nurs 406 test 5

MAOIs

(Mar Nar Par) -Marplan (Isocarboxazid) -Nardil (Phenelzine) -Parnate

STEPS to help functional psychosis

*ACKNOWLEDGE FEELING* *present reality* (positive statements better than neg) *set a limit* *enforce limit* (end convo if pt cannot stay reality based)

Anticonvulsants think anti COnVuLsaNTs or antiepileptics (AEDs) (*stabilize nerves*)-mood stabilizers

*Carbamazepine (Tegretol)* - common Oxcarbazepine (Trileptal) *Valproic acid (valproate or depakoate)* *Lamotrigine (Lamictal)* Levetiracetam (Keppra) Gabapentin (Neurontin) Topiramate (Topamax) -adjunct therapy Phenytoin (Dilantin) Pregabalin (Lyrica) - adjunct therapy

For Bipolar

*Lithium* = MOOD STABILIZER -long term therapy -levels ~ 0.6-1.2 -toxicity over 1.5 (decreased renal function/kidney disease/older pts) Carbamazepine (Tegretol) - *low WBCs* (report fever/sore throat) -need alternative birth control -antiepileptic *anticonvulsant* Valproic Acid -Liver toxic (monitor AST/ALT, jaundice) -LOW platelets (big risk of bleeding) -not safe during pregnancy -do not stop abruptly Lamotrigine (Lamictal) -anticonvulsant

vascular ch 36 medsurg

*Safe and Effective Care Environment:* -plan care for the pt with atherosclerosis and hypertension, in collaboration with the health care team, including the dietician, pharmacist, and pcp as needed -to reduce the risk for injury, caution pts about orthostatic hypotension when taking antihypertensive drugs -monitor blood pressure carefully in pts who have hypertension; be aware that they may develop a hypertensive crisis, a life-threatening medical emergency *chart 36-2* *Health Promotion & Maintenance:* -in collaboration with the dietician, help the pt incorporate healthy eating behaviors to lower cholesterol and saturated fats and increase fresh fruits, vegetables, fiber in diet. for overweight pts, assist in weight reduction plan -teach pts to engage in 40 min of moderate-to-vigorous physical activity 3-4x per week to lower bp and LDL cholesterol levels -assess the pt for modifiable and nonmodifiable risk factors for vascular disease and teach health promotion behaviors to the pt and family. pay particular attention to the pt with a family history of cardiovascular disease *Table 36-4* *Physiological Integrity:* -remember that risk factors such as smoking increase the pathophysiological process of atherosclerosis -remember that atherosclerosis occurs when fatty plaques occlude arteries and prevent adequate perfusion to vital body tissues -monitor total cholesterol, HDL-C, LDL-C levels to assess risk for atherosclerosis -teach pts taking any of the statins in TABLE 36-5 to report any adverse effects, including muscle cramping, to their primary care provider monitor liver enzymes carefully -teach pts to decrease saturated and trans fats in their diet; instruct them to consume a diet rich in fruits, vegetables, and whole grains; instruct them to include legumes, poultry, fish, and low fat dairy -hypertension is categorized as either *essential* (primary) or *secondary* (risk factors *table 36-1* -closely observe the pt receiving anticoagulants or fibrinolytics for signs of bleeding and monitor appropriate lab values for desired outcome values *chart 36-7* -monitor for decreased serum potassium levels *(hypokalemia)* when pts are taking thiazide or loop diuretics; hypokalemia could cause life-threatening cardiac dysrhythmias *chart 36-1* -teach pts to move slowly when changing position if taking any of the antihypertensive drugs listed in *chart 36-1* -recognize that s/s of peripheral vascular disease (PVD) depend on whether it affects the arteries or veins in addition to *pallor, rubor, or cyanosis*, key features of *chronic peripheral arterial disease* are listed in *chart 36-3* -vasodilating drugs or surgery can be used for arterial vascular diseases -*deep vein thrombosis (DVT)* is the most common type of *peripheral vascular problem* -be aware that DVT can lead to pulmonary embolism, a life threatening emergency -teach pts to prevent venous thromboembolism (VTE) by leg exercises, early ambulation, adequate hydration, graduated compression stockings (GCSs), sequential compression devices (SCDs) and anticoagulant therapy -monitor aPTT values for pts receiving unfractionated heparin; monitor INR for pts receiving warfarin (coumadin) -assess for venous and arterial ulcers as in *chart 36-4* -teach foot care for pts with PVD as in *chart 36-6* -teach pts about precautions for anticoagulant therapy as in *chart 36-7* -teach about food and drugs that interfere with warfarin (coumadin) as listed in *chart 36-8* -monitor for indications of aneurysm rupture: *diaphoresis, n/v, pallor, hypotension, tachycardia, severe pain, decreased LOC* -varicose veins can cause severe pain and reflux requiring the *3 Es:* *-elastic compression hose* *-exercise* *-elevation*

SSRIs (selective serotonin reuptake inhibitors) to increase serotonin

*first line* mainly for depression, anxiety, PTSD Sertraline (zoloft) Citalopram (celexa) Escitalopram (lexapro) Fluoxetine (Prozac) Paroxetine (Paxil) side effects: S - *suicide risk increased* S - slow onset,slow taper (6 weeks -may need adjunct) *serotonin syndrome*: S - sweaty, fever R - rigid muscles, restlessness, agitation I - increased tachycardia

benzodiazepine overdose treatment

*flumazenil* (Romazicon) may be used to reverse benzo effects

SSRI Sertraline (Zoloft)

