Details of TEST BANK FOR Stahls Essential Psychopharmacology 4th EditionChapter 1 Chemical neurotransmission MULTIPLE CHOICE 1. A patient with depression
... [Show More] 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. c. d.
COMT and glutamate Monamine and glycine
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. c. d.
Asking the patient to recite the alphabet Monitoring the patients blood pressure
Comparing the patients grip strength in both hands ANS:
B Accidents 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. c. d.
Dendrites and their ability to transmit electrical impulses The regulation of neurotransmitters especially dopamine
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: Necessary but generally for psychiatric nurses who focus primarily on a.
b. 1 | P a g ec.
d.
ANS: D
behavioral interventions
A complex undertaking that advance practice psychiatric nurses frequently use in their practice
Important primarily for the nursing assessment of patients with brain traumacaused
cognitive symptoms
Necessary for planning psychiatric care for all patients especially those experiencing
psychiatric disorders
Nurses 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.
c.
d.
There have been no research studies done on stress and disease yet.
Stress does cause the release of factors that suppress the immune system.
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.
b.
c.
d.
Expression of emotion
Detecting auditory stimuli
Receiving visual images
Processing associations
ANS: 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.
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
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c.
d.
Is unable to effectively hold a spoon in the left hand
Has difficulty explaining how to go about using the telephone
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 prescribed Providing
the education at a time when the patient is emotionally calm and
c.
d.
ANS: A
relaxed
Encouraging the patient to crush or dissolve the medication to help with swallowing
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 g-aminobutyric 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.
c.
d.
The patient reports that, I dont feel as anxious as I did a couple of days ago.
The patient reports that both auditory and visual hallucinations have decreased.
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 g-aminobutyric 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.
b.
c.
d.
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Has your father exhibited any signs of depression?
Does your father seem to experience mood swings?
Have you noticed your father talking about seeing things you cant see?
Is your dad preoccupied with behaviors that he needs to repeat over and over? ANS: ASerotonin 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.
c.
d.
Excess dopamine will be prevented from attaching to receptor sites.
Serotonin deficiency will be managed through a prolonged reuptake period.
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.
12. There remains a stigma attached to psychiatric illnesses. The psychiatric nurse makes the
greatest impact on this sociological problem when:
a.
Providing educational programming for patients and the public
b.
c.
Arranging for adequate and appropriate social support for the patient
Assisting the patient to achieve the maximum level of independent functioning Regularly
praising the patient for seeking and complying with appropriate
d.
ANS: A
treatment
Much of the stigma attached to psychiatric illness is due to a lack of understanding of the biologic
basis of these disorders. Therefore, effective patient, family, and public teaching is an important
function of the role of the psychiatric mental health nurse.
While the remaining options are appropriate, they are not directed towards eliminating social
stigma but rather empowering the patient.
13. The wife of a patient with paranoid schizophrenia tells the nurse, Ive learned that my
husband has several close relatives with the same disorder. Does this problem run in families?
The response based on recent discoveries in the field of genetics would be:
a.
Your children should be monitored closely for the disorder.
b.
c.
d.
Research tends to support a familiar tendency to schizophrenia.
There is no concrete evidence; it is just as likely a coincidence.
Only bipolar disorder has been identified to have a genetic component. ANS: B
Familial tendencies appear with several psychiatric disorders including schizophrenia.
To insinuate that the children are at such risk would not be supported by research.
14. A patient whose symptoms of mild depression have been managed with antidepressants is
concerned about the affect of accepting a promotion that will require working the night shift.
What will be the basis of the response the nurse gives to address the patients concern?
a.
The connection between a new job and possible depression does exist.
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c.
ANS: C
The change in sleep routine can be managed with a healthy sleep hygiene routine.
Many psychiatric and medical disorders occur more frequently or are exacerbated when sleep
patterns and biologic rhythms are disrupted. While the remaining options contain true
information regarding the management of depression that is a result of sleep disruption, they
do not effectively address the patients concern.
15. The nurse is discouraged because the patient exhibiting negative symptoms of schizophrenia
has shown no improvement with the planned interventions to reduce the symptoms. The mentors
remark that helps place the problem in perspective is:
a.
You arent responsible for the behavior of any other person.
b.
c.
d.
