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390 Cards in this Set

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What is stress? What general effects does it have on individuals?
Stress refers to both the causes and the consequences of disorder and disease in the body. Specific stress factors upset a person’s emotional and physiological homeostasis to some degree.
Describe the different forms and dimensions of stress and give examples of each.
Stress can be physical, physiological, or psychological in nature, and it can also have spiritual and cultural dimensions. Physical stressors include direct injury to the body and its organs; some examples are automobile accidents or ingestion of toxic substances. Physiological stressors include disease processes and infections. Psychological stressors are usually situational and/or relational in nature; some examples are diagnosis of a serious disease, financial or economic distress, or chronic illness of a loved one. Illness can also function as a cultural and spiritual stressor when it threatens a person’s established religious and societal value system or when the nature of a disease or disorder makes it difficult for a person to continue to carry out the practices of his or her faith.
What can be the end result when stress overwhelms a person’s normal ways of coping?
When stress overwhelms a person’s normal ways of coping, it can lead to a behavioral disorder or contribute to the development of a physical disorder.
What is the Social Readjustment Rating Scale and why is it used in nursing? Give several examples of items found on the scale.
The Social Readjustment Rating Scale is an assessment tool that helps determine the number of potentially stressful events that have occurred in a person’s life over the past year. This scale is useful to nurses because it can assist them in analyzing any experiences that may be detrimental to a patient’s emotional and physical health. Examples of items on the scale include divorce, the death of a spouse, a change in the health of a family member, marriage, and the birth of a baby.
What is behavior?
Behavior is synonymous with a person’s observable actions or reactions (both conscious and unconscious) to life stresses.
Identify six components of behavior that can be altered by stress.
Stress can change a person’s behavior by altering his or her perceptions of reality; perceptions of self; feelings and emotions; thought processes; language and communication; and interpersonal relationships.
What are the five major types of observable behavioral responses to life stresses that are amenable to some type of nursing and/or pharmacological intervention?
The five major types of observable behavioral responses are as follows:

* Affective responses and mood disorders

* Anxiety responses

* Responses associated with altered thought processes

* Aggressive and disruptive responses

* Maladaptive behavioral responses
What are the three primary categories of regulatory disorders?
The three categories of regulatory disorders are as follows:

* Disorders related to impaired adrenal and pituitary function

* Disorders related to impaired thyroid and parathyroid function

* Disorders related to impaired renal (kidney) function
What are the three primary categories of metabolic disorders?
The three categories of metabolic disorders are as follows:

* Disorders of the gallbladder

* Disorders of the pancreas

* Disorders of the liver
What is the difference between intrinsic and extrinsic influencing factors? How are these factors related to stress, disease, and nursing assessment?
Intrinsic factors belong to the essential nature of a person, while extrinsic factors originate from outside an individual. Both types of factors can influence a person’s behavioral and physiological responses to life stresses; some factors can make a person more susceptible to certain illnesses, while others can influence a person’s behavior and the course and outcome of various disease processes. Both intrinsic and extrinsic factors provide the basis for questions that help the nurse more fully explore and understand a patient’s risk for disease development and progression.
What are the major categories of intrinsic factors?
Categories of intrinsic factors include gender, age, genetic predisposition, developmental issues, personality characteristics, psychological variables, and physiological factors.
What are the major categories of extrinsic factors?
Categories of extrinsic factors include culture, ethnicity, and religion; interpersonal experiences; diet and exercise; environment; situational and socioeconomic variables; the presence of support systems; medication and substance abuse; and the use of alternative or complementary therapies.
Give an example of how being a teenage girl might affect the development of diseases and disorders.
Teenage girls are more prone to eating disorders than are teenage boys.
Give an example of how being female affects the development of diseases and disorders.
Females are more likely to develop certain diseases of the gallbladder and thyroid than are males of the same age.
Give an example of how being male affects the development of diseases and disorders.
Antisocial personality characteristics are more common in men than in women.
Give an example of how being elderly affects the development of diseases and disorders.
Aging can predispose people to certain diseases, including some conditions that contribute to memory loss or that affect various organs of the body such as the heart, lungs, and kidneys.
What are familial diseases? Why is it important to consider familial diseases when making a nursing assessment?
Familial diseases are diseases and disorders that appear to run in families because there is a genetic predisposition for their occurrence. A good nursing assessment includes a review of the patient’s family history in order to help determine the patient’s risk for acquiring a particular disease or disorder. With this information, the nurse can suggest possible preventative measures and assist patients in planning and choosing interventions that may improve their long-term health management.
What is the developmental process? How is this process related to dysfunctional behavior?
The developmental process is the sequence by which people acquire various physical, mental, and social skills and abilities. If physical, emotional, and/or social development is frustrated during a given stage of this process, dysfunctional behaviors may take root.
What are defense mechanisms? When can they be useful, and when they can they be harmful?
Defense mechanisms are psychological responses to life stresses that can help people both defend against and cope with the full impact of a crisis. When sustained over a long period of time, however, these emotions can impact the various systems of the body, thereby compromising organ function and increasing susceptibility to disease.
What are some physiological factors that can influence a person’s susceptibility to disease and response to stress?
Physiological changes such as those that occur with the onset of puberty, pregnancy, menopause, and aging can make people more susceptible to certain diseases and disorders and influence their responses to stress. Preexisting chronic illnesses can also affect both emotional and physiological responses to life stresses.
Describe at least one way in which culture, ethnicity, or religion can influence a person’s behavioral and physiological responses to stress.
Culture, ethnicity, and religion can influence both behavioral and physiological responses to life stresses in a variety of ways. For instance, cultural practices, preferences, restrictions, and taboos can influence a person’s diet and thus contribute to imbalanced nutrition; drug-food interactions may likewise occur in relation to these factors. Ethnicity also plays a part in some people’s responses to disease processes, as well as in their predisposition to certain diseases and disorders. Finally, religious beliefs about the meaning and causality of illness, pain, suffering, and healing can affect the treatment decisions that people make in response to behavioral disorders and physical illness. Such beliefs can even play a role in whether a person decides to seek treatment.
Why should nurses ask adult patients with behavioral disorders about their childhood experiences?
Many behavioral disorders have their roots in dysfunctional interpersonal relationships and experiences from childhood. Nurses should thus explore the relevancy of a patient’s past experiences to his or her present health conditions and stress responses, and they should make appropriate referrals to other health professionals when necessary.
Why is it important for the nurse to explore a patient’s diet history, especially if the patient is taking medications?
A patient’s diet history is important because eating patterns can have a profound effect on the development, course, and treatment of diseases and disorders. Nurses need to be aware of drug-food interactions and the normal dietary patterns of their patients in order to provide appropriate preventative teaching, especially when medications are prescribed.
Identify three specific types of environmental factors that may contribute to the development of behavioral, regulatory, and metabolic disorders.
choice of occupation,
sanitary conditions
location.
What are circadian rhythms and how are they related to stress?
Circadian rhythms are the behavioral or physiological patterns that are associated with the twenty-four-hour day. Humans have regular glandular and sleep rhythms that are based upon this concept of time; these rhythms can be disrupted by certain stressors and situations, such as occupations that require shift work.
Describe why support systems are valuable, and give three examples of support groups available for various populations.
Support systems are among the most important interventions for many behavioral and physiological disorders. In fact, people who have support systems may be less likely to engage in self-destructive behaviors. Three examples of support groups include Alcoholics Anonymous for chronic alcohol abusers, the National Alliance for the Mentally Ill for persons with behavioral disorders, and the American Association of Kidney Patients for individuals with renal disorders.
Why is it important for the nurse to ask a patient about his or her use of alternative or complementary therapies?
It is important for the nurse to make such inquiries because even though many alternative and complementary therapies can enhance health and well-being, others can cause harm, especially if a person fails to tell his or her physician about any natural or over-the-counter substances he or she is taking. In addition, many alternative therapies are highly controversial and might violate a patient’s belief system and prevent or delay needed treatment by established means.
Define “theory.” What is the relationship of theory to research?
A theory is a statement that attempts to explain all the available evidence that relates to a given topic. Theories can be broad and all-encompassing or highly specific to a certain subject or occurrence. Most theories are derived from past research, and many are used to generate new research.
What are the two primary categories of theories that help explain variations in behavioral, metabolic, and regulatory responses?
The two primary categories of theories that help explain these variations are biological theories and psychosocial theories.
What is genetics? How does genetic theory relate to behavioral and physiological responses?
Genetics is the study of heredity. Genetic theory states that diseases with familial patterns of inheritance can be explained by mutations in the genetic code.
What are hormones? What is their relationship to stress?
Hormones are substances that are formed in one organ or gland of the body and then carried by the blood to other organs or glands where they exert a specific effect. Secretion of many hormones seems to be affected by stress; changes in hormone levels in turn appear to contribute to symptoms associated with various behavioral, regulatory, and metabolic disorders.
What are some types of structural changes within the brain that can be seen by diagnostic imaging techniques?
Diagnostic imaging techniques can reveal structural changes such as reduced blood flow, decreased brain activity, brain atrophy, and enlarged ventricles.
What are neurotransmitters? What is their relationship to behavioral disorders and medications?
Neurotransmitters are chemical substances that are secreted by neurons. They are responsible for cell-to-cell message transmission in the central nervous system. If a person has too much or too little of a specific neurotransmitter, abnormal behavior or disease may occur. Thus, numerous medications are given to either block or enhance neurotransmitter activity. In addition, many of the untoward side effects of other medications used in the treatment of behavioral disorders are also related to neurotransmitter imbalance.
What are histamines? What effect do they have on the body?
Histamines are neuropeptides that affect the heart and muscles in similar ways as neurotransmitters. Histamines also enhance mental alertness. When released from tissue in allergic reactions, histamines can additionally dilate blood vessels, lower blood pressure, and stimulate gastric secretion.
What are antihistamines?
Antihistamines are synthetic drugs that block the action of histamines. They are also sometimes given to counter the side effects of certain medications used in the treatment of behavioral disorders.
Discuss the characteristics and effects of gamma-aminobutyric acid (GABA).
Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter that affects anxiety, seizures, and aggression; decreased GABA levels may increase any of these behaviors.
Discuss the characteristics and effects of serotonin.
Serotonin is a catecholamine neurotransmitter that plays a part in sleep-wake cycles and affective and anxiety-related mood disorders. Decreased levels of serotonin are related to depression, while increased levels are believed to elevate mood. It exerts marked effects on metabolism.
Discuss the characteristics and effects of norepinephrine.
Norepinephrine is a catecholamine neurotransmitter produced in the brain. It appears to be involved in the development of affective behavioral disorders and can trigger an increase in blood pressure. Like serotonin, it exerts marked effects on metabolism.
Discuss the characteristics and effects of dopamine.
Dopamine is a catecholamine neurotransmitter that is involved in various behavioral disorders and diseases involving abnormal movement;