*increases drug toxicities and interactions* - *increased risks* (interferes with liver break down) -causes *insomnia* but can give at bedtime -watch out for other drugs - dosages need to be lowered!!!!!! ex: St John's wart/sertraline can cause *serotonin syndrome* (SADH = sweat apprehension (impending sense of doom) dizzy headache) ex: *warfarin* (coumadin)/sertraline can cause bleeding out

Tricyclic antidepressants (TCAs)

*think elevates mood* : Elavil (amytriptyline) Tofranil (imipramine) Aventyl Desyrel

ELECTROCONVULSIVE THERAPY (ECT)

*ultimate treatment for depression* (Most effective acute treatment and highly effective somatic (physical) treatment) *also effective for psychotic illnesses* -schizophrenia, schizoaffective, major depressive, manic, etc

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key points

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nclex-examination qs (Vascular med surg bk ch 36)

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thought/mood disorders ch 13

-Bipolar I disorder is characterized by the presence of history of AT LEAST 1 MANIC episode -Bipolar II disorder is characterized by the presence or history of AT LEAST 1 HYPOMANIC episode -cyclothymia is a bipolar-related disorder with symptoms of hypomania and symptoms of mild-moderate depression -genetics play a role in the risk for the bipolar disorders -early detection of bipolar disorder can help diminish comorbid substance abuse, suicide, and decline in social and personal relationships and may help promote more positive outcomes -nurses assess the patient's mood (ex: mania, hypomania, and depression), behavior, and thought processes and are alert to cognitive dysfunction -during the acute phase of mania, physical needs often take priority and demand nursing interventions -support groups, psychoeducation, and guidance for the family can greatly affect the patient's adherence to the medication regimen -patients experiencing mania can be demanding and manipulative. nurses set limits in a firm, neutral manner and tailor communication techniques and interventions to maintain the patient's safety -healthcare workers, family, friends often feel angry and frustrated by the patient's disruptive behaviors when these feelings are not examined and shared with others, the therapeutic potential of the staff is reduced, and feelings of confusion and helplessness remain -*mood stabilizers are usually the first line of defense for bipolar disorder* and include *lithium and several anticonvulsants* -lithium is approved for treating acute mania and maintenance. blood levels, kidney function, and thyroid function should be assessed regularly -most anticonvulsant drugs are approved for acute mania. Lamotrigine (Lamictal) is approved for maintenance -antipsychotic agents, particularly *second generation antipsychotics (SGAs)* are used for *sedating and mood-stabilizing properties* screening for metabolic problems (ex: diabetes) is essential in this population -for some, ECT may be an appropriate medical treatment -patient and family teaching takes many forms and is most important in encouraging adherence to the medication regimen and reducing risk of relapse -evaluation includes examining the effectiveness of the nursing interventions, changing the outcomes as needed, and reassessing the nursing diagnoses evaluation is an ongoing process and is part of each of the other steps in the nursing process

thought/mood disorders ch 15

-anxiety has an unknown or unrecognized source, whereas fear is a reaction to a specific threat -Peplau operationally defined four levels of anxiety (mild, moderate, severe, and panic) the patient's perceptual field, ability to learn, and other characteristics are different at each level -defenses against anxiety can be adaptive or maladaptive and viewed in a hierarchy from healthy to intermediate to immature -anxiety disorders are the most common psychiatric disorders in the US and frequently co-occur with depression and substance abuse -another closely related set of disorders is *Obsessive-compulsive disorders (OCD)* in which anxiety results in *abnormal selective overattention* -research has identified biological, psychological, and environmental factors in the etiology of anxiety and obsessive-compulsive disorders -patients with anxiety and obsessive-compulsive disorders suffer from debilitating anxiety, panic attacks, irrational fears, excessive worrying, uncontrollable rituals, or severe reactions to stress -embarrassment and shame often prevent people from seeking psychiatric help instead, they may go to primary care providers with multiple somatic complaints -psychiatric treatment is effective for anxiety and obsessive-compulsive disorders -understanding the levels of anxiety will help in planning basic care including how much direction your patient will need, what precautions should be taken to prevent harm, and how able your patient is to learn -basic level nursing interventions include counseling, milieu therapy, promotion of self care activities, psychobiological intervention, and health teaching -advanced practice nursing interventions include behavioral and cognitive-behavioral therapies -quality improvement initiatives help to measure severity of symptoms and to establish interventions that are evidence based rather than tradition based

thought/mood disorders ch 16

-childhood trauma changes the brain and can cause medical and psychological problems in adulthood -a phase model of treatment is most effective with safety and stabilization first -evidence based treatments for trauma are eye movement desensitization and reprocessing (EMDR) therapy and cognitive behavioral therapy (CBT) -understanding patients as traumatized changes the conversation from "WHAT is wrong with this person?" to "WHAT HAPPENED to this person?" -trauma is stored in the body and often manifests as physical symptoms healing involves connection and integration -dissociative disorders involve a disruption in consciousness with significant impairments in memory, identity, and perception to self -assessment is especially important in clarifying the history of symptoms and obtaining a complete picture of the current physical, psychological and safety status -psychotherapy is the treatment of choice for trauma, with medication prescribed only to ameliorate symptoms -patients with trauma-related disorders are often treated on an out-patient basis except during a period of crisis such as suicidal risk -crisis intervention is important for stabilization referral for psychotherapy to attain sustained improvement in level of functioning is typically necessary

