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NRN 21 Exam 4 > Psychotic Disorders > Flashcards

Psychotic Disorders Flashcards

1
Q

Personality Disorders - Cluster A

A

Paranoid
Schizoid
Schizotypal

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2
Q

Paranoid A

A

S/s: Mistrust and suspicions of others; guarded, restricted affect

NI: serious, straight-forward approach; teach client to validate ideas before taking action; involve client in treatment planning

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3
Q

Schizoid A

A

s/s: detached from social relationship; restricted affect; involved with things more than people

NI: improve client’s functioning in the community; assist client in finding case manager

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4
Q

Schizotypal A

A

s/s: actuate discomfort in relationships; cognitive or perceptual distortions; eccentric behavior

NI: develop self-care skills; improve community functioning; social skills training

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5
Q

Personality Disorders - Cluster B

A

Antisocial
Borderline
Histrionic
Narcissistic

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6
Q

Antisocial B

A

s/s: disregard for rights of others, rules, and laws

NI: limit setting; confrontation; teach client to solve problems effectively and manage emotions of anger or frustration

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7
Q

Borderline B

A

s/s: unstable relationships, self-image, and affect; impulsivity; self-mutilation

NI: promote safety; help client to cope and control emotions; cognitive restructuring techniques; structure time; teach social skills

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8
Q

Histrionic B

A

S/s: excessive emotionality and attention seeking

NI: teach social skills; provide factual feedback about behavior

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9
Q

Narcissistic B

A

S/s: grandiose; lack of empathy; need for admiration

NI: matter-of-fact approach; gain cooperation with needed treatment; teach client any needed self-care skills

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10
Q

A patient asks, “What are neurotransmitters? The doctor said mine are imbalanced.” Select the nurse’s response that provides the most accurate information.

A. “What medications are you taking, are you experiencing side effects?”
B. “They protect us from harmful effects of free radicals, much like our nerves and white matter.”
C. “Neurotransmitters are substances we consume that influence memory and mood”
D. “Neurotransmitters are natural chemicals that pass messages between brain cells”

A

D. “Neurotransmitters are natural chemicals that pass messages between brain cells”

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11
Q

The nurse administers a medication that potentiates the action of gamma-aminobutyric acid (GABA). Which effect would be expected?

A. Reduced anxiety
B. Improved memory
C. More organized thinking
D. Fewer sensory perceptual alterations

A

A. Reduced anxiety

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12
Q

Exclusive use of Western psychological theories by nurses making client assessments will result in…

A. A high level of care for all clients
B. Standardization of nomenclature for psychiatric disorders
C. Inadequate assessment of clients of diverse cultures
D. Greater ease in selecting appropriate treatment interventions

A

C. Inadequate assessment of clients of diverse cultures

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13
Q

Which part of the nursing care plan would the nurse expect to find this statement: Decreased severity and frequency of hallucination and delusional statements.

A. Assessment
B. Diagnosis
C. Intervention
D. Evaluation

A

D. Evaluation

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14
Q

A nurse assesses a newly admitted client diagnosed with psychosis NOS. The nurse asks the client’s sibling for information about the reason for admission and any medication. What statement by the sibling would help to identify the cause of psychosis?

A. “I told my brother to stop drinking so much juice”
B. “He keeps claiming that he is the chosen one”
C. “He just finished his first year in college and failed all of his classes”
D. “The other day he said he saw angels sitting with him in his room”

A

C. “He just finished his first year in college and failed all of his classes”

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15
Q

A nurse taught a client about important precautions associated with a new prescription. Afterward, the client accurately summarized major self-management strategies associated with this drug. Which step of the nursing process applies to the client’s summarization?

A. Assessment
B. Diagnosis
C. Intervention
D. Evaluation

A

D. Evaluation

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16
Q

Which of the following would be assessed as a negative symptom of schizophrenia?

A. Anhedonia
B. Hostility
C. Agitation
D. Hallucinations

A

A. Anhedonia

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17
Q

Which symptoms would NOT be assessed as a positive symptom of schizophrenia?

A. Delusion of persecution
B. Auditory hallucinations
C. Affective flattening
D. Idea of reference

A

C. Affective flattening

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18
Q

Which side effect of antipsychotic medication is generally nonreversible?

