Exam Slam Spring 2025 Exam PDF

Exam Slam – Spring 2025 Your Hosts: Dr's Fran, Touw, and K Topics Covered Most exams are about what can kill your patient- and test if you can RECOGNIZE cues to intervene If the patients can have a bad side effect, end up dead, or suffer a consequence in so...

Exam Slam – Spring 2025 Your Hosts: Dr's Fran, Touw, and K Topics Covered Most exams are about what can kill your patient- and test if you can RECOGNIZE cues to intervene If the patients can have a bad side effect, end up dead, or suffer a consequence in some way-we will test you on it. The NCLEX and any test in nursing school is generally NOT about stable patients. Ask yourself this: What are you going to do as an RN to recognize the cues of something getting worse and act to prevent the bad thing from happening. Its all about managing risk and keeping the patients safe.  Recovery Model (Chapter 20) Person-driven recovery: Individuals should have control over their recovery journey. The model recognizes the importance of an individual's role in choosing their recovery path. HCWs act in collaboration with patient/ SO/ family to attain optimal QOL Multiple pathways: The model recognizes that there is no "one-size-fits-all" approach to recovery. * Recovery can involve various interventions, including but not limited to clinical treatment, peer support, and community engagement. b/c each individual is unique Holistic approach: Recovery involves improving overall wellness and reaching one's full potential, not just managing symptoms. It can involve multiple aspects of a person's life, not just clinical interventions. Strengths-based approach: The model focuses on building upon an individual's strengths rather than solely addressing deficits. Promotes autonomy and insight Community integration: The model highlights the importance of community relationships and support networks. Recovery Model (Chapter 20) Not testing on the specific models – but you will want to look at the interventions of the models. Check Table 20-1 (p. 344-45) and the nurse - patient collaboration in the mental health recovery process.  Therapeutic Communication (Chapter 7) Chapter 7 --> Tables (7-2) & (7-3) Techniques/Explanations/Examples In Non-Therapeutic Techniques Table - the examples have Better Alternative statements the nurse might use. * Read the non-therapeutic statement and then the alternative statement to start to show your brain how this type of communication works. Think about the concepts of active listening, voicing doubt, validation, humor, or stigmatizing language. What do those look like/sound like? How might you clarify or refocus clients? Focus on LEAPs from Dr. Touw Therapeutic Communication (Chapter 7) Effective therapeutic communication is essential Verbal as well as nonverbal As an assessment as well as an intervention Promoting positive patient outcomes The importance of building therapeutic relationships What are two key elements of therapeutic communication? 2 key elements of therapeutic communication are: o Active listening involves focusing on the patient and acknowledging their concerns. o What does active listening look like? o Empathy requires understanding and acknowledging the patient's feelings without judgment or getting lost in the emotions Legal & Ethical (Chapter 5) Not asking you about: o Ethical Theories: Utilitarianism or ethical egoism, etc – or Types of Law * Instead, you will need to know the Ethical Principles and All terms and How to apply them. Here is a sample- remember the slides from my lecture. Patient Rights: Assault & Battery, False imprisonment, etc. Ethical Principles: Autonomy, Beneficence, Non-Maleficence, veracity – etc. Duty to Warn: How to assess the situation for risk and what you do with that information Civil Rights: Voluntary or Involuntary Commitment Legal & Ethical (Chapter 5) Patient's right to make decisions about their care Importance of holistic care, including psychosocial factors Emphasis on individualized care and strengths-based approach Q: Can you explain why a client with a detailed plan to harm themselves would be a candidate for involuntary commitment, even without an immediate plan. A client with a detailed plan to harm themselves demonstrates a significant risk of self- harm, regardless of whether there is an immediate plan to act on it. This risk overrides their autonomy, so involuntary commitment might be necessary to ensure their safety by providing