it also acts in the parts of the brain responsible for thoughts and emotions. \

Dopamine additionally stimulates the hypothalamus to release reproductive hormones such as estrogen and progesterone.
Discuss the characteristics and effects of acetylcholine.
Acetylcholine is a cholinergic neurotransmitter that usually is decreased or absent in people with various thought disorders that involve memory loss, including Alzheimer’s dementia. Acetylcholine also contributes to normal motor function.
Why is it important for nurses to understand the various psychosocial theories?
Nurses should understand the various psychosocial theories because they are the basis for many interventions for behavioral disorders. Some of these theories are also useful when caring for patients with regulatory and metabolic disorders.
Briefly describe the theory of personality developed by Sigmund Freud.
Freud’s psychoanalytic theory of personality is based upon the existence of three psychic structures: the id, which operates in accordance with the pleasure principle; the superego, which embodies values, ethical decision making, and standards of morality; and the ego, which operates at the conscious level and mediates between the id and the superego. According to Freud, a person’s behavioral responses become abnormal when there is imbalance among these three aspects of personality. Psychoanalytic theory also focuses upon the use of defense mechanisms, specifically projection, repression, and denial.
What defense mechanism is most likely operating in a patient who is blocking a painful memory?
Repression is the blocking or submersion of memories or impulses into the unconscious parts of one’s personality. By repressing the remembrance of unpleasant events or relationships, people attempt to protect themselves against psychic pain.
What defense mechanism is most likely to operate in a patient experiencing guilt over having an affair?
Projection occurs when a person has an unpleasant emotion or experience and attempts to redirect that emotion by attributing it to other individuals. All variety of feelings, ideas, and impulses, especially undesirable ones that may cause shame or anxiety, can be projected.
What defense mechanism is most likely to operate in a patient who is experiencing the sudden death of a child?
Denial is the refusal to accept the reality of an actual situation. Denial is considered a normal initial response to situations like the sudden death of a loved one or the diagnosis of a serious illness.
What is the primary therapeutic intervention associated with psychoanalytic theory? What are its underlying assumptions and primary purpose?
The primary therapeutic intervention associated with psychoanalytic theory is psychoanalysis. Psychoanalysis is rooted in the belief that various mood disturbances and personality disorders are caused by the repression of unpleasant experiences from one’s past. Thus, the primary purpose of psychoanalysis is to help a person bring his or her repressed memories into the conscious mind so they can be dealt with therapeutically.
What basic assumptions serve as the foundation for Erikson’s theory of development?
Erikson’s theory includes eight different stages of human development. It assumes that each stage is characterized by conflict between a specific developmental task and a threat to the individual ego. This conflict must be resolved in order for a person to mature and move on to the next developmental level. If the conflict is not resolved, the person may not fully mature.
According to Erikson’s theory, the identity vs. role confusion stage is characteristic of which age range?
13–18 years
According to Erikson’s theory, the generativity vs. self-absorption stage is characteristic of which age range?
Middle age
According to Erikson’s theory, the initiative vs. guilt stage is characteristic of which age range?
4–5 years
According to Erikson’s theory, the ego integrity vs. despair stage is characteristic of which age range?
Old age
According to Erikson’s theory, the trust vs. mistrust stage is characteristic of which age range?
Birth to 1 year
According to Erikson’s theory, the intimacy vs. isolation stage is characteristic of which age range?
Young Adult
According to Erikson’s theory, the autonomy vs. shame and doubt stage is characteristic of which age range?
2-3 Years
According to Erikson’s theory, the industry vs. inferiority stage is characteristic of which age range?
6-12 Years
What specific needs are associated with each level of Maslow’s hierarchy? How is the consideration of these needs useful in the nursing process?
The foundation of Maslow’s hierarchy consists of basic physiological needs. The second level contains safety and security needs; the third level, love and belonging needs; the fourth level, the need for self-esteem; and the fifth level, the need for self-actualization. This hierarchy outlines the order in which patient needs should be addressed; thus, it is useful when setting nursing priorities.
Describe Sullivan’s understanding of personality and behavior. According to Sullivan, what are the two primary human needs?
According to Sullivan, people strive for only two primary things: satisfaction and security. Satisfaction needs are met through the fulfillment of the basic human requirements for rest, nourishment, sexual gratification, and close relationships with others; security needs are met when a person feels cared for and loved by other people. Given this scenario, personality is determined in the context of meaningful interpersonal relationships, and all behaviors are observable because they are interpersonal in nature.
What did Sullivan believe was one of the most observable manifestations of behavioral disorders? Describe this manifestation.
Sullivan believed that one of the most observable manifestations of behavioral disorders is a defense mechanism called dissociation. Dissociation is related to but not the same as denial; it occurs when a person, often a child, separates some past experience from his or her conscious awareness because of an inability to openly cope with the reality of that experience.
Who developed the social-interpersonal theory of nursing? What are the focus and goal of this theory?
The social-interpersonal theory of nursing was developed by Hildegard Peplau. This theory’s focus is the social and interpersonal process of the nurse-patient relationship, and its primary goal is to resolve the health difficulties of the patient.
Define “crisis.” What is the goal of crisis theory? Who developed it?
A crisis is an upset in the steady state of a person when faced with an obstacle to desired goals in his or her life. The goal of crisis theory is to confront and cope with the anxiety associated with various crises so that this anxiety does not become dysfunctional. This theory was developed by Gerald Caplan.
What is the nursing process? What is its primary purpose?
The nursing process is an ongoing and systematic cycle of sequential steps that include assessment, analysis (diagnosis), planning, implementation, and evaluation. The purpose of the nursing process is to attain expected outcomes or patient-centered goals for physical and psychosocial health restoration, health maintenance, and health promotion.
Compare and contrast subjective and objective data.
Subjective data is data that the patient provides with regard to his or her beliefs, values, preferences, feelings, and personal perspectives on health. Objective data, on the other hand, is any data that the nurse can obtain through the use of the five senses or through laboratory and diagnostic reports.
What is a nursing diagnosis? What three things does a nursing diagnosis include?
A nursing diagnosis is a brief statement that identifies an existing patient-centered problem or a potential problem for which a patient is at risk. In most cases, a nursing diagnosis will include three elements: an actual or potential problem, the etiology of that problem, and the defining characteristics of the problem as determined from the various subjective and objective assessments made by the nurse.
How do nursing diagnoses differ from medical diagnoses?
they are specifically related to concerns that are amenable to some sort of nursing action or treatment.
Which step in the nursing process requires use of the senses to collect data?



A. Assessment

B. Analysis/diagnosis

C. Planning

D. Implementation

E. Evaluation
Assessment
Which step in the nursing process involves referring the patient to a home-care agency, if appropriate?

A. Assessment

B. Analysis/diagnosis

C. Planning

D. Implementation

E. Evaluation
Implementation
Which step in the nursing process involves synthesizing objective and subjective data?


A. Assessment

B. Analysis/diagnosis

C. Planning

D. Implementation

E. Evaluation
Analysis/diagnosis
Which step in the nursing process involves determining the urgency of patient needs?

A. Assessment

B. Analysis/diagnosis

C. Planning

D. Implementation
Analysis/diagnosis
Which step in the nursing process would include administering hypertensive medication?

A. Assessment

B. Analysis/diagnosis

C. Planning

D. Implementation

E. Evaluation
Implementation
Which step in the nursing process involves determining expected outcomes or goals?

A. Assessment

B. Analysis/diagnosis

C. Planning

D. Implementation

E. Evaluation
Planning
Which step in the nursing process involves reviewing the patient’s chart for health information?


A. Assessment

B. Analysis/diagnosis

C. Planning

D. Implementation

E. Evaluation
Assessment
Which step in the nursing process includes assigning care activities to members of the health care team?

A. Assessment

B. Analysis/diagnosis

C. Planning

D. Implementation

E. Evaluation
Planning
Nursing actions are completed in which stage of the nursing process?

A. Assessment

B. Analysis/diagnosis

C. Planning

D. Implementation

E. Evaluation
Implementation
Which step in the nursing process involves assessing the patient’s response to care provided?

A. Assessment

B. Analysis/diagnosis

C. Planning

D. Implementation

E. Evaluation
Evaluation
What are affective responses?
Affective responses make up one of the primary categories of behavioral responses to life stresses.

Affective responses are characterized by disturbances in emotions or mood.
Which type of crisis concerns a stressful life event that isn’t planned but that most people experience at some point?


A. Adventitious

B. Maturational

C. Situational
Situational
Which type of crisis concerns a stressful life event that is rare, unplanned, and unexpected?

A. Adventitious

B. Maturational

C. Situational
Adventitious
Which type of crisis concerns a stressful life event that is considered a developmental milestone?

A. Adventitious

B. Maturational

C. Situational
Maturational
How does bereavement differ from mourning?
Bereavement is the experience of dealing with the loss of a loved one.

Mourning, on the other hand, refers to the cultural patterns displayed in response to grief and bereavement.
List the sequence of emotions in the grief cycle in their usual order of occurrence.

DABDA
denial, anger, bargaining, depression, and acceptance.
DABDA
What are some somatic symptoms that may be associated with the grief cycle?
Somatic or physiological symptoms often associated with the grief cycle include sensations of numbness or hollowness, sighing, hyperventilation, anorexia or overeating, insomnia or excess sleeping, a lump in the throat, crying, and fatigue.
During what stage of the grief cycle is guilt most likely to occur? Why?
guilt feelings can occur during any stage of the grief cycle, they are usually most marked when a person is experiencing depression. Individuals are likely to experience guilt at this stage because of a belief that they either did something to cause the loss or neglected to do something to prevent it.
What are some common precipitating causes of depressive responses?
Common precipitating causes of depressive responses include situational crises, long-term illness of self or significant others, and other behavioral disorders that affect the mind.
What neurotransmitters appear to play a role in depressive responses?
Two catecholamine neurotransmitters, norepinephrine and serotonin, are believed to be present in abnormally low levels in people with depressive mood disorders. Acetylcholine, a cholinergic neurotransmitter, may also be deficient in such individuals.
What hormone appears to be present in high levels in people experiencing depressive responses? How can its presence be evaluated?
Cortisol levels may be elevated in people who are experiencing depressive responses. Cortisol is a hormone secreted by the cortex of the adrenal gland and involved in protein and carbohydrate metabolism; as a glucocorticoid hormone, it also helps protect the body against stress when present in normal amounts. An assessment known as the dexamethasone suppression test can help measure cortisol response in people with major psychotic depression.
What is psychomotor retardation? How is it usually exhibited in people with depression?
Psychomotor retardation is a general slowing of both physical and mental reactions. Two examples of psychomotor retardation associated with depression include fatigue and decreased ability to concentrate.
Compare and contrast dysthymic disorder with major depressive disorder in terms of defining characteristics.
characteristics of dysthymic disorder are guilt and depression that a person may unconsciously use to help alleviate anxiety. Other defining characteristics of this condition include fatigue, anorexia or increased appetite, difficulty concentrating, insomnia or hypersomnia, impaired decision-making ability, low self-esteem, and feelings of hopelessness and helplessness. The type of depression associated with dysthymic disorder is generally present at least 50 percent of the time, and it extends over a two-year period for adults and a one-year period for children and adolescents. Dysthymic disorder is usually not severe enough to disrupt normal activities of daily living or the ability to work and relate to others.

For persons with major depressive disorder, the symptoms of depression that characterize dysthymic disorder are present but decidedly more intense. Major depressive disorder may also feature an inability to take pleasure in normally pleasurable things (anhedonia) and either anorexia with significant weight loss or hyperorexia with significant weight gain. A person with major depressive disorder may additionally have feelings of helplessness and hopelessness that are accompanied by thoughts of death and suicidal ideation. Some cases of major depressive disorder, especially those with delusions and hallucinations, may require hospitalization for treatment.
Describe the etiology and symptoms associated with seasonal affective disorder and postpartum depression.
Seasonal affective disorder (SAD) is a depressive mood fluctuation that usually occurs in the winter months. It is more common in women than in men, and it appears to have a strong physiological basis. One major contributing factor for SAD is believed to be abnormal serotonin transmission in the brain. Serotonin plays a part in sleep-wake cycles and mood regulation. Excess serotonin is believed to result in extreme drowsiness, while serotonin deficiency seems to produce abnormal states of wakefulness. Weight gain is also a common symptom of SAD, and it can exacerbate a person’s depression.

Postpartum depression occurs in some women following the birth of an infant; it is most often seen in first-time mothers. This form of depression may begin immediately following childbirth and continue for weeks or months, or symptoms may suddenly appear one or more months after delivery. The primary feeling experienced by women with postpartum depression is an inability to cope with the care of the infant; this is usually accompanied by feelings of hopelessness and helplessness. An affected mother may also feel extremely anxious about the health of her infant. She may believe that she is not caring for the child appropriately and thereby experience guilt and irrational fear. Other physiological symptoms of this condition include insomnia, fatigue, and tearfulness.
What should the nurse consider to be the greatest risk in a patient with depression? Why?
The greatest risk for a person with depression is suicide. Suicidal ideation is generally a result of the hopelessness, low self-esteem, guilt, and social isolation associated with depressive mood disorders.
Name and define the two symptoms that are consistent with psychotic forms of depression.
Delusions and hallucinations are the two symptoms that are consistent with psychotic forms of major depression. Delusions are false and generally persistent or fixed beliefs or feelings that a person holds in the face of all evidence to the contrary. Hallucinations are apparent perceptions of sights and/or sounds that are not present in reality. Hallucinations may also be associated with the senses of touch and smell.
What is the primary nursing concern for a woman with postpartum depression?
When addressing postpartum depression, the safety of both of the mother and the infant is of primary concern, as women with this condition sometimes have suicidal thoughts and/or an urge to harm their infants.
What is a bipolar response?
a condition in which a person’s mood alternates or swings widely between manic or hypomanic states and varying degrees of depression. Between these periods, affected individuals will usually experience a stable mood.
What symptoms of mania are characteristic of bipolar disorder?
• Elation

• Euphoria

• Irritability

• Loud speech with rapid and sometimes rhyming word patterns

• Flight of ideas

• Psychomotor hyperactivity (e.g., pacing, wringing one’s hands)

• Impaired judgment

• Delusions of grandeur

• Weight loss and fatigue
What are some possible factors that contribute to the development of bipolar disorder? At what age does this disorder normally become evident?
It is believed that bipolar disorder is the result of genetic predisposition as well as neurotransmitter imbalance within the brain. Norepinephrine excess has been shown to contribute to hyperexcitability and manic behavior, while norepinephrine deficiency is believed to play a role in depressive behavior. Onset of bipolar disorder usually occurs before the age of thirty.
What is cyclothymia? How does it differ from bipolar disorder?
Cyclothymia is a chronic mood disorder characterized by both depressive and manic states that alternate for a period of two or more years and are separated by brief periods of normal mood. The states of mania and depression associated with cyclothymia are much milder than those seen in bipolar disorder.
What is anxiety, and what is its relationship to behavioral disorders?
Anxiety is a feeling or state of uneasiness, apprehension, or dread

anxiety can interfere with normal activities of daily living and impact an individual’s ability to work and relate to other people.
Describe the relationship between anxiety and the autonomic nervous system.
Anxiety is generally accompanied by one or more autonomic responses that are collectively known as the fight-or-flight response. These include increased heart and breathing rates, elevated blood pressure, increased gastric motility, activation of the endocrine system, and the release of neurotransmitters.
What neurotransmitters are thought to play a role in anxiety?
Gamma-aminobutyric acid (GABA) and norepinephrine are thought to play a role in anxiety, because decreased GABA levels and increased norepinephrine levels are usually present in people who are experiencing this condition. Epinephrine (adrenaline) is another catecholamine neurotransmitter that can trigger anxiety and fear.
What are some possible long-term physiological effects of anxiety?
Chronic or recurring anxiety can result in physiological effects including stress hypertension, cardiovascular disease, and gastric ulcers.
What are the three major categories of anxiety disorders?
responsive anxiety disorders
dissociative anxiety disorders
somatoform anxiety disorders.
Compare and contrast obsessions and compulsions.
An obsession is a persistent and recurring idea or thought that does not disappear with any amount of reasoning. A compulsion, on the other hand, is an irresistible and irrational impulse to act on a thought or idea.
During assessment, a client reports having repetitive thought patterns and depression related to the disruption of his activities. When prompted by the nurse to discuss some of these activities, the client describes behaviors that he engages in ritualistically for at least an hour of time each day. This is most characteristic of which of the following disorders?


