Module 2 Exam Blueprint Flashcards
1
Q
What must be obtained before electroconvulsive therapy
A
chest x-ray, blood work, and EKG
2
Q
Why do we administer atropine or glycopyrrolate before ECT
A
dry secretions and help bradycardia ; prevent aspiration
3
Q
What conditions would prevent our patient from receiving ECT
A
heart condition, stroke, hematoma or bleed
4
Q
Why do we paralyze our patients receiving ECT
A
prevent injury/ bone breaks
5
Q
What must we keep next to clients receiving ECT
A
crash cart
6
Q
Clients become alert within ___ minutes of ECT
A
15
7
Q
Long term effects of ECT
A
memory deficits or cardiac problems (dysrhythmias, memory loss)
8
Q
When is ECT used
A
client experiencing severe mania, major depressive disorder (last line treatment)
9
Q
What are the monoamine oxidase inhibitors
A
phenelzine, selegiline
10
Q
What can cause hypertensive crisis while on MAOIs
A
eating tyramine foods
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
12
Q
Symptoms of hypertensive crisis
A
headache, tachycardia, HTN, diaphoresis, N/V, change in LOC
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
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
15
Q
What kind of drug is sertraline?
A
SSRI
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
17
Q
What are symptoms of serotonin syndrome?
A
mental confusion, abd pain, diarrhea, agitation, fever, anxiety, diaphoresis, tremors
18
Q
Nursing actions for serotonin syndrome
A
medications, fix muscle rigidity, cooling blankets, anticonvulsants, artificial ventilation
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
20
Q
What medications cannot be taken with lithium
A
NSAIDs, diuretics, anticholinergic
21
Q
What are the SSRI’s?
A
fluoxetine, citalopram, escitalopram, paroxetine, sertraline
22
Q
Hyponatremia with SSRIs is more likely to occur if
A
they are an older adult client taking diuretics
23
Q
We should teach patients on SSRIs to prevent hyponatremia by
A
obtain baselines sodium before treatment, and monitor levels during treatment
24
Q
Grief vs depression
A
grief is time limited, has resolution
Depression is stuck in grief, no resolution
25
Major depressive disorder has deficiencies in what 3 neurotransmitters
serotonin, dopamine, norepinephrine
26
SSRIs increase what neurotransmitter
serotonin
27
SNRIs increase the amount of what neurotransmitter
serotonin, norepinephrine
28
MAOIs increase the release of what neurotransmitters
dopamine (big one), norepinephrine, serotonin
29
Tricyclic antidepressants increase what neurotransmitters
serotonin (big one) , norepinephrine
30
What neurotransmitter is a key component in mobilization of the body to deal with stress
norepinephrine
31
what neurotransmitter is linked to mood, anxiety, arousal, vigilance, irritability, thinking, cognition, appetite, aggression, sleep-wakefulness cycles, eating, intestinal motility
serotonin
32
What neurotransmitter exerts a strong influence over human mood and behavior
dopamine
33
amitriptyline, nortriptyline, doxepin, amoxapine, trimipramine, desipramine, and clomipramine drug class
tricyclic antidepressants
34
Characteristics of mania
elevated/expansive mood, increased activity, 1 week, grandiosity, decreased sleep, goal directed activity, high risk activities, required hospitalization, distractibility
35
Why do those with mania potentially require hospitalization
could have HA (bc fight or flight doesn't stop); could danger themselves
36
Mania vs hypomania
hypomania lasts 4 days, no hospitalization
37
Delirious mania
panic level anxiety, hallucinations, disoriented, exhaustion, injury to self or others, death
38
Biggest difference between bipolar 1 and 2
bipolar 1 experiences mania (lasting at least a week) and hypomania, bipolar 2 experiences hypomania
39
Will bipolar 1 and 2 require hospitalization
bipolar 1 yes ; bipolar 2 will not
40
Will our patients experience hallucinations and delusions with bipolar 1 and 2
only bipolar 1
41
Priority nursing intervention for bipolar disorders
safety and maintaining physical health
42
What medications can trigger mania
any anti-depressant (tricyclic antidepressants, SSRIs, SNRIs, MAOIs, Atypical antidepressants)
43
symptoms of lithium level 1.9
mental confusion, sedation, poor coordination, coarse tremors, NVD,
44
Intervention for lithium level of 1.9
hold medication, get lithium and Na levels, give emetic, promote excretion (gastric lavage or hemodialysis)
45
Interventions for provocative or revealing clothing
encourage client to change but respectfully ? lol
46
Why is it important to reduce stimulation in clients with bipolar disorders
increased stress in the environment can trigger mania
47
What drug class is carbamazepine
mood-stabilizing anti epileptic
48
Client education for carbamazepine?
