ATI Mental Health Proctored Exam Overview

ATI MENTAL HEALTH PROCTORED TEST 2024 primary prevention interventions to prevent the onset of the disorder What is an example of primary prevention education before the condition develops secondary prevention early detection - screening the community interventions that stop/decrease the disorder's effects tertiary prevention rehab and prevention of further problems - support groups partial hospitalization assertive community treatment an approach in which patients receive treatment at a hospital during the day but return home at night. includes detox programs aimed at helping severely mentally ill wherever they are in the community, each assigned a team member available any time of the day, visited twice a week by that member. interprofessional team to reduce rehospitializations and relapses community mental health centers. education groups medication dispensing prgrams individual and ftrly counseling psychosocial rehabilitation programs Residential services, day programs for older adults classical psychoanalysis therapeutic process of assessing unconscious thoughts and feelings and resolving conflict by talking to a psychoanalyst - focuse on eawrly life psychodynamic psychotherapy therapy aimed at uncovering the unconscious motives that underlie psychological problems - emphasis on current state interpersonal psychotherapy focuses on helping clients improve current relationships and specific problems CBT focusing on individual thoughts and behaviors cognitive reframing replacing negative thoughts priority restructuring ID what requires priority, such as pleasurable activities journaling ID stressors assertive training helps clients express feelings in a socially acceptable manner behavioral therapy decreasing anxiety and avoidant behavior DBT dialectical behavior therapy for personality disorders systematic desensitization overcomes fear through gradual exposure while using relaxation techniques examples of CBT DBT systematic desensitization aversion therapy meditation guided imagery diaphragmatic breathing muscle relaxation biofeedback biofeedback increasing awareness and gaining control of reactiosn to a trigger response prevention preventing a client from performing a compulsive behavior with the intent that anxiety will diminish thought stopping use of aversive stimuli to interrupt or prevent upsetting thoughts -OCD prolonged exposure therapy combines relaxation techniques with exposure to the traumatic situation through repeated discussion or in real world situations - results in decreased anxiety EDMR eye movement desensitization and reprocessing - a therapy using rapid eye movement during desensitization techniques for PTSD 1 / 12 contraindications of EDMR active SI psychosis severe dissociative disorders detached retina glaucoma severe substance abuse disorder crisis intervention emergency counseling for crime victims somatic therapy used for dissociative disorders - increasing awareness of the present, decreases dissociative episodes hypnotherapy used for dissociative disorders risk with TMS seizures transcranial magnetic stimulation a treatment that involves placing a powerful pulsed magnet over a person's scalp, which alters neuronal activity in the brain risk for ECT confusion retrograde amnesia short term memory loss SADPERSONS sex age depression past attempts excessive drug use rational thinking loss social supports lacking organized plan no spouse sickness bleuler's As for psychosis affect disturbance autism associative looseness ambivalence SIGECAPS - for depression sleep - lack of quality of sleep interests - apathy and loss guilt - hopelessness energy - anergia concentration - indecision, inability, alterations appetite - decreases psychomotor retardation suicide - for bipolar mania Distractibility Indiscretion - esp about sex Grandiosity Flight of Ideas Activity - increase Sleep - decrease Talkative DIGFAST Dementia Electrolyte imbalance, dehydration Liver lungs kidney heart disease Infection Rx - drugs Injury pain stress surgery Unfamiliar environment Metabolic reasons DELIRIUM mnemonic 2 / 12 A's for Alzheimers amnesia aphasia apraxia agnosia expressive amnesia broca's area - know what you want to say but mouth does not work receptive amnesia Wernickes - gibberish and lack of content apraxia repetitive movement agnosia the inability to recognize familiar objects. - serotonin syndrome Shivering Hyperreflexia Increased temp Vital sign instability Encephalopathy Resltessness Sweating SHIVERS Trauma Rexperiencing - flashbacks Avoidance Unable to function Restlessness Arousal TRAUMA (PTSD mnemonic) work on GABA inhibits electrical activity in the brain. sedation. MOA of benzos not used for minor stressors Benzos therapeutic uses used to tx anxiety, sleep disorders, Alcohol withdrawals, dependence d/t high doses or prolonged use Xshort-term benzos are used for -ANXIETY Benzos can be habit forming side effects of benzos - interfere with motor ability attention and judgement - drowsy fatigue confusion slow reflexes - abuse potential - do not stop abruptly drug interactions with benzos OTC drugs kava valerian alcohol antidote for benzos flumazenil examples of benzos diazepam clonazepam alprazolam lorazepam MOA of first generation antipsychotics lowers dopamine, causing negative symptoms and adverse effects