General Exam Practice Flashcards
(110 cards)
1
Q
What are 6 words that contribute to stigmatisation of schizophrenia?
A
Crazy, dangerous, schizo, stupid, psycho, and unpredictable
2
Q
What are some aspects of life than can be affected by discrimination?
A
Social, relationships, employment, education, spork, inclusion, community, houring, physical health, self-perception/esteem, and coping skills
3
Q
What are some strategies that a nurse can do to reduce stigma?
A
Use of language, health promotion, focus on strengths no defictsm education, positive regard, respect, and hope
4
Q
“I am jesus, and I am a milionare” is an example of what?
A
Grandiose beliefs
5
Q
What are 5 sensory experiences that can be associated with hallucinations?
A
Audiotry (hearing voices), visual (seeing things), olfactory (smelling things), tactile (feeling things), gustatory (tasting things)
6
Q
The newsreader on the TV is talking about me is an example of what?
A
Ideas of reference
7
Q
What are 3 negative symptoms associated with schizophrenia?
A
affective blunting, poverty of ideas, anhedonia
8
Q
What is the mortality rate of neuroleptic malignant syndrome?
A
20-30%
9
Q
If a patient presents with symptoms of Neuro leptic malignant syndrome what is the first thing you do?
A
Contact a medical practitioner
10
Q
What are the major side effects associated with atypical antipsychotic medications?
A
Sedation, weight gain, metabolic syndrom (diabetes), and gastrointestinal upset.
11
Q
What is the main neurotransmitter target for atypical medication?
A
Dopamine
12
Q
Name a few depot antipsychotic medications
A
Flupenthixol, olanzapine, risperidone, aripiprazole
13
Q
What are 3 good reasons why someone would stop taking their medication?
A
Due to side effects, stigma, remembering ect
14
Q
What tests/investigations need to be conducted regularly for people prescribed with clozapine and why?
A
Blood tests, blood pressure, ECGs, and bowel monitoring - due to agranulocytosis, postural hypotension, QT prolongation interval, myocarditis, cardiomyopathy, and constipation.
15
Q
What is agranulocytosis?
A
A serious condition that occurs when there is an extremely low number of granulocytes (a type of white blood cell) in the blood. Granulocytes are an important part of the immune system and help the body fight infection.
16
Q
Why is it important to ask about mood?
A
Many people who develop schizophrenia have a co-morbid mood disorder. Psychosis may be present in mania or depression.
17
Q
What questions would I ask regarding perception?
A
Do you hear any voices other than mine right now or at any other time. And Do you ever hear or see things that you think other people may not be seeing
18
Q
Ive been playing with the devil and he cheated me would be assessed under what?
A
Thought content
19
Q
Why is it important to know how long symptoms of psychosis have been present?
A
Psychosis can occur at any time and be of a short duration (at least 1 day but less than a month) symptoms that are present for a significant portion of time may indicate a different diagnosis
20
Q
What are the immediate signs of neuroleptic malignant syndrome?
A
Tachycardia (heart rate thats too fast) and pyrexia (fever).
21
Q
The biological theory of schizophrenia suggests an excess of what neurotransmitter?
A
Dopamine
22
Q
The diathesis stress theory suggests that - ?what? - contributes to the development of schizophrenia.
A
Exposure to stressful events and vulnerability
23
Q
What is the difference between psychosis and schizophrenia?
A
Psychosis is a term describing a set of symptoms and can be linked to many things whereas schizophrenia is a specific diagnosis where specific psychotic, thought disorder, delusions, and hallucination symptoms occur for at least 1 month of more.
24
Q
Can schizophrenia run in families?
A
This is inconclusive. The theory is that there is a genetic vulnerability and that a person can inherit a risk that may be enhanced by the presence of other factors (Environment, stress, attachment, and trauma ect).
25
What are some things that are commonly present with schizophrenia (comorbidity)?
Drugs, alcohol, anxiety, mood disorder, hopelessness, poor self-esteem, social isolation
26
Richard is a withdrawn client with paranoid schizophrenia who has been admitted to an acute unit. His medical notes state that he has a flattened affect. From this the nurse can expect to see evidence of?
