MH Exam III

electroconvulsive therapy (ECT)

- electric current flows through electrodes placed on both sides of the head - general anesthetic is given to induce sleep - requires several treatments to be effective - client should remain NPO several hours before procedure

A client with heavy alcohol use is at high risk of developing what conditions?

- hepatitis - esophagitis - Wernicke-Korsakoff Syndrome (memory disturbance) - pancreatitis - cirrhosis of the liver

Risk factors for developing OCD

- history of childhood abuse - tobacco use - family member w OCD

findings associated with neuroleptic malignant syndrome

- hyperthermia, sweating, unstable BP - elevated creatine kinase

Neurotransmitters GLUTAMATE and DOPAMINE work together to regulate ...

- motor - affective - cognitive functions

Nurse teachings about tricyclic antidepressants

- take med at night (causes sedation) - it may take a few weeks to start working - avoid St. John's Wort (when taken with tricyclic antidepressants, can cause serotonin syndrome

trans-cranial magnetic stimulation (TMS)

- treatment for depression - lasts about 30 minutes - they will remain awake - sessions will require to take place 5 times each week for 6 weeks to be effective - during, may feel slight tapping on the head, scalp contraction, and tightening of the jaw - you may experience a mild headache afterward - very effective when combined with psychotherapyd

The therapeutic range for lithium has been established at ...

0.5 to 1.2 mmol/L

Stages of alcohol withdrawal

1 - mild tremors, nervous, nausea 2 - increased tremors, hyperactivity, nightmares, disorientation, delusions, increased pulse, increased BP 3 - most dangerous - severe hallucinations, grand map seizures

Age group that has suicide as the 2nd leading cause of death

10 - 34 years of age

A nurse is developing a discharge plan for a client who is in substance use rehabilitation. The nurse should include which of the following treatment modalities to decrease the likelihood of relapse?

12 step programs cognitive-behavioral therapy support groups

What clients have the highest risk of suicide?

< 19 and > 45 males

41-year-old client admitted with substance use disorder. Client was injured several years ago and subsequently developed an addiction to pain medications. Client is an RN and has been employed at a local health care facility on a medical-surgical unit. Expressing remorse regarding dependence on and misuse of prescription medications. Reports they have diverted narcotics while working but doesn't believe anyone knows about it. States, "I want to get better and take responsibility for my actions. Will I ever be able to work as a nurse again?"

Anticipated: - State board of nursing will investigate - Enrollment into a monitoring/recovery program She will probably not loss her license immediately nor will there be criminal charges or an arrest

____________________________ treats alcohol withdrawal.

Benzodiazepines

A client is experiencing diaphoresis, palpitations, and a sense of impending doom. The nurse anticipates the doctor prescribing ...

Benzodiazepines these treat acute anxiety by regulaing the function of the neurotransmitter GABA

A nurse is caring for a client who is experiencing manifestations of alcohol withdrawal. When assessing the client, which of the following purposes describes the function of the CIWA-Ar (Clinial Institute Withdrawal Assessment for Alcohol-Revised) scale?

Determine the client's SEVERITY of alcohol withdrawal and adjust care accordingly the CIWA-Ar provides guidlines for the nurse to follow when rating the severity of manifestations of alcohol withdrawal.

_____________________________ treats extrapyramidal symptoms.

Diphenhydramine

___________________ is identified as the neurotransmitter in the reward pathway leading to addiction.

Dopamine

___________________________________ are used to manage psychosis symptoms (such as hallucinations).

Dopamine antagonists (such as antipsychotics)

Early lithium toxicity symptoms with levels at 1.5-2.0 mmol/L

GI discomfort

When taking ___________, the client should avoid tyramine containing foods.

MAOIs can cause a hypertensive overload

_____________________ is an opiate replacement that helps clients who are experiences opiate withdrawals.

Methadone

____________________ treats opiate toxicity.

Naloxone

A client is experiencing disruptions in sleep, appetite, and mood. What med will likely be prescribed?

SSRI (antidepressant)

___________ are used to manage depression symptoms.

SSRIs

___________________ affects the neuropathway loop and plays a role in controlling anxiety; it is one of several neurotransmitters regulated by psychotropic medications.