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
49
Symptoms of blood dyscrasias
thrombocytopenia: bleeding (black tarry stools, hematuria, petechia, bruising)
Leukopenia: infections (fever, lethargy)
50
Nutritional intake for clients with bipolar disorder
high calorie, high protein finger foods (chicken nuggets)
51
Purpose of MMSE in neurocognitive disorders
get a baseline picture of their behavior.. can be used for comparison later
52
Is delirium or dementia reversible?
delirium
53
What are ways we can preserve their self-esteem if they have neurocognitive disorders
do not brush their teeth/hair ; allow them time to do it
54
Should clients with neurocognitive disorders have schedules that change
no; should be consistent and with consistent caregivers
55
What can a client with neurocognitive disorders use as defense mechanisms to preserve their own self-esteem
deny, confabulate, perseveration
56
What is the denial defense mechanism
denying that memory deficits are occuring
57
What is confabulation defense mechanism
client making up stories to avoid admitting the inability to remember an event
58
What is perseveration defense mechanism
client avoids answering questions by repeating phrases or behaviors
59
What diseases does donepezil treat?
alzheimers, Huntingtons disease, Parkinson's disease
60
How does donepezil work
inhibits acetylcholinesterase from breaking down acetylcholine
61
What does acetylcholine do
helps build memory
62
What can donepezil help improve in a client with alzheimers
ability to perform self care and slow cognitive degeneration of alzheimers disease
63
What is the onset of delirium
rapid
64
What is the onset of dementia
gradual over months or years
65
Is level of conscious altered with delirium
yes ; fluctuates a lot
66
is level of consciousness altered with dementia
LOC usually unchanged
67
Manifestations of delirium
agitation, perceptual disturbances, impaired memory, impaired judgement, impaired ability of focus
68
Manifestations of dementia
impaired memory/judgment, speech (aphasia)/ inability to recognize familiar objects (agnosia) , inability to manage tasks, impaired movement
69
Will manifestations of delirium fluctuate throughout the day
yes
70
will manifestations of dementia fluctuate throughout the day
No, but sundowning can occur
71
What is sundown syndrome
state of confusion and behavior increases in the late afternoon and at night
72
For clients with dementia, we should keep the bed
in the lowest position
73
Wandering precautions for our clients with dementia
keep structured schedule of activities, tolerating, and feeding
74
Should we approach our patients with dementia from the back? Should we touch them?
try to approach from the front, do not touch them as they could get startled
75
A client with dementia should have a room with low levels of stimuli, adequate lighting, and ....
near the nurses station
76
What cognitive precautions could we implement in a client with dementia?
