Show:
MIX 1
SCHIZOPHRENIA
ANTIDEPRESSANTS
MIX 2
MIX 3
100

What is the rationale for not massaging the site after the IM injection is given?

  • Can affect absorption
  • To avoid increasing discomfort
  • Avoid damage to the underlying tissue or force meds up the needle track
100

What medications are used to treat EPS (dystonia, akathisia, and pseudoparkinsonism)?

  • Benadryl, Cogentin are used to treat dystonic reactions
  • Beta-blockers (propranolol), benzodiazepine (Ativan) are used to treat akathisia
  • Kemadrin, Cogentin are used to treat pseudoparkinsonism
100

Why is an ECG essential when a patient is taking an SSRI, and what side effect is it related to?

  • Changes in cardiac conduction (prolonged QT interval) 
100

You’re the nurse caring for Bob. You arrive in his room at 07:00. You insert an IV and he is started on Ringer’s Lactate (RL) 1000 mL infusing at 75 mL/hr.


At what time will the IV bag need to be changed if it infuses on time?


20:20

08:20PM

100

1000 ml were to run over 6 hours. After 3 hrs only 425 ml have infused. The set being used is a 15 gtts/ml. Calculate the new flow rate to complete on time.

time remaining = 3 hr                                            volume remaining = 575 ml

 = 192 ml/hr

 = 48 gtts/min

200

What is the rationale for using the Z-track technique for IM injections?

  • Prevents leakage of meds into SC tissues preventing damage to the surrounding tissues
  • Seals meds in the muscle
200

What is the difference between positive and negative symptoms of schizophrenia? 

POSITIVE: Presence of over psychotic or distorted behaviour hallucinations, delusions)

  • Hallucinations
  • Delusions

NEGATIVE: A lessening or loss of normal function 

  • Affective flattening
  • Anhedonia



200

How long does it take for antidepressants to work, and what should be monitored in the beginning?

  • All antidepressants take a while to start working ---> delayed response, between 1 week and 1 month
  • When first starting, within first week, monitor for suicidal ideation (because of the change in neurotransmitter)
200

What is an important nursing action to verify after an ECT?

  • Check gag reflex --> avoid aspiration
200

What are risk factors for obstructive sleep apnea syndrome?

  • Increased age
  • Male
  • Increased neck circumference
  • Recessed chin
  • Large tonsils
  • Family history
  • Excess weight
  • Tongue fat volume
300

What is the therapeutic level for lithium? 

How long does it take to reach therapeutic level? 

What is a serious complication that can occur from lithium overdose? 


NARROW THERAPEUTIC WINDOW FOR LITHIUM (0.8-1.2mEq/L)

Take 1-3 weeks to reach therapeutic levels

Overdose causes extreme alteration of cerebral conductivity --> convulsions

300

What is the difference between typical and atypical antipsychotics? 

  • Conventional (traditional, typical): block the dopamine receptors
  • Atypical (second generation): block the serotonin-dopamine activity (PREFERRED)
  • The conventional (first-generation) antipsychotics target the positive symptoms of schizophrenia, and the newer atypical (second-generation) antipsychotics are thought to diminish some of the negative symptoms as well
  • The atypical agents have fewer side effects and thus are better tolerated
  • The newer atypical agents also help with symptoms of anxiety and depression, decrease suicidal behaviour, and are thought to increase neurocognitive functioning (broader spectrum)
300

What is serotonin syndrome and what are some side effects of it?

Serotonin syndrome (can happen when person is on antidepressants --> any of them)

Any drug that can cause increase of serotonin

  • Rare and life-threatening
  • Can begin 2 hours after taking first dose up to several weeks later
  • Client can exhibit:
  • Mental status changes (confusion, anxiety, restlessness)
  • Hypertension
  • Tremors
  • Sweating
  • Hyperpyrexia: fever (people confuse with infection)
  • Ataxia (without coordination)
300

Should you increase or decrease your salt intake while taking lithium?

If your patient is experiencing severe vomiting, diarrhea, or sweating, what would be your nursing intervention regarding lithium?

