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Test #2 Flashcards

Psychotic Disorders Mood Disorders Personality Disorders

1
Q

More accepted theory of the cause of schizophrenia

A

Dopamine and Serotonin Dysregulation

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2
Q

Prodromal symptoms must be present for… in order to diagnose schizophrenia

A

One year

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3
Q

Prodromal symptoms of schizophrenia include subtle changes in…

A
  1. Behavior
  2. Thinking
  3. Relating to others
  4. Caring for self/neglect of personal hygiene
  5. Mounting anxiety
  6. Emotional blunting
  7. Loss of interest
  8. Heightened sensitivity to sounds
  9. Somatic concerns/preoccupied with body parts/sense of body distortion
  10. Self-mutilation
  11. Staring
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4
Q

Examples of impaired communication in a patient with schizophrenia

A
  1. Tangentiality - central idea is never communicated
  2. Circumstantiality - digression before communicating central idea
  3. Perseveration - focus on a single topic
  4. Clang association
  5. Echolalia
  6. Concrete thinking
  7. Word salad
  8. Loose associations
  9. Flight of ideas
  10. Thought retardation
  11. Thought blocking
  12. Neologism - invention of new words
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5
Q

Examples of impaired social behavior in a patient with schizophrenia

A
  1. Agitation
  2. Aggression
  3. WAXY FLEXIBILITY**
  4. Regression
  5. Hypervigilance
  6. Stereotypic movements - nonpurposeful constant movement
  7. Echopraxia
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6
Q

Delusional types that could be seen in a patient with schizophrenia include…

A
  1. Persecution
  2. Paranoia
  3. Reference
  4. Grandeur
  5. Somatic
  6. Nihilistic
  7. Religiousity
  8. Thought broadcasting (others can hear the thoughts)
  9. Thought withdrawal (others are taking the thoughts)
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7
Q

Negative symptoms of schizophrenia (“A’s”)

A
  1. Alexithymia - difficulty naming and describing emotions
  2. Asociality - Few friends
  3. Anhedonia - Inability to experience pleasure
  4. Avolition - Lack of motivation
  5. Attention problems
  6. Apathy
  7. Affect changes (blunt or flat)
  8. Anergia
  9. Ambivalence
  10. Alogia - decreased productivity of thought and speech
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8
Q

Difficulty naming and describing emotions

A

Alexithymia

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9
Q

Few friends

A

Asociality

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10
Q

Inability to experience pleasure

A

Anhedonia

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11
Q

Lack of motivation

A

Avolition

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12
Q

Decreased productivity of thought and speech

A

Alogia

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13
Q

A patient is diagnosed with catatonia when…

A

clinical picture is dominated by 3 or more specific symptoms

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14
Q

Defining symptoms of catatonia include…

A
  1. Stupor
  2. Catalepsy
  3. Waxy flexibility
  4. Mutism
  5. Negativism
  6. Posturing
  7. Mannerisms
  8. Stereotypy
  9. Agitation (not influenced by external stimuli)
  10. Grimacing
  11. Echolalia
  12. Echopraxia
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15
Q

Types of schizoaffective disorder

A
  1. Bipolar Type (involves manic episode)

2. Depressive Type (involves major depressive episodes)

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16
Q

Psychotic and mood disorder concurrently is known as…

A

Schizoaffective disorder

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17
Q

A client is diagnosed with schizoaffective disorder when…

A

period of illness includes a major mood episode concurrent with two or more symptoms of schizophrenia (positive or negative)

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18
Q

Positive symptoms of schizophrenia

A
  1. Hallucinations
  2. Delusions
  3. Disorganized thoughts
  4. Bizarre behaviors
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19
Q

When assessing a psychotic client with potential hallucinations the nurse should always…

A

rule out an actual cause (i.e. really infested with bugs) before dismissing as an hallucination

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20
Q

Priority nursing interventions of psychotic patients in the community include…

A
  1. Relapse prevention!!!*** (ensuring med compliance)
  2. Maintaining psychosocial functioning
  3. Providing education
  4. Improving quality of life
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21
Q

This should be part of discharge planning for clients with multiple psychosocial issues who have multiple hospitalizations

A

Intense Case Management (ICM)

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22
Q

When teaching about relapse preventing, the nurse should educate to be aware of…

A
  1. Poor nutrition
  2. Lack of sleep
  3. Infection
  4. Hostile environments
  5. Social isolation/poor social skills
  6. “Hopeless” attitude
  7. Medication issues
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23
Q

Potential triggers for relapse could include…

A
  1. Events
  2. Times
  3. Places
  4. Stimuli
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24
Q

When educating a patient’s family regarding a schizophrenia diagnosis, it is important for the nurse to emphasize..