easy to read clocks and calendars, large colorful signs, familiar items, reminiscence therapy
77
What is reminiscent therapy and why is it useful in clients with dementia
having pictures of family and friends, playing music. they are living in the past and helps them feel calm
78
Symptoms of alcohol intoxication
relaxation, slurred speech, nystagmus, memory impairment, decreased motor skills, altered or decreased LOC, respiratory arrest, altered judgment
79
Symptoms of alcohol withdrawal
abdominal cramping, vomiting, tremors, restlessness, inability to sleep, increased heart rate, transient hallucinations, anxiety, increased blood pressure increased respiratory rate, seizures
80
How long after cessation of alcohol does withdrawal occur
4-12 h
81
Alcohol withdrawal is a ____ ____
medical emergency
82
If alcohol withdrawal is not treated, this can cause
delirium
83
how long after alcohol withdrawal symptoms do we have to treat it, before it turns into withdrawal delirium
24-72
84
Symptoms of alcohol withdrawal delirium
severe disorientation, psychotic manifestations (hallucinations) severe hypertension cardiac dysrhythmias and delirium
85
Symptoms of chronic alcohol use
cardiovascular damage, liver damage, erosive gastritis, gi bleeds
86
Gambling impulses increase during
times of stress
87
With a gambling addiction, clients are forced to obtain money
by any means available
88
What comorbidities can increase risk of gambling addiction
depression, SI, sunstance use, PTSD, personality disorders
89
benzodiazepine withdrawal
increase heartrate, increased movement, agitation, irritability, anxiety, illusions, hallucinations, insomnia, N/V, grand Mal seizures (think fight or flight with this)
90
what precautions should we put them on benzodiazepine withdrawal
seizure precautions
91
What medication treats benzodiazepine intoxication
flumazenil, and propranolol may be used to decrease BP and HR
92
To prevent benzodiazepine withdrawal
taper dose and do not stop abruptly
93
When treating opioid withdrawal, why may we use a benzodiazepine before clonidine?
benzodiazepines can also prevent seizures, as well as decrease blood pressure (clonidine will only reduce abstinence symptoms aka high blood pressure)
94
Do we give clonidine for opioid withdrawal?
NO, we give it for reduction of abstinence symptoms
95
Risk factors for addiction
learned responses, family history, chronic stress, lowered self-esteem, opioid/dopamine/glutamate/GABA decrease, few life successes, risk-taking, few meaningful personal relationships
96
Inhalant intoxication is most common in what age groups
young children
97
What is 'huffing' with inhalants
soaked rap applied to mouth and nose
98
what is 'bagging' with inhalants
placed in paper bag and inhaled
99
symptoms of inhalant inotxication
rapid excitation followed by drowsiness, incoordination, disinhibition (behavioral or psychological changes)
100
Inhalants can cause irritiaon in the
nasal passages, mouth, around nose, lungs
101
What is the antidote for benzodiazepine toxicity
flumazenil
102
Chronic use of inhalant intoxication can be associated with:
anxiety, psychotic disorders, fetal solvent syndrome
103
How do most opioid addictions begin
start as an injury/ recovering from surgery
104
What is acute morphine activity
when everything slows, sedation, constipation, pinpoint pupils, decreased RR
105
Opioid withdrawal increases the risk of
suicide or harming others
106
Cessation of opioids can cause these symptoms to occur
dysphoric mood, NV, muscle aches, lacrimation/rhinorrhea, pupillary dilation, sweating, diarrhea, fever, insomnia
just think the opposite of what opioids usually do
107
What medication is given for opioid withdrawal in a clinic and is medically assisted
methadone (nurse must watch them take it, must go every day)
108
What medication for opioid withdrawal can have prescriptions and given outside clinic
buprenorphine
109
What is tolerance defined by
the amount needed to achieve the desired effect continually increases
110
Can tolerance lead to addiction?
yes
111
What is the indication of acamprosate?
used to maintain abstinence of alcohol (used after treatment of alcohol) ; prevents the urge to start drinking again
112
symptoms of alcohol use
produces relaxation, loss of inhibition, lack of concentration, drowsiness, slurred speech, sleep
113
What is the CAGE screening tool?
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
What is the clinical institute withdrawal assessment of alcohol scale? (CIWA)
questionnaire that is nurse driven, determines risk of alcohol withdrawal
115
What is the highest score CIWA scale can have
67 (may depend on the nurse)
116
Disulfiram patient education
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
What products should we tell our client on disulfiram to avoid
cough syrup, aftershave, mouthwash, hand sanitizer
118
Symptoms of catatonia
rigidity or stupor that lasts hours/days, performing strange movements, staying in uncomfortable positions without moving, erratic and extreme movement, echolalia
119
Symptoms of
positive symptoms, negative symptoms, delusions, echolalia, word salad, clang association, hallucinations, neologisms (create their own word)
120
Characteristics of schizoaffective disorder
criteria for both schizophrenia and depressive bipolar disorder ; depressed mood and mania and psychosis symptoms
121
What are positive symptoms seen in psychotic disorders
hallucinations, delusions, alterations in speech, bizarre behaviors
122
What are negative symptoms found in psychotic disorder
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
Interventions for a client with hallucinations ?
