Health Differences Life Span 2

Front 1

What is stress? What general effects does it have on individuals?

Back 1

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.

Front 2

Describe the different forms and dimensions of stress and give examples of each.

Back 2

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.

Front 3

What can be the end result when stress overwhelms a person’s normal ways of coping?

Back 3

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.

Front 4

What is the Social Readjustment Rating Scale and why is it used in nursing? Give several examples of items found on the scale.

Back 4

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.

Front 5

What is behavior?

Back 5

Behavior is synonymous with a person’s observable actions or reactions (both conscious and unconscious) to life stresses.

Front 6

Identify six components of behavior that can be altered by stress.

Back 6

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.

Front 7

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?

Back 7

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

Front 8

What are the three primary categories of regulatory disorders?

Back 8

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

Front 9

What are the three primary categories of metabolic disorders?

Back 9

The three categories of metabolic disorders are as follows:

* Disorders of the gallbladder

* Disorders of the pancreas

* Disorders of the liver

Front 10

What is the difference between intrinsic and extrinsic influencing factors? How are these factors related to stress, disease, and nursing assessment?

Back 10

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.

Front 11

What are the major categories of intrinsic factors?

Back 11

Categories of intrinsic factors include gender, age, genetic predisposition, developmental issues, personality characteristics, psychological variables, and physiological factors.

Front 12

What are the major categories of extrinsic factors?

Back 12

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.

Front 13

Give an example of how being a teenage girl might affect the development of diseases and disorders.

Back 13

Teenage girls are more prone to eating disorders than are teenage boys.

Front 14

Give an example of how being female affects the development of diseases and disorders.

Back 14

Females are more likely to develop certain diseases of the gallbladder and thyroid than are males of the same age.

Front 15

Give an example of how being male affects the development of diseases and disorders.

Back 15

Antisocial personality characteristics are more common in men than in women.

Front 16

Give an example of how being elderly affects the development of diseases and disorders.

Back 16

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.

Front 17

What are familial diseases? Why is it important to consider familial diseases when making a nursing assessment?

Back 17

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.

Front 18

What is the developmental process? How is this process related to dysfunctional behavior?

Back 18

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.

Front 19

What are defense mechanisms? When can they be useful, and when they can they be harmful?

Back 19

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.

Front 20

What are some physiological factors that can influence a person’s susceptibility to disease and response to stress?

Back 20

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.

Front 21

Describe at least one way in which culture, ethnicity, or religion can influence a person’s behavioral and physiological responses to stress.

Back 21

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.

Front 22

Why should nurses ask adult patients with behavioral disorders about their childhood experiences?

Back 22

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.

Front 23

Why is it important for the nurse to explore a patient’s diet history, especially if the patient is taking medications?

Back 23

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.

Front 24

Identify three specific types of environmental factors that may contribute to the development of behavioral, regulatory, and metabolic disorders.

Back 24

choice of occupation,
sanitary conditions
location.

Front 25

What are circadian rhythms and how are they related to stress?

Back 25

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.

Front 26

Describe why support systems are valuable, and give three examples of support groups available for various populations.

Back 26

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.

Front 27

Why is it important for the nurse to ask a patient about his or her use of alternative or complementary therapies?

Back 27

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.

Front 28

Define “theory.” What is the relationship of theory to research?

Back 28

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.

Front 29

What are the two primary categories of theories that help explain variations in behavioral, metabolic, and regulatory responses?

Back 29

The two primary categories of theories that help explain these variations are biological theories and psychosocial theories.

Front 30

What is genetics? How does genetic theory relate to behavioral and physiological responses?

Back 30

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.

Front 31

What are hormones? What is their relationship to stress?

Back 31

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.

Front 32

What are some types of structural changes within the brain that can be seen by diagnostic imaging techniques?

Back 32

Diagnostic imaging techniques can reveal structural changes such as reduced blood flow, decreased brain activity, brain atrophy, and enlarged ventricles.

Front 33

What are neurotransmitters? What is their relationship to behavioral disorders and medications?

Back 33

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.

Front 34

What are histamines? What effect do they have on the body?

Back 34

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.

Front 35

What are antihistamines?

Back 35

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.

Front 36

Discuss the characteristics and effects of gamma-aminobutyric acid (GABA).

Back 36

Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter that affects anxiety, seizures, and aggression; decreased GABA levels may increase any of these behaviors.

Front 37

Discuss the characteristics and effects of serotonin.

Back 37

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.

Front 38

Discuss the characteristics and effects of norepinephrine.

Back 38

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.

Front 39

Discuss the characteristics and effects of dopamine.

Back 39

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.

Front 40

Discuss the characteristics and effects of acetylcholine.

Back 40

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.

Front 41

Why is it important for nurses to understand the various psychosocial theories?

Back 41

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.

Front 42

Briefly describe the theory of personality developed by Sigmund Freud.

Back 42

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.

Front 43

What defense mechanism is most likely operating in a patient who is blocking a painful memory?

Back 43

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.

Front 44

What defense mechanism is most likely to operate in a patient experiencing guilt over having an affair?

Back 44

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.

Front 45

What defense mechanism is most likely to operate in a patient who is experiencing the sudden death of a child?

Back 45

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.

Front 46

What is the primary therapeutic intervention associated with psychoanalytic theory? What are its underlying assumptions and primary purpose?

Back 46

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.

Front 47

What basic assumptions serve as the foundation for Erikson’s theory of development?

Back 47

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.

Front 48

According to Erikson’s theory, the identity vs. role confusion stage is characteristic of which age range?

