Chapter 1 + 2
During the fight or flight response, what physiological changes would you expect to occur?
Pupils dilate, bronchioles dilate to breathe better, heart rate and BP increase, GI motility and urinary function slows down, sweat
Describe what mental illnesses the following neurotransmitters could cause?
Acetylcholine, Norepinephrine, Dopamine, Serotonin, Histamine, GABA, Glutamate
Acetylcholine increased: depression
Acetylcholine decreased: alzheimers, huntingtons, parkinsons
Norepinephrine increased: mania, anxiety, schizophrenia
Norepinephrine decreased: depression
Dopamine increased: mania, schizo
Dopamine decreased: parkinsons, depression
Serotonin increased: anxiety
Serotonin decreased: depression
Histamine decreased: depression
GABA decreased: huntington's, anxiety, schizo, epilepsy
Glutamate increased: huntington's, anxiety, depression
Glutamate decreased: schizo
Describe important medication safety for the following anxiety medications:
1. Benzodiazepines (clonazepam, diazepam, alprazolam)
2. Buspirone/Buspar
3. SSRI
4. MAOI
Benzodiazepines (clonazepam, diazepam, alprazolam)
Potential for CNS depression
Short term use = DUE TO DEPENDENCE + TOLERANCE
Do not stop abruptly
drowsiness/confusion/ orthostatic hypotension
Busprione/Buspar: NOT USED PRN, MUST BE TAKEN DAILY
SSRI = FIRST LINE TREATMENT FOR ANXIETY
MAOI
Effective by many deadly food and drug interactions
AVOID DIETS HIGH IN TYRAMINE
Define the following terms:
1. Autonomy
2. Beneficence
3. Nonmaleficencee
4. Justice
5. Veracity
6. absolute right
7. legal right
1. emphasizes the status of persons as autonomous moral agents whose rights to determine their destinies should always be respected.
2. refers to ones duty to benefit or promote the good of others
3. abstaining from negative acts toward another’ includes acting carefully to avoid harm (do not harm)
4. principle based on the notion of hypothetical social contract between free, equal, and rational persons. The concept of justice reflects a duty to treat all individuals equally and fairly
5. principle that refers to one's duty to always be truthful
6. when there is no restriction whatsoever on the individuals entitlement
7. a right on which the society has agreed and formalized into law
Goals of Intervention
Relies on problem solving techniques and structured activities focused on change.
The goal is AT MINIMUM restore individual to previous functioning level and possibly to higher level by enhancing personal growth
A nurse is educating a client on stress management. Which of the following client statements indicates a healthy adaptive response to stress?
A. "I just bottle everything up until it passes."
B. "When I’m stressed, I isolate myself and sleep all day."
C. "I take a walk or do breathing exercises when I feel overwhelmed."
D. "I drink alcohol occasionally to calm my nerves."
C. "I take a walk or do breathing exercises when I feel overwhelmed."
Define what the following structures do within the body?
Frontal Lobe, Parietal Lobe, Temporal Lobe, Occipital Lobe, Thalamus, Hypothalamus, Limbic System, Pons, Medulla, Cerebellum
Frontal Lobes: controls voluntary body movement, executive function, planning
Parietal Lobes: language recognition and interprets sensory info like touch/pain/taste
Temporal Lobes: short term memory, manages hearing, sense of smell
Occipital Lobes: visual reception and interpretation
Thalamus: integrates all sensory input except smell
Hypothalamus: regulates anterior/posterior pituitary glands, manages appetite/body temperature, blood pressure, thirst
Limbic System: emotional brain
Pons: respiration and sleeping/dreaming
Medulla: connects the spinal cord and pons, responsible for heart rate, respiration, reflexes
Cerebellum: involuntary movements
Describe all medication safety information for the following Antidepressant medications:
a. tryclyclic antidepressants
b. SSRI
c. mood stabilizing agents (lithium)
d. anticonvulsants
e. other symptoms to watch out for with antidepressants
Tricyclic Antidepressants
Block sodium channels = deadly in cases of overdose
SSRI:
* MOOD WILL LIFT AND WITH EXTRA ENERGY = INCREASED RISK OF SUICIDE*
*serotonin syndrome, hyponatremia, increased risk of bleeding, sexual dysfunction, SSRI/SNRI)
3. Mood Stabilizing Agents --> Lithium:
LOW SODIUM + WATER + HIGH LEVELS OF LITHIUM = DEADLY
Prevent patients from becoming dehydrated!!
