Psych final

Jeff was just diagnosed with a major depressive disorder. which medication is the health care provider most likely to start the patient on? a) SSRI b) SNRI c) tricyclic antidepressant d) MAOIs

a) SSRI

sundowning

mood deterioration and increase in agitation later in the day or night

confabulation

creation of stories or answers in place of actual memories to maintain self-esteem

Jeff's parents have described his lack of interest in things he used to enjoy, like games with his friends, and his classes, which he used to like. this may be best described by the term a) inappetance b) impotence c) indolence d) anhedonia

d) anhedonia

side effects of 1st generation anti-psychotics

EPS: acute dystonia, akathisisa, pseudoparkinsonism tardive dyskinesia weight gain, sexual dysfunction, endocrine disturbances

bipolar medications

Mood Stabilizer: Lithium Anti-psychotic: Olanzapine (Zyprexa) Antiepileptics: Aalproate (Depakote) Aarbamazepine (Tegretol) Lamotrigine (Lamictal) Gabapentin (Neurontin)

apathy

a decreased interest in, or attention to, activities or beliefs that would otherwise be interesting or important

acute onset of disordered thinking is most associated with: a) delirium b) alzheimer's c) frontotemporal dementia d) dementia with lewy bodies

a) delirium

which anticonvulsant medication might be prescribed for a patient with bipolar disorder? a) divalproex. sodium (depakote) b) clonazepam (klonopin) c) olanzapine (zyprexa) d) lithium (lithobid)

a) divalproex sodium (depakote)

what is your usual level of anxiety on the day of a nursing exam? a) mild b) moderate c) severe d) panic

a) mild

which of the following should be established first in working with a child with PTSD? a) provide safety and stabilization b) reduce symptoms c) develop a value system d) provide support for catching up on developmental and social skills

a) provide safety and stabilization

a patient with major depression walks and moves slowly. which term should the nurse use to document this finding? a) psychomotor retardation b) psychomotor agitation c) vegetative sign d) anhedonia

a) psychomotor retardation

which assessment finding in a patient with major depression represents a vegetative sign? a) restlessness b) hypersomnia c) feelings of guilt d) frequent crying

b) hypersomnia

a person with which psychiatric problem is most likely to complete suicide? a) personality disorder b) major depression c) substance abuse d) schizophrenia

b) major depression

a nurse assesses a patient diagnosed with dissociative identity disorder, which finding would likely be part of the patient's history? a) travel to a foreign country b) physical or sexual abuse c) thyroid dysfunction d) eating disorder

b) physical or sexual abuse

disadvantages of 2nd generation anti-psychotics

tendency to cause significant weight gain; risk of metabolic syndrome Clozapine (Clozaril) - agranulocytosis

affective symptoms of schizophrenia

involve the experience and expression of emotions common and increase patient's suffering mood may be unstable, erratic, labile, or incongruent dysphoria, depression, hopelessness, suicidality

advantages of 1st generation anti-psychotics

less expensive than 2nd generation

aphasia

loss of language ability

avolition

loss of motivation; difficulty beginning and sustaining goal-directed activities; reduction in motivation or goal-directed beahvior

apraxia

loss of purposeful movement

agnosia

loss of sensory ability to recognize objects

neologisms

made up words/meaning for the patient only

advantage of 2nd generation anti-psychotics

minimal to no EPS or tardive dyskinesia

illusions

misperceptions or misinterpretations of a real experience

flight of ideas

moving rapidly from one thought to the next, often making it difficult for others to follow the conversation

Cabamazepine (Tegretol)

nausea, anorexia, sedation/drowsiness, anemia, and thrombocytopenia do not respond to lithium or valproate rapid cycling; therapeutic range 4-12 mcg/mL use with SSRIs can cause toxic effect weekly CBC taper slowly

short-acting sedative-hypnotic sleep agents

selective for GABA A receptors containing alpha-1 subunits amnestic and ataxic side effects FALL RISK quick onset of action so take when ready to go to sleep

alzheimer's medication

slows deterioration of cognitive functioning Cholinesterase Inhibitors: Donepezil (Aricept) Rivastigmine (Exelon) Galatamine (Razadyne) NMDA Receptor Inhibitor: Memantine (Namenda)

3rd generation anti-psychotics

targets dopamine; decreases where there's too much, increases where there's not enough, and doesn't affect areas that are normal Aripiprazole (Abilify) Brexpiprazole (Rexulti) Cariprazine (Vraylar)

