Georgettes LMR study set-with 100% verified solutions 2024-2025, Exams of Nursing

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Georgettes LMR study set-with 100% verified solutions 2024-2025 When questions ask for a priority action...think about... ans: ABC, airway breathing, circulation Maslows hierarchy If undecided on an answer due to high similarities, choose: ans: the umbrella answer What is the most common side effect of olanzapine/zyprexa ans: metabolic syndrome what is the difference between typical and atypical antipsychotics ans: Atypical 5HT2A specific 1st psychotic break... two actions to take ans: UDS and r/o sub Consider IM Geodon or Invega Three AP with least weight gain ans: Latuda, Abilify, Geodon Always encourage interprofessional collaboration ans: between therapists/pcps/SW/RN, the ENTIRE team TSH High, then....t3/t4 ans: T3, T4 low TSH low, then...t3/t4 ans: T3, T4 high cold/hot sensitivity with t3/t4 relationship ans: T3/T4 low, hypothyroid, cold, slow T3/T4 high, hyperthyroid, hot, flushed, tachy What birth defect can be caused by depakote? ans: Spina bifida What organ does depakote cause toxicity? and what sx would you expect to see? labs to run? ans: Hepatotoxicity: RUQ pain, reddish brown urine- Do LFTs kava kava is used to treat ans: anxiety and insomnia Rash and fever associated with tegretol, suspect ans: What allele is HLAB 1502 associated? ans: Asians. They CANNOT have tegretol. Test all asians for this allele. what rare and dangerous side effects are associated with tegretol ans: Aplastic anemia Agranulocytosis-DC at ANC less than 1000 Sx's of agranulocytosis ans: unusual bleeding or bruising, mouth sores, infections, fever, sore throat, fatigue if starting a woman on lithium what test should be done? why? ans: HCG--risk of ebstein anomaly adverse s/e of lamictal/lamotrigine ans: SJS labs to checke BEFORE starting on lithium ans: BUN CRE urine protein What does protein in urine indicate ans: kidney impairment; 4+ protein in urine=you cannot start on lithium best choice med for decreasing si in bipolar disorder. ans: lithium best choice med for si in schizophrenia ans: clozaril best choice med for SI in borderline ans: lithium What medications will INCREASE Li levels ans: NSAIDS ACE's Thiazides/HCTZ Besides medications, what else can cause increased Li levels ans: dehydration hyponatremia lithium s/e inc N/V, which will effect electrolytes, and dehydration status what type of tremors will you see with lithium toxicity? ans: course tremors lithium can cause what other comorbidities? ans: hypothyroidism maculopapular rash leukocytosis twave inversion what is a defining characteristic of NMS vs SS ans: muscle rigidity Sx's/labs associated with NMS ans: Inc CPK, WBC, LFT Rhabdomyolosis myoglobinuria Can lead to mutism myoglobinuria/rhabdo can cause cherry colored urine Treatment for NMS and what each does ans: DC the offending agent bromocriptin-D2 agonis dantrolene: muscle relaxant Make sure if ? is asking for agonist or relaxant Registration/ability to learn new material assessed how? ans: remember 3 words orientation is assessed by ans: Person place time fund of knowledge assessed how? ans: Who is the president? Governor? clock drawing assesses? ans: takes 1-2 minutes easy to administer tests right hemisphere health,cannot do it they have a prob in R side. First generation AP ans: haldol fluphenazine Chlorpromazine thioridazine 2nd gen AP ans: rispeidone olanzapine seroquel abilify ziprasidone lurasidone clozipine excess DA in mesolimbic pathway ans: positive sx of schizophrenia decreased DA in mesocoritcal pathway ans: negative sx of schizophrenia anhedonia mask face slow speech isolative nigrostriatal pathway ans: excess DA in this pathway but it doesn't cause any sx, but when DA is decreased in this pathway due to AP (dopamine blockade) increases acetylcholine=EPS sx Tuberoinfundibular pathway ans: excess DA is normal here but when it is decreased with AP leads to increased prolactin and hyperprolactinemia what does high prolactin levels lead to ans: breast DC amenorrhea osteoporosis breast enlargement which AP is most closely associated with hyperprolactinemia ans: risperidone Male prolactin female prolactin---normals ans: male less than 20ng/ml female less than 25ng/ml EPS caused by ans: DA blockade in the NS pathway acute dystonia ans: acute sustained contraction of muscles, usually of the head and neck spasms painful treatment of acute dystonia ans: cogentin/benztropine IM, but may need Oral follow up