Lithium toxicity early signs: levels over 1.5 mEq vomiting/diarrhea; levels over 2 mEq can cause tremors, sedation, and confusion; levels over 3.5 mEq can cause seizures, cardiovascular collapse, coma, and death
d. anticonvulsants = increased risk of suicidal thoughts
e. steven johnston syndrome + blood dyscrasias
1. A client with schizophrenia refuses medication. What ethical principle supports the client’s right to refuse?
A. Beneficence
B. Justice
C. Autonomy
D. Veracity
2. What is the term for a right that is formalized into law and enforceable by society?
1. autonomy
2. legal right
describe the characteristics of a crisis
Crisis occurs in all individuals at one time or another and is not necessarily equated with psychopathology
Crises are precipitated by specific, identifiable, events
Crises are personal by nature
Crises are acute, not chronic
What are the 3 stages of General Adaptation Syndrome?
1. Alarm: fight or flight
2. Resistance: use the physiological response of fight or flight as a defense
3. Exhaustion: prolonged stress = causes disease
A client has low serotonin levels. Which mental health disorder is most likely present?
A. Schizophrenia
B. Mania
C. Depression
D. Huntington’s disease
depression
Describe important medication safety information for the following medications:
1. Antipsychotics:
2. Antiparkinsonism/anticholingeric
3. Sedative Hypnotic
4. What does ADAPT stand for?
1. Antipsychotic Safety Issues
Increased risk of death in elderly dementia patients
Long QT syndrome leading to arrhythmia/torsades
Seizures, agranulocytosis, flu like symptoms
EPS
Neuroleptic malignant syndrome
ANTI-HAM
2. Antiparkinsonism/Anticholinergic
Dry eyes, decreased salvation, urinary retention, drowsiness.dizziness, gi upset, sedation, orthostatic hypotension
3. Sedative Hypnotic
Do not combine with other CNS depressants
Aggressiveness, hallucinations, suicidal ideation, complex behaviors during sleep
4. Acute dystonia, akathisia, pseudoparkinsomism, tardive dyskinesia
Conditions that help therapeutic relationships:
Rapport- primary task in relationship development
Trust- must be earned
Respect- believe in the dignity and worth of an individual regardless of their behavior
Genuineness- ability to be open, honest, and real in interactions with the patient
Empathy- understanding from the patients point of view
1. Which communication technique involves restating what the client said in your own words to show understanding?
2. A client says, "I’m so tired of everything." Which is the most therapeutic response?
A. "You’ll feel better soon."
B. "Why do you feel that way?"
C. "Let’s explore what 'everything' means to you."
D. "Try thinking positive thoughts."
1. paraphrasing
2. C. "Let’s explore what 'everything' means to you."
1. Define Maslows Heichary of Needs and what the different levels are?
2. A nurse is prioritizing care for a psychiatric client. According to Maslow’s hierarchy of needs, which need should the nurse address first?
A. Improving self-esteem
B. Establishing social support
C. Providing food and fluids
D. Assisting in career goals
1. Must address most basic needs first so that patient can get to self actualization.
a. physiological needs, safety and security, love and belonging, self esteem, self actualization
2. C. Providing food and fluids
A nurse is reviewing a CT scan showing damage to the frontal lobe. Which client behavior would be expected?
A. Poor coordination
B. Difficulty interpreting touch and pain
C. Impaired planning and judgment
D. Memory loss and hearing impairment
C. Impaired planning and judgment
Do not combine with other CNS stimulants or in patients with CVD = increased risk of death
Potential for misuse
Insomnia, gi upset, weight loss, tics, agitation, and psychosis
Do not take with OTC meds
Conditions that hinder therapeutic relationships
- lack of trust
- poor communication: using medical jargon, lack of active listening, unclear messaging, poor body language
- judgemental attitudes/stigma
- using why statements or encouraging/discouraging patient behavior
- lack of empathy or emotional support
- breach of confidentiality
- inconsistency or unreliability
- transference or countertransference
1. A client in crisis is unable to function at work. What is the primary goal of crisis intervention?
A. Provide long-term therapy
B. Develop insight into mental illness
C. Restore to pre-crisis functioning
D. Identify personality disorders
2. List two characteristics of a crisis.
1. C. Restore to pre-crisis functioning
2.
Precipitated by identifiable events
Personal and acute, not chronic
1. Define the following defense mechanisms: compensation, denial, displacement, identification, isolation, rationalization, regression, repression, sublimation, suppression, undoing
2. Which defense mechanism involves unconsciously blocking unpleasant feelings and experiences from one’s awareness?
1. compensation: The process of covering up weaknesses by emphasizing a more desirable trait or excelling in another area.
