Exam 2: NUR 2459/ NUR2459 (New 2023/ 2024 Update) | Mental and Behavioral Health Nursing Exam Review| Complete Guide with Questions and Verified Answers|100% Correct -Rasmussen

Exam 2: NUR 2459/ NUR2459 (New 2023/ 2024 Update) | Mental and Behavioral Health Nursing Exam Review| Complete Guide with Questions and Verified Answers|100% Correct -Rasmussen

Exam 2: NUR 2459/ NUR2459 (New 2023/
2024 Update) | Mental and Behavioral Health
Nursing Exam Review| Complete Guide with
Questions and Verified Answers|100%
Correct -Rasmussen
QUESTION
overdose treatment for opioid:
Answer:
Breathing is promoted by aspirating secretions and inserting airway.
Naloxone (Narcan), a specific opioid antagonist, which can be administered intramuscularly,
subcutaneously or intravenously.
General treatment includes is a synthetic narcotic opioid, Methadone, to decrease painful
symptoms of opiate withdrawal. It also blocks the euphoric effects of opiate drugs such as
heroin, morphine and codeine, as well as semisynthetic opioids, oxycodone and hydrocodone.
QUESTION
Sedative, Hypnotic or Anxiolytic drugs
Answer:
benzodiazepines, all prescription sleeping medications, almost all antianxiety drugs.
QUESTION
Sedative, Hypnotic or Anxiolytic Use Disorder treatment
Answer:
Gastric lavage and activated charcoal are the treatment.
If the client is awake after overdosing, prevent loss of consciousness again.

• for withdrawal Gradual reduction of benzodiazepines will prevent seizures and other
  withdrawal symptoms.

QUESTION
Stimulants
Answer:
Amphetamines, cocaine or other stimulant drugs are the second most abused illicit substance in
the U.S.
QUESTION
stimulant withdrawal treatment
Answer:
Physical symptoms of chills, muscle cramps and aching make the process extremely
uncomfortable. The physical symptoms are often severe.
Depression can last for months after physical withdrawal.
Medical detox can help to make this process more tolerable.
QUESTION
Alcohol withdrawal treatments
Answer:
Prevention of alcohol withdrawal syndrome is the goal during withdrawal.
Diazepam (Valium) may be used to relieve acute agitation, tremor, impending delirium tremors
and hallucinations.
Chloradiazepoxide (Librium) may be used to reduce the danger of progress. Once the delirium
appears, intravenous lorazepam (Ativan) is used to treat severe symptoms.
QUESTION
screening tools
Answer:
Michigan Alcohol Screening Test (MAST)
CAGE- Questions to ask clients to determine how they view their substance usage
Clinical Institute Withdrawal Assessment Scale (CIWA)

This is a scale to determine the level of detox and if additional medication is needed.
QUESTION
Typical- First Generation Antipsychotics
Answer:
haloperidol (Haldol)
loxipine (Loxitane)
perphenazine (Trilafon)
thiothixene (Navane)
chlorpromazine (Thorazine)
fluphenazine (Prolixin)
QUESTION
Both Side Effects and All EPS Side Effects are Treated with the Following
Answer:
benztropine (Cogentin)
trihexphenergdyl (Artane)
the antihistamine diphenhydramine (Benadryl)
QUESTION
meds to treat symptoms of Neuroleptic Malignant Syndrome
Answer:
bromocriptine (Parlodel)
dantrolene (Dantrium)
QUESTION
Atypical- Second Generation Antipsychotics
Answer:

*These medications are weaker dopamine receptor antagonists, but are more potent antagonists
of serotonin receptors.
aripiprazole (Abilify)
asenapine (Saphris)
clozapine (Clozaril)- side effect-agranulocytosis-WBC, ANC count necessary- risk of infection
is serious due to this side effect.
larazidone (Latuda)
clozapine (Clzoril)- may cause agranulocytosis; must have periodic WBC/Absolute neutrophil
blood levels
paliperidone (Invega)
quefiapine (Seroquel)
risperidone (Risperdal)
ziprasidone (Geodon)
QUESTION
Advantages of Atypical Antipsychotics
Answer:
Treat both positive and negative symptoms
Decrease in affective symptoms (depression and anxiety)
Fewer or no EPS ( less dopamine blockage)
Fewer anticholinergic side effects- (Except for clozapine)
Less relapse
QUESTION
Psychosocial Theories
Answer:
Psychoanalytic – Depression is caused by the loss of a loved object (death or rejection).
Learning Theory – Those who have had numerous failures (real or perceived) abandon attempts
to succeed, and thus have depressive symptoms.
Object Loss Theory – Suggests that depressive illness occurs as a result of having been
abandoned by or separated from a significant other during the first 6 months of life.
Cognitive Theory – 3 cognitive distortions that are the basis for depression. Which include
negative expectations of: environment, self, and the future.
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Substance abuse disorder is characterized by
Intoxication and withdrawal