A. Anticholinergic effects
B. Pseudoparkinsonism
C. Systolic reaction
D. Tardive dyskinesia

A

D. Tardive dyskinesia

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19
Q

A client diagnosed with disorganized schizophrenia would have greatest difficulty with the nurse:

A. Interacting with neutral attitude
B. Using concrete language
C. Giving multi-step directions
D. Providing nutritional supplements

A

C. Giving multi-step directions

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20
Q

The major feature of a personality disorder is what?

A. Onset in the thirties
B. Extreme set of personality traits
C. Flexible personality styles
D. Personality traits are adaptive

A

B. Extreme set of personality traits

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21
Q

A personality disordered person who lacks social skills and has no desire for personal intimacy probably has what personality disorder?

A. Schizotypal personality disorder
B. Schizoid personality disorder
C. Paranoid personality disorder
D. Borderline personality disorder

A

B. Schizoid personality disorder

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22
Q

Chloropromazine (Thorazine)

A

Anti-psychotic,1st generation

Block dopamine; avoid OTC meds that can cause anticholinergic

SE: weight gain; orthostatic hypotension, sedation, seizures, sexual dysfunction, skin effects, liver impairment
NMS - Hyperpyrexia, BP fluctuations, tachycardia, tachypnea, decreased LOC
EPS - akathisia, Parkinsonism, acute dystonia, Tardive dyskinesia

C/I: liver issues, Parkinson’s disease, severe hypotension, dementia

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23
Q

Haloperidol (Haldol)

A

Anti-psychotic,1st generation

Block dopamine; avoid OTC meds that can cause anticholinergic

SE: weight gain; orthostatic hypotension, sedation, seizures, sexual dysfunction, skin effects, liver impairment
NMS - Hyperpyrexia, BP fluctuations, tachycardia, tachypnea, decreased LOC
EPS - akathisia, Parkinsonism, acute dystonia, Tardive dyskinesia

C/I: liver issues, Parkinson’s disease, severe hypotension, dementia

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24
Q

Fluphenazine (Prolixin)

A

Anti-psychotic,1st generation

Block dopamine; avoid OTC meds that can cause anticholinergic

SE: weight gain; orthostatic hypotension, sedation, seizures, sexual dysfunction, skin effects, liver impairment
NMS - Hyperpyrexia, BP fluctuations, tachycardia, tachypnea, decreased LOC
EPS - akathisia, Parkinsonism, acute dystonia, Tardive dyskinesia

