NUR326 PSYCH EXAM 2
client education for Haloperidol
notify if inner restlessness, signs and symptoms of Parkinsons chew gum for dry mouth increase fluids and fiber urinate before dose wear gloves when handling avoid sun exposure
what are the three personality disorder clusters
odd/eccentric dramatic/unpredictable anxious/fearful
what drug class is buprenorphine
opioid partial agonist-antagonist
what are some disorders that are specific to kids
oppositional defiant disorder disruptive mood dysregulation disorder reactive attachment disorder conduct disorder specific to kids
interactions with clonidine
other heart/BP meds antidepressants antihistamines alcohol and marijuana sleep drugs
adaptation
over time, neurons will permanently restrict a sufficient number of their own receptors to allow for functioning within the presence of the stimulus
what are some signs of toxicity from stimulants
palpitations, tachycardia, myocardial ischemia, seizures, hallucinations, paranoia
odd/ecccentric cluster
paranoid personality disorder- distrust/suspiciousness schizoid personality disorder- emotional detachment, indifference to praise, uncooperative schizotypal personality disorder- odd beliefs, magical thinking, eccentric appearance
what are some factors that can contribute to a kid developing conduct disorder
parental neglect abuse lack of supervision, large family, chaotic home life early institutionalization parental hx of psychological illness
what is conduct disorder
persistent pattern of behavior that violates rights of others or rules and norms of society WITHOUT remorse
what are the classic four groups of extrapyramidal side effects
pesudoparkinsonism acute dystonia akathisia tardive dyskinesia
what are some signs of toxicity from a CNS depressant?
pinpoint pupils, slurred speech, shallow respirations, respiratory depression, cardiac arrest
contraindications for clonidine
pregnancy recent heart attack stroke cardiac conditions
contraindications of atypical antipsychotics
prolonged QT psychosis related to dementia sunlight exposure lactation children
primary psychosis
psychiatric illness bipolar I disorder - acute mania MDD - acute episodes
whatsis disruptive mood dysregulation disorder
recurrent temper outbursts that are severe and do not correlate with a situation inappropriate for developmental level verbal and physical outburst
expected action of clonidine
relaxes blood vessels in brain blocks chemicals in brain that trigger SNS activity
client education with atypical antipsychotics
report CNS effects report extrapyramadial effects increase exercise, low sugar/fat/calories report polydipsia and polyuria monitor glucose in diabetics
what are some characteristics of borderline personality disorder
separation insecurity identity insecurity self mutilation and self harm/suicide attempts impulsivity and risk taking impairments in empathy or intimacy
what is acute dystonia
severe painful spasms of neck and body medical emergency assume an arched position
antisocial personality disorder is also called
sociopath
pharmacologic action of conventional antipsychotics
suppresses release of dopamine blocks receptors for norepinephrine, acetylcholine, dopamine, histamine
therapeutic use of Haloperidol
suppresses symptoms of schizophrenia acute manic phase of bipolar relieves nausea and vomiting intractable hiccups
client education for disulfiram
take at bedtime if dizzy or tired abstain from all alcohol have periodic blood tests for liver effects report unusual bleeding or bruising
what is secondary psychosis
toxic psychosis (delirium) dementia medical illness (infections) toxins, drugs
therapeutic use of benzotropine
treats extrapyramidal side effects of antipsychotics tremors, stiffness Parkinson's
therapeutic use of atypical antipsychotics
treats positive and negative symptoms of schizophrenia treats bipolar manages irritability in autistic patients
A nurse is caring for a client who has schizophrenia and tells the nurse "I know not everyone can understand what it is like for me. Not everyone has superpowers". The nurse knows that the client is displaying: A. delusions of grandeur B. ideas of reference C. avolition D. somatic delusions
?
therapeutic use of buprenorphine
decreases pain severity decrease withdrawal symptoms in detox from opioids
What are the positive symptoms of schizophrenia?
delusions hallucinations disorganized speech
what are the five symptomatic domains associated with psychosis
delusions hallucinations disorganized thought disorganized or abnormal motor behavior negative symptoms
complications of buprenorphine
dizziness, drowsiness respiratory depression slow heartbeat and weak pulse chest pain decreased cortisol liver problems constipation insomnia increased sweating
client education for buprenorphine
do not stop taking abruptly increase fluids and fiber avoid driving/hazardous activities after taking report signs and symptoms of liver dysfunction
complications of atypical antipsychotics
drowsiness, insomnia, dizziness extrapyramidal effects Parkinson's symptoms weight gain new onset diabetes
complications of disulfiram
drowsy, tired, headache acne garlic-like taste in mouth decreased sex drive vision changes mental/mood changes liver disease allergic reaction
true or false: children get diagnosed with disorders like schizophrenia and personality disorders
false usually these are mistakenly diagnosed as ADHD
A client states, "I just don't know what to do about my partner's drinking. Every time I see him drinking beer, I start to feel extremely anxious." Which of the following is the most therapeutic response by the nurse? A. "The next time your partner starts drinking, what is something you might do to decrease your anxiety?" B. "I think you should attend an Al-Anon meeting. It is a support group for people who are troubled by another person's drinking". C. "Tell me more about your son. Is he still causing problems with you?" D. "At one time you told me you were drinking regularly with him. Are you continuing to do that?"