What are the signs and symptoms of intoxication for opioids
Opioid: decrease loc, respiration and HR

What are the signs and symptoms of withdrawal on opioids
Opioids: muscle aches, sweating, diarrhea, yawning, lacrimation

What is the goal for a patient going through withdrawal?
For them to go through it safely for example with opioid you may want to use a beta blocker or benzodiazepine

What are the anticipated behaviors of a patient with addiction?
Defensive mechanisms: rationalization- “I drink because she makes me angry” denial “I don’t have a problem”

What are the safety precautions for a patient with addiction going through withdrawal?
Prevention of harm, fall/injury, could experience hallucinations

The treatment for a patient going through withdrawal
Individual therapy, family therapy, medications such as naloxone

Naloxone isn’t usually used
when going through withdrawal but more management for not stopping

Neurocognitive disorders include
Delirium & dementia

Delirium is _ while dementia is
Acute/ reversible. Slow/ progressive

Signs and symptoms of delirium
Changes to loc, confusion, hallucinations, increased physical response, agitation

How do you treat delirium
Resolve underlying condition

what medications are used to treat delirium ?
haliperidol
benzodiazepines (lorazepram and diazepam)
B1 for thiamine deficiency

Signs and symptoms of dementia
Remember “a” words: aphasia(loss of purposeful speech) , apraxia(loss of purposeful movements) , agnosia (inability to recognize familiar people)
Confabulation(false answers)/ preservation:

Treatment for dementia includes
Medications increasing glutamate

Medicaiton for dementia
doepezil (all stages)
rivastigimine (all stages)

galantamine (mild to moderate)
mementine (moderate to severe)

doezpeil & memantine (combo)

Psychotic disorder spectrum includes
Schizoaffective: also have mood disorder symptoms
schizophrenia: has symptoms always
schizophreniform: only lasts 1-6 months (time)

Symptoms of schizophrenia
Delusions, hallucinations, disorganized speech, negative symptoms, grossly disorganized behavior.

Phases of schizophrenia
Prodromal phase: changes in levels of functioning but first episode hasn’t occurred.
Acute phase: active symptoms usually requires hospitalization.
Stabilization phase: medical rule out, begin medication regimen, focus on safety.
Maintenance phase: medication compliance, family education, residual symptoms, focus of relapse prevention.

Positive symptoms of schizophrenia
Hallucinations
delusions: fixed, false beliefs, persecution, grandeur, reference, control/influence, somatic.

Nursing interventions for positive symptoms of hallucinations
-present reality: letting them know they are safe etc.
-safety: decreased stimuli (Mileu therapy)

Negative symptoms
Flat affect(range of motion)
avolition(drive to do anything)
an ethos (lack of energy)
anhedonia (inability to feel pleasure)

Changes in speech due to schizophrenia
Loose associations, clang association, circumstantiality, preservation, neologisms, word salad, tangentiality, echolalia.

Nursing interventions for changes in speech due to schizophrenia
Present reality: let them know you don’t understand them

Medications for schizophrenia (for positive symptoms) (1st gen)
1st generation antis-psychotics
Focus on dopamine by decreasing it
S/e: anticholinergic, insomnia, orthostatic hypotension.
Major considerations aka s/e: EPS (trardive dyskinesia) NMS

EPS will not kill you but __ will
NMS (rigid, High fever and heart rate need to stop immediately and need to stop medication, give iv fluids, and administer meds to stop it)

Medications for schizophrenia (for positive and negative symptoms) (2nd generation)
Impacts dopamine and serotonin
S/E: weight gain, sexual dysfunction, sedation, GI disturbances.
Major considerations: clozapine (important to monitor wbc for argranulycytosis or low wbc count)

Mood disorders include
Major depression: at least 2 week period with 5 or more symptoms.
Seasonal affective disorder: mood impacted by environment (changes in weather)
Persistent depressive disorder: at least 2 years
Premenstrual dysphoric disorder: prior to week of menses

Medication classes for antidepressants
-SSRIS/SNRIS: gold standard (sertraline, fluoxetine)
-Tricyclic antidepressants:()
-MAOI: ()

Main teaching for SSRIs/ SNRIs
-can cause sexual dysfunction and monitor suicidal ideation
-can cause serotonin syndrome which can kill you from too much serotonin

Main teaching for Tricylycic antidepressants
They have a low overdose capability so don’t allow patient to take home too many
They are anticholinergic so they have anticholinergic effects

Main teaching for MAOis
They can’t be taken with tyramine containing foods which many foods have tyramine cheese etc so they are not usually given. So they need to be compliant with diet.

