Mental Health Exam 2

Front 1

Five families of psychotropic medications are;

Back 1

Antispychotics
Antidepressants
Mood stabilizers
Antianxiety or anxiolytics
Stimulants

Front 2

Examples of TYPICAL?

Back 2

-Thorazine
-Haldol (dose needs to be low for elderly)

Front 3

What sysmtoms do typical antipsychotic meds effect?

Back 3

Targets the positive symptoms of schizophrenia and psychosis
Less effective on the negative psychotic symptoms

Front 4

What side effects can typical antipsychotics cause?

Back 4

Can cause EPS’s or extrapryamidal side effects
More likely to cause tardive dyskinesia

Front 5

How do atypical antipsychotic meds work?

Back 5

and focus on blocking the serotonin postsynaptic receptors.
Works better on negative symptoms of schizophrenia or psychosis than the typical antipsychotics,

Front 6

What aree some examples of aytpical antipsychotic meds?

Back 6

Clozaril
Abilify
Risperdal

Front 7

What are side effects of aytpical antispychotic meds?

Back 7

Works better on negative symptoms of schizophrenia or psychosis than the typical antipsychotics,
Know the life threatening side effect with clozaril = agranulocytosis
Need WBC weekly every 6 mo, every 2 weeks for an additional 6 mo, and every month thereafter

Front 8

What are negative signs of schizophrenia or psychosis?

Back 8

-affective flattening(blunted/constricted), alogia(decrease thoughts/language) avolition(don’t initiate activity) anhedonia (no pleasure), attention problems

Front 9

What are positive signs of schizophrenia or psychosis?

Back 9

delusions, hallucinations, thought disorders

Front 10

what are extrapryamidal or muscular side effects are and what you do to treat them.

Back 10

Reversable SE…
-dystonia (muscle cramp)
- akinesia (lack of movement)
-tremor
-akathisia (motor restlessness)
*Tardive dyskinesia - permanent
Twitching, change posture, blinking, jerking, tics, lip smacking
Treat with…
CONGENTIN, Akineton, Norflex, Benadryle, Kemadrin, Artane, Symmetrel, Parlodal

Front 11

what are anticholinergic side effects are and what you do to treat them?

Back 11

Constipation -blurred vision -urinary retention/hesitancy -nasal congestion -dry mouth
*Treat with…

Front 12

What is neuroleptic malignant syndrome and what is the treatment?

Back 12

MEDICAL EMERGENCY
Fever, muscular rigidity, increase/labile BP, P, R
Muteness, Diaphoresis, Drooling, Dysphagia, High WBC / CPK
*Treat the symptoms! & STOP medication!
Give Cogentin, Symmetrel, Parlodel, Dantrium

Front 13

What are characteristics of major depression?

Back 13

Major depression that is recurrent requires lifelong treatment.

Front 14

What are the classes of antidepressant medication?

Back 14

Tricyclic medications-Examples..
Elavil -Tofranil -Pamelor

Selective serotonin reuptake inhibitors (SSRI’s)--Prozac -Zoloft -Paxil -Celexa -Lexapro

Monoamine oxidase inhibitors (MAOI’s) -Marplan -Nardil -Parnate -Eldepryl, Emsan

Front 15

What are tyramine rich foods?

Back 15

cheese, deli meat, wine

Front 16

What is the thearputic range for lithium toxicity?

Back 16

.6-1.2

Front 17

What are early and late signs of Li toxicity?

Back 17

Early: hand tremor, GI upset, blurred vision, drowsiness, mental dullness, slurred speech, confusion, muscle twitching, dizzy
Late: seizures, coma, arrhythmias, permanent neurologic impairment

Front 18

Side effects of benzodiazepines?

Back 18

Daytime drowsiness –Decrease tolerance to alcohol/sedative -Excitation
-Impaired judgment -Impaired motor -Dependence -Restlessness
-Trouble learning/memory

Front 19

What medications are used for stage fright or social phobias?

Back 19

beta blockers

Front 20

What are some examples of self help groups geared toward family members?

Back 20

Al-anon, Alateen and Families Anonymous

Front 21

what is an essintial ingrediant in self help groups?

Back 21

An essential ingredient for recovery that can be provided by disaster recovery self-help groups is empathy offered by other survivors.

Front 22

Three ethical principles that guide psychiatric nursing practice are:

Back 22

Autonomy- self determination (as long as they don’t affect life of others)
Beneficence –do no harm
Justice- treat fair and honest

Front 23

What is required when seeking an informed consent from people for participation in a research study?

