Mental Health Test 3

Question 1

Discuss the cognitive therapy approach to interventions in mental health nursing.

Answer 1

type of psychotherapy, based on cognitive model, which focuses on client thoughts and behaviors to solve current problems. Used to treat depression, anxiety, eating disorders and other problems that can be improved by changing the client’s attitudes towards life experiences. Therapist uses therapeutic communication to change client’s irrational thoughts to thoughts and feelings that are more objective and realistic. Therapy is time limited, active structured and directive. Helps people identify distorted thoughts (bad beliefs about themselves) and to evaluate whether those thoughts (cognitions) are realistic.
Cognitive reframing- Changing cognitive distortions can decrease anxiety. Assists the clients to identify negative thoughts that produce anxiety, examine the cause and develop supportive ideas that replace negative self talk. Through therapy, this client may change his thinking to realize that he may have made some bad choices, but that he is not a “bad person”.

Question 2

Discuss the behavioral approach to mental health therapy.

Answer 2

Behavioral therapy is based on the theory that behavior is learned and has consequences. Abnormal behavior results from an attempt to avoid painful feelings. Changing abnormal or maladaptive behavior can occur without the need for insight into the underlying cause of the behavior. Behavioral therapies show clients ways to decrease anxiety or avoidant behavior and give clients an opportunity to practice techniques. Behavioral therapy has been used successfully to treat clients who have phobias, substance use or addictive disorders.
Types-
• Modeling- A therapist or others serve as role models for a client, who imitates this modeling to improve behavior. Modeling can occur in the acute care milieu to help clients improve interpersonal skills. The therapist demonstrates appropriate behavior in a stressful situation with the goal of having the client imitate the behavior.
• Operant conditioning- The client receives positive rewards for positive behaviors. For example- a client receives tokens for good behavior and he can exchange them for a privilege or other items.
• Systemic desensitization- This therapy is the planned, progressive or graduated exposure to anxiety-provoking stimuli in real life situations or by imagining events that cause anxiety. During exposure, the client uses relaxation techniques to suppress anxiety response. Systematic desensitization begins with the client mastering relaxation techniques. Then, the client is exposed to increasing levels of the anxiety-producing stimulus (either imagined or real) and uses relaxation to overcome anxiety. The client is then able to tolerate a greater and greater level of the stimulus until anxiety no longer interferes with functioning.
• Aversion therapy- Pairing of a maladaptive behavior with a punishment or unpleasant stimuli to promote a change in the behavior. A therapist or treatment team can use unpleasant stimuli, such as bitter taste or mild electric shock, as punishment for behaviors such as alcohol use disorder, violence, self mutilation and thumb sucking.
• Meditation, guided imagery, diaphragmatic breathing, muscle relaxation and biofeedback- This therapy uses various techniques to control pain, tension and anxiety. For example- a nurse can provide instructions on diaphragmatic breathing to a client having a panic attack or to a female client in labor.

Question 3

Discuss the purpose of using self-help groups.

Answer 3

Also known as mutual help, mutual aid, or support groups, are groups of people who provide mutual support for each other. In a self-help group, the members share a common problem, often a common disease or addiction.

Question 4

Discuss the use of fluoxetine (Prozac).

Answer 4

SSRI; Expected pharmacological action- Selectively inhibits serotonin reuptake, allowing more serotonin to stay at the junction of the neurons. It does not block the uptake of dopamine or norepinephrine. Used for panic disorder and GAD.

Question 5

Discuss the adverse effects of fluoxetine (Prozac)

Answer 5

Adverse effects- Weight gain, serotonin syndrome- mental confusion, agitation, anxiety, hallucinations, hyperreflexia, fever, restlessness, tremors. Hyponatremia, bruxism- grinding and clenching of teeth, headache, sexual dysfunction.

Question 6

scuss the benefits of using an assertiveness training program

Answer 6

Educates clients to express feelings and solve problems in a nonaggressive manner. Assertiveness training is a form of behavior therapy designed to help people stand up for themselves—to empower themselves, in more contemporary terms. Assertiveness is a response that seeks to maintain an appropriate balance between passivity and aggression.

Question 7

Discuss the mode of treatment for the client with severe depression and suicidal ideation.

Answer 7

ECT is used for clients with severe depression when clients are not responsive to pharmacologic treatment. Also used for clients who are actively suicidal and for whom there is a need for rapid therapeutic response. ECT uses electrical current which enhances the effects of neurotransmitters in the brain.

