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96 Cards in this Set
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Using a Cognitive Therapy approach what intervention is most appropriate by the nurse when the client says, "I get down on myself when I make a mistake"?
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Using a Cognitive Therapy approach what intervention is most appropriate by the nurse when the client says, "I get down on myself when I make a mistake"?
- Change attitude - Illuminate the thought that something is awful, terrible or horrible (remove the word awful from the clients vocabulary) - modify the belief to eliminate or change the situation where the patient sees that anything less than perfection is unacceptable (the answer) "It’s not the situation that makes you crazy, it is what you tell yourself about the situation (inside your head)" - Cognitive-Behavioral Therapy – Type of psychotherapy, based on cognitive model, which focuses on client thoughts and behaviors to solve current problems - Several approaches: rational emotive behavior therapy, and rational behavior therapy - Used to treat depression, anxiety, eating disorders, and other problems that can be improved by changing the client’s attitudes toward life experiences - The trained therapist uses therapeutic communication to change client’s irrational thoughts to thoughts and feelings that are more objective and realistic - Therapy is time limited, active, structured, and directive – helps people identify distorted thoughts (bad beliefs about themselves) and to evaluate whether those thoughts (cognitions) are realistic |
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A psychiatric unit uses a behavioral approach to determine the level of privileges (usually in a substance abuse program); you want something objective you can measure. What can u objectively measure in behavior?
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A psychiatric unit uses a behavioral approach to determine the level of privileges (usually in a substance abuse program); you want something objective you can measure. What can u objectively measure in behavior?
- measure objectively how you respond to stress. Like "always attending groups, or making your bed in your room group or taking your meds or going to meals on time, performing hygiene and ADL's independently... they are all measureable ways to determine objective information. - Something objectively measured in behavior |
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A nurse has explored non pharmacological modalities available for treatment of phobias, what is this?
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A nurse has explored non pharmacological modalities available for treatment of phobias, what is this?
(In PowerPoint its mixed in with - Systematic desensitization – type of behavior modification used to lessen the phobias of a specific client |
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A nurse encourages a patient to join a self-help group after being discharged from a mental health facility, what is the purpose of that sort of referral?
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A nurse encourages a patient to join a self-help group after being discharged from a mental health facility, what is the purpose of that sort of referral?
- To provide structure & support - Group norm – The way they group behaves during sessions, and overtime, provides structure and support for the group - Group members support each other |
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A male nurse reminds a client that it is time for group therapy, patient responds by yelling "You tell me what to do like my Father!” What kind of defense mechanism is that?
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A male nurse reminds a client that it is time for group therapy, patient responds by yelling "You tell me what to do like my Father!” What kind of defense mechanism is that?
- Transference behavior -characterized by unconscious redirection of feelings from one person to another. |
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A nurse leads an assertiveness training program for a group of patient; they are looking for a measure that would demonstrate that the treatment would be effective.
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A nurse leads an assertiveness training program for a group of patient; they are looking for a measure that would demonstrate that the treatment would be effective.
- Example of someone being assertive: "so I told him not to do it anymore" - Assertiveness training – Client learns to communicate in a more assertive (not aggressive) manner in order to decrease psychological stressors; “When you keep telling me what to do , I feel angry and frustrated. I need to try making my own decisions.” |
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Electro convulsive therapy- what is the criterion that we use for recommending ECT?
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Electro convulsive therapy- what is the criterion that we use for recommending ECT?
- severe depression - Intractable Depression (persistent resistant depression) - Severe, Persistent, and Intractable Depression with suicidal ideation - The above and "suicidal ideation" - Not responsive to pharmacologic treatment - Risk of other treatments outweigh risk of ECT - Actively suicidal and in need of rapid response |
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What is Electroconvulsive therapy (ECT)?
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What is Electroconvulsive therapy (ECT)?
- It is an alternative somatic treatment that has been in use for 60 years and is still administered to 100,000 clients each year in the U.S. - Exact mechanism of action is still unknown - Although some studies have shown 80% of severely depressed clients improve, other studies indicate high relapse rate - Side effects: temporary memory loss and confusion - Prior to treatment, an anticholinergic, such as atropine sulfate is given to dry up oral secretions |
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What are S/E of ECT?