Valproate (Depakote) side effects

thrombocytopenia, pancreatitis, hepatic failure, birth defects monitor blood levels regularly, and liver functions and CBC

pressured speech

urgent or intense and resists comments from others

Olanzapine (Zyprexa)

used short term to bring hyperactivity under control

Lithium

used to treat acute mania side effects: nausea, fine hand tremors, polyuria, dehydration nursing considerations: 10-21 day response time, side effects range from normal to severe, take with meals to decrease nausea, high teratogenicity, use with caution in elderly, monitor fluid intake, interacts with NSAIDs, ACE inhibitors, ARBs, thiazide diuretics therapeutic level: 0.6-1.4 mEq/L toxic level: 1.5 mEq/L and above q6-12 month monitor TSH, SCr, NA, CBC, and lihtium level

symbolic speech

using symbols instead of direct communication a patient reports "demons are sticking needles in me" when what he means is that he is experiencing a sharp pain (symbolized by "needles"

tangentiality

wandering off topic or going off on tangents and never reaching the point

associative looseness

word salad most extreme form jumble of words meaningless to a listener

clang association

words chosen based on sound

a nurse is assigned the care of four patients who are detoxifying from alcohol. the patient with which symptoms would be the nurse's highest priority? a) fine motor tremors b) diaphoresis c) diarrhea d) hallucinations and delusions

d) hallucinations and delusions

cognitive retardation

generalized slowing of thinking, which is represented by delays in responding to questions or difficulty finishing thoughts

SNRIs

increase both serotonin and norepinephrine increase BP, headache, dizziness do not stop abruptly avoid alcohol may increase suicidal thoughts

MAOIs

inhibits enzyme monoamine oxidase hypertensive crisis, insomnia, confusion rarely used require close monitoring potentially fatal drug & food interactions OTC interactions contraindicated in people taking SSRIs tyramine-restricted diet

1st generation anti-psychotics

Dopamine Antagonists target positive symptoms of schizophrenia Chlorpromazine (Thorazine) Perphenazine Haloperidol decanoate (Haldol)

delusions

an ideas that is persistently held despite evidence to the contrary unshakable belief in something that is not real or true based on reality

agraphia

diminished ability to read or write

Lamotrigine (Lamictal)

dizziness, headache, nausea, toxic epidemal necrolysis effective with bipolar disorder & long-term maintenance taper slowly

Gabapentin (Neurontin)

drowsiness, ataxia, constipation do not stop abruptly wear medical ID tag take with meals

hallucinations

perceiving a sensory experience for which no external stimulus exists

medications for anxiety

Benzodiazepines: Diazepam (Valium) Clonazepan (Klonopin) Alprazolam (Xanax) Lorazepam (Ativan) Flurazepam (Dalmane) Temazepam (Restoril) Triazolam (Halcion) Estazolam (ProSom) Quazepam (Doral) Short-Acting Sedative-Hypnotic Sleep Agents: Zolpidem (Ambien) Zaleplon (Sonata) Eszopiclone (Lunesta) Melatonin Receptors: Ramelteon (Rozerem) Doxepin (Silenor) Suvorexant (Belsomra) Buspirone (Buspar)

ADHD medication

CNS Stimulants Methylphenidate (Ritalin) Dextroamphetamine (Dexedrine Amphetamine & dextroamphetamine (Adderall) Dexmethylphenidate Non-Stimulant Atomoxetine (Strattera)

medications for depression

SSRIs: Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (Paxil) Citalopram (Celexa) Escitalopram (Lexapro) Fluvoxamine (Luvox) SNRIs: Venlafaxine (Effexor) Desvenlafaxine (Pristiq) Duloxetine (Cymbalta) Levomilnacipran (Fetzima) Tricyclics: Nortriptyline (Pamelor) Amitriptyline (Elavil) Imipramine (Trfranil) MAOIs: Isocarboxazid (Marplan) Phenelzine (Nardil) Selegiline (EMSAM) Tranylcypromine (Parnate)

what is an example of malingering? a) mr. harris injures his foot to avoid military service b) mrs. adams has been making her child vomit and lose weight to pretend he has cancer c) mr. singleton has difficulty walking and uses a wheelchair, but without neurological deficits, which began 2 months after the death of his wife of 32 years d) ms. munini frequently calls or comes to the clinic in a panic, believing she is ill. her suffering is genuine, but she never has concrete signs of any illness

a) mr. harris injures his foot to avoid military service

a patient with schizophrenia says, "there are worms under my skin eating the hair follicles." how would you classify this assessment finding? a) positive symptom b) negative symptom c) cognitive symptom d) depressive symptom

a) positive symptom

negative symptoms of schizophrenia

absense of something that should be there in normally health people self-care, anhedonia, avolition, asociality, affective blunting, apathy, alogia

which question would be a priority when assessing for symptoms of major depression? a) "tell me about any special powers you believe you have." b) "you look really sad. have you ever thought of harming yourself?" c) "your family says you never stop. how much sleep do you get?" d) "do you ever find that you don't remember where you've been of what you've done?"

