Kaplan and Sadock's Synopsis of Psychiatry 11th edition
TESTBANK
Kaplan and Sadock's Synopsis of Psychiatry 11th edition
TESTBANK
Chapter 1: Neural
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Test Bank
MULTIPLE CHOICE
1. A patient with depression mentions to the nurse, My mother says depression is a chemical
disorder. What does she mean? The nurses response is based on the theory that depression
primarily involves which of the following neurotransmitters?
a. Cortisol and GABA
b. COMT and glutamate
c. Monamine and glycine
d. Serotonin and norepinephrine
ANS: D
One possible cause of depression is thought to involve one or more neurotransmitters. Serotonin
and norepinephrine have been found to be important in the regulation of depression. There is no
research to support that the other options play a significant role in the development of
depression.
2. A patient has experienced a stroke (cerebral vascular accident) that has resulted in damage to
the Broca area. Which evaluation does the nurse conduct to reinforce this diagnosis?
a. Observing the patient pick up a spoon
b. Asking the patient to recite the alphabet
c. Monitoring the patients blood pressure
d. Comparing the patients grip strength in both hands
ANS: BAccidents or strokes that damage Brocas area may result in the inability to speak (i.e., motor
aphasia). Fine motor skills, blood pressure control, and muscle strength are not controlled by the
Broca area of the left frontal lobe.
3. The patient diagnosed with schizophrenia asks why psychotropic medications are always
prescribed by the doctor. The nurses answer will be based on information that the therapeutic
action of psychotropic drugs is the result of their effect on:
a. The temporal lobe; especially Wernickes area
b. Dendrites and their ability to transmit electrical impulses
c. The regulation of neurotransmitters especially dopamine
d. The peripheral nervous system sensitivity to the psychotropic medications
ANS: C
Medications used to treat psychiatric disorders operate in and around the synaptic cleft and have
action at the neurotransmitter level, especially in the case of schizophrenia, on dopamine. The
Wernickes area, dendrite function, or the sensitivity of the peripheral nervous system are not
relevant to either schizophrenia or psychotropic medications.
4. A student nurse mutters that it seems entirely unnecessary to have to struggle with
understanding the anatomy and physiology of the neurologic system. The mentor would base a
response on the understanding that it is:
a. Necessary but generally for psychiatric nurses who focus primarily on
behavioral interventions
b. A complex undertaking that advance practice psychiatric nurses frequently use
in their practice
c. Important primarily for the nursing assessment of patients with brain
traumacaused cognitive symptoms
d. Necessary for planning psychiatric care for all patients especially those
experiencing psychiatric disorders
ANS: DNurses must understand that many symptoms of psychiatric disorders have a neurologic basis,
although the symptoms are manifested behaviorally. This understanding facilitates effective care
planning. The foundation of knowledge is not used exclusively by advanced practice psychiatric
nurses nor is it relevant for only behavior therapies or brain trauma since dealing with the results
of normal and abnormal brain function is a responsibility of all nurses providing all types of care
to the psychiatric patient.
5. A patient asks the nurse, My wife has breast cancer. Could it be caused by her chronic
depression? Which response is supported by research data?
a. Too much stress has been proven to cause all kinds of cancer.
b. There have been no research studies done on stress and disease yet.
c. Stress does cause the release of factors that suppress the immune system.
d. There appears to be little connection between stress and diseases of the body
ANS: C
Research indicates that stress causes a release of corticotropin-releasing factors that suppress the
immune system. Studies indicate that psychiatric disorders such as mood disorders are
sometimes associated with decreased functioning of the immune system. Research does not
support a connection between many cancers and stress. There is a significant amount of research
about stress and the body. Research has shown that there are some connections between stress
and physical disease.
6. A patient who has a parietal lobe injury is being evaluated for psychiatric rehabilitation needs.
Of the aspects of functioning listed, which will the nurse identify as a focus of nursing
intervention?
a. Expression of emotion
b. Detecting auditory stimuli
c. Receiving visual images
d. Processing associationsANS: D
The parietal lobe is responsible for associating and processing sensory information that allows
for functions such as following directions on a map, reading a clock, dressing self, keeping
appointments, and distinguishing right from left. Emotional expression is associated with frontal
lobe function. Detecting auditory stimuli is a temporal lobe function. Receiving visual images is
related to occipital lobe function.
