does to a drug when it’s ingested.
Pharmacodynamics is the term that describes
what a drug does to the body when ingested and paired with the individual’s pharmacodynamic gene profile.
Norepinephrine:
alertness, focused attention, learning, and memory
Dopamine
_thinking, fine muscle action, and reward-seeking behavior
GABA_
reduces arousal, aggression, and anxiety
Serotonin
regulates sleep, pain, mood states, and temperature
Nurse practitioner core competencies include the following:
Scientific foundations Leadership Quality Practice inquiry Technology and information literacy Policy Health delivery systems Ethics Independent practice
What court case determined that the presence of a mental illness alone cannot justify involuntary hospitalization?
O’Connor vs. Donaldson
The 1976 case O’Connor vs. Donaldson ruled that
harmless mentally ill patients cannot be confined against their will if they can survive outside. This case determined that the presence of a mental illness alone cannot justify involuntary hospitalization.
In 1979, Rennie vs. Klein determined that
patients have the right to refuse any treatment and use an appeal process.
In 1981, Roger vs. Oken determined that
patients have an absolute right to refuse treatment but that a guardian may authorize their treatment.
Durham vs. United States
determined that an individual is not criminally responsible if the unlawful act was the product of mental illness. This case is known for originating the insanity defense.
Patients with obsessive-compulsive personality disorder are
perfectionistic and rigid. They are often workaholics who are indecisive, excessively scrupulous, and preoccupied with detail.
Patients with paranoid personality disorder are
suspicious, have few friends, and read hidden meaning into innocent remarks
Patients with narcissistic personality disorder
act self-important. They are preoccupied with envy, fantasies of success, and ruminations about the uniqueness of their own problems. They reject criticism and need constant admiration from others.
A nurse practitioner has the duty to protect identified victims from imminent danger. When a patient threatens to harm someone, your course of action should follow these steps:
Contact the party at risk
Notify the police
Take appropriate action to protect the party at risk
There are three phases of a therapeutic relationship between a nurse practitioner and his or her patient:
Introduction
Working
Termination
During the introduction phase, the following actions usually take place:
Creating a trusting environment
Establishing professional boundaries
Establishing the length of anticipated interaction
Providing diagnostic evaluation
Setting mutually agreed-upon treatment objectives
Mind-body interventions under the umbrella of complementary and alternative therapies (CATS) include the following:
Guided imagery
Meditation
Yoga
Biofeedback
Massage therapy and acupressure are
manipulative body-based therapies.
Vitamins and supplements are a
biological-based therapy.
From a systems perspective, the goal is to optimize rather than maximize what?
the goal is to optimize the quality recommendations from the Institute of Medicine (safe, effective, patient-centered, timely, efficient, and equitable) rather than maximize them.
From a systems perspective, the goal is to optimize rather than maximize the performance of each of its components in order to bolster the system’s overall production.
When involuntarily admitted to an inpatient psychiatric facility,
the client is not able to come and go as they please, which is a civil liberty.
Preventative factors are factors that protect a person from
developing a psychiatric condition.
Preventative factors fall into three categories:
biological, psychological, and social.
Biological preventative factors:
Without a history of mental illness in the family
Healthy nutritional status
Good general health
Psychological preventative factors:
Good self-esteem
Good self-concept
Internal locus of control
Healthy ego defenses
Social preventative factors:
Low-stress occupation
Higher socioeconomic status
Higher level of education
Both serotonin and norepinephrine are removed from the synaptic cleft and returned to storage
via an active reuptake process.
Dopamine, on the other hand, is removed from the synaptic cleft by
monoamine oxidase enzymatic action.
The Institutional Review Board
protects the rights and welfare of human research participants. They have the authority to approve, require modifications, or disapprove of any research activities.
The Institutional Review Board ensures that
Risks to participants are minimized
Participant selection is equitable
Adverse events are reported
Risks and benefits are evaluated
Informed consent is obtained and documented
Data safety monitoring plans are implemented when indicated
In a medical malpractice suit, the plaintiff must establish all of the following
The nurse practitioner owed the plaintiff a duty
The nurse practitioner’s conduct fell below the standard of care
The nurse practitioner’s conduct caused the plaintiff injury
Proof beyond reasonable doubt applies to
criminal cases.
Medical malpractice suits are
civil cases.
To establish a medical malpractice suit, the plaintiff must establish that a
dereliction of duty directly caused damage (also known as the four Ds of medical malpractice).
The burden of proof in medical malpractice suits is by
a preponderance of evidence (greater than 50%).
Specifiers used to describe mood disorders include the following:
With atypical features:
These patients eat a lot and gain weight, sleep excessively, and have a feeling of being sluggish or paralyzed. They are also sensitive to rejection.
With melancholic features:
These patients feel worse in the morning than in the afternoon, and they experience decreased appetite, weight loss, and agitation. They also tend to feel excessively guilty and have trouble making decisions.
With anxious distress:
These patients have high levels of tension, restlessness, worry, and fear.
With catatonic features:
These patients exhibit either motor hyperactivity or inactivity.
With mixed features:
These patients are experiencing a mixture of both manic and depressive symptoms.
With peripartum onset:
These patients develop a mood episode during pregnancy or within a month of having their baby.
With psychotic features:
These patients develop delusions or hallucinations along with their mood symptoms.
With rapid cycling:
These patients have experienced at least four mood episodes in the past year.
With seasonal pattern:
These patients regularly become ill at a certain time of the year.
Patients with obsessive-compulsive personality disorder are
perfectionistic and rigid. They are often workaholics who are indecisive, excessively scrupulous, and preoccupied with detail.
Patients with paranoid personality disorder are
suspicious, have few friends, and read hidden meaning into innocent remarks.
Patients with narcissistic personality disorder act self-important. They are preoccupied with
envy, fantasies of success, and ruminations about the uniqueness of their own problems. They reject criticism and need constant admiration from others.
Patients with dependent personality disorder
fear abandonment, feel helpless when they are alone, and are miserable when relationships end. They desperately desire the approval of others, and they often volunteer for unpleasant tasks to gain the favor of others.
An atypical presentation is characterized by the following:
Mood reactivity Weight gain Increased appetite Hypersomnia Leaden paralysis Long-standing pattern of interpersonal rejection sensitivity
Anhedonia is
the inability to feel pleasure, and it occurs in both typical and atypical presentations of major depressive disorder.
