Psych final
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)
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
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
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
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
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
what is your usual level of anxiety on the day of a nursing exam? a) mild b) moderate c) severe d) panic
a) mild
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
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
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
sundowning
mood deterioration and increase in agitation later in the day or night
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)
disadvantages of 2nd generation anti-psychotics
tendency to cause significant weight gain; risk of metabolic syndrome Clozapine (Clozaril) - agranulocytosis
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
cognitive retardation
generalized slowing of thinking, which is represented by delays in responding to questions or difficulty finishing thoughts
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
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
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
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
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
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
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
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
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
SNRIs
increase both serotonin and norepinephrine increase BP, headache, dizziness do not stop abruptly avoid alcohol may increase suicidal thoughts
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
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
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
hallucinations
perceiving a sensory experience for which no external stimulus exists
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
alogia
reduction in speech, sometimes called poverty of speech