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Mental Health Exam 4 Review 1.0

Mental Health Exam 4 Review 1.0

by imanurseyo, Feb. 2014

Subjects: 10 4 exam health mental review

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96 Cards in this Set

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	Using a Cognitive Therapy approach what intervention is most appropriate by the nurse when the client says, "I get down on myself when I make a mistake"?	Using a Cognitive Therapy approach what intervention is most appropriate by the nurse when the client says, "I get down on myself when I make a mistake"? - Change attitude - Illuminate the thought that something is awful, terrible or horrible (remove the word awful from the clients vocabulary) - modify the belief to eliminate or change the situation where the patient sees that anything less than perfection is unacceptable (the answer) "It’s not the situation that makes you crazy, it is what you tell yourself about the situation (inside your head)" - Cognitive-Behavioral Therapy – Type of psychotherapy, based on cognitive model, which focuses on client thoughts and behaviors to solve current problems - Several approaches: rational emotive behavior therapy, and rational behavior therapy - Used to treat depression, anxiety, eating disorders, and other problems that can be improved by changing the client’s attitudes toward life experiences - The trained therapist uses therapeutic communication to change client’s irrational thoughts to thoughts and feelings that are more objective and realistic - Therapy is time limited, active, structured, and directive – helps people identify distorted thoughts (bad beliefs about themselves) and to evaluate whether those thoughts (cognitions) are realistic
	A psychiatric unit uses a behavioral approach to determine the level of privileges (usually in a substance abuse program); you want something objective you can measure. What can u objectively measure in behavior?	A psychiatric unit uses a behavioral approach to determine the level of privileges (usually in a substance abuse program); you want something objective you can measure. What can u objectively measure in behavior? - measure objectively how you respond to stress. Like "always attending groups, or making your bed in your room group or taking your meds or going to meals on time, performing hygiene and ADL's independently... they are all measureable ways to determine objective information. - Something objectively measured in behavior
	A nurse has explored non pharmacological modalities available for treatment of phobias, what is this?	A nurse has explored non pharmacological modalities available for treatment of phobias, what is this? (In PowerPoint its mixed in with - Systematic desensitization – type of behavior modification used to lessen the phobias of a specific client
	A nurse encourages a patient to join a self-help group after being discharged from a mental health facility, what is the purpose of that sort of referral?	A nurse encourages a patient to join a self-help group after being discharged from a mental health facility, what is the purpose of that sort of referral? - To provide structure & support - Group norm – The way they group behaves during sessions, and overtime, provides structure and support for the group - Group members support each other
	A male nurse reminds a client that it is time for group therapy, patient responds by yelling "You tell me what to do like my Father!” What kind of defense mechanism is that?	A male nurse reminds a client that it is time for group therapy, patient responds by yelling "You tell me what to do like my Father!” What kind of defense mechanism is that? - Transference behavior -characterized by unconscious redirection of feelings from one person to another.
	A nurse leads an assertiveness training program for a group of patient; they are looking for a measure that would demonstrate that the treatment would be effective.	A nurse leads an assertiveness training program for a group of patient; they are looking for a measure that would demonstrate that the treatment would be effective. - Example of someone being assertive: "so I told him not to do it anymore" - Assertiveness training – Client learns to communicate in a more assertive (not aggressive) manner in order to decrease psychological stressors; “When you keep telling me what to do , I feel angry and frustrated. I need to try making my own decisions.”
	Electro convulsive therapy- what is the criterion that we use for recommending ECT?	Electro convulsive therapy- what is the criterion that we use for recommending ECT? - severe depression - Intractable Depression (persistent resistant depression) - Severe, Persistent, and Intractable Depression with suicidal ideation - The above and "suicidal ideation" - Not responsive to pharmacologic treatment - Risk of other treatments outweigh risk of ECT - Actively suicidal and in need of rapid response