thought/mood disorders ch 14

-children and adolescents with disruptive mood dysregulation disorder had been previously diagnosed with bipolar disorder usually children with this disorder grow up and are diagnosed with major depressive disorder or an anxiety disorder -persistent depressive disorder is a low level depression that tends to be chronic. treatment for this disorder is similar to major depressive disorder -premenstrual dysphoric disorder is diagnosed for women with physical discomfort and emotional symptoms similar to major depression these symptoms disappear at the ONSET of menstruation -the symptoms of major depressive disorder are usually severe enough to interfere with a person's social or occupational functioning a person with depression may or may not have psychotic symptoms the most severe consequence of major depressive disorder is suicide -many theories exist about the cause of depression biochemical abnormalities are strongly supported in the scientific community the diathesis-stress theory suggests a dynamic interaction between psychosocial stressors and interpersonal events with neurochemical changes in the brain -nursing assessment includes the evaluation of affect, thought processes (esp suicidal thoughts), mood, feelings, and physical behavior the nurse must be aware of the symptoms that may mask depression -nursing diagnoses are numerous risk for suicide is always the priority diagnosis when suicidal ideation is present other common nursing diagnoses are chronic low self esteem, imbalanced nutrition, constipation, disturbed sleep pattern, ineffective coping, and disabled family coping -interventions include using specific principles of communication, planning ADLs, administering or participating in psychopharmacological therapy, maintaining a therapeutic environment, and teaching patients about the biochemical aspects of depression -depression is often overlooked in children, adolescents, and older adults -planning and interventions for patients with depression are based on the recovery model, which involves a therapeutic alliance with healthcare professionals to achieve outcomes based on individual patient's needs and values -evaluation is ongoing throughout the nursing process, and patient's outcomes are compared with the stated outcome criteria and short-term and intermediate indicators. the care plan is revised when indicators are not being met

thought/mood disorders ch 12

-schizophrenia spectrum disorders are biological disorders of the brain -schizophrenia is a group of related disorders with overlapping symptoms and treatments but varying etiologies -neurochemical, genetic, and neuroanatomical findings help explain the symptoms of schizophrenia (no one theory accounts fully for the complexities of schizophrenia) -schizophrenia varies from person to person in terms of which symptoms dominate, their severity, the impairment in affect and cognition, and their impact on functioning -psychotic symptoms are often more pronounced and obvious than symptoms of other disorders, making schizophrenia more apparent to others and increasing stigmatization -*positive symptoms* of schizophrenia (ex: hallucinations, delusions, associative looseness) are easier to recognize and respond best to antipsychotic drug therapy -*negative symptoms* of schizophrenia (ex: reduction in affect, social withdrawal and dysfunction, lack of motivation, inability to experience pleasure) respond less well to antipsychotic therapy and can be more debilitating *psychosocial interventions such as support groups improve negative symptoms* -comorbid anxiety and depression must be identified and treated to reduce the potential for suicide, substance abuse, nonadherence, and relapse helping the patient to learn to regulate emotions (ex: via stress management techniques, self-nurturance, instilling hope, and participating in rewarding activities) is very important -substance use disorders affect the majority of people with schizophrenia and can intensify symptoms and cause relapse. prevention, screening, and treatment of substance use disorders is very important -outcomes are chosen based on the phase of the disorder and the patient's individual symptoms, needs, strengths, values, and level of functioning short term and intermediate indicators are also developed to better track the incremental progress typical of schizophrenia -it is important for nurses to assess and support functions such as hygiene, self care, nutrition, and rest, to ensure a therapeutic milieu (ex: reducing undue stimuli on the unit) -antipsychotic medications are essential in treating patients with schizophrenia nurses must understand the properties, desired and undesired effects, and dosages of first and second generation antipsychotics and other medications used -side effects can be distressing to patients and are the source of nonadherence to the medication regime -some side effects such as neuroleptic malignant syndrome (NMS), agranulocytosis, paralytic ileus, bowel obstruction, and anticholinergic toxicity are potentially fatal

SSRI Fluoxetine (Prozac)

-similar to mood elevator NSSRIs with side effects: ABCDE (euphoria) -causes *insomnia* so do not give at bedtime *when changing dose in adolescents/young adults, watch for increased suicidal risk* *can be given to kids and adolescents* (not many can be given)

SGAs (second generation antipsychotics)

-zapine -used to treat severe schizophrenia -side effects WAY LESS (used more often) -only side effect: aGranulocytosis! (trashes bone marrow) think *ZAPS WBC* treats positive and negative symptoms

Benzodiazepines (minor tranquilizers) for anti anxiety (anxiolytic)

-zep indications: -used preop to induce anesthesia -used as a muscle relaxant -used for alcohol withdrawal -used to help with seizures -used to help fight a ventilator (relaxes/calms) (SEDATIVE) *for PRN use for acute anxiety* *WORK QUICKLY - do not take more than 2-4 weeks* to not develop drug dependence

FGAs (first generation typical antipsychotics)

-zines -reduce symptoms of psychosis -most side effects! ABCDEFG -major tranquilizers (BIG GUNS) -used after trying all else and nothing works -target positive symptoms *small doses act as antiemetics*