Back 48

13–18 years

Front 49

According to Erikson’s theory, the generativity vs. self-absorption stage is characteristic of which age range?

Back 49

Middle age

Front 50

According to Erikson’s theory, the initiative vs. guilt stage is characteristic of which age range?

Back 50

4–5 years

Front 51

According to Erikson’s theory, the ego integrity vs. despair stage is characteristic of which age range?

Back 51

Old age

Front 52

According to Erikson’s theory, the trust vs. mistrust stage is characteristic of which age range?

Back 52

Birth to 1 year

Front 53

According to Erikson’s theory, the intimacy vs. isolation stage is characteristic of which age range?

Back 53

Young Adult

Front 54

According to Erikson’s theory, the autonomy vs. shame and doubt stage is characteristic of which age range?

Back 54

2-3 Years

Front 55

According to Erikson’s theory, the industry vs. inferiority stage is characteristic of which age range?

Back 55

6-12 Years

Front 56

What specific needs are associated with each level of Maslow’s hierarchy? How is the consideration of these needs useful in the nursing process?

Back 56

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.

Front 57

Describe Sullivan’s understanding of personality and behavior. According to Sullivan, what are the two primary human needs?

Back 57

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.

Front 58

What did Sullivan believe was one of the most observable manifestations of behavioral disorders? Describe this manifestation.

Back 58

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.

Front 59

Who developed the social-interpersonal theory of nursing? What are the focus and goal of this theory?

Back 59

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.

Front 60

Define “crisis.” What is the goal of crisis theory? Who developed it?

Back 60

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.

Front 61

What is the nursing process? What is its primary purpose?

Back 61

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.

Front 62

Compare and contrast subjective and objective data.

Back 62

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.

Front 63

What is a nursing diagnosis? What three things does a nursing diagnosis include?

Back 63

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.

Front 64

How do nursing diagnoses differ from medical diagnoses?

Back 64

they are specifically related to concerns that are amenable to some sort of nursing action or treatment.

Front 65

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

Back 65

Assessment

Front 66

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

Back 66

Implementation

Front 67

Which step in the nursing process involves synthesizing objective and subjective data?


A. Assessment

B. Analysis/diagnosis

C. Planning

D. Implementation

E. Evaluation

Back 67

Analysis/diagnosis

Front 68

Which step in the nursing process involves determining the urgency of patient needs?

A. Assessment

B. Analysis/diagnosis

C. Planning

D. Implementation

Back 68

Analysis/diagnosis

Front 69

Which step in the nursing process would include administering hypertensive medication?

A. Assessment

B. Analysis/diagnosis

C. Planning

D. Implementation

E. Evaluation

Back 69

Implementation

Front 70

Which step in the nursing process involves determining expected outcomes or goals?

A. Assessment

B. Analysis/diagnosis

C. Planning

D. Implementation

E. Evaluation

Back 70

Planning

Front 71

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

Back 71

Assessment

Front 72

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

Back 72

Planning

Front 73

Nursing actions are completed in which stage of the nursing process?

A. Assessment

B. Analysis/diagnosis

C. Planning

D. Implementation

E. Evaluation

Back 73

Implementation

Front 74

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

Back 74

Evaluation

Front 75

What are affective responses?

Back 75

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.

Front 76

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

Back 76

Situational

Front 77

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

A. Adventitious

B. Maturational

C. Situational

Back 77

Adventitious

Front 78

Which type of crisis concerns a stressful life event that is considered a developmental milestone?

A. Adventitious

B. Maturational

C. Situational

Back 78

Maturational

Front 79

How does bereavement differ from mourning?

Back 79

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.

Front 80

List the sequence of emotions in the grief cycle in their usual order of occurrence.

DABDA

Back 80

denial, anger, bargaining, depression, and acceptance.

Hint 80

DABDA

Front 81

What are some somatic symptoms that may be associated with the grief cycle?

Back 81

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.

Front 82

During what stage of the grief cycle is guilt most likely to occur? Why?

Back 82

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.

Front 83

What are some common precipitating causes of depressive responses?

Back 83

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.

Front 84

What neurotransmitters appear to play a role in depressive responses?

Back 84

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.

Front 85

What hormone appears to be present in high levels in people experiencing depressive responses? How can its presence be evaluated?

Back 85

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.

Front 86

What is psychomotor retardation? How is it usually exhibited in people with depression?

Back 86

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.

Front 87

Compare and contrast dysthymic disorder with major depressive disorder in terms of defining characteristics.

Back 87

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.

Front 88

Describe the etiology and symptoms associated with seasonal affective disorder and postpartum depression.

Back 88

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.

Front 89

What should the nurse consider to be the greatest risk in a patient with depression? Why?

Back 89

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.

Front 90

Name and define the two symptoms that are consistent with psychotic forms of depression.

Back 90

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.

Front 91

What is the primary nursing concern for a woman with postpartum depression?

Back 91

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.

Front 92

What is a bipolar response?

Back 92

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.

Front 93

What symptoms of mania are characteristic of bipolar disorder?

Back 93

• 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

Front 94

What are some possible factors that contribute to the development of bipolar disorder? At what age does this disorder normally become evident?

Back 94

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.

Front 95

What is cyclothymia? How does it differ from bipolar disorder?

Back 95

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.

Front 96

What is anxiety, and what is its relationship to behavioral disorders?

Back 96

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.

Front 97

Describe the relationship between anxiety and the autonomic nervous system.

Back 97

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.

Front 98

What neurotransmitters are thought to play a role in anxiety?

Back 98

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.

Front 99

What are some possible long-term physiological effects of anxiety?

