Exam 2 Flashcards
(137 cards)
1
Q
How is Zyprexa/Olanzapine utilized
A
rapidly calms agitation. useful in EDs. Produces the most weight. Dont bake pills in half. Can cause skin rash.
2
Q
Which antipsychotic drugs are used for bipolar disorder as First line
A
Abilify, Lurasidone
3
Q
What do typical antipsychotics do
A
blocks dopamine leading to reduction in psychotic symptoms. Are prone to EPS such as dyskinesias
4
Q
What are Side Effects of GHB? (Gamma Hydroxyburtyrate
A
N/V, delusions, depression, vertigo, hallucinations, seizures, LOC, slow HR, Low BP, Amnesia, Coma.
5
Q
What is a priority action for bipolar I provocately dressed in the mileu
A
discuss inappropriate clothing, puts pt at risk
6
Q
What category of drug is riperdol
A
dopamine and serotonin antagonist.
7
Q
Client with Wernicke Korsakoff syndrome and history of alochoism. What is a symptoms nurse should expect?
A
loss of short term and long term memory and the use of confabulation
8
Q
Dose for Lithium
A
300-1200 mg daily
9
Q
Clozaril is a lower potency atypical antipyschotic, what needs to be monitored when taking this
A
type II diabetes, WBC count, lowers WBCs
10
Q
Priority dx for client experiencing cocaine withdrawal?
A
powerlessness
11
Q
Nursing considerations with pehnothiazines
A
parkinson like symptoms, orthostatic hypotension, avoid strenuous exercise in hot weather, wear suncscreen, no alcohol, dizziness
12
Q
Client experiencing nausea, vomiting, anorexia from Carbamazepine , what is an appropriate intervention
A
admin next dose with food.
13
Q
Describe Bipolar I- Mania
A
- angers easily
- grandiose
- can’t sleep
- unlimited energy
14
Q
Therapeutic Level for Lithium
A
0.5 - 1.5 mEq/L
15
Q
How should valproic acid be given (mood stabilizer)
A
two divided doses, 500 - 2000 mg daily. Increases GABA
16
Q
Parts of the CAGE questionnaite
A
- have you felt you should cut down
- have people annoyed you by criticising your drinking
- have you ever felt guilty about your drinking
- have you ever had a drink in the morning to steady your nerves?
17
Q
How are atypical antipsychotics used to MGMT bipolar disorder
A
sedative and mood stabilizing
Olanzapine, Aripiprazole(Abillify), Risperidone
18
Q
Relapse prevention strategies for substance dependence
A
present information simply, and easily understood terminology
19
Q
A client with cofnitivie deficitys and alchol abuse. What drug is appropriate for recovery?
A
Naltrexone (Revia), opiate antagonist
20
Q
What is the medication of choice with Bipolar disorder
A
lithium carbonate. Can be toxic.
21
Q
What medication would be expected to administer with benzos and obsessive compulsive personality disorder?
A
Clonazepam
22
Q
How do anticonvulsants work as mood stabilizers
A
enhances effects of GABA and desensitizing the kindling of bipolar disorder.
23
Q
Topamax Uses
A
Bipolar, mania, migrain headaches, fibromyalgia, schizoaffective
24
Q
What outcome would you hope to see with a pt with disturbed thought processes
A
The pt can distiguish reality from delusions
25
What is anhedonia
inability to experience pleasure risk for suicide.
26
Halperidol nursing considerations
* dystonia, muscle tighening
* akathisia
* shuffling gait
* weight gain
* dry mouth, blurred vision, constipation
* seizures
27
What drug has similar effects to Ketamine?
PCP "Angel Dust"
28
Pt complains of muscle pain, swelling and weakness of extremtieis and reddish tinged urine. What lab value should you assess?
elevated creatine phosphokinase
29
A client verbally provokes another patient who is paranoid, what is the priority implementation of the nurse
limit setting
30
waxy flexibility
having one's arms or legs placed in certain position and holding that same position for hours
31
Common traits of all personality disorders
* Failure to accept consequences of own behavior
* coipe by altering env't instead of self
* lack of insight
32
Lamictal/Lamotrigine
* Anticonulsant/Mood Stabilizer
* Good for rapic cyclers
* Steven Johnson Syndrome
* Stop medication first sign of rash
* may change estrogen oral contraceptives
33
What category drug is Rohypnol- Date Rape Drug
Benzodiazepine, like Valium. 10x more potent.
