Antipsychotic Meds
First generation anti-psychotics work through this mechanism
What is D2 antagonism?
Progressive, degenerative brain dysfunction, including deterioration in memory, concentration, language skills, visuospatial skills, and reasoning that interferes with a person’s daily functioning
What is dementia?
Grandeur, persecution, reference, control
What are delusions?
Attention-seeking flamboyance is a characteristic behavior of this personality disorder.
What is histrionic personality disorder?
Which is the most effective intervention for clients with delirium?
A) Giving detailed explanations
B) Managing environmental stimuli
C) Promoting rest with PRN medications
D) Providing activities for distraction
B: Managing environmental stimuli
Which statement would indicate that medication teaching for the parents of a 6-year-old child with attention deficit hyperactivity disorder (ADHD) has been effective?
A) We'll teach him the proper way to take the medication, so he can manage it independently.
B) We'll be sure he takes Ritalin at the same time every day, just before bedtime.
C) We're so glad that Ritalin will eliminate the problems of ADHD.
D) We'll be sure to record his weight on a weekly basis.
D: We'll be sure to record his weight on a weekly basis.
Drug-induced Parkinsonism occurs when dopamine can no longer suppress _______ release release
What is Acetylcholine?
Neurodegenetive conditions and vascular disorders
What are the two most common causes of dementia?
A nurse asks an assigned client, How are you doing today? The client responds with "doing today, doing today, doing today". Which speech pattern disturbance is this an example of?
A) Reactive attachment disorder
B) Stereotypic movement disorder
C) Selective mutism
D) Echolalia
D: Echolalia
Characteristics exhibited with this personality disorder include: recurrent suicidal and self-mutilating behaviors.
What is borderline personality disorder?
Which distinguishes delirium from dementia?
Dementia has a gradual onset and is progressive in course.
Delirium has an insidious onset and is reversable
The parents of an autistic child ask: Will my child ever be normal?
A) You seem worried about your child's future.
B) Autistic children can fully recover with the right treatment and education.
C) Your child should outgrow autistic traits by adolescence.
D) Your child will probably always have some autistic traits.
D: Your child will probably always have some autistic traits.
The mechanism of action of second-generation antipsychotics (risperidone, olanzapine, and clozapine)
What is serotonin and dopamine antagonists?
4 types of dementia
What are Lewy Body, frontal Lobe, frontal temporal, and vascular dementia?
A student nurse is having a first experience in an inpatient psychiatric unit and is frightened by the behaviors of the clients with schizophrenia. The student should take which of the following actions to deal with fear?
A) Express fear to the psychiatrist during rounds
B) Pretend to not be afraid
C) Stay in an open area while talking with the clients
D) Insist that the instructor accompanies the student at all times.
C) Stay in an open area while talking with the clients
The highest priority goal of crisis intervention.
What is patient safety?
Which client would have an increased risk for delirium?
1. A) An elderly woman with abdominal pain
2. B) A 3-year-old child with a temperature of 103.2 F
3. C) A middle-aged woman newly diagnosed with multiple sclerosis
4. D) A young adult male with gastroenteritis and dehydration
B: A 3-year-old child with a temperature of 103.2 F
A child with attention deficit hyperactivity disorder is taking methylphenidate (Ritalin) in divided doses. If the child takes the first dose at 8 AM, which behavior might the school nurse expect to see at noon?
A) Increased impulsivity or hyperactive behavior
B) Lack of appetite for lunch
C) Sleepiness or drowsiness
D) Social isolation from peers
A
Increased impulsivity or hyperactive behavior
This side effect is considered a medical emergency and is often accompanied by encephalopathy and fever
What is Neuroleptic Malignant Syndrome?
Acute confusional state
What is delirium?
The nurse is working with a client with schizophrenia, disorganized type. It is time for the client to get up and eat breakfast. Which of the following statements by the nurse would be most effective in helping the client prepare for breakfast?
A) I'll expect you in the dining room in 20 minutes.
B) It's time to put your dress on now.
C) Stay right there and I'll get your clothes for you.
D) Why don't you stay here and I'll get your tray for you.
B) It's time to put your dress on now.
