NUR 202 WCC Final Exam Spring 2026

schizophrenia

chronic condition made up of positive and negative symptoms; characterized by delusions, hallucinations, disorganized speech, and/or diminished or inappropriate emotional expression

neurotransmitters involved with schizophrenia

low serotonin (negative symptoms)

low acetylcholine (sensory perception impairment)

overreactive dopamine

phases of development for schizophrenia

premorbid- antisocial behaviors before evidence of illness

prodromal- severely depressed symptoms (lack of concentration, hygiene, not leaving the house)

active psychotic phase- hallucinations/delusions

delusional disorder

one or more delusions lasting atleast a month

brief psychotic disorder

lasts atleast 24 hours but less than a month

schizophreniform disorder

looks like schizophrenia but lasts less than 6 months

schizoaffective disorder

having a mixture of symptoms suggestive of both an affective (mood) disorder and schizophrenia

positive symptoms of schizophrenia

classified by delusions, sensory hallucinations, and speech and thought disturbances

persecutions

belief someone is being singled out for harm by others

grandiose delusions

over exaggerations of a persons identity

reference delusions

interpreting random messages as if they were meant for you specifically

control or influence delusions

believing external forces control your thoughts

somatic delusions

believes that his body is changing in an unusual way

loose associations

disorganized thinking that jumps from one idea to another with little or no evident relation between the thoughts

clang associations

the stringing together of words that rhyme but have no other apparent link

neologisms

made up words

word salad

Incoherent mixture of words, phrases, and sentences

echolalia

automatic and immediate repetition of what others say

negative symptoms of schizophrenia

symptoms that take away from the person

flat affect

lack of emotional expression

anhedonia

inability to experience pleasure

alogia

absence of speech

avolition

lack of motivation

apathy

lack of feeling, emotion

anergia

lack of energy

How is schizophrenia diagnosed?

two or more symptoms emerge:

Delusions, Hallucinations, Speech (disorganized), Behavior (catatonic), Negative Symptoms

typical antipsychotics for schizophrenia

help decrease the person's positive symptoms:

Chloropromazine

Haloperidol

Fluphenazine

Side effects of typical antipsychotics

extrapyramidal symptoms

drying effects

urinary retention

orthostatic hypotension

weight gain

hyperglycemia

dysrhythmias

Extrapyrimidal symptoms

pseudoparkinsonism

akathisia

acute dystonia

tardive dyskinesia

pseudoparkinsonism

think "TRAP"

Tremors, Rigidity, Akinesia, Postural Instability

Pill rolling motion of the hand

Akathisia

motor restlessness

Acute dystonia

Involuntary eye movement, muscle spasms, facial grimacing

tardive dyskinesia

involuntary movements of the face, smacking

Tx of extrapyramidal symptoms

Benztropine

Trihexyphenidyl

Diphenhydramine

Amantadine

Valbenazine (Tardive Dyskinesia)

atypical antipsychotics for schizophrenia

Risperidone

Cariprazine (tx. Negative symptoms)

Clozapine

Quetiapine

What do we monitor for a person taking Clozapine?

ANC levels; can cause severe neutropenia

Normal ANC levels

1500

dx. of depression determines if pt exhibits 5 or more of these s/s

Feeling hopeless

Worthlessness

Empty

Anhedonia

Impairment in areas of functioning

SSRI's for depression

Fluoxetine (also treats PMDD)

Escitalopram

Citalopram

Paroxetine

Sertraline

serotonin syndrome

complications of SSRI's classified by:

sweating, rigid muscles, agitation, increased vitals, confusion, muscle twitching, tremors, dilated pupils, hyponatremia, hallucinations

MAOI's for depression

Phenelzine

complications of MAOI's

hypertensive crisis

what do you teach a patient taking MAOI's?

avoid foods high in Tyramine (cheeses, pepperoni, salami, yogurt, pickles)

TCA's for depression

Amitriptyline

considerations for patients taking TCA's

monitor heart rhythm; can cause prolonged QT intervals, arrhythmias, orthostatic hypotension

Electroconvulsive therapy (ECT)

a treatment that involves inducing a mild seizure by delivering an electrical shock to the brain to release deficient neurotransmitters

ECT is contraindicated for patients with

intracranial pressure

side effects of ECT

short-term memory loss, confusion

Education before ECT

NPO 6-8 hours

discontinue anticonvulsants

Vagal Nerve Stimulation (VNS)

for treatment resistant depression; device implanted and can be deactivated with a magnet

side effects of VNS

· Hoarseness

· Cough

· Neck discomfort

what education should you give a patient undergoing VNS?

