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NUR209 - Mental Health > Midterm Review Chapters: 10, 13, 14 > Flashcards

Midterm Review Chapters: 10, 13, 14 Flashcards

1
Q

any psychological or physical stimuli or events that provoke a stress response in the body

A

stressors

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2
Q

the body’s way of preparing for a situation an individual perceives as a threat

A

flight-or-fight response

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3
Q

What is the aggression in a fight or flight response?

A

fight

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4
Q

What is the withdrawal in a fight or flight response?

A

flight

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5
Q

Name the general adaptation syndrome stage in order.

A.
1) alarm
2) resistance
3) exhaustion

B.
1) resistance
2) alarm
3) exhaustion

C.
1) exhaustion
2) resistance
3) alarm

D.
1) alarm
2) exhaustion
3) resistance

A

A.
1) alarm
2) resistance
3) exhaustion

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6
Q

Name this general adaption syndrome stage.

the initial, brief, and adaptive response to the stressor

A. resistance stage
B. alarm stage
C. exhaustion stage

A

B. alarm stage

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7
Q

Name this general adaption syndrome stage.

sustained and optimal resistance to the stressor occurs

A. resistance stage
B. alarm stage
C. exhaustion stage

A

A. resistance stage

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8
Q

Name this general adaption syndrome stage.

occurs when attempts to resist the stressor prove futile

A. resistance stage
B. alarm stage
C. exhaustion stage

A

C. exhaustion stage

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9
Q

What is another name for bad stress?

A. distress
B. eustress

A

A. distress

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10
Q

What is another name for good stress?

A. distress
B. eustress

A

B. eustress

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11
Q

T/F

There is an interaction between the nervous system and the immune system that happens during the alarm phase of the general adaption syndrome.

A

true

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12
Q

Name the two categories of stressors.

A
  • physiological
  • psychological
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13
Q

What assessment question is focused on identifying a long-term consequence of chronic stress on physical health?

A. “Do you have any problems with sleeping well?”
B. “How many infections have you experienced in the past 6 months?”
C. “How much moderate exercise do you engage in on a regular basis?”
D. “What management techniques do you regularly use to manage your stress?”

A

B. “How many infections have you experienced in the past 6 months?”

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14
Q

Which nursing assessments are directed at monitoring a patient’s fight-or-flight response? (SATA)

A. blood pressure
B. heart rate
C. respiratory rate
D. abdominal pain
E. dilated pupils

A

A. blood pressure
B. heart rate
C. respiratory rate
E. dilated pupils

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14
Q

The patient you are assigned unexpectedly suffers a cardiac arrest. During this emergency situation, your body will produce a large amount of:

A. carbon dioxide
B. growth hormone
C. epinephrine
D. aldosterone

A

C. epinephrine

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14
Q

Which question is focused on the assessment of an individual’s personal ability to manage stress? (SATA)

A. “Have you ever been diagnosed with cancer?”
B. “Do you engage in any hobbies now that you have retired?”
C. “Have you been taking your antihypertensive medication as it is prescribed?”
D. “Who can you rely on if you need help after you’re discharged from the hospital?”
E. “What do you do to help manage the demands of parenting a 4-year-old and a newborn son?”

A

B. “Do you engage in any hobbies now that you have retired?”

D. “Who can you rely on if you need help after you’re discharged from the hospital?”

E. “What do you do to help manage the demands of parenting a 4-year-old and a newborn son?”

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15
Q

When considering stress, what is the primary goal of making daily entries into a personal journal?

A. providing a distraction from the daily stress
B. expressing emotions to manage stress
C. identifying stress triggers
D. focusing on one’s stress

A

C. identifying stress triggers

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16
Q

Hugo is 21 and diagnosed with schizophrenia. His history includes significant turmoil as a child and adolescent. Hugo reports his father was abusive and routinely beat him, all of his siblings, and his mother. Hugo’s early response to stress most likely:

A. made him resilient to stressful situations
B. increased his future vulnerability to psychiatric disorders
C. developed strong survival skills
D. shaped his nurturing nature

A

B. increased his future vulnerability to psychiatric disorders

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17
Q

lithium range

A

0.6-1.2 mEq/L

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18
Q

T/F

A benzodiazepine antianxiety agent can help reduce agitation or anxiety.

