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NRSE-3090 Mental Health > Module 2 Exam Blueprint > Flashcards

Module 2 Exam Blueprint Flashcards

1
Q

What must be obtained before electroconvulsive therapy

A

chest x-ray, blood work, and EKG

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2
Q

Why do we administer atropine or glycopyrrolate before ECT

A

dry secretions and help bradycardia ; prevent aspiration

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3
Q

What conditions would prevent our patient from receiving ECT

A

heart condition, stroke, hematoma or bleed

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4
Q

Why do we paralyze our patients receiving ECT

A

prevent injury/ bone breaks

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5
Q

What must we keep next to clients receiving ECT

A

crash cart

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6
Q

Clients become alert within ___ minutes of ECT

A

15

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7
Q

Long term effects of ECT

A

memory deficits or cardiac problems (dysrhythmias, memory loss)

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8
Q

When is ECT used

A

client experiencing severe mania, major depressive disorder (last line treatment)

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9
Q

What are the monoamine oxidase inhibitors

A

phenelzine, selegiline

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10
Q

What can cause hypertensive crisis while on MAOIs

A

eating tyramine foods

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11
Q

What are examples of tyramine foods

A

sauerkraut, kimchi, pickled foods, aged cheese (gouda, bleu cheese, Swiss), smoked meats, processed meats (hot dogs, bologna, bacon), sausages, pepperoni, salami, beer, red wine, ripe avocado

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12
Q

Symptoms of hypertensive crisis

A

headache, tachycardia, HTN, diaphoresis, N/V, change in LOC

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13
Q

Selegiline client education (MAOI)

A

transdermal patch teaching (use clean dry area, apply topical glucocorticoid if rash occurs) change positions slowly, observe for effects of CNS stimulation (anxiety, agitation, hypomania, mania), avoid OTC decongestants

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14
Q

Client education for phenelzine (MAOI)

A

observe for effects of CNS stimulation (anxiety, agitation, hypomania, mania), change positions slowly, no tyramine foods, avoid OTC decongestants

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15
Q

What kind of drug is sertraline?

A

SSRI

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16
Q

What client education should we give for someone on sertraline?

A

notify provider of sexual dysfunction, notify provider symptoms of CNS stimulation, avoid caffeine, take in the morning, participate in regular exercise and follow healthy diet, notify provider and hold dose if you experience symptoms of serotonin syndrome, taper the dose to prevent withdrawal, antihistamine for rash, avoid driving if you have sleepiness, may need to use a mouth guard and report bruxism, no NSAIDS, suicide ideation

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17
Q

What are symptoms of serotonin syndrome?

A

mental confusion, abd pain, diarrhea, agitation, fever, anxiety, diaphoresis, tremors

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18
Q

Nursing actions for serotonin syndrome

A

medications, fix muscle rigidity, cooling blankets, anticonvulsants, artificial ventilation

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19
Q

Client education for lithium (mood stabilizer)

A

some adverse effects resolve within a few weeks of starting , maintain adequate fluid intake of 1.5-3 L/day, monitor for hypothyroidism, maintain adequate sodium intake, avoid medications with anticholinergic effects

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20
Q

What medications cannot be taken with lithium

A

NSAIDs, diuretics, anticholinergic

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21
Q

What are the SSRI’s?

A

fluoxetine, citalopram, escitalopram, paroxetine, sertraline

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22
Q

Hyponatremia with SSRIs is more likely to occur if

A

they are an older adult client taking diuretics

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23
Q

We should teach patients on SSRIs to prevent hyponatremia by

A

obtain baselines sodium before treatment, and monitor levels during treatment

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24
Q

Grief vs depression

A

grief is time limited, has resolution
Depression is stuck in grief, no resolution

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25
Q

Major depressive disorder has deficiencies in what 3 neurotransmitters

A

serotonin, dopamine, norepinephrine

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26
Q

SSRIs increase what neurotransmitter

A

serotonin

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27
Q

SNRIs increase the amount of what neurotransmitter

A

serotonin, norepinephrine

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28
Q

MAOIs increase the release of what neurotransmitters

A

dopamine (big one), norepinephrine, serotonin

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29
Q

Tricyclic antidepressants increase what neurotransmitters

A

serotonin (big one) , norepinephrine

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30
Q

What neurotransmitter is a key component in mobilization of the body to deal with stress

