Tag: Clinical-Nursing

Lack of Mental Health – Nursing and Healthcare Policy paper guidelines

Select a policy related problem (Mine is lack of mental health) that affects of persons, communities or society in general and write a policy issue paper dealing with the problem.  Include problem identification, background information (social, economic, ethical and political/legal factors), the issue statement, stakeholders, policy objectives, policy alternatives or evaluation of options, political feasibility, comparison of alternatives, and the results of your analysis.

*see if there are policies in the legislature either state (IL) or federal that you could compare.

Healthy People 2020 – chronic illness

Identify an area of chronic illness of specific interest to you and that is represented as a Healthy People 2020 topic (healthypeople.gov). Explain your choice and your interest in it. Prepare a questionnaire utilizing your knowledge of health and illness, with the aim of acquiring all information you need from patients to prepare a plan of care for the specific illness group. Submit your information in a 4- to 5-page Microsoft Word document. In addition to your questionnaire, be sure to include the following details in your paper.

Chronic Illness of interest

Morbidity and comorbidity of the disease

Impact of the chronic illness and patient morbidity and the affect to overall health of nation

Healthy People 2020 goals and objectives for specific illness group

Support your responses with examples.

On a separate references page, cite all sources using APA format.

Use this APA Citation Helper as a convenient reference for properly citing resources.

This handout will provide you the details of formatting your essay using APA style.

You may create your essay in this APA-formatted template.

Using a Health Policy Model to Develop a Change in Policy to Improve the Public’s Health

This assignment focuses on the methods to develop a change in policy to improve the public’s health by using a health policy model.

Tasks:

Suppose you want to initiate a policy of taxing sugared sodas/pop/beverages in your community. Use the Longest’s policy cycle model to ponder the following questions:

What arguments would you use to make the case for the policy?

What argument(s) would your opponents make?

How would you go about getting buy-in for your proposed policy?

What stakeholder groups need to be involved in promoting your policy?

Submission Details:

Submit your response in a 2-page Microsoft Word document (500 words).

Name your document SU_NSG4068_W1_Project_LastName_FirstInitial.doc.

Submit your document to the
 
Submissions Area by
 
the due date assigned.

Cite sources in the APA format on a separate page.

Role of an Advanced Nurse in LGBTQ

Role of an Advanced Nurse in LGBTQ Health The role of a nurse if to ensure safe and quality health care for their patients. The nursing advocacy policies regarding LGBTQ health aim at improving health and safety of the individuals. Through the policy, disparities and discrimination will be reduced. Health care needs of lesbians, gay, bisexual, transgender and queer are inadequately addressed in nursing theory and practice. LGBTQ experience unique health disparities since they represent a unique population whose health needs are ignored. Nursing education barely mentions on the needs of LGBTQ and nurses are faced with problems when dealing with the patients who belong to this category. Lack of knowledge of special needs contribute to heterosexism and homophobia when taking care of these patients. Nurses therefore are obligated to use the available resources at assess and create care environment that ensures quality health care for the LGBTQ patients. In most situations, nurses do not offer any special care to the LGBTQ patients. It is important that a patient is offered care with regard to what they identify themselves with. Nurses achieve the identification concern through support of the patient population. By advocating for equal health opportunities, nurses contribute to the improvement health of the LGBTQ and also reduces health disparities. Some of the health disparities include increased patient longevity, reduced disease transmission and increased physical and mental wellbeing. The topic relates to Essential IV: health Policy and Advocacy. Nurses are advocates and influence policy making process by engaging with policy makers in matters relating to health. In this case, nurses advocate for equality in health care of the marginalized group of individuals. Works Cited Dilley JA, Simmons KW, Boysun MJ, et al. Demonstrating the importance and feasibility of including sexual orientation in public health surveys: Health disparities in the Pacific Northwest. Am J Public Health. 2015;100(3):460-7.

 

My viewpoint regarding the LGBTQ community is that they are in most settings looked down upon. What is LGBTQ? LGBTQ stands for lesbian, gay, bisexual, transgender and queer. These are people who are considered as a misfortune in some societies. In exhibit situation a large portion of the therapeutic experts have to deal with LGBTQ individuals with great care (Chiocca, 2015). In some cases however, they are sent away when they go to seek medical attention of any nature. This is a very bad practice in the nursing sector and it should be addressed to ensure that such people are treated equally just like the other groups of people.