Innapropriate emotional responses
27
Richard repeatedly asks for directions and the day/date. The nurse should do what?
Repeat the information in a kind, respectful manner
28
The nurse observes richard sitting alone in his room with his hands over his ears, shaking his head as though saying 'no'. He is most likely ?
Seeking attention of staff
29
The referral note states "Displays positive symptoms of schizophrenia as evidence by formal thought disorder" What kind of symptoms would these be?
Delusions and hallucinations
30
A patient wants to know more about a medication, how do we educate on this?
Identify some frequently used "type" of medications: Such as identify 3 antipsychotic medications, list the commonly experiences side effects of this medication, and outline any additional information you would provide for this patient alongside the medication
31
What are the 5 main classes of drugs?
Hypnotics/anxiolytics, Antipsychotics, Antidepressants, Mood stabilisers, and stimulants
32
Give a brief description for Hypnotics/anxiolytics
Hypnotics - Insomnia
Anxiolytics - Anxiety disorders and OCD
Most common are benzodiazepines. These drugs should be reserved to short courses as dependance and tolerance can occur.
Both hypnotics and anxiolytics work by enhancing the activity of GABA, a neurotransmitter that inhibits electrical activity in the brain.
33
What are the 3 main anxiolytics?
Benzodiazepines, barbiturates, and buspirone
34
What are the pros and cons of benzodiazepines?
They can act within minutes although they are highly activity and hard to come odd.
35
What are benzodiazepines given for?
Anxiety, seizures, and also alcohol withdrawl
36
What is the mechanism of action for benzodiazepines?
It increases GABA (grandma) with decreases cell activity. Hence, sedation.
37
What are the side affects of Benzodiazepines?
It brings everything low! Low BP, low resp, sedation
38
What are some things to tell the patient if they are on benzodiazepines?
Take at bedtime, and do not skip doses. Always taper off, never abruptly stop, No alcohol or drug use, no operating machinery.
39
What are the pros and cons of barbituates?
They last longer in the body, although they take longer to get out of the body hence have the potential to cause toxicity and respiratory depression.
40
What are the pros and cons of buspirone?
There are no depressant effects i.e no sedation, they take a long time to kick in. NO WITHDRAWL SYMPTOMS.
41
Give a brief description of antipsychotics
These medications are used to treat disorders such as schizophrenia, Bipolar disorder, or very severe depression. They include: Quetiapine, Clozapine, Olanzapine, Risperidone, Aripiriprazole, Ziprasidone, and amisulpride. They work by affecting dopamine receptors in the brain i.e calming the dopamine receptors.
42
What type of medications would you most likely see neuroleptic malignant syndrome arise from?
Typical antipsychotics such as haloperidol
43
What are the key signs for NMS
High fever, sweating, change in mental status, muscle rigidity, and tremors
44
What are some common side effects of atypical antipsychotic medications?
Weight gain, hypersalivation, and sedation (improves with tolerance).
45
What is a major side effect of atypical antipsychotics that isnt NMS?
Angradulocytosis - Low WBCs and low immunity i.e increased chance of infection
Clozapine is the most likely to cause this.
46
What are the key symptoms to look out for when a patient is on clozapine?
Sore throat, fever, and flu like symptoms
47
What antipsychotic do we never give to patients with dementia?
Respiridone
48
What are extrapyramidal symptoms?
Symptoms of atypical antipsychotic medications EPS, that affects the muscles. Causing spasms, tremors, involuntary actions (dystonia ect).
49
What are anticholinergic effects?
These are a set of findings (due to antipsychotic medications) such as, dry mouth, tachycardia, blurred vision urinary retention, ect. They tend to cause issues with the resp and digest systems.
50
Give a brief definition for antidepressants
These drugs are effective in treating moderate to sever depression, as well as dysthymia (milder chronic depression - 2 years duration). The major classes of antidepressant drugs include: Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants (TCAs) serotonin and noradrenaline re-uptake inhibitors (SNRIs), and Irreversible monoamine oxidase inhibitors (MAOIs). Its not for certain - but we think antidepressants work by increasing the activity of certain neurotransmitters.