MSC: NCLEX: Psychosocial Integrity
7. At admission, the nurse learns that some time ago the patient had an infarct in the right
cerebral cortex. During assessment, the nurse would expect to find that the patient:
a. Demonstrates major deficiencies in speech
b. Is unable to effectively hold a spoon in the left hand
c. Has difficulty explaining how to go about using the telephone
d. Cannot use his right hand to shave himself or comb his own hair
ANS: B
The cerebral hemispheres are responsible for functions such as control of muscles. The right
hemisphere mainly controls the motor and sensory functions on the left side of the body. Damage
to the right side would result in impaired function on the left side of the body. The motor cortex
controls voluntary motor activity. Brocas area controls motor speech. Cognitive functions are
attributed to the association cortex. The right side of the bodys motor activity is controlled by the
left cerebral cortex.
8. A patient with chronic schizophrenia had a stroke involving the hippocampus. The patient will
be discharged on low doses of haloperidol. The nurse will need to individualize the patients
medication teaching by:
a. Including the patients caregiver in the education
b. Being careful to stress the importance of taking the medication as prescribedc. Providing the education at a time when the patient is emotionally calm and
relaxed
d. Encouraging the patient to crush or dissolve the medication to help with
swallowing
ANS: A
The hippocampus plays a major role in short-term memory and, hence, in learning. Taking the
medication as prescribed and providing the education at a time when the patient is calm and
relaxed is information or considerations that all patients should be given. The medication does
not necessarily need to be crushed or dissolved since the stroke would not have caused difficulty
with swallowing.
9. The physician tells the nurse, The medication Im prescribing for the patient enhances the gaminobutyric acid (GABA) system. Which patient behavior will provide evidence that the
medication therapy is successful?
a. The patient is actively involved in playing cards with other patients.
b. The patient reports that, I dont feel as anxious as I did a couple of days ago.
c. The patient reports that both auditory and visual hallucinations have decreased.
d. The patient says that, I am much happier than before I came to the hospital.
ANS: B
GABA is the principle inhibitory neurotransmitter. The medication should provide an antianxiety
effect. Alertness, psychotic behaviors, and mood elevation are not generally affected by gaminobutyric acid.
10. The patients family asks whether a diagnosis of Parkinsons disease creates an increased risk
for any mental health issues. What question would the nurse ask to assess for such a comorbid
condition?
a. Has your father exhibited any signs of depression?
b. Does your father seem to experience mood swings?c. Have you noticed your father talking about seeing things you cant see?
d. Is your dad preoccupied with behaviors that he needs to repeat over and over?
ANS: A
Serotonin and its close chemical relatives, dopamine and norepinephrine, are the
neurotransmitters that are most widely involved in various forms of depression. Most researchers
agree that the immediate cause of parkinsonism is a deficiency of dopamine and so a patient with
Parkinsons disease should be monitored for depression, The other mental health disorders
(bipolar disorder, hallucinations, and obsessive compulsive disorder) have not been connected to
Parkinsons disease.
11. Which explanation for the prescription of donepezil (Aricept) would the nurse provide for a
patient in the early stage of Alzheimers disease?
a. It will increase the metabolism of excess GABA.
b. Excess dopamine will be prevented from attaching to receptor sites.
c. Serotonin deficiency will be managed through a prolonged reuptake period.
d. The acetylcholine deficiency will be managed by inhibiting cholinesterase.
ANS: D
Decreased levels of acetylcholine are thought to produce many of the behavioral symptoms of
Alzheimers disease. The inhibiting action the drug has on cholinesterase will slow down the
breakdown of acetylcholine and so delay the onset of symptoms. The other neurotransmitters
(GABA, dopamine, and serotonin) are not currently believed to play a role in Alzheimers
disease.
MULTIPLE RESPONSE
1. A patient is being evaluated for a possible diagnosis of panic disorder with agoraphobia.
Which nursing assessment findings support this diagnosis? Select all that apply.
a. Patient states, Ive had these fears for more than 6 years.
b. Patient describes having a panic attack several times a month.
c. Patient is embarrassed by the limitations the disorder causes.
d. Stated, I never even think about going shopping in a crowded mall.
e. Condition began after beginning treatment for a chronic intestinal problem.
ANS: A, B, C, DTo meet the first DSM-IV-TR criterion for panic disorder with agoraphobia, the person must
experience recurrent, unexpected panic attacks, with at least one attack followed by one of the
following for a month: (1) persistent concern about having additional attacks; (2) worry about the
implications of the panic attacks; or (3) a significant change in behavior as a result of the attacks.