A. Generalized anxiety disorder

B. Post-traumatic stress disorder

C. Panic disorder

D. Obsessive-compulsive disorder

E. Agoraphobia

F. Social phobia
Obsessive-compulsive disorder
A patient reports over six months of restlessness, irritability, and muscle tension along with a history of a rigidly controlled environment. This is most characteristic of which of the following disorders?

A. Generalized anxiety disorder

B. Post-traumatic stress disorder

C. Panic disorder

D. Obsessive-compulsive disorder

E. Agoraphobia

F. Social phobia
Generalized anxiety disorder
A client reports having experienced several sudden, short-lived attacks of anxiety. During the attacks, the client experienced a numbness in the extremities and recalls a feeling of impending doom, “like I was losing control.” This is most characteristic of which of the following disorders?


A. Generalized anxiety disorder

B. Post-traumatic stress disorder

C. Panic disorder

D. Obsessive-compulsive disorder

E. Agoraphobia

F. Social phobia
Panic disorder
A victim of a natural disaster reports problems sleeping because of nightmares. The patient describes having relived parts of the disaster during these nightmares as well as during waking hours. This is most characteristic of which of the following disorders?

A. Generalized anxiety disorder

B. Post-traumatic stress disorder

C. Panic disorder

D. Obsessive-compulsive disorder

E. Agoraphobia

F. Social phobia
Post-traumatic stress disorder
A patient reports feeling extreme anxiety in social situations at work. The patient describes feeling dizzy, feverish, and out of breath upon being asked to deliver a presentation to coworkers; when prompted by the nurse, the patient recalls having worried about being humiliated. This is most characteristic of which of the following disorders?

A. Generalized anxiety disorder

B. Post-traumatic stress disorder

C. Panic disorder

D. Obsessive-compulsive disorder

E. Agoraphobia

F. Social phobia
Social phobia
A client reports having experienced chest pains and feelings of suffocation upon walking through the subway alone. The client expresses a deep desire to avoid the subway terminal and other areas where public transportation is used. This is most characteristic of which of the following disorders?

A. Generalized anxiety disorder

B. Post-traumatic stress disorder

C. Panic disorder

D. Obsessive-compulsive disorder

E. Agoraphobia
Agoraphobia
What feelings and behaviors characterize dissociative anxiety disorders? What are four subcategories of DADs?
People with dissociative anxiety disorders experience a breaking away or disordering of thought processes with a concurrent disruption in consciousness. With these disorders, perceptions of oneself and one’s environment can be markedly disturbed. Four subcategories of DADs are

dissociative identity disorder
dissociative amnesia
depersonalization disorder
dissociative fugue.
What is the purpose of an alter in dissociative identity disorder? How can alters manifest themselves?
The purpose of an alter is to protect a person’s true personality from further trauma. Whenever the true personality of an individual with DID is confronted with a stressful situation, an alter can emerge to deal with the problem and any associated anxiety. Typical behaviors associated with various alters might include having different voices, names, and even sexual orientations.
What is dissociative amnesia?
Dissociative amnesia is a specific type of amnesia characterized by an inability to recall important facts and information about the self, including one’s own name as well as any personal information that may be stressful in nature. Loss of memory associated with this disorder may be total or partial and is often precipitated by severe emotional shock.
What are somatoform anxiety disorders?
Somatoform anxiety disorders are anxiety responses that are inextricably related to the physical body. These disorders may feature actual physical symptoms of specific disease processes, but they are believed to be related to psychological factors.
Which of the following somatoform disorders may be suspected in an individual who presents with complaints of pain that have no physiological explanation?

A. Conversion disorder

B. Hypochondriasis

C. Somatization disorder

D. Pain disorder

E. Body dysmorphic disorder
Pain disorder
Which of the following somatoform disorders may be suspected in an individual who displays a persistent belief of having a serious illness despite the absence of any specific physiological symptoms?

A. Conversion disorder

B. Hypochondriasis

C. Somatization disorder

D. Pain disorder

E. Body dysmorphic disorder
Hypochondriasis
Which of the following somatoform disorders may be suspected in an individual who displays a persistent belief of having a serious illness despite the absence of any specific physiological symptoms?

A. Conversion disorder

B. Hypochondriasis

C. Somatization disorder

D. Pain disorder

E. Body dysmorphic disorder
Conversion disorder
Which of the following somatoform disorders may be suspected in an individual who manifests extreme preoccupation with his or her physical appearance, going so far as to camouflage a perceived defect?

A. Conversion disorder

B. Hypochondriasis

C. Somatization disorder

D. Pain disorder

E. Body dysmorphic disorder
Body dysmorphic disorder
Which of the following somatoform disorders may be suspected in an individual who, in spite of many tests to the contrary, continues to report unbearable pain in a particular body system?

A. Conversion disorder

B. Hypochondriasis

C. Somatization disorder

D. Pain disorder

E. Body dysmorphic disorder
Somatization disorder
What is a risk factor for somatoform anxiety disorders?
One risk factor for the development of somatoform anxiety disorders appears to be childhood situations in which emotions were not encouraged or acknowledged; adults who experienced such situations in their youth often develop or at least complain of physical symptoms in an unconscious attempt to seek attention.
What is “la belle indifférence”?
an attitude that is characteristic of people with conversion disorder. A person with this attitude is rarely anxious about the physiological symptoms of conversion disorder and generally appears emotionally detached from them.
What is the chief defining characteristic of the responses associated with altered thought processes?`
some degree of withdrawal from reality.
What are command hallucinations?
hearing voices that order them to take their own lives or harm other individuals.
What is the chief defining characteristic of paranoid behavior?
irrational suspicion or persistent belief that one is being persecuted or falsely accused by others.
Define “autism.” What are the primary symptoms of autism?
characterized by self-absorption and withdrawal from social interaction

impaired language and interpersonal communication skills; limited or repetitive behavior; rage if play or repetitive activities are interrupted; and referring to oneself in the third person. Autistic adults may also experience withdrawal from reality, delusions, daydreaming, hallucinations, and use of neologisms.
What is schizophrenia? What are some influencing factors and theories of causation associated with this disorder?
mental disorder characterized by a separation between one’s emotions and one’s thought processes

frequent relapses

specific causes of this condition are unknown

Physical changes associated with schizophrenia include enlarged brain ventricles, atrophy of the cerebellum, and the presence of excessive amounts of dopamine.
List some positive and negative symptoms that might be observed in patients with schizophrenia.
Common positive symptoms of schizophrenia include delusions, hallucinations, disorganized thought, incoherent speech, paranoia, odd or bizarre behaviors, and inappropriate affect.

Negative symptoms include flat affect, alogia, lack of close relationships, short attention span, poor grooming, anhedonia, avolition, depression, and general difficulty in carrying out routine activities of daily living.
Differentiate between echopraxia and echolalia.
Echopraxia is the repeating and imitating of motions made by others.

Echolalia involves the involuntary repetition of words and phrases spoken by others.
clang association
nonsensical rhyming of words
Differentiate between mutism and alogia.
Mutism is the inability to speak associated with catatonic schizophrenia, while alogia is a poverty of speech.
Define “avolition.”
lack of motivation
Compare and contrast the symptoms of a patient with catatonic schizophrenia with those of a patient with paranoid schizophrenia.
A patient with catatonic schizophrenia may exhibit increased psychomotor retardation or increased psychomotor activity, as well as echopraxia, echolalia, clang association, and mutism. On the other hand, a patient with paranoid schizophrenia may exhibit auditory hallucinations, delusions of persecution, extreme and irrational suspicions, argumentativeness, and use of projection.
Define “delirium” and identify some possible causative factors.
Delirium is an acute and usually reversible alteration of consciousness, cognition, and/or perception that occurs in response to stress, physical injury, or some other precipitating condition. Common causative factors include brain injury or illness, cerebrovascular accidents, high fever, medication buildup, alcohol and drug abuse and withdrawal, and various disorders that cause metabolic or electrolyte imbalance.
Describe the effects of delirium on the central nervous system.
Delirium may result in confusion, agitation, insomnia, restlessness, hallucinations, delusions, illusions, short- and/or long-term memory loss, varied levels of consciousness (especially during nights and early mornings), altered perception, and disorientation to time, place, and person.
Describe the effects of delirium on language.
individuals with delirium may slur their speech and have difficulty forming words.
Describe the effects of delirium on the cardiac system.
irregular heart rate.
Describe the effects of delirium on the respiratory system.
depressed respiration's.
Describe the effects of delirium on motor function.
difficulty in maintaining balance. Tremors of the limbs are also symptomatic of delirium.
Describe the effects of delirium on the urinary system.
urinary incontinency.
What is one of the most widely used mental status exams in dementia assessment? What does it assess?
Folstein Mini Mental Status Exam

This test assesses word memory and recall; orientation to time and place; attention and ability to calculate; language and object recognition; and reading and writing ability.
What are two types of brain scans used to diagnose and rule out dementia?
magnetic resonance imaging (MRI) and computed axial tomography (CAT) scans.
Describe the identifying characteristics, causative factors, and symptoms of dementia of the Alzheimer’s type (DAT).
Dementia of the Alzheimer’s type (DAT) accounts for 60 percent of all dementias. Some forms of DAT (but not all) are familial, suggesting that genetics play a part in some cases. Prior history of head injury may also play a part.

In DAT, the brain cells undergo distinct pathological changes that contribute to the basic symptoms of dementia. These changes include brain atrophy and the formation of senile neuritic plaques and neurofibrillary tangles that destroy nerve cells. These formations are also apparent in older individuals with Down’s syndrome.

The hippocampus, the area of the brain responsible for short-term memory and new memory establishment, is the primary area of involvement. In the initial stage, therefore, the disorder features short-term memory loss. In stage II, sundowning is a common symptom. In late stages, seizure activity may occur.
Describe the identifying characteristics, causative factors, symptoms, and treatment of vascular dementia.
Vascular dementia, also known as multi-infarct dementia, is the second most common type of chronic dementia. It is caused by multiple stroke activity in relation to an atherosclerotic process that narrows the arteries that feed brain cells. Risk factors for vascular dementia include hypertension and diabetes.

The symptoms of vascular dementia appear suddenly and progress in steplike fashion. People with vascular dementia may experience periods of confusion interspersed with periods called plateaus, in which no perceptible change in memory or behavior occurs. Individuals with this type of dementia may also exhibit specific local or focal neurological impairment related to particular areas of brain involvement. Such impediments may include slurred speech or muscle weakness.

Symptoms and progression may be prevented by medications that thin the blood. For this reason, acetylsalicylic acid (aspirin) is often used in treatment due to its anticoagulant properties.
Describe the identifying characteristics, causative factors, symptoms, and diagnosis of AIDS dementia complex (ADC).
It is caused by the infection of macrophages and the release of cytokines in the brain. Cytokines disrupt the transmission of neurotransmitters, thereby causing encephalopathy.

AIDS dementia complex progresses gradually, beginning with a decrease in the ability to concentrate. Lethargy is also often present. Other more advanced symptoms of ADC include ataxia, incontinency of the bowel and bladder, and seizure.

Diagnosis of ADC is made through observable symptoms and through the measurement of circulating levels of HIV reverse transcriptase. This enzyme is found in the cerebrospinal fluid; the higher the level of HIV reverse transcriptase in this fluid, the more profound the dementia.
Describe the identifying characteristics, causative factors, and symptoms of Wernicke-Korsakoff syndrome.
Wernicke-Korsakoff syndrome is a dementing brain encephalopathy that is associated with chronic alcoholism. This syndrome is related to a deficiency of thiamine secondary to malnutrition and malabsorption. Symptoms of thiamine deficiency include fatigue, irritability, nystagmus, ptosis, muscle tenderness, and anorexia.
Ptosis is also called
"drooping eyelid"
Describe the identifying characteristics, causative factors, and symptoms of Huntington’s chorea.
Huntington’s chorea is a rare hereditary dementia. It is characterized by involuntary writhing or dance-like movements of the face and upper extremities.