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What are S/E of ECT?
- Temporary memory loss and confusion - Severe HTN should be controlled before the procedure, since a short period of HTN occurs after ECT is performed. |
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A patient is reporting vague dread she is pacing and hyperventilating, she has a clenched jaw when u assess her, what would be the type of medication this patient would need?
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A patient is reporting vague dread she is pacing and hyperventilating, she has a clenched jaw when u assess her, what would be the type of medication this patient would need?
- Anti-manic drug - barbiturate - Antianxiety Drugs (Anxiolytics) (the answer) |
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Know the med that will reverse the seditive effects of benzodiazepine?
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Know the med that will reverse the seditive effects of benzodiazepine?
- flumazenil (Romazicon) for IV toxicity; have resuscitation equipment available (antidote) |
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What is Narcan (Naloxone) the antidote for?
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What is Narcan (Naloxone) the antidote for?
- Opioids (narcotics) |
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What is the adverse reactions from abrupt withdrawal of barbiturate use?
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What is the adverse reactions from abrupt withdrawal of barbiturate use?
- seizures & sudden death - Symptoms of barbiturate withdrawal syndrome appear 12-20 hours after the last dose: anxiety, irritability, increased heart and respiration rate, muscle pain, nausea, tremors hallucinations, confusion, and seizures, and death |
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Understand Amitriptyline (Tricyclic Antidepressants) - what is the most important patient teaching for this drug?
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Understand Amitriptyline (Tricyclic Antidepressants) - what is the most important patient teaching for this drug?
- Taper the medication before discontinuing - The TCAs must be tapered when discontinuing the medication |
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You have patient with anorexia, what would be some of the symptoms your patient would be demonstrating?
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You have patient with anorexia, what would be some of the symptoms your patient would be demonstrating?
- 85% body weight - preoccupied with a fear of obesity - obsessed with food and exercise - visual perception of themselves (concerned with their appearance) (answer) |
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Tofranil (can cause problem with glaucoma), can cause problem with glaucoma.
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Tofranil (can cause problem with glaucoma), can cause problem with glaucoma.
- narrow angle glaucoma - Used cautiously in cardiac, hepatic, or renal disease, hyperthyroid disease, history of seizures, narrow angle glaucoma, urinary retention, and risk of suicidal ideation or behavior (very lethal in overdose) - Contraindicated in clients with glaucoma or tendency for urinary retention (older men with BPH) |
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What symptom is associated with Clomipramine (Anafranil) (TCA)?
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What symptom is associated with Clomipramine (Anafranil) (TCA)?
- Gynecomastia |
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MAOI's
a patient who is on MAOI's, what should the nurse teach the patient to avoid? |
MAOI's
a patient who is on MAOI's, what should the nurse teach the patient to avoid? - avoid foods with tyramine (wine & foods with cheese) - Aged cheese, sour cream, yogurt - Beef or chicken livers, pickled herring, fermented meats (bologna, hot dogs, pepperoni, and dried fish) - Undistilled alcoholic beverages (beer, ale, red wine, especially Chianti and sherry) - Caffeinated beverage (coffee, tea, colas), chocolate - Avocado, bananas, fava beans, figs, raisins, sauerkraut, yeast extracts, soy sauce |
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patient is on the 2 MAOI inhibitors (know both names) there are only two not 3.
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patient is on the 2 MAOI inhibitors (know both names) there are only two not 3.
- phenelzine (Nardil), tranylcypromine (Parnate) - isocarboxazid (Marplan is no longer available) |
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Photosensitivity is a side effect associated with which class of drugs?
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Photosensitivity is a side effect associated with which class of drugs?
- Tricyclic Antidepressants - Antipsychotic like Thorazine (chlorpromazine) (the old ones) |
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Q1. If your patient is on lithium, what are the therapeutic and toxic levels?
Q2. If the patient's levels fall within the levels, you administer the drug. |
Q1. If your patient is on lithium, what are the therapeutic and toxic levels?