Patients can be perverse and cling to symptoms despite our efforts.
Negative symptoms have been associated with genetic pathology.
It will take several trail and error attempts to get the right combination care. ANS: C
A complex disorder, such as schizophrenia, most likely has multiple contributing
factors, including genetic predisposition, prenatal development, and the environment. Nurse
frustration can be alleviated by helping the nurse realize that negative symptoms may be the
result of actual brain dysfunction, rather than psychologically determined behaviors; thus the
remaining options are not appropriate since they do not address the complexity of the problem.
MULTIPLE RESPONSE
1. What assessment data would reinforce the diagnosis of temporal lobe injury in patient
who experienced head trauma? Select all that apply.
a.
Inability to balance a checkbook
b.
c.
d.
e.
Uncharacteristically aggressive
Affect fluctuates dramatically
Increased interest in sexual behaviors
Difficulty remembering the names of family members ANS: C,
D, E
The temporal lobe is involved with memory as well as increased sexual focus and
altered emotional responses. Personality and intellectual function is not centered in the temporal
lobe.
2. A patient has begun experiencing dysfunction of the hypothalamus. What nursing
interventions will the nurse include in the patients plan of care? Select all that apply.
a.
Reinforcing clear physical boundaries
b.
c.
d.
e.
B, C, D
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Assisting the patient with completing daily menus
Learning about healthy sleep hygiene habits
Monitoring and recording temperature every 4 hours
Monitoring and recording blood pressure every 4 hours ANS:
The medication can be adjusted to manage any increase in depression.
The interruption in normal wake-sleep patterns can influence mood disorders.
d.The hypothalamus is responsible for regulation of sleep-rest patterns, body
temperature, and physical drives of hunger. Social appropriateness and blood pressure is not
controlled by the hypothalamus.
3. The nurse is preparing a patient for a positron emission tomography (PET) scan. Which
instructions will the nurse include? Select all that apply.
There will likely be a 30 to 45 minute wait between the injection and the
a.
b.
c.
d.
e.
beginning of the scan.
A blindfold and earplugs may be used to help decrease reaction to the
environment during the scan.
Make every attempt to lie still during the scan because movement will affect
the imaging produced.
No food or fluids are to be ingested for at least 8 full hours before the scan and
none during the scan.
Staying awake during the scan is important since the results are altered when
the patient is in any phase of the sleep state.
ANS: A, B, C, E
Appropriate patient preparation for a PET scan would include information regarding the time
interval between injection of the isotope and the actual scan, the fact that steps will be taken to
minimize the effects of sights and sounds during the scan, lying still is critical to achieving a
quality image, and that being asleep during the scan will alter the results. It is not necessary to
fast before or during the scan.
4. A patient with schizophrenia is described as having difficulty with executive functions.
What patient dysfunction can the nurse expect to assess behaviorally? Select all that apply.
a.
Invades the personal space of others frequently
b.
c.
d.
e.
Consistently fails to bring money when going to buy snacks
Cannot remember the names of staff who often provide care
Requires repeated reinforcement on how to make a sandwich
Frequently speaks of hurting himself or of hurting other patients ANS: A,
B, D
Executive functions include reasoning, planning, prioritizing, sequencing behavior,
insight, flexibility, judgment, focusing on tasks, responding to social cues, and attending in
appropriate ways to incoming stimuli. Memory is not considered an
executive function and risk for harm to self and others is not generally a diagnosis
appropriate for such a patient.
5. The unit physicians have ordered magnetic resonance imaging (MRI) tests for the following
patients. For which patients would the nurse decline to make test arrangements without
further discussion with the physician? Select all that apply.
a.
A patient who is claustrophobic
b.
c.
d.
e.
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A patient who is breastfeeding
A patient who has an allergy to iodine
A patient who had a total knee replacement
A patient who is taking a neuroleptic medication ANS:A, D
Patients with claustrophobia are often unable to complete this type of study, because
the MRI machine is enclosed, and patients are required to remain motionless. Metal implants are
contraindications for MRIs since metal affects the scan. Breastfeeding, iodine sensitivity, and
neuroleptic medication therapy are not contraindications for an MRI.
Chapter 2 Transporters, receptors, and enzymes as targets of psychopharmacological drug
action
1.