Question 8

List the side effects of ECT.

Answer 8

• Memory loss and confusion- short term memory loss, confusion and disorientation can occur immediately following the procedure. Memory loss can persist for several weeks
• Reactions to Anesthesia
• ECG changes- The client’s baseline HR is expected to increase by 25% during the procedure and early recovery. BP can fall initially and then rise during the procedure. Elevated BP should resolve shortly after the procedure.
• Headache, muscle soreness and nausea can occur during and following the immediate recovery period.
• Relapse of depression

Question 9

describe the care for the client after ECT

Answer 9

• When stable, the client is transferred to a recovery area where LOC, cardiac status, VS and SaO2 are monitored
• Side lying position to facilitate drainage and prevent aspiration
• Client is monitored for ability to swallow and return of the gag reflex
• Client is usually awake and ready for transfer within 30-60 minutes after the procedure

Question 10

the use of anxiolytic would be use for which type of symptoms

Answer 10

Anti anxiety drugs used to treat anxiety disorders, panic attacks, preanesthetic sedation, muscle relaxation, convulsions or seizures, alcohol withdrawal.

Question 11

List the indications for the medications: Narcan, Methadone, Romazicon, and Chlorpromazine.

Answer 11

• Naloxone (Narcan)- opioid antagonist used for the complete or partial reversal of opioid overdose, including respiratory depression. Narcan is also used for diagnosis of suspected or known acute opioid overdose and also for blood pressure support in septic shock.
• Methadone (Dolophine)- Oral opioid agonist that replaces the opioid to which the client is addicted.
• Flumazenil (Romazicon)- GABA receptor antagonist used to it can treat drowsiness caused by sedatives following surgery or drug overdose. Also used for IV toxicity (antidote for antianxiety medications).
• Chlorpromazine (Thorazine)- Blocks dopamine, acetylcholine, histamine and norepinephrine receptors in the brain and periphery; inhibition of psychotic symptoms believed to be dopamine blockade. Used to treat acute and chronic psychosis in schizophrenia, bipolar disorders, Tourette’s syndrome, delusional disorders, schizoaffective disorders, dementia and other organic mental syndromes, Huntington’s chorea.

Question 12

List three medications that a client may abuse or develop a dependency or addiction to.

Answer 12

Lorazepam (Ativan), alprazolam (Xanax), diazepam (Valium)

Question 13

Discuss the use of tricyclic antidepressants in the client with a depressive disorder.

Answer 13

These meds block reuptake of the neurotransmitters norepinephrine and serotonin in the synaptic space, thereby intensifying the effects of the neurotransmitters. Uses- depressive episodes, bipolar disorders, OCD etc.

Question 14

Discuss the use of imipramine (Tofranil) in the client with a history of suicide.

Answer 14

These meds block reuptake of the neurotransmitters norepinephrine and serotonin in the synaptic space, thereby intensifying the effects of the neurotransmitters. Relief is not immediate and it can take several weeks or more to reach full therapeutic benefits. Encourage continued compliance.

Question 15

Discuss the client teaching for the client prescribed amitriptyline (Elavil).

Answer 15

• Change positions slowly to minimize orthostatic hypotension
• Increase fluid intake
• Minimize anticholinergic effects by chewing sugarless gum, sipping on water, wearing sunglasses, eating high fiber foods, void before taking med
• Avoid hazardous activities if drowsiness occurs
• Take med at bedtime
• Avoid alcohol and other CNS depressants

Question 16

Discuss the indications and side effects of sertraline (Zoloft).

Answer 16

Indications- SSRI used to treat major depressive disorder, OCD, bulimia, premenstrual dysphoric disorder, panic disorder, PTSD
Side effects- weight gain, serotonin syndrome- mental confusion, agitation, anxiety, hallucinations, hyperreflexia, fever, restlessness, tremors; sexual dysfunction, insomnia, bruxism, hyponatremia

Question 17

List two considerations before beginning a client on monoamine oxidase inhibitors.

Answer 17

• Contraindicated in clients taking SSRIs, pheochromocytoma, HF, cardiovascular and cerebral vascular disease, severe impairment of kidney function.
• Ensure client isn’t pregnant

Question 18

What should be taught to the client who has been prescribed phenelzine (Nardil)?