do not discontinue antidepressants

Bipolar 1

at least one manic episode

Bipolar 2

hypomania and depression

cyclothymic BPD

persistent BPD over 2 years that consists of constant cycles

BPD caused by

Excess norepinephrine and dopamine

Low serotonin and acetylcholine

Stage 1 of BPD (Hypomania)

elevated mood, grandiose thinking, easily distracted

Stage 2 BPD (Acute Mania)

continuous high

M- mood swings

A- agitated

N- nonstop

I- insomnia

A- attention span limited

Stage 3 BPD (Delirious Mania)

loss of touch with reality

mood changes fast

hallucinations

confusion

distractable

tx. for mania

lithium carbonate

Carbamazepine

Verapamil

education for pts taking Lithium

take the medication regularly

maintain fluid and sodium balance

notify HCP if vomiting/diarrhea occur

hold NSAIDs

check serum lithium q1-2 months

therapeutic range for lithium

0.6-1.2 mEq/L

s/s of lithium toxicity

n/v/d

ataxia

blurred vision

tinnitus

excessive output of urine

increase tremors

confusion

anticonvulsants for BPD

carbamazepine

Valproic acid

s/e of anticonvulsants

skin rash, unusual bleeding

bruising

dark urine

yellow skin or eyes

verapamil for BPD

orthostatic hypotension, dysthymia's, chest pain, SOB, dizziness, swelling, headache

alcohol levels associated with intoxication

100-200 mg/dL

alcoholic myopathy

-Thought to result from same B vitamin deficiency that contributes to peripheral neuropathy

-Acute: sudden onset of muscle pain, swelling, and weakness; reddish tinge to the urine; and a rapid rise in muscle enzymes in the blood

-Chronic: gradual wasting and weakness in skeletal muscles

Normal CPK levels

10-120mcg/L

Wernicke's encephalopathy

most serious form of thiamine deficiency that causes ocular muscle paralysis, diplopia, ataxia, somnolence

MEDICAL EMERGENCY

tx. IV Thiamine

Korsakoff's psychosis

syndrome of confusion, loss of memory, confabulation

Alcoholic cardiomyopathy

r/t CHF/arrythmias; causes decrease exercise tolerance, tachycardia, dyspnea, edema, palpitations, and a nonproductive cough

esophagitis and gastritis d/t alcohol

inflammation of mucosal linings; risk for bleeding

alcoholic hepatitis

enlarged/tender liver, n/v, lethargy, anorexia, increased WBC, fever, jaundice, ascites

Complications of cirrhosis of the liver

Portal hypertension

Ascites

Esophageal varices

Hepatic encephalopathy

Portal hypertension

liver damage and obstruction of venous blood flow through the liver

esophageal varices

enlarged and swollen veins at the lower end of the esophagus

Hepatic encephalopathy

inability to convert ammonia to urea for excretion

Tx of hepatic encephalopathy

lactulose, Neomycin, rifaximine

Avoid antacids

Normal ammonia levels

15-45 mcu/dL

s/s of alcohol intoxication and withdrawal

"STAIRS HD"

S-sweating

T-tremors

A-anxiety

I-Insomnia, Irritability, Illusions

R-Rapid Heart Rate

S-Seizures

H-hallucinations, headache, HTN

D-depression, delirium tremens

CAGE Questionnaire: referring to alcoholism

C=cutting down (have you felt the need to cut down?)

A=Annoyed by others criticisms

G=guilty feelings about drinking

E=Eye openers-do you feel the need to drink in the morning?

tx. for alcoholism

Disulfiram

Benzodiazepines

Anticonvulsants

s/e of Disulfiram

Tachycardia, dizziness, n/v, diaphoresis, palpitations, hypotension

pt education for Disulfiram

do not ingest any form of alcohol (mouthwash, etc.); alcohol deterrent

medications for alcohol abstinence

Naltrexone

Acamprosate

effects of opioids on the body

everything is slowed down

Pain reduction

Opioid intoxication

constructed pupils

Slurred speech

Drowsiness

Impaired memory

Opioid withdrawal

Fever

Lacrimation

Aches

Piloerection

Pupil dilation

Increased vitals

Abdominal pain

Diaphoresis

drug for opioid intoxication

Naloxone

drug for opiate withdrawal

Methadone

Buprenorphine

Clonidine

Trexone

Tx of MI (myocardial infarction)

"MONA BASIC"

M-morphine

O-oxygen

N-nitrates

A-aspirin, thrombocytopenia agent, heparin

B-beta blockers

A-ace inhibitors

S-statins

I-invasive procedures (percutaneous coronary intervention, coronary artery bypass graft, cardiac catheterization)

C-calcium channel blockers

Morphine for MI

Smooth muscle relaxant

Nitrates for MI

vasodilators; enhances blood flow

Aspirin for MI

keeps platelets from aggregating; given during STEMI's (contraindicated during ischemic stroke)

Beta blockers for MI

Slow down heart rate to consume less oxygen; not given to patients with asthma

Ace inhibitors for MI

prevent ventricular remodeling

Statins for MI

immediate plaque stabilization

Calcium channel blockers for MI

decrease HR and vasodilate

Complications of MI

cardiac tamponade

ventricular rupture

heart failure

Ventricular aneurysm

cardiogenic shock