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Exam II

Terms in this set (89)

Area of the brain that mediates fear response. Plays a substantial role in panic and phobia disorders.
Amygdala
Which medication can be given along with 1st generation antipsychotics to reduce the likelihood of EPS symptoms occurring?
Benadryl (diphenhydramine)
Which medications (name, not class) are commonly prescribed to those with PTSD?
Paxil (paroxetine) or Zoloft
Which type of therapy focuses are teaching patients to learn reframe their thinking and behavior in ways that will improve their mood, functioning & sense of well-being?
Cognitive behavior therapy
Name the SNRI that is used for the treatment of seasonal affective disorder
bupropion (Wellbutrin)
Which electrolyte that is important to monitor when patients are prescribed lithium
Sodium
In which area of the brain do visual hallucinations occur?
Occipital lobe
Which two types of medications should be avoided in patients on lithium therapy?
Diuretics & NSAIDs
What are the early symptoms of lithium toxicity?
nausea/vomiting & diarrhea
What is the therapeutic range for lithium?
0.6-1.2
Which manifestation of mania should be 1st priority?
Nonstop physical behavior
Which neurotransmitter is theorized to play a key role in schizophrenia?
dopamine
Where is the mesocortical dopamine pathway?
Frontal lobe
Where is dopamine manufactured in the brain?
substantia nigra
Atypical antipsychotic are often prescribed to those with what disorder?
Bipolar
Which dopamine pathway is associated with negative symptoms of schizophrenia such as impaired cognition & flat affect?
Mesocortical pathway
Which dopamine pathway is associated with the positive symptoms of schizophrenia and is the target of antipsychotic medications for reducing hallucinations/delusions?
Mesolimbic pathway
Dopamine blockade of which pathway can result in hyperprolactinemia & sexual dysfunction
Tuberoinfundibular pathway
Which dopamine pathway is associated with EPS symptoms and tardive dyskinesia?
Nigrostriatal pathway/mesolimbic
What side effect can be caused by either 1st or 2nd generation antipsychotics and be mistaken for an increase in symptoms of schizophrenia?
akathisia
Akathisia
restless leg syndrome like in presentation, causes pin and needle sensation
Which is the most serious of EPS syndrome symptoms and can occur even after years of therapy or when there is a change in dose?
Tardive dyskinesia
What cardiac complication can occur with 1st gen antipsychotics and Abilify?
prolonged Q-T interval
Which 2 antipsychotics cause the most weight gain (brand name)?
Zyprexa & Clozaril
Which antipsychotic causes significant weight gain and requires monitoring of WBCs due to risk for agranularcytosis.
Clozaril
This syndrome is associated with antipsychotics and can lead to renal failure, and death.
Neuroleptic malignant syndrome
Which atypical antipsychotic is very effective at assisting with suicidal thoughts?
Clozaril
Which medication could be given via injection in the ER for psychosis
Zyprexa
What is a common judgement made by family members of those with schizophrenia?
That the person is lazy
What is the term for delusional thoughts where the person thinks that a song, news article etc. is about them
delusions of reference
What is the expected outcome for someone with anxiety disorder that has recently began treatment?
That the symptoms will be relieved by the one month mark
Which antipsychotic is known for having a low risk for EPS symptoms
Risperdal (risperidone)
Which atypical antipsychotic medication is short acting and can be given via injection for management of acute mania or agitation
olanzapine (Zyprexa)
What are the vegetative symptoms of depression?
anorexia, isolation, guilt, suicidiality, functional impairment, decreased activity
What type of assessment questions are related to thought content?
cognitive assessment
Where is serotonin produced?
raphe nuclei
Which NT pathway runs through the occipital lobe of the brain?
Mesolimbic pathway
What drug classification is Haldol (haloperidol)?
1st generation antipsychotic
What drug classification is Wellbutrin (bupropion)
SNRI
Which neurotransmitter is associated with motivation
norephinephrine
What drug classification is olanzipine (Zyprexa)
2nd generation (atypical) antipsychotic
What drug classification do Parnate (tranylcypromine) & Nardil (phenelzine) fall under?
MAOIs
What adverse event can result from consumption of foods with tyramine and MAOIs?
hypertensive crisis
What drug class is lithium?
mood stabilizer/anticonvulsant
What drug class is Ativan (lorazepam)
anxiolytic/benzodiazepen
Which 1st generation antipsychotic is given due to also having a long acting decanoate form and low cost?
Prolixin (fluphenazine)
Which medication can be used for panic disorders and is often also prescribed for sleep?
Klonopin (clonazepam)
Which 1st generation antipsychotic is often used as a 1st line treatment for bipolar disorder?