further evaluation and treatment. Stress & Coping (Chapter 1- the WHOLE THING) Stress Responses and Effects: The body's reaction to stress can be described in stages: alarm reaction, resistance, and exhaustion. Know the stages of stress, stress management, and coping strategies. Practice TIP: Stress is everywhere – the challenge here is to see it BEYOND someone's medical condition. Stress is emotional, physical, environmental and or a combination While you are in clinical this week – look for the reasons for stress in your patients and key in on how can you support that person. Use active listening  (Morgan, p. 2) (Morgan Chapter 12, p. 228)  Suicide (Chapter 16) 1. Risk Factors Current suicidal ideation: Frequency, intensity, and Suicide Inquiry duration of thoughts 1. Ideation: Ask directly about suicidal thoughts Suicide plan: Specificity, lethality, and access to means Previous suicide attempts: Timing, method, and intent 2. Plan: Investigate specific details of any suicide Mental health history: Psychiatric diagnoses, plan substance abuse 3. Behavior: Assess for any preparatory actions Recent stressors: Loss, trauma, or significant life or rehearsals changes (think of life’s stressors) 4. Intent: Determine the likelihood of acting on 2. Protective Factors (Strengths) suicidal thoughts Social support systems Reasons for living Cultural or religious beliefs that discourage suicide Suicide (Chapter 16) Know Risk Factors for Suicide → review intro and Table 16-1 (Facts and Myths) Not testing you on Sociological Theory (e.g. Durkheim’s, Joiner’s, Klonsky and May) Review the application of the nursing process, Fig 16-1, table 16-2, and Table 16-3 (CARE PLAN) and continue to the end. This is ALL important. How do you assess for SI? How do YOU as the nurse manage suicidal thoughts? What resources would you engage to support someone in a crisis? Anxiety Disorders (Chapter 27) Focus on Dr. Touw’s slides and p. 571 ▪ Panic ▪ GAD ▪ Agoraphobia ▪ Social anxiety. We will not test you one how to diagnose someone as in box 27 1+2 Then skip over to 577 Focus on anxiety 2/2 medical conditions and Anxiety 2/2 substance/medication - induced disorder. Move all the way through Obsessions/Compulsions including Hoarding (we are not asking you to diagnose as in box 27-3&4). Review Outcome Criteria (p. 581) Care Plans Really look at TABLE 27-3 (outcomes/interventions/rationales)  Generalized Anxiety Disorder (GAD) What are the common symptoms of GAD? What are the nursing interventions for someone in a state of anxiety? What medications would you use? Buspirone, SSRIs, Benzodiazepines, Beta-Blockers , Antihistamines Vistaril (hydroxyzine) is classified as an antihistamine. Primarily used to treat anxiety, nausea, allergies, and as a sedative. Although it is an antihistamine, it is commonly used for its sedative and anxiolytic properties in managing short-term anxiety and tension.  Medication Management - Anxiolytics See Dr Touw’s slides along with → p. 593 (Table 24-7) Chapter 4 - p. 61 – 63 (Table 4-3). Understand the difference between and indications for use, and monitoring for Benzodiazepines and non-benzodiazepine anxiolytics (Such as lorazepam (Ativan) and hydroxyzine (Vistaril))  Anxiolytics Chemical Name (Brand Name) Nursing Interventions Monitor for sedation, assess for signs of dependence, Lorazepam (Ativan) educate about avoiding alcohol Monitor for respiratory depression, assess for changes Diazepam (Valium) in gait or balance, educate about the risks of long-term use Monitor for dizziness and lightheadedness, assess for improvement in anxiety symptoms, educate about the Buspirone (BuSpar) delayed onset of action (1-2 weeks), and the importance of consistent dosing Monitor for drowsiness and dry mouth, assess for Hydroxyzine effectiveness in reducing anxiety symptoms, educate (Vistaril) about potential for increased sedation when combined with other CNS depressants Other medications we use in anxiety Chemical Name (Brand Name) Nursing Interventions Monitor blood pressure, assess Clonidine (Catapres) for dry mouth, educate about avoiding sudden discontinuation Monitor heart rate and blood pressure, assess for signs of Propranolol (Inderal) bronchospasm, educate about avoiding abrupt discontinuation Monitor for sedation, assess for Diphenhydramine (Benadryl) anticholinergic side effects, educate about avoiding alcohol Schizophrenia (Chapter 24) Make sure you understand the phases & symptoms associated