Vietnamese describe panic attacks
“Hit by the wind”
Latin Americans:
Attack of the nerves”
C
“Cambodians
“Soul loss”
What term most accurately describes a group of members of Congress or a political party created to support a defined political ideology?
caucus. A caucus is a group of members of Congress or a political party created to support a defined political ideology
Common herbals with psychoactive effects used to treat insomnia:
Valerian
Catnip
Chamomile, which also helps with anxiety
Ginkgo,
which helps with delirium, dementia, and sexual dysfunction
Black cohosh,
which is used to treat menopausal symptoms, premenstrual syndrome, and dysmenorrhea
Belladonna,
which is used to treat anxiety
Ginseng,
which helps with depression and fatigue
Most psychotropic medications are hepatic
cytochrome P450 inhibitors. Furthermore, most psychotropic medications are both lipophilic and highly protein-bound
Because many older adults have more body fat and less protein,It takes approximately five half-lives to completely eliminate most psychotropics from the body.
they are at increased risk for toxicity.
It takes approximately______________________ to completely eliminate most psychotropics from the body.
five half-lives
Bulimia does not usually affect
thyroid function;
laboratory findings in patients with bulimia might include the following:
Hypokalemia
Hypochloremia
High serum amylase
Hypomagnesemia
Preventative factors are those that They fall into three categories: biological, psychological, and social.
protect a person from developing a psychiatric condition.
Preventative factors fall into three categories:
biological, psychological, and social.
Biological preventative factors:
Without a history of mental illness in the family
Healthy nutritional status
Good general health
Psychological preventative factors:
Good self-esteem
Good self-concept
Internal locus of control
Healthy ego defenses
Social preventative factors:
Low-stress occupation
Higher socioeconomic status
Higher level of education
According to Freud, during what psychosexual stage of development are sexual concerns largely unimportant?
Latency stage. The latency stage is characterized by a time in which sexual concerns are largely unimportant. During this phase, children establish decisive patterns of adaptive functioning. They develop a sense of industry and a capacity for mastery of objects. This is the phase in which children develop a foundation for mature adult life satisfaction.
Freud’s stages of psychosexual development:
birth to 12-18 monthsAnal 12-18 months to 3 yearsPhallic_ 3 to 5-6 yearsLatency_ 5-6 years to adolescenceGenital_ adolescence to adulthood
According to Erik Erikson, during which psychosocial stage would you expect a person to develop a sense of unity in life’s accomplishments?
Ego Integrity vs. Despair.
Ego Integrity vs. Despair is the final stage of psychosocial development. Successful resolution of this stage is characterized by a sense of unity in life’s accomplishments. Failure to resolve this stage leads to regret over lost opportunities of life.
What is the most commonly used clinician-administered anxiety rating scale?
The Hamilton Anxiety Scale (HAM-A) is the most commonly used clinician-administered anxiety rating scale. It is best used in the evaluation of anxiety severity and tracking the efficacy of anxiety treatments over time.
The HAM-A is based on various domains of anxiety including
anxious mood, fears, sleep disturbance, somatic complaints, tension, and observed behavior.
The severity of each domain in HAM A is ranked from
0 (not present) to 4 (severe).
HAM A scoring
Score of 14-17: Mild anxiety
Score of 18-24: Moderate anxiety
Score of 25-30: Severe anxiety
Calcium values can be decreased during treatment with
anticonvulsants, aspirin, corticosteroids, heparin and oral contraceptives.
is a common non-psychoactive supplement used to cure symptoms of illness and maintain health.
Fish oil
Common non-psychoactive dietary supplements with physiological (not psychological) effects used to cure illnesses and maintain health are as follows:
Omega-3 fatty acids Tryptophan Vitamin E Melatonin SAM-e
What 1960 legal precedent approved a test of competence that determines if a criminal defendant is competent to stand trial?
Dusky vs United States
The 1960 case of Dusky vs. United States approved a test of competence that seeks to ascertain whether a criminal defendant has the ability to consult with a lawyer and to rationally understand the proceedings against him or her. This case established competence to stand trial.
Durham vs. United States
determined that an individual is not criminally responsible if the unlawful act was the product of mental illness. This case is known for originating the insanity defense.
O’Connor vs. Donaldson
The 1976 case ruled that harmless mentally ill patients cannot be confined against their will if they can survive outside. This case determined that the presence of a mental illness alone cannot justify involuntary hospitalization.
In 1979, ____________ determined that patients have the right to refuse any treatment and use an appeal process.
Rennie vs. Klein case
Altitude sickness might be included in the differential diagnosis of
panic disorder.
Mitral valve prolapse might be included in the differential diagnosis of
mania and severe anxiety.
Myasthenia gravis might be included in the differential diagnosis of
anxiety.
Oppositional defiant disorder (ODD) is an enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior lasting at least
six months with at least four of the following associated symptoms:
Loses temper Touchy or easily annoyed Angry or resentful Argues with authority Actively defies or refuses to comply with requests or rules from authority figures Blames others Deliberately annoys others Spiteful or vindictive
Physical exam findings and associated features of Rett syndrome are as follows:
Seizures Irregular respirations Scoliosis Loss of purposeful hand skills Stereotypic hand movements
Rett syndrome’s etiology is unknown. However, it is believed that children suffering from Rett syndrome have
- A known, progressive, and deteriorating course of illness after an initial period without apparent disability
- A potential metabolic disorder
- Genetic mutation(s)
A client taking clozapine is presenting with elevated body temperature. You recognize this potential serious side effect as:
Agranulocytosis
Agranulocytosis is a
serious acute condition involving severe and dangerous leukopenia (lowered white blood cell count), most commonly of neutrophils, thus causing neutropenia in the circulating blood.
Hyperprolactinemia is a
condition in which a person has higher-than-normal levels of the hormone prolactin in the blood, potentially causing the stimulation of breast milk.
Anemia is a condition in which
a person lacks enough healthy red blood cells to carry adequate oxygen to the body’s organs and tissues.
Hemophilia is a condition
where the body’s ability to form blood clots is reduced.
Physical exam findings in posttraumatic stress disorder (PTSD) are
nonspecific in nature.
Primary prevention is aimed at
decreasing the number of new cases of mental disorders.
An example of primary prevention is Drug Abuse Resistance Education (D.A.R.E.) programs in elementary and middle schools.
Secondary prevention is aimed
at decreasing the number of existing cases of mental disorder. Examples of secondary prevention include telephone hotlines, crisis intervention, and disaster response.
Tertiary prevention is aimed at r.
decreasing the disability and severity of a mental health disorder. Providing social skills education for a group of intellectually disabled teenagers is an example of tertiary prevention.
The deductible is
the amount that people spend before their health insurance pays for the cost of health care services.
The insurance premium is
the amount charged for insurance coverage, usually paid on a monthly basis by both the employer and the employee.