A

true

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19
Q

What is lithium used to treat?

A. depression
B. mania
C. schizophrenia
D. seizures

A

B. mania

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20
Q

Which of the following are the correct dermatologic adverse effects of lithium?

A. acne, pruritus, eczema
B. pruritus, acne, alopecia
C. psoriasis, ringworm, acne
D. acne, alopecia, psoriasis

A

D. acne, alopecia, psoriasis

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21
Q

Which of the following are the correct digestive adverse effects of lithium?

A. diarrhea, nausea, vomiting
B. abdominal cramping, constipation, nausea
C. bloating, nausea, vomiting
D. abdominal cramping, diarrhea, vomiting

A

A. diarrhea, nausea, vomiting

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22
Q

Which of the following are the correct endocrine adverse effects of lithium?

A. hypothyroidism, weight loss
B. hypothyroidism, weight gain
C. hyperthyroidism, weight gain
D. hyperthyroidism, weight loss

A

B. hypothyroidism, weight gain

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23
Q

Which of the following are the correct fluid and electrolyte adverse effects of lithium?

A. edema, polydipsia, polyuria
B. dehydration, metabolic acidosis, polyuria
C. edema, metabolic alkalosis
D. dehydration, anuria, edema

A

A. edema, polydipsia, polyuria

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24
Q

Which of the following are the correct CNS and musculoskeletal adverse effects of lithium?

A. shuffling gait, tremors, agitation
B. fine tremors, fever
C. ataxia, sedation, fine tremor
D. ataxia, shuffling gait, fever

A

C. ataxia, sedation, fine tremor

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25
Q

Lithium must reach therapeutic __________ levels to be effective.

A. blood
B. tissue
C. trough
D. physical activity

A

A. blood

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26
Q

__________ is generally contraindicated in patients with CV disease, brain damage, renal disease, thyroid disease, or myasthenia gravis.

A. valproic acid
B. lamotrigine
C. carbamzepine
D. lithium

A

D. lithium

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27
Q

T/F

Lithium is safe for pregnant people to take.

A

false

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28
Q

Brand name for Divalproex.

A

Depakote

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29
Q

Valproate different names.

A
  • divalproex (Depakote)
  • valproic acid
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30
Q

Valproate is a(n) __________ drug.

A

anticonvulsant

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31
Q

Why should you monitor liver enzymes for your patient who is taking carbamazepine?

A. because the drug can decrease levels of liver enzymes that can speed its metabolism
B. because the drug can decrease levels of liver enzymes that can slow its metabolism
C. because the drug can increase levels of liver enzymes that can slow its metabolism
D. because the drug can increase levels of liver enzymes that can speed its metabolism

A

D. because the drug can increase levels of liver enzymes that can speed its own metabolism

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32
Q

T/F

Complete blood counts should be drawn prior to beginning carbamazepine and periodically after since it’s known to cause leukopenia and aplastic anemia.

A

true

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33
Q

__________ carries a black box warning for serious dermatologic reactions.

A. valproate
B. carbamazepine
C. lithium
D. lamotrigine

A

B. carbamazepine

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34
Q

T/F

Lamotrigine is a mood stabilizer.

A

false; anticonvulsant

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35
Q

T/F

Second-generation antipsychotics can lead to weight gain which can lead to further complications.

A

true

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36
Q

How often must a restraint order be reviewed and rewritten?

A

every 24 hours

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37
Q

T/F

NSAIDS can influence lithium levels.

A

true

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38
Q

Which degree of lithium toxicity do these side effects belong to?