A client is verbally provoking another client who is paranoid. This nursing intervention is the best initial response.
What is limit setting?
A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom?
A. Haloperidol (Haldol) to address the negative symptom
B. Clonazepam (Klonopin) to address the positive symptom
C. Risperidone (Risperdal) to address the positive symptom
D. Clozapine (Clozaril) to address the negative symptom
ANS: C
The nurse should expect the physician to order risperidone (Risperdal) to address the positive symptoms of schizophrenia. Risperidone (Risperdal) is an atypical antipsychotic used to reduce positive symptoms, including disturbances in content of thought (delusions), form of thought (neologisms), or sensory perception (hallucinations).
Which one of the following nursing interventions should take priority for a child with ADHD?
A) Structured daily routine
B) Ensuring the child's safety and that of others
C) Simplifying instructions and directions
D) Improved role performance
B
Ensuring the child's safety and that of others
This side effect involves involuntary continuous movements, such as constant chewing and facial grimacing
What is Tardive Dyskinesia?
Failure to concentrate, irritability, insomnia, no appetite, restlessness, confusion, and sometimes agitation, misperception, and hallucinations
What are signs and symptoms of delirium?
One evening, a client with schizophrenia leaves his room and begins marching in the hall. When approached by the nurse, the client says, God says I'm supposed to guard the area. Which of the following responses would be best?
A) I understand you hear a voice. You and I are the only ones in the hall, and I don't hear a voice.
B) The voices are part of your illness, and they will leave in time.
C) This guarding responsibility can make you tired. You rest for now, and I'll guard a while.
D) You are just imagining these things. Do not pay any attention to the voices.
A) I understand you hear a voice. You and I are the only ones in the hall, and I don't hear a voice.
Which characteristic of individuals diagnosed with personality disorders makes it most necessary for staff to schedule frequent team meetings?
a. Ability to achieve true intimacy
b. Flexibility and adaptability to stress
c. Ability to evoke interpersonal conflict
d. Inability to develop trusting relationships
C
Frequent team meetings are held to counteract the effects of the patients attempts to split staff and set them against one another, causing interpersonal conflict. Patients with personality disorders are inflexible and demonstrate maladaptive responses to stress. They are usually unable to develop true intimacy with others and are unable to develop trusting relationships. Although problems with trust may exist, it is not the characteristic that requires frequent staff meetings.
A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine?
A. Tactile hallucinations
B. Tardive dyskinesia
C. Restlessness and muscle rigidity
D. Reports of hearing disturbing voices
C
The symptom of tactile hallucinations and reports of hearing disturbing voices would be addressed by an antipsychotic medication such as haloperidol.
A child with ADHD complains to his parents that he does not like the side effects of his medicine, Adderall. The parents ask the nurse for suggestions to reduce the medication's negative side effects. The nurse can best help the parents by offering which advice?
A) Give the child his medicine at night.
B) Have the child eat a good breakfast and snacks late in the day and at bedtime.
C) Limit the number of calories the child eats each day.
D) Let the child take daytime naps.
B
Have the child eat a good breakfast and snacks late in the day and at bedtime.
Chlorpromazine, thioridazine, and haldol increase the risk of ______ especially in patients with cardiac risk factors
What is QTc prolongation?
Length of time delirium usually lasts
What is 1-7 days?
The nurse observes a client with schizophrenia sitting alone, laughing occasionally, and turning his head as if listening to another person. The nurse assesses this behavior to indicate that the client is experiencing auditory hallucinations and says,
A) Are you hearing something?
B) It's a beautiful day, isn't it?
C) Would you like to go to your room to talk?
D) Would you like to take some of your PRN medication?
A) Are you hearing something?
Characteristics of this disorder include grandiosity, attention seeking, and arrogance.
Narcissistic Personality Disorder
A client voluntarily admitted to the inpatient psychiatric unit is currently experiencing mild delirium. The client approaches the nurse and states, I'm going to take walk outside. I'll be back in about 10 minutes. Which is the most appropriate nursing action?
A) Further assess the client's motives for wanting to walk.
B) Give the client permission to go on a walk on the grounds.
C) Tell the client the walk is not allowed and restrict him to the unit.
D) Designate a staff member to accompany the client on the walk.
