Georgette Module 1 & 2 Questions with Complete Verified Solutions, Exams of Nursing

Download Georgette Module 1 & 2 Questions with Complete Verified Solutions and more Exams Nursing in PDF only on Docsity! Georgette Module 1 & 2 Questions with Complete Verified Solutions Lithium level --- correct answer ---0.6-1.2 Lithium toxicity level --- correct answer ---greater than or equal to 1.5 what is the gold standard for treating manic episodes? --- correct answer ---Lithium What drug has evidence of anti-suicidal effects for bipolar disorder? -- - correct answer ---Lithium baseline labs to collect in order to R/O medical diagnoses prior to giving Lithium --- correct answer ---TSH (r/o bipolar) Creatinine (0.6-1.2) BUN (10-20) Pregnancy test ECG if greater than 50 (inverted T-waves) All psychotropics should have what test prior to giving for child- bearing age? --- correct answer ---pregnancy test what is considered child-bearing age? --- correct answer ---12-51 SE of Lithium? (endocrine) --- correct answer ---HYPOthyroidism SE of Lithium? (CNS) --- correct answer ---**course hand tremors w/ toxicity SE of Lithium? (dermatological) --- correct answer ---Maculopapular rash SE of Lithium? (GI) --- correct answer ---diarrhea, vomiting, cramp, anorexia **imp. because these become severe w/ toxicity SE of Lithium? (Renal) --- correct answer ---diabetes insipidus (polyuria r/t polydipsia) SE of Lithium? (Cardiac) --- correct answer ---T-wave inversions SE of Lithium? (Hematologic) --- correct answer ---leukocytosis (increased WBC) Hypertensive Crisis occurs when..... --- correct answer ---MAOIs are taken in conjunction w/ foods containing TYRAMINE (dietary precursor of NE) Hypertensive crisis is _____-__________ and cannot be reversed unless..... --- correct answer ---life-threatening & cannot be reversed unless more MAO is produced by the body Hypertensive crisis & death can occur when MAOIs are taken in conjunction with which types of meds?? --- correct answer --- ***Meperidine ***Stimulants/other sympathomimetics Decongestants/TCA/SGA/St. Johns Wort/L-tryptophan Symptoms of Hypertensive crisis include --- correct answer ---sudden explosive-like HA in OCCIPITAL region Clozapine main SE --- correct answer ---Risk for NEUTROPENIA --> monitor for s/s of infection*** Neutropenia is monitored only by... --- correct answer ---ANC when to d/c Clozapine? --- correct answer ---ANC <1000 WBC 2000-3000 Check ____ before starting female of childbearing age (12-51yr) on psychotropic med --- correct answer ---HCG Folic acid does what & what is the recommended dosage? --- correct answer ---supports neural tube development during FIRST month of pregnancy--> ALWAYS encourage those of childbearing age to take (OTC medication) Dosage= 0.4-0.8mg daily for all women planning or capable of becoming pregnant** Symptoms of Steven's Johnson Syndrome --- correct answer ---Fever Sore throat (burning feeling) Facial/Tongue Swelling Rash Skin Sloughing Symptoms of Steven's Johnson Syndrome PRIOR to it occuring --- correct answer ---Prodromal HA Malaise Arthralgia (joint stiffness) Painful mucous membranes What two mood stabilizers can cause Steven's Johnson Syndrome? --- correct answer ---Lamictal (in everyone) & Carbamazepine (in Asians) What two medications are at risk for causing agranulocytosis (decreased WBC)? --- correct answer ---Carbamazepine & Clozapine Recommended Folic acid dosage for those of child-bearing age --- correct answer ---0.4-0.8mg/day BMI ranges --- correct answer ---underweight: <18.5 normal: 18.5-24.9 overweight: 25-29.9 obese: >30 Bulimia Nervosa BMI --- correct answer ---is normal 18.5-24.9 Bulimia Nervosa signs/syptoms --- correct answer ---Normal BMI Erosion of dental enamel d/t induced vomiting Russell's sign (calluses to back of hand) Hypertrophy of salivary glands (vomiting) Rectal Prolapse (laxative abuse) What is an FDA approved drug for Bulimia Nervosa? --- correct answer ---Prozac What two