Back 23

-Statement the study involves research -Purpose –Duration –Procedures –Experimental Aspects – Risks/Discomforts –Benefits –Alternative Procedures –Confidentiality –Contact Info needed for Info/Injury – Voluntary – Withdraw

Front 24

what does Wyatt v Stickney (1972) state?

Back 24

Wyatt v Stickney (1972) states that all clients with mental illness have the right to humane treatment

Front 25

What does Tarasoff v Regents say?

Back 25

Tarasoff v Regents of the University of California states that nurses are mandated to protect those endangered by clients. Duty to warn.

Front 26

What is the nurse’s role in the PAD?

Back 26

Nurses need to teach patients about the PAD and advocate for the use of the PAD so patients have the opportunity to make decisions about their care in writing when they can’t make decisions for themselves..

Front 27

What is vicarious traumatization?

Back 27

9/11 fireman
• Can be acute or chronic
• Can be with delayed onset if at least 6 months after stressor

Front 28

What is acute stress disorder?

Back 28

• Person experienced three or more dissociative symptoms:
– subjective sense of numbing
– detachment or absence of emotional response
– a reduction in awareness of surroundings
– De-realization
– Depersonalization
– Dissociative amnesia
• Person persistently re-experiences event in images, thoughts, dreams, illusions, or flashbacks
• Marked avoidance of stimuli
• Anxiety or arousal
• Last for minimum of 2 days to maximum 4 weeks within 2 weeks of event

Front 29

What are some charateristics of PTSD?

Back 29

• PTSD
– Duration of symptoms longer than 1 month
– Can be acute or chronic
– Can be with delayed onset if at least 6 months after stressor

Front 30

What does CODE-C stand for?

Back 30

-Consultation – Outreach – Debriefing – Defusing – Education –

Front 31

What is meant by the term defusing?

Back 31

-brief, immediate intervention used with small groups that focuses upon gathering facts, exploring thoughts, acknowledging feelings, and providing encouragement

Front 32

What are some predictors of violent behavior in patients?

Back 32

• Alcohol/substance abuse
• Brain injury- loss of impulse control
• Clients w/ behavioral symptoms
• Disorganized behavior
• Irrational beliefs
• Issues involving family
• Hx of legal problems/ gang membership

Front 33

What is a first line medication used to treat PTSD?

Back 33

-SSRI’s (Celexa, Lexapro, Zoloft, Prozac, Paxil)

Front 34

What is the foundation of Holistic Nursing Practice?

Back 34

*Self-care…..self-healing, self-awareness

Front 35

Name some benefits of progressive muscle relaxation.

Back 35

• Help w/ low back pain, postpartum depression, hypertension, tension headache and asthma

Front 36

What are the primary components of therapeutic touch?

Back 36

• Centering
• Assessment
• Unruffling
• Transmitting energy

Front 37

Define reflexology? What is the main premise underlying the practice of reflexology?

Back 37

. By massaging the arch of the foot, one can help the spine relax

Front 38

Saint John’s Wort is a weak MAOI – what else is true about Saint John’s Wort?

Back 38

• Self-treatment of mild-moderate depression
• Cautions include photosensitivity, affective disorders mania, hypomania triggered
• Used w/ SSRI, serotonin syndrome may result, change in mental status

Front 39

People with liver problems should not take what OTC herbal remedy?

Back 39

*Kava kava

Front 40

What is the goal of crisis intervention?

Back 40

*Restore, replace, or revitalize the missing balancing factors to resolve the immediate crisis situation

Front 41

Know the typical facial features of FAS

Back 41

• Epicanthal folds
• Flat nasal bridge
• Small palpebral fissures
• “Railroad track ears”
• Upturned nose
• Smooth philtrum
• Thin upper lip

Front 42

What are the implications of LAI Risperidone in the pregnant women?

Back 42

There was only one study done… no birth defects to baby, no harm to mother..

Front 43

Is lithium associated with congenital anomalies? If yes, which types?

Back 43

Yes, but not very often
Ebstein’s anomaly- abnormal placement of one the heart valves

Front 44

A major advantage of the atypical antipsychotic clozapine (Clozaril) over the traditional antipsychotic chlorpromazine (Thorazine) is its decreased

A: cost.
B: incidence of extrapyramidal side effects.
C: risk of seizures.
D: need for periodic blood tests.