for several days akathisia ans: ANXIETY restless cannot sit still pacing rocking 1st line treatment for akathisia? And which population to AVOID use in? 2nd line? 3rd line? ans: propranolol/or beta blocker client with asthma on bronchodilators due to increased risk of bronchospasm when given beta blockers 2nd line: cogentin/benztropine 3rd line: benzos akanesia ans: difficulty iniating motion treatment for akanesia ans: cogentin/benztropin Sx of akinesia ans: DIFFICULTY INITIATING MOVEMENT; PSEUDO PARKINSONIAN SX'S: muscle rigidity shuffling gait mask like facial expression affect may be flat or blunted pill rolling tremors (motor slowing) Tardive dyskinesia (TD)/timeframes ans: chewing/lip smacking facial dyskinesia Treatment: dec dose of offending agent or switch to a different AP or can switch to clozaril. can have onset between a few weeks and 2 years post starting of medication Reglan (metoclopramide) and compazine (prochlorperazine) can both cause? ans: TD what medication can worsen TD? ans: benztropine/cogentin Inducers ans: cause low serum levels inhibitors ans: cause high serum levles reglan and compazine can both cause ans: TD Smoking and dosing of meds ans: smoking is a strong inducer. therefore smoking increases drug metablolism and you may need to dose higher. If they stop smoking serum levels will increase. Always assess for smoking/cessation of. Antibiotics/macroglides are INHIBITORS and greatly effect what medication ans: tegratol what meds can cause mania ans: disulfram steroids isoniazide antidepressants what meds can cause depression ans: steroids beta blockers interferon accutane-can cause birth defects too if patient taking meds for a mood disorder and is on flonase or prednisone. What do you do with your dose of oxcarbazepine ans: increase the dose to adjust for the medication (steroids) influencing mania treating a patient with zoloft and starts taking interferon. what do you do with zoloft dosing? ans: increase dose of zoloft to adjust for the increase in depression for the interferon addiction neurotransmitters ans: DA GABA Gamma-aminobutyric acid main function ans: major inhibitory neurotransmitter Sx's of stimulant abuse ans: irritability insomnia tremors delayed gastric emptying-feeling fullness/bloated Pt with anorexia complains of pain after eating/bloating/fullness ans: Signs of delayed gastric emptying what meds can delay gastric empying? ans: PROTON PUMP INHIBITORS famotidine omeprazole ranitidine ANTACIDS /PPI do what to psychotropic medications? ans: Decrease absorption of psychotropic medication advise client to take other meds 2 hours AFTER antacids/PPI Older adults and SSRIs for anxiety? ans: May increase anxiety paradoxical effect NE S tics can be caused by what type of medication ans: stimulant how do you treat a kid with tics for adhd ans: non stimulant guanfacine and clonidine are good choice for adhd in kid with tics ans: TRUE Meds for tourettes ans: FDA approved haldol abilify pimozide guanfacine clonidine esp if kid is having impulse control problems are tics in kids normal ans: yes normal. normally by teen years they disappear. no treatment unless meeting dsm criteria for tourettes. tourettes needs trmt. 2 motor 1 vocal brain region affected in adhd ans: frontal cortex basal ganglia- dorsolateral PFC--executive function, attention, cognitive processes (problem solving, working memory) reticular activating OCD NT's ans: S NE Pandas ans: causes OCD from strep infection treat with SSRI prozac in kids, in adults use sertraline. adults can also get TCA like clomipramine DMDD (disruptive mood dysregulation disorder) ans: in kids, mood d/o 6-17yo kid has bipolar disorder but is not 18 yet moody for no reason irritible for no reason tantrums for no reason Mad/Sad for no reason IED (intermittent explosive disorder) ans: reacts grossly out of proportion to the situation violent aggressive HAVE REMORSE, feel bad about it all later irritibility, depression, labile mood...utilize a________ ans: mood questionnaire nightmares in children can be genetic or psychological ans: assess the family tree/hx for this GAD (Generalized Anxiety Disorder) ans: AT LEAST SIX MONTHS If less it is ASD Autism Spectrum Disorder NTs ans: Gaba glutamate SE impaired communication poor cognition broken mirror theory of autism- what two things do you have to have to diagnose adhd ans: a teacher and a parent evaluation Do stimulants increase DA? ans: Yes, so don't give a vmat 2 and a stimulant together. wipes one another out P450 Inducer