  • Eat a normal diet with normal salt and fluid intake (1500-3000ml/day)
  • Stop taking lithium if you are having severe vomiting, diarrhea or sweating. Dehydration can lead to increased lithium levels and cause toxicity
300

What is neuroleptic malignant syndrome? Name some side effects and the treatment

An acute life-threatening side effect can occur when using any antipsychotic, especially early in the treatment process, or if the dosage levels are rapidly increased

  • Muscle rigidity
  • High fever
  • Increased muscle enzymes (CPK)
  • Increased leukocytes

Treatment consists of early detection and discontinuation of the antipsychotic agent


400

What is the difference between bipolar 1 and 2?

BIPOLAR 1

  • One or more manic episode w/ a major depressive episode
  • Mania occurs for at least 1 week for most of the day, every day
  • Symptoms of mania are so severe that this state is a psychiatric emergency
  • Manic episodes usually alternate with depression or a mixed state of anxiety and depression

BIPOLAR 2

  • Recurrent major depressive episodes w/ hypomanic/manic episodes
  • Unlike mania, psychosis is never present with hypomania
  • Hospitalization is rare
  • However, the depressive symptoms can be quite profound and may put those who suffer from it at particular risk for suicide
  • Most common
  • May be underdiagnosed
400

Name the four extrapyramidal symptoms (EPS) and explain what each one is

  • Acute dystonia (muscle cramps of the head and neck)
  • Akathisia (restlessness, can’t sit still, pacing or fidgeting)
  • Pseudoparkinsonism (tremor, shuffling gait, rigidity)
  • Early symptoms of tardive dyskinesia are movements of the tongue or constant lip smacking. These early oral movements can develop into uncontrollable biting, chewing, or sucking motion, an open mouth, and lateral movements of the jaw
400

Are MAOIs considered first-line or last-line medications for depression? And what types of food, or food components, do they interact with? 

Last line medication (antidepressants) 

TYRAMINE!!

Turkey, cheese, avocado, chocolate

400

Give me an example of the following types of crisis:

Maturational 

Situational 

Adventitious

Maturational

  • Old coping skills not effective
  • Increased tension/anxiety
  • Think: Erikson’s stages
  • Examples: Marriage, or a child going off to university, retirement.

Situational 

  • Extraordinary
  • External
  • Often unanticipated
  • Examples: loss of a job, unintended pregnancy and the sudden death of a loved one

Adventitious 

  • Not part of every day life
  • Natural disaster
  • National disaster
  • Violence crime
  • Completely unexpected and may have never been experienced before
500

What is a serious complication that can occur when MAOIs are combined with foods containing tyramine, and what is the treatment?

  • MAOIs prevent breakdown of dietary tyramine (so increased tyramine)
  • Tyramine promotes release of NE which causes acute hypertension (--> can lead to stroke), palpitations, occipital headache, flushing, sweating, nausea

Hypertensive crisis

  • Can result from an interaction between MAOI and foods containing tyramine
  • Symptoms occur within minutes of ingesting tyramine
  • **CALCIUM CHANNEL BLOCKER STAT**
500

What is metabolic disorder, and what medication is it a side effect of?

Second-generation antipsychotics 

Metabolic syndrome is a cluster of conditions – increased BP, high blood sugar level, excess body fat around the waist and abnormal cholesterol levels – that occur together, increasing your risk of heart disease, stroke and DM

500

What can happen when MAOIs interact with: 

  • Insulin and oral hypoglycemics
  • Antihypertensive agents
  • SSRIs
  • Insulin and oral hypoglycemics --> enhance hypoglycemia
  • Antihypertensive agents --> profound hypotension --> hypertensive crisis --> Ca blocker stat
  • SSRIs --> serotonin syndrom
500

Is clozapine a typical or atypical antipsychotic?

When is it used?

What should be monitored regarding cardiac function and blood work?

  • Atypical antipsychotic but used as a last generation due to significant side effects and adverse reactions
  • ECG: could prolong QT interval (any psychotic can do that, especially first gen). If it is prolonged --> arrhythmia --> MI
  • AGRANULOCYTOSIS (can cause immunosuppression)!! And bone marrow suppression!