Advanced practice nurses underpins the equal rights, benefits and opportunity of all people and condemns segregation in light of sex, sexual introduction, sex character, race, religion, incapacity, ethnic starting point, national birthplace or age. Sexual orientation and sex personality are essential parts of the patient population and they deserve better treatment (Chiocca, 2015). To help this patient population, arrangements on LGBTQ issues needs to be put in place and work to advice people about LGBTQ severance and mishandle. It is important to have approaches that speak for lesbian, gay, androgynous and transgender individuals’ rights, which must speak to a variety of characters and issues. Lesbian, gay, cross-sexual, transgender, and strange/addressing (LGBTQ) medical attendants constitute one of the biggest subgroups inside the calling of nursing, yet there is next to no observational research in the nursing literature and essentially no regard for issues of separation and prohibition in the work environment by nursing instruction or expert nursing associations (In Stanhope & In Lancaster, 2014).

One of the MSN Essential is the clinical Nurse Specialists (CNS), which pertains to the nursing advocacy policies regarding LGBTQ populace. This is a program that evaluates the cases and help in improving patient and population outcomes.

References

Chiocca, E. M. (2015). 
Advanced pediatric assessment
.  New York, NY : Springer Publishing Company, LLC.

In Stanhope, M., & In Lancaster, J. (2014). 
Public health nursing: Population-centered health care in the community
. Maryland Heights, Missouri: Elsevier Mosby.

Diabetes Mellitus Questions and Answers

A client with diabetes mellitus visits a health care clinic. The client’s diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia?

Prednisone (Deltasone)

Allopurinol (Zyloprim)

Atenolol (Tenormin)

Phenelzine (Nardil)

Rotating injection sites when administering insulin prevents which of the following complications?

Insulin resistance

Systemic allergic reactions

Insulin lipodystrophy

Insulin edema

Insulin forces which of the following electrolytes out of the plasma and into the cells?

Phosphorus

Potassium

Magnesium

Calcium

An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump:

Gives small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal.

Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals.

Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.

Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream.

A client with type 1 DM has a fingerstick glucose level of 258mg/dl at bedtime. An order for sliding scale insulin exists. The nurse should:

Call the physician

Encourage the intake of fluids

Give the client ½ c. of orange juice

Administer the insulin as ordered

When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse’s priority is to provide:

Fluid replacement

Oxygen

Carbohydrates

Dietary instruction

When a client is in diabetic ketoacidosis, the insulin that would be administered is:

Human regular insulin

Human NPH insulin

Insulin glargine injection

Insulin lispro injection

The nurse expects that a type 1 diabetic may receive ____ of his or her morning dose of insulin preoperatively:

25-40%

10-20%

50-60%

85-90%

A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis?

Elevated blood glucose level and a low plasma bicarbonate

Comatose state

Decreased urine output

Increased respirations and an increase in pH

The lowest fasting plasma glucose level suggestive of a diagnosis of DM is:

90mg/dl

126mg/dl

115mg/dl

180mg/dl

A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a bp of 140/84. Which finding would be of most concern of the nurse?

BP

Temperature

Respiration

Pulse

A nurse is preparing a plan of care for a client with DM who has hyperglycemia. The priority nursing diagnosis would be: 1. High risk for d

Imbalanced nutrition: less than body requirements

Deficient knowledge: disease process and treatment

Disabled family coping: compromised

High risk for deficient fluid volume

Knowing that gluconeogenesis helps to maintain blood levels, a nurse should:

Document weight changes because of fatty acid mobilization

Do all of the above

Protect the patient from sources of infection because of decreased cellular protein deposits

Evaluate the patient’s sensitivity to low room temperatures because of decreased adipose tissue insulation

Which of the following chronic complications is associated with diabetes?

Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmia’s

Retinopathy, neuropathy, and coronary artery disease

Leg ulcers, cerebral ischemic events, and pulmonary infarcts

Dizziness, dyspnea on exertion, and coronary artery disease

A nurse is caring for a client admitted to the ER with DKA. In the acute phase the priority nursing action is to prepare to:

Apply an electrocardiogram monitor

Correct the acidosis

Administer 5% dextrose intravenously

Administer regular insulin intravenously

Clients with type 1 diabetes may require which of the following changes to their daily routine during periods of infection?

No changes

More insulin

Less insulin

Oral antidiabetic agents

Clinical manifestations associated with a diagnosis of type 1 DM include all of the following except:

Hypoglycemia

Hyponatremia

Ketonuria

Polyphagia

Which of the following methods of insulin administration would be used in the initial treatment of hyperglycemia in a client with diabetic ketoacidosis?

IV bolus, followed by continuous infusion

Intramuscular

IV bolus only

Subcutaneous

Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)?

Give subcutaneous insulin and monitor blood glucose

Monitor blood glucose, and assess for signs of hyperglycemia

Which of the following nursing interventions should be taken for a client who complains of nausea and vomits one hour after taking his glyburide (DiaBeta)?

Monitor blood glucose closely, and look for signs of hypoglycemia

Albert refuses his bedtime snack. This should alert the nurse to assess for:

Symptoms of hyperglycemia during the peak time of NPH insulin.

Signs of hypoglycemia earlier than expected.