The somatic nervous system provides sensory and motor innervation for:
A)
B)
C)
peripheral nerves.
abdominal viscera.
secretory glands.
D) smooth muscle. ANS.A
The proteins and other materials used by the axon are synthesized
2.
A)
B)
C)
then flow down the axon through its cytoplasm.
in the cell body
by Nissl bodies
through dendrites
D) across synapses ANS.A
Supporting cells of the nervous system, such as Schwann cells, satellite cells,
3.
A)
B)
C)
and types of glial cells, function to provide neurons with:
local protection.
control functions.
membrane permeability.
D) integrative metabolism. ANS.A
Neurons are characterized by the ability to communicate with other neurons
4.
A)
B)
C)
and body cells through:
astrocytes.
axon hillocks.
nodes of Ranvier.
D) action potentials. ANS.D
and
5. Chemical synapses rely on
between neurons.
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in order to provide communicationA)
B)
C)
diffusion
gap junctions
satellite cells
D) transmitter molecules ANS.D
The blood-brain and CSF-brain barriers control the chemical environment of
6.
A)
B)
C)
the brain by allowing easy entrance to only a few chemicals that include:
oxygen.
protein.
glutamate.
D) potassium. ANS.A
The perception of where a stimulus is in space and in relation to body parts is a
7.
A)
B)
C)
function of the:
occipital lobe.
parietal lobe.
hypothalamus.
D) prefrontal cortex. ANS.B
The pia mater is a connective tissue sheath that covers the spinal cord and also
8.
A)
B)
C)
contains:
spinal fluid.
fibrocartilage.
blood vessels.
D) segmental nerves. ANS.B
9. Which of the following is the neurotransmitter for most postganglion
sympathetic neurons?
A)
B)
C)
D)
10.
A)
B)
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Enkephalin
Glutamic acid
Catecholamines
Acetylcholine ANS.C
In contrast to the sympathetic nervous system, the functions of the
parasympathetic nervous system include:
sweating.
anabolism.C)
D)
11.
A)
B)
C)
D)
pupil dilation.
vasoconstriction. ANS.B
Which of the following substances provides the majority of the fuel needs of
the neurologic system?
Glycogen
Glucose
Amino acids
Triglycerides ANS.B
A 60-year-old woman has been recently diagnosed with multiple sclerosis, a disease in
which the oligodendrocytes of the patients central nervous system (CNS) are
progressively destroyed. Which physiologic process within the
12.
A)
B)
C)
D)
ANS.C
13.A neuron has been hyperpolarized. How will this affect the excitability of the
neuron?
A)
B)
C)
D)
14.
A)
B)
C)
D)
15.
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The neuron will have a membrane potential farther from the threshold.
The neuron will be more difficult to repolarize after firing.
The membrane potential of the neuron will be closer to the threshold.
The neurons excitability will be significantly increased. ANS.A
A pregnant womans most recent ultrasound is suggestive of spina bifida, and her
primary care provider has subsequently order further diagnostic testing.
The pathophysiologic effects of this disease are due to:
malformation of the mesoderm.
abnormal closure of the neural tube.
lesions in the dorsal root ganglia.
hypertrophy of the primary vesicles. ANS.B
Which of the following messages is most likely to be carried by general
somatic afferent (GSA) neurons?
neurologic system is most likely be affected by this disease process?
Oxygen metabolism
Neurotransmitter synthesis
Nerve conduction
Production of cerebrospinal fluidA)
B)
C)
D)
16.
A)
B)
C)
D)
ANS.D
17. A patient has required mechanical ventilation following a traumatic head injury
sustained in a motorcycle crash, during which he sustained damage to his respiratory
center. Which of the patients brain structures has been injured?
A)
B)
C)
D)
18.
A)
B)
C)
D)
19.
A)
B)
C)
D)
20.
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Brain stem
Midbrain
Diencephalon
Frontal lobe
ANS.A
A patient with a diagnosis of epilepsy has required surgical removal of part of her
prefrontal cortex. Which of the following effects should her family and
care team anticipate?
Lapses in balance and coordination
Deficits in regulation of the endocrine system
Sensory losses
Changes in behavior and judgment ANS.D
A patients primary care provider has prescribed a b-adrenergic receptor blocker.
