Chapter 6: Biologic Foundations of Psychiatric Nursing

Neuroplasticity influences psychiatric-mental health outcomes because it is or does what? A.) Is the ability of nervous tissue to change structure and functioning in response to new experiences B.) Determines a client's response to psychotropic medications C.) Initiates the neuroendocrine-mediated physiologic events that prepare the body for fight or flight D.) Is the process by which the information in RNA produces strings of amino acids

ANSWER: A.) Is the ability of nervous tissue to change structure and functioning in response to new experiences

A client is having difficulty standing without assistance and is exhibiting swaying. The client has a history of falls. Which area of the brain is most likely affected? A.) Cerebellum B.) Hypothalamus C.) Thalamus D.) Hippocampus

ANswer; A.) Cerebellum

The anatomy and physiology instructor is talking about the nervous system. What would the instructor tell the students about the cerebrum? Select all that apply. - It has a parietal lobe. - It has a frontal lobe. - It has a capses collusam. - It has a temporal lobe. - It has an occipital lobe.

Answer: - It has a parietal lobe. - It has a frontal lobe. - It has a temporal lobe. - It has an occipital lobe. Rationale: The brain is divided into three parts: the cerebrum, the cerebellum, and the brain stem. The cerebrum consists of two hemispheres connected by the corpus callosum, a band of white fibers that acts as a bridge for transmitting impulses between the left and right hemispheres. Each hemisphere has four lobes: frontal, parietal, temporal, and occipital.

Which functions are controlled by the extrapyramidal motor system? Select all that apply. - muscle tone - common reflexes - automatic voluntary motor functioning - memory - Vision

Answer: - muscle tone - common reflexes - automatic voluntary motor functioning Rationale: Muscle tone, common reflexes, and automatic voluntary motor functioning, such as walking, are controlled by this nerve track. Memory and vision are not affected by the extrapyramidal motor system.

A client diagnosed with a stroke is exhibiting expressive aphasia. Which area in the frontal lobe is responsible for the motor function of speech? A.) Broca's area B.) Wernicke's area C.) Basal ganglia D.) Limbic system

Answer: A.) Broca's area Rationale: The frontal lobe contains Broca's area, which controls the motor function of speech. Damage to Broca's area produces expressive aphasia, or difficulty with the motor movements of speech. Wernicke's area is primarily responsible for receptive speech. The basal ganglia are involved with motor functions and association in both the learning and the programming of behavior or activities that are repetitive and, when done over time, become automatic. Basic emotions, needs, drives, and instinct begin and are modulated in the limbic system.

What part of the brain would be responsible for activities such as walking and dancing? A.) Cerebellum B.) Cerebrum C.) Midbrain D.) Brain stem

Answer: A.) Cerebellum

A client is experiencing acute stress leading to the stimulation of increased gastric acid. In this situation, which body system uses acetylcholine as a neurotransmitter? A.) Cholinergic B.) Dopaminergic C.) GABA-ergic D.) Noradrenergic

Answer: A.) Cholinergic Rationale: The cholinergic system uses acetylcholine as a neurotransmitter. The dopaminergic system uses dopamine as its neurotransmitter. The GABA-ergic system uses GABA as its neurotransmitter. The noradrenergic system uses norepinephrine as its neurotransmitter.

Abnormalities in which lobe is believed to be associated with schizophrenia? A.) Frontal B.) Occipital C.) Temporal D.) Parietal

Answer: A.) Frontal

The client cannot remember anything before an accident yesterday. Which brain structure might be injured? A.) Hippocampus B.) Midbrain C.) Reticular formation D.) Basal ganglia

Answer: A.) Hippocampus

The hypothalamus affects the body primarily through which action? A.) Maintaining homeostasis B.) Processing sensory input C.) Secreting melatonin D.) Integrating motor activities

Answer: A.) Maintaining homeostasis Rationale: The diencephalon consists of the thalamus, hypothalamus, and pineal gland. The hypothalamus maintains homeostasis and controls the autonomic nervous system and the pituitary gland.

The brain stem consists of which structure? A.) Midbrain B.) Cerebellum C.) Hypothalamus D.) Thalamus

Answer: A.) Midbrain Rationale: The brain stem consists of the midbrain, pons, and medulla.