The loading charge is .
the amount charged by the health insurance company on a person’s renewal premium when they make claims on their policy
The latency stage is characterized by a time
in which sexual concerns are largely unimportant. During this phase, children establish decisive patterns of adaptive functioning. They develop a sense of industry and a capacity for mastery of objects. This is the phase in which children develop a foundation for mature adult life satisfaction.
Freud’s stages of psychosexual development:
birth to 12-18 monthsAnal 12-18 months to 3 yearsPhallic_ 3 to 5-6 yearsLatency_ 5-6 years to adolescenceGenital_ adolescence to adulthood
Enuresis refers to the repeated voiding of urine (either voluntarily or involuntarily) into bedding or clothing when
five years old or older.
Which piece of legislation established the prescription drug coverage (Part D) option under Medicare?
The Medicare Prescription Drug Improvement and Modernization Act of 2003 established the prescription drug coverage (Part D) option under Medicare. This legislation replaced Medicare + Choice with Medicare Advantage.
The Technology Informatics Guiding Education Reform (TIGER) initiative developed
a 10-year plan for nursing’s path toward computer and information literacy.
In February 2009, President Barack Obama signed into law the American Recovery and Reinvestment Act (ARRA) (Pub. L. 111-5). The ARRA includes
the Health Information Technology for Economic and Clinical Health (HITECH) Act, which attempts to update the American infrastructure, including the use of electronic health records.
Patients with obsessive-compulsive personality disorder are
perfectionistic and rigid. They are often workaholics who are indecisive, excessively scrupulous, and preoccupied with detail.
Minipress (prazosin) is
FDA-approved for the treatment of nightmares associated with PTSD.
SSRIs FDA approved for the treatment of PTSD
Zoloft and Paxil
The benefits of group therapy include the following:
Increases insight about oneself
Increases one’s social skills
Is cost-effective
Develops sense of community
Screening for developmental delays is a critical component of assessing for ASD. Checklists for this include the following:
Modified Checklist for Autism in Toddlers (Age-Specific)
Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Ages and Stages Questionnaires
Parents may also report the following symptoms in child with ASD:
No cooing by age one year, no single words by age 16 months, no two-word phrases by age 24 months
Loss of language skills
No imaginary play
Little interest in playing with other children
Extremely short attention span
No response when called by name
Little or no eye contact
Intense tantrums
Fixations on single objects
Unusually strong resistance to changes in routines
Oversensitivity to certain sounds, textures, or smells
Appetite or sleep-rest disturbance, or both
Self-injurious behavior
For an act to be considered criminal, it must have two components:
actus reus and mens rea.
Actus reus refers to
voluntary conduct. Voluntary conduct is deemed impossible if the offender’s mental status is deficient, abnormal, or diseased in a way that inhibits rational intent.
Mens rea refers
to evil intent. Evil intent is defined as the resolve to do harm.
Neither behavior nor intent alone is enough to convict a person of a crime.
is the only state where nurse practitioners bill at 100% of the allowable physician rate.
Iowa
Circadian rhythm sleep-wake disorders are characterized by
a mismatch between a person’s biological clock and the environment.
There are five subtypes of circadian rhythm mismatch:
Delayed sleep phase type
Advanced sleep phase type
Irregular sleep-wake type
Non-24-hour sleep-wake type
Shift work type
Delayed sleep phase type:
falling asleep and waking later than desired
Advanced sleep phase type:
falling asleep and waking earlier than desired
Irregular sleep-wake type:
falling asleep and waking at random times
Non-24-hour sleep-wake type:
falling asleep and usually waking progressively later than desired
Shift work type:
sleepiness associated with changes in work schedule
Jet lag refers to
feeling sleepy or “hungover” after crossing time zones. It is no longer considered a sleep disorder.
Which anxiety disorder is characterized by brief episodes of intense dread accompanied by physical symptoms like chest pain, chills, shortness of breath, and an irregular heartbeat?
Panic d/o
Privilege refers to
the patient’s right to prevent disclosure of confidential information in judicial hearings.
Nonmaleficence refers to the principle of .
bioethics that asserts an obligation not to inflict harm intentionally.
Beneficence refers to
an action done for the benefit of others.
Confidentiality refers to
the nurse practitioner’s responsibility to not release patient information learned in the course of treatment to third parties
The National Institutes of Health (NIH) created the National Center for Complementary and Alternative Medicine (NCCAM) in ____with mission to ___________
in 1998. The mission of NCCAM is to study therapies outside of traditional medicine.
Decreased levels of sodium (Na) can cause
Diuresis
Increased, levels of sodium (Na) can cause
dehydration, diabetes insipidus, and gastroenteritis.
laboratory findings in patients with bulimia might include the following:
Hypokalemia
Hypochloremia
High serum amylase
Hypomagnesemia
Forensic risk assessments are specifically for those with a
violent, dangerous, and/or criminal record and often take place in a judicial arena such as jail, prison, or court.
Failure to resolve the Generativity vs. Stagnation stage is associated with the
development of a mid-life crisis.
Failure to resolve the Industry vs. Inferiority stage is associated with
creative inhibition.
Failure to resolve the Initiative vs. Guilt stage is associated with
conversion disorder, phobias, and psychosomatic disorders.
during the DNA sequencing process single nucleotide polymorphisms detect
Single nucleotide polymorphisms detect single based changes
The FDA has approved both ______ for the treatment of ADHD in children.
stimulants and non-stimulants
The following medications are FDA approved but are not classified as stimulants:
Strattera (atomoxetine)
Intuniv (guanfacine)
Kapvay (clonidine)
The following are stimulants:
Adderall (amphetamine salts)
Dexedrine (dextroamphetamine)
Wellbutrin XL (bupropion) is an SNRI but is indicated in the treatment of
ADHD in adults.
The trigeminal nerve CN _________ assessment tests for tactile perception of the facial skin.
(cranial nerve V, sensory division)
The facial nerve CN_________assessment checks for flaccid paralysis.
(cranial nerve VII, motor division)
The hypoglossal nerve CN_____ assessment tests for tremors and other involuntary movements when the client protrudes their tongue.
(cranial nerve XII)
The most common suicide site in the world is the
Golden Gate Bridge in San Francisco, California.
Suicide rates are lowest in and highest in Monta
New Jersey
Suicide rates are highest in
Montana
Panic disorder is significantly comorbid with many general medical conditions, including the following:
Irritable bowel syndrome Dizziness Cardiac arrhythmias Hyperthyroidism Asthma COPD
Brain tissue is categorized as either
white matter or gray matter.
White matter is the
myelinated axons of neurons
Gray matter is composed
of nerve cell bodies and dendrites.
Gray matter is found in the
working area of the brain and contains the synapses.
A Medicare medical savings account plan is
a health plan that allows individuals to establish tax-free savings funds to finance their medical care.