Genetic research has linked the disorder to a gene on the fourth chromosome that appears to bring about pathological changes in the brain, including marked atrophy of portions of the cerebral cortex and basal ganglia, extensive nerve cell loss, and a decrease in the presence of white matter.
Differentiate between aphasia, anomia, agnosia, apraxia, and ataxia.
Aphasia is an inability to produce or understand language.

Anomia is an inability to remember the names of objects.

Agnosia is the failure to recognize or identify certain objects.

Apraxia is the inability to perform learned motor activities even though no neuromuscular deficiencies exist.

Ataxia is a lack of muscle coordination.
Define “sundowning.”
display of agitation, wandering, and restlessness when the sun begins to set.
Describe catastrophic reactions.
extreme emotional outbursts often precipitated by multiple stimuli.
Define “infarcts.”
infarcts are areas of tissue necrosis.
Differentiate between macrophages and cytokines.
Macrophages are white blood cells that have moved from the circulatory system into the brain tissue. Cytokines are proteins produced by white blood cells that disrupt the transmission of neurotransmitters like acetylcholine.
Differentiate between pill rolling and festination.
Pill rolling is a nonintentional rolling of the thumb against the fingers; festination is a shuffling gait marked by involuntary acceleration. Both are characteristic of Parkinson’s disease.
What are the symptoms of thiamine deficiency?
fatigue, irritability, nystagmus, ptosis, muscle tenderness, and anorexia.
What is Parkinson’s disease and what neurotransmitters are associated with it?
a progressive degenerative disorder that involves nerve cell destruction in the basal ganglia of the brain. This disease is also characterized by an imbalance in the neurotransmitters acetylcholine and dopamine.
Describe the appearance and mood of a patient with Parkinson’s disease.
muscle rigidity in the hands and generalized hand tremors with pill rolling; they may also have nonintentional tremors that cease once purposeful movement begins

The facial expression of people with advanced Parkinson’s appears masklike and may feature an absence of the blink reflex. As the disease progresses, drooling can occur in relation to an inability to swallow saliva. The posture of patients with Parkinson’s is stooped, and their gait is shuffling and marked by festination and loss of balance as they lean forward. In addition to these physical symptoms, people with Parkinson’s disease also tend to experience depression and emotional liability.
Retrograde amnesia is an inability to transfer memories from short- to long-term memory.

True or False
False

Retrograde amnesia is amnesia for events occurring prior to the episode precipitating the disorder.
Transient global amnesia is a loss of both declarative and procedural memory.


True or False
False

TGA is an anxiety-producing temporary loss of the ability to form new long-term memories that by definition resolves within 24 hours and most commonly affects the middle-aged or elderly
Anterograde amnesia is an inability to recall events that occurred before the onset of amnesia.


True or False
False

Anterograde amnesia is a form of amnesia where new events are not transferred to long-term memory, so the sufferer will not be able to remember anything that occurs after the onset of this type of amnesia for more than a few moments.
Traumatic amnesia is the amnesia that occurs after a head injury.


True or False
True
What are the two primary categories of aggressive responses?
self-destructive behaviors and aggressive behaviors directed at other people.
What are the four types of self-destructive behavior?
suicide, substance abuse, eating disorders, and self-mutilation
What types of people are most at risk for suicide?
people with undiagnosed and/or untreated mood disorders; people with a family history of mood disorders; people who suffer from depression; people with schizophrenia; alcohol and drug abusers; isolated elderly individuals (especially men); people who are chronically or terminally ill; and people who are either experiencing or anticipating uncontrollable pain.
What primary warning signs might alert a nurse that a patient is suicidal?
• Specific verbalizations expressing a desire to die or take one’s own life

• Readily available means for committing suicide

• Feelings of euphoria or well-being following a period of depression

• Verbalizations or a specific written plan outlining how one could attempt suicide

• Previous failed attempt(s) at suicide

• Auditory hallucinations with voices encouraging the taking of one’s own life
Describe the approach a nurse should take when dealing with a suicidal patient.
it is most important that the nurse stay with that individual at all times, remaining calm while providing for his or her safety. A direct approach should be taken when asking the patient about his or her intentions; this involves asking specific questions like “Have you thought about suicide?” and “Do you have a specific plan?”
What is the CAGE questionnaire? What four areas does it explore?
The CAGE questionnaire is a diagnostic test that is used to screen for alcoholism. It is based on an exploration of four main areas:

C: Consumption: alcohol consumption and desire to cut down;

A: Annoyance when alcohol use is criticized by others;

G: Guilt associated with alcohol use;

E: Eye openers,” or use of alcohol in the morning.
What are the main types of aggressive behavior disorders in which aggression is largely directed at others?
antisocial personality disorder and the conduct disorders. Abuse is also a type of aggressive behavior.
Compare and contrast psychopathic and sociopathic behavior.
Psychopathic behavior is marked by a desire to harm other people, such as through mental or physical abuse. Sociopathic behavior is similar, but it implies indifference to the pain of others. There is no guilt or remorse involved when a sociopathic person abuses or manipulates another individual. Both types of behaviors are characterized by impulsivity and irresponsibility.
What are conduct disorders?
Conduct disorders are persistent, repetitive behavior patterns that result in some sort of violation of the rights of others.
Describe the cycle of violence typically associated with ongoing abusive relationships.

T-AB-H
tension-building stage, during which there may be minor incidents of abuse that are not confronted by the victim.

the acute battering stage; here, the perpetrator loses control and commits the abusive act.

the honeymoon stage, the perpetrator is usually apologetic and loving, and the victim wants to believe the perpetrator’s promises.
What is attention deficit/hyperactivity disorder? What seems to be its cause?
Attention deficit/hyperactivity disorder (ADHD) is a pattern of persistent inattention that is accompanied by hyperactivity and/or impulsivity. ADHD seems to result from some type of neurochemical imbalance in the brain, specifically in the areas responsible for acting on the reticular activating system.
Name and briefly define the four impulse control disorders discussed in the text.
kleptomania,

pyromania,

trichotillomania-is hair loss caused by compulsive pulling or
twisting of the hair until it breaks of

intermittent explosive disorder
Differentiate between the three clusters of personality disorders according to their general defining characteristics.
Cluster A personality disorders are characterized by detachment and distrust. Individuals with these disorders appear odd and seem to be eccentric.

Cluster B personality disorders are characterized by emotional instability and impulsiveness. Individuals with these disorders are described as dramatic, emotional, erratic, and intense.

Cluster C personality disorders are characterized by anxiety and fear. Included in this group are avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder.
What are the key characteristics of paranoid personality disorder?
Individuals with paranoid personality disorder display extreme suspiciousness and distrust of others with no objective basis in reality; this can sometimes be accompanied by delusions of persecution. The focus of attention and criticism is on other people rather than the self, and forgiveness of others is rare. Individuals with paranoid personality disorder also tend to overreact to criticisms and suggestions for improvement, and they take offense easily. Withdrawal from social relationships is common.
What is desensitization?
Desensitization involves gradually exposing a person to a feared object or situation for very brief periods in a safe environment in order to help that person overcome a specific fear. This practice is useful in the treatment of people with phobic disorders, such as the fear of elevators or of tall buildings.
What is modeling?
In the process of modeling, the therapist encourages the patient to learn a desired behavior by personally serving as a role model for that behavior. Role-play is also a means of modeling that can encourage an individual to exhibit a desired behavior.
What is the primary goal of nursing according to Peplau’s social-interpersonal theory?
According to Peplau’s theory, the primary goal of nursing is to resolve the health difficulties of the patient.
What are the three stages of Peplau’s theory? What specific actions do they include?
The three stages of Peplau’s theory are orientation, working, and termination. These stages include establishing trust, setting short- and long-term patient-centered goals, maintaining boundaries, and referring patients to support systems.
What is debriefing?
Debriefing is a component of crisis intervention that is used with groups. In a debriefing session, one or more therapists come together with a small group of people who have experienced a crisis; the therapists then encourage these people to share their reactions to the crisis.
Explain the origin of crisis intervention.
arises out of the work of Gerald Caplan and other theorists, including Erich Lindemann. During the 1940s, Lindemann studied the crisis reactions of people whose loved ones had died in a nightclub fire. He discovered that prevention was the key to moving people through a crisis successfully and with fewer associated behavior disorders and reactions later in life. This provides a theoretical basis for crisis therapy.
Describe remotivation therapy, including its purpose and methods.
Remotivation therapy focuses on resocializing people who are apathetic and have regressive behaviors. It often engages the senses as a way of drawing patients into the present state of reality.
Describe cognitive therapy, including its purpose and methods.
Cognitive therapy focuses on helping people to view themselves realistically. To do so, it often challenges patients’ unhealthy attitudes about themselves.
Describe operant conditioning, including its purpose and methods.
Operant conditioning focuses on encouraging a behavior change by rewarding the desired behavior.
What is the specific rationale for the use of antipsychotics in patients with schizophrenia?
Antipsychotic medications are used to treat schizophrenia because it is believed that some of the positive symptoms of this condition are related to excess dopamine in portions of the limbic system of the brain.
Name the four common antipsychotic medications mentioned in the text and list the defining characteristics for each.
* Haloperidol

* Risperidone

* Clozapine

* Chlorpromazine
Haloperidol
(Haldol) is classified as a butyrophenone and is used to treat acute agitation. It is often prescribed for persons who exhibit assaultive and aggressive behavior. The adult dosage range is 1–15 mg/day. A major adverse side effect of the drug is urinary retention.
Risperidone
(Risperdal) is an atypical antipsychotic that can treat the negative as well as the positive symptoms of schizophrenia. The adult range is 4–6 mg/day.
Clozapine
(Clozaril) is also an atypical antipsychotic used to treat the negative symptoms of schizophrenia. The adult range is 300–450 mg/day. Side effects may include seizure activity and agranulocytosis.
Chlorpromazine
(Thorazine) is a low-potency antipsychotic that is classified a phenothiazine. It is the most sedating of the antipsychotics. The adult range is 200–800 mg/day.
What is agranulocytosis? What are some symptoms that nurses should look for in a patient who may be developing this condition?
Agranulocytosis is an acute depression or absence of white blood cells that can compromise the immune system and put the patient at risk for infection. Symptoms of infection in relation to developing agranulocytosis include cough, sore throat, fever, and mouth sores.
What are some specific anticholinergic side effects and why do they usually occur?
Specific anticholinergic effects include dry mucous membranes (especially the mouth), dry eyes, mydriasis, blurred vision, constipation, nasal congestion, and urinary retention. These effects occur when anticholinergic agents block the impulses of the parasympathetic nerves.
Why do extrapyramidal side effects occur?
Extrapyramidal side effects (EPSEs) are caused by the blocking effects of high-potency antipsychotic medications on dopamine, a neurotransmitter that normally helps regulate or control movement.
List the defining characteristics of pseudoparkinsonism
Pseudoparkinsonism is characterized by bradykinesia, diminished blink reflex, pill rolling, drooling, cogwheeling, and a masklike facial expression.
List the defining characteristics of akinesia.
Akinesia is characterized by a loss of voluntary muscle movement in addition to muscle pain and overall fatigue.
List the defining characteristics and treatments of akathisia.
Akathisia is characterized by extreme and involuntary motor restlessness, including pacing and constant foot or finger tapping. Valium may be used to counter the side effects.
List the defining characteristics of acute dystonia.
The onset of dystonia can be dramatic and frightening. It is characterized by twisting or rhythmic jerking of the head and neck, along with torticollis. Muscle spasms may cause oculogyric crisis. Benadryl may be given for immediate symptom relief.
List the defining characteristics of tardive dyskinesia.
involuntary movement of various body parts that sometimes results from long-term antipsychotic therapy. Symptoms include grinding of the teeth, lip smacking, tongue protrusion, facial tics, and repetitive rocking or thrusting motions, especially of the pelvis.
What diagnostic scale is used to evaluate tardive dyskinesia? What areas does it target for observation?
Diagnosis of tardive dyskinesia frequently includes use of the Abnormal Involuntary Movement Scale (AIMS). This scale targets three areas for observation: the face (including the mouth), the extremities (including the hands), and the trunk.
What is the usual treatment for extrapyramidal side effects?
usually includes discontinuing current drug therapy and switching to different antipsychotic medications. It may also involve decreasing the dose of current antipsychotic medications and adding an antiparkinsonian medication to help relax muscles and reduce tremors. Providing a quiet environment may additionally help decrease the occurrence of extrapyramidal side effects.
What are some common antiparkinsonian medications that are used to treat extrapyramidal side effects?
(Cogentin) and trihexyphenidyl (Artane), both of which are anticholinergics.

Amantadine (Symmetrel), a dopaminergic antiparkinsonian drug that works specifically to decrease bradykinesia and muscle rigidity.
What is neuroleptic malignant syndrome (NMS)? When can it occur? What are the primary defining characteristics of this condition?
Neuroleptic malignant syndrome (NMS) is a rare but sometimes fatal condition that results when dopamine is blocked in the hypothalamus.

It can occur following the administration of high-dosage and high-potency antipsychotics or after the withdrawal of drugs that increase dopamine levels.