A

norepinephrine

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31
Q

what neurotransmitter is linked to mood, anxiety, arousal, vigilance, irritability, thinking, cognition, appetite, aggression, sleep-wakefulness cycles, eating, intestinal motility

A

serotonin

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32
Q

What neurotransmitter exerts a strong influence over human mood and behavior

A

dopamine

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33
Q

amitriptyline, nortriptyline, doxepin, amoxapine, trimipramine, desipramine, and clomipramine drug class

A

tricyclic antidepressants

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34
Q

Characteristics of mania

A

elevated/expansive mood, increased activity, 1 week, grandiosity, decreased sleep, goal directed activity, high risk activities, required hospitalization, distractibility

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35
Q

Why do those with mania potentially require hospitalization

A

could have HA (bc fight or flight doesn’t stop); could danger themselves

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36
Q

Mania vs hypomania

A

hypomania lasts 4 days, no hospitalization

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37
Q

Delirious mania

A

panic level anxiety, hallucinations, disoriented, exhaustion, injury to self or others, death

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38
Q

Biggest difference between bipolar 1 and 2

A

bipolar 1 experiences mania (lasting at least a week) and hypomania, bipolar 2 experiences hypomania

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39
Q

Will bipolar 1 and 2 require hospitalization

A

bipolar 1 yes ; bipolar 2 will not

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40
Q

Will our patients experience hallucinations and delusions with bipolar 1 and 2

A

only bipolar 1

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41
Q

Priority nursing intervention for bipolar disorders

A

safety and maintaining physical health

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42
Q

What medications can trigger mania

A

any anti-depressant (tricyclic antidepressants, SSRIs, SNRIs, MAOIs, Atypical antidepressants)

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43
Q

symptoms of lithium level 1.9

A

mental confusion, sedation, poor coordination, coarse tremors, NVD,

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44
Q

Intervention for lithium level of 1.9

A

hold medication, get lithium and Na levels, give emetic, promote excretion (gastric lavage or hemodialysis)

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45
Q

Interventions for provocative or revealing clothing

A

encourage client to change but respectfully ? lol

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46
Q

Why is it important to reduce stimulation in clients with bipolar disorders

A

increased stress in the environment can trigger mania

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47
Q

What drug class is carbamazepine

A

mood-stabilizing anti epileptic

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48
Q

Client education for carbamazepine?

A

monitor for s/s of blood dyscrasias (anemia, thrombocytopenia, leukopenia), CNS effects should subside in a few weeks, do not get pregnant, signs of fluid overload, avoid grapefruit

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49
Q

Symptoms of blood dyscrasias

A

thrombocytopenia: bleeding (black tarry stools, hematuria, petechia, bruising)
Leukopenia: infections (fever, lethargy)

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50
Q

Nutritional intake for clients with bipolar disorder

A

high calorie, high protein finger foods (chicken nuggets)

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51
Q

Purpose of MMSE in neurocognitive disorders

A

get a baseline picture of their behavior.. can be used for comparison later

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52
Q

Is delirium or dementia reversible?

A

delirium

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53
Q

What are ways we can preserve their self-esteem if they have neurocognitive disorders

A

do not brush their teeth/hair ; allow them time to do it

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54
Q

Should clients with neurocognitive disorders have schedules that change

A

no; should be consistent and with consistent caregivers

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55
Q

What can a client with neurocognitive disorders use as defense mechanisms to preserve their own self-esteem

A

deny, confabulate, perseveration

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56
Q

What is the denial defense mechanism

A

denying that memory deficits are occuring

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57
Q

What is confabulation defense mechanism

A

client making up stories to avoid admitting the inability to remember an event

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58
Q

What is perseveration defense mechanism

A

client avoids answering questions by repeating phrases or behaviors

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59
Q

What diseases does donepezil treat?