from each pathway - more negative symptoms adverse effects of first generation antipsychotics anticholinergic antiadrenergic antihistamine what med must be given with first generation antipsychotics benztropine for EPS first generation low potency antipsychotic thioridazine - more sedating, more anticholinergic, less EPS, tachycardia 3 / 12 first generation high potency antipsychotic haloperidol - less sedation less anticholinergic - more EPS second generation antipsychotic. least sedating orthostatic hypotension appetite stimulation can be used as a mod stabilizer risperidone -loss of glucose control -risk of hypertension -weight gain -anticholernergic effects -tremors Risperiodne side effects include last choice second generation antipsychotic. helps with SI clozapine agranulocytosis - check CBC every 2 weeks for 6 months second generation olanzapine weight gain and can be used as a mood stabilizer ziprasidone second generation antipsychotic that needs to be taken with food QT prolongation what are second generation antipsychotics notorious for weight gain - monitor for metabolic syndrome aripiprazole third generation antipsychotic that is best for weight gain, best for CV, improves both positive and negative symptoms and cognitive function - dopamine system stabilizer - adjunct therapy for depression examples of MAOIs phenelzine isocaboxazid tranylcyrpomide selegiline MOA of MAOIs raise SE NE DA and tyramine by preventing destruction adverse effects of MAOIs hypertensive crisis CVI HA NV hyperthermia palpitations stiff sore neck contraindications of MAOIs CVD HTN CHF liver disease foods with tyramine aged cheese cured meats fava beans chocolate wine beer caffeine figs yeast MSG soybeans 4 / 12 shrimp paste ginseng protein supplements avocados examples of TCAs amitriptyline imipramine doxepin nortriptyline amoxapine trimipramine clomipramine MOA of TCAs raise SE and NE by stopping their reuptake adverse effects of TCAs anticholinergic antiadrenergic antihistamine sedation ataxia confusion insomnia lethal in overdose** ïDepression ï Depressive episodes of bipolar disorders ï Autistic disorder ï ADHD in children and adults ï Panic, school phobia, separation anxiety disorder ï PTSD ï OCD TCAs therapeutic uses -NEUROPATHIC PAIN True/ false the sedation effects of TCAs will minimize true antiadrenergic effects orthostatic hypotension reflex tachycardia dizziness fainting antihistamine effects weight gain examples of SSRIs fluoxetine citalopram escitalopram paroxetine sertraline paroxetine (SSRI) therapeutic uses -Generalized anxiety disorder -OCD -PTSD -Depressive disorders What SSRIs can be used for vernalized anxiety disorder -citalopram -escitalopram -fluvoxamine SSRIs are contraindicated in patients taking MAOIs and TCAs MDD medications adverse effects include anticholernergic how does it take for SSRIs to work 4-6 weeks adverse effects of SSRIs HA - early Stomach nausea - early weight change - paroxetine sexual side effects hyponatremia bruxism increased suicide risk 5 / 12 low dose - increase SE high dose - increase NE higher dose - increase DA MOA with SNRIs used for panic attacks anxiety and ADHD side effects of SNRIs less weight gain less poop out sleep disturbance dry mouth HTN - terrible discontinuation syndrome! examples of SNRIs venlafaxine duloxetine desvenlafaxine SSRIs are the first line treatment for Panic disorders and trauma and stress related disorders. MOA of buproprion NE/DA reuptake inhibitor may increase anxiety side effects of bupropion no sexual side effects lowers seizure threshold - TBI what can bupropion be used for smoking cessation eating disorders addictive behaviors what to avoid with bupropion abuse potential what can bupropion be combined with and why SSRIs to reduce sexual side effects mirtazapine antidepressant that works fast, no sexual side effects but has huge weight gain trazodone poor antidepressant that aids in sleep and has priaprism as side effect what are all anticonvulsants teratogenic who to use valproic acid and divalproex sodium for rapid cyclers side effects of divalproex soidum and valproic acid hepatoxicity GI symptoms thrombocytopenia decrease effectiveness of BC side effects of carbamazepine blurred vision - nystagmus leukopenia agranulocytosis SJS what decreases the effectivess of carbamezpine grapefruit juice side effects of lamotrigine SJS blurred vision nystagmus pharmacokinetics of lithium absorbed in GI tract excreted through the kidneys takes 1-2 weeks to work therapeutic index of lithium 0.6-1.2 required emetic or gastric lavage. blurry vision ataxia twitching hypotension polyuria lithium toxicity 2.0-2.5 6 / 12 coarse hand tremor vomiting lithium toxicity above 2.5 hemodialysis Blurred vision, ataxia, tinnitus, persistent nausea and vomiting, and severe diarrhea symptoms of lithium toxicity coarse hand tremor - projectile vomiting diuretics and lithium increase LI NSAIDS andlithium increase LI when causes decrease in NA sweating diarrhea vomiting use of diuretics mild adverse effects of lithium fine hand tremors polyuria thirst nausea weight gain nursing interventions with lithium take at the same time daily with meals maintain salt intake monitor sweating, fever draw lithium level in the morning 8-12 hours after last dose drink 6-8 glasses glasses water avoid conception reduce caffeine amphetamines