1. A client has experienced the death of a close family member and at the same time becomes unemployed. This situation has resulted in a 6-month score of
... [Show More] 110 on the Recent Life Changes Questionnaire. How should the nurse evaluate this client data?
A. The client is experiencing severe distress and is at risk for physical and psychological illness.
B. A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no significant threat of stress-related illness.
C. Susceptibility to stress-related physical or psychological illness cannot be estimated without knowledge of coping resources and available supports.
D. The client may view these losses as challenges and perceive them as opportunities.
ANS: C
The Recent Life Changes Questionnaire is an expanded version of the Schedule of Recent Experiences and the Rahe-Holmes Social Readjustment Rating Scale. A 6-month score of 300 or more, or a year-score total of 500 or more, indicates high stress in a clients life. However, positive coping mechanisms and strong social support can limit susceptibility to stress-related illnesses.
2. A physically and emotionally healthy client has just been fired. During a routine office visit he states to a nurse: Perhaps this was the best thing to happen. Maybe Ill look into pursuing an art degree. How should the nurse characterize the clients appraisal of the job loss stressor?
A. Irrelevant
B. Harm/loss
C. Threatening
D. Challenging
ANS: D
The client perceives the situation of job loss as a challenge and an opportunity for growth.
1. A patient has symptoms of acute anxiety related to the death of a parent in an automobile accident 2 hours ago. The patient will need teaching about a drug from which group?
A. Tricyclic antidepressants
B. Antimanic drugs
C. Benzodiazepines
D. Antipsychotic drugs
ANS: C
Benzodiazepines provide anxiety relief. Tricyclic antidepressants are used to treat symptoms of depression. Antimanic drugs are used to treat bipolar disorder. Antipsychotic drugs are used to treat psychosis.
2. A patient is hospitalized for severe depression. Of the medications listed below, a nurse can expect to provide the patient with teaching about:
A. clozapine (Clozaril)
B. chlordiazepoxide (Librium)
C. tacrine (Cognex)
D. fluoxetine (Prozac)
ANS: D
Fluoxetine is an SSRI. It is an antidepressant that blocks the reuptake of serotonin with few anticholinergic and sedating side effects. Clozapine is an antipsychotic. Chlordiazepoxide is an anxiolytic. Tacrine is used to treat Alzheimer’s disease.
3. A patient hospitalized with a mood disorder has an elevated unstable mood, aggressiveness, agitation, talkativeness, and irritability. A nurse begins care planning based on the expectation that the health care provider is most likely to prescribe a medication classified as a(n):
A. anticholinergic.
B. mood stabilizer
C. psychostimulant
D. antidepressant
ANS: B
The symptoms describe a manic attack. Mania is effectively treated by the antimanic drug lithium and selected anticonvulsants such as carbamazepine, valproic acid, and lamotrigine. No drugs from the other classifications listed are effective in the treatment of mania.
4. A drug causes muscarinic receptor blockade. A nurse will assess the patient for:
A. gynecomastia
B. pseudoparkinsonism
C. orthostatic hypotension
D. dry mouth
ANS: D
Muscarinic receptor blockade includes atropine-like side effects such as dry mouth, blurred vision, and constipation. Gynecomastia is associated with decreased prolactin levels. Movement defects are associated with dopamine blockade. Orthostatic hypotension is associated with alpha-1 antagonism.
5. A patient tells a nurse, "My doctor prescribed Paxil [paroxetine] for my depression. I suppose I’ll have side effects like I had when I was taking Tofranil [imipramine]." The nurse’s reply should be based on the knowledge that paroxetine is a(n):
A. tricyclic antidepressant
B. MAOI
C. selective serotonin reuptake inhibitor
D. selective norepinephrine reuptake inhibitor
ANS: C
Paroxetine is a selective serotonin reuptake inhibitor and will not produce the same side effects as imipramine, a tricyclic antidepressant. The patient will probably not experience dry mouth, constipation, or orthostatic hypotension.