FGAs

-zines and Haldol

36-2 a client diagnosed with atherosclerosis and hypertension has been newly prescribed a combination drug of amlodipine and atorvastatin (caduet). which statement by the client indicates a need for further teaching? A. i'll continue to take my amlodipine with the new medication B. i'll continue to follow up with my nurse practitioner on a regular basis C. i need to quit smoking as soon as i possibly can D. i shouldn't drink grapefruit juice while on this drug

A

36-4 a client is being discharged home following 5 days of acute care for treatment of a deep vein thrombosis (DVT) which statement made by the client indicates a need for further teaching? A. i will be going home on oral heparin and warfarin B. i have an appointment for followup care with my primary care provider C. i will avoid dark green leafy vegetables while taking warfarin D. i will report any signs of bleeding to my primary health care provider

A

side effects of FGAs

A - anticholinergics (dry mouth) B - blurred vision C - constipation D - drowsiness E - EPS - *acute dystonia* (contraction of neck, head), *akathisia* (muscle restlessness, pacing), *pseudoparkinsonisms* (involuntary muscle symptoms) F - (F)Photosensitivity G - aGranulocytosis

A pt diagnosed with bipolar disorder is dressed in a red leotard & bright scarves. The pt twirls & shadow boxes. The pt says gaily, "Do you like my scarves? Here; they are my gift to you." How should you document the pt's mood? A. Euphoric B. Irritable C. Suspicious D. Confident

A --> The pt has demonstrated clang associations & pleasant, happy behavior. Excessive happiness indicates euphoria. I rritability, belligerence, excessive happiness, & confidence are not the best terms for the pt's mood. Suspiciousness is not evident

36-5 the nurse is admitting a client with an ulcer on the right foot. which statement made by the client indicates venous insufficiency ? SELECT ALL THAT APPLY: A. my ankles swell up all the time B. my leg hurts after i walk about a block C. my feet are always cold D. my veins really stick out in my legs E. my ankles have been discolored for years

A D E

A nurse is interested in providing community education and screening on hypertension. In order to reach a priority population, to what target audience should the nurse provide this service? a. African-American churches b. Asian-American groceries c. High school sports camps d. Women's health clinics

A. African-American churches African Americans in the United States have one of the highest rates of hypertension in the world. The nurse has the potential to reach this priority population by providing services at African-American churches. Although hypertension education and screening are important for all groups, African Americans are the priority population for this intervention.

A pt diagnosed with bipolar disorder commands other pts, "Get me a book. Take this stuff out of here," & other similar demands. The nurse wants to interrupt this behavior without entering into a power struggle. Which initial approach should the nurse select? A. Distraction: "Let's go to the dining room for a snack." B. Humor: "How much are you paying servants these days?" C. Limit setting: "You must stop ordering other pts around." D. Honest feedback: "Your controlling behavior is annoying others."

A. Distraction: "Let's go to the dining room for a snack." The distractibility characteristic of manic episodes can assist the nurse to direct the pt toward more appropriate activities without entering into power struggles. Humor usually backfires by either encouraging the pt or inciting anger. Limit setting and honest feedback may seem heavy-handed and may incite anger

A nurse is assessing a client with peripheral artery disease (PAD). The client states walking 5 blocks is impossible without pain. What question asked next by the nurse will give the best information? A. could you walk further than that a few months ago? B. do you walk mostly uphill, downhill or on flat surfaces? C. have you ever considered swimming instead of walking? D. how much pain medication do you take each day?

A. could you walk further than that a few months ago? As PAD progresses, it takes less oxygen demand to cause pain. Needing to cut down on activity to be pain free indicates the clients disease is worsening. The other questions are useful, but not as important.

(3). The nurse is caring for four clients with a history of hypertension. Which client would require intervention? A.40-year-old with chronic kidney disease, BP 138/80. B.58-year-old on diuretics, BP 160/80 C.28-year-old with LDL-C 140 mg/dL, BP 114/84 D.30-year-old with pre-eclampsia, BP 120/68

A.58-year-old on diuretics, BP 160/80 A client on diuretics that remains hypertensive requires intervention. The other options have a normal blood pressure.

36-1 a client is prescribed lisinopril (zestril) for control of hypertension. what health teaching will the nurse provide to this patient? SELECT ALL THAT APPLY A. this medication can cause increased potassium levels B. it's important to change positions slowly when you start this medication C. this medication may cause you to develop a persistent, non productive cough D. to achieve maximum benefit of zestril, your diet should include foods high in sodium E. Be sure to monitor your BP regularly while taking this medication

ABCE

A nurse is caring for a client with a nonhealing arterial lower leg ulcer. What action by the nurse is best? a. Consult with the Wound Ostomy Care Nurse. b. Give pain medication prior to dressing changes. c. Maintain sterile technique for dressing changes. d. Prepare the client for eventual amputation.

ANS: A A nonhealing wound needs the expertise of the Wound Ostomy Care Nurse (or Wound Ostomy Continence Nurse). Premedicating prior to painful procedures and maintaining sterile technique are helpful, but if the wound is not healing, more needs to be done. The client may need an amputation, but other options need to be tried first.

A client has peripheral arterial disease (PAD). What statement by the client indicates misunderstanding about self-management activities? a. I can use a heating pad on my legs if its set on low. b. I should not cross my legs when sitting or lying down. c. I will go out and buy some warm, heavy socks to wear. d. Its going to be really hard but I will stop smoking.

ANS: A Clients with PAD should never use heating pads as skin sensitivity is diminished and burns can result. The other statements show good understanding of self-management.

