MH Exam 2 Flashcards
WHAT DISORDER IS BEING DESCRIBED HERE?
EXCESSIVE ACTIVITY AND ENERGY FOR AT LEAST FOUR DAYS
PSYCHOSIS IS NEVER PRESENT
LOW-LEVEL AND LESS DRAMATIC MANIA
Bipolar II
HYPOMANIA ALTERNATING WITH SYMPTOMS OF MILD TO
MODERATE DEPRESSION FOR AT LEAST TWO YEARS DESCRIBES
WHAT DISORDER?
Cyclothymic Disorder
IDENTIFY THIS THOUGHT PROCESS:
“HONESTY IS ESSENTIAL IN PEOPLE’S LIFE. EVERYONE SHOULD BE HONEST. MY
COUSIN’S NAME IS “HONEST.” HIS CAR’S MODEL IS MERCEDES. MERCEDES ARE
HIGH QUALITY CARS MADE IN GERMANY. GERMANY IS SUPERIOR IN CARS
MANUFACTURING. MANUFACTURING IS ESSENTIAL TO COUNTRIES’ ECONOMY ALL
OVER THE WORLD. THE WORLD IS IN CHAOS NOWADAYS ECONOMICALLY,
POLITICALLY, AND SOCIALLY.
Flight of Ideas
IDENTIFY THREE HIGH PRIORITY CLINICAL PROBLEMS ASSOCIATED
WITH BIPOLAR I DISORDER PLACING THEM IN PRIORITY ORDER:
- Mania
- Depression
- Anxiety
IDENTIFY THIS THOUGHT PROCESS:
“I WROTE THE BOAT OVERLOAD SHOWED MY GOAT FLOAT TOTE. HE
RAINED THE TRAIN BRAIN STRAIN GAIN THE CRANE. GO OUT AND
VOTE. SO, I WROTE.”
Clang Associations
YOU NOTICED THAT A NEW RESIDENT PHYSICIAN PRESCRIBED THE
SSRI, PAROXETINE, FOR YOUR PATIENT WITH BIPOLAR
DEPRESSION. THIS IS THE ONLY MEDICATION PRESCRIBED FOR
THE PATIENT. AS YOUR PATIENT’S ADVOCATE, YOU UNDERSTAND
THAT PRESCRIBING THIS MEDICATION ALONE INCREASES THE
RISK OF THE PATIENT EXPERIENCING A
Manic Episode
IDENTIFY TWO POTENT BENZODIAZEPINES USED IN THE
TREATMENT OF ACUTE MANIA
Clonazepam
Lorazepam
IDENTIFY THIS SPEECH PATTERN:
NURSE: HOW OLD WAS YOUR MOTHER WHEN SHE DIED?
PATIENT RESPONSE: “ACCIDENTS HAPPEN ALL THE TIME. TOO MANY ACCIDENTS
HAPPEN IN THE UNITED STATES. SOMETIMES, THEY ARE CAUSED BY DRUNK
DRIVERS. SOMETIMES, THEY ARE CAUSED BY PEOPLE TALKING ON THEIR
PHONES. SOMETIMES, ACCIDENTS JUST HAPPEN, AND IT WAS NOBODY’S FAULT. I
WONDER HOW MANY ACCIDENTS HAPPENED IN THE UNITED STATES LAST YEAR.
MANY PEOPLE DIE IN ACCIDENTS. SOMETIMES, PEOPLE DON’T DIE. BUT OFTEN
THEY DO. MY MOTHER WAS 42 WHEN SHE DIED.”
Circumstantial Speech
IN ONE WORD, WHY SHOULD BENZODIAZEPINE USE
BE SHORT TERM UNTIL MANIA SUBSIDES?
Dependence
YOUR PATIENT IS TAKING LITHIUM 1200 MG DAILY. HE COMES
TO THE OFFICE WITH COMPLAINTS OF GI UPSET, HAND
TREMORS, SEDATION, AND THIRST. HIS LITHIUM LEVEL IS
FOUND TO BE 1.4 MEQ/L. IDENTIFY TWO INTERVENTIONS THE
NURSE SHOULD ANTICIPATE:
Symptoms often subside during treatment
Doses should be kept low
Kidney function and thyroid levels should be assessed before treatment and then on an annual basis.
IDENTIFY THE TWO MOST IMPORTANT CONCEPTS
LEARNED IN THIS COURSE TO DATE:
Safety and Boundaries
WHICH OF THE FOLLOWING MEDICATIONS MIGHT BE
PRESCRIBED TO PATIENTS DIAGNOSED WITH BIPOLAR
DISORDER?
A. LITHIUM
B. VALPROATE
C. LAMOTRIGINE
D. OLANZAPINE
IDENTIFY THIS THOUGHT PROCESS:
“MY TEA IS TOO SWEET. MY UNCLE’S CAR IS A TOYOTA. WE
DEFEATED THEM 3 - 0. MY WATCH IS NOT WORKING WELL. MY
FATHER IS AT WORK RIGHT NOW. YESTERDAY WE ATE A
BURGER. WE WILL GO TO NEW YORK AND WASHINGTON.
Loose Associations
WHICH OF THE FOLLOWING COULD BE INTERVENTIONS FOR
PATIENTS EXPERIENCING A MANIC EPISODE?