Back 99

Chronic or recurring anxiety can result in physiological effects including stress hypertension, cardiovascular disease, and gastric ulcers.

Front 100

What are the three major categories of anxiety disorders?

Back 100

responsive anxiety disorders
dissociative anxiety disorders
somatoform anxiety disorders.

Front 101

Compare and contrast obsessions and compulsions.

Back 101

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.

Front 102

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

Back 102

Obsessive-compulsive disorder

Front 103

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

Back 103

Generalized anxiety disorder

Front 104

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

Back 104

Panic disorder

Front 105

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

Back 105

Post-traumatic stress disorder

Front 106

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

Back 106

Social phobia

Front 107

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

Back 107

Agoraphobia

Front 108

What feelings and behaviors characterize dissociative anxiety disorders? What are four subcategories of DADs?

Back 108

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.

Front 109

What is the purpose of an alter in dissociative identity disorder? How can alters manifest themselves?

Back 109

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.

Front 110

What is dissociative amnesia?

Back 110

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.

Front 111

What are somatoform anxiety disorders?

Back 111

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.

Front 112

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

Back 112

Pain disorder

Front 113

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

Back 113

Hypochondriasis

Front 114

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

Back 114

Conversion disorder

Front 115

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

Back 115

Body dysmorphic disorder

Front 116

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

Back 116

Somatization disorder

Front 117

What is a risk factor for somatoform anxiety disorders?

Back 117

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.

Front 118

What is “la belle indifférence”?

Back 118

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.

Front 119

What is the chief defining characteristic of the responses associated with altered thought processes?`

Back 119

some degree of withdrawal from reality.

Front 120

What are command hallucinations?

Back 120

hearing voices that order them to take their own lives or harm other individuals.

Front 121

What is the chief defining characteristic of paranoid behavior?

Back 121

irrational suspicion or persistent belief that one is being persecuted or falsely accused by others.

Front 122

Define “autism.” What are the primary symptoms of autism?

Back 122

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.

Front 123

What is schizophrenia? What are some influencing factors and theories of causation associated with this disorder?

Back 123

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.

Front 124

List some positive and negative symptoms that might be observed in patients with schizophrenia.

Back 124

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.

Front 125

Differentiate between echopraxia and echolalia.

Back 125

Echopraxia is the repeating and imitating of motions made by others.

Echolalia involves the involuntary repetition of words and phrases spoken by others.

Front 126

clang association

Back 126

nonsensical rhyming of words

Front 127

Differentiate between mutism and alogia.

Back 127

Mutism is the inability to speak associated with catatonic schizophrenia, while alogia is a poverty of speech.

Front 128

Define “avolition.”

Back 128

lack of motivation

Front 129

Compare and contrast the symptoms of a patient with catatonic schizophrenia with those of a patient with paranoid schizophrenia.

Back 129

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.

Front 130

Define “delirium” and identify some possible causative factors.

Back 130

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.

Front 131

Describe the effects of delirium on the central nervous system.

Back 131

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.

Front 132

Describe the effects of delirium on language.

Back 132

individuals with delirium may slur their speech and have difficulty forming words.

Front 133

Describe the effects of delirium on the cardiac system.

Back 133

irregular heart rate.

Front 134

Describe the effects of delirium on the respiratory system.

Back 134

depressed respiration's.

Front 135

Describe the effects of delirium on motor function.

Back 135

difficulty in maintaining balance. Tremors of the limbs are also symptomatic of delirium.

Front 136

Describe the effects of delirium on the urinary system.

Back 136

urinary incontinency.

Front 137

What is one of the most widely used mental status exams in dementia assessment? What does it assess?

Back 137

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.

Front 138

What are two types of brain scans used to diagnose and rule out dementia?

Back 138

magnetic resonance imaging (MRI) and computed axial tomography (CAT) scans.

Front 139

Describe the identifying characteristics, causative factors, and symptoms of dementia of the Alzheimer’s type (DAT).

Back 139

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.

Front 140

Describe the identifying characteristics, causative factors, symptoms, and treatment of vascular dementia.

Back 140

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.

Front 141

Describe the identifying characteristics, causative factors, symptoms, and diagnosis of AIDS dementia complex (ADC).

Back 141

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.

Front 142

Describe the identifying characteristics, causative factors, and symptoms of Wernicke-Korsakoff syndrome.

Back 142

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.

Front 143

Ptosis is also called

Back 143

"drooping eyelid"

Front 144

Describe the identifying characteristics, causative factors, and symptoms of Huntington’s chorea.

Back 144

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.

Front 145

Differentiate between aphasia, anomia, agnosia, apraxia, and ataxia.

Back 145

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.

Front 146

Define “sundowning.”

Back 146

display of agitation, wandering, and restlessness when the sun begins to set.

Front 147

Describe catastrophic reactions.

Back 147

extreme emotional outbursts often precipitated by multiple stimuli.

Front 148

Define “infarcts.”

Back 148

infarcts are areas of tissue necrosis.

Front 149

Differentiate between macrophages and cytokines.

Back 149

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.

Front 150

Differentiate between pill rolling and festination.

Back 150

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.

Front 151

What are the symptoms of thiamine deficiency?

Back 151

fatigue, irritability, nystagmus, ptosis, muscle tenderness, and anorexia.

Front 152

What is Parkinson’s disease and what neurotransmitters are associated with it?

Back 152

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.

Front 153

Describe the appearance and mood of a patient with Parkinson’s disease.

Back 153

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.

Front 154

Retrograde amnesia is an inability to transfer memories from short- to long-term memory.

True or False

Back 154

False

Retrograde amnesia is amnesia for events occurring prior to the episode precipitating the disorder.