Medicare + Choice was
part of the Balanced Budget Act of 1997 that significantly increased the number of managed care insurance plans available to Medicare recipients. This program was replaced with the Medicare Advantage plan in 2003.
The Medicare Advantage plan
created regional Preferred Provider Organizations (PPO) and gave Medicare enrollees the option of enrolling in private insurance plans.
Medigap insurance policies are
private policies purchased by elderly individuals to cover some or all of their medical expenses not paid for by Medicare.
Medicare + Choice was replaced by
This program was replaced with the Medicare Advantage plan in 2003.
Psychoanalytic theory originated with
Sigmund Freud, who believed that behavior is determined by unconscious motivations and instinctual drives. This theory posits that change occurs through the development of greater insight and awareness of maladaptive defenses. Psychoanalytic-focused therapy attends to past developmental and psychodynamic factors, which shape present behaviors.
Cognitive therapy,
helps patients view reality more clearly by examining their distorted cognitions.
A patient presents with oculomotor disturbances, cerebellar ataxia, and mental confusion. What psychiatric emergency would you suspect?
Wernicke’s encephalopathy
Give thiamine IM or IV 100mg
has the lowest risk of sedation of all antipsychotics, and it is recommended as the treatment of choice for those wanting to avoid side effects of fatigue and sleepiness.
Aripiprazole
Extrapyramidal symptoms are associated with a deficiency of .
dopamine and an excess of acetylcholine in the nigrostriatal pathway.
A common type of extrapyramidal symptom is called pseudo-Parkinson’s, which presents
with a shuffling gait, motor slowing, mask-like facial expression, tremors, and muscle rigidity.
Muscarinic 1 agonist medications reduce the effects of
excess acetylcholine and relieve extrapyramidal symptoms
Biofeedback teaches a patient
to control their physiological responses
Acupuncture and acupressure aid in the activity of
endorphins by manipulating points of energy flow in the body.
Aromatherapy stimulates
the olfactory system to elicit feelings and memories.
Massage increases
blood circulation, improves lymph flow, and enhances musculoskeletal tone.
The overall goal of case management is
to promote quality, cost-effective patient care.
Mentoring is the process of
guiding and supporting junior colleagues in the development of new roles, competencies, and skills.
The acoustic nerve (cranial nerve)
CN VIII) vestibulocochlear is assessed by checking the client’s hearing using an audiometer or by simply whispering in the client’s ear. Hearing loss is tested with the Weber and Rinne tests.
The oculomotor nerve
(cranial nerve III) assessment checks the five extrinsic eye muscles; it is tested together with the trochlear (cranial nerve IV) and abducens (cranial nerve VI). This test checks for equality of pupils, their reaction to light, and accommodation. This test also checks for the corneal light reflex.
The trochlear assessment
(cranial nerve IV) uses the same process as the oculomotor (cranial nerve III) and abducens (cranial nerve VI) and tests for synergy of the eyes working together and in tandem.
The ten common withdrawal symptoms assessed on the CIWA scale are as follows:
Nausea and vomiting Tremors Paroxysmal sweats Anxiety Agitation Tactile disturbances Auditory disturbances Visual disturbances Headaches Altered sensorium
The four major dimensions of recovery include
health, home, purpose, and community.
What is the most common sexual dysfunction side effect reported by women who are prescribed a selective serotonin reuptake inhibitor (SSRI)?
Anorgasmia is the most commonly reported sexual dysfunction side effect in women who are taking SSRIs. This is defined as the persistent inability to achieve orgasm despite responding to sexual stimulation.
To prevent medical malpractice suits, nurse practitioners should follow these guidelines:
Be careful about establishing a patient-provider relationship.
Know the standard of care and practice within it.
Follow the practice guidelines and protocols adopted by the office or agency and follow them.
When in doubt, take a conservative approach.
Rule out the worst diagnosis early on.
Know the limits of training and expertise.
Follow up.
At 40 weeks of age, landmarks of normal behavioral development include the following:
Sits alone with good coordination
Creeps
Pulls self to standing position
Points with index finger
Matches two objects at midline
Attempts to imitate scribble
Develops separation anxiety when away from mother
Responds to social play such as peek-a-boo
Feeds self a cracker and holds own bottle
For a person to be diagnosed with Tourette’s (TS), they must
Have two or more motor tics (for example, blinking or shrugging the shoulders) and at least one vocal tic (for example, humming, clearing the throat, or yelling out a word or phrase), although they might not always happen at the same time.
Have had tics for at least a year. The tics can occur many times a day (usually in bouts) nearly every day, or off and on.
Have tics that begin before he or she is 18 years of age.
Have symptoms that are not due to taking medicine or other drugs or due to having another medical condition (for example, seizures, Huntington disease, or postviral encephalitis).
Attention-deficit/hyperactivity disorder is characterized
by hyperactivity, impulsivity, and inattentiveness.
Stuttering, also called
childhood-onset fluency disorder, occurs when the normal fluency of speech is frequently interrupted.
Oppositional defiant disorder is characterized by
multiple examples of negativistic behavior persistent for at least six months, usually beginning when a child is three or four years old.
Computer competency is the
ability to demonstrate proficiency in the use of software applications, such as Microsoft Word, Excel, and PowerPoint, and knowledge of computer terminology, hardware selection, and simple maintenance functions.
Computer literacy is
the level of expertise and familiarity someone has with computers. It generally refers to the ability to use an application rather than to write code. Individuals who are very computer literate are called power users.
Information literacy involves
recognizing when information is needed and being able to efficiently locate and use it.
Information competency is
often used as a synonym for information literacy.
Megasystem:
American health care system
Metasystem:
economic, political, and social level of society
Privilege
refers to the patient’s right to prevent disclosure of confidential information in judicial hearings
Nonmaleficence
refers to the principle of bioethics that asserts an obligation not to inflict harm intentionally.
Beneficence
refers to an action done for the benefit of others.
The hypothalamus is part of the limbic system. It plays a key role in
various regulatory functions including appetite, water balance, circadian rhythms, body temperature, and libido.
The hippocampus regulates .
memory and converts short-term into long-term memory.
The amygdala regulates
mood, fear, emotion, and aggression.
The thalamus regulates
the flow of sensory information to the cortex
Ninety-five percent of lithium is excreted through the kidneys; therefore, you should check
the patient’s kidney function by ordering electrolytes, creatinine, BUN, and a urinalysis. Lithium also inhibits the synthesis of thyroid hormone, so you should always check thyroid studies as well.
Target symptoms of antidepressant treatment include
depressed mood, sleep/rest disturbance, anxiety, irritability, impaired concentration, impaired memory, appetite disturbance, agitation, anhedonia, and impaired energy and motivation.