A patient diagnosed with bipolar disorder is dressed in a red leotard and bright scarves. The patient twirls and shadow boxes. The patient says gaily, "Do you like my scarves? Here; they are my gift to you." How should the nurse document the patient's mood? a. Euphoric b. Irritable c. Suspicious d. Confident

ANS: A The patient has demonstrated clang associations and pleasant, happy behavior. Excessive happiness indicates euphoria. Irritability, belligerence, excessive happiness, and confidence are not the best terms for the patient's mood. Suspiciousness is not evident.

A client with a history of heart failure and hypertension is in the clinic for a follow-up visit. The client is on lisinopril (Prinivil) and warfarin (Coumadin). The client reports new-onset cough. What action by the nurse is most appropriate? a. Assess the clients lung sounds and oxygenation .b. Instruct the client on another antihypertensive. c. Obtain a set of vital signs and document them. d. Remind the client that cough is a side effect of Prinivil.

ANS: A This client could be having an exacerbation of heart failure or be experiencing a side effect of lisinopril (and other angiotensin-converting enzyme inhibitors). The nurse should assess the clients lung sounds and other signs of oxygenation first. The client may or may not need to switch antihypertensive medications. Vital signs and documentation are important, but the nurse should assess the respiratory system first. If the cough turns out to be a side effect, reminding the client is appropriate, but then more action needs to be taken.

The nurse working in the emergency department knows that which factors are commonly related to aneurysm formation? (Select all that apply.) a. Atherosclerosis b. Down syndrome c. Frequent heartburn d. History of hypertension e. History of smoking

ANS: A, D, E Atherosclerosis, hypertension, hyperlipidemia, and smoking are the most common related factors. Down syndrome and heartburn have no relation to aneurysm formation.

A person was online continuously for over 24 hours, posting rhymes on official government web-sites and inviting politicians to join social networks. The person has not slept or eaten for 3 days. What features of mania are evident? a. Increased muscle tension and anxiety b. Vegetative signs and poor grooming c. Poor judgment and hyperactivity d. Cognitive deficits and paranoia

ANS: C Hyperactivity (activity without sleep) and poor judgment (posting rhymes on government web-sites) are characteristic of manic episodes. The distracters do not specifically apply to mania.

A patient undergoing diagnostic tests says, "Nothing is wrong with me except a stubborn chest cold." The spouse reports the patient smokes, coughs daily, lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using? a. Displacement b. Regression c. Projection d. Denial

ANS: D denial

Benzodiazepines examples

Alprazolam (Xanax) Diazepam (Valium) Lorazepam (Ativan)

Third Generation Antipsychotics

Aripiprazole (Abilify) - *little or no weight gain* Brexipiprazole (Rexulti) Cariprazine (Vraylar) *newer, less side effects, less risk of EPS/tardive dyskinesia* *may help with positive,negative symptoms and cognitive function*

Priority interventions for a pt diagnosed with major depression and feelings of worthlessness should include: A. Distracting the patient from self-absorption. B. Careful unobtrusive observation around the clock. C. Allowing the pt to spend long periods alone in meditation. D. Opportunities to assume a leadership role in the therapeutic milieu

B --> Approximately 2/3 of people with depression contemplate suicide. Pts with depression who exhibit feelings of worthlessness are at higher risk. Regular planned observations of the pt diagnosed with depression may prevent a suicide attempt on the unit

Which assessment questions would be most appropriate for the nurse to ask a patient with possible obsessive-compulsive disorder? (Select all that apply.) A. "Are there certain social situations that cause you to feel especially uncomfortable?" B. "Are there others in your family who must do things in a certain way to feel comfortable?" C. "Have you been a victim of a crime or seen someone badly injured or killed?" D. "Is it difficult to keep certain thoughts out of your awareness?" E. "Do you do certain things over and over again?"

B D E B. "Are there others in your family who must do things in a certain way to feel comfortable?" D. "Is it difficult to keep certain thoughts out of your awareness?" E. "Do you do certain things over and over again?"

(1). A client has been diagnosed with hypertension but does not take the antihypertensive medications because of a lack of symptoms. What response by the nurse is best? A. "Do you have trouble affording your medications?" B. "Most people with hypertension do not have symptoms." C. "You are lucky; most people get severe morning headaches." D. "You need to take your medicine, or you will get kidney failure."

B. "Most people with hypertension do not have symptoms." htn is often a "silent killer"

A nurse is caring for four clients. which one should the nurse see first? A. client who needs a beta blocker, and has a blood pressure of 92/58 mmHg B. client who had a first dose of captopril (capoten) and needs to use the bathroom C. hypertensive client with a blood pressure of 188/92 mmHg D. client who needs pain medication prior to a dressing change of a surgical wound

B. Client who had a first dose of captopril (Capoten) and needs to use the bathroom

The nurse is evaluating a 3-day diet history with a client who has an elevated lipid panel. what meal selection indicates the client is managing this condition well with diet? A. a 4oz steak, french fries, iceberg lettuc B. baked chicken breast, broccoli, tomatoes C. fried catfish, cornbread, peas D. spaghetti with meat sauce, garlic bread

B. baked chicken breast, broccoli, tomatoes The diet recommended for this client would be low in saturated fats and red meat, high in vegetables and whole grains (fiber), low in salt, and low in trans fat. The best choice is the chicken with broccoli and tomatoes. The French fries have too much fat and the iceberg lettuce has little fiber. The catfish is fried. The spaghetti dinner has too much red meat and no vegetables.

