Stahl's Essential Psychopharmacology Neuroscientific Basis and Practical Applications 5th Edition Test bank/ Study Guide
Table ofContents Chapter 1
... [Show More] Chemical neurotransmission ................................ ...................... 1
Chapter 2 Transporters, Receptors, And Enzymes As Targets Of PsychopharmacologicalDrug Action .. 8 Chapter 3 Ion Channels as Targets Of Psychopharmacological Drug Action ....................... 15 Chapter 4 Psychosis and schizophrenia................................ ..................... 21 Chapter 5 Antipsychotic agents................................ ............................ 34 Chapter 6 Mood disorders ................................ ................................ 41 Chapter 7 Antidepressants................................ ................................ 49 Chapter 8 Mood stabilizers ................................ ............................... 57 Chapter 9 Anxiety disorders and Anxiolytics ................................ ................ 72 Chapter 10 Chronic pain and its treatment ................................ .................. 77 Chapter 11 Disorders Of Sleep And Wakefulness And Their Treatment .......................... 85 Chapter 12 Attention Deficit Hyperactivity Disorder And Its Treatment.......................... 91 Chapter 13 Dementia and its treatment................................ ..................... 99 Chapter 14 Impulsivity, Compulsivity, And Addiction ................................ ........ 109
Chapter 1 Chemical neurotransmission 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 theorythat 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 thisdiagnosis? a.
Observing the patient pick up a spoon
b. c. d.
ANS: B 1 | P a g e
Asking the patient to recite the alphabet Monitoring the patients blood pressure
Comparing the patients grip strength in both handsAccidents 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 thatthe 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 cleftand 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.
b.
c.
d.
Necessary but generally for psychiatric nurses who focus primarily on
behavioral interventions
A complex undertaking that advance practice psychiatric nurses frequently usein 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
ANS: D
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 notused 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 tothe psychiatric patient.
5. A patient asks the nurse, My wife has breast cancer. Could it be caused by herchronic
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 mooddisorders are
sometimes associated with decreased functioning of the immune system.Research does not
2 | P a g esupport 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 identifyas 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 theright
cerebral cortex. During assessment, the nurse would expect to find that the patient:
a.
Demonstrates major deficiencies in speech
b.
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 sideof 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. Thepatient 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.
c.
d.
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 begiven. The medication does
not necessarily need to be crushed or dissolved since the stroke would not have caused
difficulty with swallowing.
3 | P a g e
Encouraging the patient to crush or dissolve the medication to help with
swallowing
Being careful to stress the importance of taking the medication as prescribed
Providing the education at a time when the patient is emotionally calm andrelaxed9. The physician tells the nurse, The medication Im prescribing for the patient enhances
the g-aminobutyric acid (GABA) system. Which patient behavior willprovide 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 anantianxiety
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.
Has your father exhibited any signs of depression?
b.
c.
d.
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: 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 nurseprovide
for a patient in the early stage of Alzheimers disease?
a.
It will increase the metabolism of excess GABA.
b.
c.
d.
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 cholinesterasewill 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 nursemakes the
greatest impact on this sociological problem when:
a.
Providing educational programming for patients and the public
b.
c.
4 | P a g e
Arranging for adequate and appropriate social support for the patient
Assisting the patient to achieve the maximum level of independent functioning
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.d.
Regularly praising the patient for seeking and complying with appropriatetreatment
ANS: A
Much of the stigma attached to psychiatric illness is due to a lack of understanding ofthe 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 eliminatingsocial
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 runin 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 givesto address the patients concern?
a.
The connection between a new job and possible depression does exist.
b.
c.
The medication can be adjusted to manage any increase in depression.
The interruption in normal wake-sleep patterns can influence mood disorders.
5 | P a g ed.
The change in sleep routine can be managed with a healthy sleep hygieneroutine.
ANS: C
Many psychiatric and medical disorders occur more frequently or are exacerbated when sleep
patterns and biologic rhythms are disrupted. While the remaining optionscontain 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 thesymptoms. 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 notaddress the complexity of the problem.
MULTIPLE RESPONSE
1. What assessment data would reinforce the diagnosis of temporal lobe injury inpatient
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 thetemporal 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.
Assisting the patient with completing daily menus
6 | P a g ec.
d.
e.
Learning about healthy sleep hygiene habits
Monitoring and recording temperature every 4 hours
Monitoring and recording blood pressure every 4 hours
ANS: B, C, D
The hypothalamus is responsible for regulation of sleep-rest patterns, body temperature, and
physical drives of hunger. Social appropriateness and blood pressureis 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.
a.
b.
c.
d.
e.
There will likely be a 30 to 45 minute wait between the injection and the
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 affectthe
imaging produced.
No food or fluids are to be ingested for at least 8 full hours before the scan andnone
during the scan.