C/I: liver issues, Parkinson’s disease, severe hypotension, dementia

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25
Loxapine (Loxitane)
Anti-psychotic,1st generation Block dopamine; avoid OTC meds that can cause anticholinergic SE: weight gain; orthostatic hypotension, sedation, seizures, sexual dysfunction, skin effects, liver impairment NMS - Hyperpyrexia, BP fluctuations, tachycardia, tachypnea, decreased LOC EPS - akathisia, Parkinsonism, acute dystonia, Tardive dyskinesia C/I: liver issues, Parkinson’s disease, severe hypotension, dementia
26
Extra pyrimidal s/s (EPS) treatment
Benzotropine (Cogentin) & Diphenhydramine (Benedryl)
27
Rispridone (Risperdal)
Anti-psychotic, 2nd generation SE: fewer/mild EPS, orthostatic hypotension, anticholinergic effects, sleep disturbances, sexual dysfunction NMS - hyperpyrexia, BP fluctuations, tachycardia, tachypnea, decreased LOC C/I: pregnancy, dementia, DM Complications: metabolic syndrome
28
Clozapine (Clozaril)
Anti-psychotic, 2nd generation SE: fewer/mild EPS, orthostatic hypotension, anticholinergic effects, sleep disturbances, sexual dysfunction Agranulocytosis - flu-like symptoms; WBC <5000; ANC <1000 NMS - hyperpyrexia, BP fluctuations, tachycardia, tachypnea, decreased LOC C/I: dementia, DM Complications: metabolic syndrome
29
Olanzapine (Zyprexa)
Anti-psychotic, 2nd generation SE: fewer/mild EPS, orthostatic hypotension, anticholinergic effects, sleep disturbances, sexual dysfunction NMS - hyperpyrexia, BP fluctuations, tachycardia, tachypnea, decreased LOC C/I: dementia, DM Complications: metabolic syndrome
30
Quetiapine (Seroquel)
Anti-psychotic, 2nd generation SE: fewer/mild EPS, orthostatic hypotension, anticholinergic effects, sleep disturbances, sexual dysfunction NMS - hyperpyrexia, BP fluctuations, tachycardia, tachypnea, decreased LOC C/I: dementia, DM Complications: metabolic syndrome
31
Amitriptyline (Elavil)
Anti-depressant, 1st generation TCA SE: orthostatic hypotension, sedation Anti-cholinergic SE - dry mouth, urinary retention, constipation, blurred vision, photophobia, tachycardia Avoid use with other anticholinergic medications; paradoxical SE, can increase SI C/I: pregnancy; seizures; caution with CAD, DM, liver/kidney/respiratory issues, urinary retention or obstruction; caution with MAOI, can cause bad HTN
32
Nortriptyline (Aventyl)
Anti-depressant, 1st generation TCA SE: orthostatic hypotension, sedation Anti-cholinergic SE - dry mouth, urinary retention, constipation, blurred vision, photophobia, tachycardia Avoid use with other anticholinergic medications; paradoxical SE, can increase SI C/I: seizures; caution with CAD, DM, liver/kidney/respiratory issues, urinary retention or obstruction; caution with MAOI, can cause bad HTN
33
Imipramine (Tofranil)
Anti-depressant, 1st generation TCA SE: orthostatic hypotension, sedation Anti-cholinergic SE - dry mouth, urinary retention, constipation, blurred vision, photophobia, tachycardia Avoid use with other anticholinergic medications; paradoxical SE, can increase SI C/I: seizures; caution with CAD, DM, liver/kidney/respiratory issues, urinary retention or obstruction; caution with MAOI, can cause bad HTN
34
Trimipramine (Surmontil)
Anti-depressant, 1st generation TCA SE: orthostatic hypotension, sedation Anti-cholinergic SE - dry mouth, urinary retention, constipation, blurred vision, photophobia, tachycardia Avoid use with other anticholinergic medications; paradoxical SE, can increase SI C/I: seizures; caution with CAD, DM, liver/kidney/respiratory issues, urinary retention or obstruction; caution with MAOI, can cause bad HTN
35
Phenelzine (Nardil)
Anti-depressant, 1st generation MAOI SE: CNS simulation (anxiety, hypo mania, mania); orthostatic hypotension, HTN crisis (HA, HV, tachycardia, HTN, sweating, altered LOC) C/I: pregnancy, caution with TCA or SSRI, can cause serotonin syndrome; not with ephedrine or amphetamines, can cause HTN crisis *Use with BP meds can cause dangerous hypotension; reduce caffeine intake
36
Isocarboxazid (Marplan)