- Initial treatment: 0.8-1.4 mEq/L - Maintenance: 0.4-1.0 mEq/L - Levels > 1.5 mEq/L cause toxicity - Monitor plasma lithium levels during treatment: at initiation, monitor every 2-3 days and then every 1-3 months: 0.6-1.2 mEq/L is desirable Q2. If the patient's levels fall within the levels, you administer the drug. - If the levels are higher, you hold it and contact the primary care provider. |
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Patient on lithium what would be some of the meds you would question the patient receiving?
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Patient on lithium what would be some of the meds you would question the patient receiving?
- Lasix (loop dieretic) - NSAIDS - Antacids - any sodium depleting meds - Lithium is contraindicated in clients with hypersensitivity to tartrazine, renal or cardiovascular disease, sodium depletion, dehydration, and in clients receiving diuretics |
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Which meds require careful monitoring of the patients’ blood level? Know the levels
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Which meds require careful monitoring of the patients’ blood level? (there are 4 that you would need to monitor closely). Know the levels
- Lithium – 0.4-1.4 mEq/L - Tegretol (carbamazepine) – 3-14 mcg/ml - Valproic acid (Depakote) – 50-100 mcg/ml - Dilantin (phenytoin) – 10-20 mcg/ml |
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patient on Valproic acid (Depakote), what meds would you question if they were ordered?
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patient on Valproic acid (Depakote), what meds would you question if they were ordered?
- Like birth control - Should not be used by those pregnant or nursing; need to use contraception |
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a 24 year old female client with Bipolar disorder is prescribed valporic acid (depakote) anticonvulsive, which question would the nurse ask the client?
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a 24 year old female client with Bipolar disorder is prescribed valporic acid (depakote) anticonvulsive, which question would the nurse ask the client?
- "are you taking any type of birth control?" (Valproic acid makes the birth control ineffective) |
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What is the pathophysiology of Alzheimer’s meds like Aricept (donepezil)?
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What is the pathophysiology of Alzheimer’s meds like Aricept (donepezil)?
- increases the availability of acetylcholine at the cholinergic synapses |
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What do u do with all children when you admin Ritalin? What do you monitor?
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What do u do with all children when you admin Ritalin? What do you monitor?
- Monitor VS, height, weight, growth, and behavior |
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Do you know the S/S of Tardive Dyskinesia?
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Do you know the S/S of Tardive Dyskinesia?
- Syndrome consisting of irreversible, involuntary dyskinetic movements - Symptoms: rhythmic, involuntary movements of the tongue, face, mouth, or jaw and sometimes the extremities - Tongue may protrude and there may be chewing movements, mouth puckering, or facial grimacing - Drug therapy must be discontinued |
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What is Extrapyramidal Syndrome (EPS)
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What is Extrapyramidal Syndrome (EPS)
- Group of adverse reactions affecting the extrapyramidal portion of the nervous system - Symptoms: Parkinson-like symptoms, akathisia (restless movements), dystonia (facial grimacing and twisting of the neck into unnatural positions) - Typically the primary health care provider prescribes trihexyphenidyl (Artane), biperiden (Akineton), or benzotropine (Cogentin) |
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What is Neuroleptic Malignant Syndrome?
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What is Neuroleptic Malignant Syndrome?
- Rare reaction characterized by a combination of extrapyramidal effects, hyperthermia, and autonomic disturbance - Typically occurs within 1 month after drug regimen occurs - Potentially fatal; immediate discontinuation of drug - Recovery occurs within 7-10 days |
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Non pharmacological approach to a pt who states "I get down on myself sometimes"?
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Non pharmacological approach to a pt who states "I get down on myself sometimes"? Tell them no one is perfect
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Behavioral approach for level of priviledges for pt?
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Behavioral approach for level of priviledges for pt? You are able to increase priviledges if pt has an increased ability in function (behavior, not cognitive)
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Non pharmacological modalities for phobias?
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Non pharmacological modalities for phobias? systematic desensitization
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Main goal of self help group?
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Main goal of self help group? Support
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Nurse tells pt its time to go to group and the pt responds "You always tell me what to do, just like my dad", what is happening?
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Nurse tells pt its time to go to group and the pt responds "You always tell me what to do, just like my dad", what is happening? Transference
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In an assertiveness training program how will you know its been effective?
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In an assertiveness training program how will you know its been effective? The pt confronts someone with assertiveness but not aggressively
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Treatment plan for severe persistent intractable depression and suicidal ideation?
