Psychiatric Nursing: Pharmacology & Interventions
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Questions and Answers

A client with depression is prescribed an SSRI. What should the nurse monitor the client for?

  • Hypertension
  • Serotonin Syndrome (correct)
  • Agitation
  • Increased risk of bleeding

    • Which of the following medications is an SSRI?

  • Amitriptyline
  • Duloxetine
  • Lithium
  • Fluoxetine (correct)

    • A client taking an SNRI is at an increased risk of what?

  • Bleeding (correct)
  • Hypertension
  • Suicide
  • Serotonin Syndrome

    • What is the therapeutic range for lithium?

    <p>0.6 - 1.2 mEq/L (D)</p> Signup and view all the answers

    Which of the following is a common side effect of TCAs?

    <p>All of the above (D)</p> Signup and view all the answers

    A client is prescribed a benzodiazepine for anxiety. What should the nurse educate the client on?

    <p>Avoid alcohol (A), Avoid driving (C)</p> Signup and view all the answers

    What is the first-line treatment for bipolar disorder?

    <p>Lithium (D)</p> Signup and view all the answers

    Which of the following foods should a client taking an MAOI avoid?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the primary nursing intervention for a client who is suicidal?

    <p>Asking directly about suicidal thoughts (A)</p> Signup and view all the answers

    A client with obsessive-compulsive disorder (OCD) is performing rituals to decrease anxiety. What is the nurse's best response?

    <p>Encourage the client to discuss their fears and concerns (A)</p> Signup and view all the answers

    Which of these principles focuses on the patient's right to make their own informed decisions regarding their treatment?

    <p>Autonomy (C)</p> Signup and view all the answers

    Which of the following is NOT a symptom of serotonin syndrome?

    <p>Hypotension (D)</p> Signup and view all the answers

    What is the primary goal of Cognitive Behavioral Therapy (CBT)?

    <p>To identify and challenge negative thought patterns that contribute to distress (D)</p> Signup and view all the answers

    Which ethical principle is most aligned with the nurse's responsibility to maintain the confidentiality of client information?

    <p>Justice (A)</p> Signup and view all the answers

    What is a typical treatment course for electroconvulsive therapy (ECT)?

    <p>6-12 sessions administered 3 times per week (A)</p> Signup and view all the answers

    What is the priority nursing intervention for a client experiencing acute alcohol withdrawal?

    <p>Performing a neurological assessment (C)</p> Signup and view all the answers

    Which medication is used to assist with alcohol cravings in the long-term treatment of alcohol dependence?

    <p>Naltrexone (C)</p> Signup and view all the answers

    Which of the following is a characteristic of Cluster B personality disorders?

    <p>Dramatic and impulsive behaviors (C)</p> Signup and view all the answers

    Which of these is a sign of opioid toxicity?

    <p>Loss of consciousness (B)</p> Signup and view all the answers

    What is the name of the antipsychotic medication class that acts on both serotonin and dopamine?

    <p>Atypical antipsychotics (D)</p> Signup and view all the answers

    Which of these is a common side effect of typical antipsychotics?

    <p>Tardive dyskinesia (D)</p> Signup and view all the answers

    What is the antidote for benzodiazepine overdose?

    <p>Flumazenil (C)</p> Signup and view all the answers

    Which of the following is a defense mechanism characterized by going back in age?

    <p>Regression (B)</p> Signup and view all the answers

    Which of the following is a key characteristic of Bipolar II Disorder?

    <p>Episodes of hypomania and depression (D)</p> Signup and view all the answers

    What is the name of the extreme form of somatic disorder where an individual intentionally makes themselves ill?

    <p>Munchausen syndrome (A)</p> Signup and view all the answers

    What is the primary goal of Alcoholics Anonymous?

    <p>Complete abstinence from alcohol (C)</p> Signup and view all the answers

    Which of the following is a common symptom of depression in older adults?

    <p>Social withdrawal (D)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of severe anxiety?

    <p>Calm and collected (D)</p> Signup and view all the answers

    In acute alcohol withdrawal, what medication may be used for tachycardia or hypertension not relieved by benzodiazepines?