Staying awake during the scan is important since the results are altered whenthe
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, lyingstill is critical to achieving a
quality image, and that being asleep during the scan willalter 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 thefollowing
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
7 | P a g eb.
c.
d.
e.
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 anMRI.
Chapter 2 Transporters, Receptors, And Enzymes As Targets Of
PsychopharmacologicalDrug Action
1.
A)
B)
C)
D)
The somatic nervous system provides sensory and motor innervation for:
peripheral nerves.
abdominal viscera.
secretory glands.
smooth muscle.
2.
A)
B)
C)
D)
3.
A)
B)
C)
D)
ANS.A
The proteins and other materials used by the axon are synthesized
then flow down the axon through its cytoplasm.
in the cell body
by Nissl bodies
through dendrites
across synapses
ANS.A
Supporting cells of the nervous system, such as Schwann cells, satellite cells,and types
of glial cells, function to provide neurons with:
local protection.
control functions.
membrane permeability.
integrative metabolism.
and
8 | P a g eANS.A
4.
A)
B)
C)
D)
Neurons are characterized by the ability to communicate with other neuronsand body
cells through:
astrocytes.
axon hillocks.
nodes of Ranvier.
action potentials.
ANS.D
5. Chemical synapses rely on in order to provide communication between neurons.
A)
B)
C)
D)
diffusion
gap junctions
satellite cells
transmitter molecules
6.
A)
B)
ANS.D
The blood-brain and CSF-brain barriers control the chemical environment of the brain by
allowing easy entrance to only a few chemicals that include:
oxygen.
protein.
9 | P a g eC)
D)
glutamate.
potassium.
ANS.A
7.
A)
B)
C)
D)
The perception of where a stimulus is in space and in relation to body parts is a function of
the:
occipital lobe.
parietal lobe.
hypothalamus.
prefrontal cortex.
8.
A)
B)
C)
D)
ANS.B
The pia mater is a connective tissue sheath that covers the spinal cord and also contains:
spinal fluid.
fibrocartilage.
blood vessels.
segmental nerves.
ANS.B
10 | P a g e9. Which of the following is the neurotransmitter for most postganglion
sympathetic neurons?
A)
B)
C)
D)
10.
A)
B)
C)
D)
11.
A)
B)
C)
D)
Enkephalin
Glutamic acid
Catecholamines
Acetylcholine
ANS.C
In contrast to the sympathetic nervous system, the functions of the
parasympathetic nervous system include:
sweating.
anabolism.
pupil dilation.
vasoconstriction.
ANS.B
Which of the following substances provides the majority of the fuel needs ofthe
neurologic system?
Glycogen
Glucose
Amino acids
Triglycerides
ANS.B
12.
A)
B)
C)
D)
A 60-year-old woman has been recently diagnosed with multiple sclerosis, adisease in
which the oligodendrocytes of the patients central nervous system(CNS) are
progressively destroyed. Which physiologic process within the neurologic system is
most likely be affected by this disease process?
Oxygen metabolism
Neurotransmitter synthesis
Nerve conduction
Production of cerebrospinal fluid
11 | P a g eANS.C
13.A neuron has been hyperpolarized. How will this affect the excitability of the neuron?
A)
The neuron will have a membrane potential farther from the threshold.
B)
The neuron will be more difficult to repolarize after firing.
C)
The membrane potential of the neuron will be closer to the threshold.
D)
The neurons excitability will be significantly increased.
ANS.A
14.
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:
A)
malformation of the mesoderm.
B)
abnormal closure of the neural tube.
12 | P a g eC)
lesions in the dorsal root ganglia.
D)
hypertrophy of the primary vesicles.
ANS.B
15.
Which of the following messages is most likely to be carried by general somatic afferent
(GSA) neurons?
A)
The sensation of cold when touching ice
B)
The message to move a finger and thumb
C)
The message to move the larynx during speech
D)
Information about the position of a joint
16.
ANS.A
Which of the following processes is most likely to occur as a result of a spinal reflex?
13 | P a g eA)
Peristalsis of the small and large bowel
B)
Control of oculomotor function in changing light levels
C)
Pain sensation from a potentially damaging knee movement
D)
Withdrawal of a hand from a hot stove element
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)
14 | P a g e
Brain stem
Midbrain
Diencephalon
Frontal lobe
ANS.A
A patient with a diagnosis of epilepsy has required surgical removal of part ofher
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 judgmentANS.D
19.
A)
B)
C)
D)
20.
A)
B)
C)
D)
A patients primary care provider has prescribed a b-adrenergic receptor blocker.
Which of the following therapeutic effects do the patient and careprovider 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 whichof the
following ways?
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
1.
A)
B)
C)
D)
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 concepts would the nurse
integrate into the response?