A

alzheimers, Huntingtons disease, Parkinson’s disease

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60
Q

How does donepezil work

A

inhibits acetylcholinesterase from breaking down acetylcholine

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61
Q

What does acetylcholine do

A

helps build memory

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62
Q

What can donepezil help improve in a client with alzheimers

A

ability to perform self care and slow cognitive degeneration of alzheimers disease

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63
Q

What is the onset of delirium

A

rapid

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64
Q

What is the onset of dementia

A

gradual over months or years

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65
Q

Is level of conscious altered with delirium

A

yes ; fluctuates a lot

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66
Q

is level of consciousness altered with dementia

A

LOC usually unchanged

67
Q

Manifestations of delirium

A

agitation, perceptual disturbances, impaired memory, impaired judgement, impaired ability of focus

68
Q

Manifestations of dementia

A

impaired memory/judgment, speech (aphasia)/ inability to recognize familiar objects (agnosia) , inability to manage tasks, impaired movement

69
Q

Will manifestations of delirium fluctuate throughout the day

A

yes

70
Q

will manifestations of dementia fluctuate throughout the day

A

No, but sundowning can occur

71
Q

What is sundown syndrome

A

state of confusion and behavior increases in the late afternoon and at night

72
Q

For clients with dementia, we should keep the bed

A

in the lowest position

73
Q

Wandering precautions for our clients with dementia

A

keep structured schedule of activities, tolerating, and feeding

74
Q

Should we approach our patients with dementia from the back? Should we touch them?

A

try to approach from the front, do not touch them as they could get startled

75
Q

A client with dementia should have a room with low levels of stimuli, adequate lighting, and ….

A

near the nurses station

76
Q

What cognitive precautions could we implement in a client with dementia?

A

easy to read clocks and calendars, large colorful signs, familiar items, reminiscence therapy

77
Q

What is reminiscent therapy and why is it useful in clients with dementia

A

having pictures of family and friends, playing music. they are living in the past and helps them feel calm

78
Q

Symptoms of alcohol intoxication

A

relaxation, slurred speech, nystagmus, memory impairment, decreased motor skills, altered or decreased LOC, respiratory arrest, altered judgment

79
Q

Symptoms of alcohol withdrawal

A

abdominal cramping, vomiting, tremors, restlessness, inability to sleep, increased heart rate, transient hallucinations, anxiety, increased blood pressure increased respiratory rate, seizures

80
Q

How long after cessation of alcohol does withdrawal occur

A

4-12 h

81
Q

Alcohol withdrawal is a ____ ____

A

medical emergency

82
Q

If alcohol withdrawal is not treated, this can cause

A

delirium

83
Q

how long after alcohol withdrawal symptoms do we have to treat it, before it turns into withdrawal delirium

A

24-72

84
Q

Symptoms of alcohol withdrawal delirium

A

severe disorientation, psychotic manifestations (hallucinations) severe hypertension cardiac dysrhythmias and delirium

85
Q

Symptoms of chronic alcohol use

A

cardiovascular damage, liver damage, erosive gastritis, gi bleeds

86
Q

Gambling impulses increase during

A

times of stress

87
Q

With a gambling addiction, clients are forced to obtain money

A

by any means available

88
Q

What comorbidities can increase risk of gambling addiction

A

depression, SI, sunstance use, PTSD, personality disorders

89
Q

benzodiazepine withdrawal

A

increase heartrate, increased movement, agitation, irritability, anxiety, illusions, hallucinations, insomnia, N/V, grand Mal seizures (think fight or flight with this)

90
Q

what precautions should we put them on benzodiazepine withdrawal

A

seizure precautions

91
Q

What medication treats benzodiazepine intoxication

A

flumazenil, and propranolol may be used to decrease BP and HR

92
Q

To prevent benzodiazepine withdrawal

A

taper dose and do not stop abruptly

93
Q

When treating opioid withdrawal, why may we use a benzodiazepine before clonidine?

A

benzodiazepines can also prevent seizures, as well as decrease blood pressure (clonidine will only reduce abstinence symptoms aka high blood pressure)

94
Q

Do we give clonidine for opioid withdrawal?

