Test Map 1; chpts 15-18

Question 1

Physiologic signs of anxiety

Answer 1

tachycardia, palpitations, tremor, sweating, gastrointestinal upset

Question 2

Symptoms of psychotic behavior

Answer 2

loss of reality; perceptual deficits: hallucinations and delusions; and deterioration of social functioning; disorganized thinking; loosening of association;, disorganized behavior; negative symptoms: changes in affect, diminished emotional expressiveness, poor eye contact, reduced spontaneous movement, withdrawn, face often immobile and unresponsive, speech often minimal (alogia), brief, slow, monotone replies given in response to questions; withdrawn from areas of functioning: affect interpersonal relationships, work, education, and self-care (asociality) and the decreased ability to experience pleasure from positive stimuli or reduced pleasure from previously positive stimuli (anhedonia)

Question 3

Uses of Vistaril – besides helping with anxiety

Answer 3

antihistamine: relieves itching; preop and postop sedative to control vomiting, diminish anxiety and reduce amount of opioids needed for analgesia; mild tranquilizer for psychiatric conditions

Question 4

MOAIs – foods to avoid

Answer 4

No tyramine: aged cheese, yeast extricate, red wine, pickled herring, sauerkraut, overripe bananas, avocados, figs, chicken liver, beer- will cause high bp; use caffeine cautiously

Question 5

How would hallucinations be defined

Answer 5

false sensory perceptions that are experienced without an external stimulus and seem real to the pt; auditory hallucinations: voices that are characteristically heard saying negative comments about pt in the third person; hallucinations of touch, sight, taste, smell, and bodily sensations can also occur

Question 6

Benefits of giving benzodiazepines with antipsychotic meds when patient’s first begin treatment

Answer 6

the benzo’s cause relaxation/calmness

Question 7

How to taper antianxiety medications

Answer 7

withdrawal should be instructed by hcp, usually requires 4 weeks of gradual reduction in dosage and widening the intervals of administration

Question 8

Serious side effect of Lamictal – what do you do about it

Answer 8

aseptic meningitis: contact hcp if they experience s/s of meningitis (headache, fever, stiff neck, nausea, vomiting, rash, and sensitivity to light)

Question 9

How would you describe mania in regard to bipolar disorder?

Answer 9

heightened mood (euphoria), quicker thoughts (flight of ideas), more and faster speech (pressured speech), increased energy, increased physical and mental activities (psychomotor excitement), decreased need for sleep, irritability, heightened perceptual acuity, paranoid or grandiose delusions, increased sexual activity, impulsivity

Question 10

What symptoms does a patient exhibit when experiencing dystonic reactions?

Answer 10

intense muscular contractions that cause them to fall to the ground, lose consciousness, and lie rigid

Question 11

Premedication assessments for patients diagnosed with a mood disorder include what

Answer 11

History of mood disorder
Basic mental status
Interpersonal relations
Mood and Affect
Clarity of thought
Suicidal Ideation
Psychomotor function
Sleep pattern
Dietary History
Nonadherence

Question 12

Drug of choice for tonic clonic seizures

Answer 12

phenytoin Dilantin is effective in tonic-clonic seizures with minimal side effects

Question 13

What symptom would indicated possible Dilantin toxicity?

Answer 13

seizures

Question 14

Assessment criteria that is very important to know prior to giving a patient Tegretol

Answer 14

-baseline and repeat at regular intervals of CBC, serum iron, liver function tests, urinalysis, BUN, serum creatinine, serum sodium, and ophthalmologic exam
-exclude Asian ancestry, including South Asian Indian ancestry
-baseline assessment of pt’s speech patterns, degrees of alertness, and orientation to name and place, and time before therapy
-review pt’s seizure hx

Question 15

Signs/symptoms that support the diagnosis of psychosis

Answer 15

-delusions
-hallucinations
-loosening of associations
-disorganized behavior
-negative symptoms- diminished emotional expressiveness (e.g. poor eye contact and reduced spontaneous movement
-Before initiating therapy

Question 16

What patient would benefit the most from depot antipsychotic medication regimens

Answer 16

pt’s experiencing acute psychosis and help with nonadherence problems

Question 17

Adverse effects that may occur when taking antipsychotic drug therapy

Answer 17

Dystonias- spasmodic movements of muscle groups such as tongue protrusion, rolling of eyes, jaw spasms, and neck torsion.
Pseudoparkinsonian symptoms- tremor, muscular rigidity, mask-like, expression, shuffling gait, loss or weakness of motor function (typically begin 2-3 weeks of antipsychotic drug therapy but may occur up to 3 months); commonly seen in older adults
Akathisia- subjective feelings of anxiety and restlessness and objective signs of pacing, rocking, and inability to sit or stand in one place for extended periods of time
Tardive dyskinesia- persistent and involuntary hyperkinetic abnormal movements; mild forward-backward, or lateral tongue movements, tongue thrusting, rolling, or “fly-catching” movements, chewing or lateral jaw movements interfering with pt’s ability to chew, speak or swallow
Neuroleptic malignant syndrome (NMS)- potentially fatal often w/ high potency antipsychotic therapy; symptoms include fever, severe EPS, autonomic instability, and alterations in consciousness

Question 18

What do you do when a patient has suicidal ideation

Answer 18

-assess for a presence of a detailed plan with the intention and ability to carry it out
-Do Not Leave the Patient Alone and notify the HCP

Question 19

When are adverse effects of antipsychotic medications most likely to occur

Answer 19

Within the first 72 hours of therapy

Question 20

Safest narcotic to give a patient taking MAOIs, thyroid hormones and multivitamins

Answer 20

Morphine might be an alternative at lower doses, but monitoring is needed.

