final mental health

what type of activities for those in manic phase

-1 to 1 activity with nurse -solitary activities -non competitive activities

what is the main concern in a facility after a patient commits suicide

-figuring out what led up to the suicide what was missed -support the other patients to prevent another suicide

avoidant personality disorder

A personality disorder characterized by consistent discomfort and restraint in social situations, overwhelming feelings of inadequacy, and extreme sensitivity to negative evaluation.

What is methylphenidate/Ritalin used for?

ADHD stimulant medication

what is the medication atomoxetine/Straterra for

ADHD(SNRI)

is benztropine helpful for extrapyramidal symptoms

Benztropine can be helpful in reversing the symptoms of EPS. benztropine = anticholinergic

Which of the following interventions is important for a Cely experiencing a paranoid personality disorder taking olanzapine (Zyprexa)? A. Explain effects of serotonin syndrome. B. Teach the client to watch for extrapyramidal adverse reactions. C. Explain that the drug is less effective if the client smokes. D. Discuss the need to report paradoxical effects such as euphoria.

C. Explain that the drug is less effective if the client smokes. Olanzapine (Zyprexa) is less effective for clients who smoke cigarettes. Olanzapine is a second-generation (atypical) antipsychotic medication. Olanzapine also has approval for use with fluoxetine, a selective serotonin reuptake inhibitor (SSRI), in patients with episodes of depression associated with bipolar disorder type 1 and treatment-resistant depression.

can you/should you drink coffee while taking benzodiazepine

Coffee contains caffeine, which has a stimulating effect on the central nervous system that will counteract the effect of the antianxiety medication oxazepam. None of the remaining foods is contraindicated. These drugs may act as depressants to the CNS, specifically inhibiting respiratory drive. Therefore, careful monitoring of all vitals, especially blood pressure and respiratory rate, should be performed after the administration of benzodiazepines. Waveform capnography, if available, should be seriously considered to monitor respiratory status.

The nurse is aware that the following ways in vascular dementia different from Alzheimer's disease is: A. Vascular dementia has a more abrupt onset. B. The duration of vascular dementia is usually brief. C. Personality change is common in vascular dementia. D. The inability to perform motor activities occurs in vascular dementia.

Correct Answer: A. Vascular dementia has a more abrupt onset. Vascular dementia differs from Alzheimer's disease in that it has a more abrupt onset and runs a highly variable course. VD is distinguished from other forms of dementia in that it results from brain ischemia, although the temporal relationship to the ischemic event may be subtle or go unnoticed. There are various subtypes and multiple terms to describe the vascular pathology and affected brain tissue, such as multi-infarct dementia, small vessel disease or Binswanger disease, strategic infarct dementia, hypoperfusion dementia, hemorrhagic dementia, hereditary vascular dementia, and AD with cardiovascular disease

Ricardo, an outpatient in a psychiatric facility is diagnosed with dysthymic disorder. Which of the following statements about dysthymic disorder is true? A. It involves a mood range from moderate depression to hypomania. B. It involves a single manic depression. C. It's a form of depression that occurs in the fall and winter. D. It's a mood disorder similar to major depression but of mild to moderate severity.

D. It's a mood disorder similar to major depression but of mild to moderate severity Dysthymic disorder is a mood disorder similar to major depression but it remains mild to moderate in severity. Persistent depressive disorder is a newly coined term in the DSM-5 to capture what was originally known as dysthymia and chronic major depression. This disorder has been poorly understood, and its classification has evolved due to the complicated and ever-evolving nature of the nosology of depressive disorders. It was not until the DSM-III that dysthymic disorder was defined as a mild chronic depression lasting longer than 2 years.

what is sublimation

Dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression (using exercise as a release of anxiety)

The nurse collecting family assessment data asks. "Who is in your family and where do they live?" Which of the following is the nurse attempting to identify? A. Boundaries B. Ethnicity C. Relationships D. Triangles

Family boundaries are parameters that define who is inside and outside the system. The best method of obtaining this information is asking the family directly who they consider to be members. Every system has ways of including and excluding elements so that the line between those within the system and those outside of the system is clear to all. If a family is permeable and has vague boundaries it is considered "open." Open boundary systems allow elements and situations outside the family to influence it. It may even welcome external influences. Closed boundary systems isolate its members from the environment and seem isolated and self-contained. No family system is completely closed or completely open.