Depakote (divalproex)
Which neuroanatomical area of the brain is being affected in the patient complaining of issues with sleep, change in libido, feeling fatigued, or appetite?
hypothalamus
What structures comprise the limbic system
diencephalon, amygdala, hippocampus
What effect does nicotine have on antipsychotic medications
speeds up metabolism
What is a priority assessment for children/teens that are beginning antidepressant medications?
Assess for suicide risk
Before a newly admitted patient for anxiety can begin benzodiazepines, the nurse must ask the patient about their use of what substances?
alcohol/other CNS depressants
What purpose does compulsive behavior serve in the patient with OCD?
Relief of anxiety
Which finding enables the nurse conclude that the client is in the premorbid phase of schizophrenia?
A) The client is anxious and irritable
B) The client is very shy & withdrawn
C) The client has disorganized speech
D) The client has diminished emotional expression
B) The client is very shy & withdrawn-
While reviewing the lab report of a client w/psychotic disorder, the nurse finds abnormally high levels of prolactin. Which medication might be the cause of this finding?
A) clozapine
B) haloperidol
C) risperidone
D) lurasidone
B) haloperidol
Which anticholinergic side effect is associated with second generation (atypical) antipsychotic medications?
A) tremor
B) drowsiness
C) weightloss
D) bradycardia
A) tremor
A client with a psychiatric illness tells the nurse, "It is very cold. I am cold and bold. The gold has been sold." Which intervention would the nurse implement in this situation?
A) ignore the statement
B) ask the client for clarification
C) observe the client
D) notify the health-care provider
B) ask the client for clarification
Which does the catatonia specifier stupor indicate?
A) absence of verbal response
B) no influence on external stimuli
C) absence of psychomotor activity
D) no response to external stimuli
C) absence of psychomotor activity
Which side effect associated with antipsychotics occurs due to the blockade of alpha1-adrenergic receptors?
A) urinary retention
B) dry mouth
C) orthostatic hypotension
D) constipation
C) orthostatic hypotension
A female client is on hormonal replacement therapy due to hormonal imbalance. Which disorders are more likely to appear in the client? Select all that apply.
A) Major depressive disorder
B) Persistent depressive disorder
C) Premenstrual dysphoric disorder
D) Disruptive mood dysregulation disorder
E) Medication induced depressive disorder
C, E
A primary health-care provider infers from a test that a client's depression is somatically treatable. The elevated level of which parameter might be the reason for reaching such a conclusion?
A) calcium
B) serum cortisol
C) thyroid stimulating hormone
D) sodium bicarbonate
B) serum cortisol
A client has been in multiple abusive relationships yet stays with the significant other because the client feels he or she cannot leave. Which theory best explains the client's depression?
A) cognitive theory
B) learning theory
C) psychoanalytical theory
D) object loss theory
B-learning theory
A client who suffered a head injury reports frequent sleepiness and loss of appetite. Which part of the client's brain was most likely affected?
A) cerebellum
B) hippocampus
C) hypothalamus
D) pre-frontal cortex
C-hypothalamus
Which signs of depression are commonly observed in a 7-year-old child? Select all that apply.
A) lack of emotional expressiveness
B) agression
C) morbid thoughts
D) lack of social interactions
E) excessive worrying
B & D
A nurse is assessing a client who is on monoamine oxidase inhibitor (MAOI) therapy. Which suggestion provided by the nurse prevents a hypertensive crisis in the client?
A) avoid putting cottage cheese on food
B) include raisins in regular diet plan
C) use soy sauce topping on food
D) avoid consuming red wine
D: avoid consuming red wine
Which electrolyte imbalance would the nurse expect to be present in an elderly client receiving a serotonergic antidepressant?
A) hyponatremia
B) hyperkalemia
C) hypocalcemia
D) hypermagnesemia
A- hyponatremia
Which part of the brain mediates the symptoms of psychomotor retardation?
A) amygdala
B) cerebellum
C) prefrontal cortex
D) hypothalamus
B-hypothalamus
The parent of an adolescent client says, "My child keeps talking about calling the U.S. president to give him suggestions." The nurse also finds that the client has increased libido. Which does the nurse interpret from these findings?
A) the client is experiencing acute mania
B) the client is experiencing psychosis
C) the client is experiencing hypomania
D) the client is experiencing delirious mania
C- the client is experiencing hypomania
The nurse is caring for a client with mania who is on lithium carbonate therapy. The nurse monitors the client's skin turgor daily. Which sign or symptom observed in the client supports this nursing intervention
A) polyuria
B) dry mouth
C) dehydration
D) dizziness
C-dehydration
At which age would the nurse expect to begin documenting manic episodes in a client diagnosed with bipolar disorder?