What is D: Designate a staff member to accompany the client on the walk.
Which of the following symptoms are characteristic of ADHD? (SELECT ALL THAT APPLY)
A) Enuresis
B) Inattentiveness
C) Encopresis
D) Overactivity
E) Impulsiveness
B Inattentiveness
D Overactivity
E Impulsiveness
A common assessment scale to monitor for abnormal movements
What is Abnormal Involuntary Movement Scale (AIMS)?
Pharmalogical treatment for delirium
What are low dose antipsychotics and short acting benzodiazepines?
TJ is a 34 yo man that presents to the clinic a week after being initiated on PO Haldol. TJ is in tears complaining on painful involuntary muscle contractions in his trunk. What medication should be given to the patient?
A. Benztropine 1 mg PO BID
B. Lorazepam 1 mg PO QD
C. Intramusuclar Diphenhydramine 100 mg, then repeat after 30 minutes
D. Intramuscular Benztropine 1 mg, then repeat after 30 minutes
D. Intramuscular Benztropine 1 mg
In acute dystonia, you would want to utilize the IM route in order to therapeutic effect quicker. IM diphenhdyramine would be a good option; however, the initial dose is to high. Diphenhydramine should be 25-50 mg IM initially
The most challenging nursing intervention for patients diagnosed with personality disorders who use manipulation to get their needs met is:
a. supporting behavioral change.
b. monitoring suicide attempts.
c. maintaining consistent limits.
d. using aversive therapy.
C
Maintaining consistent limits is by far the most difficult intervention because of the patients superior skills at manipulation. Supporting behavioral change and monitoring patient safety are less difficult tasks. Aversive therapy would probably not be part of the care plan; positive reinforcement strategies for acceptable behavior are more effective than aversive techniques.
During the change of shift report in the intensive care unit, the nurse learns that a client has developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes would be consistent with delirium?
A) Unable to identify a water pitcher
B) Unable to transfer to sitting position
C) Difficulty with verbal expression
D) Disoriented to person
D) Disoriented to person
The nurse is assessing a 16-month-old child during a well-baby checkup. Which of the following behaviors would be consistent with autism spectrum disorder? Select all that apply.
A) The child displays little eye contact with others.
B) The child thrives on changes in routine.
C) The child makes few facial expressions toward others.
D) The child does not like repetition.
E) The child answers questions verbally.
A:
The child displays little eye contact with others.
C: The child makes few facial expressions toward others.
D: The child does not like repetition.
First generation anti-psychotics are mainly used to reduce ________ symptoms in patients with schizophrenia
What is Positive Symptoms?
A new nurse has been working with clients with Alzheimer's disease for almost 6 months. During a staff meeting, the nurse expresses frustration because the same instructions have to be given to clients on a daily basis. The nurse states, I feel like all my work doesn't do them any good. Which should the nurse's supervisor encourage the nurse to do?
A) Cease giving instructions because the clients will not remember them anyway.
B) Try to stay supportive and meet the clients' needs at the current moment.
C) Seek counseling if personal feelings get in the way of client care.
D) Consider transferring to a different client care specialty area.
B. Try to stay supportive and meet the clients' needs at the current moment?
Delusions and hallucinations
What are positive symptoms of schizophrenia?
A nurse set limits for a patient diagnosed with a borderline personality disorder. The patient tells the nurse, You used to care about me. I thought you were wonderful. Now I can see I was mistaken. You're terrible. This outburst can be assessed as:
a. denial.
b. splitting.
c. reaction formation.
d. separation-individuation strategies.
B
Splitting involves loving a person and then hating the person; the patient is unable to recognize that an individual can have both positive and negative qualities.
A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse immediately report to the client's attending psychiatrist?
A. Respirations of 22/minute
B. Weight gain of 8 pounds in 2 months
C. Temperature of 104F (40C)
D. Excessive salivation
ANS: C
When assessing a client diagnosed with schizophrenia who takes an antipsychotic agent daily, the nurse should immediately address a temperature of 104F (40C). A temperature this high can be a symptom of the rare but life-threatening neuroleptic malignant syndrome.