The primary defining characteristics of NMS are hyperthermia and muscular rigidity.
How is neuroleptic malignant syndrome treated?
Treatment of NMS includes immediately discontinuing antipsychotic medications and instituting measures to lower body temperature; for example, hypothermia blankets and antipyretics such as aspirin or acetaminophen may be used. Curare-based paralytic medications such as dantrolene (Dantrium) or bromocriptine may additionally be given to alleviate muscle spasms; bromocriptine also reduces fever.
What are anxiolytic medications used for? What is their overall action and effect?
Anxiolytic medications are given to treat mood disorders in which generalized anxiety is present. They are also used for more severe and specific anxiety disorders like phobias, panic disorder, and acute mania accompanied by extreme movement or motor agitation. Anxiolytics depress the central nervous system and thereby aid in muscle relaxation and sleep.
What are benzodiazepines? What is their primary effect?
Benzodiazepines make up the primary category of anxiolytic medications. These drugs enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA), thereby decreasing the electrical activity and excitability of nerve cells in the brain.
What specific precautions should the nurse take when administering benzodiazepines?
The nurse should advise patients that severe respiratory depression can occur if benzodiazepines are taken together or in conjunction with alcohol or other medications that have sedative effects. These drugs should also be used with caution in the elderly, because they may contribute to drowsiness and confusion that can precipitate falls. Since benzodiazepines are lipophilic, dosage levels should be carefully monitored. Moreover, when given intravenously, these drugs must be administered slowly to prevent respiratory arrest. Benzodiazepines can be addictive, so discontinuation of these drugs should be gradual in order to prevent symptoms of withdrawal.
All of the following anxiety medications are antihistamines except

A. Hydroxyzine hydrochloride (Atarax)

B. Hydroxyzine pamoate (Vistaril)

C. Buspirone hydrochloride (BuSpar)

D. Cyproheptadine hydrochloride (Periactin)
Buspirone hydrochloride (BuSpar)
Which of the following medications is best described as a benzodiazepine with anticonvulsant properties.



A. Diazepam (Valium)

B. Alprazolam (Xanax)

C. Hydroxyzine pamoate (Vistaril)

D. Clonazepam (Klonopin)
Clonazepam (Klonopin)
Which of the following medications is used to treat insomnia of short duration?

A. Diazepam (Valium)

B. Hydroxyzine hydrochloride (Atarax)

C. Clonazepam (Klonopin)

D. Temazepam (Restoril)
Hydroxyzine hydrochloride (Atarax)
Which of the following medications is used to treat long-term generalized anxiety?


A. Hydroxyzine pamoate (Vistaril)

B. Clonazepam (Klonopin)

C. Lorazepam (Ativan)

D. Buspirone hydrochloride (BuSpar)
Buspirone hydrochloride (BuSpar)
Which of the following medications may help prevent tardive dyskinesia?


A. Buspirone hydrochloride (BuSpar)

B. Diazepam (Valium)

C. Cyproheptadine hydrochloride (Periactin)

D. Temazepam (Restoril)
Diazepam (Valium)
Which of the following medications may be used to help treat depression associated with severe anorexia?

A. Diazepam (Valium)

B. Cyproheptadine hydrochloride (Periactin)

C. Temazepam (Restoril)

D. Hydroxyzine hydrochloride (Atarax)
Cyproheptadine hydrochloride (Periactin)
Which of the following medications is used preoperatively for sedation and nausea control?


A. Diazepam (Valium)

B. Alprazolam (Xanax)

C. Hydroxyzine pamoate (Vistaril)

D. Clonazepam (Klonopin)
Hydroxyzine pamoate (Vistaril)
Which of the following medications is best described as a benzodiazepine used to aid in sleep?

Checkmark
A. Buspirone hydrochloride (BuSpar)

B. Diazepam (Valium)

C. Cyproheptadine hydrochloride (Periactin)

D. Temazepam (Restoril)
Temazepam (Restoril)
What are antidepressants used for? How do they act in the body?
Antidepressants are given to patients who are experiencing depressive mood disorders and certain anxiety disorders like PTSD. It is believed that antidepressants act by raising levels of norepinephrine and serotonin within the brain, thereby increasing the efficacy of these neurotransmitters.
Why are antidepressants generally not used to treat bipolar disorder?
Antidepressants are generally not used in the treatment of people with bipolar disorder because they have a tendency to induce mania in these individuals.
What are the signs of an impending hypertensive crisis related to an MAOI-tyramine interaction?
-severe headache in the occipital region at the back of the skull.

-hypertension

-heart palpitations

-pain and stiffness of the neck

-perspiration

-nausea/vomiting

-photophobia
What foods and beverages should patients avoid if they are taking an MAOI?
Patients should avoid certain dairy products (most aged and natural cheeses, yogurt, and sour cream), beverages (beer, red wine, and caffeinated and chocolate drinks), fruits and vegetables (bananas, raisins, and avocados), and meats (pickled herring, sausage, and organ meats). They should also avoid soy sauce and yeast products.
What is serotonin syndrome? What are its symptoms?
Serotonin syndrome is a serious drug-drug interaction that can occur if an MAOI is given in conjunction with an SSRI or initiated too soon after an SSRI is discontinued. Symptoms of serotonin syndrome include very high fever, hypertension, and muscle rigidity and twitching.
What are antimanics and how do they work?
Antimanics, also called mood stabilizers, are medications that are used in the treatment of manic states. Antimanics alter sodium transport, thereby working to decrease psychomotor activity.
What is the most common antimanic medication? For what two conditions is it primarily used? How is this drug believed to work?
The most common antimanic medication is lithium carbonate (Lithane, Eskalith). Lithium is used to treat mania and prevent the depression associated with bipolar disorder; it is also used in the treatment of autism. Lithium is believed to work by enhancing the action of four neurotransmitters: acetylcholine, GABA, norepinephrine, and serotonin.

hint-lithium enhances GANS
Why should a patient’s blood levels be closely monitored when he or she is taking lithium? What is the normal range for lithium levels in the blood?
t is important to monitor blood levels of patients who are taking lithium because of the potential for toxicity; lithium levels that are considered therapeutic are very close to those that are considered toxic.

Normal therapeutic plasma levels of lithium are between 1.0 and 1.2 mEq/L.
What are the symptoms of lithium toxicity?
Symptoms of lithium toxicity include
muscle weakness
lack of coordination
coarse hand tremors
polydipsia, confusion
blurred vision
persistent gastrointestinal side effects including nausea, vomiting, and diarrhea.


More severe symptoms of this condition include muscle rigidity, seizure activity, and coma.
What medications, if given at the same time as lithium, may result in lithium toxicity? Why? What medications increase lithium excretion?
Thiazide diuretics like Diuril deplete sodium and can thus contribute to dehydration and lithium toxicity. Conversely, medications like sodium bicarbonate can increase lithium excretion.
What two mood stabilizers are frequently given to people who do not respond to lithium? How do these drugs work?
Two mood stabilizers that are frequently given to people who do not respond to lithium are carbamazepine (Tegretol) and valproic acid (Depakene, Depakote). Tegretol is primarily used to treat tonic-clonic seizures by preventing or reducing the discharge of impulses in the nerve synapses in the brain. It also has a sedative effect. Valproic acid acts by increasing the concentration of the neurotransmitter GABA.
What are central nervous system stimulants used for? How do they act in the body?
Central nervous system stimulants are used for a variety of situations involving disruptive responses, sleep disorders, and impulsive behavior patterns, particularly in children. These medications are generally amphetamines or amphetamine-like substances that act by stimulating the release of catecholamine neurotransmitters, especially norepinephrine, in the cerebral cortex. The effect of this norepinephrine release is increased alertness.
When are anticonvulsants used? What is their effect?
Anticonvulsants are used to control chronic aggressive behavior and seizures, including those precipitated by electroconvulsive therapy. These drugs stabilize nerve cell membranes and raise the seizure threshold, thereby acting to decrease initiation of the nervous impulses in the CNS that precipitate seizure activity by increasing the action of neurotransmitters like GABA.
List the classifications, uses, and side effects of valproic acid (Depakene, Depakote)
Valproic acid (Depakene, Depakote) is used to treat lithium-resistant bipolar disorders. Side effects include anorexia and hair loss. Valproic acid is hepatotoxic.
carbamazepine (Tegretol)
Carbamazepine (Tegretol) is another alternative to lithium used to treat bipolar disorders. Side effects include hepatotoxicity. It may cause a hypertensive crisis if given with an MAOI.
gabapentin (Neurontin)
Gabapentin (Neurontin) is an anticonvulsant used to treat partial seizures. Common side effects include short-term mild to moderate dizziness, ataxia, and nystagmus
clonazepam (Klonopin).
Clonazepam (Klonopin) is a benzodiazepine used to treat akinetic seizures in children. It can cause aggressive behavior and hypersalivation.
What are sedatives/hypnotics used for? How do they work?
Sedatives/hypnotics are used primarily in the treatment of sleep disorders such as insomnia; sleep disturbances frequently accompany mood disorders and can contribute to the development of a variety of abnormal behaviors. These drugs work by depressing the central nervous system.
Why are sedatives/hypnotics normally recommended for short-term use?
Patients can become dependent on them, and they slow down REM causing abnormal sleep patterns
What are some common symptoms of withdrawal from sedatives/hypnotics? When will these symptoms usually occur?
Initial symptoms of sedative/hypnotic withdrawal include headache, nausea, vomiting, anxiety, restlessness, and insomnia, especially in the elderly. More severe withdrawal symptoms can occur within several days of drug discontinuation; these symptoms include tinnitus, delirium, disturbing dreams, and seizure activity.
What are the symptoms of sedative/hypnotic overdose? How is this overdose treated?
The symptoms of sedative/hypnotic overdose are respiratory depression, unconsciousness, coma, and seizure. Immediate treatment for overdose involves the induction of vomiting. Activated charcoal is also given to absorb the drug; it can be used in a gastric lavage if the person is in a coma. Seizure precautions are necessary with this condition, and vital signs should be checked frequently.
What are substance abuse deterrents?
Substance abuse deterrents are pharmacological interventions that are given to help treat drug misuse and abuse.
What are the symptoms of an Antabuse-alcohol reaction? What causes these symptoms?
The symptoms of an Antabuse-alcohol reaction include confusion, nausea, vomiting, throbbing headache, tachycardia, heart palpitations, dyspnea, hypotension, neck and/or chest pain, diaphoresis, flushing, blurred vision, and vertigo. These symptoms are caused by an accumulation of acetaldehyde, an intermediate product of alcohol metabolism.
What are the symptoms of methadone withdrawal?
Symptoms of methadone withdrawal include nausea, vomiting, elevated blood pressure, tachycardia, abdominal cramping, and flushing.
What is phototherapy, and what patients might benefit from it?
Phototherapy is treatment via exposure to direct sunlight or artificial ultraviolet (UV) light, especially in the morning. It is used in the treatment of patients with seasonal affective disorder (SAD).
When is electroconvulsive therapy (ECT) useful?
Electroconvulsive therapy (ECT) is useful in the treatment of major depressive disorders when medications fail to alleviate symptoms. ECT also appears to be helpful in cases of depression accompanied by suicidal ideation and psychomotor retardation, as well as in the treatment of certain bipolar disorders, especially those associated with lithium-resistant mania
What type of injuries could result from ECT? What medications might prevent them?
The seizures produced during ECT can result in injury to the long bones of the extremities or the cervical vertebrae. Muscle relaxants like succinylcholine (Anectine) are usually given before the procedure to decrease the likelihood of these injuries.
Briefly describe the defining characteristics and uses of donepezil hydrochloride (Aricept), ginkgo biloba, St. John’s wort, thiamine, vitamin E, and acetaminophen.
Donepezil hydrochloride (Aricept) increases acetylcholine levels in the brain to improve memory and orientation and to help moderate other symptoms associated with mild to moderate dementia. Bradycardia is a major side effect.

Gingko biloba is an herbal remedy and antioxidant with antidepressant properties. It is sometimes used as a memory aid for people with thought disorders.

St. John’s wort is an herbal remedy used as a topical healing salve and for the treatment of mild to moderate depression.

Thiamine is used as part of a multivitamin regimen to combat chronic alcoholism and is necessary to prevent Wernicke-Korsakoff syndrome.

Vitamin E is an antioxidant that may help delay symptom progression in Alzheimer’s disease by blocking free radicals and combating cellular damage.

Acetaminophen has an anti-inflammatory effect that may help treat dementia.
Is there ever a time in which a patient’s right to confidentiality may be justifiably violated by a nurse or other health care professional? If so, when and why?
Cases in which patients are contemplating suicide or homicide may involve the justifiable violation of the right to confidentiality. The general rule with regard to such situations is that confidentiality may be breached only when patients are risks to themselves or to other people
What are endocrine glands and what do they do?
Endocrine glands are ductless glands that secrete hormones directly into the bloodstream or lymph system.
Describe the structure and location of the adrenal glands.
The adrenal glands are attached to the top of the kidneys. Each gland consists of a cortex and a medulla.
Describe the structure and location of the thyroid gland, and identify its products.
The thyroid gland is a shield-shaped gland surrounding the trachea. It consists of two lobes separated by an isthmus. The thyroid secretes calcitonin, triiodothyronine (T3) and thyroxine (T4).
Describe the location of the parathyroid glands, and identify their products.
The parathyroid glands are located in the neck, behind or embedded in the thyroid gland. The four glands secrete parathormone (PTH).
Describe the structure and location of the pituitary gland, and identify its products.
The pituitary gland, also called the hypophysis, is located on the anterior portion of the brain, attached to the lower portion of the hypothalamus. It consists of an anterior and posterior lobe. The pituitary gland secretes several important hormones, including thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, growth hormone, antidiuretic hormone (ADH), prolactin, oxytocin, and adrenocorticotropic hormone (ACTH). For this reason, it is often called the “master gland” of the endocrine system.
Name the hormones secreted by the adrenal cortex. Provide an example of each. What are the functions of each of these hormones?
The adrenal cortex secretes three types of corticosteroid hormones: glucocorticoids, mineralocorticoids, and sex hormones (androgen and estrogen).