	What is Electroconvulsive therapy (ECT)?	What is Electroconvulsive therapy (ECT)? - It is an alternative somatic treatment that has been in use for 60 years and is still administered to 100,000 clients each year in the U.S. - Exact mechanism of action is still unknown - Although some studies have shown 80% of severely depressed clients improve, other studies indicate high relapse rate - Side effects: temporary memory loss and confusion - Prior to treatment, an anticholinergic, such as atropine sulfate is given to dry up oral secretions
	What are S/E of ECT?	What are S/E of ECT? - Temporary memory loss and confusion - Severe HTN should be controlled before the procedure, since a short period of HTN occurs after ECT is performed.
	A patient is reporting vague dread she is pacing and hyperventilating, she has a clenched jaw when u assess her, what would be the type of medication this patient would need?	A patient is reporting vague dread she is pacing and hyperventilating, she has a clenched jaw when u assess her, what would be the type of medication this patient would need? - Anti-manic drug - barbiturate - Antianxiety Drugs (Anxiolytics) (the answer)
	Know the med that will reverse the seditive effects of benzodiazepine?	Know the med that will reverse the seditive effects of benzodiazepine? - flumazenil (Romazicon) for IV toxicity; have resuscitation equipment available (antidote)
	What is Narcan (Naloxone) the antidote for?	What is Narcan (Naloxone) the antidote for? - Opioids (narcotics)
	What is the adverse reactions from abrupt withdrawal of barbiturate use?	What is the adverse reactions from abrupt withdrawal of barbiturate use? - seizures & sudden death - Symptoms of barbiturate withdrawal syndrome appear 12-20 hours after the last dose: anxiety, irritability, increased heart and respiration rate, muscle pain, nausea, tremors hallucinations, confusion, and seizures, and death
	Understand Amitriptyline (Tricyclic Antidepressants) - what is the most important patient teaching for this drug?	Understand Amitriptyline (Tricyclic Antidepressants) - what is the most important patient teaching for this drug? - Taper the medication before discontinuing - The TCAs must be tapered when discontinuing the medication
	You have patient with anorexia, what would be some of the symptoms your patient would be demonstrating?	You have patient with anorexia, what would be some of the symptoms your patient would be demonstrating? - 85% body weight - preoccupied with a fear of obesity - obsessed with food and exercise - visual perception of themselves (concerned with their appearance) (answer)
	Tofranil (can cause problem with glaucoma), can cause problem with glaucoma.	Tofranil (can cause problem with glaucoma), can cause problem with glaucoma. - narrow angle glaucoma - Used cautiously in cardiac, hepatic, or renal disease, hyperthyroid disease, history of seizures, narrow angle glaucoma, urinary retention, and risk of suicidal ideation or behavior (very lethal in overdose) - Contraindicated in clients with glaucoma or tendency for urinary retention (older men with BPH)
	What symptom is associated with Clomipramine (Anafranil) (TCA)?	What symptom is associated with Clomipramine (Anafranil) (TCA)? - Gynecomastia
	MAOI's a patient who is on MAOI's, what should the nurse teach the patient to avoid?	MAOI's a patient who is on MAOI's, what should the nurse teach the patient to avoid? - avoid foods with tyramine (wine & foods with cheese) - Aged cheese, sour cream, yogurt - Beef or chicken livers, pickled herring, fermented meats (bologna, hot dogs, pepperoni, and dried fish) - Undistilled alcoholic beverages (beer, ale, red wine, especially Chianti and sherry) - Caffeinated beverage (coffee, tea, colas), chocolate - Avocado, bananas, fava beans, figs, raisins, sauerkraut, yeast extracts, soy sauce
	patient is on the 2 MAOI inhibitors (know both names) there are only two not 3.	patient is on the 2 MAOI inhibitors (know both names) there are only two not 3. - phenelzine (Nardil), tranylcypromine (Parnate) - isocarboxazid (Marplan is no longer available)
	Photosensitivity is a side effect associated with which class of drugs?	Photosensitivity is a side effect associated with which class of drugs? - Tricyclic Antidepressants - Antipsychotic like Thorazine (chlorpromazine) (the old ones)
	Q1. If your patient is on lithium, what are the therapeutic and toxic levels? Q2. If the patient's levels fall within the levels, you administer the drug.	Q1. If your patient is on lithium, what are the therapeutic and toxic levels? - Initial treatment: 0.8-1.4 mEq/L - Maintenance: 0.4-1.0 mEq/L - Levels > 1.5 mEq/L cause toxicity - Monitor plasma lithium levels during treatment: at initiation, monitor every 2-3 days and then every 1-3 months: 0.6-1.2 mEq/L is desirable Q2. If the patient's levels fall within the levels, you administer the drug. - If the levels are higher, you hold it and contact the primary care provider.