34
schizophrenia and psychosis
ALL schizophrenia are psychosis but not all psychosis are schizophrenia
35
A narcissist states "I do not think that the whole world owes me a living" what defense mechanism is this?
denial
36
A schizotypal personality disorder stated "I envision my future death by fire", what is appropriate response?
I can see you thoughts are bothersome, how can I help?
37
How is Saphris given and what are SEs
Sublingual tablet only, watch for getting bit by pt. Can cause oral numbing, weight gain, EPS like typical antipsychotics.
38
Client with borderline personality disorder what is the unmet developmental need
awareness of separateness of self
39
Client states "We wanted to take the bus, but the airport took all the traffic".
associative looseness
40
A client diagnosed with borderline personality disorder requests diazepam (Valium). The physician refuses, the client gets mad and demands to see another physican. What defense mechanisms is the client using?
splitting
41
How should Latuda be given
with 350 calories of food. Watch for increase in SI for bipolar, depressed pt. Hyperglycemia
42
What characteristics is representative of passive aggressive behavior?
seeks subtle retribution when feeling others have wronged him or her
43
what does echopraxia mean
repeating movements of another person
44
Valproic Acid/Depakore
* Anticonvulsant/Mood Stabilizer- First line for Mania, rage, rapid cyclers
* Liver Problems
* avoid alcohol
* taper
45
What medication is used for maintenance therapy for bipolar disorder?
Lamotrigine (Lamictal)
46
What are other medication used to reduce symptoms of bi polar disorder
Valproic Acid (Depakote), Carbamazepine (Tegretol)
47
What happens as trust in other increases w/ delusions
delusions decrease
48
SE of Rohypnol Date Rape Ddrug
drowsiness, headaches, memory loss, dizzy, nightmares, tremors. Can induce aggression and excitability
49
What is the action behind lithium
alters sodium transport across cell membranes, alters metabolism of neurotranmitters
50
"Then dentist put a filling in my tooth, now receive transmission that control what i think and do:, What is this a symptom of
client is experiencing d*elusion of influenc*e. Believing objects have control of behavior.
51
Common Atypical antipsychotics
seroquel, risperidone, alnzapine, clozapine, aripiprazole, Latuda
52
What is true about outcomes of nursing interventions for clients experiencing *chemcial dependence?*
should be tailored to the individual's immediate needs and abilities
53
Nursing considerations with Lithium
* do not administer with NSAIDS
* can cause seizures dysrthmia
* EKG changes
* fatigue, confusion, Nausea, norexia
* Hypothyroidism
* tremors
* ACE inhibitors may increase serum levels
* lots of fluids and sodium
54
Speaking as if words are being forced out quickly
pressured speech
55
What can large doses of ketamin do?
vomiting convulsions oxygen starvation to the brain and muscles. 1 gram can cause death. Flashbacks can occur 1 year after use.
56
What medication is commonly used for treatment of EPS
Benztropine (Congentin)
57
When do schizophrenia symptoms develop
late adolescent or earl adulthood
58
Antisocial personality disorder pt demands to speak with ethics committe at midnight. What is appropriate response?
"Let me give you a sleeping pill to help your mind at ease"
## Footnote
*expresses empathy*
59
DSM V Criteria for avoidant personality disorder
* does not form intimate relationships
* unwilling to be invovled with people unless certain of being liked
* views self as socially inpet, unappealing and inferior
60
A client admitted for chest pain r/t cocaine abuse states. "This is nothing but a little indigestion. What is all the fuss about?" What defense mechanism?
denial
61
When should Divalproex (Depakote) be taken
at bedtime, 500-2000mg mood stabilizer
62
Disorganized schizophrenia looks like
regressive, primitive behavior. Poor contact with reality. Flat affect. Personal appeance is neglected and social impairment is extreme.
63
Ectasy (MDMA) Side effects
muscle tension, involuntary teeth clenching, nausea, blurred vision, feeling faint, tremors, rapid eye movement. Sweating or chills. Increase HR and BP. Long term use can produce Parkinson's Syndrome. Damage to brain that are critical to thought and memory
64
A client in active phase of paranoid schizphrenia. What nursing intervention would facilitate other interventions
difficulty to establish trust. Make sure staff is consisstent.