The second criterion is that the individual experiences agoraphobia. Agoraphobic fears typically
involve being in a crowd. The third criterion is that the person avoids agoraphobic situations or
has anxiety about having a panic attack. This person will not go to an area or event where he or
she has experienced an agoraphobic reaction. The fourth criterion states that panic attacks are not
caused by the direct effects of a substance, a medication, or a medical condition.
2. The nurse has identified a nursing diagnosis of disturbed thought processes for a patient with
obsessive-compulsive disorder. What abilities displayed by the patient would be related to an
appropriate outcome for this problem? Select all that apply.
a. Can identify when obsessions are worsening
b. Speaks of obsessions as being embarrassing behaviors
c. Describes lessening anxiety when compulsive rituals are interrupted
d. Plans to ignore obsessive thoughts and so minimizes resulting stress
e. Limits time focusing on obsessive thoughts to 15 minutes, 4 times a day
ANS: A, C, E
It is desirable for the patient to experience a sense of being able to identify and control the
obsessive thinking and the resulting anxiety. Identifying the behaviors as embarrassing is not
showing control nor is ignoring the behaviors.
3. Which lifestyle changes should the nurse incorporate in the nursing care plan for a patient with
generalized anxiety disorder? Select all that apply.
a. Stop smoking.
b. Limit caffeine intake.
c. Eliminate stress from your life.d. Practice a relaxation technique daily.
e. Limit worrying to specific times each day.
ANS: A, B, D, E
CNS stimulants, including caffeine and nicotine, increase anxiety symptoms such as heart rate
and muscle tension. Relaxation techniques are invaluable in the management of stress and
anxiety. Limiting the time to allow worrying will help control the invasive thoughts. One cannot
avoid stressful situations and attempting to do so does not help in managing its affects.
4. A nursing interview for a patient being admitted for depression reveals that the patient has
been taking a benzodiazepine for anxiety for 3 years. Which actions by the nurse reflect an
understanding of the effects of this classification of drugs? Select all that apply.
a. The nurse asks how much of the drug the patient takes daily.
b. The admitting physician is notified of the patients medication history.
c. The nurse prepares to discuss the process of detoxification with the patient.
d. The nurse suggests to the patient that the dosage is likely to be increased.
e. The patient is interviewed regarding how well the anxiety has been controlled.
ANS: A, B, C
Benzodiazepines are relatively safe and effective for short-term use to control the debilitating
symptoms of anxiety. However, longer-term treatment with these drugs raises issues of
tolerance, abuse, and dependence. The medication dosage would not be increased. The
effectiveness of the medication is irrelevant but rather the length of the therapy is the prime
concern.
5. A patient comes to the ED exhibiting severe physical and emotional symptomology. When no
physical cause can be found for the symptoms, the patient is diagnosed with severe anxiety with
panic attack symptoms. Which assessment data supports this diagnosis? Select all that apply.
a. Blood pressure 158/90; 15 minutes later 130/80b. Claims that she feels like she going to die
c. Random but controlled thoughts
d. Unable to follow instructions
e. Dry, flushed skin
ANS: A, B, D
Blood pressure will begin to drop in a panic attack as the sympathetic nervous system release
occurs; the patient may express an emotional sensation of doom and the patient will not be able
to concentrate and so will be unable to follow instructions. Thoughts during a panic attack are
uncontrolled and the skin is diaphoretic.
6. Which considerations should a nurse include when conducting a mental health assessment on
a culturally diverse patient Select all that apply.
a. Men and women are equally likely to seek psychiatric health care.
b. The role that spirits and magic play in a patients belief system is cultural based.
c. Rituals are only deemed obsessive when applied to the patients cultural
standards.
d. Agoraphobia is more difficult to assess in cultures that restrict female
socialization.
e. The nurse should consider the universal application of the Diagnostic and
Statistical Manual (DSM-IVTR).
ANS: B, C, D
Some cultures restrict womens participation in public activities; thus agoraphobia is less
commonly diagnosed. Fears of magic and spirits are present in many cultures and are pathologic
only when they are deemed excessive in the context of that culture. Many cultures have rituals to
mark important events in peoples lives. The observation of these rituals is not indicative of OCD
unless it exceeds norms for that culture, is exhibited at times or places that are inappropriate for
that culture, or interferes with social functioning. Most research that supports the development of
the Diagnostic and Statistical Manual, ed 4, text revision (DSM-IVTR) classification occurred inthe United States; consequently, symptoms that define disorders are representative of U.S.
culture. Overall, women are more likely than men to present for treatment or to come in contact
with health care providers.