A mother expresses concern to the nurse that the child's regularly scheduled vaccines may not be safe. The mother states that she has heard reports that they cause autism. The most appropriate response by the nurse is,
A) It is recommended that you wait until the child is older to vaccinate.
B) There are safer alternative immunizations available now.
C) There has been no research to establish a relationship between vaccines and autism.
D) The risks do not outweigh the benefits of immunization against childhood diseases.
C) There has been no research to establish a relationship between vaccines and autism.
This is the major side effect of clozapine which results in the loss of white blood cells.
What is agranulocytosis?
The grown daughter of a woman with Alzheimer's disease reports to the nurse that she is trying to keep her mother's condition from worsening by asking her questions whenever they are together. Which will be accomplished by this intervention?
A) Decrease environmental misinterpretation
B) Improve memory retention
C) Increase frustration
D) Slow the progress of the disease
C: Increases frustration
A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client's safety?
A. Assess for medication noncompliance
B. Note escalating behaviors and intervene immediately
C. Interpret attempts at communication
D. Assess triggers for bizarre, inappropriate behaviors
B
The nurse should note escalating behaviors and intervene immediately to maintain this client's safety. Early intervention may prevent an aggressive response and keep the client and others safe.
_____________________ personality disorder is a pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent.
Paranoid
Anergia (lack of energy) and anhedonia (lack of pleasure in doing things).
What are negative symptoms of schizophrenia?
When we discuss negative symptoms of schizophrenia, that means the patient is not presenting with certain typical behaviors or actions, because of schizophrenia. The term negative in this case, means the absence of.
Which is a predisposing factor in the diagnosis of autism? (SELECT ALL THAT APPLY)
A. Having a sibling diagnosed with mental retardation.
B. Congenital rubella.
D. Dysfunctional family systems.
D. Inadequate ego development
B Children diagnosed with congenital rubella, postnatal neurological infections, phenylketonuria, or fragile X syndrome are predisposed to being diagnosed with autism
This side effect of typical antipsychotic agents causess tremors, restlessness, fidgeting, drooling
What is EPS (extrapyramidal syndrome)?
The nurse is caring for a client with Alzheimer's disease. The nurse observes that the client's pacing and mumbling to himself increase at mealtime and shift change. Which intervention should the nurse implement first?
A) Administer an anti-anxiety drug such as lorazepam (Ativan) at these times.
B) Explain the unit routine and the reasons for increased activity to the client.
C) Keep unit activity to a minimum.
D) Move the client to a quieter area during these times.
D: Move the client to a quieter area during these times.
Which statement should indicate to a nurse that an individual is experiencing a delusion?
A. "There's an alien growing in my liver."
B. "I see my dead husband everywhere I go."
C. "The IRS may audit my taxes."
D. "I'm not going to eat my food. It smells like brimstone."
A
The nurse should recognize that a client who claims that an alien is inside his or her body is experiencing a delusion. Delusions are false personal beliefs that are inconsistent with the person's intelligence or cultural background
_____________________ personality disorder is characterized by colorful, dramatic, and extraverted behavior in excitable, emotional people.
Histrionic
Rationale: Histrionic personality disorder is characterized by colorful, dramatic, and extraverted behavior in excitable, emotional people. They have difficulty maintaining long-lasting relationships, although they require constant affirmation of approval and acceptance from others.
The nurse is planning care for a young, nonverbal patient with autism spectrum disorder. In order to plan the best care for the child, which question is most important for the nurse to ask the child's parents?
A. "What are some of your child's rituals that we can incorporate into daily care?"
B. "How do you supervise your child to prevent infection?"
C. "Which one method of communication is best to use with your child?"
D. "How do you complete the activities for daily living for your child?"
A
"What are some of your child's rituals that we can incorporate into daily care?"
The school nurse assesses a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which of the following symptoms are characteristic of the disorder? (SELECT ALL THAT APPLY)
A. Constant fidgeting and squirming
B. Excessive fatigue and somatic complaints
C. Difficulty paying attention to details
D. Easily distracted
E. Running away
F. Talking constantly, even when inappropriate
A: Constant fidgeting and squirming
C: Difficulty paying attention to details
D: Easily distracted
F: Talking constantly, even when inappropriate