Coarse hand tremor, worsening GI symptoms, confusion, slurred speech, marked lethargy, nausea, vomiting, diarrhea

A. early toxicity
B. severe toxicity
C. past severe toxicity

A

A. early toxicity

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39
Q

Which degree of lithium toxicity do these side effects belong to?

ataxia, confusion, polyuria with dilute urine, blurred vision, clonic movement (twitching), hypotension, seizures, stupor, coma

A. early toxicity
B. severe toxicity
C. past severe toxicity

A

B. severe toxicity

40
Q

Which degree of lithium toxicity do these side effects belong to?

cardiac dysrhythmias

A. early toxicity
B. severe toxicity
C. past severe toxicity

A

C. past severe toxicity

41
Q

T/F

It is okay for your patient on lithium to drink coffee, tea, or cola in large amounts.

A

false; small amounts only

42
Q

A sudden __________ in sodium intake may result in __________ lithium levels.

A. increase; increased
B. decrease; increased
C. increase; decreased
D. decrease; decreased

A

B. decrease; increased

43
Q

T/F

Take lithium with meals to avoid stomach irritation.

A

true

44
Q

Name this drug based on the MOA.

may alter sodium, potassium ion transport across cell membranes in nerve, and muscle cells; may balance biogenic amines of norepinephrine, and serotonin in CNS areas involved in emotional responses

A

lithium

45
Q

Name this drug based on the MOA.

increases levels of GABA in the brain, which decreases seizure activity

A

valproic acid

46
Q

Name this drug based on the MOA.

decreases polysynaptic responses and block post-tetanic potentiation

A

carbamazepine

47
Q

What is the neurotransmitter for lithium?

A

GABA

48
Q

What is the neurotransmitter for carbamazepine?

A

GABA

49
Q

Name this drug based on the MOA.

may inhibit voltage-sensitive sodium channels, decreasing seizures

A

lamotrigine

50
Q

What is the neurotransmitter for lamotrigine?

A

GABA

51
Q

Many of the __________-generation antipsychotics are approved for acute mania.

A. first
B. second
C. third
D. fourth

A

B. second

52
Q

__________ is contraindicated in mothers who are breastfeeding and children under 12 years of age.

A. valproic acid
B. carbamazepine
C. lithium
D. risperidone

A

C. lithium

53
Q

The FDA has a black box warning against __________ use in pregnancy due to teratogenicity.

A. valproic acid
B. carbamazepine
C. lithium
D. risperidone

A

A. valproic acid

54
Q

__________ is more common after valproic acid use during pregnancy.

A. dwarfism
B. autism
C. ADHD
D. cancer

A

B. autism

55
Q

When a child grows and their parent took valproic acid while pregnant, a condition sometimes known as __________ may become evident.

A. ADHD
B. congenital myotonia
C. fetal anticonvulsant syndrome
D. paraplegia

A

C. fetal anticonvulsant syndrome

56
Q

Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar disorder and her support system? (SATA)

A. “Remember that alcohol and caffeine can trigger a relapse of your symptoms.”
B. “Due to the risk of a manic episode, antidepressant therapy is never used with bipolar disorder.”
C. “It’s critical to let your HCP know immediately if you aren’t sleeping well.”
D. “It will be helpful for your family to understand the management of this disorder.”
E. “The symptoms tend to come and go and so you need to be able to recognize the early signs.”

A

A. “Remember that alcohol and caffeine can trigger a relapse of your symptoms.”

C. “It’s critical to let your HCP know immediately if you aren’t sleeping well.”

D. “It will be helpful for your family to understand the management of this disorder.”

E. “The symptoms tend to come and go and so you need to be able to recognize the early signs.”

57
Q

Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? (SATA)

A. “I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day.”
B. “I discussed the diuretic my cardiologist prescribed with my psychiatric care provider.”
C. “Lithium may help me lose the few extra pounds I tend to carry around.”
D. “I take my lithium on an empty stomach to help with absorption.”
E. “I’ve already made arrangements for outpatient lithium level monitoring.”

A

A. “I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day.”

B. “I discussed the diuretic my cardiologist prescribed with my psychiatric care provider.”

E. “I’ve already made arrangements for outpatient lithium level monitoring.”

58
Q

The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? (SATA)

A. getting up at night to urinate
B. increased attentiveness
C. improved vision
D. an upset stomach for no apparent reason
E. shaky hands that make holding a cup difficult

A

D. an upset stomach for no apparent reason
E. shaky hands that make holding a cup difficult

59
Q

A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially?