    <p>Beta blockers (B)</p> Signup and view all the answers

    What type of therapy helps clients with anxiety gradually confront their fears?

    <p>Exposure Therapy (B)</p> Signup and view all the answers

    What is a sign of alcohol withdrawal delirium?

    <p>Tremors (A)</p> Signup and view all the answers

    Which of the following is a negative symptom of schizophrenia?

    <p>Alogia (A)</p> Signup and view all the answers

    Which of the following is a negative symptom of schizophrenia?

    <p>Flat affect (B)</p> Signup and view all the answers

    Which of the following medications is commonly used to treat Bipolar Disorder?

    <p>Mood stabilizers (D)</p> Signup and view all the answers

    What is the legal and ethical obligation to warn a potential victim when a client expresses threats of harm?

    <p>Duty to warn (D)</p> Signup and view all the answers

    What is the mental health continuum stage where a client experiences social withdrawal?

    <p>Surviving (A)</p> Signup and view all the answers

    Which of the following is a common risk factor for Major Depressive Disorder?

    <p>Family history of depression (A)</p> Signup and view all the answers

    What is a key nursing intervention for clients with moderate to severe anxiety?

    <p>Move the client to a quiet setting (A)</p> Signup and view all the answers

    Which of the following medication classes is commonly used to reduce anxiety and agitation associated with alcohol withdrawal?

    <p>Benzodiazepines (A)</p> Signup and view all the answers

    Which of the following is an example of a delusion?

    <p>Believing that you are being followed by the government (C)</p> Signup and view all the answers

    What is the primary goal of milieu therapy in treating mental health conditions?

    <p>Creating a therapeutic environment to promote healing and recovery (C)</p> Signup and view all the answers

    Which of the following is a TRUE statement regarding the relationship between anxiety and physiological factors?

    <p>Physiological factors should always be ruled out before diagnosing anxiety (B)</p> Signup and view all the answers

    Which of the following is a common medication used to treat depression?

    <p>SSRIs (C)</p> Signup and view all the answers

    What is the main reason why clients with depression often experience readmission to the hospital?

    <p>Relapse into depressive symptoms (B)</p> Signup and view all the answers

    Which of the following is a key aspect of therapeutic communication with clients experiencing depression?

    <p>Engaging in active listening and validation (B)</p> Signup and view all the answers

    What is the role of assertive communication treatment (ACT) in managing mental health conditions?

    <p>Teaching clients to express their needs and feelings effectively (C)</p> Signup and view all the answers

    Which of the following is a characteristic of manic episodes in Bipolar Disorder?

    <p>Risk-taking behavior and poor judgment (C)</p> Signup and view all the answers

    Study Notes

    Major Depressive Disorder

    • Diagnosis: Determined by DSM-5, based on symptom expression over time. Common in older adults, potentially mimicking dementia.
    • Symptoms: Anergia (lack of energy), anhedonia (lack of interest), agitation, sad or blunt affect, dishevelled/poor hygiene, slumped posture, sluggish responses, appetite/weight changes. Includes memory loss, confusion, social isolation, and agitation.
    • Risk Factors: Neurotransmitter deficiencies (serotonin and norepinephrine), genetics, family history, female gender.
    • Treatment: SSRIs, SNRIs, TCAs, MAOIs, assertive communication treatment (ACT) for severe/persistent MDD with psychosis.
    • Nursing Care: Assess suicide/self-harm risk, implement 1:1 observation (for risk), place client near nurses' station, not in a private room, encourage therapeutic communication, educate about relapse risk.
    • Milieu Therapy: Safe environment, empathetic communication (observe rather than question), assist with self-care until independent, spend time with client even w/o verbal interaction, allow for delayed responses.
    • Other Considerations: All depression clients should have thyroid function checked. Hypothyroidism can mimic depression symptoms.