A client has been taking antidepressants for 2 years. The client tells the nurse that the medication no longer seems to be working. The nurse suspects that which situation is occurring? A.) Refractoriness B.) Supersensitivity C.) Affinity D.) Neurocircuitry

Answer: A.) Refractoriness Rationale: Refractoriness means the desensitization of cells to a drug over time. Also called downregulation, refractoriness generally occurs when agonists continually stimulate cells. The resultant repeated exposure of cells to the same concentration of the drug causes the drug to have diminished effectiveness. Affinity refers to the strength of attraction to the receptor; supersensitivity refers to a greater than usual response to the neurotransmitter. Neurocircuitry refers to the complex neural functional networks that link the brain structures such as the prefrontal cortex, striatum, hippocampus, and amygdala.

A client suffers from low mood and disturbed sleep. This client is most likely experiencing a change in which neurotransmitter? A.) Serotonin B.) Calcitonin C.) Melatonin D.) Parathyroid

Answer: A.) Serotonin

Which is the primary cholinergic neurotransmitter found in greatest concentration in the peripheral nervous system? A.) acetylcholine B.) dopamine C.) norepinephrine D.) serotonin

Answer: A.) acetylcholine Rationale: Acetylcholine is the primary cholinergic neurotransmitter. Dopamine is an excitatory neurotransmitter found in distinct regions of the central nervous system and is involved in cognition, motor, and neuroendocrine functions. Norepinephrine is an excitatory neurochemical that plays a major role in generating and maintaining mood states. Serotonin plays a role in emotions, cognition, sensory perceptions, and essential biologic functions.

A client taking an antipsychotic is exhibiting manifestations of neuroleptic malignant syndrome (NMS). Which area of the brain is involved with the increased temperature noted with NMS? A.) hypothalamus B.) thalamus C.) amygdala D.) hippocampus

Answer: A.) hypothalamus Rationale: Body temperature is regulated by the hypothalamus. The thalamus functions as a regulatory structure to relay all sensory information, except smell, sent to the central and peripheral nervous systems. The amygdala is directly connected to more primitive centers of the brain involving the sense of smell. The hippocampus is involved in storing information, especially the emotions attached to memories.

The most important reason that psychiatric nurses need to know about the brain is that ... A.) it is the organ of the mind and governs all forms of human behavior. B.) it is the center of all metabolic processes for drugs that are used for psychiatric disorders. C.) it is responsible for the etiology of many mental disorders. D.) it is the central location for transcription of genes related to behavior.

Answer: A.) it is the organ of the mind and governs all forms of human behavior.

The client presents to the mental health clinic with reports of mood swings, inability to handle stress, and forgetfulness.The nurse talks about the different neurotransmitters and what each neurotransmitter does. How should the nurse elaborate on the type of symptoms this client is demonstrating? A.) "Lack of histamine in the body produces symptoms such as anxiety, hypertension, and difficulty regulating body temperature." B.) "Lack of dopamine in the body produces symptoms such as depression, fatigue, and lack of motivation." C.) "Lack of serotonin in the body produces symptoms such as irritability, sleep disturbances, and compulsiveness." D.) "Lack of norepinephrine in the body produces symptoms such as obesity, fibromyalgia, and panic attacks."

Answer: B.) "Lack of dopamine in the body produces symptoms such as depression, fatigue, and lack of motivation."

A nurse is teaching family members about the brain's connection to behaviors commonly seen in mental illnesses. How can the nurse best explain the term "neurotransmitter" to the family? A.) A hormone in the brain. B.) A molecular substance released in the brain. C.) A specific location in the brain. D.) A nerve that transmits impulses in the brain.

Answer: B.) A molecular substance released in the brain. Rationale: Neurotransmitters are small molecules that play a key role in synaptic transmission. They are chemicals stored in the neuron and released as neural messengers when stimulated by an electrical impulse. They are involved with functions that affect human emotions and behavior. Neurotransmitters are the target for drugs used to treat mental illnesses. They are stored in the axon terminal of the presynaptic neuron. A neurotransmitter is not a hormone that is stored in a gland or a location in the brain, nor is it a nerve.

Neurotransmission is important in the function of the CNS. For neurotransmission to occur, how do neurons communicate with other cells? A.) Selectively B.) Chemically C.) Excitably D.) Accessibly

Answer: B.) Chemically Rationale: The transmission of information between two nerves or between a nerve and a gland or muscle is chemical. Selectively, excitably, and accessibly are incorrect.