(2). At the end of the visit, the provider prescribes hydrochlorothiazide (HydroDIURIL) 25 mg PO each morning to manage the client's hypertension. Which statement do you include when teaching the client about this drug? A."This is a loop diuretic that decreases sodium reabsorption." B."Eat foods rich in potassium, such as bananas and orange juice." C."A potassium supplement will be prescribed along with this drug." D."HydroDIURIL is a potassium-sparing diuretic that helps prevent the loss of essential potassium."

B."Eat foods rich in potassium, such as bananas and orange juice." Hydrochlorothiazide is a thiazide diuretic. The most frequent side effect is hypokalemia, so it's important to teach clients the signs of low potassium, as well as which foods are rich in potassium. Some clients need a potassium supplement, but this is prescribed based on the client's serum potassium level.

(4). A client with hypertension is discussing the cause of hypertension. Which statement by the nurse is appropriate? A."Pregnancy can cause essential hypertension." B."High cholesterol can be a big factor in the development of essential hypertension." C."Stopping intake of caffeine can cause hypertension to go away." D.Race is associated with secondary hypertension.

B."High cholesterol can be a big factor in the development of essential hypertension."

(5). What is the most common symptom when a client is diagnosed with hypertension? A.Headache B.Hypertension is often asymptomatic C.Fainting and dizziness D.Slurred speech

B.Hypertension is often asymptomatic Hypertension is often asymptomatic and has become known as the "silent killer" due to the lack of symptoms. Headaches may occur but not always. Hypertension does not cause slurred speech or fainting.

Miscellaneous anxiolytic

Buspirone (buspar) -*lacks sedative properties* so can take regularly/throughout the day (THINK can still drive BUS) (take 2-4 weeks to become effective) -*NO dependency potential* and NO withdrawal symptoms

A pt diagnosed with bipolar disorder becomes hyperactive after discontinuing lithium. The pt threatens to hit another pt. Which comment by the nurse is appropriate? A. "Stop that! No one did anything to provoke you." B. "If you do that one more time, you will be secluded immediately." C. "Do not hit anyone. If you are unable to control yourself, we will help you." D. "You know we will not let you hit anyone. Why do you continue this behavior?"

C --> When the pt is unable to control his or her behavior & violates or threatens to violate the rights of others, limits must be set in an effort to de-escalate the situation. Limits should be set in simple, concrete terms. The incorrect responses do not offer appropriate assistance to the pt, threaten the pt with seclusion as punishment & ask a rhetorical question

Consider these three anticonvulsant meds: divalproex (Depakote), carbamazepine (Tegretol) & gabapentin (Neurontin). Which med also belongs to this classification? A. Clonazepam (Klonopin) B. Risperidone (Risperdal) C. Lamotrigine (Lamictal) D. Aripiprazole (Abilify)

C The three drugs in the stem of the question are all anticonvulsants. Lamotrigine is also an anticonvulsant. Clonazepam is an anxiolytic; aripiprazole and risperidone are antipsychotic drugs. See relationship to audience response question.

A soldier returned home from active duty in a combat zone in Afghanistan and was diagnosed with posttraumatic stress disorder (PTSD). The soldier says, If theres a loud noise at night, I get under my bed because I think were getting bombed. What type of experience has the soldier described? A. Illusion B. Nightmare C. Flashback D. Auditory hallucination

C. Flashback Flashbacks are dissociative reactions in which an individual feels or acts as if the traumatic event were recurring. Illusions are misinterpretations of stimuli, and although the experience is similar, it is better termed a flashback because of the diagnosis of PTSD. Auditory hallucinations have no external stimuli. Nightmares commonly accompany PTSD, but this experience was stimulated by an actual environmental sound.

SGAs

Clozapine (Clozaril) •Olanzapine (Zyprexa) •Risperidone (Risperdal) Ziprasidone (Geodon) - *black box warning* -can cause QT prolongation and lead to sudden cardiac arrest (do not use in heart problem pts) •Lurasidone (Latuda) •Quetiapine (Seroquel, Seroquel XR)

36-3 the nurse is caring for the client with intermittent claudication pain related to peripheral arterial disease (PAD). which statement made by the client indicates understanding of proper self-management? A. i need to reduce the number of cigarettes that i smoke each day B. i'll elevate my legs above the level of my heart C. i'll use a heating pad to promote circulation D. i'll start to exercise gradually, stopping when i have pain

D

A nursing student is caring for a client with an abdominal aneurysm. What action by the student requires the registered nurse to intervene? a. Assesses the client for back pain b. Auscultates over abdominal bruit c. Measures the abdominal girth d. Palpates the abdomen in four quadrants

D Abdominal aneurysms should never be palpated as this increases the risk of rupture. The registered nurse should intervene when the student attempts to do this. The other actions are appropriate.

A pt became severely depressed when the last of the family's 6 kids moved out of the home 4 months ago. The pt repeatedly says, "No one cares about me. I'm not worth anything." Which response would be most helpful? A. "Things will look brighter soon. Everyone feels down once in a while." B. "Our staff members care about you and want to try to help you get better." C. "It is difficult for others to care about you when you repeatedly say the same negative things." D. "I'll sit with you for 10 minutes now and 10 minutes after lunch to help you feel better."