    Bipolar Disorder

    • Description: Characterized by episodes of depression and mania.
    • Types: Bipolar I (severe mania and depression), Bipolar II (hypomania and depression), Cyclothymic (hypomanic and depressive symptoms for >2 years).
    • Symptoms (Mania): Overactivity, overspending, overeating, insomnia, pressured speech.
    • Symptoms (Depression): Flat affect, slow speech, anhedonia, feelings of worthlessness or hopelessness.
    • Diagnosis: Mood episodes impact function (social, occupational) not due to substance use or other disorders (e.g., thyroid dysfunction).
    • Treatment: Mood stabilizers, atypical antipsychotics, ECT, Cognitive Behavioral Therapy (CBT).
    • Nursing Care (Mania): Client may be placed further from nurses' station, provide high-protein, high-calorie finger foods. Implement milieu therapy to maintain safety and communication.

    Anxiety Disorders

    • Description: Persistent, excessive worrying with resulting physical or psychological symptoms. Physiological causes should always be ruled out first.
    • Risk Factors: Female gender.
    • Symptoms: Excessive worrying (>6 months), restlessness, fatigue, irritability, muscle tension, insomnia. Anxiety initially increases blood flow to the heart, muscles/brain for functioning.
    • Anxiety Levels: Low (restless, beneficial), moderate (sleep trouble, increased HR/RR), severe (overwhelmed, acting out), panic (terror, exhaustion, unresponsive).
    • Treatment: Talk therapy, CBT, SSRIs, benzodiazepines, buspirone, exposure therapy.
    • Nursing Care: Evaluate coping mechanisms (mild/moderate anxiety), move client to quiet setting (severe/panic), avoid dismissive statements ("you're okay"). Provide information about medication side effects especially insomnia or drowsiness at discharge.
    • DSM-5 Criteria: Excessive anxiety and worry, occurring more days than not for at least 6 months, with 3 or more symptoms (restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep disturbances)

    Schizophrenia

    • Description: Psychotic disorder affecting thought, behavior, and perception.
    • Risk Factors: Family history, prenatal/birth complications.
    • Positive Symptoms (Additions): Delusions (false beliefs), hallucinations (false sensory perceptions), disorganized speech.
    • Negative Symptoms (Subtractions): Anhedonia (lack of pleasure), anergia (lack of energy), alogia (lack of speech).
    • Diagnosis: Two or more symptoms present for >6 months, significantly disrupting social/occupational function. Rule out physical causes (electrolyte imbalance, hypoglycemia, substance use).
    • Treatment: Antipsychotics, CBT, assertive communication treatment for severe/persistent schizophrenia.
    • Nursing Care: Directly ask about hallucinations, acknowledge/do not validate. Decrease stimuli. Command hallucinations require immediate attention.

    Suicide

    • Risk Factors: Family history, age (>50), unmarried, chronic illness, mental health disorder, substance abuse, isolation.
    • Protective Factors: Access to mental health services, family/community support, effective coping skills.
    • Warning Signs: Making a will/giving away possessions, talking about suicide, hopelessness/worthlessness, increased substance use, sudden mood improvement.
    • Treatment: Pharmacological therapy, talk therapy, routine screening.
    • Nursing Care: Directly ask about suicidal thoughts (priority), 1:1 observation (near nurses' station, remove harmful objects, ensure medications are swallowed). Document observations every 15 minutes.

    Obsessive-Compulsive Disorder (OCD)

    • Description: Intrusive thoughts leading to ritualistic behaviors.
    • Obsessions: Unwanted thoughts/urges/images.
    • Compulsions: Repetitive behaviors/thoughts/rituals to reduce anxiety. Recognize that routine behaviors serve a purpose in reducing anxiety.
    • Treatment: SSRIs, CBT, antipsychotics.

    Antidepressants

    • SSRIs: Inhibit serotonin reuptake (citalopram, fluoxetine, escitalopram, paroxetine, sertraline). First-line treatment for depression. Takes 4-6 weeks to show effect, used for anxiety, OCD.
    • Side Effects (SSRIs): Serotonin syndrome (mental changes, tachycardia, muscle tightness, etc.), increased suicidal thoughts/behaviors. Interact with MAOIs, TCAs, zofran, St. John's Wort.
    • SNRIs: Inhibit serotonin and norepinephrine reuptake (duloxetine, venlafaxine, etc.). Used for depression and anxiety. Side effects include HA, dizziness, tremors, and others. Increased risk of bleeding with overdose.
    • TCAs: Increase serotonin and norepinephrine in the CNS (clomipramine, amitriptyline). Used for depression and anxiety. Wait 14 days after stopping MAOIs. Cardiotoxic - use with caution with telemetry. Side effects include anticholinergic effects (urinary retention, constipation, etc.)
    • MAOIs: Inhibit monoamine oxidase, increasing neurotransmitter levels (Marplan, Nardil, Parnate). Used for depression. Avoid tyramine-rich foods, interacts with other meds (OTC cold meds). Watch for suicidal thoughts, HTN crisis.