Adderall Dexedrine examples of methyphenidates Ritalin concerta Vyvanse focalin daytrana contraindications with stimulants caffeine cocaine cold meds NE reuptake inhibitors examples of non-stimulants ADHD atomoxetine (Strattera) bupropion venlafaxine clonidine guanfacine alpha 2 agonists helps with impulsivity drugs for Alzheimers mild to moderate donepezil Exelon razadine adverse effects of donepezil Exelon razadyne GI symptoms bradycardia facial flushing leg crampsl contraindications with donepezil Exelon razadyne COPD NMDA antagonist for alheizmer Memantine improves cognitive function, slow the rate of decline in severe stages 7 / 12 drug of choice with OCD clomipramine drugs to treat delirium tremens carbamazepine opioids drugs for alcohol abuse disulfiram naltrexone Acamprosate drugs for nicotine addiction Chantix bupropion drug to reverse anticholinergic toxicity in older adults stop antipsychotic and start physostigmine fluctuating vital signs dilated pupils anticholinergic toxicity older adults excessive dopamine blockage and increased muscle tone. autonomic dysfunction Neuromalignant syndrome agitation confusion high fever drug treatment for NMS stop antipsychotic and start dantrolene normal and adaptive good eye contact may be tense but energetic low irritability more alert and concentrating wide visual field mild anxiety can talk to the patient moderate anxiety increase in vitals but pulse is normal sporadic eye contact good startle reflex protective mode more irritable overly sensitized treatment for moderate anxiety oral medication needs relaxation deep breathing and visualization sweating pacing tense poor eye contact dread defensive strike first verbally disortions in effective reasoning closed visual field only thinking about the problem mild delusions or paranoia severe anxiety out of range VS treatment with severe anxiety firm simple directions remove from stimuli IM or oral panic anxiety flight fight or freeze fixed eyes out of control overwhelmed cannot articulate emotions disorganized thinking guiding patient IM 8 / 12 possibility of restraints quickly intervene treatment of panic anxiety leaving home marriage birth of a child retirement death of a parent maturational crisis internal loss of job divorce severe illness situational crisis external adventitious crisis unplanned accidental natural disaster crime of violence immature types of defense mechanisms denial dissociation intellectualization projection regression UC refusal or ignoring denial I can quit at any time UC separating feelings from situation or object Dissociation an out of body experience UC overuse of logic without reason intellectualization being overly analytical about death UC incorporating other's values introjection dressing like your therapist UC blaming of others for unacceptable thoughts or feelings projection my ex is so unreasonable UC return to earlier development regression sucking thumb repression reaction formation undoing displacement rationalization intermediate defense mechanisms UC forgetting to painful events repression I can't remember behaviors that make up for an unacceptable thought or behavior undoing gift giving after abuse overcompensation reaction formation saying you love someone even though you hate them UC taking out anger on a less threatening object displacement 9 / 12 kicking the dog punching a wall UC justifying illogical feelings rationalization I was going to quit my job anyway altruism sublimation suppression transference countertransference mature defense mechanisms helping others to suppress drives altruism voluntary sublimation substituting an acceptable activity for an unacceptable drive example of sublimation A man with aggressive urges becomes a surgeon conscious denial of an event suppression not ready to talk about it transference the feelings that a patient has and puts on the nurse countertransference feelings that a nurse has and puts ont eh patient 0-18 months trust vs. mistrust erikson's infant stage attachment and bonding 18mont-3 years autonomy vs. shame eriksons toddler stage sense of self control and adequacy 3-6 years initiative vs. guilt eriksons preschool stage ability to be a self starter 6-12 years industry vs. inferiority eriskson's school stage ability to learn how things work 12-18 years ID vs. role diffusion erikson's adolescence stage unique, integrated person 18-30 years Intimacy vs. isolation erikson's young adult stage commitment to another person 30-65 years generativity vs. stagnation erikson's middle adulthood stage family and society 65+ years integrity vs. despair erikson's senrio stage sense of fulfillment Mania in Bipolar disorder S/S: ressured speech, boundless energy, little or no sleep, grandiose, poorjudgment, flight of ideas- continuous fast speech with abrupt shifts in topics, hyperactive, limited attentionspan, hypersexual 10 / 12 Depression-MDD S/S anhedonia- loss of pleasure anergia- lack of energy avolition- lack of motivation lowself-esteem inability to perform tasks social withdrawal neglect of personal hygiene sleep disturbances repressed feelings of anger/hostility turned inward What is the number one concern in patients with MDD Suicide risk What are side effects of SSRIs weight gain, sexual problems, initial: H/A's, GI effects (nausea, diarrhea) How long does it take for SSRIs to have an initial effect ? 