Denial: Refusing to acknowledge the existence of a painful or anxiety-provoking reality.
Displacement: Redirecting emotions or impulses from a threatening target to a safer substitute
Identification: Imitating the behavior, values, or traits of another person, often someone admired or feared
Isolation: Separating thoughts or memories from the feelings associated with them to cope with emotional distress
Rationalization: Justifying or explaining away unacceptable behaviors or feelings in a logical or socially acceptable way to avoid the true explanation
Regression: Reverting to behaviors typical of an earlier developmental stage when faced with stress.
Repression: Unconsciously blocking unacceptable thoughts, feelings, or memories from awareness
Sublimation: Channeling unacceptable impulses into socially acceptable or constructive activities.
Suppression: Consciously choosing to avoid thinking about disturbing feelings or thoughts
Undoing: Trying to "reverse" or make up for an unacceptable thought or behavior through a contrary action
2. repression
Which brain structure regulates temperature, appetite, and hormones through the pituitary gland?
hypothalamus
NCLEX QUESTIONS
1. A client taking lithium reports nausea and tremors. The nurse notes a lithium level of 2.2 mEq/L. What is the priority action?
A. Reassure the client the level is therapeutic
B. Hold the next dose and notify the provider
C. Administer antiemetics
D. Encourage more fluids to flush the drug
2. Which class of medications should not be taken with tyramine-rich foods due to the risk of hypertensive crisis?
Answer: MAOIs
3. A client newly prescribed an SSRI states, "I finally have the energy to do things again." What is the nurse’s priority response?
A. "That means your depression is gone!"
B. "Great! You can now stop taking the medication."
C. "Let’s talk about how you're feeling emotionally."
D. "Have you had any thoughts of harming yourself?"
4. Which medication should be taken daily (not PRN) for anxiety and has no risk of dependence?
1. B. Hold the next dose and notify the provider
2. MAOI
3. D. "Have you had any thoughts of harming yourself?"
4. Buspirone
1. A nurse establishes rapport with a client. Which statement by the client indicates this is occurring?
A. "You remind me of my sister."
B. "I feel like I can talk to you about anything."
C. "I don’t trust any nurses."
D. "I’ll do what you say, but I don’t like it."
2. Name two conditions that help build a therapeutic relationship.
1. B. "I feel like I can talk to you about anything."
2. trust and empathy
End of Jeopardy Quiz!
1.
A client diagnosed with major depressive disorder refuses to eat, states they no longer want to live, and refuses their prescribed antidepressant. Based on Maslow's hierarchy and ethical principles, which action should the nurse take first?
A. Respect the client’s autonomy and document the refusal
B. Notify the healthcare provider about the suicidal ideation
C. Educate the client on the benefits and risks of medication
D. Offer the client privacy and return in 30 minutes
2.
A client on lithium therapy presents with vomiting, diarrhea, and coarse hand tremors. The nurse reviews their chart and notes a sodium level of 128 mEq/L. What is the nurse's priority action?
A. Encourage oral hydration and recheck the level in the morning
B. Administer the next dose of lithium and monitor
C. Hold the lithium dose and notify the provider
D. Reassure the client and monitor for further symptoms
3. A client in a psychiatric inpatient unit yells, "I’m not taking these pills, they’re trying to poison me!" Which response by the nurse best demonstrates therapeutic communication?
A. "Those medications are prescribed to help, not hurt you."
B. "Let’s talk about how you are feeling"
C. "If you don’t take them, I’ll have to inform the doctor."
D. "There’s no poison; you’re just paranoid right now."
4.
A client recently experienced the death of a spouse and says, "I can’t function anymore. I feel lost and don't know how to go on." Which intervention aligns with the goals of crisis intervention?
A. Recommend long-term cognitive behavioral therapy
B. Encourage the client to journal daily for self-reflection
C. Explore immediate coping strategies to restore functioning
D. Refer the client to an inpatient facility for observation
5.
A client presents with symptoms of auditory hallucinations, delusions, and disorganized thinking. The provider suspects schizophrenia. Which neurotransmitter alteration is most likely responsible?
A. Decreased dopamine and increased serotonin
B. Increased dopamine and increased norepinephrine
C. Decreased GABA and increased glutamate
D. Increased acetylcholine and decreased histamine
1. B. Notify the healthcare provider about the suicidal ideation
2. C. Hold the lithium dose and notify the provider
3. B. "Let’s talk about how you are feeling"
4. C. Explore immediate coping strategies to restore functioning
5. B. Increased dopamine and increased norepinephrine