The glucocorticoids are sometimes called the stress hormones, because they are involved in the body’s long-term response to stress. Their release varies in accordance with circadian body rhythms; secretion is usually highest in the morning and lowest during nighttime sleep, when energy demands are generally decreased. Glucocorticoids act by elevating blood glucose levels and regulating the metabolism of carbohydrates, fats, and proteins; some synthetic glucocorticoids are also used to treat allergic reactions. One of the most important glucocorticoid hormones is cortisol.

The mineralocorticoids are steroid hormones that are responsible for regulating fluid and electrolyte excretion by the kidneys. They include aldosterone, which is involved in sodium, water, and potassium balance and in regulating blood pressure.

The sex hormones include androgens and estrogens. Androgens act to stimulate male sex characteristics, while estrogens act to stimulate female sex characteristics.
Name the hormones secreted by the adrenal medulla and describe their function, including how they operate and what effects they have on the body.
The adrenal medulla secretes two catecholamine hormones: epinephrine (adrenaline) and norepinephrine. Both of these hormones act on the cardiovascular and central nervous systems and are involved in the body’s fight-or-flight response. Their release is stimulated by the sympathetic nervous system. The effect of epinephrine and norepinephrine on the body is significant and includes increased heart rate and cardiac output along with blood vessel constriction.
Discuss the function and production of the thyroid hormones.
The thyroid gland produces three hormones: calcitonin, triiodothyronine (T3), and thyroxine (T4). Adequate amounts of all three hormones are essential for normal fetal development and physical and mental growth through life. Calcitonin acts by increasing calcium deposition in bones and by aiding in serum calcium regulation. T3 and T4, known together as thyroid hormone, are involved in the synthesis of protein and in the speeding of cellular metabolism, which increases both energy production and the body’s basal metabolic rate (BMR). Iodine is important for T3 and T4 synthesis. T3 and T4 secretion is controlled by thyroid-stimulating hormone (TSH), a substance that is secreted by the anterior pituitary gland.
Describe the function and production of growth hormone (GH).
Growth hormone (GH), also known as somatotropic hormone (STH), stimulates growth through protein anabolism, a process that extracts nutrients from the blood for cellular growth and development. Growth hormone also increases blood glucose levels and breaks down or catabolizes fat in tissues. Exercise and stress are the primary external factors that stimulate GH secretion.
Differentiate between the roles played by follicle-stimulating hormone (FSH), prolactin, and luteinizing hormone (LH).
Follicle-stimulating hormone (FSH) stimulates estrogen secretion in women. Prolactin stimulates the production of breast milk. Luteinizing hormone (LH) stimulates both estrogen secretion and ovulation in women, as well as testosterone secretion in men.
Identify the function of both adrenocorticotropic hormone (ACTH) and thyroid-stimulating hormone (TSH).
Adrenocorticotropic hormone (ACTH) stimulates the secretion of cortisol by the adrenal glands. Thyroid-stimulating hormone (TSH) stimulates the secretion of hormones in the thyroid gland.
Name the hormones produced by the posterior lobe of the pituitary gland and identify the function of each.
oxytocin and antidiuretic hormone.

Oxytocin, a hormone that is secreted during pregnancy, stimulates milk ejection and increases muscle tone and contraction of the uterus during birth.

Antidiuretic hormone (ADH), also called vasopressin, is responsible for water absorption by the kidneys and for regulation of urine output. It also raises blood pressure by constricting blood vessels and increasing arterial resistance; secretion of vasopressin increases when blood pressure drops.
What are the primary functions of the kidneys?
The primary functions of the kidneys include forming urine, regulating fluids and electrolytes, and maintaining the electrolyte and acid-base balance in blood and other body fluids. The kidneys also help regulate blood pressure.
What are the three primary structures of the kidney?
The three primary structures of the kidney are the cortex, medulla, and renal pelvis.
What is the functional unit of the kidney and what is its action?
The functional unit of the kidney is the nephron. Each kidney contains over one million nephrons, and these nephrons in turn contain the glomeruli that are involved in urine formation. The process of urine formation is called glomerular filtration.
Urea is:

A. a product of purine metabolism.

B. a waste product of skeletal muscle metabolism.

C. a waste product of the metabolism of proteins and amino acids.
C. a waste product of the metabolism of proteins and amino acids.
Creatinine is:"

A. a product of purine metabolism.

B. a waste product of skeletal muscle metabolism.

C. a waste product of the metabolism of proteins and amino acids.
B. a waste product of skeletal muscle metabolism
Uric acid is

A. a product of purine metabolism.

B. a waste product of skeletal muscle metabolism.

C. a waste product of the metabolism of proteins and amino acids.
A. a product of purine metabolism.
Discuss the causative factors, defining characteristics, symptoms, and treatment of pheochromocytoma.
Pheochromocytoma is a neuroendocrine disorder that usually is caused by the presence of a tumor in the adrenal medulla; it causes increased secretion of two catecholamine hormones: epinephrine and norepinephrine.

Signs of pheochromocytoma include
nausea, vomiting, nervousness, visual disturbances, tachycardia, palpitations, headache, hyperhidrosis, hypermetabolism, and hyperglycemia. All are symptoms of overactivity of the sympathetic nervous system. Pheochromocytoma may also result in malignant hypertension. Primary surgical treatment is usually adrenalectomy.
Discuss the causative factors, defining characteristics, symptoms, and treatment of Cushing’s syndrome.
Cushing’s syndrome is a condition that is caused by the presence of high levels of corticosteroids, especially glucocorticoids. Chronic use of oral corticosteroids is its usual cause. Cushing’s syndrome may also develop when pituitary lesions cause increased secretion of ACTH and this in turn triggers the adrenal cortex to release large amounts of cortisol. Androgens like testosterone, which stimulates the development of masculine sexual characteristics, are also excessively secreted with this disorder.
Discuss the causative factors, defining characteristics, and symptoms of Addison’s disease.
Addison’s disease is caused by the insufficient production of corticosteroid hormones by the adrenal cortex. Common causes of this disease are autoimmune destruction of the adrenal glands and infectious processes such as tuberculosis. This condition can also be related to bilateral adrenalectomy.

Symptoms can include fatigue, irritability, depression, muscle weakness, nausea and vomiting, abdominal pain, a craving for salt, and skin pigmentation that becomes bronze or dark in color. An Addisonian crisis may occur in response to sodium and potassium imbalances, causing severe hypotension and cardiac dysrhythmias.
Discuss the causative factors, defining characteristics, and symptoms of syndrome of inappropriate antidiuretic hormone secretion (SIADH).
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a regulatory disorder related to excessive secretion of antidiuretic hormone (ADH) from the posterior pituitary lobe. Causes of SIADH are multiple and can include various infections, malignant processes, and stress.

The primary symptoms of SIADH are oliguria (low urinary output), weight gain, and fluid retention that is centered in the brain. Cerebral edema may develop and can cause headaches, seizures, and changes in mental status with altered levels of consciousness.
Discuss the causative factors, defining characteristics, and treatment of diabetes insipidus.
Diabetes insipidus (DI) is a condition caused by the insufficient secretion of ADH by the posterior pituitary lobe. This type of DI is sometimes referred to as central DI. There is also another form of diabetes insipidus caused by the inability of the kidneys to respond to ADH; this form is called nephrogenic DI. Nephrogenic DI appears to have a genetic predisposition. Central DI, on the other hand, can develop at any point in a person’s life, although it is commonly precipitated by head injury, brain tumor, or hypothalamic dysfunction. Certain medications like lithium may also contribute to the sudden development of DI.

The two primary symptoms of diabetes insipidus are increased thirst (especially for cold water) and polyuria. The degree of excess urination associated with this disease is much greater than that associated with type I or type II diabetes (discussed in later chapters); output can range between 5 and 25 L/day of very dilute urine. Extremely dry skin, nocturia, dehydration, fever, and hypovolemic hypotension and shock may also accompany DI.

Treatment of DI is primarily related to causation. If the causative factor is excess amounts of lithium, this medication should be discontinued. If causation is due to hypothalamic dysfunction, the treatment of choice is antidiuretic hormone replacement medication, either in the form of vasopressin (Pitressin) given intramuscularly (IM) or desmopressin acetate (DDAVP) given intravenously (IV), subcutaneously (SC), or as a nasal spray (intranasally). Yet another option is vasopressin tannate (Pitressin tannate), a peanut oil suspension that may be given intramuscularly.
Discuss the causative factors, defining characteristics, and treatment of acromegaly.
Acromegaly is a chronic endocrine disorder caused by the overproduction of growth hormone (GH), usually because of a benign adenoma, or tumor in the anterior pituitary gland. Acromegaly usually occurs following the closure of the epiphyses, or areas at the ends of the long bones where tissue and cartilage are ossified to bone. If acromegaly occurs prior to epiphyseal closure, it results in giantism or gigantism.

Primary defining characteristics of acromegaly include enlarged hands, feet, and bones; enlarged and thickened facial features, especially the nose, jaw, lips, and tongue; somnolence, and headaches and vision loss related to the pressure of the tumor on the optic nerve.

Primary treatment of acromegaly involves reducing growth hormone production and preserving pituitary function. Both medical and surgical treatments are used. Most patients respond to treatment with octreotide or bromocriptine (Parlodel). A new class of drugs called growth hormone receptor antagonists is also effective; one such medication is pegvisomant (Somavert). Treatment must be for life. If necessary, surgery involves hypophysectomy or resection or removal of the pituitary adenoma responsible for the secretion of excess growth hormone.
Discuss the causative factors, defining characteristics, and treatment of hypopituitarism.
Hypopituitarism, also called pituitary insufficiency, is often caused by a tumor of the pituitary gland, but it can also be triggered by head trauma; infection, radiation, or surgery of the brain; hypothalamic dysfunction; or a number of other causes. Hypopituitarism is often a progressive disease.

Signs and symptoms seen with hypopituitarism vary depending on the deficiency of hormones and the age of the patient. Typically, manifestations of this condition include symptoms such as headache, loss of axillary and pubic hair, visual disturbances, cessation of menstruation and infertility, or growth delay.
List five signs of pheochromocytoma.
nausea, vomiting, nervousness, visual disturbances, tachycardia, palpitations, hypertension, headache, hyperhidrosis, hypermetabolism, and hyperglycemia. All are symptoms of overactivity of the sympathetic nervous system.
What is malignant hypertension? What causes this condition?
Malignant hypertension is a condition in which the patient’s systolic blood pressure can be over 300 mm Hg and his or her diastolic blood pressure can be as high as 200 mm Hg. It is caused by constriction of the blood vessels.
What are some specific interventions aimed at the relief of episodes of malignant hypertension associated with pheochromocytoma?
To help counter episodes of malignant hypertension, the patient should be placed on bed rest with the head of the bed in an elevated position. Muscle relaxants and antihypertensives like sodium nitroprusside (Nipride) may be given to immediately and dramatically lower blood pressure.
What are some specific nonpharmacological interventions that should be implemented prior to catecholamine testing?
Because physical, mental, or emotional stress of any kind can increase catecholamine levels, it is important to provide a quiet environment before any diagnostic testing. Patients should generally be placed on bed rest prior to blood and urine analysis, and they may be taught or encouraged to relax by doing deep-breathing or visualization exercises.
What medications, foods, and beverages should be avoided prior to any catecholamine testing?
Medications such as aspirin or any over-the-counter drugs containing stimulants like ephedrine must be discontinued prior to testing. Some foods and beverages should also be avoided, because they can increase catecholamine production; these include bananas, caffeinated drinks, and chocolate. Similarly, vanilla, alcoholic beverages, and citrus fruit should not be consumed, as they can affect urine levels of VMA.
What is the rationale for intravenous therapy prior to surgical removal of the adrenal glands?
Intravenous therapy ensures that the patient is well hydrated; inadequate hydration can lead to hypotensive states both during and after surgery.
What medications are usually given prior to an adrenalectomy? Why?
Preoperative care for adrenalectomy usually includes medications to lower and stabilize high blood pressure and correct any cardiac dysrhythmias. Specific drugs for these purposes are phentolamine (Regitine) and propranolol hydrochloride (Inderal). Additional preoperative medications may include alpha- and beta-adrenergic blocking agents. These drugs block or inhibit the secretion of catecholamines that could elevate blood pressure to dangerous levels; this often occurs when the adrenal glands are handled during surgery.
What type of medication will the patient take for the remainder of his or her life following a bilateral adrenalectomy? Why? What is the most common drug prescribed for this purpose?
If a bilateral adrenalectomy is performed, the patient will be placed on corticosteroid therapy for the rest of his or her life, generally by way of oral prednisone, in order to prevent hypoglycemia.
Identify the diagnostic tests and laboratory values for pheochromocytoma.
Glucagon stimulation tests and clonidine suppression tests may be used in diagnosis of pheochromocytoma. Urine specimens may be conducted to test for increased levels of vanillylmandelic acid (VMA) and other catecholamines. Angiography may also be used to determine the presence and location of a tumor that may be responsible for adrenal hypersecretion.
Identify the diagnostic tests and laboratory values for Cushing’s syndrome.
twenty-four-hour urine sample may be collected to test for elevated levels of 17-hydrocorticosteroid and 17-ketosteroids. Dexamethasone suppression tests and corticotrophin stimulation tests may also be used in diagnosis.
Identify the diagnostic tests and laboratory values for Addison’s disease.
Serum blood analysis of patients with Addison’s disease reveals hyponatremia, hyperkalemia, and hypoglycemia. The patient’s white blood count (WBC) may be high in relation to an infectious process. Twenty-four-hour urine tests indicate increased plasma ACTH, decreased serum cortisol, and low levels of 17-ketosteroids and 17-hydroxycorticosteroids.
Identify the diagnostic tests and laboratory values for syndrome of inappropriate antidiuretic hormone secretion (SIADH).
Laboratory values related to SIADH include hyponatremia related to fluid retention. In addition, the patient’s urine will have high specific gravity (> 1.030), sodium levels, and osmolality.
Identify the diagnostic tests and laboratory values for diabetes insipidus.
A fluid deprivation test is used in the diagnosis of diabetes insipidus. If the patient has diabetes insipidus, the specific gravity of his or her urine will be low (< 1.005). In addition, as the disease progresses, his or her serum osmolality will rise and hypernatremia (high serum sodium levels) will develop.
Identify the diagnostic tests and laboratory values for acromegaly.
In addition to its physical symptoms, acromegaly is characterized by high serum GH and ACTH levels. Serum glucose and lipid levels may also be elevated. Radiographic studies of people with acromegaly can reveal structural changes in the long bones, as well as the location of the causative tumor.
Identify the diagnostic tests and laboratory values for hypopituitarism.
Laboratory, radiologic, and vision exams are all used to establish a diagnosis of hypopituitarism. CT and MRI scans are used to evaluate the presence of a tumor. In addition, hormone assays are performed to confirm low levels of ACTH, ADH, TSH, GH, FSH, LH, and prolactin.
True or False

