NRSG 347 Exam 3 Questions and Answers
What must every treatment decision consider? - Answer--how it will help the person now
-what impact it may hve over the coming months or years
-how it interacts with the person's values and beliefs
What is important in the treatment of schizophrenia ...
What must every treatment decision consider? - Answer--how it will help the person
now
-what impact it may hve over the coming months or years
-how it interacts with the person's values and beliefs
What is important in the treatment of schizophrenia to be successful? - Answer-
important that there are no gaps in their care/treatment
Which medications are effective in treating psychotic symptoms associated with
schizophrenia, mania, drug intoxication, and medical symptoms such as delerium? -
Answer-antipsychotic drugs
How do antipsychotic drugs work? - Answer-by blocking/suppressing dopamine
receptors in the brain (most particularly in the frontal cortex)
How are antipsychotic medications divided? - Answer-into 1st and 2nd generation
classes
Which generation of antipsychotic meds are "typicals", older, and have more side
effects? - Answer-1st generation
Which generation of antipsychotic meds are "atypicals", newer, more selective, and
have fewer side effects? - Answer-2nd generation
What is dopamine sometimes called? - Answer-the pleasure hormone/neurotransmitter
what happens in psychosis regarding dopamine? - Answer-there is too much dopamine
and too much is going on in the brain
antipsychotics help suppress this activity
true or false: changing dopamine levels has little effect on the body outside of the brain -
Answer-false
it can have dramatic effects on the rest of the body
,what are 2 examples of 1st generation antipsychotics (typicals)? - Answer--
chloropromazine (Thorazine) PO or IM: 1953 first antipsychotic in the US
-Haldol PO, IM, IV
what are some characteristics of chlorpormazine (Thorazine)? - Answer--very sedating
-many motor side effects and anticholinergic effects (dry mouth, blurred vision, urinary
retention)
-rarely used today
what are some characteristics of Haldol? - Answer--most potent of the 1st generation
antipsychotics
-most chance of causing motor side effects
-least chance of anticholinergic effects
-still very commonly used today
what are some examples of 2nd generation (atypicals) antipsychotics? - Answer--
clozapine (Clozaril): late 1980s
-risperderone (Risperdal) PO: early 1990s
-olansapine (Zyprexa), quetiapine (Seroquel): late 1990s
-zipradsidone (Geodone), aripiprazole (Abilify): early 2000s
what are some characteristics of clozapine (Clozaril)? - Answer--more effective with
negative and cognitive symptoms
-extremely effective mood stabilizer
-strong anticholinergic effects
-weight gain is a big issue
-agranulocytosis
-associated with fatal heat stroke
-especially in higher doses can cause seizures
-associated with myocarditis
-costly: brand name $867/month, generic $200/month plus the cost of biweekly WBC
checks
-often trialed after several other antipsychotics have failed
what are some characteristics of risperderone (Risperdal)? - Answer--good at
decreasing negative and cognitive symptoms
-has some antidepressant activity
-long acting 2 week injection and fast dissolving tablet
-inexpensive
-watch for orthostatic hypotension, especially in the elderly
what are some characteristics of olanzepine (Zyprexa)? - Answer--effective on negative
and cognitive symptoms as well as positive symptoms
-weight gain can be a big issue
,what are some characteristics of quetiapine (Seroquel)? - Answer--sedation is the
biggest side effect
-usually taken at bedtime
what are some characteristics of zipradsidone (Geodon)? - Answer--first antipsychotic
that was "weight neutral"
-must be taken with food because its not absorbed on an empty stomach
-low blood levels leads to agitation
what are some characteristics of aripiprazole (Abilify)? - Answer--very well tolerated and
relatively few side effects
-it blocks and partially stimulates dopamine receptors (decreases dopamine activity
where it needs, increases dopamine activity where needed)
-people report feeling mentally sharper, more alive and engaged in the world
-better success rates of people staying on it
what is a benefit of the 2nd generation antipsychotics? - Answer-they have fewer side
effects than the older ones (1st generation)
what might have been done in the past to treat patients with hallucinations and
combativeness with delusions? - Answer-put in a coma with insulin
what are some side effects of antipsychotics? - Answer--metabolic problems
-extrapyramidal
-common, non-muscle related side effects that are uncomfortable but not life
threatening
-rare but dangerous problems
what is one metabolic side effect associated with 2nd generation antipsychotics? -
Answer-weight gain
why does weight gain seem to occur with 2nd generation antipsychotics? - Answer-
seem to cause changes in how the body handles glucose and insulin; people tend to
crave carbs and frequently feel very hungry
what problems are associated with weight gain from 2nd generation antipsychotics? -
Answer--problem for self-image and general sense of wellbeing
-significant medical problems such as heart disease and diabetes
-diabetes may even develop in the absence of weight gain while taking these drugs
in general, what are extrapyramidal side effects (EPS)? - Answer-spastic movements,
twitches, etc.
what are pyramidal cells? - Answer-nerve cells in the brain that are involved in the
control of voluntary muscle movements
, what does extrapyramidal refer to? - Answer-the part of the central nervous system
concerned with the control and coordination of muscle movements that is not part of the
pyramidal tract (hence extrapyramidal)
what do extrapyramidal cells/tract deal with? - Answer-muscle tone and finnesse of your
movements
what are some EPS affects from antipsychotic medications? - Answer--dystonias
-pseudoparkinsonism
-akathisia
-tardive dyskinesia (TD)
-akinesia
what are dystonias? - Answer-sudden, often dramatic muscle spasms of the head,
neck, lips, and tongue (swollen)
what are some manifestations of dystonias? - Answer--tilted head
-slurred speech
-eyes deviated to one side
what are some characteristics of dystonias? - Answer--can be frightening and
sometimes dismissed as a bizarre behavior rather than a drug side effect
-usually occurs hours or days after a drug is started or dose increased
the nurse is on an Alzheimer's unit. a client is agitated and pulling at things. Which of
the following should the nurse do?
A) provide the client with therapeutic sensory devices
B) cohort the client with another client who is agitated, because they will calm each
other
C) place the client in a room with several other clients
D) leave the client alone for a period of time to reduce stimulation - Answer-A) provide
the client with therapeutic sensory devices
rationale:
A) correct. alzheimer's patients often pick at items, such as buttons on clothing or
medical devices, which poses a danger to them. Providing them with safely designed
sensory devices serves the need of stimulating the senses as well as their urge to pick.
B) Cohorting the client with another agitated client can worsen the problem due to
increased stimulation.
C) Placing the client in a room with several other clients can worsen the problem due to
increased stimulation.
D) Leaving the client alone could lead to injuries related to the agitation, picking.
The nurse is caring for a male client. The client has exhibited some signs of anxiety and
hostility. The nurse is aware the client is a recently returned combat veteran. The nurse
should assess the client for which of the following conditions?
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