What psychoactive substance is most widely used in the United States?
Cannabinoids, particularly cannabis, are the most widely used psychoactive substances in the United States. The 12-month prevalence of cannabis use disorder is 3.4%. The rates of cannabis use disorder are highest among adult and adolescent males.
Which term describes a public agency that uses its bargaining power to negotiate competitive prices for health insurance from the private insurance market?
Health alliance
A health alliance is a public agency that uses its bargaining power to negotiate competitive prices for health insurance from the private insurance market.
A special interest agency is
a group of people seeking or receiving special advantages through political lobbying.
Public interest groups
promote issues of general public concern.
A political action committee is
an organization that raises money privately to influence elections or legislation, especially at the federal level.
Nursing science is the domain of knowledge concerned with
The adaptation of individuals and groups to actual or potential health problems
The environments that influence health in humans
The therapeutic interventions that promote health and affect the consequences of illness
When initiating treatment with clients who have newly diagnosed bipolar disorder, clients should be seen monthly for titration of medications and monitoring of serum blood levels.
new diagnosed bipolar should be seen weekly. When initiating treatment with clients who have newly diagnosed bipolar disorder, clients should be seen weekly for titration of medications and monitoring of serum blood levels.
Beta blockers, benzodiazepines, and retroviral agents cause an exacerbation of,
depressive symptoms
presentations of hyponatremia include the following:
Apprehension Seizures Coma Hypotension Tachycardia Decreased urine output Weight gain Edema Ascites Jugular vein distension
Presentations of hypernatremia:
Convulsions Pulmonary Edema Thirst Fever Dry mucous membranes Hypotension Tachycardia Low jugular venous pressure Restlessness
Tryptophan puts a patient on psychotropics at risk
for serotonin syndrome and is not advised when a patient is taking selective serotonin reuptake inhibitors (SSRIs) or monoamine oxidase inhibitors (MAOIs).
The major characteristics of the phallic stage include
seeking gratification through the genitals, coming to terms with the Oedipal conflict, and identifying with the same sex parent.
The latency stage is
characterized by a time in which sexual concerns are largely unimportant.
During the genital phase, sexual interests
reemerge and individuals begin to establish mature sexual relationships.
Global developmental delay describes a child under
the age of five who seems to be falling behind developmentally, but the practitioner cannot reliably assess the degree.
Unspecified intellectual disability is a term used when a c
hild is five years old or older and cannot be reliably assessed due to a physical or mental impairment.
Borderline intellectual functioning describes a person with a nominal IQ
ranking of 71 to 84 who does not have the coping problems associated with an intellectual disability.
Autism spectrum disorder forms in
early childhood and results in impaired social interactions and communication. These patients usually demonstrate stereotyped behaviors and interests.
Bipolar I disorder:
These patients experience at least one manic episode and may or may not experience a major depressive episode.
Bipolar II disorder:
These patients experience at least one hypomanic episode and at least one major depressive episode.
Cyclothymic disorder:
These patients experience mood swings, but they are not severe enough to be called major depressive episodes or manic episodes.
Schizoaffective disorder is a psychotic disorder
characterized by patients experiencing symptoms of schizophrenia along with either depression or mania.
Vitamin E is a
.
dietary supplement used in treating neurological disorders, diabetes, and premenstrual syndrome. It is also used for enhancing the immune system and protecting cells against the effects of free radicals.
Vitamin B is an
important dietary supplement that plays important roles in cell metabolism.
Vitamin D is an
important dietary supplement for maintaining strong bones and aiding the body in calcium absorption.
Vitamin C is an
important dietary supplement involved in the repair of tissue and the enzymatic production of certain neurotransmitters
The reticular formation is the part of the brain stem that regulates
involuntary movement, muscle tone, blood pressure, and respiratory rate.
The parietal lobe is the
primary sensory area and is responsible for regulating taste, reading, and writing.
The limbic system’s amygdala
regulates mood, fear, emotion, and aggression.
The limbic system’s hypothalamus
regulates appetite, water balance, body temperature, and libido.
Symptoms of neurosyphilis include the following:
Wide-based gait Positive Romberg sign Loss of vibratory and proprioceptive senses in lower extremities Decreased deep tendon reflexes Pupil abnormalities Tremors Dyscoordination Spasticity in lower extremities
Possession syndrome is
an umbrella English-language term used to describe South Asian presentations of involuntary possession trances. These episodes usually begin with a somatic complaint like a headache or abdominal pain. Next, patients appear as though they are possessed by a secondary personality, usually either a culturally famous figure or a recently deceased family member. Often, the patient will develop partial or total amnesia related to the altered state.
Health care system describes
the organizational and institutional structures through which an economy makes choices regarding the production, consumption, and distribution of medical services.
Health production function
is a mathematical expression that shows the relationship between an individual’s health and a number of other variables, including the amount of health care consumed.
A health alliance is
a public agency that uses its bargaining power to negotiate competitive prices for health insurance from the private insurance market.
Health economics is related
to the value, effectiveness, and efficiency of care received.
the act of discussion among two or more people with the goal of reaching an agreement.
Negotiation
EMDR is
the gold standard in treating PTSD and involves having the patient recall distressing events/images while generating one type of bilateral sensory input such as hand tapping or side-to-side eye movements.
DBT is used in
treating borderline personality disorder.
In 1981, the case of ___________ determined that patients have an absolute right to refuse treatment, but a guardian may authorize their treatment.
Roger vs. Oken
Pretraumatic risk factors:
Female gender Emotional disturbances prior to age six Childhood mental illness Externalizing behaviors Lower socioeconomic status Low education Childhood adversity Fatalistic or self-blaming coping mechanisms Minority social/ethnic status Low intelligence Poor social support Family history of psychiatric disorders
Peritraumatic risk factors:
Severity of trauma
Duration of trauma
Perceived life threat
Personal injury
Trauma perpetrated by a loved one or caregiver
Witnessing a threat directed toward a loved one or caregiver
Dissociation during trauma
For military personnel, witnessing atrocities or killing the enemy
Posttraumatic risk factors:
Negative appraisals Inappropriate coping strategies Development of an acute stress reaction Subsequent exposures to reminders Subsequent adverse life events and financial losses Lack of social support
.gastrointestinal finding suggestive of alcohol dependency
Splenomegaly is a gastrointestinal finding suggestive of alcohol dependency. Other gastrointestinal findings include hepatomegaly and intestinal tenderness
endocrine findings suggestive of alcohol dependency.
Testicular atrophy, gynecomastia, and sexual dysfunction are all endocrine findings suggestive of alcohol dependency.
Dementia with Lewy bodies is usually accompanied by s.
extrapyramidal symptoms
Huntington’s disease is accompanied by
spasmodic movement and incoordination.