Anti-depressant, 1st generation MAOI SE: CNS simulation (anxiety, hypo mania, mania); orthostatic hypotension, HTN crisis (HA, HV, tachycardia, HTN, sweating, altered LOC) C/I: caution with TCA or SSRI, can cause serotonin syndrome; not with ephedrine or amphetamines, can cause HTN crisis *Use with BP meds can cause dangerous hypotension; reduce caffeine intake
37
Tranylcypromine (Parnate)
Anti-depressant, 1st generation MAOI SE: CNS simulation (anxiety, hypo mania, mania); orthostatic hypotension, HTN crisis (HA, HV, tachycardia, HTN, sweating, altered LOC) C/I: caution with TCA or SSRI, can cause serotonin syndrome; not with ephedrine or amphetamines, can cause HTN crisis *Use with BP meds can cause dangerous hypotension; reduce caffeine intake
38
Selegiline (Emsam)
Anti-depressant, 1st generation MAOI SE: CNS simulation (anxiety, hypo mania, mania); orthostatic hypotension, HTN crisis (HA, HV, tachycardia, HTN, sweating, altered LOC) C/I: caution with TCA or SSRI, can cause serotonin syndrome; not with ephedrine or amphetamines, can cause HTN crisis *Use with BP meds can cause dangerous hypotension; reduce caffeine intake
39
Fluoxetine (Prozac)
Anti-depressant, 2nd generation SSRI SE: weight changes (early loss, late gain); sexual dysfunction, serotonin syndrome (confusion, agitation/anxiety, fever/sweating, hallucinations, diarrhea, tremors), CNS stimulation (insomnia, agitation, anxiety) C/I: pregnancy; DO NOT TAKE WITH MAOI, TCA, St. John’s wort, lithium, NSAIDs; use caution with liver/renal dysfunction, cardiac disease, seizure disorder, DM, ulcers, GI bleed *taper of with discharge to avoid withdrawal syndrome
40
Paroxetine (Paxil)
Anti-depressant, 2nd generation SSRI SE: weight changes (early loss, late gain); sexual dysfunction, serotonin syndrome (confusion, agitation/anxiety, fever/sweating, hallucinations, diarrhea, tremors), CNS stimulation (insomnia, agitation, anxiety) C/I: DO NOT TAKE WITH MAOI, TCA, St. John’s wort, lithium, NSAIDs; use caution with liver/renal dysfunction, cardiac disease, seizure disorder, DM, ulcers, GI bleed *taper of with discharge to avoid withdrawal syndrome
41
Sertraline (Zoloft)
Anti-depressant, 2nd generation SSRI SE: weight changes (early loss, late gain); sexual dysfunction, serotonin syndrome (confusion, agitation/anxiety, fever/sweating, hallucinations, diarrhea, tremors), CNS stimulation (insomnia, agitation, anxiety) C/I: pregnancy; DO NOT TAKE WITH MAOI, TCA, St. John’s wort, lithium, NSAIDs; use caution with liver/renal dysfunction, cardiac disease, seizure disorder, DM, ulcers, GI bleed *taper of with discharge to avoid withdrawal syndrome
42
Citalopram (Celexa)
Anti-depressant, 2nd generation SSRI SE: weight changes (early loss, late gain); sexual dysfunction, serotonin syndrome (confusion, agitation/anxiety, fever/sweating, hallucinations, diarrhea, tremors), CNS stimulation (insomnia, agitation, anxiety) C/I: pregnancy; DO NOT TAKE WITH MAOI, TCA, St. John’s wort, lithium, NSAIDs; use caution with liver/renal dysfunction, cardiac disease, seizure disorder, DM, ulcers, GI bleed *taper of with discharge to avoid withdrawal syndrome
43
Escitalopram (Lexapro)
Anti-depressant, 2nd generation SSRI SE: weight changes (early loss, late gain); sexual dysfunction, serotonin syndrome (confusion, agitation/anxiety, fever/sweating, hallucinations, diarrhea, tremors), CNS stimulation (insomnia, agitation, anxiety) C/I: pregnancy; DO NOT TAKE WITH MAOI, TCA, St. John’s wort, lithium, NSAIDs; use caution with liver/renal dysfunction, cardiac disease, seizure disorder, DM, ulcers, GI bleed *taper of with discharge to avoid withdrawal syndrome
44
Venlafaxine (Effexor)
Anti-depressants, 2nd generation SNRI SE: hyponatremia, anorexia, HTN, sexual dysfunction C/I: DO NOT TAKE WITH MAOI, St. John’s wort, ETOH; use caution with use of diuretics, NSAID *taper off with discharge to avoid withdrawal syndrome; take with food; can take 4 weeks to achieve therapeutic effect
45
Duloxetine (Cymbalta)
Anti-depressants, 2nd generation SNRI SE: hyponatremia, anorexia, HTN, sexual dysfunction C/I: DO NOT TAKE WITH MAOI, St. John’s wort, ETOH; use caution with use of diuretics, NSAID; no hepatic disease or patients who consume a lot of ETOH *taper off with discharge to avoid withdrawal syndrome; take with food; can take 4 weeks to achieve therapeutic effect
46
Desvenlafaxine (Pristiq)