    Mood Stabilizers

    • Lithium: Regulates mood swings (depression, mania, bipolar). #1 treatment for bipolar. Therapeutic level: 0.6-1.2 mEq/L.
    • Side Effects (Lithium): Nephrotoxicity, fine hand tremors, polyuria. Watch for toxicity (confusion, blurred vision, etc.). Avoid dehydration, low salt diet.

    Benzodiazepines

    • Description: Enhance GABA effects in CNS (diazepam, lorazepam, alprazolam). Short-term use only due to dependence/withdrawal, antidote is flumazenil. Side effects include sedation and respiratory depression.

    Antipsychotics

    • Typical: Block dopamine, treat positive symptoms (hallucinations, delusions) (haloperidol, chlorpromazine). Side effects include Tardive dyskinesia, neuroleptic malignant syndrome.
    • Atypical: Act on serotonin and dopamine, treat positive and negative symptoms (risperidone, clozapine). Side effects include type 2 diabetes, weight gain, hypercholesterolemia, agranulocytosis.

    Substance Abuse/Addiction

    • Symptoms: Mood changes, decreased performance, weight loss, sleep changes, financial/valuable loss. Provide compassionate/nonjudgmental care.
    • Opioid Use: Toxicity symptoms (respiratory depression, pallor, loss of consciousness) Withdrawal symptoms (agitation, sweating, diarrhea, increased HR/BP). Monitor narcan administration.
    • Alcohol Withdrawal: Treated with benzodiazepines (diazepam, chlordiazepoxide). Barbiturates used if contraindicated to benzodiazepines. Assess time, amount, and type of last alcohol consumption.
    • Alcohol Withdrawal Symptoms: Restlessness, diarrhea, vomiting, cold flashes, delirium, tremors, confusion, tachycardia, tachypnea, seizures. Prevent Wernicke-Korsakoff syndrome with thiamine. Use clonidine/beta-blockers (as needed).

    Personality Disorders

    • Cluster A: Reclusive, eccentric, odd behaviors (paranoid, schizoid, schizotypal).
    • Cluster B: Dramatic, impulsive behaviors (antisocial, borderline, histrionic, narcissistic).
    • Cluster C: Anxious, fearful behaviors (avoidant, dependent, obsessive-compulsive).

    Somatic Disorders

    • Description: Excessive/maladaptive thoughts/emotions/behaviors relating to physical symptoms that significantly disrupt daily life, excessive preoccupation, increased anxiety.

    Foundational Concepts

    • Mental Health Continuum: Well-being to mental illness (excelling, thriving, surviving, struggling, crisis).
    • Duty to Warn: Responsibility to protect others when a client threatens harm to another individual.
    • Ethical Principles: Beneficence, autonomy, nonmaleficence, justice, self-determination, confidentiality.

    Serotonin Syndrome

    • Symptoms: Agitation, fever, diaphoresis, tremors, tachycardia, nausea/vomiting, muscle rigidity.

    ECT

    • Description: Use of electrical current to induce a generalized cerebral seizure under anesthesia.
    • Side Effects: Short-term memory loss, confusion.
    • Nursing Care: Monitor vital signs, EEG, EKG continuously. Typically 6-12 treatments 3x/week.

    CBT

    • Description: Therapy aimed at modifying thought and behavior patterns. Replace negative/distorted thoughts w/positive/rational ones.

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    Test your knowledge on psychiatric nursing with this quiz, focusing on psychopharmacology and nursing interventions for mental health clients. Questions cover SSRIs, SNRIs, benzodiazepines, and ethical principles in treatment. Perfect for nursing students and professionals looking to sharpen their skills.

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