Patients with frontotemporal dementia are
usually extremely talkative and disinhibited.
There are five subtypes of Circadian rhythm sleep-wake disorders
Delayed sleep phase type: falling asleep and waking later than desired
Advanced sleep phase type: falling asleep and waking earlier than desired
Irregular sleep-wake type: falling asleep and waking at random times
Non-24-hour sleep-wake type: falling asleep and usually waking progressively later than desired
Anticholinergic side effects include
dry mouth, blurred vision, constipation, and memory problems.
Orthostatic hypotension is an
antiadrenergic side effect.
Sedation and weight gain are
antihistaminergic side effects.
If a nurse practitioner is sued, she should follow these guidelines:
Call her professional liability insurance company and report the lawsuit.
Never talk to the patient or the plaintiff’s attorney.
Consider retaining her own attorney if the suit is against a group of providers.
Never change a patient’s record after learning of a lawsuit.
Think carefully before settling a case because settlement awards will appear on the nurse practitioner’s record.
**S/S of anticholinergic intoxication
Psychosis, dry mouth, hyperpyrexia, mydriasis, restlessness, and tachycardia are symptoms of anticholinergic intoxication
*******If anticholingeric intoxication the NP should
The nurse practitioner should discontinue the offending medication or substance and consider IV physostigmine and benzodiazepines. **Remember, antipsychotics are contraindicated in this situation.
Alcohol withdrawal would present with
irritability, nausea, vomiting, insomnia, malaise, autonomic hyperactivity, and shakiness.
Benzodiazepine intoxication would present with
sedation, somnolence, and ataxia
Catatonic schizophrenia would present with
marked psychomotor disturbance (either excitement or stupor) and exhaustion.
Vitamin E interacts with warfarin by
increasing anticoagulant effects of antiplatelet drugs and statins, increasing additive effects and the risk of rhabdomyolysis (muscle wasting).
There are three phases in EMDR:
.
desensitization, installation, and body scan.
Describe each phase of EMDR
Desensitization: The patient visualizes the trauma, verbalizes negative or maladaptive beliefs, and remains attentive to physical sensations. The patient also blocks out negative thoughts, breathes deeply, and verbalizes what he or she is imagining.
Installation: The patient installs and strengthens the positive thought that he or she has declared as a replacement of the original negative thought.
Body scan: The patient visualizes the trauma along with the positive thought and then scans his or her body mentally to identify any tension within
In EMDR use fro trauma therapy the patient
The patient visualizes the trauma, verbalizes negative thoughts, and remains attentive to physical sensations
EMDR developed by
Eye movement desensitization and reprocessing (EMDR) is a form of behavioral therapy that was developed by Francine Shapiro. It is most commonly used in posttraumatic stress disorder, and its goal is adaptive resolution.
****For an act to be considered criminal, it must have two components: actus reus and mens rea.
actus reus and mens rea.
***Actus reus refers to
voluntary conduct. Voluntary conduct is deemed impossible if the offender’s mental status is deficient, abnormal, or diseased in a way that inhibits rational intent.
**Mens rea refers.
to evil intent. Evil intent is defined as the resolve to do harm
A person is more likely to develop antisocial personality disorder if they were diagnosed with
conduct disorder and attention-deficit/hyperactivity disorder before the age of 10
Cluster A 4 characterization and includes 3 types
Cluster A patients are characterized as withdrawn, cold, suspicious, and irrational. Cluster A includes paranoid, schizoid, and schizotypal personality disorders.
Cluster B 3 characterization and includes 4 types
Cluster B patients are characterized as theatrical, emotional, and attention-seeking. They often experience intense interpersonal conflicts and exhibit an extremely labile mood. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders.
Cluster C 4 characterization and includes 3 types
Cluster C patients tend to be anxious, fearful, tense, and overcontrolled. Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders.
Clonazepam dosing
start at 0,25mg and titrate to 1mg/day after 3 days.
Neurotransmitters fall into four categories:
Monoamines
Amino acids
Cholinergics
Neuropeptides (divided into nonopioid type and opioid type)
examples of monoamine neurotransmitters
Dopamine, norepinephrine, and serotonin. These are also called biogenic amines.
examples of amino acids
Glutamate, GABA, aspartate, and acetylcholine
Substance P and somatostatins are examples of
nonopioid-type neuropeptides
Endorphins, enkephalins, and dynorphins are examples of
opioid-type neuropeptides.
Irvin Yalom was the first person to put a theoretical perspective on group work. He believed that all groups go through specific phases:
Pre-group Forming Storming Norming Performing Adjourning During the performing phase:
The group’s work becomes more focused
Solutions begin to emerge through creative problem-solving
Experiential learning takes place
Group energy is directed toward completion of goals
Retinal pigmentation can occur in patients prescribed
> 1,000 mg of thioridazine. Even when thioridazine is stopped, this side effect may persist and lead to blindness.
Hyperprolactinemia, priapism, and tardive dyskinesia can occur as side effects
of any antipsychotic medication.
When assessing judgment, the provider is determining whether the patient’s judgment is
grossly impaired for both self and social judgment.
A nurse practitioner’s scope of practice is legally the most secure when it is
clearly defined by a statute. Physicians’ organizations often try to prevent nurse practitioners from providing patient care by pointing to state law and asking for a strict interpretation. When a nurse practitioner’s scope of practice is clearly defined by statute, it is most secure against physician special interest groups.
Mental status exam findings of ADHD include all of the following:
Restlessness Inattention Distractible speech patterns Overproductive speech patterns Affective lability Poor memory Poor concentration
Bupropion is a
norepinephrine-dopamine reuptake inhibitor (NDRI),
phenelzine is a
monoamine oxidase inhibitor (MAOI)
Galactorrhea, is a
milky nipple discharge unrelated to the normal milk production of breastfeeding.
Hyperprolactinemia is an indication of
elevated prolactin levels, which can cause galactorrhea and is a risk factor for those taking antipsychotics, especially second-generation antipsychotics such as Invega or Risperdal.
The general function of glutamate involves
memory and sustained autonomic functions.
The general function of dopamine involves
normal functioning of thinking, decision-making, reward-seeking behavior, fine muscle action, and integrated cognition.
The general function of norepinephrine involves
alertness, orientation, fight-or-flight, learning, memory, and focus and attention.