A
  1. schizophrenia has many different presentations

2. each case of schizophrenia is different and should not be compared to other schizophrenics in the family

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25
Q

Antipsychotic drugs treat the symptoms, but are not a cure. True or False?

A

True

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26
Q

Antipsychotic drugs cause addiction. True or False?

A

False

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27
Q

An African American client taking antipsychotics may require a(n)…. dose of medication due to….

A

Increased dose due to fast metabolism (medication leaves body quicker, requiring more drugs to achieve desired effect)

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28
Q

An Asian client taking antipsychotics may require a(n)… dose of medication due to…

A

Decreased does due to slow metabolism (medication stays in body longer lengthening amount of time medication has to cause desired effect)

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29
Q

First generation (Typical) antipsychotic drug suffix

A

-azine

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30
Q

Typical antipsychotic drugs treat which symptoms of schizophrenia?

A

Positive only

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31
Q

Second/Third generation (Atypical) antipsychotic drug suffixes

A
  • pine

- done

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32
Q

Atypical antipsychotic drugs treat which symptoms of schizophrenia?

A

Both positive and negative

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33
Q

Oral disintegrating antipsychotics

A
  1. Zyprexa Zydis
  2. Risperdol-M Tab
  3. Abilify Discmelt
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34
Q

Long acting injectable antipsychotics

A
  1. Prolixin Decanoate
  2. Haldol Decanoate
  3. Risperdal Consta
  4. Invega Sustenna
  5. Zyprxa Relprevv
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35
Q

A nurse should include what in her education to a patient regarding taking antipsychotic drugs?

A
  1. Use sunscreen (photosensitivity)
  2. Monitor for EPS
  3. Caution becoming pregnant
  4. Avoid antacids
  5. Diet teaching
  6. Risk slowly (orthostatic hypotension risk)
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36
Q

This antipsychotic drug is most likely to cause agranulocytosis

A

Clozaril

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37
Q

A client taking Clozaril is complaining of a sore throat, mouth sores, an increased temperature, and flu-like symptoms. The nurse knows the patient is most likely experiencing…

A

Agranulocytosis

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38
Q

Nursing interventions for a patient who has developed agranulocytosis include…

A
  1. Check WBC
  2. Hold dose of Clozaril
  3. Notify healthcare provider
  4. Monitor patient for increased or worsening symptoms
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39
Q

How frequently are WBC checked in a patient taking Clozaril initially?

A

Weekly for 6 months

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40
Q

A patient taking antipsychotics begins to experience increased BP/P, lead pipe rigidity, a fever of 107, and confusion. The nurse know the patient is most likely showing signs of…

A

Neuroleptic Malignant Syndrome

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41
Q

Extrapyramidal Side Effects (EPS) include…

A
  1. Pseudoparkinsonism
  2. Akathesia (most common - ants in pants)
  3. Dystonia
  4. Tardive Dyskinesia (TD) -irreversible
  5. Bradykinesia
  6. Akinesia (no movement)
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42
Q

Treatment for EPS is…

A

Anticholinergics

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43
Q

Can anticholinergics be used for the treatment of TD?

A

NO! Will make it worse.

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44
Q

Anticholinergic ABC’s

A

A - Artane (trihexphenidyl)
B - Benadryl (diphenhydramine)
C - Cogentin (benzotropine)

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45
Q

Common anticholinergic side effects include…

A
  1. Blurred vision (can’t see)
  2. Urinary retention (can’t pee)
  3. Dry mouth (can’t drink)
  4. Constipation (can’t poop)
46
Q

Why is education regarding medication compliance so important?

