Midterm Review Chapters: 10, 13, 14 Flashcards
any psychological or physical stimuli or events that provoke a stress response in the body
stressors
the body’s way of preparing for a situation an individual perceives as a threat
flight-or-fight response
What is the aggression in a fight or flight response?
fight
What is the withdrawal in a fight or flight response?
flight
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.
1) alarm
2) resistance
3) exhaustion
Name this general adaption syndrome stage.
the initial, brief, and adaptive response to the stressor
A. resistance stage
B. alarm stage
C. exhaustion stage
B. alarm stage
Name this general adaption syndrome stage.
sustained and optimal resistance to the stressor occurs
A. resistance stage
B. alarm stage
C. exhaustion stage
A. resistance stage
Name this general adaption syndrome stage.
occurs when attempts to resist the stressor prove futile
A. resistance stage
B. alarm stage
C. exhaustion stage
C. exhaustion stage
What is another name for bad stress?
A. distress
B. eustress
A. distress
What is another name for good stress?
A. distress
B. eustress
B. eustress
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.
true
Name the two categories of stressors.
- physiological
- psychological
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?”
B. “How many infections have you experienced in the past 6 months?”
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. blood pressure
B. heart rate
C. respiratory rate
E. dilated pupils
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
C. epinephrine
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?”
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?”
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
C. identifying stress triggers
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
B. increased his future vulnerability to psychiatric disorders
lithium range
0.6-1.2 mEq/L
T/F
A benzodiazepine antianxiety agent can help reduce agitation or anxiety.
true
What is lithium used to treat?
A. depression
B. mania
C. schizophrenia
D. seizures
B. mania
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
D. acne, alopecia, psoriasis
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. diarrhea, nausea, vomiting
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
B. hypothyroidism, weight gain
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. edema, polydipsia, polyuria
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
C. ataxia, sedation, fine tremor
Lithium must reach therapeutic __________ levels to be effective.
A. blood
B. tissue
C. trough
D. physical activity
A. blood
__________ 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
D. lithium
T/F
Lithium is safe for pregnant people to take.
false
Brand name for Divalproex.
Depakote
Valproate different names.
- divalproex (Depakote)
- valproic acid
Valproate is a(n) __________ drug.
anticonvulsant
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
D. because the drug can increase levels of liver enzymes that can speed its own metabolism
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.
true
__________ carries a black box warning for serious dermatologic reactions.
A. valproate
B. carbamazepine
C. lithium
D. lamotrigine
B. carbamazepine
T/F
Lamotrigine is a mood stabilizer.
false; anticonvulsant
T/F
Second-generation antipsychotics can lead to weight gain which can lead to further complications.
true
How often must a restraint order be reviewed and rewritten?
every 24 hours
T/F
NSAIDS can influence lithium levels.
true
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. early toxicity
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
B. severe toxicity
Which degree of lithium toxicity do these side effects belong to?
cardiac dysrhythmias
A. early toxicity
B. severe toxicity
C. past severe toxicity
C. past severe toxicity
T/F
It is okay for your patient on lithium to drink coffee, tea, or cola in large amounts.
false; small amounts only
A sudden __________ in sodium intake may result in __________ lithium levels.
A. increase; increased
B. decrease; increased
C. increase; decreased
D. decrease; decreased
B. decrease; increased
T/F
Take lithium with meals to avoid stomach irritation.
true
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
lithium
Name this drug based on the MOA.
increases levels of GABA in the brain, which decreases seizure activity
valproic acid
Name this drug based on the MOA.
decreases polysynaptic responses and block post-tetanic potentiation
carbamazepine
What is the neurotransmitter for lithium?
GABA
What is the neurotransmitter for carbamazepine?
GABA
Name this drug based on the MOA.
may inhibit voltage-sensitive sodium channels, decreasing seizures
lamotrigine
What is the neurotransmitter for lamotrigine?
GABA
Many of the __________-generation antipsychotics are approved for acute mania.