-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
What is an example of a response a nurse should give to a client that states they are seeing things
"I don't see anything, but you seem to be frightened"
125
What are the first generation anti-psychotics?
chlorpromazine, haloperidol, loxapine, fluphenazine
126
do typical antipscychotics treat positive or negative symptoms
positive
127
Do atypical antipsychotics treat positive or negative symptoms
negative
128
What drugs are atypical antipsychotics
risperidone, clozapine, seraquil, olanzapine
129
Anticholinergic side effects of antipsychotic drugs
dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia
130
What medications can cause extrapyramidal symptoms
typical / first gen antipsychotics
131
What is tardive dyskinesia
EPS found with typical antipsychotics
132
Manifestations of tardive dyskinesia
involuntary movements of tongue/face, lip smacking, tongue fascinations, involuntary movements of the arms, legs, and truk
133
If TD is beginning to appear, the dosage of typical antipsychotics should be
lowered or switch to another med completely
134
This adverse effect of typical antipsychotics is a medical emergency
neuroleptic malignant syndromesy
135
symptoms of neuroleptic malignant syndrome
sudden high fever, blood pressure fluctuations, diaphoresis, tachycardia, muscle rigidity, decrease LOC
136
Nursing actions during NMS
apply cooling blankets, obtain crash cart, administer dantrolene
137
What is the AIMS scale
used to detect abnormal involuntary movements in clients on typical antipsychotics
138
How often is AIMS scale done
q 28 days
139
What medication can be used to reduce EPSs symptoms found in the AIMS scale
benzotropine
140
What is a flat affect
when facial expression never changes ; negative symptom of psychosis
141
When is the onset of schizophrenia
end of high school and entering college, sometimes genetic (also from physical trauma and sports injuries)
142
Describe echolalia
client repeats back words spoken to them ; symptoms of psychosis
143
Therapeutic interventions for a client with communication deficit
simple phrases, calm voice
144
What is waxy flexibility?
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
What is word salad
words jumbled together with little meaning or significance to the listener (hip hooray, the flip is cast and wide sprinting in the forest)
146
Disturbed sensory perception interventions (idk if this is right)
-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
What type of drug is clozapine
atypical antipsychotic
148
clozapine can cause
fatal agranulocytosis, metabolic syndrome
149
Client education for clozapine
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
What blood test should be done for clients on clozapine
ANC (absolute neutrophil count)
151
Hyponatremia and how it affects lithium
hyponatremia can increase chance of lithium toxicity
152
What medication is given for benzodiazepine or alcohol*** withdrawal
chlordiazepoxide
153
Nursing interventions for withdrawal of benzodiazepines
quiet atmosphere, sleep, nutrition, suicide precautions, antidepressants
154
The basal ganglia plays a role in
pleasure and habit forming
155
The amygdala plays a response in
stressors such as anxiety or perceived threats
156
Prefrontal cortex plays a response in
thinking, problem-solving, judgment and impulse control
157
What three structures of the brain play a role in addiction
basal ganglia, amygdala, prefrontal cortex
158
the brain ties to compensate for excessive activation by raising levels of neurotransmitters, so the client feels sick.
false
159
Exposure to acetylaldehyde leads to which of the following
hypertension, flushing, vomiting, nausea
160
a CNS depressant such as a sedative works on which areas of the body
muscles, nerves, brain, heart
161
a client is experiencing withdrawal symptoms from alcohol use. Which of the following medications is most appropriate
diazepam (benzodiazepine)
162
163