A. reinforce that the level is considered therapeutic
B. instruct the patient to hold the next dose of medication and contact the prescriber
C. have the patient go to the hospital emergency department immediately
D. alert the patient to the possibility of seizures and appropriate precautions

A

B. instruct the patient to hold the next dose of medication and contact the prescriber

60
Q

an abnormal lack of energy, may result in psychomotor retardation

A

anergia

61
Q

SSRIs should not be taken within __________ of the last dose of a MOAI.

A

14 days

62
Q

Which of the following are the first line of treatment drugs for depression?

A. MAOIs
B. SSRIs
C. tricyclics
D. SARIs

A

B. SSRIs

63
Q

What time of day should you administer tricyclics to your patient?

A. morning
B. afternoon
C. evening
D. night

A

D. night

64
Q

Dry mouth, sweating, weight change, mild nausea, and loose stools are all examples of __________ reactions.

A. autonomic
B. peripheral
C. somatic
D. central

A

A. autonomic

65
Q

the outward representation of a person’s internal state

A

affect

66
Q

Affect is __________ data.

A. objective
B. subjective

A

A. objective

67
Q

Which of the following nursing diagnoses for depression is always considered?

A. impaired coping
B. social isolation
C. failure to thrive
D. risk for suicide

A

D. risk for suicide

68
Q

Name the three phases in treatment and recovery from major depression.

A.
- acute
- continuation
- maintenance
B.
- acute
- continuation
- chronic
C.
- partial
- acute
- maintenance
D.
- acute
- continuation
- partial

A

A.
- acute
- continuation
- maintenance

69
Q

T/F

SSRIs have an anticholinergic effect.

A

false

70
Q

What type of foods should someone taking an MAOI avoid?

A. protein
B. tyramine
C. iron
D. fish, omega-3 fatty

A

B. tyramine

71
Q

contains phenylethylamine, a pressor agent; large amounts can cause a reaction

A. chocolate
B. fava beans
C. ginseng
D. caffeinated beverages

A

A. chocolate

72
Q

__________ is a weak pressor agent; large amounts may cause a reaction.

A. chocolate
B. fava beans
C. ginseng
D. caffeinate

A

D. caffeinate

73
Q

headache, tremulousness, and mania-like reactions have occurred

A. chocolate
B. fava beans
C. ginseng
D. caffeinated beverages

A

C. ginseng

74
Q

contain dopamine, a pressor agent; reactions are most likely with overripe beans

A. chocolate
B. fava beans
C. ginseng
D. caffeinated beverages

A

B. fava beans

75
Q

Which of the following is the second line of treatment drugs for depression?

A. MAOIs
B. SSRIs
C. tricyclics
D. SARIs

A

C. tricyclics

76
Q

T/F

TCAs have an anticholinergic effect.

A

true

77
Q

Why are MAOIs 3rd in line for the treatment of depression?

A

too many significant drug and food interactions

78
Q

T/F

Antidepressants do not cross the placenta.

A

false

79
Q

Which of the following supplements increases serotonin (happiness)?

A. caffeine
B. magnesium glycolate
C. st. john wort
D. ginseng

A

C. st. john wort

80
Q

_________ selectively stop serotonin reuptake, allowing more serotonin to stay at the junction of the neurons.

A. SSRIs
B. MAOIs
C. TCAs
D. SARIs

A

A. SSRIs

81
Q

T/F

SSRIs do not block the uptake of dopamine or norepinephrine.

A

true

82
Q

T/F

SSRIs have a short half-life.

A

false; long half-life

83
Q

In a patient taking an SSRI, how long could it take before signs of serotonin syndrome start to manifest?

A. 24-48 hours
B. 2-72 hours
C. up to 12 hours
D. 2-20 hours

A

B. 2-72 hours

84
Q

T/F

SSRIs are compatible with MAOIs and TCAs.

A

false

85
Q

What do SSRIs treat?

A

depression

86
Q

What is Zoloft used to treat?

A

depression

87
Q

__________ causes CNS stimulation, which can cause insomnia.

A. fluoxetine
B. sertraline
C. citalopram
D. paroxetine

A

D. paroxetine

88
Q

What is Prozac used to treat?