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Treatment plan for severe persistent intractable depression and suicidal ideation? ECT
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S/E of post procedure of an ECT?
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S/E of post procedure of an ECT? amnesia and confusion
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Pt is pacing and hyperventilating with their jaw clenched?
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Pt is pacing and hyperventilating with their jaw clenched? Needs anti-anxiety meds
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What is a barbiturate?
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What is a barbiturate? sedative/hypnotic
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Clozaril is an atypical antipsychotic
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Clozaril is an atypical antipsychotic
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Drug most helpful to reduce psychotic symptoms in schizophrenia pt with active
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Drug most helpful to reduce psychotic symptoms in schizophrenia pt with active
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psychosis?
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psychosis? Geodon (Ziprasidone)
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What is the antidote for opioid toxicity?
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What is the antidote for opioid toxicity? Narcan
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Antidote for benzodiazepine toxicity?
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Antidote for benzodiazepine toxicity? Romazicon
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ataxia =
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ataxia = unsteady gait
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seizure =
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seizure = electrical stimulation in brain that causes an interruption
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#1 side effect of Lithium toxicity?
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#1 side effect of Lithium toxicity? Diarrhea
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Pt with Major Depressive Disorder taking Elavil, what is Elavil?
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Pt with Major Depressive Disorder taking Elavil, what is Elavil? Tricyclic antidepressant
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Client wants to stop taking Elavil, what do you teach?
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Client wants to stop taking Elavil, what do you teach? Taper
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17 y/o with anorexia and is prescribed a tricyclic antidepressant but the pt continues to have issues?
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17 y/o with anorexia and is prescribed a tricyclic antidepressant but the pt continues to have issues? Med is not effective
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Impramine (Tofranil) is contraindicated/caution?
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Impramine (Tofranil) is contraindicated/caution? Narrow angle glaucoma
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What class of antidepressant is fluoxetine?
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What class of antidepressant is fluoxetine? SSRI
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Teach the pt taking fluoxetine (Prozac)?
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Teach the pt taking fluoxetine? (Prozac) it will take time for it to be effective
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Pt with MDD taking the SSRI, fluoxetine and calls to say they are feeling confused, restless and has a high fever?
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Pt with MDD taking the SSRI, fluoxetine and calls to say they are feeling confused, restless and has a high fever? DISCONTINUE (serotonin syndrome)
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What is sertraline (Zoloft) for?
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What is sertraline (Zoloft) for? Depression
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Pt on SSRI and prescription is stopped, how long do they need to wait to start an MAOI?
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Pt on SSRI and prescription is stopped, how long do they need to wait to start an MAOI? Ask MD
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Pt on MAOI and prescription is stopped, how long before they can start taking an SSRI?
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Pt on MAOI and prescription is stopped, how long before they can start taking an SSRI? 14 days
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MAOI's and Tricyclics has a definite half life.
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MAOI's and Tricyclics has a definite half life. Ask MD for others
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Pt teaching to avoid with MAOI's?
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Pt teaching to avoid with MAOI's? OTC meds and foods with tyramines
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Always double check with MD before adding an MAOI to any regimen
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Always double check with MD before adding an MAOI to any regimen
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MAOI's =
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MAOI's = Parnate and Nardil
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Foods with tyramine =
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Foods with tyramine = aged cheese, livers, bologna, hot dogs, pepperoni, beer, ale, red wine, chianti, sherry, coffee, tea, colas and soy sauce
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Always make sure pt swallows medication
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Always make sure pt swallows medication
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Photosensitivity is a S/E of?
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Photosensitivity is a S/E of? Haldol and Thorazine
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Olanzipine (Zyprexa) for bipolar disorders, pt teaching?
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Olanzipine (Zyprexa) for bipolar disorders, pt teaching? orthostatic hypotension, instruct them to rise slowly
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Common, manageable general adverse effects on neuroleptics?
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Common, manageable general adverse effects on neuroleptics? sedation, hypotension, dry mouth and photosensitivity
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43 y/o taking clorapromazine (Thorazine) for 20 years, what warrants it to be d/c?