Elevated serum bicarbonate and a decreased blood pH.

Sugar in the urine

 

A bedtime snack is provided for Albert. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of:

16-20 hours

6-8 hours

24-28 hours

10-14 hours

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The nurse recognizes that additional teaching is necessary when the client who is learning alternative site testing (AST) for glucose monitoring says:

“I need to rub my forearm vigorously until warm before testing at this site.”

“The fingertip is preferred for glucose monitoring if hyperglycemia is suspected.”

“I have to make sure that my current glucose monitor can be used at an alternate site.”

“Alternate site testing is unsafe if I am experiencing a rapid change in glucose levels.”

A client with DM demonstrates acute anxiety when first admitted for the treatment of hyperglycemia. The most appropriate intervention to decrease the client’s anxiety would be to:

Make sure the client knows all the correct medical terms to understand what is happening

Administer a sedative

Convey empathy, trust, and respect toward the client

Ignore the signs and symptoms of anxiety so that they will soon disappear

A client is in DKA, secondary to infection. As the condition progresses, which of the following symptoms might the nurse see?

Shallow respirations and severe abdominal pain

Cheyne-stokes respirations and foul-smelling urine

Decreased respirations and increased urine output

Kussmaul’s respirations and a fruity odor on the breath

Rotation sites for insulin injection should be separated from one another by 2.5 cm (1 inch) and should be used only every:

Week

Third day

2-3 weeks

2-4 weeks

A client with DM has an above-knee amputation because of severe peripheral vascular disease, Two days following surgery, when preparing the client for dinner, it is the nurse’s primary responsibility to:

Assist the client out of bed to the chair

Check the client’s serum glucose level

Place the client in a high-fowlers position

Ensure that the client’s residual limb is elevated

A client with type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercise. Which statement by the client indicated an inadequate understanding of the peak action of NPH insulin and exercise?

“The best time for me to exercise is after breakfast.”

“The best time for me to exercise is every afternoon.”

“The best time for me to exercise is after my morning snack.”

“The best time for me to exercise is right after I eat.”

Clinical nursing assessment for a patient with microangiopathy who has manifested impaired peripheral arterial circulation includes all of the following except:

Observation for paleness of the lower extremities

Palpation for increased pulse volume in the arteries of the lower extremities

Integumentary inspection for the presence of brown spots on the lower extremities

Observation for blanching of the feet after the legs are elevated for 60 seconds

Glucose is an important molecule in a cell because this molecule is primarily used for:

Synthesis of protein

Extraction of energy

Building of genetic material

Formation of cell membranes

A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is:

Weakness

Nausea

Diaphoresing

Blurred vision

The insulin that has the most rapid onset of action would be:

Lispro

Humulin N

Lente

Ultralente

The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply.

Palpitations

Thirst

Hyperventilation

Diaphoresis

Slurred speech

Which adaptations should the nurse caring for a client with diabetic ketoacidosis expect the client to exhibit? Select all that apply:

Low PCO2

Sweating

Acetone breath

Elevated serum bicarbonate

Retinopathy

A client with DM states, “I cannot eat big meals; I prefer to snack throughout the day.” The nurse should carefully explain that the:

Large meals can contribute to a weight problem

Small, frequent meals are better for digestion

Regulated food intake is basic to control

Salt and sugar restriction is the main concern

Albert, a 35-year-old insulin dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of:

1530 and 2130

1330 and 1930

1730 and 2330

1130 and 1330

A client’s blood gases reflect diabetic acidosis. The nurse should expect:

Decreased HCO3

Decreased PO2

Increased PCO2

Increased pH

The physician orders 36 units of NPH and 12 units of regular insulin. The nurse plans to administer these drugs in 1 syringe. Identify the steps in this procedure by listing them in priority order. 1. Inject air equal to NPH dose into NPH vial 2. Invert regular insulin bottle and withdraw regular insulin dose 3. Inject air equal to regular dose into regular dose 4. Invert NPH vial and withdraw NPH dose.

1, 4, 3, 2.

1, 2, 3, 4.

1, 4, 2, 3,

1, 3, 2, 4.

The nurse knows that glucagon may be given in the treatment of hypoglycemia because it:

Provides more storage of glucose

Increases blood glucose levels

Stimulates the release of insulin

Inhibits gluconeogenesis

Which of the following causes of HHNS is most common?

Undiagnosed, untreated diabetes mellitus

Removal of the adrenal gland

Undiagnosed, untreated hyperpituitarism

Insulin overdose

A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is:

6-14 hours after administration

2-4 hours after administration

18-24 hours after administration

16-18 hours after administration

Get in touch for the answers to the above Diabetes Mellitus Questions and Answers

Health Care Management Homework

Here is the assignment:

Get out your ACA One-Pager you completed before Fall Break. Review the three (3) covered services      you chose for each of the three (3) groups: Services for Adults; Services for Women,      Including Pregnant Women and Services for Children. Next, pick out any state in the United      States and report a health status indicator associated with each of the      three (3) services you chose. Try      to use the most current secondary health data you can find.