classes of drugs are effective in reducing frequency of binging/purging? --- correct answer ---SSRIs & TCAs Anorexia Nervosa signs/symptoms --- correct answer ---LOW BMI**/Emaciation** Amenorrhea*** Bradycardia*** Hypotension*** Inversion of T waves & Prolong QT Hypertrophy salivary glands/Russel's sign if BMI <15 what intervention do you do? --- correct answer ---send to ED or hospital for rehabilitation specific meds for Anorexia Nervosa --- correct answer ---there are NONE management for bulimia & anorexia nervosa --- correct answer ---med management as adjunctive therapy to psychotherapy Psychotherapeutic interventions for bulimia & anorexia include what types of therapy? --- correct answer ---behavioral/CBT family & group therapy eating disorders __________ seizure thresholds, which ______ the risks of seizures --- correct answer ---DECREASES seizure thresholds (dehydrates/depletes body, causing kidneys/heart to fail), which INCREASES risk of seizures Wellbutrin (Bupropion) is what class type of drug? --- correct answer - --NDRI (norepinephrine-dopamine reuptake inhibitor) Clarithromycin Fluoroquinolone Amiodarone Nefazodone SSRIs Clomipramine Grape fruit Bupropion @ Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol (acute) Chloramphenicol Erythromycin Sulfonamides Ciprofloxacin Omeprazole Metronidazole Liver disease will affect liver enzyme activity AND _____-____ metabolism, possibly resulting in ________ plasma drug levels --- correct answer ---first-pass metabolism, toxic kidney disease or drugs that reduce renal clearance include.......... and what do they do to serum drug concentrations?? --- correct answer --- (A.N.T.s decrease renal clearance) ACE inhibitors,NSAIDS (ibuprofen, indocin), Thiazide, INCREASE serum drug concentrations that are excreted by the kidney such as lithium what is decreased & what is increased in Older Adults?? --- correct answer ----DECREASED Intracellular water, Protein binding, muscle mass, metabolism -INCREASED body fat concentration "Everything is decreasing, except body fat is Increasing"*** decreased protein binding in older adults means... --- correct answer -- -there is less protein available for psychotrpics to bind too, therefore there are more freer or "active" drug that remains in the body which predisposes older adults to toxicity NE is produced where --- correct answer ---locus coeruleus and RAS (medullary reticular formation system) Serotonin is produced where --- correct answer ---raphe nuclei in the brainstem DA is produced where --- correct answer ---substantia nigra, nucleus accumbens, and VTA (ventral tegmental area) Acetylcholine is produced where --- correct answer ---Nucleus of Meynert GABA produces a __________effect --- correct answer ---"calming" GABA is what type of neutrotransmitter? --- correct answer --- Inhibitory Decreasing GABA _____________anxiety --- correct answer ---increases Glutamate is what type of neurotransmitter? --- correct answer --- excitatory Increased levels of corticotropin releasing hormone in the amygdala, hippocampus, and locus coeruleus __________symptoms of anxiety --- correct answer ---INCREASES Increasing glutamate __________anxiety --- correct answer --- increases Autism Spectrum Disorder has persistent deficits in _________ __________ and _______ _____ across multiple settings --- correct answer ---social communication and social interaction ASD has deficits in --- correct answer ----social reciprocity -nonverbal communication -develop/maintain/understand relationships -restricted repetitive behavior Function of Frontal Lobe --- correct answer ---WORKING memory, reasoning, planning, prioritizing, sequencing behaviors, insight, flexibility, judgment, impulse control, behavioral curing, intelligence, abstraction, personality Which area contains Broca's area and what is it? --- correct answer --- Frontal Lobe**** function of EXPRESSIVE SPEECH What lobe is responsible for personality