NCLEX Mental Health Nursing

NEVER leave a sucidal client alone

!!!

Other bipolar medications?

-Divalproex -Olanzapine -Carbamazepine

Side effects of SSRI's?

-Drowsiness -Dizziness -Headache -Insomnia -Depressed Appetite

Side effects of antipsychotics?

-Extrapyramindal symptoms -Akathisis -Acute Dystonia -Pseudoparkonsonism -Anticholerngic

Signs of Lithium Toxicity?

-Hyperthermia as high as 108 degrees, cognitive impairments and autonomic symptoms -Muscular rigidity -Altered mental status -Irregular pulse -Cardiac Dysrhytmias -Diaphoresis

Medications for Bipolar Disorder?

-Lithium Carbonate: medication of choice- can be toxic and requires regular monitoring and serum lithium levels

Side effects of TCAs?

-May take 2-4 weeks to produce effects -Tachycardia -Drowsiness -Dizziness -Insomnia -Fluid retention

Antidepressant medication therapy?

-SSRIs (Selective serotonin reuptake inhibitors)-> 1st line -TCAs (Tricyclic antidepressants) -> 2nd line -MAOIs (Monoamine oxidase inhibitors)-> 2nd line SNRIS

Blood alcohol level above _______ is considered intoxication. -Clients may present to the ED with blood alcohol levels as has as 3-5% (300-500 mg/dL)

0.1 % or greater

Antidepressant medications TCAS examples?

1. Amitripline 2. Clomipramine (Anafranil) 3. Desipramine (Norpramin) 4. Imipramine (Tofranil) 5. Notriptyline 6. Protriptyline 7. Trimipramine (Surmontil)

Antidepressant medications SSRI's examples?

1. Citalopram (Celexa) 2. Escitalopram (Lexapro) 3. Fluvoxamine (Luvox) 4. Fluoxetine (Prozac) 5. Paroxetine (Paxil) 6. Sertraline (Zoloft)

Long acting antipsychotic meds?

1. Clozapine (Clozaril) 2. Riperdal (Risperidone) Long Acting Injection

Neurocognitive Disorder Medications?

1. Donepezil (Aricept) 2. Galantamine (Razadyne) 3. Memantine (Namenda) 4. Rivastigimine (Exelon) 5. Tacrine

Nursing management with lithium toxicity?

1. Immediately discontinue the lithium 2. Client may need to be transferred to a critical care unit

Alcohol withdrawl -Peaks after ________ -________ is the "gold standard" and most commonly prescribed medication of acute alcohol withdrawal.

24-48 hours Chlordiazepoxide (Librium)

Withdrawal Delirium -Peaks _______ after cessation of intake and lasts _______ -It is a MEDICAL EMERGENCY -At time of admission, always ask the client when the last drink was ingested -Death can occur from myocardial infarction, fat emboli, peripheral vascular collapse, electrolyte imbalance, aspiration pneumonia, or suicide

47-72 hours 2-3 days

A 68 year old client who is diagnosed with Alzheimer's disease is admitted to the nurse home by the nurse. The client does not recognize their spouse or children and forgets how to eat and dress. Which is the nurses priority intervention for the newly admitted client? A. Establish a daily routine and schedule B. Encourage involvement in structured activites C. Discuss strategies to coordinate care D. Stress the importance of self- nurturing

A

The mental health RN is assigned to five clients. Which clients should have priority assessments? (Place in order of priority) A. A newly admitted client diagnosed with major depression whose assessment is incomplete. B. A client diagnosed with schizophrenia who is having auditory hallucinations of an infant crying C. A client who has a 5 year history of daily consumption of two 6 packs of better D. A client diagnosed with bulimia who is having difficulty attending group E. A client who has been taking benzodiazepines off and on daily for the past 2 years

A C E B D

Todays lab report of the lithium level is 1.3 mEq/mL for a client diagnosed with bipolar disorder. Which is the first action the nurse should take? A. Withhold the doses until after breakfast. B. Give the client the prescribed dose C. Obtain a prescription to increase the dose. D. Withhold the dose and notify the HCP.

A Lithium level of 1.3 is high and very dangerous

During the initial phase, a group member, who has a masters degree, states, "My educational background makes it easier for me to help the other group members." Which action should the nurse take to assure effective group functioning? A. Reiterating the purpose of the support group sessions B. Asking the group to identify various stressful problems C. Obtaining ideas from the members about strategies for stressful situations D. Terminating the meeting and evaluate the situation

A Restate purpose and goal of a support group and the responsibilities of the group members.