	Patient on lithium what would be some of the meds you would question the patient receiving?	Patient on lithium what would be some of the meds you would question the patient receiving? - Lasix (loop dieretic) - NSAIDS - Antacids - any sodium depleting meds - Lithium is contraindicated in clients with hypersensitivity to tartrazine, renal or cardiovascular disease, sodium depletion, dehydration, and in clients receiving diuretics
	Which meds require careful monitoring of the patients’ blood level? Know the levels	Which meds require careful monitoring of the patients’ blood level? (there are 4 that you would need to monitor closely). Know the levels - Lithium – 0.4-1.4 mEq/L - Tegretol (carbamazepine) – 3-14 mcg/ml - Valproic acid (Depakote) – 50-100 mcg/ml - Dilantin (phenytoin) – 10-20 mcg/ml
	patient on Valproic acid (Depakote), what meds would you question if they were ordered?	patient on Valproic acid (Depakote), what meds would you question if they were ordered? - Like birth control - Should not be used by those pregnant or nursing; need to use contraception
	a 24 year old female client with Bipolar disorder is prescribed valporic acid (depakote) anticonvulsive, which question would the nurse ask the client?	a 24 year old female client with Bipolar disorder is prescribed valporic acid (depakote) anticonvulsive, which question would the nurse ask the client? - "are you taking any type of birth control?" (Valproic acid makes the birth control ineffective)
	What is the pathophysiology of Alzheimer’s meds like Aricept (donepezil)?	What is the pathophysiology of Alzheimer’s meds like Aricept (donepezil)? - increases the availability of acetylcholine at the cholinergic synapses
	What do u do with all children when you admin Ritalin? What do you monitor?	What do u do with all children when you admin Ritalin? What do you monitor? - Monitor VS, height, weight, growth, and behavior
	Do you know the S/S of Tardive Dyskinesia?	Do you know the S/S of Tardive Dyskinesia? - Syndrome consisting of irreversible, involuntary dyskinetic movements - Symptoms: rhythmic, involuntary movements of the tongue, face, mouth, or jaw and sometimes the extremities - Tongue may protrude and there may be chewing movements, mouth puckering, or facial grimacing - Drug therapy must be discontinued
	What is Extrapyramidal Syndrome (EPS)	What is Extrapyramidal Syndrome (EPS) - Group of adverse reactions affecting the extrapyramidal portion of the nervous system - Symptoms: Parkinson-like symptoms, akathisia (restless movements), dystonia (facial grimacing and twisting of the neck into unnatural positions) - Typically the primary health care provider prescribes trihexyphenidyl (Artane), biperiden (Akineton), or benzotropine (Cogentin)
	What is Neuroleptic Malignant Syndrome?	What is Neuroleptic Malignant Syndrome? - Rare reaction characterized by a combination of extrapyramidal effects, hyperthermia, and autonomic disturbance - Typically occurs within 1 month after drug regimen occurs - Potentially fatal; immediate discontinuation of drug - Recovery occurs within 7-10 days
	Non pharmacological approach to a pt who states "I get down on myself sometimes"?	Non pharmacological approach to a pt who states "I get down on myself sometimes"? Tell them no one is perfect
	Behavioral approach for level of priviledges for pt?	Behavioral approach for level of priviledges for pt? You are able to increase priviledges if pt has an increased ability in function (behavior, not cognitive)
	Non pharmacological modalities for phobias?	Non pharmacological modalities for phobias? systematic desensitization
	Main goal of self help group?	Main goal of self help group? Support
	Nurse tells pt its time to go to group and the pt responds "You always tell me what to do, just like my dad", what is happening?	Nurse tells pt its time to go to group and the pt responds "You always tell me what to do, just like my dad", what is happening? Transference
	In an assertiveness training program how will you know its been effective?	In an assertiveness training program how will you know its been effective? The pt confronts someone with assertiveness but not aggressively
	Treatment plan for severe persistent intractable depression and suicidal ideation?	Treatment plan for severe persistent intractable depression and suicidal ideation? ECT
	S/E of post procedure of an ECT?	S/E of post procedure of an ECT? amnesia and confusion
	Pt is pacing and hyperventilating with their jaw clenched?	Pt is pacing and hyperventilating with their jaw clenched? Needs anti-anxiety meds
	What is a barbiturate?	What is a barbiturate? sedative/hypnotic

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