Answer 18

MAOI. Client teaching-
• Avoid OTC decongestants and cold remedies
• Avoid use of SSRIs
• Instruct client to avoid foods containing tyramine- aged meats and cheeses, smoked or pickled meats, meat extracts, avocado, smoked fish, some dietary supplements, some beers and red wine.
• Avoid foods that contain caffeine, chocolate, fava beans, ginseng.
• Inform provider if pregnant

Question 19

Discuss Serotonin Syndrome and how it happens.

Answer 19

Serotonin syndrome occurs within 2-72 hours of beginning of treatment with meds that affect serotonin levels or excessively increasing the dose of one you are already taking. Manifestations include- 
•	Mental confusion
•	Abd pain
•	Diarrhea
•	Agitation
•	Fever
•	Anxiety 
•	Hallucinations
•	Hyperreflexia, incoordination 
•	Diaphoresis 
•	Tremors

Question 20

Neuroleptics are used to treat which type of disorders?

Answer 20

Antipsychotics or neuroleptics are used to treat acute and chronic psychotic disorders, schizophrenia, bipolar disorder (primarily manic phase), Tourette’s disorder, prevention of nausea/vomiting through blocking of dopamine in the chemoreceptor trigger zone of the medulla.

Question 21

List the side effects of

a. Chlorpromazine hydrochloride (Thorazine):
b. Methylphenidate (Ritalin):
c. Sertraline (Zoloft):
d. Lithium carbonate (Lithane):

Answer 21

a. Chlorpromazine hydrochloride (Thorazine): granulocytosis, anticholinergic effects such as dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipation, tachycardia; acute dystonia (severe spasm of the tongue, neck, face and back), parkinsonism such as bradykinesia, rigidity, shuffling gait, drooling, tremors; akathisia, tardive dyskinesia, neuroendocrine effects such as menstrual irregularities, neuroleptic malignant syndrome- sudden high fever, BP fluctuations, dysrhythmias, changes in LOC, muscle rigidity, coma; orthostatic hypotension, sedation, seizures, photosensitivity
b. Methylphenidate (Ritalin): Insomnia, restlessness, weight loss, CV effects such as dysrhythmias, chest pain, high BP, hallucinations, paranoia, withdrawal reaction
c. Sertraline (Zoloft): ht gain, serotonin syndrome- mental confusion, agitation, anxiety, hallucinations, hyperreflexia, fever, restlessness, tremors; sexual dysfunction, insomnia, bruxism, hyponatremia
d. Lithium carbonate (Lithane): Nausea, diarrhea, abd pain, fine hand tremors, polyuria, mild thirst, weight gain, kidney toxicity, goiter, hyperthyroidism, bradydysrhythmias, hypotension, electrolyte imbalances

Question 22

How does haloperidol (Haldol) work in the body?

Answer 22

Blocks dopamine, acetylcholine, histamine and norepinephrine receptors in the brain and periphery. Inhibition of psychotic manifestations is believed to be a result of dopamine blockade in the brain.

Question 23

List the possible side effects of Haldol.

Answer 23

Agranulocytosis, anticholinergic effects such as dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipation, tachycardia; acute dystonia (severe spasm of the tongue, neck, face and back), parkinsonism such as bradykinesia, rigidity, shuffling gait, drooling, tremors; akathisia, tardive dyskinesia, neuroendocrine effects such as menstrual irregularities, neuroleptic malignant syndrome- sudden high fever, BP fluctuations, dysrhythmias, changes in LOC, muscle rigidity, coma; orthostatic hypotension, sedation, seizures, photosensitivity

Question 24

List one mental health medication that can increase the risk for the client developing Type II diabetes.

Answer 24

Atypical antipsychotics such as risperidone (Risperdal) can increase the risk for developing DM

Question 25

List the medication most useful in treating the psychotic symptoms in the schizophrenic client.

Answer 25

Conventional antipsychotics such as chlorpromazine, haloperidol

Question 26

List the disorders treated by the following medications:

a. Acetaminophen with hydrocodone (Lortab):
b. Citalopram (Celexa):
c. Benztropine mesylate (Cogentin):
d. Ziprasidone hydrochloride (Geodon):

Answer 26

a. Acetaminophen with hydrocodone (Lortab): Lortab is used to relieve moderate to severe pain
b. Citalopram (Celexa): Major depressive disorder, OCD, bulimia, premenstrual dysphoric disorders, panic disorders, PTSD
c. Benztropine mesylate (Cogentin): Treating Parkinson disease in combination with other medicines. It is also used to control tremors and stiffness of the muscles due to certain antipsychotic medicines (eg, phenothiazines). Cogentin is an anticholinergic.
d. Ziprasidone hydrochloride (Geodon): Schizophrenia, psychosis induced by levodopa therapy, bipolar disorder

Question 27

List the side effects of Thorazine.

