NUR 2488 Mental Health Nursing

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Mental Health Exam 2 Study Guide Rasmussen Summer 2021

When can a patient stop taking their mood stabilizer?

- They should not stop taking their mood stabilizer.

Inpatient, you are accessing your patient for depression 3 days after starting medication

treatment, your client is in a cheerful mood and says "I feel great", you should change his

care plan to include which of the following

- Keep a closer eye on the patient, consider asking for an order for staff view

at all times.

Your patient is experiencing acute mania, what type of environment should you put the

patient in?

- A neutral-colored room with minimal furnishing

Your patient with acute mania now seems to be responding well to treatment, how are

you able to tell.

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- Participating in groups, taking turns speaking, appropriately dressed.

Pick healthy coping strategies

- ● Exercise

● Journaling

● Using learned coping strategies 

Your patient tells you "They are after me, they want to kill me", what is your best

response?

- That must make you scared, how does that make you feel?

Your patient is experiencing auditory hallucinations, what is your next step?

- Ask your patient what the voices are saying.

Should you assess for depression and suicidal ideation in a schizophrenic patient

- Yes

MAOI meds

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- Isocarboxazid (Marplan)

Phenelzine (Nardil)

Tranylcypromine (Parnate)

Selegiline (Eldepril)

Phenelzine (Nardil) patient education

(MAOI)

- ● Avoidance of foods high in tyramine

● Check with the pharmacist before taking any OTC (examples are cold

medications)

Risk of taking an SSRI and MAOI inhibitor together

- ● Serotonin syndrome

● Hypertensive crisis

Bipolar patient is making demands and disrupting the unit, how do you respond

- ● Set clear limits

● Distraction techniques

● Use a firm calm approach 

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High level suicide precautions for inpatients include

- ● 1:1 staff within arm's length of patient at all times

● Removal of any hard removals at meal times

● Removal of anything that the patient potentially uses to harm themselves

Anhedonia

- The inability to feel pleasure. It's a common symptom of depression as well

as other mental health disorders. Most people understand what pleasure

feels like.

Anergia

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- Abnormal lack of energy is among the negative symptoms common to

schizophrenia and depression.

SSRI patient/family teaching points

- ● Medications of any kind — prescribed, over-the-counter, or herbal

supplements — should never be mixed without consulting the doctor

- ● Alcohol (wine, beer and hard liquor) or street drugs, may reduce the

effectiveness of antidepressants

- ● Avoid consuming certain foods that contain high levels of tyramine, such as

many cheeses, wines, fermented meat and pickles.

Lithium adverse reactions

- ● Excessive urination and thirst (polyuria and polydipsia) are consistently

found to be among the most common side effects associated with lithium

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- ● Hives; difficulty breathing; swelling of face, lips, tongue, or throat.

- ● Too much lithium in the body can cause death. 

What activities can put someone at risk for lithium toxicity?

- ● Lithium toxicity can occur if you take only slightly more than a

recommended dose. Risk factors for lithium toxicity include older age and

factors that lead to disturbances in renal blood flow and water-salt

homeostasis, such as fever, diarrhea or vomiting, and use of nonsteroidal

anti-inflammatory drugs (NSAIDs), diuretics, and renin- -angiotensinaldosterone system (RAAS) inhibitors. Female sex has also been associated

with a higher risk of lithium toxicity

Lithium patient education - teaching points

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- ● Stop using lithium and call the doctor for symptoms of lithium toxicity:

muscle weakness, twitching, drowsiness, feeling light-headed, mood changes,

blurred vision, ringing in the ears(tinnitus), irregular heartbeats, confusion,

slurred speech, clumsiness, trouble breathing, or seizures.

- ● Some medicines can interact with lithium and cause a serious condition

called serotonin syndrome

Assessment of Suicide, what would be considered a high-risk assessment?

- ● Communicating suicidal thought

- ● Verbally or in writing; seeking access to lethal means such as firearms or

medications; and demonstrating

- ● Preparatory behaviors such as putting affairs in order.

St. John's wort considerations

- ● St. John's wort might cause serious interactions with some medications.

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- ● St. John's wort is most commonly used for "the blues" or depression and

symptoms that sometimes go along with mood such as nervousness,

tiredness, poor appetite, and trouble sleeping.

- ● It can cause some side effects such as trouble sleeping, vivid dreams,

difficulty sitting still, nervousness, irritability, stomach upset, tiredness, dry

mouth, dizziness, headache, skin rash, diarrhea, and skin tingling

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