Question 21

Side effects of the medication Dilantin and what to do about it

Answer 21

-Blood dyscrasias (Routine labs, Monitor for sore throat, fever, purpura, jaundice, or excessive or progressive weakness)
-hyperglycemia (Watch this very closely and work with HCP on correct medication dosage), -gingival hyperplasia (Good oral hygiene, including gum massage, frequent brushing, and proper dental care)
-nystagmus toxicity (Report to HCP immediately due to being a sign of toxicity)

Question 22

Information that is important to educate patients about before having a baby when then take benzodiazepines

Answer 22

-Recommended that benzos not be administered during the first trimester of pregnancy. There may be an increased incidence of birth defects because these agents readily cross the placenta and enter fetal circulation. Baby should be monitored after birth for signs of withdrawal.

Question 23

Adverse side effects associated with hydantoins/what about a patient with diabetes?

Answer 23

-nausea, vomiting, indigestion, sedation, drowsiness, fatigue, lethargy, confusion, blurred vision, nystagmus, gingival hyperplasia, hyperglycemia, blood dyscrasias, hepatotoxicity
-monitor for hyperglycemia; may elevate blood glucose levels, pt with DM are more susceptible to hyperglycemia, particularly during the early weeks of therapy

Question 24

Potency of antipsychotic medications relates to what

Answer 24

-The ability of the liver to process the medication

Question 25

Know the action of MAOIs – how do they work

Answer 25

-Block the metabolic destruction of epinephrine, norepinephrine, dopamine, and serotonin neurotransmitters by the enzyme monoamine oxidase in the presynaptic neurons of the brain. As a result , the concentration of these CNS transmitters has increased.

Question 26

Mixing Dilantin in a syringe or in IV fluids/administration rate of IV dilantin

Answer 26

-Do not mix parenteral diazepam or lorazepam in the same syringe with other medications; do not add these to other IV solutions because of precipitate formation. Administer diazepam slowly at a rate of no more than 5 mg/min or lorazepam at a rate of no more than 2 mg/min. If at all possible, give these drugs to the patient under electrocardiogram (ECG) monitoring and observe closely for bradycardia. When bradycardia occurs, stop boluses until the heart rate returns to normal.

Question 27

Complications that can occur when a patient taking an MAOI eats food with tyramine

Answer 27

If you take an MAOI and eat high-tyramine foods, tyramine can quickly reach dangerous levels. This can cause a severe spike in blood pressure and require emergency treatment.

Question 28

Teaching to be done regarding side effects of alprazolam and azapirone

Answer 28

-Both can cause sedation and lethargy.
-Avoid alcohol
-Avoid Rifampin with both medications as it enhances the metabolism of the medications.

Question 29

When is it necessary to consider in patient treatment with patients having mood disorders

Question 30

Besides seizures, what else is Tegretol used to treat

Answer 30

Trigeminal Neuraligas

Question 31

Contraindications of taking MAOIs – who should avoid taking them

Answer 31

Tyramine foods.
They can increase BP which can lead to Hypertension crisis and then a stroke/Death.

Question 32

If a patient taking an MAOI to changed to imipramine therapy – how long must you wait before initiating imipramine

Answer 32

14 days after discontinuation

Question 33

Know about treatment for psychological drug dependence

Answer 33

-Trazodone is commonly used to treat insomnia in patients with substance abuse because it is sedating, improves sleep continuity, and has minimal potential for tolerance and addiction.
-Ozazepam, lorazepam, Chlordiazepoxide, diazepam, and clorazepate are used for the treatment of anxiety associated with alcohol withdrawals.

Question 34

When giving Lorazepam for s/s of alcohol withdrawal, what do we do when that patient starts to have N/V

Answer 34

Diazepam or lorazepam may be administered intramuscularly in case of N/V due to alcohol withdrawal.

Question 35

Teaching to do when giving Wellbutrin to help a patient quit smoking

Answer 35

Coadministration of nicotine replacement products with bupropion may cause hypertension. Monitor the patient’s blood pressure when products such as nicotine patches or nicotine gum are being used.

Question 36

Important labs to monitor with antipsychotic medications

Answer 36

-Electrolytes, Blood glucose level, lipid profile, hepatic function cardiac function, and thyroid function
-Also check WBC if taking clozapine

Question 37

What side effect would you report immediately for a patient taking nefazodone

Question 38

norepinephrine, serotonin, dopamine, acetylcholine, and gamma-aminobutyric acid

Answer 38

neurotransmitters

Question 39

more chronic, ongoing symptoms of depression that last for at least 2 years

Answer 39

dysthymia

Question 40

rapid shifts toward anger and irritability

Answer 40

labile mood

Question 41

milder form of bipolar

Answer 41

cyclothymia

Question 42

these symptoms of depression include slowed or retarded movements, thought processes, and speech or agitation manifesting a purposeless, restless motion (pacing, hand wringing, outbursts of shouting)

Answer 42

psychomotor symptoms

Question 43

symptoms of depression include inability to concentrate, slowed thinking, confusion, and poor memory of recent events

Answer 43

cognitive symptoms