Front 155

Transient global amnesia is a loss of both declarative and procedural memory.


True or False

Back 155

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

Front 156

Anterograde amnesia is an inability to recall events that occurred before the onset of amnesia.


True or False

Back 156

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.

Front 157

Traumatic amnesia is the amnesia that occurs after a head injury.


True or False

Back 157

True

Front 158

What are the two primary categories of aggressive responses?

Back 158

self-destructive behaviors and aggressive behaviors directed at other people.

Front 159

What are the four types of self-destructive behavior?

Back 159

suicide, substance abuse, eating disorders, and self-mutilation

Front 160

What types of people are most at risk for suicide?

Back 160

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.

Front 161

What primary warning signs might alert a nurse that a patient is suicidal?

Back 161

• 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

Front 162

Describe the approach a nurse should take when dealing with a suicidal patient.

Back 162

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?”

Front 163

What is the CAGE questionnaire? What four areas does it explore?

Back 163

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.

Front 164

What are the main types of aggressive behavior disorders in which aggression is largely directed at others?

Back 164

antisocial personality disorder and the conduct disorders. Abuse is also a type of aggressive behavior.

Front 165

Compare and contrast psychopathic and sociopathic behavior.

Back 165

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.

Front 166

What are conduct disorders?

Back 166

Conduct disorders are persistent, repetitive behavior patterns that result in some sort of violation of the rights of others.

Front 167

Describe the cycle of violence typically associated with ongoing abusive relationships.

T-AB-H

Back 167

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.

Front 168

What is attention deficit/hyperactivity disorder? What seems to be its cause?

Back 168

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.

Front 169

Name and briefly define the four impulse control disorders discussed in the text.

Back 169

kleptomania,

pyromania,

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

intermittent explosive disorder

Front 170

Differentiate between the three clusters of personality disorders according to their general defining characteristics.

Back 170

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.

Front 171

What are the key characteristics of paranoid personality disorder?

Back 171

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.

Front 172

What is desensitization?

Back 172

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.

Front 173

What is modeling?

Back 173

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.

Front 174

What is the primary goal of nursing according to Peplau’s social-interpersonal theory?

Back 174

According to Peplau’s theory, the primary goal of nursing is to resolve the health difficulties of the patient.

Front 175

What are the three stages of Peplau’s theory? What specific actions do they include?

Back 175

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.

Front 176

What is debriefing?

Back 176

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.

Front 177

Explain the origin of crisis intervention.

Back 177

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.

Front 178

Describe remotivation therapy, including its purpose and methods.

Back 178

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.

Front 179

Describe cognitive therapy, including its purpose and methods.

Back 179

Cognitive therapy focuses on helping people to view themselves realistically. To do so, it often challenges patients’ unhealthy attitudes about themselves.

Front 180

Describe operant conditioning, including its purpose and methods.

Back 180

Operant conditioning focuses on encouraging a behavior change by rewarding the desired behavior.

Front 181

What is the specific rationale for the use of antipsychotics in patients with schizophrenia?

Back 181

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.

Front 182

Name the four common antipsychotic medications mentioned in the text and list the defining characteristics for each.

Back 182

* Haloperidol

* Risperidone

* Clozapine

* Chlorpromazine

Front 183

Haloperidol

Back 183

(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.

Front 184

Risperidone

Back 184

(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.

Front 185

Clozapine

Back 185

(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.

Front 186

Chlorpromazine

Back 186

(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.

Front 187

What is agranulocytosis? What are some symptoms that nurses should look for in a patient who may be developing this condition?

Back 187

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.

Front 188

What are some specific anticholinergic side effects and why do they usually occur?

Back 188

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.

Front 189

Why do extrapyramidal side effects occur?

Back 189

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.

Front 190

List the defining characteristics of pseudoparkinsonism

Back 190

Pseudoparkinsonism is characterized by bradykinesia, diminished blink reflex, pill rolling, drooling, cogwheeling, and a masklike facial expression.

Front 191

List the defining characteristics of akinesia.

Back 191

Akinesia is characterized by a loss of voluntary muscle movement in addition to muscle pain and overall fatigue.

Front 192

List the defining characteristics and treatments of akathisia.

Back 192

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.

Front 193

List the defining characteristics of acute dystonia.

Back 193

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.

Front 194

List the defining characteristics of tardive dyskinesia.

Back 194

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.

Front 195

What diagnostic scale is used to evaluate tardive dyskinesia? What areas does it target for observation?

Back 195

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.

Front 196

What is the usual treatment for extrapyramidal side effects?

Back 196

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.

Front 197

What are some common antiparkinsonian medications that are used to treat extrapyramidal side effects?

Back 197

(Cogentin) and trihexyphenidyl (Artane), both of which are anticholinergics.

Amantadine (Symmetrel), a dopaminergic antiparkinsonian drug that works specifically to decrease bradykinesia and muscle rigidity.

Front 198

What is neuroleptic malignant syndrome (NMS)? When can it occur? What are the primary defining characteristics of this condition?

Back 198

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.

Front 199

How is neuroleptic malignant syndrome treated?

Back 199

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.

Front 200

What are anxiolytic medications used for? What is their overall action and effect?

Back 200

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.

Front 201

What are benzodiazepines? What is their primary effect?

Back 201

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.

Front 202

What specific precautions should the nurse take when administering benzodiazepines?

Back 202

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.