A
A nurse is caring for a client who has schizophrenia and is experiencing a variety of hallucinations. Which of the following hallucinations is the priority for the nurse to address? A. Command hallucinations B. Tactile hallucinations C. Olfactory hallucinations D. Visual hallucinations
A
A nurse is caring for a client who is experiencing acute alcohol withdrawal. Which of the following findings should the nurse expect? A. Hand tremors B. Stuporous LOC C. Hypotension D. Bradycardia
A
A nurse is providing teaching to a client who has schizophrenia and is to begin taking haloperidol. Which of the following information should the nurse include in the teaching? A. "You may experience dizziness upon standing when taking this medication" B. "This medication will decrease your symptoms of OCD" C. "This medication may cause excess salivation" D. "You can stop taking the medication if the adverse effects are bothersome"
A- Haloperidol can cause orthostatic hypotension B- used for schizophrenia, not OCD C- may cause dry mouth, not excess salvation D- do not discontinue abruptly
A nurse is caring for a client who has schizophrenia and is taking haloperidol. The nurse should monitor for which of the following adverse effects of this med? A. Extrapyramidal symptoms B. Fever C. Intractable hiccups D. Excessive salivation
A- associated with typical antipsychotics (movement disorders) B- not an adverse effect C- not an adverse effect D- not an adverse effect
A nurse is caring for a client who is experience acute manifestations of withdrawal from alcohol. Which of the following medications should the nurse expect to administer to the client? A. Diazepam B. Acamprosate C. Naltrexone D. Disulfiram
A- benzos used for acute alcohol withdrawal B- helps manage and maintain abstinence in clients following acute withdrawal from alcohol C- for opioid withdrawal D- used to maintain alcohol abstinence
A nurse is caring for a client who has schizophrenia and a new prescription for risperidone. Which of the following statements should the nurse include in the teaching? A. Increase fluid and fiber intake to prevent constipation B. Have blood pressure checked frequently for hypertension C. Expect to have blood checked weekly for serum electrolyte imbalances D. Increase caloric intake to prevent weight loss
A- constipation is common adverse effect B- orthostatic hypotension is common, not hypertension C- changes in electrolytes are not expected; CBC and liver function will be checked monthly D- weight gain, dyslipidemia, and increases in blood glucose are common adverse effects of this medication
A nurse is caring for a client who has severe manifestations of schizophrenia and is medication PRN for agitation with haloperidol. The nurse should assess the client for which of the following adverse effects? A. Dysrhythmias B. Cataracts C. Pancreatitis D. Bleeding
A- dysrhythmias are a risk for a client taking antipsychotics B- risk for glaucoma, but not cataracts C- risk for hepatitis, but not pancreatitis D- not true
A nurse overhears a client who has schizophrenia talking to herself. The client keeps stating, "The flakalas are here. The flakalas are here." The nurse correctly recognizes the client's use of the word flakala as an example of which of the following alterations in speech? A. Neologism B. Echolalia C. Clang association D. Word salad
A- neologism is where new phrases/words are invented by client
A nurse is assessing a client who has schizophrenia and is taking risperidone. Which of the following findings should the nurse expect? A. Weight gain B. Dependent edema C. Nightmares D. Bradycardia
A- this is an expected adverse effect B- not an adverse affect C- not an adverse effect D- tachycardia is a potential adverse effect, not bradycardia
what is the brand name of disulfiram
Antabuse
A client with schizophrenia is agitated and states, "The FBI is coming to get me! I know they are listening to everything I say!" The best response by the nurse is: A. "What if the FBI is trying to protect you?" B. "That sounds very frightening" C. "I do not think the FBI is coming to get you" D. "Why would the FBI be listening to you?"
B
A nurse is assessing a client who has a history of opioid use disorder. Which of the following questions should the nurse include to determine how the use of opioids affects the client's psychosocial behaviors? A. "Do you receive treatment for any mental health disorders?" B. "Has opioid use affected your work performance?" C. "At what age did you begin using opioids?" D. "Have you received prior treatment for substance use disorder?"