Answer 27

Agranulocytosis, anticholinergic effects such as dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipation, tachycardia; acute dystonia (severe spasm of the tongue, neck, face and back), parkinsonism such as bradykinesia, rigidity, shuffling gait, drooling, tremors; akathisia, tardive dyskinesia, neuroendocrine effects such as menstrual irregularities, neuroleptic malignant syndrome- sudden high fever, BP fluctuations, dysrhythmias, changes in LOC, muscle rigidity, coma; orthostatic hypotension, sedation, seizures, photosensitivity

Question 28

Discuss the nursing considerations when caring for a client taking clozapine (Clozaril), including contraindications.

Answer 28

• Do not use in clients with dementia
• Avoid alcohol
• Use cautiously in clients who have CV or CBV disease, seizures, DM
• Ensure clients with DM have baseline fasting blood sugar and blood glucose monitored frequently
• Monitor cholesterol, triglycerides and blood glucose
• Baseline and weekly monitoring of WBC
• Notify provider of infection
• Monitor for anticholinergic effects
• Monitor for orthostatic hypotension and sedation
• Do not use with clients using levodopa

Question 29

Which medication cam be used intramuscularly to treat schizophrenia.

Answer 29

risperidone

Question 30

Discuss the use of trihexyphenidyl (Artane) in mental health.

Answer 30

Used to treat involuntary movements due to the side effects of certain psychiatric drugs (antipsychotics such as chlorpromazine/haloperidol). Trihexyphenidyl belongs to a class of medication called anticholinergics that work by blocking a certain natural substance (acetylcholine). This helps decrease muscle stiffness, sweating, and the production of saliva, and helps improve walking ability in people with Parkinson's disease.
Anticholinergics can stop severe muscle spasms of the back, neck, and eyes that are sometimes caused by psychiatric drugs. It can also decrease other side effects such as muscle stiffness/rigidity (extrapyramidal signs-EPS). It is not helpful in treating movement problems caused by tardive dyskinesia and may worsen them.

Question 31

Discuss the use of benzotropine (Cogentin) in mental health.

Answer 31

Treating Parkinson disease in combination with other medicines. It is also used to control tremors and stiffness of the muscles due to certain antipsychotic medicines (eg, phenothiazines). Cogentin is an anticholinergic.

Question 32

Discuss the nursing considerations when caring for the client taking lithium (Eskalith).

Answer 32

• Administer with food
• Advise client to report increase in tremors
• Increase fluid intake
• Assist client to follow a healthy diet (adequate Na) and exercise
• Monitor I&Os
• Check baseline BUN and Crt
• Obtain thyroid function tests
• Ensure client isn’t pregnant
• Discourage breastfeeding
• Use cautiously in patients with impaired kidney function, heart disease, sodium depletion and dehydration
• Maintenance levels are 0.4-1.0
• Encourage client to adhere to regular lab check ups

Question 33

List the signs and symptoms of lithium toxicity.

Answer 33

• Diarrhea
• Nausea/vomiting
• Polyuria and polydipsia
• Muscle weakness
• Fine hand tremors, coarse tremors
• Slurred speech
• Mental confusion
• Poor coordination
• Tinnitus
• Blurred vision
• Ataxia
• Seizures
• Severe hypotension
• Respiratory complications, coma, death

Question 34

List two medications that can be used as mood stabilizers.

Answer 34

Lithium, valporic acid (Depakote) and carbamazepine (Tegretol)

Question 35

List 2 medications for which the nurse must review the client’s serum blood level.

Answer 35

Carbamezapine (Tegretol), valporic acid (Depakote)

Question 36

Discuss two common medications used to treat ADHD in the child. Include nursing considerations.

Answer 36

Methylphenidate (Ritalin)- CNS stimulant. Used cautiously in clients with hyperthyroidism, heart disease, glaucoma, history of drug abuse and those taking MAOIs. Can cause tolerance and dependence. Monitor VS, height, weight, growth and behavior
Atomoxetine (Strattera)- nonstimulant that controls ADHD through selective inhibition of norepinephrine transport. May cause GI upset, anorexia, mood swings, insomnia, weight loss and growth retardation. Monitor VS, height, weight, growth and behavior.