The extrapyramidal motor system
The amygdala
Neuroplasticity
Psychoneuroimmunology
ANS.C
2.
A)
B)
C)
D)
15 | P a g e
Which of the following would a nursing instructor identify when
describing the area of the brain involved with verbal language
function, including areas for both receptive and expressive speech?
Right hemisphere
Parietal lobe
Occipital lobe
Left hemisphereANS.D
3.
A)
B)
C)
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 sustained damage to which of the
following?
The postcentral gyrus
Brocas area
Basal ganglia
The hippocampus
ANS.B
4.
A)
B)
C)
D)
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 will have difficulty with which of the
following?
Smell
Concept formation
Receptive speech
Hearing
ANS.B
5.
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 difficultywith which of the following?
A)
B)
C)
D)
Perceiving sensory input
Calculating a math problem
Seeing objects in front of him
Speaking fluently
ANS.B
6.
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 ofthe following?
16 | P a g eA)
B)
C)
D)
Basal ganglia
Limbic system
Frontal lobe
Hippocampus
ANS.D
7.
A)
B)
C)
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 thefollowing areas would the nurse
anticipate a problem?
Sleep
Constipation
Speech
17 | P a g eD)
Motor activity
ANS.A
8.
A patient who is scheduled to undergo a sleep deprivation electroencephalogram (EEG)
in the morning is experiencing moderate anxietyabout the procedure. Based on an
understanding of this test, which of the following would the nurse avoid?
A)
B)
C)
D)
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 drugs
Giving her a noncaffeinated beverage of her choice
ANS.B
9.
A)
B)
C)
D)
A nursing instructor asks a student to explain the influence of chronobiologyon
depression. Which of the following would the student include when responding?
The exact location of genes leads to identifying the gene responsible forcausing
depression.
A break in the corpus coliseum blocks information exchange between theright 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 indicativeof clinical
depression.
ANS.D
10.
A)
B)
C)
D)
18 | P a g e
When describing the various neurotransmitters, which of the following wouldthe nurse
identify as the primary cholinergic neurotransmitter?
Dopamine
Acetylcholine
Norepinephrine
SerotoninANS.B
11.
A)
B)
C)
D)
A group of nursing students are reviewing the various neurotransmitters. Thestudents
demonstrate understanding when they identify which of the following as a
neuropeptide?
Melatonin
Serotonin
Glutamate
Gamma-aminobutyric acid
ANS.A
12.
A)
B)
C)
D)
The nurse is assessing a patient experiencing anxiety and observes increasedsweating
and gooseflesh. The nurse understands that these are the result of which substance?
Acetylcholine
Norepinephrine
Serotonin
Histamine
ANS.B
13.
A)
B)
C)
D)
ANS.B
14.A group of students are reviewing information about neurotransmitter subtypes. The
group demonstrates understanding of the information when theyidentify which
neurotransmitter as having muscarinic and nicotinic receptors?
19 | P a g e
A nurse is developing a plan of care for a patient diagnosed with schizophrenia. The
nurse integrates knowledge of this disorder, identifyingwhich neurotransmitter as
being primarily involved?
Acetylcholine
Dopamine
Norepinephrine
SerotoninA)
B)
C)
D)
Serotonin
Gamma-aminobutyric acid (GABA)
Dopamine
Acetylcholine
ANS.D
15.
A)
B)
C)
D)
A nurse is involved in gathering information about the inheritance of mental disorders
using population genetics. Which of the following would the nurse be least likely to be
evaluating?
Concordance rates
Occurrence in first-degree relatives
Risk factor analysis
Adoptions studies
ANS.C
16.
A)
B)
C)
D)
E)
A nurse is reading a journal article about psychoneuroimmunology. Which
information would the nurse most likely find? Select all that apply.
Neurotoxins role in receptor site damage
Hypothalamicpituitarythyroid axis disruption
Static activity of natural killer cells in response to stress
Hypothalamic damage leading to immune dysfunction
Interruption in the typical circadian rhythm cycle
ANS.A,B,D
17.
A)
B)
A patient is scheduled for a challenge test. Which of the following would thenurse
include when explaining this test to the patient?
Intravenous administration of a substance to induce symptoms
Application of electrodes to the scalp for monitoring
C)
D)
Evaluation electrical impulses recorded on graph paper
Exposure to a flashing strobe light to elicit abnormal activity
20 | P a g eANS.A
A patient with depression tells the nurse that he is to have a test that involvesthe
recording of an electroencephalogram (EEG) throughout the night. The nurse most
likely identifies this testing as which of the following?
18.
A)
B)
C)
D)
Sleep deprivation EEG
Polysomnography
Evoked potentials
Functional magnetic resonance imaging
ANS.B
19.
A)
B)
C)
D)
A group of nursing students are reviewing the role of serotonin in psychiatricdisorders.