ORDER A PLAGIARISM-FREE PAPER

For the United States I suggest using the website below:

http://www.americashealthrankings.org/

http://www.countyhealthrankings.org/

-health status associated with the Service for Adults; (10 points)

-health status associated with the Service for Women; and, (10 points)

-health status associated with the Service for Children. (10 points)

What is your state doing (what is going on in your state or a local      community/ies) to promote the utilization of each of the Preventive Health      Services you chose and are covered in the Affordable Care Act?

-health status associated with the Service for Adults; (20 points)

-health status associated with the Service for Women; and, (20 points)

-health status associated with the Service for Children. (20 points)

Provide a 3-5 minute presentation in class (10 points)

Psychopharmacology – Psychiatry Questions and Answers

1. 
Tricyclic antidepressants are contraindicated in:

A. Glaucoma

B. Brain tumour

C. Bronchial asthma

D. Essential hypertension

 

2. 
Which of the antipsychotic drugs has a prolonged action?

A. Trifluperazine

B. Thioridazine

C. Penfluridol

 

D. Fluphenazine

3. 
The congenital anomaly produced by lithium therapy is:

A. Limb shortening

B. Anencephaly

C. Heart block

D. Renal agenesis

About 10 percent of newborns exposed in 1st tri­mester of pregnancy had major congenital malforma­tions. The most common is Epstein’s anomaly of the tricuspid valves. Lithium is not indicated in a lactating woman. Signs of is toxicity in infants include lethargy, cyanosis, abnormal reflexes, rarely hepatomegaly.

4. 
All the following are side-effects of Fluoxetine, except:

A. Weight gain

B. Sweating

C. Urinary retention

D. Diarrhea

 

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5. 
Akathisia is treated by all the following, except:

A. Trihexyphenidyl

B. Diazepam

C. Haloperidol

D. Promethazine

6. 
Prophylactic maintenance of serum level of lithium is:

A. 0.2-0.8 mEq/L

B. 0.7-1.2 mEq/L

C. 1.2-2.0 mEq/L

D. 2.0-2.5 mEq/L

7. 
The treatment of choice in depression with suicidal ten­dencies is:

A. Tricyclic antidepressants

B. MAO inhibitors

C. Fluoxetine

D. Electroconvulsive therapy

The first and most important indication for ECT is depression with suicidal tendencies.

8. 
The drug not used for prophylaxis of MDP is:

A. Carbamazepine

B. Sodium valproate

C. Chlorpromazine

D. Lithium

Antipsychotics are used as adjuvant in the treatment of mood disorders.

9. All the following are true about clozapine, except:

A. Used in schizophrenia

B. Precipitates seizures

C. Agranulocytosis

D. Extra pyramidal side-effects

The only FDA approved indication for clozapine is as a therapy for treatment resistant schizophrenia. Clozapine suppresses the abnormal movements of TD (Tardive dyskinesia) as does treatment with conventional antipsychotics.

Other indication: Clozapine may treat the movement disorder. Clozapine is more potent on Dl, D3, D4, and 5HT2 receptors in comparison to other typical antipsychotic which are more potent over D2 receptors. Animal models show that clozapine is more active over meso-limbic pathway than nigro- striatal pathway because of which we notice less EPS.

10. 
Which of the following is not an antidepressant?

A. Trazodone

B. Amitriptyline

C. Fluoxetine

D. Pimozide

11. 
Carbamazepine is used in all the following except:

A. Mania

B. Alcohol withdrawal

C. Schizophrenia

D. Trigeminal neuralgia

But recent data indicates that CB2 can be used in schizophrenia and Schizo-affective disorders. Other indications are:

Recurrent depressive disorder

Impulse control disorder v

PTSD (post-traumatic stress disorder)

Alcohol /benzodiazepine withdrawal

Severe blood dyscrasias occur in about 1 in 125,000 pts treated with Carbamazepine.

12. 
A patient of schizophrenia treated for 5 years, developed abnormal movement. The patient has:

A. Tardive dyskinesia

B. Muscular dystonia

C. Akathisia

D. Malignant neuroleptic syndrome

TD delayed effects of antipsychotic caused by dopamine receptor super sensitivity in basal ganglia. Serotonin – dopamine antagonists may be used in pts with TD.

