NRS 3016 Psych Quiz 2

Anxiety

Vague, non‑specific dread without an identifiable source.

Fear

Response to a specific, identifiable threat.

Mild Anxiety

Increased alertness; best level for teaching.

Moderate Anxiety

Narrowed focus; use calm, simple directions.

Severe Anxiety

Tunnel vision; stay with patient; one‑step commands.

Panic Level Anxiety

Loss of rational thought; safety priority; never leave alone.

Generalized Anxiety Disorder (GAD)

Excessive worry for 6+ months with symptoms like restlessness, fatigue, irritability, muscle tension, and sleep disturbance.

GAD Nursing Interventions

Build trust, assess severity, teach relaxation, cognitive restructuring, problem‑solving.

Buspirone

Used only for GAD; not PRN; takes 2–4 weeks to work.

Panic Disorder

Recurrent unexpected panic attacks plus persistent worry or behavior change for 1+ month.

Panic Attack Symptoms

Palpitations, SOB, chest pain, GI distress, derealization, fear of dying, paresthesias.

Nursing Care During Panic Attack

Stay with patient, calm reassurance, quiet environment, guide breathing, simple commands.

Nursing Care After Panic Attack

Educate, identify early warning signs, provide coping plan, refer to CBT.

Social Anxiety Disorder

Fear of negative evaluation; avoidance or distress is social situations.

Performance Anxiety Treatment

Propranolol.

Specific Phobias

Irrational fear recognized as excessive; treated with exposure therapy.

Agoraphobia

Fear of places where escape may be difficult.

Obsessive‑Compulsive Disorder (OCD)

Obsessions cause anxiety; compulsions reduce anxiety temporarily.

OCD Cycle

Obsession → Anxiety ↑ → Compulsion → Temporary relief → Anxiety returns stronger.

OCD Nursing Interventions

Do not stop rituals abruptly; allow ritual time then gradually delay; protect skin integrity.

ERP Therapy

Exposure and Response Prevention; gold standard for OCD.

PTSD Intrusion Symptoms

Flashbacks, nightmares, intrusive thoughts.

PTSD Avoidance Symptoms

Avoiding trauma‑related thoughts or reminders.

PTSD Negative Cognition/Mood Symptoms

Guilt, shame, emotional numbing.

PTSD Hyperarousal Symptoms

Hypervigilance, exaggerated startle, irritability, sleep disturbance.

PTSD Risk Factors

Severity of trauma, prior trauma, lack of social support, female gender, occupational exposure.

PTSD Nursing Care

Trauma‑informed approach, grounding techniques, predictable environment, screen for SI/HI.

PTSD Medications

Sertraline and paroxetine (only FDA‑approved).

Prazosin

Used for PTSD nightmares.

Dissociation

Detachment from reality; protective response to trauma.

Dissociative Identity Disorder (DID)

Two or more identity states with memory gaps; trauma‑based.

Depersonalization

Feeling detached from one’s body or self.

Derealization

Feeling surroundings are unreal or dreamlike.

Dissociative Amnesia

Inability to recall trauma‑related information.

Dissociative Fugue

Sudden travel with identity loss; specifier of amnesia.

Somatic Symptom Disorder (SSD)

Physical symptoms with excessive worry; validate distress.

Illness Anxiety Disorder (IAD)

Minimal or no symptoms with fear of serious illness.

Conversion Disorder

Neurological symptoms inconsistent with disease; symptoms are real.

Factitious Disorder

Intentional symptoms for psychological gain (sick role).

Malingering

Intentional symptoms for external gain (money, drugs, avoiding work).

First‑line antidepressants

4–6 week onset; sexual dysfunction; risk of serotonin syndrome.

SNRIs

Like SSRIs plus hypertension; severe discontinuation syndrome.

TCAs

Anticholinergic effects; sedation; lethal in overdose; ECG monitoring required.

MAOIs

Tyramine restrictions; hypertensive crisis risk; many drug interactions.

Bupropion

No sexual side effects; seizure risk.

Mirtazapine

Sedation and weight gain.

Trazodone

Risk of priapism.

Buspirone

GAD only; slow onset; non‑habit forming.

Serotonin Syndrome

Agitation, fever, tachycardia, hyperreflexia, clonus; stop serotonergic agents; give cyproheptadine.

Lithium Therapeutic Range

0.6–1.2 mEq/L.

Lithium Toxicity

≥1.5 mEq/L; tremor, confusion, seizures.

Factors Increasing Lithium Levels

NSAIDs, ACE inhibitors, dehydration, low sodium.

Lithium Nursing Care

Monitor kidneys and thyroid; maintain consistent sodium and fluids.

Valproic Acid

Monitor LFTs, ammonia, CBC; risk of liver failure and pancreatitis.

Carbamazepine

Risk of agranulocytosis, SJS, hyponatremia; strong CYP inducer.

Lamotrigine

Slow titration; rash may indicate SJS.

Typical Antipsychotics

Treat positive symptoms; high EPS risk.

Atypical Antipsychotics

Treat positive and negative symptoms; metabolic syndrome risk.

Acute Dystonia

Muscle spasms; treat with benztropine.

Akathisia

Restlessness; treat with propranolol.

Parkinsonism (EPS)

Rigidity and tremor; treat with benztropine.

Tardive Dyskinesia

Involuntary movements; treat with valbenazine or deutetrabenazine.

Neuroleptic Malignant Syndrome (NMS)

Fever, lead‑pipe rigidity, elevated CPK; stop antipsychotic; ICU care.

Clozapine

Risk of agranulocytosis and seizures; requires monitoring.