65
DSM VI Borderline personality disorder
* avoid real or imagined abandonment
* recurrent suicidal and self mutilating behaviors
* feelings of emptiness
66
interventions for aggressive behavior
* identify feelings of frustration
* encourage discussion
* identify precipitating events
* describe consequences
* previous coping mech
67
What is a priority action for pt with pressured speech and increased levels of anziety
vital signs. Physican complications can occur due to pyschological symptoms
68
Antisocial personality disorer pt is smoking in a non smoking area. what do you do?
Confront the client about the behavior. Must be done in a timely manner
69
Early alocholic phase s.sx
amnesia occurs during or immediately after period of drinking
70
Flight of ideas
constant flow fo speech in which client jumps from one topic to another in rapid succession
71
What intake do you need when monitoring pt on lithium
dietary **sodium** and fluid (2-3 L/day)
72
Alcoholic client with ineffective health maintenance. What is a longterm goal
the client will exhibit reduced medical complications r/t alcoholism within 6 months
73
Common Typical Antipsychotics
Haloperidol, Perphen**azine**
74
What drug helps client control cravings for alcohol
Naltrexone (ReVia)
75
How are antianxiety agents used to MGMT bipolar disorder
managing psychomotor agitation characteristics of mania
## Footnote
*avoid if pt has substance abuse*
76
A client with nursing dx of disturbed thought processes has an expected outcome of recognizing delusional thinking. What should the nurse implement?
appreciate that the client has experienced disturbing delusional thinking. Shows empathy
77
Types of delusions
grandiose persecutaory
78
What is a longer acting medium potency Atypical antipsychotic?
zypreza/olanzapine. Injectable form
79
What sort of state the Ketamine put the user in?
dissasociative
80
Why does pt receive Lorazepam for high CIWA score?
detterent therapy that helps to motivate clients to maintain alcohol abstinence
81
Manipulative behavior
* set clear limits
* communicate expectations
* clear about consequences
* discuss behavior in non judgmental way
* gather staff to provide an escort to take pt to room
82
What kind of effects does Ketamine/PCP have?
numbness, loss of coordination, muscle rigidity, aggresssive, slurred speech/blocked speach. Blank Stare, exaggerated speech.Does not depress CNS. Relieves pain, may cause user to hurt themselves. Intensifies colors/sounds
83
Assessment for Schizophrenia physical characteristics
unkempt appearnce, body image distortions, hyponatremia, somatic complaince, poor sleep
84
Lamotrigine (Mood stabilizer), mode of action
inhibits release of glutamate and excitatory neurotransmitter. Dose 100-200 mg daily
85
What type of approach is attaching consequences to adaptive and maladaptive behavior
behavioral therapy approach
86
What are antipsychotic drugs predominatnlty
dopamine antagonists. Treat positive symptoms of schizphrenia
87
What does echolalia mean
repeating speech of another person
88
Which medication has the highest potential for client to experience serious side effects?
Clozapine. Life threatening agranulocytosis.
89
A client with borderline personality disorder has disturbed personal identiy. What is an appropriate nursing intervention?
help the client identify values and beliefs.
## Footnote
*fixation from early developmental level*
90
a client diagnosed with substance dependence states, "My wife causes me to abuse meth. She uses and expects me to. What defense mechanism?
projection
91
Medications commonly used for bipolar affective disorder
Depakote (Anticonvulsant), Verapamil (Caclium Channel Blocker), Olanzapine
92
Positive prognosis after being diagnosed with schizophrenia
diagnosed at ate 35, female whose s/sx began after rape, family with hx of mood disorder
93
What is the purpose of delusions
establish identity and self esteem
94
What does Gamma Hydroxybutyrate (GHB) do?
relaxant, causing loss of muscle tone and reduced inhibitions
95
What symptom of schizoid personality disorder is a high risk for schizophrenia
limited range of emotional experience and expression. Do not enjoy close relationships
96
A client with antisocial personality disorder states "my kids are busy at home they don't miss me or even know i'm gone". Which nursing dx is applicative
ineffective denial
97
what is catatonic excitement
moving excitedly with no environmental stimuli present
98
Olfactory hallucinations
smeeling things that do not exist
99
What is an appropriate nursing intervention for a pt risk for injury r/t extreme hyperactivity
use prn antipsychotic meds. Need to sedate the pt quickly. A mood stabilizer can be given concurrently for maintenance therapy.