The general function of serotonin involves
regulation of sleep, pain perception, mood states, temperature, aggression, and libido
The services covered under Medicaid:
Inpatient medical hospitalizations
Outpatient services
Family planning services
Home health services when there is no local home health agency
Home health aides
Skill nursing facilities services for those age 21 and older
Services rendered by nurse practitioners and nurse midwives
Medical supplies for use in-home
Pregnancy-related services up to 60 days postpartum
The services not covered under Medicaid:
Vision care Eyeglasses Dental care Dentures Hearing exams Hearing aids Routine physical exams Inpatient psychiatric hospitalizations
Individuals with chronic alcohol misuse often consume most of their calories from alcohol and are at high risk for
thiamine deficiency. A thiamine-deficient person can develop Wernicke encephalopathy if they attempt to metabolize food. You must administer thiamine immediately for this patient.
The evidence-based practice movement gained popularity in 2001 when the Institute of Medicine (IOM) published
Crossing the Quality Chasm, which exposed the unacceptable gap between scientific knowledge and clinical practice: “Between the health care we have and the care we could have lies not just a gap but a chasm.” They estimated that nearly 200,000 patients die from avoidable medical errors every year, and 40% of patients do not receive scientifically proven treatments.
Competency is a
legal concept but not a medical one.
Cigarette smoking induces
the cytochrome p450 1A2 enzyme.
Olanzapine is metabolized
by cytochrome P450 1A2; therefore, its plasma levels would decrease if an individual began taking a p450 1A2 inducer.
The two phases of the action potential are .
depolarization and repolarization
Depolarization is characterized by:
The initial phase of the action potential;
An excitatory response; and
An influx of sodium and calcium ions into the cell.
Repolarization is characterized by:
The restoration phase;
An inhibitory response; and
Potassium leaving the cell or chloride entering the cell.
The services covered under Medicaid include the following:
Inpatient medical hospitalizations
Outpatient services
Family planning services
Home health services when there is no local home health agency
Home health aides
Skill nursing facilities services for those age 21 and older
Services rendered by nurse practitioners and nurse midwives
Medical supplies for use in-home
Pregnancy-related services up to 60 days postpartum
The services not covered under Medicaid:
Vision care Eyeglasses Dental care Dentures Hearing exams Hearing aids Routine physical exams Inpatient psychiatric hospitalizations
The 8 goals of DBT are as follows:
Decrease suicidal behaviors Decrease therapy-interfering behaviors Decrease emotional reactivity Decrease self-invalidation Decrease crisis-generating behaviors Decrease passivity Increase realistic decision-making Increase accurate communication of emotions and competencies
Credentialing is
a process used to protect the public by ensuring a minimum level of professional competence.
Licensure is a process by which an
agency of state government grants permission to individuals to engage in the practice of that profession. Licensure prohibits all unlicensed persons from engaging in a legally protected practice.
Certification is a process by which a professional organization
certifies that an individual has met certain predetermined standards specified by that specialty practice. The nurse practitioner’s certification determines his or her scope of practice, and it assures the public that he or she has mastered a body of knowledge in a particular medical specialty.
The American Medical Association’s Scope of Practice Partnership (SOPP) initiative lobbies the federal government to limit patients’ chiropractors, social workers, and others.
choice of which health care provider they can see for treatment.
a group of 35 non-physician organizations created the Patients’ Access to Responsible Care Alliance (PARCA). PARCA aim is
This alliance aims to provide federal policymakers with more accurate information from all health care disciplines. PARCA is committed to ensuring patients have a choice of providers. PARCA includes nurses, nurse practitioners, audiologists, optometrists,
Individuals who are very computer literate are called
power users.
Cognitive therapy was originated by ______________ and purports that
by Aaron Beck. This therapy purports that external events do not cause anxiety, but rather a person’s expectations or perceptions. Cognitive therapy helps patients view their reality more clearly by examining their central distorted conceptions. The goal is to change patients’ irrational beliefs, faulty conceptions, and negative cognitive distortions.
Patients suffering from anhedonia present with a decrease in
dopamine activity.
Patients suffering from psychosis and schizophrenia present with an increase in
dopamine activity.
Patients suffering from anxiety disorders present with a decrease in
gamma-aminobutyric acid, or GABA.
Patients suffering from obsessive-compulsive disorders present with a decrease in
serotonin activity.
The mini-mental status exam (MMSE) is a brief instrument designed to assess the patient’s overall cognitive functioning.
Asking the patient to spell the word “world” backward assesses their attention.
Asking the patient to say this “no ifs, ands, or buts” assesses their ability to repeat what they hear.
Asking the patient remember the three objects apple, table, and penny assesses their short-term memory.
Asking the patient tell the year, season, month, date, and day assesses their orientation.
Informatics researchers are those who develop methods in areas such
as data mining, text processing, human interface design, decision support, and other tools for data analysis.
Decrease levels of sodium (Na) can cause
Addison’s disease, renal disorders, and gastrointestinal fluid loss from vomiting and diarrhea.
What did the Technology Informatics Guiding Education Reform (TIGER) initiative successfully define for nurse practitioners?
The Technology Informatics Guiding Education Reform (TIGER) initiative developed a 10-year plan for nursing’s path toward computer and information literacy. It involved more than 1,100 nursing content experts, and it took three years to complete. This initiative successfully defined the basic technology competencies and required curriculum for nurse practitioner education. The TIGER initiative declared that it is a nurse practitioner’s responsibility to understand and shape the landscape of health care technology in order to improve access, quality, and the patient experience.
Which term describes the use of a software application for placing medical orders in both inpatient and outpatient settings?
Computerized provider order entry (CPOE) is the use of a software application for the ordering of medications, laboratory and radiology testing, consultation, and referral requests. The CPOE is a replacement for written orders in both inpatient and outpatient settings. It is cited as an important tool in avoiding medical errors and improving patient safety.
Nursing informatics is
the specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice.
Systemic effects of hypernatremia include which of the following?
Restlessness
Negative symptom clusters of schizophrenia include
affective flattening, alogia or poverty of speech, avolition, apathy, abstract thinking problems, and anhedonia, Attention deficits
Positive symptom clusters of schizophrenia include
hallucinations, delusions, disorganized behaviors, hostility, grandiosity, mania, and paranoia.
Associated symptom clusters of schizophrenia include
inappropriate affect, dysphoric mood, depersonalization, derealization, and high anxiety.
****Piaget’s cognitive behavioral theory states that
humans develop through learning, comprehending, and cognition. Piaget also believed that the course of a child’s development is shaped through native endowment and biological and environmental factors.
*****Introduced the interpersonal theory.
Harry Stack Sullivan
*** developed the hierarchy of needs theory.
Abraham Maslow
**proposed the health belief model.
Marshall Becker
**Bipolar disorder is believed to be related to an increase in what neurotransmitter?
Glutamate. Glutamate is an excitatory amino acid neurotransmitter. While the exact connection between glutamate and bipolar disorder remains unclear, proton magnetic resonance spectroscopy studies have found increased glutamate in those with bipolar disorder compared with healthy controls. Glutamate is also implicated in seizure disorders and schizophrenia.