Which of the following therapeutic effects do the patient and care
provider likely seek?
Reduction in heart rate and blood pressure
Slowing of gastrointestinal motility
Increase in mental acuity
Decreased production of gastric acid ANS.A
Neurotrophic factors contribute to the maintenance of homeostasis in which
of the following ways?
The sensation of cold when touching ice
The message to move a finger and thumb
The message to move the larynx during speech
Information about the position of a joint ANS.A
Which of the following processes is most likely to occur as a result of a
spinal reflex?
Peristalsis of the small and large bowel
Control of oculomotor function in changing light levels
Pain sensation from a potentially damaging knee movement
Withdrawal of a hand from a hot stove elementA)
B)
C)
D)
By catalyzing the effects of neurotransmitters
By increasing the sensitivity of receptors on postsynaptic cells
By promoting the growth and survival of neurons
By selectively increasing or decreasing the release of neurotransmitters ANS. C
Chapter 3 Ion channels as targets of psychopharmacological drug action
A nurse is teaching a medication class to a group of psychiatric patients. One of them
asks the nurse why he has so much more trouble learning now when hes in his 60s
than he did when he was younger. Which of the following
1.
A)
B)
C)
concepts would the nurse integrate into the response?
The extrapyramidal motor system
The amygdala
Neuroplasticity
D) Psychoneuroimmunology ANS.C
Which of the following would a nursing instructor identify when describing the area of
the brain involved with verbal language function, including areas
2.
A)
B)
C)
for both receptive and expressive speech?
Right hemisphere
Parietal lobe
Occipital lobe
D) Left hemisphere ANS.D
A nurse is developing a plan of care for a patient experiencing expressive aphasia. The
nurse incorporates knowledge that the patient most likely has
3.
A)
B)
C)
sustained damage to which of the following?
The postcentral gyrus
Brocas area
Basal ganglia
D) The hippocampus ANS.B
The nurse is caring for an older adult who has experienced damage to the frontal lobe
after an automobile accident. The nurse anticipates that the patient
4.
A)
B)
C)
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will have difficulty with which of the following?
Smell
Concept formation
Receptive speechD) Hearing ANS.B
The nurse is caring for a patient who has experienced damage to the parietal lobes of
the brain. The nurse anticipates that the patient with have difficulty
5.
A)
B)
C)
with which of the following?
Perceiving sensory input
Calculating a math problem
Seeing objects in front of him
D) Speaking fluently ANS.B
A patient has been diagnosed with memory dysfunction associated with Alzheimers
disease. The nurse determines that damage to the patients brain includes deterioration
of temporal lobe structures and the nerves of which of
6.
A)
B)
C)
the following?
Basal ganglia
Limbic system
Frontal lobe
D) Hippocampus ANS.D
The nurse is caring for a hospitalized patient who has a disorder of the
hypothalamus. When developing the patients plan of care, in which of the
7.
A)
B)
C)
following areas would the nurse anticipate a problem?
Sleep
Constipation
Speech
D) Motor activity ANS.A
A patient who is scheduled to undergo a sleep deprivation electroencephalogram (EEG)
in the morning is experiencing moderate anxiety about the procedure. Based on an
understanding of this test, which of the
8.
A)
B)
C)
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following would the nurse avoid?
Explaining in depth what to expect during the upcoming procedure
Administering a benzodiazepine medication prescribed for anxiety
Taking a thorough history of her use of prescribed and illicit drugsD) Giving her a noncaffeinated beverage of her choice ANS.B
9. A) B) C) D)
10.
A nursing instructor asks a student to explain the influence of chronobiology on depression. Which of the following would the student include when responding? The exact location of genes leads to identifying the gene responsible for causing depression.
A break in the corpus coliseum blocks information exchange between the right and left hemispheres.
Damage to the posterior areas of the parietal lobe leads to altered discriminative sensory function. Internal and external triggers can elicit biologic rhythm changes indicative of clinical depression.
ANS.D
When describing the various neurotransmitters, which of the following would the nurse identify as the primary cholinergic neurotransmitter?
A) B) C)
D) Dopamine Acetylcholine Norepinephrine [Show Less]