Back 44

B

Reason: Clozaril is associated with a decreased incidence of extrapyramidal side effects. Compared with Thorazine, Clozaril costs more, not less (option A), has a risk of seizures (option C), and requires more frequent blood tests (option D) due to its associated risk of agranulocytosis.

Front 45

A patient who is receiving the antipsychotic medication clozapine (Clozaril) should be given instructions concerning the risk of

A: agranulocytosis.
B: sedation.
C: urinary retention
D: all the above

Back 45

D
Reason: A patient receiving Clozaril must be given instructions concerning the need for frequent blood tests because of Clozaril's associated risk of agranulocytosis. Clozaril is also associated with sedation that can be severe for the first few weeks or months, and urinary retention, one of the anticholinergic side effects.

Front 46

Signs and symptoms of neuroleptic malignant syndrome include
A: flaccid muscles.
B: bradycardia.
C: decreased white blood count.
D: increased blood pressure.

Back 46

D
Reason: Symptoms of neuroleptic malignant syndrome include increased blood pressure; rigid, rather than flaccid muscles (option A); tachycardia, rather than bradycardia (option B); and increased, rather than decreased (option C) white blood count.

Front 47

Patients who are receiving tricyclic antidepressants should be observed for which of these side effects?

A: Urinary frequency
B: Excessive drooling
C: Suicidal ideation
D: Diarrhea

Back 47

C
Reason: Suicidal ideation is probably the greatest risk during the time after the first dose is prescribed until the patient has full symptom relief. This lag period for antidepressants can last several weeks or months.

Front 48

6: A depressed patient who is receiving a monoamine oxidase inhibitor (MAOI) should be observed for symptoms of hypertensive crisis, which include

A: neck stiffness.
B: decreased heart rate.
C: sluggish pupils.
D: joint pain.

Back 48

A

Reason: Symptoms of hypertensive crisis include neck stiffness. Other symptoms include increased, rather than decreased (option B) heart rate, and hyperactive, rather than sluggish (option C) pupils. Joint pain is not a symptom of hypertensive crisis.

Front 49

Clonidine (Catapres), an alpha-adrenergic antagonist, is used in some psychiatric settings in treating

A: Alzheimer's disease.
B: alcohol withdrawal.
C: bipolar disorder.
D: social phobia.

Back 49

B
Reason: Catapres has been found to be helpful in treating alcohol and drug withdrawal, posttraumatic stress disorder, ADHD and Tourette's disorder. It is not helpful in treating Alzheimer's disease (option A), bipolar disorder (option C), or social phobia (option D).

Front 50

Diabetes is one of the more troubling side effects of atypical antipsychotics
T/F

Back 50

T

Front 51

Nurses who assist victims of a disaster may experience vicarious traumatization (VT). Which of these interventions is indicated for nurses and other disaster workers who experience VT?

A: High-dose anxiolytic therapy
B: Twelve-step, self-help group
C: Long-term group psychotherapy
D: Critical incident stress management

Back 51

D
Reason: Critical incident stress management is an intervention which allows those involved in the disaster experience to process what has occurred and begin the recovery process themselves.

Front 52

The nurse who cares for victims of rape should be aware that they are at risk for developing

A: kleptomania.
B: paranoid schizophrenia.
C: posttraumatic stress disorder.
D: manic episodes.

Back 52

C
Reason: Victims of rape may develop posttraumatic stress disorder. They are not at risk for development of kleptomania (option A), paranoid schizophrenia (option B), or manic episodes (option D).

Front 53

Traumatic flashbacks can be stimulated by

A: transcortical aphasia
B: sensory stimuli
C: ritualistic behavior
D: cholinergic agonists

Back 53

B
Reason: Sensory stimuli can stimulate flashbacks in patients with post traumatic stress disorder. Transcortical aphasia (option A), ritualistic behaviors (option C), and cholinergic agonists are not related.

Front 54

Symptoms of arousal after trauma may include all the following except
A: irritability
B: dysomnia
C: hyperventilation
D: extrapyramidal side effects

Back 54

D
Reason: Irritability (option A), dyssomnias or sleep disorders (option B) and hyperventilation (option C) have been associated with symptoms of arousal after trauma.

Front 55

What factor in assessment for suicide risk would cause the most immediate concern
A: inconsistencies in history and report
B: history of manipulative behavior
C: stable interpersonal relationships
D: separation anxiety

Back 55

A
Reason: Inconsistencies in history and report may immediately affect the risk assessment. A history of manipulation (option B) or of separation anxiety (option D) may be of value in planning treatment but are not an immergent concern. Stable family relationships (option C) would be a strength and may decrease risk but would be outweighed by the risk of missing information.