Physical and emotional stress decreases the need for prednisone.
False. Physical and emotional stress increases the need for prednisone.
True or False

Corticosteroids are generally given at bedtime.
Corticosteroids are generally given in the morning.
True or False

Patients who are taking prednisone may require additional sodium if they experience vomiting.
True
True or False

Prednisone and other steroids should be given with fruit juice because of their bitter taste.
False. Prednisone and other steroids should be given with milk or antacids because they can cause ulcers.
True or False

Rest is essential when receiving steroid therapy, because it helps decrease stress.
True
True or False

Diet should be high in carbohydrates and protein but very low in sodium.
False. Diet should be high in carbohydrates, sodium, and protein.
What are four symptoms of steroid overdose?
weight gain
edema
elevated blood pressure
euphoria.
What are four symptoms of inadequate steroid dosage?
weight loss
dizziness
postural hypotension
depression.
Explain how polydipsia, polyuria, and polyphagia may occur in individuals with Cushing’s syndrome.
Polydipsia, polyuria, and polyphagia may occur related to the inhibiting effect of glucocorticoid hormones on insulin.
Explain how frequent infections may occur in individuals with Cushing’s syndrome.
Frequent infections may occur related to increased susceptibility.
Explain how depression and psychosis may occur in individuals with Cushing’s syndrome.
Depression and psychosis may occur related to changing body image and the effect of cortisol on the neurological system.
Which of the following is true of phentolamine (Regitine)?


A. Prevents constriction of blood vessels

B. Used for malignant hypertension

C. Suppresses adrenal secretions

D. Is a common antiarrhythmic drug
A. Prevents constriction of blood vessels
Which of the following is true of propranolol hydrochloride (Inderal)?

A. Prevents constriction of blood vessels

B. Used for malignant hypertension

C. Suppresses adrenal secretions

D. Is a common antiarrhythmic drug
D. Is a common antiarrhythmic drug
Which of the following is true of sodium nitroprusside (Nipride)?

A. Prevents constriction of blood vessels

B. Used for malignant hypertension

C. Suppresses adrenal secretions

D. Is a common antiarrhythmic drug
B. Used for malignant hypertension
Which of the following is true of metyrapone (Metopirone)?

A. Prevents constriction of blood vessels

B. Used for malignant hypertension

C. Suppresses adrenal secretions

D. Is a common antiarrhythmic drug
C. Suppresses adrenal secretions
Which of the following is true of Prednisone?


A. Used to treat fluid retention related to SIADH

B. Often given following bilateral adrenalectomy

C. Comes in a nose spray

D. Contraindicated if patient is allergic to peanuts
B. Often given following bilateral adrenalectomy
Which of the following is true of Furosemide (Lasix)?

A. Used to treat fluid retention related to SIADH

B. Often given following bilateral adrenalectomy

C. Comes in a nose spray

D. Contraindicated if patient is allergic to peanuts
A. Used to treat fluid retention related to SIADH
Which of the following is true of pitressin tannate?

A. Used to treat fluid retention related to SIADH

B. Often given following bilateral adrenalectomy

C. Comes in a nose spray

D. Contraindicated if patient is allergic to peanuts
D. Contraindicated if patient is allergic to peanuts
Which of the following is true of desmopressin acetate (DDAVP)?


A. Used to treat fluid retention related to SIADH

B. Often given following bilateral adrenalectomy

C. Comes in a nose spray

D. Contraindicated if patient is allergic to peanuts
C. Comes in a nose spray
Differentiate between intravenous hydrocortisone (Solu-Cortef) and oral hydrocortisone (Cortef).
Intravenous hydrocortisone (Solu-Cortef) and oral hydrocortisone (Cortef) are both pare of the corticosteroid therapy instituted for treatment of Addison’s disease. Intravenous hydrocortisone (Solu-Cortef) is instituted immediately in the event of an Addisonian crisis, while oral hydrocortisone (Cortef) will be prescribed later for lifetime management of the disease.
What precipitates an Addisonian crisis? What are the symptoms?
Imbalanced sodium and potassium levels, often as a result of emotional or physiological stress, can precipitate an Addisonian crisis. Symptoms of Addisonian crisis include back pain, severe dehydration, severe hypotension, tachycardia with weak pulse, cardiac dysrhythmias, rapid respirations, and even circulatory collapse if the aforementioned symptoms are untreated.
What is the usual initial treatment for Addisonian crisis?
-Treat hypovolemic shock.

-The patient’s lower extremities should be elevated in a shock position

-Intravenous saline solution should be given to restore circulation and raise blood pressure

-IV dextrose should be given to elevate blood sugar

-Corticosteroid therapy will be immediately instituted, often by way of intravenous hydrocortisone (Solu-Cortef).
What postoperative nursing care should follow pituitary surgery?
Following pituitary surgery, cerebrospinal fluid (CSF) can leak into the brain during instances of intracranial pressure; activities that increase this pressure, such as sneezing, coughing, and straining to have a bowel movement, should therefore be avoided. If needed, stool softeners and antitussives may be ordered. The head of the patient’s bed should also be elevated at a thirty-degree angle. A common sign of CSF leakage is frequent swallowing. Leakage may be detected by using a reagent strip to check the patient’s nasal drainage for glucose.
Why are high-protein diets contraindicated for patients with diabetes insipidus?
High-protein diets are contraindicated for patients with diabetes insipidus because high-protein foods increase urinary output and sodium excretion.
Discuss the causative factors and defining characteristics of hyperthyroidism.
excessive amounts of circulating thyroid hormone (T3 and T4)

gradual weight loss secondary to increased BMR and protein catabolism, polyphagia, and amenorrhea
Discuss the causative factors, defining characteristics, and treatment of hypothyroidism.
Hypothyroidism is a condition that is caused by inadequate amounts of circulating thyroid hormone. The most common cause of this is thyroiditis, an inflammation of the thyroid. Hashimoto’s disease, an autoimmune disorder that affects the thyroid gland, is the most common type of thyroiditis.

Hypothyroidism occurs most frequently in women and in people with Down’s syndrome

Treatment for hypothyroidism and myxedema is symptom-directed and includes a diet low in calories and fat in order to promote weight loss. Thyroid hormone replacement therapy must be continued throughout the patient’s life
What are the three phases of ARF?
The three phases of ARF are the oliguric phase, the diuretic phase, and the recovery phase.
Compare and contrast urine output and quality in each phase of ARF.
During the oliguric phase of ARF, most patients have a urine output of less than 400 mL/day; output for elderly patients is usually less than 600–700 mL/day.

Anuria, or output of less than 100 mL/day, can also occur. During the diuretic phase of ARF, urine volume increases gradually and often significantly, sometimes reaching output levels of over 2,000 mL/day. With this increase, the urine itself is usually very dilute. During the recovery phase, urine values normalize.
What causes the anemia that is sometimes associated with ARF?
With ARF, anemia is often caused by decreased production of erythropoietin, as well as elevated BUN levels that increase bleeding tendencies.
What foods should be avoided by patients who are recovering from ARF?
Patients who are recovering from ARF should limit their protein, potassium, and phosphorus intake; this includes salt substitutes, citrus fruits, fruit juices, bananas, and coffee. Fluid and sodium intake may be restricted as well.
What are the major causes of chronic renal failure (CRF)?
Major causes of CRF include
poorly controlled diabetes mellitus
chronic hypertension
kidney infection
What are the three phases of CRF?
The three phases of CRF are those of diminished renal reserve,
renal insufficiency,
end-stage renal disease (ESRD).
How does the liver help maintain normal blood glucose levels after carbohydrates are consumed?
The liver converts carbohydrates from digested foods into glucose; this glucose is then used by the cells to meet the body’s energy needs. Any excess glucose that is not immediately needed for energy is converted by the liver into glycogen. When the body needs additional energy, the liver reconverts glycogen to glucose and releases it into the bloodstream. This conversion and storage process helps maintain normal blood glucose levels.
What are fatty acids? What happens when they combine with oxygen?
Fatty acids are the end products of ingested fat that are transported to the liver from the small intestine. When the body needs energy but glucose is not available, the liver can convert fatty acids into energy.

oxygen + fatty acids = cholesterol and ketones.
What are ketones? What is their relationship to metabolic acidosis?
Ketones are products of fatty acid oxidation that can be used for energy under normal circumstances.

If too many ketones are produced, however, they can accumulate in the blood and result in metabolic acidosis.
What are the end products of protein digestion? What is their function?
Amino acids are the end products of protein digestion. They are used as a source of energy and as an aid in building and repairing tissue.
Where is bile produced? What is the function of this substance?
Bile is a fluid that aids in digestion; it is produced and secreted by the liver. When a person eats food that contains a great deal of fat, bile is released by the liver and then used to emulsify that fat in the small intestine.
What is bilirubin? How is it formed?
Bilirubin is a product of red blood cell destruction and a major component of bile. It is formed when hemoglobin is broken down in the liver.
Briefly describe the role of Vitamin A in the body.
Vitamin A is essential for normal growth and development. It aids in resistance to infections and is needed for visual acuity.
Briefly describe the role of Vitamin D in the body.
Vitamin D is necessary for calcium and phosphorous absorption and aids in bone and tooth development.
Briefly describe the role of Vitamin E in the body.
Vitamin E promotes the stability of red blood cells and may help counter free radical production.
Briefly describe the role of Vitamin K in the body.
Vitamin K is essential for blood coagulation and for the synthesis of prothrombin by the liver. It also appears to inhibit the growth of oxalate stones and help regulate calcium levels in the blood.
Briefly describe the role of iron in the body.
Iron is a component of hemoglobin and is important for oxygen transport in the blood.
How is the gallbladder related to digestion?
The gallbladder stores and concentrates bile that has been secreted by the liver. It does so by absorbing the bile’s water content. When bile is required for digestion, the gallbladder contracts and forces this substance to flow out of it toward the small intestine.
What exocrine secretions does the pancreas produce?
Exocrine secretions from the pancreas consist of digestive enzymes (also known as pancreatic juice) that break apart carbohydrates, fats, and proteins in the small intestine.
What three hormones are secreted by the pancreas? What cells produce each of type of hormone? Where are these cells located?
The pancreas secretes:
glucagon
insulin
somatostatin.

Glucagon is produced by alpha cells
insulin is produced by beta cells
somatostatin is produced by delta cells.

All three types of cells are located in groups known as islets of Langerhans.
Describe the action of glucagon, insulin, and somatostatin.
Glucagon acts by raising serum glucose levels.

Insulin acts by lowering blood glucose levels and by aiding in the metabolism of carbohydrates, fats, and proteins.