6. A nurse can anticipate anticholinergic side effects are likely when a patient is taking:
A. lithium (Lithobid).
B. isperidone (Risperdal).
C. buspirone (BuSpar).
D. fluphenazine (Prolixin).
ANS: D
Fluphenazine, a first-generation antipsychotic, exerts muscarinic blockade, resulting in dry mouth, blurred vision, constipation, and urinary retention. Lithium therapy is more often associated with fluid balance problems, including polydipsia, polyuria, and edema. Risperidone therapy is more often associated with movement disorders, orthostatic hypotension, and sedation. Buspirone is associated with anxiety reduction without major side effects.
7. A nurse instructs a patient taking a drug that inhibits monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of:
A. hypotensive shock.
B. hypertensive crisis.
C. cardiac dysrhythmia.
D. cardiogenic shock
ANS: B
Patients taking MAO-inhibiting drugs must be on a tyramine-free diet to prevent hypertensive crisis. In the presence of MAOIs, tyramine is not destroyed by the liver and in high levels produces intense vasoconstriction, resulting in elevated blood pressure.
8. A patient has taken many conventional antipsychotic drugs over years. The health care provider, concerned about early signs of tardive dyskinesia, prescribes risperidone (Risperdal). A nurse planning care for this patient understands that atypical antipsychotics:
A. are less costly.
B. have higher potency.
C. are more readily available.
D. produce fewer motor side effects.
ANS: D
Atypical antipsychotic drugs often exert their action on the limbic system rather than the basal ganglia. The limbic system is not involved in motor disturbances. Atypical antipsychotics are not more readily available. They are not considered to be of higher potency; rather, they have different modes of action. Atypical antipsychotic drugs tend to be more expensive.
9. A nurse administering psychotropic medications should be prepared to intervene when giving a drug that blocks the attachment of norepinephrine to alpha-1 receptors because the patient may experience:
A. increased psychotic symptoms.
B. a hypertensive crisis.
C. orthostatic hypotension.
D. severe appetite disturbance.
ANS: C
Sympathetic mediated vasoconstriction is essential for maintaining normal blood pressure in the upright position. Blockage of alpha-1 receptors leads to vasodilation and orthostatic hypotension. Orthostatic hypotension may cause fainting and falls. Patients should be taught ways of minimizing this phenomenon.
10. A nurse cares for four patients who are receiving clozapine, lithium, fluoxetine, and venlafaxine, respectively. For which patient should the nurse be most alert for alterations in cardiac or cerebral electrical conductivity as well as fluid and electrolyte imbalance? The patient receiving:
A. lithium (Lithobid)
B. clozapine (Clozaril)
C. fluoxetine (Prozac)
D. venlafaxine (Effexor)
ANS: A
Lithium is known to alter electrical conductivity, producing cardiac dysrhythmias, tremor, convulsions, polyuria, edema, and other symptoms of fluid and electrolyte imbalance. Patients receiving clozapine should be monitored for agranulocytosis. Patients receiving fluoxetine should be monitored for acetylcholine block. Patients receiving venlafaxine should be monitored for heightened feelings of anxiety.
Chapter 04. Concepts of Psychobiology
Multiple Choice
1. A depressed client states, I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again. Which nursing response is appropriate?
A. Medications are one way to address chemical imbalances. Environmental and interpersonal factors can also have an impact on biological factors.
B. Because biological factors are the sole cause of depression, medications will improve your mood.
C. Environmental factors have been shown to exert the most influence in the development of depression.
D. Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment).
ANS: A
The nurse should advise the client that medications are one treatment approach to address biological factors, but there are other factors that affect mood. The nurse should educate the client on environmental and interpersonal factors that can lead to depression and the potential for psychological treatments to have a positive impact on biological factors.
2. A client diagnosed with major depressive disorder asks, What part of my brain controls my emotions? Which nursing response is appropriate?