with each phase of the disease What is the significance of each phase? Make sure you know the Key Terms terms - (p. 461) Box (24-2) Differentiate Positive Symptoms/Negative Symptoms- We are not focusing on psychobiology- except for the dopamine hypothesis in the way that it causes symptoms in the patients. ▪ Review: Pg 474 – 485 Starting with Disturbed Thoughts Processes --> * * Focus on the terms, care plans, and the nursing interventions. ▪ P. 485 - look at the concept map ▪ Check the interventions and outcomes Review Psychological Treatments: individual therapy, (types of) group therapy, i.e. CBT, social skills, pet, art, family therapy, etc (p. 486-488) Medication Management - Antipsychotics (p. 490/Ch 4 & 24) Pg. 490 - Check the sections on indications, actions * Side effects is a huge deal – what is the significance? Make sure you can teach about the medications (see the next slide) Teaching is an intervention. Starting on p. 73 → review the content and pay attention to safety issues and nursing interventions for antipsychotics We will not test you on the AIMS test- though you should know what it is b/c → ATI Review the antipsychotic medications – These medications primarily work by blocking dopamine receptors (particularly D2 receptors), reducing dopamine activity. This blockade can alleviate symptoms such as hallucinations, delusions, and disorganized thinking. These are dopamine receptor blocking agents (DRBA) TEACHING PATIENTS / SO/ FAMILY ABOUT MEDICATION MANAGEMENT What is/ are the Indication(s) for Use ? When will I feel ‘better’? AKA when will the medication become effective? When should I contact my PCP? How do I manage the side effects? When should I go to the ER? When and how do I refill the prescription? Antipsychotics Chemical Name (Brand Name) Nursing Interventions Monitor for extrapyramidal symptoms, assess for tardive Haloperidol (Haldol) dyskinesia, check vital signs regularly Monitor weight and metabolic parameters, assess for sedation, Olanzapine (Zyprexa) educate about orthostatic hypotension Monitor white blood cell count weekly, assess for Clozapine (Clozaril) agranulocytosis symptoms, monitor for seizures Monitor prolactin levels, assess for gynecomastia, educate Risperidone (Risperdal) about proper hydration Monitor for akathisia, assess for changes in mood or behavior, Aripiprazole (Abilify) educate about the importance of consistency in taking medication Monitor for extrapyramidal symptoms, assess for tardive Fluphenazine (Prolixin) dyskinesia, educate about avoiding sudden discontinuation Monitor for photosensitivity, assess for orthostatic hypotension, Chlorpromazine (Thorazine) educate about avoiding alcohol Monitor for weight gain, assess for changes in menstrual cycle, Paliperidone (Invega) educate about avoiding grapefruit juice DRBA-induced movement disorders EPS Type Description Onset Time Sudden, sustained muscle contractions Hours to days after starting Acute Dystonia causing abnormal postures. treatment Inner restlessness, inability to stay still, Hours to days after starting Akathisia constant movement or agitation. treatment Symptoms resembling Parkinson's disease: Drug induced tremor, rigidity, shuffling gait, slowness of parkinsonianism movement. Develops after prolonged use Chronic involuntary movements, often of the Occurs after long-term use, Tardive Dyskinesia face and limbs, usually irreversible. may be irreversible  Acute Dystonia Tardive Dyskinesia (TD) Occurs within hours to days of starting or Develops after prolonged use of Onset Timing increasing DRBA dose DRBAs, typically months to years Temporary, usually resolves within 24-48 Persistent, can become permanent Duration hours after treatment or discontinuing even after discontinuation medication Age of Onset More common in younger patients More common in older adults Sudden, severe muscle contractions; Involuntary, repetitive movements (e.g., Symptoms abnormal postures (e.g., torticollis, lip smacking, tongue protrusion) oculogyric crisis) Primarily affects the face, trunk, and Affected Areas Primarily affects the face, neck, and back extremities Treated quickly with anticholinergics (e.g., More challenging; may involve Treatment benztropine) or antihistamines (e.g., reducing/discontinuing the offending diphenhydramine) drug or using VMAT2 inhibitors Can persist and be more difficult to Prognosis Generally, resolves quickly with treatment treat; lower likelihood of complete remission