A. first
B. second
C. third
D. fourth
B. second
__________ is contraindicated in mothers who are breastfeeding and children under 12 years of age.
A. valproic acid
B. carbamazepine
C. lithium
D. risperidone
C. lithium
The FDA has a black box warning against __________ use in pregnancy due to teratogenicity.
A. valproic acid
B. carbamazepine
C. lithium
D. risperidone
A. valproic acid
__________ is more common after valproic acid use during pregnancy.
A. dwarfism
B. autism
C. ADHD
D. cancer
B. autism
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
C. fetal anticonvulsant syndrome
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. “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.”
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. “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.”
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
D. an upset stomach for no apparent reason
E. shaky hands that make holding a cup difficult
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
B. instruct the patient to hold the next dose of medication and contact the prescriber
an abnormal lack of energy, may result in psychomotor retardation
anergia
SSRIs should not be taken within __________ of the last dose of a MOAI.
14 days
Which of the following are the first line of treatment drugs for depression?
A. MAOIs
B. SSRIs
C. tricyclics
D. SARIs
B. SSRIs
What time of day should you administer tricyclics to your patient?
A. morning
B. afternoon
C. evening
D. night
D. night
Dry mouth, sweating, weight change, mild nausea, and loose stools are all examples of __________ reactions.
A. autonomic
B. peripheral
C. somatic
D. central
A. autonomic
the outward representation of a person’s internal state
affect
Affect is __________ data.
A. objective
B. subjective
A. objective
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
D. risk for suicide
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.
- acute
- continuation
- maintenance
T/F
SSRIs have an anticholinergic effect.
false
What type of foods should someone taking an MAOI avoid?
A. protein
B. tyramine
C. iron
D. fish, omega-3 fatty
B. tyramine
contains phenylethylamine, a pressor agent; large amounts can cause a reaction
A. chocolate
B. fava beans
C. ginseng
D. caffeinated beverages
A. chocolate
__________ is a weak pressor agent; large amounts may cause a reaction.
A. chocolate
B. fava beans
C. ginseng
D. caffeinate
D. caffeinate
headache, tremulousness, and mania-like reactions have occurred
A. chocolate
B. fava beans
C. ginseng
D. caffeinated beverages
C. ginseng
contain dopamine, a pressor agent; reactions are most likely with overripe beans
A. chocolate
B. fava beans
C. ginseng
D. caffeinated beverages
B. fava beans
Which of the following is the second line of treatment drugs for depression?
A. MAOIs
B. SSRIs
C. tricyclics
D. SARIs
C. tricyclics
T/F
TCAs have an anticholinergic effect.
true
Why are MAOIs 3rd in line for the treatment of depression?
too many significant drug and food interactions
T/F
Antidepressants do not cross the placenta.
false
Which of the following supplements increases serotonin (happiness)?
A. caffeine
B. magnesium glycolate
C. st. john wort
D. ginseng
C. st. john wort
_________ selectively stop serotonin reuptake, allowing more serotonin to stay at the junction of the neurons.
A. SSRIs
B. MAOIs
C. TCAs
D. SARIs
A. SSRIs
T/F
SSRIs do not block the uptake of dopamine or norepinephrine.
true
T/F
SSRIs have a short half-life.
false; long half-life
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
B. 2-72 hours
T/F
SSRIs are compatible with MAOIs and TCAs.
false
What do SSRIs treat?
depression
What is Zoloft used to treat?
depression
__________ causes CNS stimulation, which can cause insomnia.
A. fluoxetine
B. sertraline
C. citalopram
D. paroxetine
D. paroxetine
What is Prozac used to treat?
depression
bupropion
atypical antidepressant
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.”
D. “I go to sleep around 11 pm but I’m always up by 3 am and can’t go back to sleep.”
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. conducting routine suicide screenings at a senior center
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. fluoxetine (Prozac)
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
D. monoamine oxidase inhibitor
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
B. use the technique of making observations
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
B. deep brain stimulation
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.
C. “The client is at greatest risk for suicide during the first weeks of a major depressive disorder episode.”
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
C. presence of manifestations for at least 2 years
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. placing the client on one-to-one observation
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
B. hallucinations
D. diaphoresis
E. agitation
