Exam 2 Mental Health Galen With 100% correct answers 2025-2026 already graded A+

Lithium

Mood stabilizer, used for treatment of bipolar disorder

Narrow therapeutic window

Lithium Levels

0.4-1.0 therapeutic

1.5 mild toxicity

1.5-2.0 advanced toxicity

2.0- 2.5 severe toxicity

> 2.5 death

Signs & Symptoms of Lithium Toxicity

Thirst, Tremors, Vomiting, Diarrhea, Muscle Weakness

Bipolar II Disorder

Episodes of hypomania (elation, high energy, but less than bipolar I)

Does not experience psychosis

Bipolar I Disorder

Episodes of mania (super elation, super energy, doesn't eat/drink/sleep, takes risks, spends excessive, hypersexual)

May have hallucinations

What is a priority when a Manic Bipolar I patient arrives at the ED?

1. Medically evaluate

2. IVF

2. Benzodiazepines

Nursing Interventions for Bipolar I Disorder

Limit Stimuli, Safety, Encourage Sleep, Set Limits

Benztropine (Cogentin)

Used for treatment of EPS, pseudo-parkinson symptoms

Signs & Symptoms of Neuroleptic Malignant Syndrome

Muscle rigidity, board-like, High temperature, diaphoretic, tachycardic

Generation Three Antipsychotics

Aripiprazole (Abilify)

Better side effect profile than generation one or two

Treats positive and negative symptoms of schizophrenia

Generation Two Antipsychotics (Atypical)

First line treatment, less chance of EPS

Treats positive and negative symptoms of schizophrenia

Clozapine, Olanzapine, Quetiapine, Risperadone, Ziprasidone

Metabolic Syndrom

Occurs with generation two antipsychotics (atypical)

Weight gain, hyperglycemia, hyperlipidemia

Generation One Antipsychotics

Treats positive symptoms of schizophrenia

Extrapyramidal Side Effects

Chlorpromazine, Haloperidol, Fluphenazine

Catonia

Moves very little or not at all

Evaluate for hazards of immobility (edema, cyanosis, injury, skin impairment)

Nursing Interventions for Delusions

Do not say you believe the delusion, don't try to talk the patient out of the delusion

Explore delusion and how they feel about it

If afraid of poisoning, let them eat prepackaged or wrapped food to establish trust

Paranoid Schizophrenics

Most Dangerous

If they feel that someone will harm them, they may assault them

You do not know whom they feel is harmful

Nursing Interventions for Hallucinations

Non-harmful: divert from hallucination and focus of feelings

Command Hallucinations: Explore the hallucination and assess for safety ("What are the voices saying? Do you recognize them?")

Delusions

A thought that is not based upon reality

Ex.) You feel that people are trying to hurt you

Illusions

You see/ hear something, but perceive it wrong

You see an IV pole and believe its a large snake.

Hallucinations

Things that are not present, but are perceived through one of the five senses

You see spiders on the walls

Negative Symptoms of Schizophrenia

Flat affect, anergia, avolition, poverty of speech, no ADLs, anhedonia

Positive Symptoms of Schizophrenia

Hallucinations, delusions, illusions, word salad, clang association

Causes of Schizophrenia

Increased Levels of Dopamine

Genetics/Biologics

Environmental Issues

Catharsis

Expressing of feelings or emotions

Universality

I am not alone, others share my problems

Pre-orientation

Planning

Orientation

Group normals, HIPAA, boundries, trust, rapport, start termination

Working

Set goals, develop coping skills, problem solve

Termination

Review positive accomplishments, goodbye/good luck, cut all ties

Critical Incident Stress Debriefing

A series of sessions offered to personnel that were directly involved in crisis

Nursing Interventions for Crisis & Disaster

Goals are short term and direct

You can be more direct with patients

Patient's are more receptive to learning

If too upset to talk, just sit with them

Establish Safety

Decrease Anxiety

Tertiary Intervention

Occurs after the crisis or disaster

Rebuilding & Rehabilitation

Secondary Intervention

Occurs during the crisis or disaster

Taking care of clients during the crisis or disaster

Primary Intervention

Occurs before the crisis or disaster

Public education, Disaster Planning

Adventitious Human Crisis

Things that go wrong that are extroidinary

Ex.) tornado, bombing, murder, child abuse, riots

Situations Human Crisis

Things that go wrong that are a part of everyday life

Ex.) car accident, illness, divorce, death of spouse

Maturational Human Crisis

Cannot adjust to the stage of development

Ex.) Just married cries every day and wants to move back with parents

Erich Lindeman Crisis/ Disaster Theory

Phase I- crisis encountered, mild anxiety

Phase II- coping fails, anxiety increases

Phase III- Panic

Phase IV- decomposition

Intermittent Explosive Disorder

Becomes enraged over something, has an angry outburst, followed by remorse

Ex.) Road rage

Conduct Disorder

Children involved with pyromania, kleptomania, or criminal activities

No remorse

Break Laws/ Involved in justice system

Oppositional Defiant Disorder

Blames others, noncompliant, seeks retaliation, annoys others, defiant

"No, I won't do it!"

Needs structure & guidance

Redirect- "Why don't we go for a walk."

Firm tone if harmful

Anti-Anxiety Medication (Non-benzo's)

Buspirone, Benadryl, Propanolol, hydroxyzine

Non-habit forming

Benzodiazepines

Alprazolam, Lorazepam, Diazepam

Addictive

Cause CNS depression

No etoh or driving

Nursing Interventions for Anxiety

Rule out physical problem

Assess problem-solving capabilities

Calm, supportive environment

Body Dysmorphic Disorder

Normal in appearance but are obsessed with perceived imperfections of their bodies

Frequently have plastic surgery or seek psychiatric help

Obsessive Compulsive Disorder Treatment

Gradually limit time spent of these while working on underlying anxiety

Phobias

Unrealistic Fears

Know fear is unfounded, telling them will not help

Gradual Desensitisation

Generalized Anxiety Disorder

Worries about everything; goes from one worry to the next

Restless, irritable, muscle tension, inability to make decisions, poor concentration, poor sleep

May be on a daily benzodiazepine

Social Anxiety Disorder

Not afraid of crowds or groups, but afraid of being judged or making a fool of themselves

Disrupts interpersonal relationships

Panic Disorder

Feels like you're having a heart attack/ choking

Comes out of the blue without warning

Cannot process or discuss until it is over

Physical work up may be done to rule out medical issue

Panic Anxiety

Fight or Flight Symptoms Increase

Cannot problem solve

Distorted perceptions

May have hallucinations

Severe Anxiety

Fight or Flight (Dilated pupils, elevated vital signs)

Decrease perceptual field

Decreased ability to problem solve

Moderate Anxiety

Feeling a little uneasy

Little perceptual field narrowing, may miss a few details

Mild Anxiety

Necessary for motivation

Stress Reduction Techniques

Deep Breathing, Progressive Muscle Relaxation, Meditation, Mindfulness, Guided Imagery, Exercise, Journaling, Humor

Eustress

Good things that cause stress

Ex.) New job

Distress

Bad things that cause stress