-Irreversible form of senile dementia caused by nerve cell deterioration. -Priority is clients safety!! -Maintain comfort, toilet as necessary: keep dry -Reduce environmental stimulation during late afternoon and evening -Maintain daily routine -Provide environmental cues; turn on lights before dusk, provide a night light -Provide soothing music -Provide reassurance and companionship, especially during difficult evening period

Alzheimers Disease

Some clients will lose interest in life and events around them (related to SSRI's)

Antidepressant Apathy (High alert)

Sometimes medications are no longer effective

Antidepressant loss of effectiveness (High Alert)

Abrupt cessation of antidepressants engenders withdrawal symptoms

Antidepressant withdraws syndrome (High alert)

This could happen especially those 18-24 years old in the early stages of treatment BE ON HIGH ALERT FOR THIS WHEN STARTING MEDS!

Antidepressant-induced suicide

-Screen for EPS using Abnormal Involuntary Movement Scale (AIMS) -Encourage fluid, gum, and hard candy, and increase fiber intake

Antipsychotic meds

What should the nurse do IMMEDIATELY if a client starts having NMS?

Antipsychotics are stopped immediately !!!

Aggressive toward others without remorse -Is manipulative, self-centered, ad impulsive

Antisocial Personality Disorder

Purpose: To treat all + and - symptoms Side effects: Multiple side effects depending on medication Nursing assessment: Tolerance to effect, NMS

Atypical MEdications -Aripiprazole (Abilify)

Includes many formats that are used to assist the client in changing behavior

Behavior therapy

-Recommended for only short term use because these drugs are addictive and may depress the CNS -Have anxiety- reducing (anxiolytic), sedative- hypnotic, muscle relaxing, and anticonvulsant actions

Benzodiazepines

Side effects of long acting antipsychotic meds?

Blood dycrasias and neuroleptic malignant syndrome (Very high Fever)

-Highly changeable and intense affect -Poor impulse control, engages in self damaging behavior (Sexual or even sucidial) -Pits perceived good person (nurse, friend, family member) against perceived bad person; switches which person is good

Borderline Personality Disorder

A client diagnosed with a history of bulimia is admitted to the mental health unit. What intervention is most important for the nurse to include in the initial treatment plan? A. Observe the client after meals for purging. B. Assess daily weights and vital signs. C. Monitor serum potassium and calcium D. Provide a structured environment at mealtime.

C Resulting from vomiting and use of laxatives

The nurse is planning to teach client strategies for coping with anxiety. The nurse finds the client engaged in compulsive handwashing. What action should the nurse take next? A. While the client is hand washing, introduce alternatives to hand washing. B. Ask the client to immediately stop hand washing; then begin teaching. C. Allow client to complete hand washing; then begin teaching. D. Ask the client to describe events that precipitated the hand washing.

C Start teaching when the anxiety is at the lowest

The nurse and the UAP take a group of mental health clients to a baseball game. During the game, a client reports SOB and dizziness. Which interventions should the nurse implement first? A. Have the UAP escort the client back to the unit B. Request that the client describes current feelings. C. Accompany the client to a quiet area D. Ask the client if anything untoward occurred

C To decrease stimuli

Traditional antipsychotic drugs?

Chlorpromazine Haloperidol (Haldol)

Directive, time-limited approach

Cognitive Therapy

The hallmark treatment in mental health. The team includes nurses, psychiatrists, social workers, mental health technicians, drug/alochol therapists, etc

Collaborative Care

Directed as resolution of the immediate crisis and to returning the individual to the pre crisis level of functioning

Crisis Intervention

A client with a history of alcohol abuse is admitted to the medical unit for gastrointestinal bleeding and pancreatitis. The admission data included BP 156/96, pulse 92, and temp 99.2. Which intervention is most important for the nurse to implement? A. Provide a quiet low stimuli environment B. Initiate seizure precautions C. Administer as needed (PRN) lorazepam (Ativan) as prescribed D. Deter the time and quantity of the clients last alcohol intake

D

A female client who is a 5 year breast cancer survivor received confirmation that she has a recurrence of breast cancer. She informs her family that the biopsy was negative. What action should the nurse take? A. Tell the clients family to consult the HCP B. Ask the client to restate what the HCP told her C. Encourage the client to inform her family about the results D. Suggest the client talk to the nurse about her fears

D Nurse can provide a safe place for the concerns

An adult client is admitted to the inpatient mental health unit with a diagnosis of severe depression. As the client begins to recover, the client develops rapport with the nurse. After being discharged from the hospital, the client and the nurse happen to meet in the coffee shop. The client asks the nurse if they can schedule future meetings at the coffee shop. Which response by the nurse is most therapeutic? A. "Ill contact the nurse supervisor about this plan" B. "Lets not plan to meet, however, we Maya inadvertently see each other here" C. "Its not appropriate for me to discuss therapy with you when I'm off duty" D. "A social relationship with a former client is not appropriate"

D Uneven balance in a friendly relationship and work is not appropriate.