Therapy for mood disorders
Is called CBT and should be utilized along with medications

Biological for mood disorders
-transcranial stimulation
-vagus nerve stimulation
-ECT (can cause seizure)**
(Rarely used but are used for last resort)

Bipolar disorder is characterized by
Depression and mania

S/S of mania in bipolar disorder
-don’t eat, don’t sleep, Labile (mood swings), manic (think energized bunny)

Medications for bipolar disorder
Lithium (important to prevent lithium toxicity)
Mood stabilizers (divalproex/ depakote& lamotrigine/ lamictal)

Nursing interventions for bipolar manic disorder
-encourage finger foods
-encourage routine sleep
-encourage schedule
-reduction of stimuli (mileu therapy)
-be simple and direct when talking
-keep them safe and others bc they can be aggressive

lithium toxicity in treatment of manic phase of bipolar disorder important to remember
When sodium goes down lithium goes up so this increases risk of lithium toxicity so therefor it’s important to monitor dehydration which can be caused by (sauna, excessive exercising, stomach bug, not eating or drinking, fasting, diuretics)

Important to remember when giving mood stabilizers such as depakote to a patient with manic bipolar disorder
-liver function
-CBC count (platelet)
-category X pregnancy

Important to remember for lamotrogine (lamictal) mood stabilizer for manic phase of bipolar disorder
-rash Steven Johnson’s syndrome!

With all medications it’s important to
Have medication compliance

medications for delirium:
Antipsychotic (low-dose) haloperidol (Haldol)
Benzodiazepine-commonly used if etiology is substance withdrawal. (lorazepam (Ativan) or diazepam (Valium)
B1 IV for thiamine deficiency
Supplemental oxygen

medications for dementia:
donepezil (Aricept) cholinesterase inhibitor-all stages
rivastigmine (Exelon) cholinesterase inhibitor-all stages
galantamine (Razadyne) cholinesterase inhibitor-mild to moderate
memantine (Namenda) blocks NMDA-moderate to severe
donepezil and nemantine (Namzaric)- (combination)

how do drugs given for dementia work?
Cholinesterase inhibitors keep the acetylcholinesterase enzyme from breaking down the neurotransmitter acetylcholine.
In Alzheimer’s disease, the brain is producing less of this neurotransmitter, and this allows for more acetylcholine production.
In the brain of a client with Alzheimer’s disease (AD), there is also excessive glutamate, which leads to chronic overexposure to calcium in the brain. This process is damaging to the neurons.
Memantine blocks N-methyl-D aspartate (NMDA) receptors, thus reducing calcium.

Confabulation
the creation of stories or answers in place of actual events to maintain self-esteem

Preservation
The persistent repetition of a word, phrase, or gesture.

Agraphia
The diminished ability and eventual inability to read or write.

Aphasia
The loss of language ability.

Apraxia
The loss of purposeful movement in the absence of motor or sensory impairment.

Agnosia
The loss of sensory ability to recognize objects

Auditory agnosia
The inability to recognize familiar sounds.

Hyperorality
The tendency to taste, chew, and put everything in the mouth.

Hypermetamorphesis
The urge to touch everything.

Sundowning
The tendency for the mood to deteriorate and agitation to increase in the later part of the day or night.

overdose treatment for opioid:
Breathing is promoted by aspirating secretions and inserting airway.
Naloxone (Narcan), a specific opioid antagonist, which can be administered intramuscularly, subcutaneously or intravenously.
General treatment includes is a synthetic narcotic opioid, Methadone, to decrease painful symptoms of opiate withdrawal. It also blocks the euphoric effects of opiate drugs such as heroin, morphine and codeine, as well as semisynthetic opioids, oxycodone and hydrocodone.

Sedative, Hypnotic or Anxiolytic drugs
benzodiazepines, all prescription sleeping medications, almost all antianxiety drugs.

Sedative, Hypnotic or Anxiolytic Use Disorder treatment
Gastric lavage and activated charcoal are the treatment.
If the client is awake after overdosing, prevent loss of consciousness again.

• for withdrawal Gradual reduction of benzodiazepines will prevent seizures and other withdrawal symptoms.

Stimulants
Amphetamines, cocaine or other stimulant drugs are the second most abused illicit substance in the U.S.

stimulant withdrawal treatment
Physical symptoms of chills, muscle cramps and aching make the process extremely uncomfortable. The physical symptoms are often severe.
Depression can last for months after physical withdrawal.
Medical detox can help to make this process more tolerable.