13. 
The mechanism of action of Fluoxetine is:

A. Serotonin reuptake inhibitor

B. MAO-B inhibitor

C. Nor adrenaline reuptake inhibitor

D. Benzodiazepine antagonist Other SSRI are:

Fluvoxamine Sertraline

Paroxetine

Citalopram

Escitalopram

Serotonin norepinephrine reuptake

Inhibitors:

1. Venlafaxine

2. Sibutramine

Atypical antipsychotics: (serotonin dopamine antagonists)

Risperidone

Olanzapine

Quetiapin

Sertindole

Ziprasidone

Clozapine (dibenzodiazepine)

Central presynaptic 2 – adrenergic receptor antagonist – clonidine

Mirtazapine (tetracyclic antidepressant)

14. 
An irritable urge to move about with inner restlessness is called:

A. Akathisia

B. Akinesia

C. Hyperkinesia

D. Dyskinesia

15. 
The drug of choice for rapid cycle MDP is:

A. Lithium

B. Carbamazepine

C. Sodium Valproate

D. Haloperidol

16. 
A 35-year-old female on chlorpromazine for 10 years schizophrenia complains of hearing voices. The loud­ness of the voices of taking chlorpromazine but not stop completely. The best treatment is:

A. Clozapine

B. Haloperidol

C. Tianeptine

D. Sulpiride

Clozapine, the only FDA approved drug for treatment resistant schizophrenia.

17. Tianeptine is a:

A. Selective serotonin reuptake enhancer »

B. Selective serotonin reuptake inhibitor.

C. Selective norepinephrine reuptake inhibitor

D. Norepinephrine agonist

Tianeptine – Norepinephrine serotonin selective reuptake enhancers

Venlafaxine – Norepinephrine serotonin reuptake inhibitor

MAOI-Hydroxide – a. Phenelezine b. isocarboxazide Norhydroxide – a. tranylcypromine Reversible selective

MAOls

MAOI – B – Selegiline

MAOI – A – Moclobamide

Broforamine Irreversible selective MAOI: clorgyline

Sympathomimetic stimulants:

1. Dextroamphetamine

2. Methylphenidate

Mood Stabilizers:

1. Lithium

2. Carbamazepine

3. Sodium valproate

4. Topiramate

5. Lamotrigine

6. Clonazepam

18. 
A 50-year-old man has presented with pain in back, lack of interest in recreational activities, low mood, lethargy, decreased sleep, and appetite for 2 months. There is no history suggestive of delusions or hallucinations. He did not suffer from any chronic medical illness. There was no family history of psychiatric illness. Routine investi­gations including hierogram, renal function tests, elec­trocardiogram, did not reveal any abnormality. This pa­tient should be treated with:

A. Haloperidol

B. Sertraline

C. Alprazolam

D. Olanzapine

(The only antidepressant in this group)

Clinical history suggests that the patient is depressed.

19. 
Carbamazepine was first used in:

A. Depression

B. MDP

C. Anxiety

D. All of the above

Carbamazepine is an antimonies and mood stabilizing agent. It is a tricyclic compound synthesized in 1953 by Schindler.

20. 
The treatment of choice for acute or abrupt onset de­pression includes:

A. Lithium

B. Tricyclic antidepressants

C. MAO inhibitors

D. Electroconvulsive therapy

21. 
In acute mania, the therapeutic serum level of lithium
 includes:

A. 0.2 – 0.5 mEg/L

B. 0.8-1.5 mEq/L

C. 1-2 mEq/L

D. 2-5 mEQ/L

22. 
Antipsychotic drug to be avoided especially in first tri­mester of pregnancy:

A. Chlorpromazine

B. Haloperidol

C. Carbamazepine

D. Lithium

i. Neurological – Tremor, muscle weakness, cogwheel rigidity, seizures, neurotoxicity.

ii. Renal – Polyuria, polydipsia, tubular changes nephrogenic diabetes insipid nephritic syndrome.

iii. CVS – Hypokalemia, T wave depression.

iv. Endocrine – Goiter, hypothyroidism, abnormal thyroid function, weight gain.

v. GIT – Nausea, vomiting, diarrhea, abdominal pain, metallic taste.

vi. Dermatological-Acne form eruptions, popular eruptions, exacerbation of psoriasis.

vii. During pregnancy of lactation-teratogenic, increased incidence of Ebstein’s anomaly also created in milk with 30 to 100 percent of maternal blood hi level. Cause toxicity in infant. Contraindications of lithium we are cardio renal, thyroid, neurological dys­function blood dyscrasias, during first traumata of pregnancy and lactation, concomitant administration of theorize diuretics, tetracycline, or anesthetics.

23. Lithium is used in psychiatry to treat:

A. Hysteria

B. Phobia

C. Mood disorders

D. Acute organic brain syndrome Indications of lithium in psychiatry:

Acute mania

Prophylaxis of bipolar mood disorders

Schizoaffective disorder

Impulsive aggression.