Front 203

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)

Back 203

Buspirone hydrochloride (BuSpar)

Front 204

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)

Back 204

Clonazepam (Klonopin)

Front 205

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)

Back 205

Hydroxyzine hydrochloride (Atarax)

Front 206

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)

Back 206

Buspirone hydrochloride (BuSpar)

Front 207

Which of the following medications may help prevent tardive dyskinesia?


A. Buspirone hydrochloride (BuSpar)

B. Diazepam (Valium)

C. Cyproheptadine hydrochloride (Periactin)

D. Temazepam (Restoril)

Back 207

Diazepam (Valium)

Front 208

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)

Back 208

Cyproheptadine hydrochloride (Periactin)

Front 209

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)

Back 209

Hydroxyzine pamoate (Vistaril)

Front 210

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)

Back 210

Temazepam (Restoril)

Front 211

What are antidepressants used for? How do they act in the body?

Back 211

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.

Front 212

Why are antidepressants generally not used to treat bipolar disorder?

Back 212

Antidepressants are generally not used in the treatment of people with bipolar disorder because they have a tendency to induce mania in these individuals.

Front 213

What are the signs of an impending hypertensive crisis related to an MAOI-tyramine interaction?

Back 213

-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

Front 214

What foods and beverages should patients avoid if they are taking an MAOI?

Back 214

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.

Front 215

What is serotonin syndrome? What are its symptoms?

Back 215

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.

Front 216

What are antimanics and how do they work?

Back 216

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.

Front 217

What is the most common antimanic medication? For what two conditions is it primarily used? How is this drug believed to work?

Back 217

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

Front 218

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?

Back 218

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.

Front 219

What are the symptoms of lithium toxicity?

Back 219

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.

Front 220

What medications, if given at the same time as lithium, may result in lithium toxicity? Why? What medications increase lithium excretion?

Back 220

Thiazide diuretics like Diuril deplete sodium and can thus contribute to dehydration and lithium toxicity. Conversely, medications like sodium bicarbonate can increase lithium excretion.

Front 221

What two mood stabilizers are frequently given to people who do not respond to lithium? How do these drugs work?

Back 221

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.

Front 222

What are central nervous system stimulants used for? How do they act in the body?

Back 222

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.

Front 223

When are anticonvulsants used? What is their effect?

Back 223

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.

Front 224

List the classifications, uses, and side effects of valproic acid (Depakene, Depakote)

Back 224

Valproic acid (Depakene, Depakote) is used to treat lithium-resistant bipolar disorders. Side effects include anorexia and hair loss. Valproic acid is hepatotoxic.

Front 225

carbamazepine (Tegretol)

Back 225

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.

Front 226

gabapentin (Neurontin)

Back 226

Gabapentin (Neurontin) is an anticonvulsant used to treat partial seizures. Common side effects include short-term mild to moderate dizziness, ataxia, and nystagmus

Front 227

clonazepam (Klonopin).

Back 227

Clonazepam (Klonopin) is a benzodiazepine used to treat akinetic seizures in children. It can cause aggressive behavior and hypersalivation.

Front 228

What are sedatives/hypnotics used for? How do they work?

Back 228

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.

Front 229

Why are sedatives/hypnotics normally recommended for short-term use?

Back 229

Patients can become dependent on them, and they slow down REM causing abnormal sleep patterns

Front 230

What are some common symptoms of withdrawal from sedatives/hypnotics? When will these symptoms usually occur?

Back 230

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.

Front 231

What are the symptoms of sedative/hypnotic overdose? How is this overdose treated?

Back 231

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.

Front 232

What are substance abuse deterrents?

Back 232

Substance abuse deterrents are pharmacological interventions that are given to help treat drug misuse and abuse.

Front 233

What are the symptoms of an Antabuse-alcohol reaction? What causes these symptoms?

Back 233

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.

Front 234

What are the symptoms of methadone withdrawal?

Back 234

Symptoms of methadone withdrawal include nausea, vomiting, elevated blood pressure, tachycardia, abdominal cramping, and flushing.

Front 235

What is phototherapy, and what patients might benefit from it?

Back 235

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).

Front 236

When is electroconvulsive therapy (ECT) useful?

Back 236

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

Front 237

What type of injuries could result from ECT? What medications might prevent them?

Back 237

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.

Front 238

Briefly describe the defining characteristics and uses of donepezil hydrochloride (Aricept), ginkgo biloba, St. John’s wort, thiamine, vitamin E, and acetaminophen.

Back 238

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.

Front 239

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?

Back 239

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

Front 240

What are endocrine glands and what do they do?

Back 240

Endocrine glands are ductless glands that secrete hormones directly into the bloodstream or lymph system.

Front 241

Describe the structure and location of the adrenal glands.

Back 241

The adrenal glands are attached to the top of the kidneys. Each gland consists of a cortex and a medulla.

Front 242

Describe the structure and location of the thyroid gland, and identify its products.

Back 242

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).

Front 243

Describe the location of the parathyroid glands, and identify their products.

Back 243

The parathyroid glands are located in the neck, behind or embedded in the thyroid gland. The four glands secrete parathormone (PTH).

Front 244

Describe the structure and location of the pituitary gland, and identify its products.

Back 244

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.

Front 245

Name the hormones secreted by the adrenal cortex. Provide an example of each. What are the functions of each of these hormones?

Back 245

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.

Front 246

Name the hormones secreted by the adrenal medulla and describe their function, including how they operate and what effects they have on the body.

Back 246

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.

Front 247

Discuss the function and production of the thyroid hormones.

Back 247

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.

Front 248

Describe the function and production of growth hormone (GH).

Back 248

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.

Front 249

Differentiate between the roles played by follicle-stimulating hormone (FSH), prolactin, and luteinizing hormone (LH).