Alcohol withdrawal treatments
Prevention of alcohol withdrawal syndrome is the goal during withdrawal.
Diazepam (Valium) may be used to relieve acute agitation, tremor, impending delirium tremors and hallucinations.
Chloradiazepoxide (Librium) may be used to reduce the danger of progress. Once the delirium appears, intravenous lorazepam (Ativan) is used to treat severe symptoms.

screening tools
Michigan Alcohol Screening Test (MAST)
CAGE- Questions to ask clients to determine how they view their substance usage
Clinical Institute Withdrawal Assessment Scale (CIWA)
This is a scale to determine the level of detox and if additional medication is needed.

Typical- First Generation Antipsychotics
haloperidol (Haldol)
loxipine (Loxitane)
perphenazine (Trilafon)
thiothixene (Navane)
chlorpromazine (Thorazine)
fluphenazine (Prolixin)

Both Side Effects and All EPS Side Effects are Treated with the Following
benztropine (Cogentin)
trihexphenergdyl (Artane)
the antihistamine diphenhydramine (Benadryl)

meds to treat symptoms of Neuroleptic Malignant Syndrome
bromocriptine (Parlodel)
dantrolene (Dantrium)

Atypical- Second Generation Antipsychotics
*These medications are weaker dopamine receptor antagonists, but are more potent antagonists of serotonin receptors.

aripiprazole (Abilify)
asenapine (Saphris)
clozapine (Clozaril)- side effect-agranulocytosis-WBC, ANC count necessary- risk of infection is serious due to this side effect.
larazidone (Latuda)
clozapine (Clzoril)- may cause agranulocytosis; must have periodic WBC/Absolute neutrophil blood levels
paliperidone (Invega)
quefiapine (Seroquel)
risperidone (Risperdal)
ziprasidone (Geodon)

Advantages of Atypical Antipsychotics
Treat both positive and negative symptoms
Decrease in affective symptoms (depression and anxiety)
Fewer or no EPS ( less dopamine blockage)
Fewer anticholinergic side effects- (Except for clozapine)
Less relapse

Psychosocial Theories
Psychoanalytic – Depression is caused by the loss of a loved object (death or rejection).

Learning Theory – Those who have had numerous failures (real or perceived) abandon attempts to succeed, and thus have depressive symptoms.

Object Loss Theory – Suggests that depressive illness occurs as a result of having been abandoned by or separated from a significant other during the first 6 months of life.

Cognitive Theory – 3 cognitive distortions that are the basis for depression. Which include negative expectations of: environment, self, and the future.

Transactional Model – Recognizes combined effects of genetic, biochemical, and psychosocial influences on individual’s susceptibility to depression.

Selective Serotonin Reuptake Inhibitors (SSRI’s)
SSRI’s block the neuronal uptake of serotonin. This blockage increases the availability of serotonin in the synaptic cleft.
SSRI’s include the following:
Citalopram (Celexa)
Fluoxetine (Prozac)
Sertraline (Zoloft)
Escitalopram (Lexapro)
Fluvoxamine (Luvox)

important to watch in for SSRIs
serotonin syndrome

Serotonin syndrome symptoms
diarrhea, sweating, fever, tachycardia, elevated BP and delirium.
Severe manifestations can induce hyperpyrexia, cardiovascular shock, or death.

Serotonin Norepinephrine Reuptake Inhibitors (SNRI’s)
Venlafaxine (Pristiq)
Duloxetine (Cymbalta)
Venlafaxine (Effexor)

Tricyclic Antidepressants (TCA’s)
Amitriptyline (Elavil)
Desipramine (Norpramin)
Imipramine (Tofranil)

side effects of TCA
These cause anticholinergic side effects:
dry mouth
blurred vision
tachycardia
urinary retention
constipation
Potential toxic effects
dysrhythmia’s
myocardial infarction
heart block

Monoamine Oxidase Inhibitors (MAOI’s)
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Selegiline (Eldepril)

Biological Interventions
Electroconvulsive therapy (ECT
Transcranial Magnetic Stimulation (TMS
Deep Brain Stimulation (DBS)

Anticonvulsants
Carbamazepine (Tegretol)
Divalproex (Depakote)
Lamotrigine (Lamictal)
Topiramate (Topamax)

Antipsychotics are used
in early treatment to promote sleep and decrease anxiety and agitation. Antidepressants- Selective Serotonin Reuptake Inhibitors (SSRIs) are useful during the depressive phase.
These are usually prescribed in combination with a mood stabilizer.

sources;
https://www.gcu.edu/
https://yaveni.com/
https://www.rasmussen.edu/