A

Non-compliance is the #1 reason for hospital re-admissions!!

47
Q

Psychodynamic theory states that depression is…

A
  1. Anger turned inwards**
  2. Cognitive distortions
  3. Reaction to distressing experiences
48
Q

In order to be diagnosed with a major depressive disorder, the patient must experience at least 4 of what symptoms for 2 or more weeks, in addition to being sad and disinterested in activities?

A 
S - Sleep (insomnia)
I - Interest reduced
G - Guilt
E - Energy low
C - Concentration poor
A - Appetite either increased or decreased
P - Psychomotor retardation
S - Suicidality
49
Q

Resolution of symptoms of a major depression disorders is characterized by…

A

No more complaint of SIGECAPS symptoms (i.e. resolved insomnia, increased appetite)

50
Q

How does Psychotherapy work to treat major depressive disorders?

A
  1. Persistent negative thoughts are identified
  2. The thoughts are challenged
  3. Work to reframe the idea***
51
Q

Main nursing intervention for a patient with depression is…

A

Maintain safety! (15-30 minute checks, monitor for dangerous items)

52
Q

What occurs when a suicidally depressed patient starts to feel better?

A

They have enough energy to attempt suicide! (Continue to monitor for safety even if they state they are feeling better)

53
Q

Nursing interventions towards a depressed patients activity needs include…

A
  1. Promoting some type of movement
  2. Monitoring for psychomotor retardation
  3. Allowing more time to complete activities (they may resist self-care)
54
Q

A patient diagnosed with Bipolar Disorder will display signs of…

A 
D - Distractiblity
I - Irritability
G - Gradiosity
F - Flight of ideas
A - Activity increase
S - Sleep decreased
T - Talkative
55
Q

What will a person with Bipolar Disorder look like?

A
  1. Disruptive
  2. Invasive
  3. Hypermotor agitation
  4. Flight of ideas
  5. Pressured speech
  6. Illogical thinking
  7. Rapid-fire demands
  8. Confrontational
56
Q

Another term for hypermotor agitation is…

A

Hyperactive psychomotor activity

57
Q

Safety nursing interventions for a patient with Bipolar Disorder include…

A
  1. Decreased stimulation
  2. Shelter from embarrassment
  3. Intervene with “acting out” early on
  4. Frequent checks
  5. Stay calm
58
Q

What interventions should the nurse try first when promoting safety for a Bipolar client?

A

Least invasive first (verbal limit setting, environment manipulation, PRN meds if all else fails)

59
Q

Why are Bipolar clients less likely to comply with their medications?

A

They like the feeling of mania

60
Q

What types of foods are good for a Bipolar client in a manic phase?

A

High protein finger foods (banana, peanut butter sandwich)

61
Q

This mood disorder is characterized by two years of a depressed mood, but are STILL FUNCTIONAL

A

Dysthymia

62
Q

A client is considered at high risk suicide if which factors are present?

A
  1. Definite plan
  2. Time
  3. Place
  4. Means
  5. Rescue is unlikely
63
Q

The drug Luvox is used to treat what type of mood disorder?

A

OCD

64
Q

When switching from a 1st generation mood disorder drug to a 2nd generation mood disorder drug, there must be a…

A

Washout period

65
Q

The first choice of mood disorder antidepressants is….

A

Serotonin Reuptake Inhibitors (SSRI) - lower side effects and lower lethal potential

66
Q

An important piece of client education when starting on a SSRI is…

A

It may take up to 4 weeks for the drug to take full effect

67
Q 
Celexa (Citalopram)
Lexapro (escitalopram)
Luvox (Fluvoxamine)
Paxil (paroxetine)
Prozac (fluoxetine)
Zoloft (sertraline)
Viibryd (vilazodone)
A

SSRI Antidepressants

68
Q

Anticholinergic side effects include…

A

Impaired vision
Impaired urination
Dry mouth
Constipation

69
Q

This is caused by a rapid increase in serotonin and can begin hours to days after the initial dose of antidepressants

A

Serotonin Syndrome

70
Q

A patient who just started a new antidepressant is exhibiting increased pulse, increased BP, and increased temperature, changes in mental status, tremors, and muscle spams. What are they showing signs of?