B
A nurse is caring for a client who has a history of alcohol use disorder and has been hospitalized for detoxification. The nurse enters the room and finds the client shouting in a terrified voice, "Get these bugs off of me!" Which of the following responses by the nurse is appropriate? A. "I do not see anything. This is part of withdrawal process" B. "I do not see any bugs, but you seem very frightened" C. "Tell me more about the bugs that you see in your room" D. "Im sure that the bugs you see will not harm you"
B
A nurse is caring for a client who has schizophrenia and a new prescription for fluphenazine. Which of the following information should the nurse provide? A. "This medication might turn your urine orange" B. "Sleepiness should subside within a week" C. "Stop the medication if hypotension occurs" D. A low-grade fever is expected with the first doses"
B- first-gen antipsychotics can cause sedation with early treatment A- might turn urine pink to reddish brown C- rise slowly but do not stop med abruptly D- med can cause leukopenia or agranulocytosis; notify provider immediately if having sore throat, fever, or malaise
splitting is a common symptom of people with
BPD
A nurse is collecting a health history on a client who has a diagnosis of Wernicke-Korsakoff syndrome. Which of the following is an expected finding? A. Family history of Alzheimers B. Current rehab for opioids C. Personal history of alcohol use disorder D. Undergoing HIV treatment
C
A nurse is reviewing the medical record of a client who reports drinking three to four glasses of wine each night and taking 3,000 mg of acetaminophen daily. Which of the following laboratory values is the priority for the nurse to assess? A. Amylase B. ADH C. AST D. Creatinine
C
A nurse in a substance abuse clinic is assessing a client who recently started taking disulfiram. The client reports having discontinued the medication after experiencing severe nausea and vomiting. Which of the following reasons should the nurse suspect to be a likely cause of the client's distress? A. The client had an allergic response B. The client experienced a common side effect C. The client consumed alcohol D. The client took an overdose of the medication
C- Disulfiram is given to avoid alcohol intake in clients with addiction to alcohol; it causes a highly unpleasant reaction
A nurse is caring for a client who has Wernicke-Korsakoff psychosis as a result of chronic alcohol use disorder. Which of the following interventions should the nurse anticipate? A. Lab analysis of cardiac enzymes B. Monitor for presence of esophageal varices C. Administration of thiamine D. Place client in protective isolation
C- Thiamine is given to client with this psychosis due to hepatic dysfunction
what is the brand name of benzotropine
Cogentin
interactions with Haloperidol
CNS depressants antacids/antidiarrheals
opioid overdose med
Naloxone (Narcan)
adverse drug reaction of Antabuse
acetylaldehyde syndrome: severe nausea, vomiting, headache, sweating, palpitations, hypotension, respiratory depression, seizures, death hepatotoxicity metallic aftertaste
what are some adverse effects of Haldol that require immediate interventions
acute dystonia tardive dyskinesia NMS
treatment for acute dystonia versus tardive dyskinesia
acute dystonia- give Benadryl, then can still give med tardive dyskinesia- withhold med and contact provider
Wernicke encephalopathy
acute lack of thiamine (ETOH = poor uptake of vitamin B) leads to mental confusion, vision problems, ataxia, hypothermia, memory problems daily thiamine given with withdrawal
therapeutic use of disulfiram
aid in alcohol detox
complications of Haloperidol
akathisia Parkinson-like symptoms acute dystonia anticholinergic effects decreased sex drive dysrhythmias neuroleptic malignant syndrome
interactions with buprenophrine
alcohol benzos opioids drugs affecting serotonin drugs that alter breathing
interactions with disulfiram
alcohol (even the smallest amount) TCAs blood thinners seizure meds can increase effects of caffeine
what drug class is disulfiram
alcohol antagonist
contraindications of Haloperidol
alcohol withdrawal bone marrow suppression CNS depression pregnancy and lactation caution w hypertension, diabetes
examples of CNS depressants
alcohol, barbiturates, benzos, opioids
contraindications for disulfiram
allergy to thiuram CAD psychosis mental or mood conditions
what are some products clients taking Antabuse should not use
cough syrup, aftershave, mouthwash, hand sanitizer, vanilla extract, some perfumes
what drug class is benzotropine
anticholinergic
pharm action of Cogentin
anticholinergic blocks histamine receptors and blocks Ach
what drug class is clonidine
antihypertensive
dramatic/emotional/erratic cluster
antisocial personality disorder- disregard for others, lack of empathy borderline personality disorder- instability of affect, identity, and relationships histrionic personality disorder- emotional attention-seeking behavior narcissistic personality disorder- grandiose views of self importance