A. The occipital lobe governs perceptions, judging them as positive or negative.
B. The parietal lobe has been linked to depression.
C. The medulla regulates key biological and psychological activities.
D. The limbic system is largely responsible for one’s emotional state.
ANS: D
The nurse should explain to the client that the limbic system is largely responsible for ones emotional state. This system is often called the emotional brain and is associated with feelings, sexuality, and social behavior. The occipital lobes are the area of visual reception and interpretation. Somatosensory input (touch, taste, temperature, etc.) occurs in the parietal lobes. The medulla contains vital centers that
3. Which part of the nervous system should a nurse identify as playing a major role during stressful situations?
A. Peripheral nervous system
B. Somatic nervous system
C. Sympathetic nervous system
D. Parasympathetic nervous system
ANS: C
The nurse should identify that the sympathetic nervous system plays a major role during stressful situations. The sympathetic nervous system prepares the body for the fight-or-flight response. The parasympathetic nervous system is dominant when an individual is in a nonstressful state.
4. Which client statement reflects an understanding of the effect of circadian rhythms on a person’s ability to function?
A. When I dream about my mother’s horrible train accident, I become hysterical.
B. I get really irritable during my menstrual cycle.
C. I’m a morning person. I get my best work done in the a.m.
D. Every February, I tend to experience periods of sadness.
ANS: C
By stating, I am a morning person, the client demonstrates an understanding that circadian rhythms may influence a variety of regulatory functions, including the sleepwake cycle, regulation of body temperature, and patterns of activity. Most humans follow a 24-hour cycle that is largely affected by light and darkness.
5. Which types of adoption studies should a nurse recognize as providing useful information for the psychiatric community?
A. Studies in which children with mentally ill biological parents are raised by adoptive parents who were mentally healthy
B. Studies in which children with mentally healthy biological parents are raised by adoptive parents who were mentally ill
C. Studies in which monozygotic twins from mentally ill parents were raised separately by different adoptive parents
D. Studies in which monozygotic twins were raised together by mentally ill biological parents
E. All of the above
ANS: E
The nurse should determine that all of the studies could possibly benefit the psychiatric community. The studies may reveal research findings relating genetic links to mental illness. Adoption studies allow comparisons to be made of the influences of the environment versus genetics.
6. Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective?
A. The study of neuroendocrinology
B. The study of psychoimmunology
C. The study of diagnostic technology
D. The study of neurophysiology
ANS: B
Psychoimmunology is the branch of medicine that studies the effects of social and psychological factors on the functioning of the immune system. Studies of the biological response to stress hypothesize that individuals become more susceptible to physical illness following exposure to stressful stimuli.
7. A withdrawn client diagnosed with schizophrenia expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being implicated in this behavior?
A. Dendrites
B. Axons
C. Neurotransmitters
D. Synapses
ANS: C
The nurse should recognize that neurotransmitters play an essential function in the role of human emotion and behavior. Neurotransmitters are targeted and affected by many psychotropic medications.
8. An instructor is teaching nursing students about neurotransmitters. Which term best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron?
A. Regeneration
B. Reuptake
C. Recycling
D. Retransmission
ANS: B
The nursing instructor should best explain that the process by which neurotransmitters are released into the synaptic cleft and returned to the presynaptic neuron is by reuptake. Reuptake is the process by which neurotransmitters are stored for reuse.
9. A nurse concludes that a restless, agitated client is manifesting a fight-or-flight response. The nurse should associate this response with which neurotransmitter?
A. Acetylcholine
B. Dopamine
C. Serotonin
D. Norepinephrine
ANS: D
The nurse should associate the neurotransmitter norepinephrine with the fight-or-flight response. Norepinephrine produces activity in the sympathetic postsynaptic nerve terminal and is associated with the regulation of mood, cognition, perception, locomotion, sleep, and arousal.
10. A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the clients neurotransmitters should a nurse expect to be elevated?
A. Serotonin
B. Dopamine
C. Gamma-aminobutyric acid (GABA)
D. Histamine
ANS: B
The nurse should expect that elevated dopamine levels might be an attributing factor to the clients current level of functioning. Dopamine functions include regulation of movements and coordination, emotions, and voluntary decision-making ability.
11. A clients wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The clients therapist stresses the importance of proper sleep, nutrition, and exercise. What is the best rationale for the therapists advice?