24. 
Clozapine is a:

A. Atypical antipsychotic

B. Anti-anxiety drug

C. Used in dementia

D. Also known as disulfiram

Other atypical antipsychotics – Risperidone, olanzapine, ziprasidone.

Also remember – Clozapine is the drug of choice in treatment-resistant schizophrenia.

25. 
Paroxetine is a:

A. Antipsychotic drug

B. Used in opiate poisoning

C. Tricyclic antidepressant

D. Selective serotonin reuptake inhibitor

Others SSRI’s

Paroxetine, fluvoxamine, fluoxetine, sertraline, citalopram

Also remember –

SSRI with longest half-life-fluoxetine

SSRI with shortest half-life-fluvoxamine

26. 
Imipramine is mainly used as a:

A. Sedative

B. Tranquilizer

C. Antidepressant

D. All of the above

Remember – imipramine is the first antidepressant to be introduced.

27. 
Nausea is a troublesome side effect of the following an­tidepressant:

A. Doxepine

B. Fluoxetine

C. Trazodone

D. Mianserin

Other side effects: Insomnia, akathisia, loss of appetite, sexual dysfunction.

28. 
Which antidepressant found to be associated with tar­dive dyskinesia and narcoleptic malignant syndrome?

A. Amoxapine

B. Trazodone

C. Fluoxetine

D. Amineptin

This is because of blockade of dopamine receptors in the striatum.

29. 
Blood levels of neuroleptics are useful to check the fol­lowing:

A. Toxicability

B. Therapeutic levels

C. Resistance

D. All of the above

Clozapine and haloperidol levels are important to monitor toxicities.

30. 
The drug of first choice in weight reduction programme
 is:

A. Amphetamine

B. Phenylethlamine

C. Fenfluramine

D. Diethyl propion

31. 
Therapeutic range of lithium is:

A. 0.5 to 1 mmol/1

B. 0.8 to 1.4 mmol/1

C. 1.4 to 2.5 mmol/1

D. 1.0-2.6 mmol/1

Remember toxicity – if level > 2.0 mEq/1

Life threatening intoxication – > 3.5 mEq/1

32. 
Akathisiais:

A. Neurotic disease

B. Seen in schizophrenia

C. Side effect of lithium

D. Side effect of antipsychotic drugs.

Akathisia manifests as motor restlessness. It is due to blockade of dopamine type-2 receptors in striatum.

33. 
Neuroleptic malignant syndrome is characterized:

A. Bradycardia

B. Labile hypertension

C. Hypotonia

D. Hypothermia

Feature of NMS – fever, elevated, EPS, catatonic symptoms, autonomic dysfunction

34. 
Akathisia is treated by:

A. Haloperidol

B. Fluoxetine

C. Propranolol

D. Lithium

Drug of choice – Propranolol. Benzodiazepines are useful.

35. 
Feature of akathisia is:

A. Cogwheel rigidity

B. Oculogyric crisis

C. Restlessness

D. Periodic movements

Motor restlessness is the key feature of akathesia Cogwheel rigidity occurs in parkinsonism Oculogyric crises is an acute dystonia Perioral movements could be rabbit syndrome or Tardier dyskinesia.

36. 
Malignant neuroleptic syndrome is treated by:

A. Dantrolene

B. Diazepam

C. Haloperidol

D. Chlorpromazine Bromocriptine can also be used.

37. 
Side effect of clozapine is:

A. Within one week – neutropenia

B. Dl- ve, D2 +ve

C. Agranulocytosis

D. Excitement

Clozapine must be stopped immediately.

38. 
The drug of choice for obsessive-compulsive disorder is:

A. Haloperidol

B. Clomipramine

C. Amitryptilline

D. Diazepam

Dose of Clomipramine – 75 to 300 mg 1 day.

39. 
Lithium is used in all except:

A. Endogenous depression

B. Recurrent attacks of mania

C. Schizoaffective psychosis

D. Paranoid psychosis

40. 
Side effect of chlorpromazine for which anti cholinergic is used:

A. Blurred vision

B. Oculogyric crises

C. Hypotension

D. Dry mouth

41. 
Newer nonsedative, nonhypnotic anxiolytic is:

A. Alprazolam

B. Buspirone

C. Lorazepam

D. Diazepam

Buspirone acts as a partial against at 5HTIA receptor. It doesn’t have anticonvulsant and muscle relaxant properties.

42. 
The drug of choice for panic disorders is:

A. Imipramine

B. Nitrazepam

C. Clonidine

D. Diazepam

Small doses of antidepressants are used (imipramine and fluoxetine).

136 Psychiatry Question Bank for PG Entrance Exams

43. 
In drug induced parkinsonism, benzhexol has got no role
 in:

A. Sialorrhea

B. Tremor

C. Akathisia

D. Rigidity

Akathisia is treated with P blockers and benzodiazepines (propranolol).