Anti-depressants, 2nd generation SNRI SE: hyponatremia, anorexia, HTN, sexual dysfunction C/I: DO NOT TAKE WITH MAOI, St. John’s wort, ETOH; use caution with use of diuretics, NSAID *taper off with discharge to avoid withdrawal syndrome; take with food; can take 4 weeks to achieve therapeutic effect
47
Buproprion
Atypical anti-depressant Causes appetite suppression C/I: seizure risk
48
Lithium
Mood stabilizer Therapeutic level (acute phase): 0.6-1.2 mEq/L Therapeutic level (maintenance phase): 0.4-1.0 mEq/L C/I: pregnancy risk, NO breastfeeding! Liver/kidney disease, cardiac disease, hypovolemia, schizophrenia, NSAIDs EDU: drink 1.5-3L of water daily; NO diuretics; daily sodium intake 2-3g; take with food; blood draws frequently initially, then every few months; RISKS: hypothroidism & impairment of kidney’s ability to concentrate urine
49
Common adverse effects, signs & symptoms of lithium <1.5 mEq/L
NVD, thirst, polyuria, lethargy, slurred speech, fine hand tremor, muscle weakness
50
Early toxicity, signs & symptoms of lithium 1.5-2.0 mEq/L
Worsening NVD, stupor, mental confusion, coarse hand tremors, poor coordination
51
Advanced toxicity, signs & symptoms of lithium 2.0-2.5 mEq/L
Extreme polyuria of dilute urine, tinnitus, giddiness, jerking movements, blurred vision, ataxia, seizures, severe hypotension, stupor/coma, possible death from respiratory complications
52
Severe toxicity, signs & symptoms of lithium 2.5+ mEq/L
Coma, death
53
Valproate/Valproic Acid (Depakote)
Anti-convulsants/Anti-epileptic Therapeutic level = 50-125 ug/mL SE: CNS effects (nystagmus, double vision, vertigo, staggering gait, HA) C/I: pregnancy, blood disorders, bone marrow disorders *watch for hepatotoxicity
54
Carbamazepine (Tegretol)
Anti-convulsants/Anti-epileptic SE: CNS effects (nystagmus, double vision, vertigo, staggering gait, HA) C/I: pregnancy, blood disorders, bone marrow disorders *watch for hepatotoxicity; REPORT blood issues (leukopenia, anemia, thrombocytopenia); NO grapefruit
55
Lamotrigine (Lamictal)
Anti-convulsants/Anti-epileptic SE: CNS effects (nystagmus, double vision, vertigo, staggering gait, HA) C/I: pregnancy, blood disorders, bone marrow disorders *watch for hepatotoxicity
56
Alprazolam (Xanax)
Benzodiazepine HIGHLY addictive, can cause dependence; short term use Withdrawal s/s: anxiety, insomnia, diaphoresis, tremors, delirium, seizures SE: Drowsiness, dry mouth, acute toxicity (confusion, respiratory depression, hypotension), anterograde amnesia, paradoxical response (anxiety, insomnia) C/I: pregnancy, sleep apnea, respiratory depression, glaucoma, history of substance abuse
57
Diazepam (Valium)
Benzodiazepine HIGHLY addictive, can cause dependence; short term use Withdrawal s/s: anxiety, insomnia, diaphoresis, tremors, delirium, seizures SE: Drowsiness, dry mouth, acute toxicity (confusion, respiratory depression, hypotension), anterograde amnesia, paradoxical response (anxiety, insomnia) C/I: pregnancy, sleep apnea, respiratory depression, glaucoma, history of substance abuse
58
Lorazepam (Ativan)
Benzodiazepine HIGHLY addictive, can cause dependence; short term use Withdrawal s/s: anxiety, insomnia, diaphoresis, tremors, delirium, seizures SE: Drowsiness, dry mouth, acute toxicity (confusion, respiratory depression, hypotension), anterograde amnesia, paradoxical response (anxiety, insomnia) C/I: pregnancy, sleep apnea, respiratory depression, glaucoma, history of substance abuse
59
Chlordiazepoxide (Librium)
Benzodiazepine HIGHLY addictive, can cause dependence; short term use Withdrawal s/s: anxiety, insomnia, diaphoresis, tremors, delirium, seizures SE: Drowsiness, dry mouth, acute toxicity (confusion, respiratory depression, hypotension), anterograde amnesia, paradoxical response (anxiety, insomnia) C/I: pregnancy, sleep apnea, respiratory depression, glaucoma, history of substance abuse
60
Buspirone (Buspar)
Non-Benzodiazepine Not addictive, do not use while breastfeeding; NO grapefruit juice, St. John’s wort, erythromycin, MAOI
61
Diphenhydramine (Benedryl)
Non-Benzodiazepine Not addictive; may cause anticholinergic s/s; high doses = shleepy

NRN 21 Exam 4 (4 decks)

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