*****developed structured family therapy, which emphasizes how, when, and to whom family members relate in order to understand and change the family’s structure.
Salvador Minuchin
The primary treatment goal of structured family therapy is to
produce structural change in the family organization and to alter transactional patterns.
developed experiential therapy
Virginia Satir
developed family systems therapy
Murray Bowen
developed strategic therapy
Jay Haley
EMDR, originated by, is a form of exposure therapy meant to help the patient address past trauma and work through it for long-term stabilization.
Francine Shapiro
ENDR is a form of
is a form of exposure therapy meant to help the patient address past trauma and work through it for long-term stabilization.
Cognitive therapy is used in
situations when clients have irrational beliefs, faulty conceptions, and negative cognitive distortions about themselves.
Dialectical behavioral therapy (DBT) is used.
with patients suffering from borderline personality disorder
Existential therapy is an approach
in which the client reflects on life, and self-confrontation is encouraged.
Eye movement desensitization and reprocessing (EMDR) is used on patients suffering from
PTSD,
Activities or systems designed to recognize and intervene to reduce the risk of injury to clients are in the category of:
Risk management
Risk assessment is
continuous monitoring for high-risk situations and assessing persons for non-healthy behaviors.
Risk mitigation is
the act of process change in order to mitigate the risk finding.
Risk intervention a task performed
in real time in order to prevent an immediate risk.
Risk management interventions are implemented to reduce
non-healthy behaviors in clients and high-risk situations. Risk management is also the process of recognizing and intervening in order to reduce subsequent claims against healthcare providers.
Nurse practitioners have the legal authority to dispense controlled substances in ____ states
34
The 16 states where NP can’t dispense controlled substances
Alabama, Arizona, Arkansas, Florida, Hawaii, Kansas, Kentucky, Massachusetts, Michigan, Nebraska, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, and Texas.
a movement disorder that can occur after long-term use of antipsychotic medication like haloperidol (Haldol). It is characterized by abnormal motor movements including lip smacking, facial grimacing, and choreoathetosis-like movements of the limbs and trunk.
tardive dyskinesia
Anticholinergic toxicity would be accompanied by
delirium
an oral facial dystonia that involves blinking and chin thrusting.
Meige syndrome
is associated with rheumatic fever and occurs in children.
Sydenham chorea
Herbal supplements such as St. John’s Wort are contraindicated as adjunctive therapy when taking
an SSRI. Prozac is an SSRI.
Hyperparathyroidism is caused by i
ncreased levels of calcium.
Decreased levels of calcium can cause
alkalosis and pancreatitis.
If a patient is taking sertraline at the time of a drug screen, they may falsely test positive
for benzodiazepines.
If the patient is taking amoxicillin or NSAIDS, they may falsely test positive for
cocaine
If a patient is taking codeine, they may falsely test positive for
methadone or PCP.
In hyperthyroidism,
T4 is increased and TSH is decreased, which produces excitatory and labile/anxious-like symptomatology.
Other presentations of hyperthyroidism include the following:
Motor restlessness Emotional lability Tremors Insomnia Impotence Weight loss Increased appetite Abdominal pain Excessive sweating Flushing Elevated upper eyelid leading to decreased blinking, staring, and fine tremors of the eyelid Tachycardia Dysrhythmias
In hypothyroidism,
T4 is decreased and TSH is increased, which produces slowed processes and depressive-like symptomatology.
Patients with hypothyroidism may present with the following symptoms:
Confusion Decreased libido Impotence Decreased appetite Memory loss Lethargy Constipation Headaches Slow or clumsy movements Syncope Weight gain Fluid retention Muscle aching and stiffness Slowed reflexes Somatic discomfort including aching and joint stiffness Slowed speech and thinking Sensory disturbances, including hearing Cerebellar ataxia Loss of amplitude in ECG
Panic disorders mimic.
fight-or-flight episodes and potentiate a response from the central nervous system
Devaluation is a defense mechanism that
attributes excessive negative qualities to another.
Idealization is a defense mechanism that
attributes excessive positive qualities to another.
Repression is a defense mechanism that
expels disturbing wishes from conscious awareness.
A decrease in serotonin is related to .
major depressive disorder, obsessive-compulsive disorder, and schizophrenia
Alzheimer’s disease is related to a decreased in
acetylcholine,
Examples of mental health promotion and education:
Teaching patients about interventions and ways to cope with specific life-stressors
Validating “normalcy” of feelings and ensuring patients that they are not “crazy”
Helping patients recognize and identify their feelings and behaviors
Helping patients identify resources in their community
Case management involves
coordinating care across treatment settings to ensure quality outcomes.
Inattentive traits of ADHD include all of the following:
Fails to give attention to details Has difficulty sustaining attention Does not listen when spoken to Does not follow through on instructions Is disorganized Avoids or dislikes tasks that require sustained mental effort Loses things Is distracted Is forgetful
Hyperactive and impulsive traits of ADHD are as follows:
Fidgets Leaves seat Runs or climbs Is unable to engage in quiet activities Is always on the go Talks excessively Blurts out information Has a difficult time waiting their turn Interrupts others
Evidence-based practice demands the use of the best knowledge. The evidence hierarchy ranks sources of knowledge according to the strength of information they provide. The best evidence comes from Level 1 of the evidence hierarchy, which includes meta-analyses. All levels are listed below.
Level 1 (strongest): Systematic review of randomized controlled trials or systematic review of nonrandomized trials
Level 2: Single randomized controlled trial or single nonrandomized trial
Level 3: Systematic review of correlational or observational studies
Level 4: Single correlational or observational study
Level 5: Systematic review of descriptive, qualitative, or physiologic studies
Level 6: Single descriptive, qualitative, or physiologic study
Level 7 (weakest): Opinions of authorities and expert committee
Positive symptom clusters of schizophrenia include
hallucinations, delusions, disorganized behaviors, hostility, grandiosity, mania, and paranoia Hostility and referential thinking
Negative symptom clusters of schizophrenia include
affective flattening, alogia or poverty of speech, avolition, apathy, abstract-thinking problems, anhedonia, and attention deficits.
The strongest and most consistent risk factor for developing bipolar disorder is
a family history of bipolar disorder. These individuals are 10 times more likely to develop the condition.
When monoamine oxidase is inhibited, tyramine
exerts a strong vasopressor effect, stimulating the release of catecholamines, epinephrine, and norepinephrine, which can increase blood pressure and heart rate.
Foods containing high levels of magnesium, calcium, and tryptophan do not puts.
the patient at risk for a hypertensive crisis when taken with MAOI