what drug class is Abilify, Seroquel, Latuda
atypical antipsychotic
what drug class is olanzepine (Zyprexa)
atypical antipsychotic
what drug class is risperidone
atypical antipsychotic
what is clozapine (Clozaril)
atypical antipsychotic but has more adverse effects high risk of weight gain, dyslipidemia, diabetes risk for Fatal agranulocytosis**
client education for benzotropine
avoid driving until CNS effects known report vision problems, GI, urinary retention decreased sweating take with food
anxious/fearful cluster
avoidant personality disorder- social inhibition dependent personality disorder- extreme dependency in close relationship obsessive-compulsive disorder- indecisiveness and extreme perfectionism
CAGE questionnaire
cut down annoyed guilty eye opener
meds for detox from alcohol
benzos to prevent seizures antiepileptics/anticonvulsants Zofran for nausea thiamine, folic acid
expected action of buprenorphine
binds to opioid receptors partial antagonist properties for opioid withdrawal alters perception/response to pain
expected action of benzotropine
blocks Ach receptors blocks dopamine reuptake
expected action of conventional/typical antipsychotics
blocks CNS and non-CNS receptors (norepinephrine, acetylcholine, dopamine, histamine)
pharm action of atypical antipsychotics
blocks dopamine and serotonin receptors
expected action of disulfiram
blocks processing of alcohol in body; causes bad reaction if patient does drink
expected pharmacologic action of atypical antipsychotics
blocks receptors for dopamine and serotonin
What are the negative symptoms of schizophrenia?
blunted affect alogia asociality anhedonia avolition
contraindications for buprenorphine
breathing issues sleep apnea liver/kidney disease head injury/brain tumor alcoholism mental illness hallucinations pregnancy and lactation
what are some interventions for mood disorders in children
calm, firm approach reward system short and clear expectations set limits positive feedback encourage activity
Korsakoff syndrome
chronic thiamine deficiency leading to irreversible brain damage same manifestations as Wernicke but permanent memory loss
CIWA-Ar
clinical institute withdrawal assessment for alcohol, revised
opioid withdrawal meds
clonidine (Catapres) loperamide (Imodium) for diarrhea
what is antisocial personality disorder linked to in childhood
conduct disorder
what drug class is Haloperidol
conventional/typical antipsychotic
what drug class is chlorpromazine
conventional/typical antispsychotic
nursing interventions for neuroleptic malignant syndrome
cooling blanket ASA for fever hydration IV admin of bromocriptine (agonize D2 receptors) IV admin of dantrolene (muscle relaxer)
habituation
neurons chemically inhibit their own receptors to restrict stimulus
tolerance
habituation and adaptation
complications of clonidine
headache, dizziness, drowsiness mood swings dry mouth constipation insomnia depression cardiac problems
therapeutic use of clonidine
hypertension opioid withdrawal ADHD Tourette's menstrual cramps
admission criteria for a child/adolescent in psych
immediate danger to others or danger to self cannot maintain safety outside of hospital need 24/7 care
what is splitting
inability to reconcile positive and negative aspects of oneself or others into a cohesive image black and white thinking
what are some extrapyramidal side effects
inability to sit still, involuntary muscle contraction, tremors, stiff muscles, and involuntary facial movements
medication administration of Haloperidol
incompatible in IV form with many other drugs keep client recumbent 30 mins after IV/IM
symptoms of neuroleptic malignant syndrome
lead pipe rigidity mental status change high fever unstable vitals sweating
what are some nursing interventions for autism
maintain routine like at home remove overwhelming stimuli do not look px directly in the eye cluster care encourage and reward positive skills
what are some characteristics of antisocial personality disorder
manipulativeness, deceitful, lack of remorse, impairment in empathy or intimacy, risk taking, at least 18 years old (conduct as a kid)
meds for relapse prevention of alcohol/opioids
naltrexone (Revia) reduces positive reinforcement of ETOH use acamprosate (Campral) reduces cravings disulfiram (Antabuse) produces bad reaction when consuming alcohol
opioid relapse prevention meds
naltrexone (Vivitrol) methadone buprenorphine (Buprenex) Suboxone
complications of benzotropine
nausea, vomiting, dry mouth CNS effects depression, hallucinations tachycardia/palpitations urinary retention paralytic ileus
contraindications of benzotropine
urinary retention tachycardia closed angle glaucoma patients under 3 alcoholism with CNS depression
What is tardive dyskinesia?
writhing movements of tongue and neck, may extend to extremities and trunk rolling of tongue, sucking and smacking of lips, chewing motion