A) 19
B) 21
C) 23
D) 25
D
A client with bipolar disorder is diagnosed with migraine. Which medication is effective when the primary health-care provider prefers a single medication for the treatment of both conditions?
A) chlorpromazine
B) aripiprazole
C) clonazepam
D) lamotrigine
A) chlorpromazine
Which medication carries the highest risk of causing elongation of the QT interval?
thioridazine (Mellaril)
What are common side effects associated with tricyclic antidepressants?
anticholinergic effects, sedation & hypotension
What is the maximum amount of time past the scheduled dose of lithium in which the drug may still be administered?
2 hours. After the 2 hour mark, the dose must be skipped.
Which part of the brain integrates all sensory input (except smell) on the way to the cortex?
Thalamus
Which part of the brain deals w/sensory perception and interpretation?
Parietal lobe
Which part of the brain is concerned with hearing, short term memory and sense of smell?
Temporal lobe
Double dosing to make up for a missed dose of Wellbutrin in contraindicated for what reason?
increased risk for seizure
A client w/schizophrenia has physician's orders for Haldol 5mg IM STAT & then 3mg PO tid; 2 mg benztropine PO bid PRN. Why is the benztropine ordered?
A) to treat EPS symptoms
B) to prevent NMS
C) to decrease psychotic symptoms
D) to induce sleep
To treat EPS symptoms
A client reports that his foot is on fire and he thinks the demons are trying to burn off his flesh. The priority nursing intervention for this symptom is to:
A) give PRN Haldol as ordered
B) assess the client's foot to rule out physical causes for the complaint
C) Administer PRN benztropine as ordered
D) Ask the client is he'd like to speak with the chaplain
assess the client's foot to rule out a physical cause
A client's score of the Hamilton Depression Rating Scale is 40 and they complain of feeling more depressed over the last few weeks. What is the priority nursing action?
A) Asses client's history of treatment for depression
B) Encourage the client to keep weekly appointment at the clinic
C) Educate the client about treatment options for depression
D) Asses the client's current risk for suicide
Assess the client's current risk for suicide
A client that is admitted for MDD keeps making negative comments about herself. Which of the following interventions will promote positive self-esteem in the client? (select all that apply)
A) teach assertive communication skills
B) make observations to the client when she completes a goal/task
C) instruct the client that you will not talk to her unless she stops talking negatively about herself
D) offer to spend time with the client using a nonjudgemental approach
A, B & D
An acutely depressed client isolates herself in her room and just sits and stares into space. Which of these is the best example of an active communication approach with this client?
A. "Do you like exercise?"
B. "Come with me. I will go with you to group therapy."
C. "Would you like to go to group therapy, stay in bed, or come out to the day lounge for some activities?"
D. "Why do you stay in your room all the time?"
B
Over the last month a recently widowed (6mo ago) woman has become socially withdrawn, lost weight and told her sister today that she "doesn't have anything more to live for." She has been placed inpatient for MDD. The priority nursing diagnosis for this client would be:
A) imbalanced nutrition; less than body requirements
B) complicated grieving
C) risk for suicide
D) social isolation
risk for suicide
Historically lithium has been the med of choice for mania, several others have been used w/good results. Which of the following are used to treat bipolar disorder (select all that apply)
A) Olanzapine (Zyprexa)
B) Oxycodone (OxyContin)
C) Carbamazepine (Tegretol)
D) Gabapentin (Neurontin)
E) Tranylcypromine (Parnate)
A, C & D
One way to promote adequate nutritional intake for a client in an acute manic episode who is not eating is to:
a. Sit with the client during meals to reinforce the importance of eating everything on the tray.
b. Have family members bring food from home so the client will have only favorite foods.
c. Provide high-calorie, nutritious finger foods and snacks that can be eaten "on the run."
d. Restrict the client to their room until they begin to gain weight.
provide high-calorie, nutritious finger foods & snacks
A nurse is educating a patient about his lithium therapy & explaining signs & symptoms of toxicity. Which of the following would she instruct the patient to be on the alert for?
A) fever, sore throat, malaise
B) tinnitus, severe diarrhea, ataxia
C) occipital headache, palpitations, chest pain
D) skin rash, marked rise in BP, bradycardia
B
A client is brought to the ER by a family member who reports that the client stopped their mood stabilizer a few months ago. The client is now agitated, pacing, demanding and speaking very loudly. The family member reports that she eats very little, is losing weight and almost never sleeps. What is the priority nursing diagnosis?
A) imbalanced nutrition
B) risk for injury r/t hyperactivity
C) disturbed sleep patter r/t agitation
D) ineffective coping r/t denial of depression
B
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