A

NO, we give it for reduction of abstinence symptoms

95
Q

Risk factors for addiction

A

learned responses, family history, chronic stress, lowered self-esteem, opioid/dopamine/glutamate/GABA decrease, few life successes, risk-taking, few meaningful personal relationships

96
Q

Inhalant intoxication is most common in what age groups

A

young children

97
Q

What is ‘huffing’ with inhalants

A

soaked rap applied to mouth and nose

98
Q

what is ‘bagging’ with inhalants

A

placed in paper bag and inhaled

99
Q

symptoms of inhalant inotxication

A

rapid excitation followed by drowsiness, incoordination, disinhibition (behavioral or psychological changes)

100
Q

Inhalants can cause irritiaon in the

A

nasal passages, mouth, around nose, lungs

101
Q

What is the antidote for benzodiazepine toxicity

A

flumazenil

102
Q

Chronic use of inhalant intoxication can be associated with:

A

anxiety, psychotic disorders, fetal solvent syndrome

103
Q

How do most opioid addictions begin

A

start as an injury/ recovering from surgery

104
Q

What is acute morphine activity

A

when everything slows, sedation, constipation, pinpoint pupils, decreased RR

105
Q

Opioid withdrawal increases the risk of

A

suicide or harming others

106
Q

Cessation of opioids can cause these symptoms to occur

A

dysphoric mood, NV, muscle aches, lacrimation/rhinorrhea, pupillary dilation, sweating, diarrhea, fever, insomnia

just think the opposite of what opioids usually do

107
Q

What medication is given for opioid withdrawal in a clinic and is medically assisted

A

methadone (nurse must watch them take it, must go every day)

108
Q

What medication for opioid withdrawal can have prescriptions and given outside clinic

A

buprenorphine

109
Q

What is tolerance defined by

A

the amount needed to achieve the desired effect continually increases

110
Q

Can tolerance lead to addiction?

A

yes

111
Q

What is the indication of acamprosate?

A

used to maintain abstinence of alcohol (used after treatment of alcohol) ; prevents the urge to start drinking again

112
Q

symptoms of alcohol use

A

produces relaxation, loss of inhibition, lack of concentration, drowsiness, slurred speech, sleep

113
Q

What is the CAGE screening tool?

A

used for every client to asses for alcohol
C: need to ‘cut down drinks’
A: is anyone ‘annoyed by your drinking’
G: are you ever ‘guilty about how much’
E: ever drink to start day function, steady nerves

114
Q

What is the clinical institute withdrawal assessment of alcohol scale? (CIWA)

A

questionnaire that is nurse driven, determines risk of alcohol withdrawal

115
Q

What is the highest score CIWA scale can have

A

67 (may depend on the nurse)

116
Q

Disulfiram patient education

A

avoid any alcohol, avoid use or contact with household products containing alcohol, wear medical alert bracelet, acetaldehyde syndrome can occur for 2 weeks following discontinuation

117
Q

What products should we tell our client on disulfiram to avoid

A

cough syrup, aftershave, mouthwash, hand sanitizer

118
Q

Symptoms of catatonia

A

rigidity or stupor that lasts hours/days, performing strange movements, staying in uncomfortable positions without moving, erratic and extreme movement, echolalia

119
Q

Symptoms of

A

positive symptoms, negative symptoms, delusions, echolalia, word salad, clang association, hallucinations, neologisms (create their own word)

120
Q

Characteristics of schizoaffective disorder

A

criteria for both schizophrenia and depressive bipolar disorder ; depressed mood and mania and psychosis symptoms

121
Q

What are positive symptoms seen in psychotic disorders

A

hallucinations, delusions, alterations in speech, bizarre behaviors

122
Q

What are negative symptoms found in psychotic disorder

A

5 A’s:
affect: blunted or flat
alogia: poverty of thought or speech
anergia: lack of energy
Anhedonia: lack of pleasure or joy
Avolition: lack of motivation and hygiene

123
Q

Interventions for a client with hallucinations ?

A

-ask the client directly about hallucinations , do not argue or agree with them
-do not argue with delusions
-provide safety for command hallucinations
-identify triggers of hallucinations (ex. loud noise)

124
Q

What is an example of a response a nurse should give to a client that states they are seeing things

A

“I don’t see anything, but you seem to be frightened”

125
Q

What are the first generation anti-psychotics?