Serotonin

_____________________ is prescribed to treat tardive dyskinesia.

Valbenazine

neurotransmitter - regulates SLEEP-WAKE cycle - muscle function

acetycholine

extrapyramidal symptoms

acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome

Depression is more prevalent among what demographic

adult females

Clients who encounter symptoms of ___________________________ experience marked fear and anxiety upon exposure to circumstances associated with travel or location.

agoraphobia

In ALCOHOL withdrawals, large amounts of GLUTAMATE are released, causing CNS excitation which causes ...

an increased HR and BP GI disturbances (n/v) hallucinations risk of seizure

Activation syndrome

clinical manifestations that include irritability, anxiety, impulsivity, aggressiveness, agitation, suicidal ideation

The __________________________________________ circuit is associated with manifestations such as worry, apprehension, and obsession.

cortico-striato-thalamo-cortical

Disruptive Mood Dysregulation Disorder

diagnoses for children that are persistently irritable and have frequent behavior outbursts

A client experiencing muscle spasms in their neck and difficulty opening their mouth due to their medication, risperidone. The nurse would anticipate the doctor prescribing ...

diphenhydramine (an anticholinergic med used to treat acute dystonia)

neurotransmitter - excitatory! - transmits info about EMOTIONAL responses - complex movements - cognition

dopamine

Clients who experience anxiety and worry in response to numerous situations have __________________________________________.

generalized anxiety disorder

The cause of mental illness is largely unknown. The cause seems to be related to ... and ...

genetic and environmental factors.

High levels of ________________ can serve as a precursor to manifestations of PSYCHOSIS.

glutamate

The nurse should identify that in OPIATE withdrawals, large amounts of NOREPINEPHRINE are released, causing findings such as ...

goose flesh, muscle aches, and GI discomfort

neurotransmitter - regulates glutamate, serotonin, and GAMA

histamine

A nurse is reviewing the cient's assessment findings and pathophysiology of anxiety. What findings are associated with overactivation of the neural circuits within the limbic system?

increased heart rate, restlessness, increased blood pressure, and irritability are all manifestations of anxiety These manifestations are caused by overactivation of the cortico-striato-thalamo-cortical (CSTC) circuit of the limbic system. (not necessarily an increased temp)

Lithium toxicity symptoms at levels of 2.0 - 2.5 mmol/L

jerking motor movements

What labs may be indicated to determine chronic alcohol use?

liver panel CMP BAL/BAC magnesium

Dysthymia (Persistent Depressive Disorder)

milder form of bipolar disorder, chronic - difficulty sleeping - mild level of depression

CIWA-Ar score < 8-10 indicates

minimal to mild withdrawal

CIWA-Ar score 8-15 indicates

moderate withdrawal (marked autonomic arousal)

neurotransmitter - excitatory! - LEARNING - SLEEP - MOOD - MEMORY - ATTENTION

norepinephrine

mania

obsessive preoccupation, impulsiveness, staying awake for extended periods of time, hyperactivity

substance-induced depressive disorder

occurs soon after a client begins taking or withdrawing from a substance, with the most common occurrences involving - alcohol - phencyclidine - hallucinogens - opioids - amphetamines

A client is demonstrating _______________________________ when they are experiencing periods of physiologic and psychologic hyperarousal. ex. - A client experiences discrete periods of acute psychological distress that includes palpitations, dyspnea, and lightheadedness.

panic disorder

What is a modifiable risk factor that can decrease the intensity and frequency of panic attacks?

physical activity

Addiction is defined as ...

recurring uncontrollable urges to engage in compulsive behaviors (such as substance misuse) even though there are harmful consequences

Clients who demonstrate consistent failure to speak in specific social situations have ___________________________.

selective mutism

neurotransmitter - inhibitory x - EMOTIONAL regulations - SEXUAL behaviors - TEMPERATURE - SLEEP - PAIN

serotonin

Severe lithium toxicity symptoms at levels > 2.5 mmol/L

severe respiratory complications

CIWA-Ar score 15 or more indicates

severe withdrawal (impending delirium tremens)

When a drug is ... is travels faster to the brain, which raises the addiction potential.

smoked or injected

Clients with _______________________________ fear being in groups of people or are concerned with others' opinions of their clothing are exhibiting manifestations of social anxiety disorder. Clients who have this disorder experience fear and anxiety in social situations and perceived scrutiny from others.

social anxiety disorder

Clients who experience manifestations related to a ________________________ manifest marked fear and anxiety upon exposure to the specific object or situation.

specific phobia

Psychiatric Pharmacogenomic Testing

strategy that the health care provider may use to help select the appropriate psychotropic med based on the client's genes it may also provide information about the severity of adverse effects

Why do some medications that treat mental illness take a few weeks to become effective?

the brain has to establish a new neuronal pathway in response to medications

What often happens when an addict patient is labeled as "drug seeking" by providers?

the patient is discharged without getting the treatment needed