A) USE A FIRM AND CALM APPROACH
B) BE INCONSISTENT IN TREATMENT APPROACHES
C) PROVIDE MULTIPLE ACTIVITIES TO REDIRECT THE PATIENT
D) OBSERVE FOR SIGNS OF LITHIUM TOXICITY
E) PROVIDE FREQUENT HIGH CALORIE FLUIDS
F) USE FEWER FIRM APPROACHES WITH AGGRESSIVE
BEHAVIOR
USE A FIRM AND CALM APPROACH
OBSERVE FOR SIGNS OF LITHIUM TOXICITY
PROVIDE FREQUENT HIGH CALORIE FLUIDS
THE RATIONALE FOR ENCOURAGING FREQUENT REST
PERIODS DURING THE DAY FOR A PATIENT DIAGNOSED
WITH BIPOLAR MANIA IS, “LACK OF SLEEP CAN LEAD TO
____________ AND INCREASE ___________.
1) Exhaustion
2) Mania
THE NURSE IS INTERVIEWING MR. GEORGE CLOONEY, A PATIENT DIAGNOSED
WITH MAJOR DEPRESSION. MR. CLOONEY IS MOST OFTEN SILENT AND
CONTINUOUSLY KEEPS HIS EYES ON THE FLOOR AS TEARS RUN DOWN HIS
FACE. WHEN HE DOES SPEAK, HIS TONE IS SOFT, AND WORDS ARE BRIEF.
WHICH OF THE FOLLOWING ARE EFFECTIVE GUIDELINES FOR COMMUNICATING
WITH THIS PATIENT?
ASK THE PATIENT, “DO YOU EVER THINK ABOUT SUICIDE?”
USE SIMPLE, CONCRETE WORDS
LISTEN FOR COVERT MESSAGES ABOUT SUICIDE PLANS
ALLOW TIME FOR THE PATIENT TO RESPOND
WHICH OF THE FOLLOWING THERAPEUTIC COMMUNICATION
TECHNIQUES WOULD BE MOST EFFECTIVE TO USE WHEN MR.
CLOONEY IS SILENT?
MAKING OBSERVATION
THE MOTHER OF A DEPRESSED, SUICIDAL CLIENT STATES SHE IS “AT
HER WITS END” ABOUT WHAT TO DO TO HELP HER CHILD. SHE TOLD
YOU THAT MEDICATIONS ALONE ARE NOT ENOUGH, BECAUSE THEY
HAVE TRIED THESE MANY TIMES IN THE PAST. SHE ASKS, “ARE THERE
ANY OTHER RELIABLE AND EFFECTIVE ALTERNATIVE TREATMENTS?”
WHAT IS YOUR RESPONSE TO THIS DISTRAUGHT MOTHER
Electroconvulsive Therapy
MS. ALEXIA RUDD ( ) PRESENTS WITH THE
FOLLOWING SYMPTOMS: BP 205/130; TEMP. 102.5; NAUSEA/VOMITING;
AND SEVERE HEADACHE. HER MEDICATIONS INCLUDE PHENELZINE,
LINZESS, AND CEPHALEXIN. DURING THE ASSESSMENT, THE PATIENT
MENTIONS THAT SHE BEGAN DEVELOPING SYMPTOMS ABOUT AN
HOUR AGO AFTER DINNER IN WHICH SHE ATE FISH, MACARONI AND
CHEESE CASSEROLE, AND HAD A GLASS OF “SOME KIND OF WINE”
HER HUSBAND ORDERED. WHAT IS LIKELY HAPPENING WITH THIS
PATIENT?
Hypertensive Crisis
THE DOCTOR STOPPED MS. RUDD’S MEDICATION. WHEN
CAN SHE RESUME HER NORMAL DIETARY HABITS?
2 weeks
A PATIENT PRESENTS WITH SUICIDAL IDEATIONS WITH A PLAN TO
OVERDOSE WITH PILLS. THE PATIENT STATES HE HAS BEEN SEVERELY
DEPRESSED FOR ABOUT 8 MONTHS. WHICH MEDICATIONS DO YOU
ANTICIPATE THE PHYSICIAN WILL LIKELY NOT ORDER?
DOXEPINE
PAROXETINE
A PATIENT ARRIVES IN THE ER WITH THE FOLLOWING SYMPTOMS:
BLOOD PRESSURE 206/110; ABDOMINAL PAIN; DELIRIUM; MUSCLE
SPASMS; TEMPERATURE 105OF. THE PATIENT HAS BEEN PRESCRIBED
PAROXETINE BY ONE PHYSICIAN AND PHENELZINE BY A NURSE
PRACTITIONER. YOU RECOGNIZE THE PATIENT IS LIKELY
EXPERIENCING WHAT?
Serotonin Syndrome
TRICYCLIC ANTIDEPRESSANT ANTICHOLINERGIC SIDE EFFECTS INCLUDE WHICH OF THE FOLLOWING
WEIGHT GAIN
DRY MOUTH
CONSTIPATION
BLURRED VISION
A MAJOR DRAWBACK OF ANTIDEPRESSANT MEDICATIONS
IS THEY MAY TAKE _____ TO _______ WEEKS BEFORE________
1
3
Improving mood