The students demonstrate a need for additional study when they identify which
disorder as being associated with its dysfunction?
Depression
Obsessive-compulsive disorder
Panic disorder
Schizophrenia
ANS.D
20.
A)
B)
C)
D)
ANS.B
Chapter 4 Psychosis and schizophrenia
MULTIPLE CHOICE
1. A newly admitted patient has the diagnosis of catatonic schizophrenia. Which behavior
observed in the patient supports that diagnosis?
a.
Uses a rhyming form of speech
21 | P a g e
When describing neuronal transmission, an instructor describes the areawhere
the electrical intracellular signal becomes a chemical one. The instructor is
describing which of the following?
Soma
Synaptic cleft
Terminal
Receptor siteb.
c.
d.
Refuses to eat any unwrapped foods
Laughs when watching a sad movie
Maintains an immobilized state for hours
ANS: D
Catatonic schizophrenia is characterized by extremes of psychomotor activity ranging from
frenzied behavior to immobilization and may include echopraxia and posturing. Paranoid
thinking is characteristic of paranoid schizophrenia. Inappropriate affect and clanging are seen in
disorganized schizophrenia.
2. What would be an appropriate short-term outcome for a patient diagnosed with residual
schizophrenia who exhibits ambivalence?
a.
Decide their own daily schedule.
b.
c.
d.
Decide which unit groups they will attend.
Choose which clinic staff member to work with.
Choose between two outfits to wear each morning.
ANS: D
An early step would be to make choices about nonthreatening matters when presentedwith
limited alternatives. The remaining options represent decisions that are too complicated for the
patient to make initially.
3. What is the priority nursing diagnosis for a catatonic patient?
a.
Ineffective coping
b.
c.
d.
Impaired physical mobility
Impaired social interaction
Risk for deficient fluid volume
ANS: D
The highest priority for the patient is maintenance of basic physiologic needs, such ashydration.
Mobility is of lesser physiological importance than fluid volume. The remaining options do not
have priority over a physiological need.
4. Which nursing diagnosis is appropriate for a patient who insists being called YourHighness
and demonstrates loosely associated thoughts?
a.
Risk for violence
b.
c.
Defensive coping
Impaired memory
22 | P a g ed.
Disturbed thought processes
ANS: D
Delusions and loose associations suggest disturbed thought processes. The otheroptions
are not supported by data in the scenario.
5. Which initial short-term outcome would be appropriate for a patient who wasadmitted
expressing delusional thoughts?
a.
Accept that delusion is illogical.
b.
c.
d.
Distinguish external boundaries.
Explain the basis for the delusions.
Engage in reality-oriented conversation.
ANS: D
Delusions are not reality oriented; thus an appropriate outcome would be that patient will engage
in reality-oriented conversation rather than discussing delusional beliefs. Delusions are fixed,
false beliefs. Patients rarely accept anyone using logic to dispute them. Data are not present to
suggest boundary disturbance. Explaining the delusion isnot progress; it suggests the patient still
holds to the belief.
6. Which of the following interventions should the nurse plan to use to reduce patientfocus on
delusional thinking?
a.
Confronting the delusion
b.
c.
d.
Refuting the delusion with logic
Exploring reasons the patient has the delusion
Focusing on feelings suggested by the delusion
ANS: D
Focusing on feelings suggested by the delusion will help meet patient needs and helpthe patient
stay based in reality. This technique fosters rapport and trust while discouraging the belief
without challenging or refuting it.
7. Which assessment observation supports a patients diagnosis of disorganized
schizophrenia?
a.
Reports suicidal ideations
b.
c.
d.
Last relapse was 6 years ago
Consistent inappropriate laughing
Believes that the government is out to get me
ANS: C
The presence of disorganization and inappropriate affect identifies this disorder as
disorganized schizophrenia. The symptoms of residual schizophrenia have long periods of
remission. Schizoaffective disorder presents with severe mood disorders
along with symptoms of schizophrenia. Paranoid schizophrenia is characterized by
persecutory or grandiose delusions.
8. A patient tried to gouge out his eye in response to auditory hallucinations commanding, If
thine eye offends thee, pluck it out. The nurse would analyze thisbehavior as indicating:
a.
Derealization
b.
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Inappropriate affectc. d.
Impaired impulse control Inability to manage anger
ANS: C Command hallucinations may be so intense that the patient cannot control the impulseto do what the hallucination tells him to do; thus the patient has impaired impulse control. This is not an anger management problem. Derealization is a feeling that the environment is distorted or unreal and not suggested in the scenario. No evidence of inappropriate affect is given. 9. An appropriate intervention for a patient with an identified nursing diagnosis of situational low self-esteem would be: a.
Providing large muscle activities to relieve stress
b. c. d.
Attempting to determine triggers to hallucinations Engaging patient in activities designed [Show Less]