variables/development? --- correct answer ---Frontal Problems in the Frontal lobe can lead to what --- correct answer --- personality changes, emotional/intellectual changes What lobe is responsible for auditory? --- correct answer ---Temporal lobe What area contains Wernicke's area and what is it? --- correct answer ---Temporal lobe function of RECEPTIVE speech & language COMPREHENSION Temporal lobe function --- correct answer ---auditory, language comprehension, memory, emotion problems in the temporal lobe can result in --- correct answer --- auditory hallucinations, **aphasia, ***amnesia Which lobe is primarily responsible for vision? --- correct answer --- occipital lobe Occipital lobe function --- correct answer ---integration area of vision with other senses problems in the occipital lobe can lead to? --- correct answer ---Visual field deficits, blindness and visual hallucinations. what area is mostly responsible for sensory? --- correct answer --- parietal Parietal lobe is responsible for --- correct answer ---sensation, TASTE, reading/writing problems in the parietal lobe can lead to --- correct answer ---Sensory- perceptual disturbances and agnosia**** agnosia --- correct answer ---inability to interpret Clock Drawing Test (CDT) is used to screen people for --- correct answer ---**neuro problems such as Alzheimer's or dementia*** **quick 1 to 2 min to complete How long does it take to complete the Clock drawing test (CDT) --- correct answer ---only 1 to 2 minutes impairments on the CDT (clock drawing test) is associated with damage where... --- correct answer ---damage to the R parietal lobe (R hemisphere)*** what system is essential for the regulation and modulation of emotions and memory?? --- correct answer ---Limbic system What are the key components of the limbic system? --- correct answer ---Hypothalamus Thalamus Hippocampus Amygdala Function of Hypothalamus --- correct answer ---1. Eat (appetite/satiety/hunger) 2. Temperature regulation 3. Emotional expression (rage/pleasure/fear 4. Libido 5. Autonomic system (circadian rhythm/parasympathetic/sympathetic) 6. Water balance 7. Anterior pituitary (hormonal regulation/endocrine function) Thalamus function --- correct answer ---Sensory relay station for all senses EXCEPT SMELL**** -modulates flow of sensory info to prevent overwhelming cortex -Regulates emotions/memory/affective behaviors Thalamus regulates --- correct answer ---emotions, memory, affective behaviors Hippocampus function --- correct answer ---regulates memory, motivation, stress, emotion, learning*** CONVERTS short term into LONG-TERM MEMORY what is acute dystonia often mistaken for????******** --- correct answer ---agitation/unusual, stereotypic movements characteristics of schizophrenia Is acute dystonia "painful neck" aka stiff neck is usually mistaken for --- correct answer ---agitation ***what is a rare presentation of acute dystonia??? --- correct answer ---OCULOGYRIC CRISIS-->involuntary upwards deviation of eyes bilaterally, can lead to permanent injury Oculogyric crisis** --- correct answer ---rare presentation of Acute Dystonia - can lead to PERMANENT INJURY -prolonged involuntary upwards deviation of eyes bilaterally what to do and give someone who has Acute dystonia?? and why??**** --- correct answer ---1. STOP offending agent 2. Give COGENTIN (BENZTROPINE) , will decrease ACh in this pathway Reslessness (inability to remain still) is known as --- correct answer -- -AKATHESIA Akathesia is --- correct answer ---inability to remain still aka restlessness -pacing -difficulty standing still -feet constantly in motion/rocking what is akathesia often mistaken for??**** --- correct answer --- ANXIETY What rating scale is used for Akathesia? --- correct answer ---Barnes Akathisia Rating Scale Extrapyramidal Symptoms Rating Scale Treatment for Akathesia? --- correct answer ----Betablocker (DON'T GIVE if taking ALBUTEROL OR HAVE ASTHMA--> can cause BRONCHOSPASMS) -Benztropine (Cogentin) - Benzodiazepine Akinesia is.. --- correct answer ---Absence of movement; difficulty initiating motion, subjective feeling of lack of motivation to move what is akinesia often mistaken for??