Flumazenil (Romazicon) has been ordered for a male client who has overdosed on oxazepam (Serax). Before administering the medication, nurse Gina should be prepared for which common adverse effect? A. Seizures B. Shivering C. Anxiety D. Chest pain

Seizures are the most common serious adverse effect of using flumazenil to reverse benzodiazepine overdose. The effect is magnified if the client has a combined tricyclic antidepressant and benzodiazepine overdose. Benzodiazepine reversal has correlations with seizures. Seizures may happen more frequently in patients who have been on benzodiazepines for long-term sedation or in patients who are showing signs of severe tricyclic antidepressant overdose. The required dosage of Flumazenil should be measured and prepared by the practitioners to manage seizures. Flumazenil use requires caution in patients relying on a benzodiazepine for seizure control.

Serotonin syndrome symptoms

hypertension, tachycardia; myoclonic jerking, tremors; nausea, diarrhea, sweating, hyperthermia; agitation, confusion

side effect of bupropion a medication used for depression and smoking cessation

insomnia/headache/ GI distress/agitation/seizures

if patient has hx of seizures or head trauma can you give buproprion

no

A nurse is teaching a client who has anxiety and a new prescription for buspirone. Which of the following pieces of information should the nurse include in the teaching? A.buspirone carries high potential for abuse B. avoid consuming grapefruit juice while taking this medication C. Take medication 4 times a day D. Peak effects of medication take 1 week

"Avoid consuming grapefruit juice when taking this medication." The nurse should instruct the client to avoid drinking grapefruit juice when taking buspirone because it can cause levels of the medication to increase. Elevated levels can cause drowsiness and subjective effects such as dysphoria.

symptoms of relapsing in schizophrenia

-hallucinations may start again -sleep deprivation -difficulty concentrating -avoiding other people

lithium levels

0.5-1.5

What information concerning paroxetine (Paxil) should you communicate to the patient? -Do not stop abruptly. -Take this medication after meals. Increase fluid intake while taking this medication. -Do not take with aspirin.

1.Do not stop abruptly. Stopping paroxetine abruptly can result in a return of symptoms and needs to be titrated for best results. 2.Do not take with aspirin. Taking paroxetine with aspirin can increase the risk of bleeding and should be avoided.

what is the typical course of ECT treatment

2-3 times a week, for a total of 6-12 treatments for depression

potassium levels

3.5-5

what is considered binge drinkind

5 or more drinks by males in 2 hours or 4 or more in females

defense mechanism introjection

A quality or attribute of another is internalized and becomes part of the individual

Methadone (Dolophine)

Abstinence maintenance med for opioids. Binds with opiate receptors in CNS to produce analgesic and euphoric effects. Prevents withdrawal symptoms in clients who were addicted to opiate drugs. Precautions/interactions: do not use in clients who have severe asthma, chronic respiratory disease, or history of head injury. Side/adverse effects: sedation, respiratory depression, paradoxical CNS excitation.

acute stress disorder

An anxiety disorder in which fear and related symptoms are experienced soon after a traumatic event and last less than a month

should antipsychotic medications be stopped when EPS occurs

Antipsychotic medications should be stopped when extrapyramidal symptoms are exhibited

Russel's sign

Calluses/scars on the knuckles or dorsal hand from self-induced vomiting found in bulimia

schizotypal personality disorder

Cluster A (odd or eccentric) display abnormal or highly unusual thoughts, perceptions, speech, and behavior patterns.

what is the cognitive impairment of confabulation

Confabulation involves filling in gaps in memory by fabrication. The client unconsciously makes up responses that are inaccurate to avoid the embarrassment of memory loss.

A nurse is providing teaching to a client who has generalized anxiety disorder and a new prescription for venlafaxine. Which of the following statements should the nurse make? A. "This medication is only for short-term use." B. "This medication can be taken on an as-needed basis." C. "This medication will effectively reduce your physical manifestations of anxiety." D. "This medication should not be stopped abruptly."