Front 56

Which of the following may be considered a predisposing factor for the development of post traumatic stress disorder

A: alteration in tactile sensations and impaired concentration
B: sporadic exposure to significant others
C: employment related issues and workplace environment
D: prior trauma or a history of abuse as a child

Back 56

D
Reason: Prior trauma, abuse or victimization may influence a predisposition to development of post traumatic stress disorder. Impaired concentration and perceptual disturbances (option A) may be symptoms of stress and PTSD. Sporadic exposure to significant others (option B) and workplace environment (option C) and are not significant determining factors.

Front 57

In a crisis situation, consideration of rapid tranquilization may involve
A: using alternating doses of agonist/antagonist drugs
B: use of combinations of anti-psychotic and antioxylants
C: using (LAAM) levo-alpha acetylmothadol as a long acting alternative to antipsychotics
D: use of combinations of antioxylants and hypnotics to sedate the patient

Back 57

B
Reason: Combinations of anti-anxiety and antipsychotic medications are typically used in rapid tranquilization. Alternating doses of angonist/antagonists (option A), LAMM (option C) and combinations of anti-anxiety and hypnotics (option D) are not used.

Front 58

Which of the following is a symptom of anxiety?
A: fatigue
B: hypervigilance
C: hyperventilation
D: flashbacks
E: derealization

Back 58

C

Front 59

Verbal insults by clients are not threats and should not be taken seriously by health care professionals.
T/F

Back 59

F

Front 60

The basic legal document that governs psychiatric nursing practice is the:

A: Scope and Standards of Practice for Psychiatric-Mental Health Clinical Nursing Practice.
B: State nurse practice act.
C: Code of Ethics for Nurses with Interpretive Statements.
D: Standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Back 60

B
Reason: The state nurse practice act is the legal document that governs nursing practice, including psychiatric nursing. However, in a court of law, the psychiatric nurse would be judged not only by adherence to the nurse practice act but also by adherence to other authoritative documents, which include the professional standards of practice and performance (option A), the code of ethics (option C), and the ]CAHO standards (option D).

Front 61

A: autonomy
B: beneficence
C: justice
D: least restrictive treatment

Back 61

B
Reason: Autonomy or self-determination is the underlying ethical principle that allows clients to make decisions for themselves. The principle of beneficence (option B) means to act in the client's welfare by preventing harm and doing no harm. The principle of justice (option C) states that people should be treated equally and fairly. Ensuring the least restrictive setting (option D) is part of fulfilling the ethical principle of beneficence.

Front 62

A client has been receiving neuroleptic treatment for many years. It is important for the nurse to:
A: complete the abnormal voluntary motor scale every 3-6 months.
B: complete a mini-mental status examination every 3-6 months.
C: complete the Hamilton Depression Scale every 3-6 months.
D: verify the client has completed the HIPAA form.

Back 62

A
Reason: The abnormal voluntary motor scale (AIMS) is the tool used to evaluate tardive dyskinesis (TD). The other choices do not necessarily relate to neuroleptic treatment. The Mini-mental status examination and the Hamilton Depression Scale may also be indicated but these would be client specific. Options B and C and therefore are not the answers. HIPPA option D is for all patients and does not specifically relate to HIPAA.

Front 63

Nar-Anon is a program developed for the specific purpose of assisting

A: The drug abuser with recovery.
B: Adult children of narcotic abusers.
C: Families of compulsive gamblers.
D: Family and friends of the drug abuser.

Back 63

D
Reason: Nar-Anon was established to meet the needs of family members of the drug abuser. Narcotics Anonymous is for the drug abuser (option A), there is no group yet developed for adult children of narcotic abusers (option B) but there is ACOA for Adult Children Of Alcoholics, and Gam-Anon is for families of compulsive gamblers (option c).

Front 64

A primary role which a nurse can play in the development of a self-help group is that of a
A: Therapist.
B: Group leader.
C: Consultant.
D: Decision maker.

Back 64

A
Reason: Increased community visibility and public good will. Constructive criticism of their services (Option B) could be a benefit if there was a partnership. It's unlikely that the groups themselves can generate direct revenue for an agency (Option C), although they could indirectly help increase revenues by helping to increase referrals for service and/or increased community visibility and good will.