A

Serotonin Syndrome

71
Q

Common side effects associated with the use of tricyclic antidepressants include…

A
  1. Anticholinergic SE
  2. Blurred vision (DO NOT use if pt has glaucoma)
  3. Cardiac arrythmias (need baseline EKG)
  4. Lethality in combination with alcohol and other drugs
72
Q

Nardil (phenelzine)
Parnate (trianyclcypramine)
Emsam Patch (selequiline)

A

MAOI Antidepressants

73
Q

In order to start a MAOI antidepressant, the patient must complete….

A

14 day washout period (NO drugs whatsoever)

74
Q

Side effects of MAOI’s include…

A
  1. Peripheral edema
  2. Muscle weakness
  3. Forgetfulness
  4. Hypertensive crisis
75
Q

Why do MAOI’s cause hypertensive crisis?

A

Block the breakdown of neurotransmitters that are vasoconstrictive. Cause a buildup that leads to hypertensive crisis.

76
Q

A client who is taking a MAOI that complains of headache, tachycardia, chest pain, nose bleeds, has flushed clammy skin, and dilated pupils is exhibiting symptoms of…

A

Hypertensive crisis

77
Q

What should the nurse do if she suspects a patient is in hypertensive crisis?

A
  1. Hold dose of medication
  2. Get vital signs
  3. Contact the MD IMMEDIATELY
78
Q

Patients taking MAOI’s should avoid…

A

Tyramine containing food (i.e. aged cheese, wine, yeast products, fava beans, organ meats, deli meats)

79
Q

A client taking a MAOI can take other antidepressants simultaneously. True or False?

A

FALSE! Same goes for OTC medications, diet medications, buspar, demerol, or stimulants

80
Q

Therapeutic range for lithium

A

0.6-1.2

81
Q

A normal workup before a patient begins taking lithium includes…

A
  1. Pregnancy test
  2. Thyroid function test
  3. Kidney function test
  4. EKG
82
Q

A patient taking lithium that is hypovolemic (excessive diarrhea, vomiting, perspiring) will have… lithium levels.

A

Increased

83
Q

A patient taking lithium that is hypervolemia (increased fluid intake) will have… lithium levels

A

Decreased

84
Q

Is a fine tremor an adverse effect of taking lithium?

A

No, only course tremor. Fine tremor should subside.

85
Q

Clients with what conditions should avoid taking lithium?

A

Cardiac and Kidney

86
Q

What type of client is prescribed anticonvulsant mood stabilizers?

A
  1. Rapid cyclers (4x/year)

2. Clients with renal or cardiac problems

87
Q

A major side effect of anticonvulsant therapy as a mood stabilizer is…

A

Steven-Johnson Syndrome

88
Q

Client teaching for a patient taking anticonvulsants as a mood stabilizer includes…

A
  1. The desired effects
  2. Side effects and how to control them
  3. Need for regular lab work
  4. Not to stop abruptly
  5. Not to double up on missed doses
  6. Avoid alcohol
89
Q

Set of patterns or traits that HINDER a person’s ability to interact and maintain meaningful relationships and that deviate from cultural expectations, leading to distress and impairment in functioning.

A

Personality disorders

90
Q

Traits of a personality disorder include…

A
  1. Behavior pattern deviates from cultural norms
  2. Use of ineffective coping mechanisms
  3. Inflexible and maladaptive approaches to relationships
  4. Rigid, stereotyped behavior patterns
  5. Stability is tenuous, fragile, and they lack resilience
91
Q

Odd/eccentric cluster of personality disorders that are more common in biological relatives of patients with schizophrenia

A

Cluster A

92
Q

Personality disorders under category of Cluster A

A
  1. Paranoid
  2. Schizoid
  3. Schizotypal
93
Q

Dramatic/emotional cluster of personality disorders that are correlated with mood disorders, alcoholism, and somatization

A

Cluster B

94
Q

Personality disorders under Category B

A
  1. Borderline
  2. Histrionic
  3. Narcissistic
  4. Antisocial
95
Q

Anxious/Fearful cluster of personality disorders that are correlated with high anxiety

A

Cluster C

96
Q

Personality disorders under Category C

A
  1. Avoidant
  2. Dependent
  3. Obsessive-Compulsive
97
Q

Common characteristics of a personality disorder include..