A. The therapist is using an interpersonal approach.
B. The client has an alteration in neurotransmitters.
C. It is routine practice to remind clients about nutrition, exercise, and rest.
D. The client is susceptible to illness due to effects of stress on the immune system.
ANS: D
The therapists advice should be based on the knowledge that the client has been exposed to stressful stimuli and is at an increased risk of developing illness due to the effects of stress on the immune system. The study of this branch of medicine is called psychoimmunology.
12. Which mental illness should a nurse identify as being associated with a decrease in prolactin hormone level?
A. Major depression
B. Schizophrenia
C. Anorexia nervosa
D. Alzheimers disease
ANS: B
Although the exact mechanism is unknown, there may be some correlation between decreased levels of the hormone prolactin and the diagnosis of schizophrenia. Some studies have shown an inverse relationship between prolactin concentrations and symptoms of schizophrenia.
13. Which cerebral structure should a nursing instructor describe to students as the emotional brain?
A. The cerebellum
B. The limbic system
C. The cortex
D. The left temporal lobe
ANS: B
The limbic system is often referred to as the emotional brain. The limbic system is largely responsible for ones emotional state and is associated with feelings, sexuality, and social behavior.
14. A nurse understands that the abnormal secretion of growth hormone may play a role in which illness?
A. Acute mania
B. Schizophrenia
C. Anorexia nervosa
D. Alzheimers disease
ANS: C
A nurse should understand that research has found a correlation between abnormal levels of growth hormone and anorexia nervosa. The growth hormone is responsible for growth in children, as well as continued protein synthesis throughout life.
15. A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the presentation of these symptoms?
A. Abnormal levels of serotonin
B. Decreased levels of dopamine
C. Increased levels of norepinephrine
D. Decreased levels of acetylcholine
ANS: D
The nurse should correlate memory deficits and decreased motor function with decreased levels of acetylcholine. Acetylcholine is a major effector chemical of the autonomic nervous system.
Functions of acetylcholine include sleep regulation, pain perception, the modulation and coordination of movement, and memory.
16. A nurse should recognize that a decrease in norepinephrine levels would play a significant role in which mental illness?
A. Mania
B. Schizophrenia
C. Anxiety
D. Depression
ANS: D
The nurse should recognize that a decrease in norepinephrine levels would play a significant role in generating the symptoms of depression. The functions of norepinephrine include the regulation of mood, cognition, perception, locomotion, cardiovascular functioning, and sleep and arousal.
17. Which client diagnosis should a nurse associate with a decrease in gamma-aminobutyric acid (GABA)?
A. Alzheimers disease
B. Schizophrenia
C. Panic disorder
D. Depression
ANS: C
The nurse should associate a decrease in GABA with panic disorder. Enhancement of the GABA system is the mechanism of action by which benzodiazepines produce a calming effect, thus reducing anxiety. Alterations in the GABA system are also associated with movement disorders and epilepsy.
18. A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness?
A. Schizophrenia
B. Depression
C. Body dysmorphic disorder
D. Parkinson’s disease
ANS: A
The nurse should expect that an increase in dopamine activity might play a significant role in the development of schizophrenia. Dopamine functions include regulation of emotions, coordination, and voluntary decision- making ability. Increased dopamine activity is also associated with mania.
19. A nursing instructor is teaching about the monoamine category of neurotransmitters. Which student statement indicates that learning about the function of norepinephrine has occurred?
A. Norepinephrine functions to regulate movement, coordination, and emotions.
B. Norepinephrine functions to regulate mood, cognition, and perception.
C. Norepinephrine functions to regulate arousal, libido, and appetite.
D. Norepinephrine functions to regulate pain, inflammatory response, and wakefulness.
ANS: B
The functions of norepinephrine include the regulation of mood, cognition, perception, locomotion, and cardiovascular function. Norepinephrine has also been implicated in certain mood disorders such as depression and mania, anxiety states, and schizophrenia.
20. A student nurse is studying the effect of the drug isocarboxazid (Marplan) on neurobiology. The student should recognize that the neurotransmitter serotonin is catabolized by which enzyme?
A. Glycosyltransferase
B. Peptidase
C. Polymerase
D. Monoamine oxidase [Show Less]