A

depression

89
Q

bupropion

A

atypical antidepressant

90
Q

Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder?

A. “I’m so restless. I can’t seem to sit still.”
B. “I spend most of my time studying. I have to get into a good college.”
C. “I’m obsessed with counting telephone poles as I drive by them.”
D. “I go to sleep around 11 pm but I’m always up by 3 am and can’t go back to sleep.”

A

D. “I go to sleep around 11 pm but I’m always up by 3 am and can’t go back to sleep.”

91
Q

Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population?

A. conducting routine suicide screenings at a senior center
B. identifying depression as a natural, but treatable result of aging
C. identifying males as being at a greater risk for developing depression
D. stressing that most individuals experience just a single episode of major depressive disorder in a lifetime

A

A. conducting routine suicide screenings at a senior center

92
Q

Tammy, a 28-year-old with major depressive disorder and bulimia nervosa, is ready for discharge from the county hospital after 2 weeks of inpatient therapy. Tammy is taking citalopram (Celexa) and reports that it has made her feel more hopeful. With a secondary diagnosis of bulimia nervous, what is an alternative antidepressant to consider?

A. fluoxetine (Prozac)
B. isocarboxazid (Marplan)
C. amitriptyline
D. duloxetine (Cymbalta)

A

A. fluoxetine (Prozac)

93
Q

Cabot has multiple symptoms of depression, including mood reactivity, social phobia, anxiety, and operating. With a history of mild hypertension, which classification of antidepressants dispensed as a transdermal patch would be a safe medication?

A. tricyclic antidepressants
B. selective serotonin reuptake inhibitors
C. serotonin and norepinephrine reuptake inhibitors
D. monoamine oxidase inhibitor

A

D. monoamine oxidase inhibitor

94
Q

When a nurse uses therapeutic communication with a withdrawn patient who has major depressive disorder, an effective method of managing the silence is to:

A. ask simple questions even if the patient will not answer
B. use the technique of making observations
C. meditate in the quiet environment
D. simply sit quietly and leave when the patient falls asleep

A

B. use the technique of making observations

95
Q

The biological approach to treating depression with electrodes surgically implanted into specific areas of the brain to stimulate the regions identified to be underactive in depression is:

A. transcranial magnetic stimulation
B. deep brain stimulation
C. vagus nerve stimulation
D. electroconvulsive therapy

A

B. deep brain stimulation

96
Q

A charge nurse is discussing the care of a client who has major depressive disorder with a new grad nurse. Which of the following statements made by the new-grad nurse indicates an understanding of the teaching?

A. “Care during the continuation phase focuses on treating continued manifestations of major depressive disorder.”
B. “The treatment of major depressive disorder during the maintenance phase lasts for 6 to 12 weeks.”
C. “The client is at greatest risk for suicide during the first weeks of a major depressive disorder episode.”
D. “Medication and psychotherapy are most effective during the acute phase of major depressive disorders.

A

C. “The client is at greatest risk for suicide during the first weeks of a major depressive disorder episode.”

97
Q

A nurse is interviewing a client who has a new diagnosis of persistent depressive disorder. Which of the following findings should the nurse expect?

A. wide fluctuations in mood
B. report of a minimum of five clinical findings of depression
C. presence of manifestations for at least 2 years
D. inflated sense of self-esteem

A

C. presence of manifestations for at least 2 years

98
Q

A nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. Which of the following actions is the nurse’s priority?

A. placing the client on one-to-one observation
B. assisting the client to perform ADLs
C. encouraging the client to participate in counseling
D. teaching the client about medication adverse effects

A

A. placing the client on one-to-one observation

99
Q

A nurse is assessing a client 4 hours after receiving an initial dose of fluoxetine. Which of the following findings should the nurse report to the provider as indications of serotonin syndrome? (SATA)

A. hypothermia
B. hallucinations
C. muscular flaccidity
D. diaphoresis
E. agitation

A

B. hallucinations
D. diaphoresis
E. agitation

NUR209 - Mental Health (6 decks)

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