meds ans: carbamazepine rifampin alcohol phenytoin griseofulvin phenobarbital sulfonylureas P450 inhibitor ans: Valproate ketoconazole isoniazid sulfonomides choramphenical amiodarone erythromycin quinidine grapefruit juice pneumonic for inducers ans: CRAP GPS induces my rage Carbamazepine Rifampin Alcohol Phenytoin Griseofulvin Phenobarbital Sulfonylureas 450 subtypes 1A2 2E1 2C9 2D6 3A4 ans: 1A2. AcetAminophen- 1 big word with 2A 2E1 - 21 years to drink ETOH 2C9- Warfarin factors 2, C, 9 2D6- 2D echo-cardiac drug metabolism 3A4- most common, metabolizes up to 60% of ALL medications, so if its not one of the above it is likely 3A4. What NT are involved with OCD ans: NE SE Trmt med for kid with ocd ans: SSRI: prozac trmt med for adult with ocd ans: ssri: sertralin or TCA (clomipramine) GAD pneumonic ans: WATCHERS x 6 months Worry Anxiety Tension Concentration Hyperarousal Energy Loss Restlessness Sleep issues Stages of change ans: precontemplation: Not acknowledged an issue. " I don't have a drug problem" contemplation: acknowledges, but NOT YET ready to change. "i know heroin is killing me, but i have no time for rehab"... some self doubt preparation: acknowledges issue, intends to eventually act. "Ive been thinking about rehab or buprenorphine, what do you think?" No action or behavioral modification yet... researching action: behavioral change occurs. "I'm in inpatient rehab and I'm feeling much better!" maintenance: effort made to sustain the change. "Ive been on buprenorphine for a year and I'm still doing well" relapse: reversion to a previous stage... goes back to a prior stage to start over. caffeine lack of exercise diet low in cal and vit D What is the hippocampus responsible for? ans: ST to LT memory emotions stress learning Amygdala ans: fear anger anxiety aggression stress cerebellum ans: balance anterior cingulate ans: cognitive functions decision making empathy impulse control emotions decision making frontal lobe issues ans: social skills tumor here can cause behavioral problems If you are caring for an infant that is dying and the parents are present, what action should you take ans: give the infant to the parents to hold and grieve their loss osteoporosis can be prevented by a diet rich in what? and other ways to prevent ans: calcium and vitamin d weight bearing exercises not using tobacco Cognitive theory basics ans: trying to replace automatic negative beliefs/irrational thoughts with positive / functional thoughts Humanistic therapy basics ans: Person centered self actualization self directed growth Behavioral therapy ans: problem solving techniques role playing skills training relaxation SKILLS SKILLS interpersonal therapy (IPT) ans: interpersonal distress with lots of people and in several settings. also used in marital conflict for a 12-16 weeks. Think relationship distress with this Family systems therapy ans: triangles triangulation self differentiation genograms structural family therapy ans: hierarchies keyword structural mapping genograms strategic family therapy ans: problem focused/symptom focused paradoxical strategies or a straight forward directive Reframe patients belief system solution focused family therapy ans: miracle question miracle solution exception based finding questions scaling questions Appreciative inquiry ans: focused on the strengths of client if question answers give closed ended questions and one open ended question and all are appropriate, choose open ended because open ended questions promote the relationship ans: promote the relationship between client/provider. if they won't talk, you can f/u with closed ended questions if the child remains avoidant... stays avoidant, then go to parents as a last resort therapy session with a couple and only one party shows up, what do you do? ans: reschedule both of them. they must both be present. if someone has lost someone, ask them....? ans: how is that loss affecting you...how do you feel about it? Not affected? maybe you don't need to focus on it too much If client is moving to another state, how can you assist in not abruptly stopping medications? ans: give plenty of meds until they can see a new provider...maybe three month supply Sibling abuse 5yo sodomized by his 15yo borther reported to you. Inform parent to ______, and call______? ans: tell parents to separate the siblings cps suspect rheumatoid arthritis, check.....? ans: ESR level, which indicates inflammation PICOT ans: Population Intervention Comparison Outcome Time Level 1 evidence ans: systematic