Back 249

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.

Front 250

Identify the function of both adrenocorticotropic hormone (ACTH) and thyroid-stimulating hormone (TSH).

Back 250

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.

Front 251

Name the hormones produced by the posterior lobe of the pituitary gland and identify the function of each.

Back 251

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.

Front 252

What are the primary functions of the kidneys?

Back 252

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.

Front 253

What are the three primary structures of the kidney?

Back 253

The three primary structures of the kidney are the cortex, medulla, and renal pelvis.

Front 254

What is the functional unit of the kidney and what is its action?

Back 254

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.

Front 255

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.

Back 255

C. a waste product of the metabolism of proteins and amino acids.

Front 256

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.

Back 256

B. a waste product of skeletal muscle metabolism

Front 257

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.

Back 257

A. a product of purine metabolism.

Front 258

Discuss the causative factors, defining characteristics, symptoms, and treatment of pheochromocytoma.

Back 258

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.

Front 259

Discuss the causative factors, defining characteristics, symptoms, and treatment of Cushing’s syndrome.

Back 259

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.

Front 260

Discuss the causative factors, defining characteristics, and symptoms of Addison’s disease.

Back 260

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.

Front 261

Discuss the causative factors, defining characteristics, and symptoms of syndrome of inappropriate antidiuretic hormone secretion (SIADH).

Back 261

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.

Front 262

Discuss the causative factors, defining characteristics, and treatment of diabetes insipidus.

Back 262

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.

Front 263

Discuss the causative factors, defining characteristics, and treatment of acromegaly.

Back 263

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.

Front 264

Discuss the causative factors, defining characteristics, and treatment of hypopituitarism.

Back 264

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.

Front 265

List five signs of pheochromocytoma.

Back 265

nausea, vomiting, nervousness, visual disturbances, tachycardia, palpitations, hypertension, headache, hyperhidrosis, hypermetabolism, and hyperglycemia. All are symptoms of overactivity of the sympathetic nervous system.

Front 266

What is malignant hypertension? What causes this condition?

Back 266

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.

Front 267

What are some specific interventions aimed at the relief of episodes of malignant hypertension associated with pheochromocytoma?

Back 267

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.

Front 268

What are some specific nonpharmacological interventions that should be implemented prior to catecholamine testing?

Back 268

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.

Front 269

What medications, foods, and beverages should be avoided prior to any catecholamine testing?

Back 269

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.

Front 270

What is the rationale for intravenous therapy prior to surgical removal of the adrenal glands?

Back 270

Intravenous therapy ensures that the patient is well hydrated; inadequate hydration can lead to hypotensive states both during and after surgery.

Front 271

What medications are usually given prior to an adrenalectomy? Why?

Back 271

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.

Front 272

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?

Back 272

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.

Front 273

Identify the diagnostic tests and laboratory values for pheochromocytoma.

Back 273

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.

Front 274

Identify the diagnostic tests and laboratory values for Cushing’s syndrome.

Back 274

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.

Front 275

Identify the diagnostic tests and laboratory values for Addison’s disease.

Back 275

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.

Front 276

Identify the diagnostic tests and laboratory values for syndrome of inappropriate antidiuretic hormone secretion (SIADH).

Back 276

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.

Front 277

Identify the diagnostic tests and laboratory values for diabetes insipidus.

Back 277

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.

Front 278

Identify the diagnostic tests and laboratory values for acromegaly.

Back 278

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.

Front 279

Identify the diagnostic tests and laboratory values for hypopituitarism.

Back 279

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.

Front 280

True or False

Physical and emotional stress decreases the need for prednisone.

Back 280

False. Physical and emotional stress increases the need for prednisone.

Front 281

True or False

Corticosteroids are generally given at bedtime.

Back 281

Corticosteroids are generally given in the morning.

Front 282

True or False

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

Back 282

True

Front 283

True or False

Prednisone and other steroids should be given with fruit juice because of their bitter taste.

Back 283

False. Prednisone and other steroids should be given with milk or antacids because they can cause ulcers.

Front 284

True or False

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

Back 284

True

Front 285

True or False

Diet should be high in carbohydrates and protein but very low in sodium.

Back 285

False. Diet should be high in carbohydrates, sodium, and protein.

Front 286

What are four symptoms of steroid overdose?

Back 286

weight gain
edema
elevated blood pressure
euphoria.

Front 287

What are four symptoms of inadequate steroid dosage?

Back 287

weight loss
dizziness
postural hypotension
depression.

Front 288

Explain how polydipsia, polyuria, and polyphagia may occur in individuals with Cushing’s syndrome.

Back 288

Polydipsia, polyuria, and polyphagia may occur related to the inhibiting effect of glucocorticoid hormones on insulin.

Front 289

Explain how frequent infections may occur in individuals with Cushing’s syndrome.

Back 289

Frequent infections may occur related to increased susceptibility.

Front 290

Explain how depression and psychosis may occur in individuals with Cushing’s syndrome.

Back 290

Depression and psychosis may occur related to changing body image and the effect of cortisol on the neurological system.

Front 291

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

Back 291

A. Prevents constriction of blood vessels

Front 292

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

Back 292

D. Is a common antiarrhythmic drug

Front 293

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

Back 293

B. Used for malignant hypertension

Front 294

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

Back 294

C. Suppresses adrenal secretions

Front 295

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

Back 295

B. Often given following bilateral adrenalectomy

Front 296

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

Back 296

A. Used to treat fluid retention related to SIADH

Front 297

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

Back 297

D. Contraindicated if patient is allergic to peanuts

Front 298

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

Back 298

C. Comes in a nose spray

Front 299

Differentiate between intravenous hydrocortisone (Solu-Cortef) and oral hydrocortisone (Cortef).