*** --- correct answer --- laziness/lack of interest Treatment for Akinesia --- correct answer ---Cogentin (Benztropine) Psudeo-Parkinsonian Symptoms is... --- correct answer ---presence of symptoms of Parkinson's disease produced by D2 blockage symptoms of Pseudo-Parkinsonian --- correct answer ---muscle rigidity shuffling gait motor slowing mask-like facial expression pill-rolling tremors in fingers** (key for parkinsonism) In Pseudo-Parkinsonian DA levels are ______ and ACh levels are______ --- correct answer ---DA levels LOW ACh levels are HIGH In Pseudo-Parkinsonian, what are mask-like facial expressions often confused with?? --- correct answer ---affective blunting/flattening What is involuntary abnormal muscle movement of the mouth/tongue/face/jaw that may progress to limbs and can be irreversible? --- correct answer ---Tardive dyskinesia is TD reversible or irreversible? --- correct answer ---It can be IRREVERSIBLE, may be reversible if caught early Symptoms of TD include --- correct answer ----protrusions & rolling of tongue -lip smack/sucking -chewing motion -facial dyskinesia what is the course of TD? how long does TD take to occur??*** --- correct answer ---can be up to 1 to 2 years************* but can also be an ACUTE process with initiation of meds OR as chronic condition at any point in tx Treatment of TD --- correct answer ---Reduce current dosage OR change to atypical agent Steroids like Flonase & Prednisone can induce... --- correct answer --- depression, mania, and psychosis**** Treatment if a patient is taking a med that induces mania/depression?? --- correct answer ---increase their mood stabilizer/antidepressant Ex. if pt is taking Lexapro + Interferon--> increase Lexapro b/c may not be helping since Interferon can induce symptoms of depression Key characteristics of Neuroleptic Malignant Syndrome (NMS) --- correct answer ---1. Caused by Antipsychotics******** 2. Extreme muscular RIGIDITY**** 3. MUTISM****** 4. Elevated CPK d/t muscle contraction/destruction 5. Myoglobinuria***(Rhabdomyolysis/muscle breakdown) 6. Elevated WBC (Leukocytosis) 7. Elevated LFTs (liver function tests) Both NMS & Serotonin Syndrome can have --- correct answer --- Hyperthermia aka fever Tachycardia aka high HR Diaphoresis Altered LOC Treatment for NMS --- correct answer ---1. Stop offending agent (antipsychotic) 2. Give med w/ mechanism of action Bromocriptine (Parlodel)- D2 agonist Dantrolene- muscle relaxant What two meds can you give for NMS and what is their mechanism of action? --- correct answer ---Bromocriptine (Parlodel)= D2 agonist Dantrolene= muscle relaxant key characteristics of serotonin syndrome --- correct answer ---1. Caused by ANTIDEPRESSANTS *** 2. HYPERreflexia***** 3. MYOCLONIC JERKS****** - agitation/restlessness -rapid HR/elevated BP -HA -Sweat/shiver/goose bumps -confusion/fever/seizures/unconsciousness Treatment for serotonin syndrome --- correct answer ---STOP offending agent and give CYPROHEPTADINE medication used for serotonin syndrome --- correct answer --- Cyprohepatadine**************** Drug combos that can cause serotonin syndrome --- correct answer --- SSRI + MAOI Placing pt on more than 1 SSRI Drugs + Herbal interaction SSRI + St. John's Wort********* SSRI/TCA/MAOI/SNRI When switching from SSRI to MAOI how long to wait? --- correct answer ---14 days aka 2 weeks******* When switching from Fluoxetine (Prozac) to MAOI how long should you wait? --- correct answer ---5 to 6 wks (prozac has long 1/2 life) When switching from MAOI to Prozac how long to wait? --- correct answer ---2 weeks aka 14 days Serotonin Discontinuation Syndrome s/s --- correct answer ---- Flu-like symptoms - Fatigue/Lethargy/Myalgia - Decreased concentration - Impaired memory - N/V - Ataxia (unsteady gait) - Agitation What is a false belief firmly maintained despite evidence to the contrary? --- correct answer ---Delusion - Visuospatial (draw 3D cube/clock) Mini Mental Status Exam (MMSE) uses what scale??? --- correct answer ---Folstein scale*** MMSE: when asking pt to count backwards from 100 by sevens/doing serial 7s, what are you testing? --- correct answer --- concentration/attention/calculation MMSE: when asking year/season/date/day/month and where we are, what are you testing? --- correct answer ---orientation MMSE: when asking pt to name 3 objects one second each and then have pt repeat them to you until they learn that, what are you testing? --- correct answer ---Registration/ability to learn new ability MMSE: when asking pt to repeat 3 objects you introduced to them, what are you testing? --- correct answer ---ability to recall/short term memory MMSE: when asking pt who the president/governor is, what are you testing? --- correct answer ---fund of knowledge Name 4 instruments for assessing level of cognitive impairment --- correct answer ---1. MMSE 2. Montreal Cognitive Assessment (MoCA) 3. Mini-Cog 4. St. Louis University Mental Status Exam (SLUM) Risk factors for suicide include --- correct answer ---**Prev. suicide attempt (#1) **MALE **Male >/= 45 years **Female >/= 55 years Divorced/single/separated WHITE*** Living alone Psych d/o Phy. illness Substance abuse Family hx suicide Recent loss** Suicide questions: if they give you A,B,C,D patients and ask you to compare, how do you answer? --- correct answer ---count # of risk factors, and the one with the most amount of risk factors is most likely the right answer ***there is NO risk factor greater than the other Suicide questions: If not comparing patients in question regarding suicide, how do you answer? --- correct answer ---choose the HIGHEST risk factor which is previous suicide attempt What is it called when client and RN enter a mutual, interactive, interpersonal relationship specifically to focus on the identified needs of the client? --- correct answer ---therapeutic relationship Therapeutic relationships are focused on the clients _________ and is ________-_________ --- correct answer ---needs and is goal-directed what are 7 characteristics of a therapeutic relationship --- correct answer ---***Professional boundaries Genuineness Acceptance Nonjudgmental Authenticity Empathy Respect What kind of questions should you ask in therapeutic relationship? --- correct answer ---Open-ended (avoid yes/no) Transference is when --- correct answer ---PATIENT displaces feelings for significant people in their past ONTO PMHNP in the present Countertransference is when --- correct answer ---PMHNP's emotional reaction to client is based off his/her past experiences CIWA-AR aka Clinical Institute Withdrawal Assessment is used to do what.... --- correct answer ---assess for alcohol withdrawal & determine when to administer meds for ETOH withdrawal CIWA: what score on CIWA indicates when you should start treatment? --- correct answer ---8 or higher (if ordered PRN only) 15 or higher (if on sched. med/sched. + PRN) Muscle Aches** Lacrimation ** Rhinorrhea** -sweat -insomnia -N/V/D Opiates and pupils: intoxication vs withdrawal --- correct answer --- intoxication= pinpoint withdrawal= dilation only for test purposes** what med should you not choose for opioid withdrawal? --- correct answer ---methadone d/t safety risks For scales regarding anxiety/depression when should you give meds? - -- correct answer ---ONLY*** when moderate or severe for anxiety/depression scales, what must you assess for if considered "severe" --- correct answer ---suicidal ideation MMSE scale (used for and scale # range) --- correct answer ---mental status **the lower the worst Moderate= 10-20 Severe= 0-9 SLUM (St. Louis University Mental Status Exam) scale is used for and what is the range for moderate --- correct answer ---Mental status **the lower the