44. 
In fluoxetine and imipramine, the main difference is in:
 –

A. Less side effects

B. Onset of action

C. Effect of OCD

D. Duration of action

 

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45. 
Which of the following drug has the minimum extra py­ramidal side effect?

A. Clozapine

B. Metoclopramide

C. Reserpine

D. Trifluperazine

46. 
Which of the following drugs produce rapid induction of sleep with least influence of sleep architecture?

A. Zaleplon

B. Diazepam

C. Chlorpromazine

D. Haloperidol

Dosage of zaleplon 5 to 10 mg

As it has a half-life of one hour it is useful in initial insomnia

47. 
All of the following are antidepressants, except:

A. Imipramine

B. Amitryptilline

C. Risperidone

D. Citalopram

Imipramine and amitryptilline are tricyclic anti­depressants; citalopram is a SSRI risperidone is an atypical antipsychotic.

48. 
Which of the following side effects of chlorpromazine are ameliorated by anticholinergic antiparkinson medi­cation?

A. Confusion

B. Hypotension

C. Blurred vision

D. Oculogyric crisis

49. 
Lithium is used to treat:

A. Hysteria

B. Phobia

C. Mood disorders

D. Acute organic brain syndrome

50. 
Lithium is used in:

A. Acute mania

B. Depression

C. Hyperkinetic disorder

D. All of the above.

51. 
The least affected organ in lithium toxicity is:

A. Liver

B. Heart

C. Kidney

D. Brain

There is no hepatic metabolism for lithium in body.

52. 
Treatment of Panic attack includes the use of:

A. Diazepam

B. Imipramine

C. Fluoxetine

D. Clonazepam

E. Bothb + c

Both imipramine and fluoxetine in small doses are useful in treating panic disorder

53. 
All the following are anxiolytic except:

A. Fluoxetine

B. Buspirone

C. Diazepam

D. Nitrazepam

Fluoxetine is an antidepressant. It acts by selecting serotonin reuptake inhibition

54. 
Lithium is treatment of choice for:

A. Unipolar MDP prophylaxis

B. Bipolar MDP

C. Schizophrenia

D. Acute mania

Lithium is indicated in prophylaxis of bipolar MAP and acute mania.

55. 
The most useful drug in enuresis is:

A. Haloperidol

B. Diazepam

C. Imipramine

D. Chlorpromazine

Imipramine is the drug of choice in nonorganic enuresis usual dose range is 25 to 75 mg 1 day.

56. 
The least extra pyramidal effect is seen with:

A. Haloperidol

B. Thioridazine

C. Clozapine

D. Chlorpromazine

Drugs with minimal EPS are clozapine, quetipin sulpiride and ziprasidone.

Drugs useful in Heroin withdrawal are clonidine, methadone, buprenorphin, LAAM, and dextropropoxyphene.

57. 
Long-term therapy of lithium causes:

A. Neutropenia

B. Hypothyroidism

C. Hepatotoxicity

D. Bone narrow depression

Long-term lithium use causes renal side-effects also.

58. 
All of the following are selective serotonin (5HT) reuptake inhibitors, except:

A. Fluvoxamine

B. Fluoxetine

C. Paroxetine

D. Olanzapine

SSRI’s are fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram.

59. 
A psychiatric patient on tricyclic antidepressants presents with bradycardia, hypotension, decreased sweating, and retention of urine. The most likely drug used is:

A. Amitryptilline

B. Fluoxetine

C. Selegiline

D. Lithium

Decreased sweating, retention of urine, bradycardia are anticholinergic side effects of amitryptilline, hypotension is due to Ll-adrenergic blockade.

60. 
A 63-year-old man who is taking amitryptilline suddenly develops confusion, urinary retention and blurring of vi­sion. The cause is:

A. Anticholinergic side-effects

B. Reactive depression

C. Emergence of negative symptoms

D. CVA

61. 
A patient was found stuporous and he did not eat or sleep the whole day. On examination, he was found to be con­scious. The treatment should be: (AIIMS-2000)

A. ECT

B. Antipsychotics

C. Antidepressants

D. Neuroleptic

62. 
30-year-old Bano Begum was brought to the casualty is a state of altered sensorium. She was on lithium treat­ment for the affective disorder and suffered an attack of epileptic fits. On examination she has tremors, increased deep tension reflexives, and insentience of urine. She also had undergone an episode of severe gash enteritis 2 days ago. Lithium level in the serum is 1.95 mEq/l. The most likely cause is:

A. lithium toxicity

B. severe dehydration

C. Manic stupor

D. Epileptic fits

63. 
The most common cardiac abnormality associated with use of lithium in 1st trimester of pregnancy:

A. Deacon’s syndrome

B. Epstein’s anomaly of tricuspid valve

C. PDA

D. Coarctation of aorta

In Epstein’s anomaly there is a distortion and down ward displacement of tricuspid valve. Use of lithium is contraindicated in the 1st trimester of pregnancy.