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43 y/o taking clorapromazine (Thorazine) for 20 years, what warrants it to be d/c? fine wormlike movements of tongue (Tardive Dyskinesia)
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Schizo pt on Clozapine (Clozaril), what labs are most important?
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Schizo pt on Clozapine (Clozaril), what labs are most important? WBC
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Clozapine is contraindicated with what?
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Clozapine is contraindicated with what? Bone Marrow Depression
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Nurse understands that common signs of neuroleptics are?
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Nurse understands that common signs of neuroleptics are? unintentional movements
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What meds are given IM and last up to 3 weeks?
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What meds are given IM and last up to 3 weeks? decanoates
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What drugs are usually prescribed as antipsychotic neuroleptic agents for EPS?
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What drugs are usually prescribed as antipsychotic neuroleptic agents for EPS? Artane, Akineton and Cogentin
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Lithium lab range =
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Lithium lab range = 0.5 - 1.2 (toxic at 1.5)
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do u Question giving lithium to a pt with kidney problems?
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Question giving lithium to a pt with kidney problems
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Blood level monitoring drugs?
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Blood level monitoring drugs? Lithium, Dilantin and Valproic acid and Tegretol
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What might prevent Alzheimers?
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What might prevent Alzheimers? Hormone replacement therapy (estrogen)
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Barbiturate W/D symptoms?
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Barbiturate W/D symptoms? Anxiety, irritability, increased HR and respirations, muscle pain, nausea, tremors, hallucinations, confusion, SEIZURES and DEATH
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Drugs for ADHD?
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Drugs for ADHD? Amphetamines (Ritalin, Concerta, Focalin and Strattera)
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Aricept is a cholinesterase inhibitor for cognitive disorders and works by increasing availability of acetylcholine at cholinergic synapses
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Aricept is a cholinesterase inhibitor for cognitive disorders and works by increasing availibility of acetylcholine at cholinergic synapses
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Serotonin Syndrome = begins ? hours after start of treatment. S/S ?
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Serotonin Syndrome = begins 2-72 hours after start of treatment. S/S are MENTAL CONFUSION, agitation, anxiety, hallucinations, hyperreflexia, FEVER, RESTLESSNESS, TREMORS. Notify MD and stop immediately
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Trazodone (Desyrel) can cause
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Trazodone (Desyrel) can cause priapism
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Extrapyramidal Syndrome (EPS) =
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Extrapyramidal Syndrome (EPS) = Parkinson like symptoms, akathisia (RESTLESS MOVEMENTS), dystonia (FACIAL GRIMACING AND TWISTING) of the neck
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Tardive Dyskinesia (TD) -
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Tardive Dyskinesia (TD) - Rhythmic, involuntary movements of the tongue, face, mouth and jaw
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Neuroleptic Malignant Syndrome (NMS) =
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Neuroleptic Malignant Syndrome (NMS) = Extrapryamidal effects, hyperthermia and autonomic disturbance
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Reaction Formation - Overcompensation.
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Reaction Formation - Overcompensation. Developing opposite emotion or behavior
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Transference -
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Transference - Unconscious redirection of feelings from one person to another
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Counter-Transference -
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Counter-Transference - Redirection of therapists feelings to client
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Major Depressive Disorder -
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Major Depressive Disorder - Symptoms must happen almost every day, last most of the day, and occur continously for a min of 2 weeks
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Brief reactive psychosis -
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Brief reactive psychosis - Occurs due to a marked stressor
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Schizophrenia -
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Schizophrenia - a group of psychotic disorders that affect thinking, behavior, emotions and the ability to perceive reality
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S/S of glaucoma =
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S/S of glaucoma = pain, halos around lights, decreased vision, nausea and vomiting
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Barbiturate - CNS depressant
CLOMIPRAMINE = |
Barbiturate - CNS depressant
CLOMIPRAMINE =GYNOMASTIA MUST BE TAPERED |
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buspar anxiety, wellbutrin anti depressant, clozaril anti psychotic
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buspar anxiety, wellbutrin anti depressant, clozaril anti psychotic
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floppy infant syndrome baby in utero when mom takes
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floppy infant syndrome baby in utero when mom takes benzos
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pharmasist can only dispence with copy of wbc report
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pharmasist can only dispence with copy of wbc report
- clozapine (Clozaril) |