51
What is serotonin syndrome?
Serotonin syndrome is a serious drug reaction. It is caused by medications that build up high levels of serotonin in the body. Serotonin syndrome symptoms usually occur within hours to days of taking the medicine or increasing the dose of a medicine you are already taking. Signs and symptoms include:
```
feeling agitated or restless
confusion
fast heart rate or irregular heart beat
loss of muscle coordination or twitching muscles
muscle rigidity
heavy sweating
diarrhoea
headache
shivering
goose bumps
high fever
seizures
unconsciousness.
```
52
What are the 4 rules of antidepressants?
1. Antidepressants can increase suicidal thoughts in the first few weeks of treatment (Notify clinican of any new SI)
2. Never stop abruptly, Slow onset and Slow taper off.
3. Never mix! (SSRIs with st johns wort and MAOIs with any other antidepressants - 2 week wash off period needed).
4. All psych drugs usually decrease BP and causes weight changes
53
What are the 3 most common SSRIs?
Sertraline, citalopram, and escitalopram
54
What are the 4 common side effects of SSRIs?
Weight gain, sexual dysfunction, insomnia. Suicide risk increased, Slow onset and slow taper off, Serotonin syndrome.
55
What is dualxetine given for?
Dual purpose: Chronic pain, Insomnia and/or depression.
56
What are the 2 most common TCAs?
Amitriptyline, and imipramine
57
What do TCAs help with?
Depression and anxiety also neuropathy
58
Common side effects of TCAs?
Anticholenergic effects: See (blindness), Pee (Urinary retention), Spit (dry mouth), Poop (consitpation). + sedation.
59
What is the mechanism of action for MAOIs.
It increases the avaliability of norepinephrine, serotonin and dopamine in the brain - i.e used for depression
60
What are the key points regarding MAOIs?
M: Massive hypertension crisis risk
A: Avoid tyramine - can trigger hypertension crisis
O: OTC (over the counter drugs) can also contibute to hypertension crisis
O: Other antidepressants - avoid. and ensure 2 week wash out period.
I: Increased risk of suicide (within first few weeks of treatment).
61
Give a brief description of mood stabilisers.
These are effective medications used to treat and prevent mania and depressive episodes in bipolar disorder and schizoaffective disorder. They promote consistent mood. The most common are lithium, valporate, and carbamazepine. They work by influencing neurotransmitters that may be involved in mood disturbance. Do not stop suddenly! These are not addictive.
62
What is the pros and dangers of lithium?
Lithium is the first recommended medication for classic bipolar disorder i.e when there is a clean gap (returns to baseline) between mania and depression. Lithium is not good when there is a mixture of mania and depression at the same time. It is really good at treating suicidal ideation. Although it can cause weight gain, fatigue and cloudy thinking. It can cause thyroid problems, decline to kidney function (diabetes insipitus). It can easily reach toxic levels and damage your kidneys hence the patient will need regular check ups of lithium levels
63
What are some early signs of lithium toxicity?
Tremor, slurred speech, feeling tired and weak, diaoreah and vomiting.
64
Give a brief description of stimulants.
Prescription stimulants are a group of drugs that result in increased activity in the body. Usually used to treat ADHD. Theres are usually abused due to their performance enhancing effects. Stimulants work by speeding up the mental and physical processes which contribute to desirable effects in the short-term by increasing levels of dopamine in the brain. Examples include: ritalin, adderall, and concerta.
65
What are some common side effects and nursing considerations for ritalin?
Difficulty falling asleep, headache, lower appetite. Nursing considerations: Take at the same time each day, avoid alcohol and caffeine, do not use alongside MAOIs, monitor cardiovascular system, monitor for behavioural changes, and monitor for dependence (addiction).
66
What are some common side effects and nursing considerations for lithium?