64. 
Vasanti, 45-year-old, was brought to casualty with ab­normal movements which included persistent deviation of the meek to the right side. One day earlier, she had been prescribed haloperidol 5mg three times daily by the psychiatrist. She also had an altercation with her bush and recently. Which of the following is the most likely cause for her symptoms?

A. Acute drug dystonia

B. Conversion reaction

C. Acute psychosis

D. Cerebrovascular accident.

Acute dystonia is an acute extra pyramidal symptom caused by antipsychotic medication. In this case, the neck muscles are affected by dystonia.

65. Contraindications to lithium administration include:

A. An administration in combination with chlorpromazine

B. The presence of renal disease

C. Any occurrence of the symptoms of schizophrenia

D. The presence of depression

E. An administration in combination with imipramine.

 

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Kidney Stone Pathophysiology Essay – Porth’s Pathophysiology: Concepts of Altered Health States

Fred, a fit and healthy 44-year-old, was working outside one warm summer afternoon. When he returned home by the end of the day, his lower back felt sore and he felt nauseated. His wife made him dinner, but he was not hungry and chose to go to bed instead. Fred’s symptoms progressed, and soon he was rolling on the bed with excruciating pain. He said his back hurt as well as his stomach and groin area. The pain would ease off only to return a short while later, and when it did, Fred would begin to sweat and run to the bathroom to vomit. His wife became concerned and she helped him into the car and rushed him to the hospital.

Please answer the following questions and submit your assignment via Blackboard by the due date.

1. At the hospital, an abdominal radiograph showed the presence of renal calculi in Fred’s right ureter (urolithiasis).  What is the pathophysiological mechanism of stone formation in the kidney?

2. In the hospital, Fred’s urine is being strained for the presence of stones that he may have passed. What is the importance of this action?

3. What are the 4 primary types of renal calculi and what are the risk factors for each of these types of renal calculi?

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4. Hydronephrosis can be a complication of renal calculi. Why is hydronephrosis such a serious complication?

5. View the following youtube video entitled “How do kidney stones form?”   

Identify two key points that you learned about renal calculi in the video?

This is the grading  criteria : 

Grading:
Subject Knowledge and Accuracy (6 points)

Normal physiological principles, processes, and mechanisms are explained at the molecular, cellular, and organ levels.

Physiological processes and mechanisms relating to the pathology are clearly explained.

Answers focus on substantive ideas that are supported by relevant facts and examples.

Explanations are clear and incorporate appropriate vocabulary.

Thoughtful and convincing responses clearly demonstrate depth of subject knowledge.

Information is derived from good quality, credible sources.

All questions are answered completely.

All content is current and accurate.

Bibliography / Citations / Writing (3 points)

Two (2) or more sources used for the assignment (your textbook can be one of the sources).

All material that is not considered “common knowledge” is cited.

All quotations and/or paraphrasing are cited according to APA format.

The full reference for each citation is found in the bibliography.

References are listed alphabetically at end of assignment in the bibliography.

Bibliography and citations follow APA format.

Writing is free of grammatical errors.

Sentences are complete, clear, and concise.

Spelling is correct.

This book should be used as reference also:

Porth’s Pathophysiology: Concepts of Altered Health States (9th edition) 
ISBN-13:
 978-1451146004
ISBN-10:
 1451146000

Answers

1.A 2.D 3.C 4.A 5.C 6.B 7.D 8.C 9.D 10.D 11.C 12.A 13.A 14.A 15.A 16.A 17.A 18.B 19.B 20.A 21.B 22.D 23.C 24.A 25.D 26.C 27.B 28.A 29.A 30.D 31.B 32.D 33.B 34.C 35.C 36.A 37.C 38.B 39.D 40.B 41.B 42.A 43.C 44.A 45.A 46.A 47.C 48.D 49.C 50.A 51.A 52.E 53.A 54.D 55.C 56.C 57.B 58.D 59.A 60.A 61.C 62.A 63.B 64.A 65.B

Bio-terrorism Threats Essay

Select a potential bioterrorism threat from the following:

Anthrax

Food supply contamination

Water system contamination

Air borne contamination

Using the South University Online Library or the Internet, research on  your selected potential bioterrorism threat. Based on your research,  create a 3- to 4-page Microsoft Word report that covers the following  aspects in detail:

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The main surveillance methods used in public health that could also be used to detect a bioterrorism threat.

The basic functions of all levels of government―federal, state, and local―when responding to a possible bioterrorism threat.

The existing surveillance systems and their adequacy to meet emergency preparedness needs.

Submission Details:

Support your responses with examples.

Cite any sources in APA format.