Persistent or recurrent episodes of feelings of detachment from oneself that occurs in response to acute stress

Depersonalition or Derealization Disorder

One or more episodes of an inability to recall important information, usually of a traumatic nature

Dissociated Amnesia with Fugue

A sudden temporary inability to recall important personal events following a traumatic event

Dissociative Amnesia

Two or more distinct identities, at least two of which recurrently take control.

Dissociative identity disorder

Alcohol Deterrent -Instruct the client who is on ___________ to avoid the use of substances that contain alcohol, such as: *Cough Medicines *Mouthwashes *Aftershave lotions -Other medications used to assist with alcohol cravings *Acamprosate Calcium *Naltrexone

Disulfiram (Antabuse) Therapy

Infrequently used treatment that uses controlled electrically induced seizures to treat severely depressed individuals who fail to respond to antidepressant medications and treatments

Electroconvulsive Therapy (ECT)

A benzodiazepine antagonist administered IV that reverses benzos intoxication in 5 minutes

Flumazenil (Anexate; ROmazicon)

-Perceptions without a basis of reality -Includes the 5 senses

Hallucinations

The mixture of these combinations result in what?

Hypertensive Crisis

Brief experience of mi a-reception of reality that usually occurs with delirium, DTs, or drug induced

Illusions

Involved superficial communication

Initial Stage

Stages of group development?

Initial stage Working Stage Transition Stage

Uses a therapeutic relationship to modify the clients feelings, attitudes, and behaviors

Interpersonal Psychotherapy

Toxic lithium level?

Less than 1.2 mEq/L

With antidepressant use, _______ is potentially fatal!!!

Lithium Toxicity

-Teach patient with these to change positions slowly to prevent dizziness, and report urinary retention. -Stress importance of maintaining medication therapy.

Long Acting Antipsychotic Medications

-Inhibit the enzyme monoamine oxidase, which is present in the brain, blood platelets, liver, spleen, and kidneys. -Administered to clients with depression who have not responded to other antidepressant therapies, including ECT. -There must be a 2 week wash out period between MAOIS AND SSRIS OR SNRIS

MAOIs

A client diagnosed with borderline personality disorder returns after a weekend pass with lacerations to both wrists. The client complains about how the nurse is performing the dressing change. The nurses response should be presented in which manner? A. Disinterested B. Concerned C. Matter of Fact D. Empathetic

Matter of Fact

Types of anxiety?

Mild- Tension of everyday life Moderate- Immediate concerns Severe- Feeling that something bad is about to happen Panic- Terror and a sense of impending doom

The physical, social, and therapeutic environment in which the client is receiving treatment

Milieu Therapy

Involves autonomic, motor, and behavioral symptoms Symptoms include: -Severe muscle rigidity -Increases temp, increased pulse, and labile BP -Confusion (Altered mental status) -Autonomic Dysfunction -Agitation

Neuroleptic Malignant Syndrome (NMS)

-Persisitenly intrusive thoughts -Reptitive behaviors designed to divert unacceptable thoughts and reduce anxiety

OCD

Difficulty understanding or using information

Perceptual Distortions

Alcohol is a CNS depressant. __________ a biological need for alcohol to avoid physical withdrawal symptoms _____ a craving for the subjective effect of alcohol

Physical Dependence Psychological Dependence

Inhibit serotonin reuptake

SSRI

With schizophrenia spectrum and other psychotic disorders.. _____ is always the number one priority

Safety!

A group of mental disorders characterized by psychotic features Key symptoms include: -Delusions -Hallucinations -Disorganized speech -Negative Symptoms

Schizophrenia

-Hyperthermia, rigidity, cognitive impairments, and autonomic symptoms -Potentially fatal and may occur at any time during therapy SSRIs and SNRs combined with MAOIs -Treatment is symptomatic with propranolol, cooling blankets, chlorpromazine for hyperthermia, diazepam for muscle rigidity or rigors

Serotonin Syndrome (HIGH ALERT)

Persistent worry or statements regarding physical illness without physical findings Treatment: Cognitive behavioral Therapy

Somatic Symptom Disorder (DSM-5)

Provides opportunity to learn to deal with letting go

Termination Stage

_____ can cause Priapism. Priapism affects the penis and in rare instances, the clitoris

Trazadone

-Block the reuptake of norepinephrine at the presnayptic neuron -May take several weeks to produce the desired effect (2-4 weeks after the first dose)

Tricyclic Antidepressants (TCA)

Block reuptake of NE at presynaptic neurons

Tricyclic Antidepressants (TCAS)

Real work is done by the group; nurse and client orient to parameters of a therapeutic relationship

Working Stage

Antianxiety medications?

benzodiapines Flumazenil (Anexate; Romazicon)

False beliefs

delusions

Hallucinations and delusions

positive symptoms of schizophrenia