Back 299

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.

Front 300

What precipitates an Addisonian crisis? What are the symptoms?

Back 300

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.

Front 301

What is the usual initial treatment for Addisonian crisis?

Back 301

-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).

Front 302

What postoperative nursing care should follow pituitary surgery?

Back 302

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.

Front 303

Why are high-protein diets contraindicated for patients with diabetes insipidus?

Back 303

High-protein diets are contraindicated for patients with diabetes insipidus because high-protein foods increase urinary output and sodium excretion.

Front 304

Discuss the causative factors and defining characteristics of hyperthyroidism.

Back 304

excessive amounts of circulating thyroid hormone (T3 and T4)

gradual weight loss secondary to increased BMR and protein catabolism, polyphagia, and amenorrhea

Front 305

Discuss the causative factors, defining characteristics, and treatment of hypothyroidism.

Back 305

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

Front 306

What are the three phases of ARF?

Back 306

The three phases of ARF are the oliguric phase, the diuretic phase, and the recovery phase.

Front 307

Compare and contrast urine output and quality in each phase of ARF.

Back 307

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.

Front 308

What causes the anemia that is sometimes associated with ARF?

Back 308

With ARF, anemia is often caused by decreased production of erythropoietin, as well as elevated BUN levels that increase bleeding tendencies.

Front 309

What foods should be avoided by patients who are recovering from ARF?

Back 309

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.

Front 310

What are the major causes of chronic renal failure (CRF)?

Back 310

Major causes of CRF include
poorly controlled diabetes mellitus
chronic hypertension
kidney infection

Front 311

What are the three phases of CRF?

Back 311

The three phases of CRF are those of diminished renal reserve,
renal insufficiency,
end-stage renal disease (ESRD).

Front 312

How does the liver help maintain normal blood glucose levels after carbohydrates are consumed?

Back 312

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.

Front 313

What are fatty acids? What happens when they combine with oxygen?

Back 313

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.

Front 314

What are ketones? What is their relationship to metabolic acidosis?

Back 314

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.

Front 315

What are the end products of protein digestion? What is their function?

Back 315

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.

Front 316

Where is bile produced? What is the function of this substance?

Back 316

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.

Front 317

What is bilirubin? How is it formed?

Back 317

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.

Front 318

Briefly describe the role of Vitamin A in the body.

Back 318

Vitamin A is essential for normal growth and development. It aids in resistance to infections and is needed for visual acuity.

Front 319

Briefly describe the role of Vitamin D in the body.

Back 319

Vitamin D is necessary for calcium and phosphorous absorption and aids in bone and tooth development.

Front 320

Briefly describe the role of Vitamin E in the body.

Back 320

Vitamin E promotes the stability of red blood cells and may help counter free radical production.

Front 321

Briefly describe the role of Vitamin K in the body.

Back 321

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.

Front 322

Briefly describe the role of iron in the body.

Back 322

Iron is a component of hemoglobin and is important for oxygen transport in the blood.

Front 323

How is the gallbladder related to digestion?

Back 323

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.

Front 324

What exocrine secretions does the pancreas produce?

Back 324

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.

Front 325

What three hormones are secreted by the pancreas? What cells produce each of type of hormone? Where are these cells located?

Back 325

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.

Front 326

Describe the action of glucagon, insulin, and somatostatin.

Back 326

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.

Front 327

State the relationship of insulin to each of the following: glycogen, fat, and protein.

Back 327

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.

Front 328

What is cholelithiasis? What are some contributing factors for this condition?

Back 328

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.

Front 329

What is cholecystitis?

Back 329

Cholecystitis is an inflammation of the gallbladder. It usually occurs when cholelithiasis restricts bile flow to the duodenum.

Front 330

Severe gallbladder pain that is located in the upper right quadrant of the abdominal cavity is called _________________.

Back 330

Biliary colic

Front 331

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

Back 331

C. Contraction; gallbladder; bile ducts

Front 332

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

Back 332

C. Guarding

Front 333

Where might a patient experience pain in relation to cholecystitis?

Back 333

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.

Front 334

What are ursodiol (Actigall) and chenodiol (Chenix)?

Back 334

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.

Front 335

Why are fried and fatty foods restricted for patients with cholecystitis?

Back 335

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.

Front 336

What is the most common complaint following laparoscopic cholecystectomy? Why? What nursing measures may help resolve this situation?

Back 336

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.

Front 337

What are the complications of laparoscopic laser cholecystectomy? What are some associated symptoms?

Back 337

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.

Front 338

What is acute pancreatitis? What enzymes are associated with this condition?

Back 338

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.

Front 339

Describe the pain associated with acute pancreatitis. When is this pain likely to occur?

Back 339

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.

Front 340

What sign would indicate the resolution of an acute episode of pancreatitis?

Back 340

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.

Front 341

Describe the pain associated with chronic pancreatitis. What precipitates this pain?

Back 341

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.

Front 342

In addition to pain, what signs and symptoms are associated with chronic pancreatitis?

Back 342

In addition to pain, symptoms of chronic pancreatitis include anorexia, weight loss, jaundice, diarrhea, steatorrhea, and signs of developing diabetes.

Front 343

What is cirrhosis? What is another name for this condition?

Back 343

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.

Front 344

What are three common causes of cirrhosis?

Back 344

alcoholism, chronic viral hepatitis, and ingestion of toxic substances, including drugs.

Front 345

Differentiate between Laënnec’s cirrhosis and postnecrotic cirrhosis.