Correct Answer: D. "This medication should not be stopped abruptly." The nurse should instruct the client that stopping venlafaxine (antidepressant) abruptly will lead to manifestations of withdrawal. WHY NOT C The nurse should instruct the client that venlafaxine is effective against cognitive and psychic manifestations of anxiety but does little to decrease somatic manifestations.

dialectical behavior therapy

Dialectical behavior therapy (DBT) is a type of cognitive-behavioral therapy. Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others common in borderline personality disorder

is hyperthermia an extrapyramidal symptoms?

Extreme hyperthermia is an extrapyramidal symptom and requires immediate attention to prevent permanent brain damage.

what is response prevention

Focuses on preventing the patient from performing a compulsive behavior with the intent that anxiety will diminish

medications associated with electroconvulsive therapy

IM injection of atropine sulfate or glycopyrrolate etomidate or propofol succinycholine a muscle relaxant

patient is experiencing acute dystonia what the possible meds to give

IM injection of benztropine or diphenhydramine

Bipolar Manic definition:

Inflated self-esteem, grandiosity, decreased need for sleep, excessive talking, flight of ideas, easily distracted, engaging in risky activities physical or financial.

Major Depressive Disorder definition

Lasting at least two weeks, feeling sad, empty or tearful (anhedonia), insomnia or hypersomnia, worthlessness, poor concentration and suicidal ideation.

schizoid personality disorder

Person is a loner with little interest or involvement in close relationships with anyone

what is projection

Projection occurs when the client attributes undesired impulses to another person.

define reaction formation

Reaction formation occurs when the client exhibits a behavior or emotion that is the opposite of what the client actually feels. example of reaction formation would be treating someone you strongly dislike in an excessively friendly manner in order to hide your true feelings.

pressured speech what is it? and when is it seen

Speaking as if the words are being forced out quickly seen in schizophrenia

what is ideas of reference

When they think everything is about them. (Everyone is talking about me)

what is the first step in a 12 step program

admitting you have a problem

dissociative identity disorder

aka multiple personality disorder

Tricyclic antidepressants side effects

anticholinergic effects- dry mouth, blurred vision, tachycardia orthostatic hypotension sedation

SSRIS (paroxetine/sertraline/fluoxetine) can be used for

anxiety and depression and OCD and PTSD

what kind of medication is buspirone

anxiolytic

Counter-trasnference

as redirection of a psychotherapist's feelings toward a client

what type of training good for patient with dependent personality and histrionic personality disorder

assertiveness training

cognitive distortion Castrophizing

assuming worst possible outcomes will occur

why would a provider order olanzapine after ordering lithium for a patient in a manic period

because lithium takes a while to work, and the olanzapine will rapidly bring down the mania olanzapine =2nd generation antipsychotic and mood stabilizer

somatic delusions

believes that his body is changing in an unusual way, such as growing a third arm

define erotomania

believing someone is in love with you even when they barely know you

medications given when patient experiencing extrapyramidal symptoms

benztropine=anticholinergic

narcissistic personality disorder

characterized by a grandiose sense of self-importance, a preoccupation with fantasies of success or power, and a need for constant attention or admiration

what is the pre ECT workup done

chest xray, blood work, ECG

A nurse asks an older adult client, "Did you have any visitors yesterday?" The client responds, "Yes, several members of my church choir came to see me." The nurse knows that only the client's daughter visited on the day in question. Which cognitive impairments is the client demonstrating?

confabulation Confabulation involves filling in gaps in memory by fabrication. The client unconsciously makes up responses that are inaccurate to avoid the embarrassment of memory loss.

after ECT patient may present as

confusion/headache/muscle soreness/temporary memory loss

medications for neuroleptic malignant syndrome

dantrolene=muscle relaxant bromocriptine

a patient with anxiety is taking diazepam, what is the onset of action

diazepam and other benzodiazepine medications onsets are immediate

what medication is given for extrapyramidal effects

diphenhydramine

what is displacement

displacement as the redirection of thoughts, feelings, and impulses from an object that causes to anxiety to a safer, more acceptable one.