A

chlorpromazine, haloperidol, loxapine, fluphenazine

126
Q

do typical antipscychotics treat positive or negative symptoms

A

positive

127
Q

Do atypical antipsychotics treat positive or negative symptoms

A

negative

128
Q

What drugs are atypical antipsychotics

A

risperidone, clozapine, seraquil, olanzapine

129
Q

Anticholinergic side effects of antipsychotic drugs

A

dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia

130
Q

What medications can cause extrapyramidal symptoms

A

typical / first gen antipsychotics

131
Q

What is tardive dyskinesia

A

EPS found with typical antipsychotics

132
Q

Manifestations of tardive dyskinesia

A

involuntary movements of tongue/face, lip smacking, tongue fascinations, involuntary movements of the arms, legs, and truk

133
Q

If TD is beginning to appear, the dosage of typical antipsychotics should be

A

lowered or switch to another med completely

134
Q

This adverse effect of typical antipsychotics is a medical emergency

A

neuroleptic malignant syndromesy

135
Q

symptoms of neuroleptic malignant syndrome

A

sudden high fever, blood pressure fluctuations, diaphoresis, tachycardia, muscle rigidity, decrease LOC

136
Q

Nursing actions during NMS

A

apply cooling blankets, obtain crash cart, administer dantrolene

137
Q

What is the AIMS scale

A

used to detect abnormal involuntary movements in clients on typical antipsychotics

138
Q

How often is AIMS scale done

A

q 28 days

139
Q

What medication can be used to reduce EPSs symptoms found in the AIMS scale

A

benzotropine

140
Q

What is a flat affect

A

when facial expression never changes ; negative symptom of psychosis

141
Q

When is the onset of schizophrenia

A

end of high school and entering college, sometimes genetic (also from physical trauma and sports injuries)

142
Q

Describe echolalia

A

client repeats back words spoken to them ; symptoms of psychosis

143
Q

Therapeutic interventions for a client with communication deficit

A

simple phrases, calm voice

144
Q

What is waxy flexibility?

A

maintaining a specific position for an extended period of time (symptom of psychosis and catatonia)… you can move them like a doll , allows them to be moved and placed (blood pressure and their arm is still sticking out)

145
Q

What is word salad

A

words jumbled together with little meaning or significance to the listener (hip hooray, the flip is cast and wide sprinting in the forest)

146
Q

Disturbed sensory perception interventions (idk if this is right)

A

-main priority is safety
-re-orientation
-keep bed lowest position, assist with ambulation, walking, dancing, rhythmic dancing
-(perceptions could be increased, decreased, or distorted with the patient’s hearing, vision, touch sensation, smell, or kinesthetic responses to stimuli)

147
Q

What type of drug is clozapine

A

atypical antipsychotic

148
Q

clozapine can cause

A

fatal agranulocytosis, metabolic syndrome

149
Q

Client education for clozapine

A

report to provider indications of infection (fever, sore throat, mouth lesions) , you will need baseline and regular monitoring of ANC q week for first 6 months

150
Q

What blood test should be done for clients on clozapine

A

ANC (absolute neutrophil count)

151
Q

Hyponatremia and how it affects lithium

A

hyponatremia can increase chance of lithium toxicity

152
Q

What medication is given for benzodiazepine or alcohol*** withdrawal

A

chlordiazepoxide

153
Q

Nursing interventions for withdrawal of benzodiazepines

A

quiet atmosphere, sleep, nutrition, suicide precautions, antidepressants

154
Q

The basal ganglia plays a role in

A

pleasure and habit forming

155
Q

The amygdala plays a response in

A

stressors such as anxiety or perceived threats

156
Q

Prefrontal cortex plays a response in

A

thinking, problem-solving, judgment and impulse control

157
Q

What three structures of the brain play a role in addiction

A

basal ganglia, amygdala, prefrontal cortex

158
Q

the brain ties to compensate for excessive activation by raising levels of neurotransmitters, so the client feels sick.

A

false

159
Q

Exposure to acetylaldehyde leads to which of the following

A

hypertension, flushing, vomiting, nausea

160
Q

a CNS depressant such as a sedative works on which areas of the body

A

muscles, nerves, brain, heart

161
Q

a client is experiencing withdrawal symptoms from alcohol use. Which of the following medications is most appropriate

A

diazepam (benzodiazepine)

162
Q
A
163
Q
A

NRSE-3090 Mental Health (3 decks)

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