D --> Spending time with the pt at intervals throughout the day shows acceptance by the nurse & will help the pt establish a relationship with the nurse. The therapeutic technique is "offering self." Setting definite times for the therapeutic contacts & keeping the appointments show predictability on the part of the nurse, an element that fosters trust building

SNRIs

Duloxetine (cymbalta) -for dual depression/pain Venlafaxine (effexor) *better at treatment of negative symptoms* (bring about pleasure/excitement)

Zs for ZANIES

FGA *-zines* SGA *-zapines* minor tranquilizers *-zep*

decanoate or D (after medication)

LONG acting form of drug 2 weeks - month action depending on drug -given IM(injectable) form noncompliant pts; typically court ordered

Psychotic vs Non Psychotic

Psychosis = no insight, not reality based -positive symptoms of delusions hallucinations illusions Psychotic - functional: -*schizophrenia* -*schizoaffective disorder* -*major depressive disorder* -*manic* (bipolar not in depressive state)

toxic effects of lithium (HOLD dose and CALL provider)

TREMORS METALLIC TASTE SEVERE DIARRHEA

A young adult says, I was sexually abused by my older brother. During those assaults, I went somewhere else in my mind. I dont remember the details. Now, I often feel numb or unreal in romantic relationships, so I just avoid them. Which disorders should the nurse suspect based on this history? Select all that apply. A. Acute stress disorder B. Depersonalization disorder C. Generalized anxiety disorder D. Posttraumatic stress disorder E. Reactive attachment disorder F. Disinhibited social engagement disorder

a. Acute stress disorder b. Depersonalization disorder d. Posttraumatic stress disorder Acute stress disorder, depersonalization disorder, and posttraumatic stress disorder can involve dissociative elements, such as numbing, feeling unreal, and being amnesic for traumatic events. All three disorders are also responses to acute stress or trauma, which has occurred here. The distracters are disorders not evident in this patients presentation. Generalized anxiety disorder involves extensive worrying that is disproportionate to the stressors or foci of the worrying. Reactive attachment disorder and disinhibited social engagement disorder are problems of childhood.

A 10-year-old child was placed in a foster home after being removed from parental contact because of abuse. The child has apprehension, tremulousness, and impaired concentration. The foster parent also reports the child has an upset stomach, urinates frequently, and does not understand what has happened. What helpful measures should the nurse suggest to the foster parents? The nurse should recommend: (select all that apply) A. conveying empathy and acknowledging the childs distress. B. explaining and reinforcing reality to avoid distortions. C. using a calm manner and low, comforting voice. D. avoiding repetition in what is said to the child. E. staying with the child until the anxiety decreases. F. minimizing opportunities for exercise and play.

a. conveying empathy and acknowledging the childs distress. b. explaining and reinforcing reality to avoid distortions c. using a calm manner and low, comforting voice. e. staying with the child until the anxiety decreases. The childs symptoms and behavior suggest that he is exhibiting posttraumatic stress disorder. Interventions appropriate for this level of anxiety include using a calm, reassuring tone, acknowledging the childs distress, repeating content as needed when there is impaired cognitive processing and memory, providing opportunities for comforting and normalizing play and physical activities, correcting any distortion of reality, and staying with the child to increase his sense of security.

cyclothymic disorder

alternate with mild-mod depression for at least 2 years (adolescents/young adults)

A client has hypertension and high risk factors for cardiovascular disease. The client is overwhelmed with the recommended lifestyle changes. What action by the nurse is best? a. Assess the client's support system. b. Assist in finding one change the client can control. c. Determine what stressors the client faces in daily life. d. Inquire about delegating some of the client's obligations.

b. Assist in finding one change the client can control

1. A nurse works with a patient diagnosed with posttraumatic stress disorder who has frequent flashbacks as well as persistent symptoms of arousal. Which intervention should be included in the plan of care? A. Trigger flashbacks intentionally in order to help the patient learn to cope with them. B. Explain that the physical symptoms are related to the psychological state. C. Encourage repression of memories associated with the traumatic event. D. Support numbing as a temporary way to manage intolerable feelings.

b. Explain that the physical symptoms are related to the psychological state. Persons with posttraumatic stress disorder often experience somatic symptoms or sympathetic nervous system arousal that can be confusing and distressing. Explaining that these are the bodys responses to psychological trauma helps the patient understand how such symptoms are part of the illness and something that will respond to treatment. This decreases powerlessness over the symptoms and helps instill a sense of hope. It also helps the patient to understand how relaxation, breathing exercises, and imagery can be helpful in symptom reduction. The goal of treatment for posttraumatic stress disorder is to come to terms with the event so treatment efforts would not include repression of memories or numbing. Triggering flashbacks would increase patient distress.

A woman just received notification that her husband died. She approaches the nurse who cared for him during his last hours and says angrily, If you had given him your undivided attention, he would still be alive. How should the nurse analyze this behavior? A. The comment suggests potential allegations of malpractice. B. In some cultures, grief is expressed solely through anger. C. Anger is an expected emotion in an adjustment disorder. D. The patient had ambivalent feelings about her husband.

c. Anger is an expected emotion in an adjustment disorder.