worst Mild: 21-26 (no moderate) Dementia: 0-20 For all scales, which way is worst?? higher or lower number --- correct answer ---For all scales EXCEPT mental status, the higher the number the worst. Mental status= the lower the number, the worst HAM D scale (used for/range) --- correct answer ---Depression Moderate: 14-18 PHQ-9 scale (used for/range) --- correct answer ---Depression Moderate: 10-14 Beck Scale (used for/range) --- correct answer ---Depression Moderate= 19-29 HAM A scale (used for/range) --- correct answer ---Anxiety Moderate: 18-24 GAD scale (used for/scale) --- correct answer ---Anxiety Moderate: 10-14 COWS scale is used for/range --- correct answer ---Opioid withdrawal Moderate= 13-24 (give buprenorphine/suboxone) CIWA used for/scale --- correct answer ---Alcohol withdrawal Moderate: 16-20 **if PRN start Tx at 8 or more ** If sched. med + PRN Tx at 15 or more If Mild on anxiety/depression scale, what do you do? --- correct answer ---therapy, no meds If moderate on anxiety/depression scale, what do you do? --- correct answer ---Meds only If severe on depression scale, what do you do? --- correct answer --- assess for suicide Screening Brief Intervention Referral for Treatment (SBIRT) is used for and what method is used to do this? --- correct answer ---screening people for substance use disorder -FRAMES is used for this**** FRAMES --- correct answer ---is used as brief intervention for alcohol that includes Feedback Responsibility Advice Menu of options -Pay attention to basic needs -Have room w/ familiar things + clock/calendar in sight Dementia key characteristics --- correct answer ----GRADUAL** -Impaired executive functioning (problem solving, organizational skills, global intellect w/ ***Preservation of LOC*******) Two main types of Dementia --- correct answer ---Cortical and Subcortical Cortical Dementia affects...***** --- correct answer ---MEMORY + LANGUAGE (APHASIA) Subcortical Dementia symptoms***** --- correct answer ---- DEPRESSION -IRRITABILITY -APATHY -MOTOR SYMPTOMS ***(EPS/Dystonia/Increased tone/Ataxia) Delirium or Dementia mostly has signs of a medical illness? --- correct answer ---Delirium*** (Acute) 6 Types of Dementia (name all pertinent ones to know) --- correct answer ---Alzheimer's (DAT) HIV Disease Lewy Body Vascular Pick's Huntington's Dementia of Alzheimer's Type (DAT) --- correct answer ---- cortical dementia - gradual onset/progressive decline WITHOUT focal neuro deficits aka w/o deficits in nerve/spine/brain function what is the most common type of dementia? --- correct answer --- Alzheimer's Dementia d/t HIV disease is what type of dementia --- correct answer - --subcortical dementia, due to HIV disease Early signs of HIV dementia includes --- correct answer ---- ***Cognitive decline -***Motor abnormalities (lack of coordination/tremor/dystonia/**ATAXIA) -Behavior abnormalities clinical signs of HIV Dementia --- correct answer ----Global cognitive impairment -Mutism** -Seizures** -Hallucinations*** -Delusions -Apathy -Mania Lewy Body Disease********************************* characteristics --- correct answer ---***VISUAL HALLUCINATIONS -Parkinson features (bradykinesia, cogwheel rigidity, tremors) -****Adversely reacts to antipsychotics, can give atypicals, don't give typicals*** what drug should you NOT give with lewy body dementia?? --- correct answer ---First generation antipsychotics**** (ok to give SGA) What is the second most type of dementia? --- correct answer --- Vascular Vascular dementia is primarily caused by.... --- correct answer ---CV disease & characterized by step-type declines Vascular Dementia is most common in.... --- correct answer ---MEN w/ pre-existing high BP & CV risk factors Hallmarks of Vascular dementia ******** --- correct answer --- **carotid bruits **fundoscopic abnormalities (ophthalmologist) **enlarged cardiac chambers Pick's disease/dementia aka --- correct answer ---Frontotemporal dementia Frontal Lobe dementia