Nausea, vomiting, dry mouth, sedation, metallic taste, fine tremor, weight gain, and difficulty concentrating. Nursing considerations: Take at the same time each day, Drink plenty of water and take with food, do theraputic drug monitoring due to potential of dose related toxicity, monitor for excessive urination or excessive thirst, monitor closely for serotonin syndrome, avoid alcohol use, driving, and machines.
67
What are some common side effects and nursing considerations for fluoxetine (SSRI)?
Nausea, vomiting, diarrhoea, dry mouth, abdominal pain, change of appetite, sedation, sexual dysfunction. Nursing considerations: Monitor closely for serotonin syndrome, monitor mood changes and assess for SI, avoid alcohol use, driving, and machinery.
68
What are some common side effects and nursing considerations for Quetiapine?
Sedation, weight gain, and headache. Nursing considerations: enchourage fluids, avoid alcohol, driving, and machinery, observe to adverse side effects (NMS). Do not drink alongside grapefruit.
69
What are some common side effects and nursing considerations for diazepam.
Sedation, dry mouth, changes in vision, urinary retention, sexual dysfunction, headache. Nursing considerations: Never double dose, enchourage water, evaluate theraputic response to medication and physical dependency, observe for adverse side effects, avoid alcohol.
70
What is involved in psychiatric nursing assessment?
* Establish rapport.
* Obtain an understanding of the current problem or chief complaint.
* Review physical status and obtain baseline vital signs.
* Assess for risk factors affecting the safety of the patient or others (suicide/homicide).
* Assess mental status.
* Assess psychosocial status.
* Identify mutual goals for treatment.
* Formulate a plan of care that prioritizes the patient’s immediate condition and needs.
71
What are a couple of nursing diagnosis examples for schizophrenia
1. Distress related to auditory hallucinations saying/compelling....
2. Constipation related to increase of clozapine dose
72
What are some protective factors (client strengths)?
Readiness for treatment/effective coping strategies, self-aware, willingness to accept limitations and strengths. Positive physical development, Academic achievement, High self-esteem, capable young person ect.
73
What are the principles of recovery?
Bourne of hope, journey, supportive environment refining who they are, non-linear journey, education, managing internal and external stigma.
74
What are some short term nursing objectives?
1. PT will carry out ADLs
2. PT will talk in a coherent matter
3. PT will report lack of fear of others
4. PT will participate in non-life threatening acitivites
5. PT to recognise times when she/he/they feels desperate and requires coping skills
6. PT to develop hope that she/he/they can recovery
75
What are some long term nursing objectives?
1. PT will verbalise need for medication/councelling and seek this (insight)
2. PT will return to outpatient team
3. PT will return to school/work in ...
76
What are some Nurse-Patient Relationship Principles?
Focus on behavior, not “deeper” meaning
A long-term relationship is most therapeutic
Accept patient but not all behaviors
Be consistent
Do not reinforce hallucinations and delusions
Avoid whispering or laughing if patient cannot hear all of conversation
77
Describe the nursing intervention and rationale for: Nurse-Patient relationship.
Spend 1 on 1 with PT to establish a theraputic relationship. Attend, understand, explore, and conclude with PT and utalise principles of recovery: Hope, supportive environment, education, and getting involved (autonomy). RATIONALE: For PT to feel safe in expressing and sharing information, and enable partnership during care
78
What is the rationale for assessment in a nursing care plan?
Establishing a baseline ect facilitates the establishment of realistic goals, the foundation for planning effective care.
79
What would be the rationale for: Keep client in an environment as free of stimuli (loud noises, crowding) as possible.
Client might respond to noises and crowding with agitation, anxiety, and increased inability to concentrate on outside events.
80
What are the concerns with olanzapine?
Olanzapine raises the risk of death in seniors (ages 65 years or older) with dementia-related psychosis. and alongside clozapine is more likely to cause metabolic syndrome (diabetes) and can lead to neuroleptic nalignant syndrome.
81
What is Tardive dyskinesia?
Tardive dyskinesia is characterized by involuntary and abnormal movements of the jaw, lips and tongue. This is caused usually by antipsychotic medications
82
what is metabolic syndrome?
Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes.
83
What causes metabolic syndrome?