A
  1. Failure to accept the consequences of behavior
  2. Lack of insight
  3. External response to stress
  4. Significant impairment in fulfilling family, academic, employment and other functional roles
  5. Often have the ability to evoke interpersonal conflict
  6. Involve reliance on maladaptive coping skills
98
Q

A patient who is suspicious, preoccupied with doubts about loyalty, reluctant to confide in others, bears, grudges, and has recurrent suspicions regarding the fidelity of their spouse is displaying characteristics of what type of personality disorder?

A

Paranoid Personality Disorder (Cluster A)

99
Q

A patient who fails to conform to social norms/laws, is deceitful (lying and conning others), displays charming and witty characteristics, has a reckless disregard for others, is irresponsible with work and finances, and cannot maintain relationships is displaying characteristics of what type of personality disorder?

A

Antisocial Personality Disorder (Cluster B)

100
Q

A client who has unstable relationships starting in adulthood, is frantic to avoid real or imagined abandonment, has an unstable self-image, is impulsive, makes recurrent suicidal gestures/attempts, has extreme mood shifts, and had a dysfunctional childhood is displaying what type of personality disorder?

A

Borderline Personality Disorder (Cluster B)

101
Q

A client who is uncomfortable in situations where they are not the center of attention, has inappropriate sexual seduction interactions, has impressionistic speech and theatrically exaggerated expression of emotion, and considers relationships to be more intimate than they actually are is displaying what type of personality disorder?

A

Histrionic Personality Disorder (Cluster B)

102
Q

A patient who has a grandiose sense of self-importance, is preoccupied with fantasies of success, takes advantage of others for self-gain, requires excessive admiration, has a sense of entitlement, and believe that others are envious of them is displaying what type of personality disorder?

A

Narcissistic Personality Disorder (Cluster B)

103
Q

A client who has difficulty making everyday decisions, needs excessive amounts of advice and reassurance from others, has difficulty expressing disagreement and initiating projects, and goes to excessive lengths to obtain nurturing from others is displaying what type of personality disorder?

A

Dependent Personality Disorder (Cluster C)

104
Q

A client who is preoccupied with orderliness, has perfectionism that interferes with task completion, is excessively devoted to work and productivity, is inflexible and reluctant to delegate, and who is unable to discard worn out and worthless objects is displaying what type of personality disorder?

A

Obsessive Compulsive Personality Disorder (Cluster C)

105
Q

Nursing implications for a patient with a personality disorder

A
  1. Identify behavioral patterns as maladaptive symptoms (acknowledge patient will rely on these maladaptive coping mechanisms)
  2. Understand defense mechanisms (projective identification, repression/suppression, cutting)
106
Q

Why do people with personality disorders rely on cutting as a form of defense mechanism?

A

Relieves anxiety

107
Q

Why is limit setting an important nursing implication for a client utilizing manipulation?

A

Puts external controls into place while client develops internal controls

108
Q

Nursing interventions for a manipulative client include…

A
  1. Assign one primary staff member
  2. Maintain realistic, consistent, firm limits with enforceable consequences
  3. Give a rationale for limits and consequences
  4. Maintain consistency amongst staff
  5. Confront client each time manipulation occurs
109
Q

Intervention for a client with a personality disorder

A
  1. Understand own reactivity
  2. Consistent approach
  3. Structure environment
  4. Assist patient in recognizing negative effect/consequences of behavior and appropriate boundaries
  5. Firm assertive limits vs. authoritative punitive stance
  6. Encourage follow up on therapeutic modalities, constructive support
110
Q

Nursing diagnoses for clients with personality disorders

A
  1. Impaired social interaction
  2. Risk of self harm/self mutilation (especially with borderline)
  3. Self esteem disturbance
  4. As Evidenced By-Pattern of Maladaptive Behavior

Psych (3 decks)

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