4 weeks -8-12 weeks to full effect TCAs adverse effects sedating, initial dizziness,lethal in OD • Clang associations- rhyming words "cat in the hat" • Perseveration-persistent repetition of words • Neologism- an invented word "gobbletyguck" • Word salad- jumbled, meaningless words (also seen in Bipolar) • Echolalia- repeating other's words • Echopraxia- mimicking other's movements postive symptoms of schizophrenia include negative symptoms of schizophrenia Buspirone therapeutic uses Generalized anxiety disorder What CNS effects occur with Buspirone -dizziness -nausea -headache -lightheadedness -agiataion -Erythromycin -ketoconazole -st. Johns wort -grape fruit juice What are drug interactions for buspirone ? ALL INCREASE EFFECTS conversion disorder A rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found. Methadone is used for Treatment of opioid abuse When caring for a patient with dementia it is important to maintain what type of environment low stimulus Alcohol withdrawal symptoms tremors, fatigue, anxiety, abdominal cramping, hallucinations, confusion, seizures, delirium Fluphenazine hydrochloride (Prolixin) Antipsychotic - Phenothiazine Neuroleptic Malignant Syndrome Adverse reaction to antipsychotics with severe "lead pipe" rigidty, FEVER, and mental status changes What medication can be used to counteract the alcohol withdrawal s/s, sz, and delirium chhlorodiproide What is the classic sign of alcohol withdrawal? tremulousness/shakes/jitters -begins 6 - 8hrs after alcohol cessation Chloropromazine (Thorazine) first-generation (typical) antipsychotic -used for schzo Opioid withdrawal symptoms agitation, insomnia, flu-like symptoms, yawning, sweating, diarrhea 11 / 12 What OTC drug interacts with phenelzine pseudoephedrine Haloperidol adverse effects Akathisia (inability to be still) -hypervigelence -dilated pupils -hyperactivity -hyperalterness Cocaine intoxication s/s PARANOID "Buspirone causes nausea in some people." A nurse is providing teaching to a client who has a new prescription for buspirone to treat anxiety. Which of the following statements should the nurse include in the teaching? -Adverse effects of buspirone include nausea, dizziness, headaches, nervousness, sedation, lightheadedness, and excitement. Paranoia A nurse is assessing a client who has a history of methamphetamine use. Which of the following findings indicates that the client is currently under the influence of this drug? Acute effects of methamphetamine use include increased heart rate and metabolism, mental alertness and reduced appetite Increased Blood pressure A nurse is assessing a client who is experiencing alcohol with-Lorazepam is a benzodiazepine that is administered to a client drawal. For which of the following findings should the nurse antic- who is experiencing alcohol withdrawal for stabilizing vital signs, ipate the administration of lorazepam? preventing seizures, and treating delirium tremens. The nurse should anticipate the provider to prescribe lorazepam for increasing blood pressure. A nurse is providing teaching to a client who recently completed detoxification from alcohol and has a new prescription for acamprosate. Which of the following statements should the nurse make? A. "You will get very sick if you drink alcohol while taking this medication." D. "The medication might cause you to have episodes of diarrhea." • B. "The medication will be administered as a subcutaneous injection." C. "You should take this medication on an empty stomach." • D. "The medication might cause you to have episodes of diarrhea." A nurse at an acute care facility is caring for a client receiving IV antibiotic treatments for an infection. The client reports daily alcohol use at home. On the second day of admission, the client becomes agitated and has a blood pressure of 195/102 mmHg and a heart rate of 118/min. Which of the following actions should the nurse plan to take? • A. Administer methadone when agitation increases • B. Administer zolpidem before meals • C. Request a prescription for a different antibiotic • D. Request a prescription for chlordiazepoxide A nurse is assessing a client who is receiving disulfiram for alcohol aversion therapy. The client is experiencing palpitations and reports nausea, a headache, and extreme thirst. The nurse should identify that which of the following situations is occurring? A. The client is experiencing mild acetaldehyde syndrome B. The client is having delirium tremens C. The client is experiencing disulfiram toxicity D. The client is not having a therapeutic response to disulfiram • D. Request a prescription for chlordiazepoxide The nurse should recognize the client's findings as indicating withdrawal from alcohol and intervene to decrease the adverse manifestations. Chlordiazepoxide, an anxiolytic, is a benzodiazepine prescribed for alcohol withdrawal that reduces manifestations and can help prevent seizures and delirium tremens. A. The client is experiencing mild acetaldehyde syndrome The nurse should recognize that these manifestations are an indication of acetaldehyde syndrome, which occurs when alcohol consumption is combined with disulfiram use. The client's current manifestations represent the mild form of acetaldehyde syndrome that can occur by consuming as little as 7 mL (0.2 oz) of alcohol. 12 / 12