Metabolic syndrome is often caused by an unhealthy lifestyle. People who eat too much food or consume a lot of sweetened beverages are most at risk of developing metabolic syndrome. A lack of exercise can also be a factor.
84
What are the stages of change?
Precontemplation, Contemplation, Preperation, Action, Maintenance, and Relapse
85
What is brief intervention?
Any interaction with the patient where the clinician is trying to promote changes to a risky health behaviour
86
What does AS EAN stand for and what is it used for?
Assessment, Summarisation, Education, Advice, and Negotiation of a plan. These are used for a brief intervention for a PT with a risky behaviour.
87
What is the screening tool we use for substance use disorders?
AUDIT: Alcohol use disorders identification test - self report or maybe Assist V3
88
What are some tips for communication when working with a PT with a substance disorder?
Stay calm and reasonable
Ask the PT about their substance abuse - dont make assumptions
Paraphrase and clarify misunderstandings
Stick to the point - dont get drawn into arguments or discussions
Do not criticise alcohol/drug use
Do not refer to PT as an addict or alcoholic
89
What is stigma?
A sign of shame, disgrace or disapproval. It is to shun or reject and is a combination of ignorance, prejudice, and discrimination.
90
How might stigma impact on people experiencing mental illness and their family and friends?
Their family and friends (or even themself - self stigma) may want the 'old person' back hence enabling thoughts of low self-worth due to MI
91
How do we define discrimination?
The systematic, unfair treatment of people because they might be 'different'. It is a behaviour that says to people with MI or Addiction "We dont want you here, your not as good as us, your not one of us, your not important, you dont belong"
92
What groups might discriminate against people with mental illness?
Policiys (immigration policys), employees, families, DHBs, insurance ect.
93
Why might there be discrimination in families?
1. lack of education - possible unhelpfulness
2. Feeling responsible, ashamed of reputation
3. Feeling helpless to fix loved one and frustrated that services cant help
94
what are some examples of discrimination in mental health services?
Not being involved in clinical decisions, lack of consultation, exclusive treatment of individuals, assumption of ignorance, blamed for problem
95
What are the 3 strategies to reduce stigma and discrimination?
Education, Contact (discussion) and Protest (complaint)
96
How can we use language that reduces stigma in mental health?
1. "a person experiencing a mental illness" ect
i. e refering to the patient as a person rather than their illness
2. Avoid emotionally negative terms such as victim or suffering from
3. Avoid offensive expressions: crazy, psycho
4. Refer to people as "Contributing community members"
97
Do we say someone that is suffering from MI or someone that is experiencing a MI?
Never say suffering! say "experiencing"
98
What is mental health?
A psychological state where a person functions at a suitable level of emotional and behavioural stability and comprises the persons ability to enjoy and balance life (meeting mental equilibrium)
99
What is a mental illness?
Any disease or condition that influences the cognitive, emotional, and social behaviours of a person. i.e this person is not meeting mental equilibrium
100
How can we utalise the principles of recovery in our practice?
1. Being hopeful that a patient will recover, will empower change in this patient.
2. Enchouraging the PT to take control over recovery
3. Tapping into the persons own capacity for self-knowing
4. Facilitating self-help and personal responsibility
5. Listening to the patient, recognising what is going on for them, and working alongside them in their cares
101
What are the four cornerstones of the Te Whare Tapa Wha model?
Hingengaro (Mental health), Tinana (Physical), Wairua (Spirituality), Whanau (Family).
102
What is trauma?
The lasting adverse effects on a persons or collectives functioning and mental, physical, social, emotional, or spiritual wellbeing. Caused by events, circumstances, or intergenerational historical traumatic experiences
103
what is the trauma informed approach?
A strenghts based model of care delivery which focuses on the persons strengths and competencies (tidal model)
104
Mental health is a state of?
Well-being
105
What is anhedonia?
The inability to feel pressure
106
What is alogia?
Poverty of speech
107
What is avolution?
Lack of motivation
108
What is ambivalence?
Mixed feelings
109
What is apathy
Lack of intrest or concern
110
What is asocial behaviour
Declining to engage or incapable of engaging