what is the most effective acute treatment for depression

electroconvulsive therapy

how many hours are restraints good for

every 4 hours

histrionic personality disorder

excessive emotionality and attention seeking

what generation antipsychotic is haloperidol

first

what is generalized anxiety disorder

general state of tenseness and uneasiness greater than 6 months

antianxiety medications should be avoided in patients with what hx

history of substance abuse

when a patient is taking clozapine what should they inform the doctor of immediately

if they start to experience flu like symptoms, fever, sore throat may be signs of agranulocytosis

anhedonia

inability to experience pleasure

Define apraxia

inability to perform a previously learned set of coordinated movements, not related to paralysis or lack of comprehension

Define agnosia

inability to recognize objects, people, sounds, shapes or smells; symptom common to tumors of the parietal lobes

does SSRIs cause sedation or insomnia

insomnia

Avolition

lack of motivation

nausea and vomiting while taking lithium can indicate

lithium toxicity

how does conversion disorder manifest as

manifests as deficits in motor or sensory functions

panic level of anxiety is characterized by

markedly disturbed behavior, and they are not able to process what is occurring in the environment and can lose touch with reality

at what level of anxiety does a person benefit from the direction of others

moderate

when administering clozapine what to monitor

monitor WBCs every week for 1st six months, because can cause agranulocytosis

localized dissociative amnesia

most common; loss of all memory of events occurring within a limited period

are headaches an expected side effect of ECT

no

can some one in severe panic take directions from someone else

no

should you interrupt a patients compulsive behavior

no, unless they jeapordize the safety of the client/others allow time for patient to perform the compulsive behavior

When does disenfranchised grief occur?

occurs when social expectations restrict an individual's ability to cope with grief in an expected way. This type of grief can occur when the social relationship between the client and another individual cannot be openly recognized. As a result, the client does not have the social support that may be available to another individual who has an uncomplicated form of grief.

which of these medications can treat PTSD allopurinol (Zyloprim) simvastatin (Zocor) paroxetine (Paxil) phenytoin sodium (Dilantin)

paroxetine (Paxil) This works to control the depression, hypervigilance and avoidance of social situations that accompany PTSD.

what is perservation

persistent repetition of same word or idea in response to different questions

somatic symptom disorder

psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause anxiety redirected into somatic concern

how should the environment be when someone is experiencing severe to panic level anxiety

quiet environment with minimal stimulation

important thing to monitor while patient takes chlorpramazine

respiration rate

risk of serotonin syndrome is greatest when

risk of this syndrome seems to be greatest when an SSRI is administered in combination with a second serotonin-enhancing agent, such as a monoamine oxidase inhibitor (MAOI).

a patient on buspirone and starts sweating what may that be leading to

serotonin syndrome

what to do if client is obsessed with a delusion

set firm limits on amount of time talking about the delusion

extrapyramidal symptoms

side effects such as restlessness, involuntary movements, and muscular tension produced by antipsychotic medications dystonia tardive dyskinesia=lip smacking, tongue rolling parkinsonism= shuffling gait and rigidity

what type of fracture in a child is suspicious of child abuse

spiral fracture

what is a common behavior in borderline personality disorder

splitting causing problems amongst people

#1 thing to when a patient is experiencing sever to panic level anxiety

stay with them

what to do when patient taking lithium informs you they are vomiting/diarrhea

stop lithium, come in and see HCP

thought stopping technique

teaching client that when a negative thought or compulsive behaviors arise to say or shout stop

sytematic desensitization

the patient is exposed to progressively more anxiety-provoking stimuli and taught relaxation techniques.

conventional antipsychotics such as chlorpromazine and haloperidol mainly control what symptoms of schizophrenia

the positive symptoms

what class of medication is impramine

tricyclic cheantidepressant

What is altruism?

unselfish regard for the welfare of others

what does it mean for a patient to use projection

using projection when unconsciously transferring unacceptable feelings, thoughts, or traits from oneself onto another person.

when does a client lose the right to refuse treatment

when they pose and immediate danger to self or others, requirieng immediate action

how long does it take serotonin syndrome to start

within 24 hours after starting/ increasing a serotonergic medication and the majority of those start within six hours.

should you avoid touching a client during active hallucinations

yes

can buspirone cause xerostomia

yes buspirone side effect is dry mouth