A patient states, I feel detached and weird all the time. It is as though I am looking at life through a cloudy window. Everything seems unreal. It really messes up things at work and school. This scenario is most suggestive of which health problem? a. Acute stress disorder b. Dissociative amnesia c. Depersonalization disorder d. Disinhibited social engagement disorder

c. Depersonalization disorder Depersonalization disorder involves a persistent or recurrent experience of feeling detached from and outside oneself. Although reality testing is intact, the experience causes significant impairment in social or occupational functioning and distress to the individual. Dissociative amnesia involves memory loss. Children with disinhibited social engagement disorder demonstrate no normal fear of strangers and are unusually willing to go off with strangers. Individuals with ASD experience three or more dissociative symptoms associated with a traumatic event, such as a subjective sense of numbing, detachment, or absence of emotional responsiveness; a reduction in awareness of surroundings; derealization; depersonalization or dissociative amnesia. In the scenario, the patient experiences only one symptom.

The high-potency antianxiety benzodiazepines ______________ and _________________ are useful in the treatment of acute mania.

clonazepam (Klonopin) and lorazepam (Ativan) They may calm agitation and reduce insomnia, aggression, and panic. (USED IN THE SHORT TERM UNTIL MANIA SUBSIDES)

Lamictal (lamotrigine)

commonly used for *Bipolar pts* or for seizures common adverse effects: relatively minor CNS and GI symptoms, possible Steven Johnson syndrome

A student nurse is assessing the peripheral vascular system of an older adult. What action by the student would cause the faculty member to intervene? a. Assessing blood pressure in both upper extremities b. Auscultating the carotid arteries for any bruits c. Classifying capillary refill of 4 seconds as normal d. Palpating both carotid arteries at the same time

d. Palpating both carotid arteries at the same time The student should not compress both carotid arteries at the same time to avoid brain ischemia. Blood pressure should be taken and compared in both arms. Prolonged capillary refill is considered to be greater than 5 seconds in an older adult, so classifying refill of 4 seconds as normal would not require intervention. Bruits should be auscultated.

psych drugs

essentially all cause WEIGHT GAIN and HYPOTENSION *nonadherence is a common problem*

Antiparkinson drugs

helps decrease/ slow symptoms: (take without other meds different times) -levodopa carbidopa (*Sinemet*) (increase dopamine for about 5-10 yrs) -*Cogentin* (anticholinergic) -*Artane* -*Benadryl*

Antidepressants

increase levels of neurotransmitter concentration in CNS (dopamine, epinephrine, norepinephrine, serotonin, etc) reduces depressants in the brain

Haldol (haloperidol)

like FGA similar to -zines -only major antipsychotic tranquilizer that can be given to pregnant women -side effects ABCDEFG *can cause NMS* if given too much or too high dosage (this is why it is advised to start with low dose and gradually work up if needed)

MAOIs (antidepressants)

monoamine oxidase inhibitors -not really given much anymore except still given some in veteran hospitals (cheap cost) and many dietary/medical interactions side effects: ABCD *pt teaching: PREVENT severe acute fatal HYPERTENSIVE crisis by avoiding tyramines* allowed all fruits/veggies EXCEPT: (*think salad BAR*): -bananas -avocado -raisins aka all dried fruit -also no organ meat, no preserved meats, no hotdogs, no deli meats, no cheese except cottage/mozzarella, no alcohol or chocolate

BPD TYPE II

more in females at least one HYPO MANIC episode (not as severe as manic) and at least one MAJOR DEPRESSIVE EPISODE

BPD TYPE I

most dangerous/severe more in males at least one MANIC episode

tardive dyskinesia

occurs with long term, continuous antipsychotic therapy or too high dose involuntary contractions of oral and facial muscles, chorea

NSSRIs (Tricyclic antidepressants - TCAs)

old class of drugs (grandfathered into Non selective serotonin reinhibitor class) *MOOD elevators* side effects ABCDE Anticholinergic - dry eyes Blurry vision Constipation Drowsiness *Euphoria* *must take 2-4 weeks before see results/benefits* (takes longer to see working, reassure pts) SLOW ONSET & SLOW TAPER OFF *NEVER MIX WITH MAOIs - 2 week break in between changing*

Cognitive behavioral therapy (CBT)

only advanced practice RNs and higher level can utilize aka psychotherapy *most effective THERAPY used to treat depression*

NMS (neuroleptic malignant syndrome)

similar to EPS but *life threatening* neurological disorder (anxiety, tremors, altered mental status, unstable BP, *fever*) -caused by an adverse reaction to neuroleptic or antipsychotic drugs.....causes *extremely HIGH fevers (pyrexia)* *106 - 108 F* *if 102F call RAPID RESPONSE TEAM* *make sure elderly pt dose is HALF the adult dose*

EPS treatment

use antiparkinson drugs -benztropine (Cogentin) -trihyexyphenydil (Artane) and benadryl too sometimes

for non psychotic pts....

use good therapeutic communication (they are reality based and have insight into their issues and how they affect their life)

EMDR therapy (eye movement desensitization and reprocessing)

used by advanced practice providers -an extensively researched, effective psychotherapy method proven to help people recover from *trauma and other distressing life experiences*, including PTSD, anxiety, depression, and panic disorders.

Lithium

used to treat bipolar disorder (decreases manic phase - calms everything down) -stabilizes nerve cell membranes *side effects: (THREE P's)* = think electrolytes -Peeing (increased) -Pooping (increased) -Paresthesias (numbness/tingling expected) *#1 intervention: GIVE FLUIDS* (increase since losing, peeing all the time) make sure to monitor sodium: -too little sodium, toxic effect of lithium (high risk: diarrhea/vomiting, dehydrated pts) TOXICITY ABOVE 1.5 -too much sodium, lithium does not work effectively