Back 345

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.

Front 346

What changes in the body contribute to the development of the symptoms of cirrhosis?

Back 346

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.

Front 347

Explain why fatigue, general weakness, and malaise may occur as symptoms of cirrhosis.

Back 347

Fatigue, general weakness, and malaise in cirrhosis are often related to anemia.

Front 348

Explain why shortness of breath may occur as a symptom of cirrhosis.

Back 348

Shortness of breath results when abdominal ascites or hepatomegaly pushes the diaphragm into the chest cavity.

Front 349

Explain why esophageal varices may occur as a symptom of cirrhosis.

Back 349

Esophageal varices are caused by portal hypertension, a complication associated with cirrhosis.

Front 350

Explain why jaundice and pruritis may occur as symptoms of cirrhosis.

Back 350

Jaundice and pruritus may develop in relation to a buildup of bile pigments in the skin.

Front 351

Explain why bleeding gums, ecchymoses, and spider angiomas may occur as symptoms of cirrhosis.

Back 351

Bleeding gums, ecchymoses, and spider angiomas may occur in relation to high estrogen levels and decreased absorption of vitamin K.

Front 352

In a patient with cirrhosis, would levels of aspartate aminotransferase (AST) be high or low?

Back 352

High

Front 353

In a patient with cirrhosis, would levels of alanine aminotransferase (ALT) be high or low?

Back 353

high

Front 354

In a patient with cirrhosis, would hemoglobin levels be high or low?

Back 354

Low

Front 355

In a patient with cirrhosis, would hematocrit levels be high or low?

Back 355

low

Front 356

In a patient with cirrhosis, would serum albumin levels be high or low?

Back 356

Low

Front 357

In a patient with cirrhosis, would serum bilirubin levels be high or low?

Back 357

High

Front 358

In a patient with cirrhosis, would folic acid levels be high or low?

Back 358

Low

Front 359

If diuretic therapy is not effective in treating ascites, what other procedure can be performed? How?

Back 359

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.

Front 360

How should nurses assess for fluid buildup in patients with cirrhosis?

Back 360

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.

Front 361

What dietary recommendations (including specific vitamins and minerals) should be given to patients with cirrhosis?

Back 361

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

Front 362

What is portal-systemic encephalopathy (PSE)? What causes this condition?

Back 362

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.

Front 363

What are the early signs of PSE?

Back 363

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.

Front 364

What are the advanced symptoms of PSE?

Back 364

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.

Front 365

What medications are used to reduce bacteria in the bowel? What are some side effects of these medications?

Back 365

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.

Front 366

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?

Back 366

* 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

Front 367

Nick is admitted with bleeding esophageal varices. What would be a priority diagnosis for Nick?

Back 367

One priority diagnosis for a patient with bleeding esophageal varices would be deficient fluid volume related to hemorrhage caused by portal hypertension.

Front 368

What would be a priority need for a patient with acute pancreatitis?

Back 368

One example of a priority need for a patient with acute pancreatitis would be to decrease his or her release of pancreatic enzymes.

Front 369

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?

Back 369

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

Front 370

The sequential acquisition of physical, mental, and social skills is called:

Back 370

the developmental process

Front 371

What organization publishes the DSM-IV?

Back 371

American Psychiatric Association (APA)

Front 372

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

Back 372

Reiki therapy

Front 373

A nurse who is interested in applying Caplan’s theory to behavior management would focus on:

Back 373

preventative strategies to help patients cope with anxiety.

Front 374

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

Back 374

Need to teach patient about ways to prevent diarrhea

Front 375

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?

Back 375

Hypomania is a primary characteristic of cyclothymia

Front 376

Which of the following values characteristically accompanies aggression and anxiety?

Back 376

Low levels of GABA

Front 377

The symptom most commonly associated with conversion disorder is:

Back 377

la belle indifférence

Front 378

Which of the following is characteristic of a person with retrograde amnesia?

Back 378

The patient is unable to recall events before the onset of amnesia

Front 379

The symptoms of what type of dementia can be treated with medication that may prevent additional pathological changes in the brain

Back 379

Multi-infarct dementia

Front 380

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

Back 380

risperdal

Front 381

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?

Back 381

Aged cheese, chocolate, bananas, and soy sauce

Front 382

Which of the following symptoms are associated with pheochromocytoma?

Back 382

Headaches
Nausea
Vomiting

Front 383

The nurse listens over the patient’s thyroid gland and hears a whistling sound. What is she hearing?

Back 383

A bruit- A vascular murmur heard over a hyperactive thyroid gland.

Front 384

Which of the following might the nurse expect to see in a patient after he or she has undergone thyroidectomy?

Back 384

Twitching of the eye when the facial nerve is tapped

Front 385

Metabolism of what substance produces ketones?

Back 385

Fat

Front 386

Prior to intravenous cholangiogram or oral cholecystography, what action would be most important for the nurse to take?

Back 386

Asking the patient about any allergies

Front 387

Discharge teaching for a patient who has undergone cholecystectomy includes providing information about signs of biliary obstruction. A set of these signs might include:

Back 387

pruritus, dark urine, and clay-colored stools.

Front 388

For what purpose would the nurse give a patient lactulose or sorbitol?

Back 388

To reduce bacteria in the bowel

Front 389

Blood analysis of the newborn of a mother with uncontrolled gestational diabetes might reveal:

A. hyperglycemia.
B. hypercalcemia.
C. hyperbilirubinemia.
D. hyperphosphatemia

Back 389

C. hyperbilirubinemia

Front 390

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.

Back 390

D. a diet high in protein.