b) "you look really sad. have you ever thought of harming yourself?"

which patient behavior is a criterion for mechanical restraint? a) screaming profanities b) assaulting a staff person c) refusing a medication dose d) throwing a pillow at another patient

b) assaulting a staff person

a person has recently abused morphine. the person's pupils would most likely be a) dilated b) constricted c) asymmetrical d) unresponsive to light

b) constricted

child abuse perpetrators are most often a) extended family members b) child care workers c) the child's parents d) strangers

c) the child's parents

tricyclics

block reuptake of norepinephrine and serotonin anti-cjolinergic symptoms, sedation, orthostatic hypotension, arrhythmias (overdose) small window between therapeutic and toxic levels highly lethal in overdose use with caution in older adults

side effects of alzheimer's medication

cholinesterase inhibitors: n/v/d, insomnia, fatigue, muscle cramps, incontinence, bradycardia, syncome NMDA receptor inhibitors: dizziness, agitation, headache, constipation, confusion

which is an example of illness anxiety disorder? a) mr. harris injures his foot to avoid military service b) mrs. adams has been making her child vomit and lose weight to pretend he has cancer c) mr. singleton has difficulty walking and uses a wheelchair, but without neurological deficits, which began 2 months after the death of his wife of 32 years d) ms. munini frequently calls or comes to the clinic in a panic, believing she is ill. her suffering is genuine, but she never has concrete signs of any illness

d) ms. munini frequently calls or comes to the clinic in a panic, believing she is ill. her suffering is genuine, but she never has concrete signs of any illness

alogia

reduction in speech, sometimes called poverty of speech

a patient complains of frustration with his impulse to use tissues "to touch or grab anything and everything around me, i just feel clean and safe doing it that way, but sometimes if i dont have a tissue, i can barely stand to open a door." this patient appears to have which anxiety problem? a) panic disorder b) generalized anxiety disorder c) posttraumatic stress disorder d) obsessive-compulsive disorder

d) obsessive-compulsive disorder

which method of suicide has the highest lethality? a) ingesting pills b) cutting one's wrists c) inhaling natural gas d) self-inflicted gunshot wound

d) self-inflicted gunshot wound

asociality

decreased desire for, or comfort during, social interaction

melatonin receptor agents

high selectivity and potency at the MT1 receptor site (regulates sleepiness) and at the MT2 receptor site (regulates circadian rhythm) long-term use of Ramelteon can lead to increased prolactin and sexual dysfunction avoid use with alcohol, change positions slowly, can drop BP and cause fainting

cognitive symptoms of schizophrenia

impairments that can lead to poor judgment and leave the patient less able to cope, learn, manage health, or succeed in school/work concrete thinking, impaired memory, impaired attention, impaired executive functioning: problem solving and decision making, illogical thinking, impaired judgment

circumstantiality

including unnecessary and often tedious details in conversation, but eventually reaching the point

SSRIs

inhibits serotonin reuptake GI symptoms, sexual dysfunction, anxiety, behavioral activation, tension headaches may initially increase suicidal thoughts withdrawal syndrome, serotonin syndrome be careful with herbal supplements potential GI bleed with NSAIDs 2-4 weeks for clinical response dont stop abruptly

side effects of ADHD medication

insomnia, common appetite suppression, weight loss, tics may increase HR and BP slightly can cause lethargy, abdominal pain, headaches could cause delayed growth in children may worse other psychiatric disorders if not prescribed correctly, dosing is important

positive symptoms of schizophrenia

not normally present in mentally healthy people hallucinations, delusions, paranoia, disorganized or bizarre thoughts, behavior, or speech

2nd generation anti-psychotics

often chosen as first-line positive and negative symptoms Serotonin and Dopmaine Antagonists Olanzapine (Zyprexa) Clozapine (Clozaril) Risperidone (Risperdal) Quetiapine (Seroquel) Ziprasidone (Geodon) Paliperidone (Invega)

echolalia

pathological repetition of another's words

perseveration

persistent repetition of words, phases, or gestures

benzodiazepines

promote the activity of GABA can interfere with motor ability, attention, and judgment avoid use with alcohol not used long term

anhedonia

reduced ability or inability to experience pleasure in everyday life

affective blunting

reduced or constricted affect