reviews of random control trials (RCTs) -highest internal validity due to randomizations Level 2 evidence ans: at least 1 RCT how do you continue to give evidence based care? ans: by reading current up to date journals Shrill cry in infant ans: intracranial pressure; inconsolable when do you start aftercare plan? ans: when patient is admitted masturbating is normal in what age range? Freud stage? ans: 3 to six year old phallic stage normal for young boys to develop breast enlargement/swelling/tenderness. Usually goes away in....? ans: six months sex drive is driven by what hormone? ans: testosterone. so check this if c/o dec libido. Testosterone decreases as we...? ans: age if male or female c/o dec sex drive, chec...? ans: testosterone Alcohol dehydrogenase ans: etoh enzyme women have less than men so get intoxicated faster compared to men best way to normalize the grieving process in children? ans: supportive group therapy do psychoeducation do not give prescriptive advise these reflexes go away at what age: grasp/palmar moro/startle babinski ans: grasp/palmar 5-6 months moro/startle 5-6 months babinski 9-12 months what class of medications are PDE5? ans: sexual dysfunction viagra short absorption, rapidly absorbed 14-18 moderate 19-22 severe 23 plus very severe PHQ 9 ans: 0-4 normal 5-9 mild 10-14 moderate 15-19 moderate to severe 20-27 severe Beck ans: 0-9 normal 10-18 mild 19-29 moderate 30-63 severe HAM A ans: under 17 mild 18-24 moderate 25 plus severe GAD ans: 0-4 normal 5-9 mild 10-14 moderate 15-21 severe COWs ans: 0-4 none 5-12 mild 13-24 moderate 25-35 mod to severe 35 plus severe CIWA ans: 0-9 none 10-15 mild 16-20 moderate 21 plus severe cows criteria ans: mod: treatment at 13 and above for scheduled. consider buprenorphine or Suboxone. methadone consider safety concerns and under supervision pulse sweating restlessness pupil size-dilated bone aches runny nose tearing gi upset yawning tremors anxi/irritable goosebumps ciwa ans: scheduled medication starts at score of 15 Nausea vomiting tremor sweats anxiety agitation tactile disturbances auditory disturbances HA orientation etoh abuse treatment ans: disulfram no etoh for two weeks after stopping/none 12 hours before starting aversion therapy naltrexone idealization ans: exaggeration of good qualities of the person or object lost, followed by acceptance for the loss. widow exaggeraes how amzing her not so amazing husban is false positive screen for pcp ans: tramadol dextromethorphan alprazolam clonazepam carvedilol diphenhydramine rationalization ans: always to work late and tells boss "I'm not the only one" intellectualization ans: new diagnosis so you go home and do tons of research scope of practice ans: varies state to state defines role and action varies broadly standard of practice ans: determined by american nurses association judges care given reasonably prudent is standard confidentiality ans: the assurance that messages and information are available only to those who are authorized to view them exceptions to confidentiality ans: when info outweighs risk (think murder trial) intent to harm self or others info given to atty in litigation releasing records to insurance companies answering court orders, subpoenas, summons Meeting state requirements for mandatory reporting of dx of condition informed consent in apt with dementia ans: if client can repeat the benefits and risks o the med/ autonomy is: ans: right to self determination EXCEPT rennie vs klein: right to refuse medication if NOT-found incompetent Rights of patient re environment ans: least restrictive first just culture ans: safety continual learning designing safe systems managing behavioral choices Recovery model ans: treatment approach doesn't really focus on the dx/illness looking beyond the dx and search out abilities dreams goals self direction finding meaning in life despite the dx person centered individualized NON LINEAR not step by step but based on growth setbacks and learning experiences quality improvement projects focus on... ans: improving systems decrease cost improve productivity a retrospective chart review would be a type of.... ans: quality improvement initiative PDSA is a process ans: not a project an effective strategy reflective practice ans: linking theory to practice providing feedback industry vs inferiority ans: school age 6-12 becoming industrious and getting confidence about what they can do... fx is feeling bad and inferior intimacy vs isolation ans: age 20-35 in a loving relationship