100
Deescalation techniques
* Large personal space
* non aggressive posture
* calm approach
* determine client's need
* don't argue
* problem solving
101
Gustatory
experiencing tast in the absence of stimuli
102
Hallucination interventions
* ask about hallucination
* do not react as if it were real
* decrease stimuli
* do not negate experience
* engage through a concrete activity
* avoid touching client
* monitor for anxiety/agitation (hallucinations could be icnreasing
103
Why should a pt pacing the halls be a priority
most at risk for assaultive behavior due to hyperactivity
104
What is confabulation
fillin in memory gap with detailed fantasy
105
Mixture of words and phrases that has no meaning
word salad
106
Describe schizophrenia
disordered throught processes, disrupted interpersonal relationship. Disturbances in affect, mood, behavior and thought processes.
107
Cuation for women taking antipsychotic medications
amenorrhea can occur but ovulation still occurs. Risk for pregnancy
108
What is a priority nursing dx for alcohol withdrawal
risk for injury
109
What may have a good prognosis on schizphreniform disorder?
confusion and perplexity, good premorbid social and occupational functioning, absence of blunted or flat affect, onset of psychotic symptoms within 4 weeks of noticeable behavioral change.
110
How should Carbamazepine (Tegretol) Mood Stabilizer be given
2 divided doses, inhibits release of glutamate, an excitatory neurotransmitter.
400-1200 mg daily
111
Oscarbazepine
* Anticonvulsant Bipolar
* Birth control pills may not work
* taper
112
Looseness of association
haphazard, illogical and confused thinking. Interrupted connections (Mostly schizophrenic)
113
Topamax
* Anticonvulsant/Mood Stabilizer
* May alter liver enzymes
* No Alcohol
* Taper
* Decrease hormonal contraceptives
* *May feel groggy*
114
What do atypical antipsychotics do
block dpamine, boost serotonine. Less prone to EPS, but have metabolic side effects
115
When would a schizophrenic pt benefit from group therapy
diagnosed in an outpatient clinic
116
What classification of drugs shares similar featurs with alchol overdose and withdrawal
anxiolytics
117
Thought Blocking
sudden cessation of a thought in the middle of a sentence. Unable to continue the train of thought.
118
Abnormal thought processs: *circumstantiality*
pt gets caught up in countless details and explanations
119
What is catatonic posturing in schizo client
holding bizarre postsures for long periods of time
120
What symptoms might you expect of pt lithium level is 2.6 mEq/L
excessive output of dilute urine, tremors and muscular irritability
121
When alcohol is consumed, what percentage is absorbed immediately into the blood stream?
20% through the stomach wall
122
Medication combination for auditory hallucination and bipolar I
riperidone for auditory hallucination and Lamitrigine mood stabilizer for bipolar I
123
Abnormal thought processs: *confabulation*
filling a memory gap with detailed fantasy belived by the teller, maintains self esteem
124
Lithium is to mania as clozapine is to
psychosis
125
Crucial phase of drinking pattern?
client lost family, job, driver's license
126
Carbazepine
* Anticonvulsant/Mood stabilizer
* Steven Johnson syndrome
* Taper
* decrease oral contraceptives
* avoid alcohol
* no grapefruit juice
127
Overcompliance
deny responsibility for any action by doing only what another person instructs exactly
128
Describe Bipolar II- Depression
* affects appetite
* easily fatigued
* can't make decisions
* lack of energy
* no self confidence
129
Neologisims
makes up words that have meaning only for the individual. Part of a delusional system
130
A client insists that grandmother has come back to life as a pet kitten through reincarnation. Which personality disorder?
Schizotypal personality disorder
131
What is the process of delusions
* denial
* projection
* rationalization
132
Can a true alcoholic go on benzos?
No never
133
what co morbidity can alcoholic have
ADHD
134
Assessment for alcohol
how much, what type, how long
135
Treatment for Alcohol withdrawal
* Folic Acid
* Thiamine
* Antacid prn
* Ecotrin for headache and pain (safest for kidneys
* need to have platelets
* pepsid
* lactulose for liver
136
What drug is used to reverse effects of benzos
flumezenil
137
What can overdose of inhalants cause
damage to nervous system and death