Chapter 11: Trauma- and Stressor-Related Disorders
ULTIPLE CHOICE
1. Although stress may result from either a positive or a negative event, the physical effects are
similar. Which statement best describes the long term effects of stress?
a. Eustress is likely to result in short term stress.
b. Chronic distress can take a toll on the individual.
c. Stress usually manifests in physical symptoms first.
d. Distress generally results in more effective coping skills.
ANS: B
MULTIPLE CHOICE
1. Which physical disturbance is commonly assessed in patients experiencing acute grief?
a. Hypersomnia
b. Increased appetite
c. Tightness in the chest
d. Cardiovascular problems
ANS: C
Chest discomfort is common with the bereaved person. Anorexia is more common. There is no
research to support the connection with cardiovascular involvement. Insomnia is more frequent
than sleepiness.
2. When differentiating between bereavement symptoms and depression, the nurse will base the
formulation on knowledge that in bereavement:
a. Suicide thoughts are common.
b. Symptoms remit and exacerbate.
c. Guilt feelings are overwhelming.
d. Psychomotor retardation is obvious.
ANS: B
Acute exacerbations are common especially around holidays and significant milestones. The
remaining options are more common with depression.3. A grief support group is held at the local community center to assist persons who are dealing
with issues of loss. Which remark by one of the members would the nurse interpret as indicating
unresolved feelings of guilt?
a. I know that my husband had a good life.
b. It seems I miss my son more as time goes on.
c. I am still wishing I had gotten help to him sooner.
d. The Christmas season is always a sad time for me.
ANS: C
Unresolved guilt reflects that the person should have done more. Expressing peace with a
situation indicates closure on the husbands life. Missing indicates continued grieving but not
guilt. Reflection on difficult times is not guilt.
4. A young woman had just learned of the accidental death of her husband. She begins to cry and
states, Its not fair! How could he do this to me? This remark is assessed as:
a. A plea for help
b. An explosive episode
c. An expression of anger
d. Fear of making decisions alone
ANS: C
The remark indicates anger that her husband died on purpose. She is not asking for help nor is
there data to support an explosive response. She is not stating fear.
5. Family and friends rush to offer support to a friend who has lost her teenage son. Which of
these persons, through an intended act of kindness, may contribute to prolonging the womans
grief?
a. The physician who prescribed antianxiety agentsb. The nurse who offered to spend the night at her home
c. The next-door teenager who provided care for the sons pet
d. The accountant who assisted with stabilizing their financial affairs
ANS: A
Frequent use of anxiolytic medications can mask grief. The other options are usual offers of
assistance.
6. When a hospitalized patient dies, his wife stares blankly at the nurse and states, It cant be. The
nurse assesses this as indicating:
a. Despair and protest
b. Shock and disbelief
c. Anger and hostility
d. Disorganization and confusion
ANS: B
Shock and disbelief are often the first responses to a death, followed by protest and despair. The
wifes statement does not indicate confusion or anger.
7. When asked, the nurse explains that grief work refers to:
a. Establishing new methods of coping with stress
b. Evaluating progress made toward accepting the loss
c. The means by which one moves through the grief process
d. Actively seeking assistance to cope with the loss experiences
ANS: C
Grief work is moving through the stages of grief. The remaining options can be components of
grief work.8. A teen is grieving the loss of her pet dog. She states to her mother, I miss my dog so much, but
I know that if I start crying, I will never stop. The teen is expressing a fear of:
a. Losing control over her emotions
b. Appearing emotionally immature
c. Embarrassing herself by crying in public
d. Losing the support of her friends and family
ANS: A
The teens statement that she will never stop indicates a control concern. The statement does not
indicate embarrassment, immaturity concerns, or lack of support.
9. During a grief-processing group, an elderly patient stated, For the first time since my husband
died, Im having more good days than bad. This statement suggests that the patient has:
a. Replaced old memories with new ones
b. Reached the phase of reestablishment
c. Completed her grief work successfully
d. Determined she is ready to terminate the support group
ANS: B
Reestablishment is the gradual decrease in symptoms. There are not enough data to support the
remaining options.
10. A patient returned from attending the service memorializing his wife, who died after a
sudden illness. Although those around him were visibly saddened, he smiled and remained in
control. He refused support from friends, stating, I can handle anything that comes my way. The
patients behavior is an example of _____ grief.
a. Normal
b. Inhibitedc. Distorted
d. Conflicted [Show Less]