Somatostatin has an inhibitory effect on the secretion of glucagon, insulin, and the pituitary hormones, specifically growth hormone.
State the relationship of insulin to each of the following: glycogen, fat, and protein.
Insulin aids in the formation and storage of glycogen.

Insulin inhibits fat catabolism by preventing the breakdown of stored fats and by promoting fat synthesis.

Insulin increases protein anabolism and aids in the transport of amino acids across cell membranes.
What is cholelithiasis? What are some contributing factors for this condition?
Cholelithiasis is a disorder that is marked by the presence or formation of stones in the gallbladder. In some cases, these stones can obstruct the bile ducts and thereby prevent the flow of bile. Contributing factors include disturbances in cholesterol metabolism and various infections, especially those caused by E. coli bacteria.
What is cholecystitis?
Cholecystitis is an inflammation of the gallbladder. It usually occurs when cholelithiasis restricts bile flow to the duodenum.
Severe gallbladder pain that is located in the upper right quadrant of the abdominal cavity is called _________________.
Biliary colic
The pain associated with cholecystitis is caused by _________________ of the gallbladder and by the movement of stones through the _________________ or _________________.


A. Distention; duodenum; small intestine

B. Infection; duodenum; bile ducts

C. Contraction; gallbladder; bile ducts
C. Contraction; gallbladder; bile ducts
A muscle spasm that occurs when the abdomen is palpated over an inflamed or diseased area is called _________________..


A. Biliary colic

B. A gallbladder series

C. Guarding
C. Guarding
Where might a patient experience pain in relation to cholecystitis?
The pain associated with cholecystitis is usually located in the upper right quadrant of the abdominal cavity, but it can radiate to the back, right shoulder, or right flank.
What are ursodiol (Actigall) and chenodiol (Chenix)?
Ursodiol (Actigall) and chenodiol (Chenix) are two bile acid medications that may be used to dissolve small cholesterol-based gallstones and prevent others from forming.
Why are fried and fatty foods restricted for patients with cholecystitis?
Fried and fatty foods are restricted because they require bile for absorption. When gallbladder function is compromised, bile flow is restricted, so pain can result when undigested fats stimulate the gallbladder to attempt to excrete bile.
What is the most common complaint following laparoscopic cholecystectomy? Why? What nursing measures may help resolve this situation?
The most common complaint following laparoscopic cholecystectomy is pain in the right shoulder; this is related to the migration of CO2. A covered heating pad can relieve this pain; patients should also be encouraged to walk, sit at a forty-five to ninety-degree angle, and lie on their left side with their right leg pulled up at an angle and their left arm pulled around by their back (Sims’ position) to facilitate gas absorption.
What are the complications of laparoscopic laser cholecystectomy? What are some associated symptoms?
Complications of laparoscopic laser cholecystectomy are related to internal bleeding or leakage of bile. Symptoms can include severe pain and/or tenderness in the upper right quadrant, increase in abdominal girth, drop in blood pressure, tachycardia, and bile-colored drainage or bleeding from the puncture sites.
What is acute pancreatitis? What enzymes are associated with this condition?
Acute pancreatitis is an inflammation of the pancreas. With this condition, there is an increase in the secretion of trypsin in the pancreas. Because of trypsin’s high acid content, it can literally digest the pancreas; this is called autodigestion. Trypsin secretion also activates elastase, an enzyme that can cause pancreatic hemorrhage.
Describe the pain associated with acute pancreatitis. When is this pain likely to occur?
Acute pancreatitis is characterized by sudden and severe left or midepigastric pain that may be described as burning or stabbing; this pain may radiate to the left shoulder and back. Onset of the pain associated with acute pancreatitis usually occurs twenty-four to forty-eight hours after a heavy meal or after ingestion of large amounts of alcohol.
What sign would indicate the resolution of an acute episode of pancreatitis?
One primary indicator of the resolution of an acute episode of pancreatitis is a change in the color of the patient’s stools from a pale or clay color back to a normal shade.
Describe the pain associated with chronic pancreatitis. What precipitates this pain?
The pain associated with chronic pancreatitis is intermittent or chronic and severe. It is located in the upper abdomen but can radiate to the back. This pain is precipitated by heavy meals or alcohol intake, and it can persist or recur with vomiting.
In addition to pain, what signs and symptoms are associated with chronic pancreatitis?
In addition to pain, symptoms of chronic pancreatitis include anorexia, weight loss, jaundice, diarrhea, steatorrhea, and signs of developing diabetes.
What is cirrhosis? What is another name for this condition?
Cirrhosis is a potentially life-threatening, chronic condition that impairs the normal functioning of liver cells and increases the resistance of the liver to blood flow. Cirrhosis is caused by liver fibrosis and is sometimes referred to as hepatic biliary disease.
What are three common causes of cirrhosis?
alcoholism, chronic viral hepatitis, and ingestion of toxic substances, including drugs.
Differentiate between Laënnec’s cirrhosis and postnecrotic cirrhosis.
Laënnec’s cirrhosis, also called portal cirrhosis, is usually associated with chronic alcoholism. Laënnec’s cirrhosis is more common in men than women, and it is especially prevalent in Hispanic, African American, and Native American males. Postnecrotic cirrhosis, on the other hand, refers to cirrhosis that results from hepatitis and ingestion of toxic substances, including drugs.
What changes in the body contribute to the development of the symptoms of cirrhosis?
The symptoms of cirrhosis are related to scar tissue formation; portal hypertension; poor absorption of various fat-soluble vitamins including A, D, E, and K; and the inability of the liver to detoxify waste products, such as those produced by protein catabolism.
Explain why fatigue, general weakness, and malaise may occur as symptoms of cirrhosis.
Fatigue, general weakness, and malaise in cirrhosis are often related to anemia.
Explain why shortness of breath may occur as a symptom of cirrhosis.
Shortness of breath results when abdominal ascites or hepatomegaly pushes the diaphragm into the chest cavity.
Explain why esophageal varices may occur as a symptom of cirrhosis.
Esophageal varices are caused by portal hypertension, a complication associated with cirrhosis.
Explain why jaundice and pruritis may occur as symptoms of cirrhosis.
Jaundice and pruritus may develop in relation to a buildup of bile pigments in the skin.
Explain why bleeding gums, ecchymoses, and spider angiomas may occur as symptoms of cirrhosis.
Bleeding gums, ecchymoses, and spider angiomas may occur in relation to high estrogen levels and decreased absorption of vitamin K.
In a patient with cirrhosis, would levels of aspartate aminotransferase (AST) be high or low?
High
In a patient with cirrhosis, would levels of alanine aminotransferase (ALT) be high or low?
high
In a patient with cirrhosis, would hemoglobin levels be high or low?
Low
In a patient with cirrhosis, would hematocrit levels be high or low?
low
In a patient with cirrhosis, would serum albumin levels be high or low?
Low
In a patient with cirrhosis, would serum bilirubin levels be high or low?
High
In a patient with cirrhosis, would folic acid levels be high or low?
Low
If diuretic therapy is not effective in treating ascites, what other procedure can be performed? How?
If ascites is severe and does not respond to diuretic therapy, paracentesis may be required. With paracentesis, a needle attached to a catheter is inserted into the abdomen to drain fluid from the peritoneal cavity.
How should nurses assess for fluid buildup in patients with cirrhosis?
Nurses should measure various parts of the patient’s body on a daily basis in order to check for dependent edema; this can include measurements of abdominal girth and ankle size. The sacrum and scrotum should also be assessed for fluid buildup, and daily weights and intake and output should be recorded.
What dietary recommendations (including specific vitamins and minerals) should be given to patients with cirrhosis?
high in carbohydrates and low in protein

Patients with cirrhosis may also need calcium, zinc, thiamine, folic acid, and vitamin A, B12, D, E, and K supplements
What is portal-systemic encephalopathy (PSE)? What causes this condition?
a brain disorder that can result from chronic liver disease. When the liver functions normally, it detoxifies various chemicals in the foods and beverages that a person ingests. When the liver is damaged, however, these chemicals either bypass or fail to be detoxified by the liver and thereby accumulate in the blood. Hypokalemia and internal bleeding can also contribute to the development of PSE.
What are the early signs of PSE?
Early symptoms of PSE are similar to those of the organic dementias and include confusion, disorientation, memory impairment, difficulty reasoning and making judgments, and abnormalities in speech and language.
What are the advanced symptoms of PSE?
Advanced symptoms of PSE include asterixis or flapping tremor. In addition, as the amount of ammonia in the patient’s blood continues to rise, he or she may become delirious and eventually unresponsive to any external auditory or tactile stimuli. This final stage of PSE is called hepatic coma.
What medications are used to reduce bacteria in the bowel? What are some side effects of these medications?
hyperosmotic laxatives like lactulose and sorbitol, both of which increase peristalsis and produce diarrhea. Side effects may include increased gas in the bowel and hypokalemia. Neomycin, an antibiotic, may also be given either orally or in enema form to cleanse the bowel.
You are assigned to a patient with cholecystitis secondary to cholelithiasis. You note that the patient has upper right quadrant pain, abdominal rigidity and guarding, nausea and vomiting, a low prothrombin level, and prolonged clotting times. What are some NANDA nursing diagnoses that would apply to this situation?
* Acute pain related to obstruction of bile flow and gallbladder inflammation

* Imbalanced nutrition less than body requirements related to anorexia, nausea, and vomiting

* Ineffective health maintenance related to deficient knowledge regarding care of disease

* Impaired comfort related to toxic metabolites excreted in the skin
Nick is admitted with bleeding esophageal varices. What would be a priority diagnosis for Nick?
One priority diagnosis for a patient with bleeding esophageal varices would be deficient fluid volume related to hemorrhage caused by portal hypertension.
What would be a priority need for a patient with acute pancreatitis?
One example of a priority need for a patient with acute pancreatitis would be to decrease his or her release of pancreatic enzymes.
One of the goals for a patient with acute pancreatitis is to provide instruction regarding diet and alcohol use. What would be some appropriate outcome criteria to use to determine whether this goal was achieved?
Appropriate outcome criteria in this situation might include the following:

* Patient verbalizes understanding of need to abstain from alcohol and caffeinated beverages

* Patient verbalizes the importance of consuming small meals that are low in fat, protein, and fiber, but high in carbohydrates
The sequential acquisition of physical, mental, and social skills is called:
the developmental process
What organization publishes the DSM-IV?
American Psychiatric Association (APA)
Which of the following interventions may require the patient to sign an informed consent form?

A. Reiki therapy
B. Diuretic therapy
C. Active range of motion therapy
D. Validation therapy
Reiki therapy
A nurse who is interested in applying Caplan’s theory to behavior management would focus on:
preventative strategies to help patients cope with anxiety.
Which of the following is the best example of a health promotion need?


A. Need to treat diarrhea with Kaopectate
B. Need to maintain weight within normal limits
C. Need to restore fluid and electrolyte balance related to diarrhea
D. Need to teach patient about ways to prevent diarrhea
Need to teach patient about ways to prevent diarrhea
A nurse who is caring for a patient with a cyclothymic affective disorder knows that cyclothymia differs from true bipolar disorder in which of the following ways?
Hypomania is a primary characteristic of cyclothymia
Which of the following values characteristically accompanies aggression and anxiety?
Low levels of GABA
The symptom most commonly associated with conversion disorder is:
la belle indifférence
Which of the following is characteristic of a person with retrograde amnesia?
The patient is unable to recall events before the onset of amnesia
The symptoms of what type of dementia can be treated with medication that may prevent additional pathological changes in the brain
Multi-infarct dementia
A patient who is exhibiting negative symptoms of psychosis might benefit most from which of the following medications?

A. Thorazine
B. Risperdal
C. Haldol
D. Cogentin
risperdal
A patient who is about to be discharged is given a prescription for phenelzine sulfate (Nardil). Patient teaching should include information about avoiding which of the following foods and/or beverages?
Aged cheese, chocolate, bananas, and soy sauce
Which of the following symptoms are associated with pheochromocytoma?
Headaches
Nausea
Vomiting
The nurse listens over the patient’s thyroid gland and hears a whistling sound. What is she hearing?
A bruit- A vascular murmur heard over a hyperactive thyroid gland.
Which of the following might the nurse expect to see in a patient after he or she has undergone thyroidectomy?
Twitching of the eye when the facial nerve is tapped
Metabolism of what substance produces ketones?
Fat
Prior to intravenous cholangiogram or oral cholecystography, what action would be most important for the nurse to take?
Asking the patient about any allergies
Discharge teaching for a patient who has undergone cholecystectomy includes providing information about signs of biliary obstruction. A set of these signs might include:
pruritus, dark urine, and clay-colored stools.
For what purpose would the nurse give a patient lactulose or sorbitol?
To reduce bacteria in the bowel
Blood analysis of the newborn of a mother with uncontrolled gestational diabetes might reveal:

A. hyperglycemia.
B. hypercalcemia.
C. hyperbilirubinemia.
D. hyperphosphatemia
C. hyperbilirubinemia
All of the following would be included in teaching a diabetic patient about how to prevent renal complications except:

A. annual testing for protein in the urine.
B. monthly blood pressure checks.
C. a diet high in complex carbohydrates.
D. a diet high in protein.
D. a diet high in protein.