The nurse is teaching the client with anxiety about the mechanisms of benzodiazepines. Which is increased with this medication? A.) Dopamine B.) GABA C.) Norepinephrine D.) Epinephrine

Answer: B.) GABA Rationale: GABA is the major inhibitory neurotransmitter in the brain and has been found to modulate other neurotransmitter systems rather than to provide a direct stimulus. Dopamine, norepinephrine, and epinephrine are excitatory neurotransmitters.

A client is brought to the emergency room following a motor vehicle accident in which he sustained head trauma. The client is complaining of blindness in the left eye. The nurse would be correct in documenting this abnormal finding as corresponding to which of the following cerebral lobes? A.) Temporal B.) Occipital C.) Parietal D.) Frontal

Answer: B.) Occipital Rationale: The posterior lobe of the cerebral hemisphere is responsible for visual interpretation. The temporal lobe contains the auditory receptive areas. The parietal lobe contains the primary sensory cortex, and is essential to an individual's awareness of the body in space, as well as orientation in space and spatial relations. The frontal lobe functions in concentration, abstract thought, information storage or memory, and motor function.

The nurse is with a young client who has just been informed of the client's terminal illness. The client's heart rate increases, the client's eyes dilate, and the client's blood pressure increases. The nurse recognizes this response as: A.) part of the limbic system response. B.) sympathetic nervous response. C.) hypothalamic-pituitary response. D.) local adaptation syndrome.

Answer: B.) sympathetic nervous response.

The student nurse is working with a client that presents to the mental health clinic with reports of loss of appetite, weight loss, and anhedonia. The student nurse discusses with the instructor that lack of a neurotransmitter may be affecting the client. How would the student explain what neurotransmitters do? A.) "Connected by the corpus calosum, allows quick information exchange" B.) "Relay-switch of the brain, that filters information" C.) "Molecules that control the opening/closing of ion channels" D.) "Governs basic emotions, needs, drives, and instinct"

Answer: C.) "Molecules that control the opening/closing of ion channels" Rationale: Neurotransmitters are the chemical substances that aid in the transmission of information throughout the body. Neurotransmitters either open or close ion channels. The neurotransmitters fit into specific receptor cells in the membrane of the dendrite, like a key fits a lock opening/closing ion channels. The limbic system, the thalamus, and the hemispheres of the brain are not molecules that control the opening/closing of ion channels. The limbic system governs basic emotions, needs, drives, and instinct. The thalamus is sometimes called the relay-switch of the brain, and it filters information. The two hemispheres of the brain are connected to the corpus callosum, allowing quick information exchange.

A professional boxer has suffered several concussions while boxing. Since retirement, the client has experienced periods of depression and suffers from short-term memory loss. Which provides the best explanation for the neurological basis of the client's symptoms? A.) Damage to the nucleus accumbeus B.) Damage to the medulla C.) Damage to the hippocampus D.) Damage to the thalamus

Answer: C.) Damage to the hippocampus

Which lobe of the brain assists in spatial perception? A.) Frontal B.) Temporal C.) Parietal D.) Occipital

Answer: C.) Parietal Rationale: The temporal lobes are centers for the senses of smell and hearing and for memory and emotional expression. The frontal lobes control the organization of thought and body movement. The occipital lobes assist in coordinating language generation and visual interpretation, such as depth perception.

A college student wakes up and notices a racing heart and dilated pupils. The student is scheduled to write an exam later that morning. Which system is responsible for this physiological response? A.) Autonomic nervous system B.) Cardiovascular irregularity C.) Sympathetic nervous system D.) The release of dopamine

Answer: C.) Sympathetic nervous system

The nurse is caring for a client diagnosed with Parkinson's disease. How would the nurse explain which transmitter is increased by taking antiparkinson's medication? A.) norepinephrine B.) epinephrine C.) dopamine D.) serotonin

Answer: C.) dopamine Rationale: Dopamine, a neurotransmitter, is involved in the control of complex movements. Dopamine is implicated in movement disorders such as Parkinson's disease. Dopamine levels are decreased in Parkinson's disease, and abnormally high activity of dopamine has been associated with schizophrenia. Norepinephrine, serotonin, and epinephrine are not correct. Norepinephrine increases alertness and arousal, and speeds reaction time. Serotonin is believed to help regulate mood and social behavior, appetite and digestion, sleep, memory, and sexual desire and function. Commonly known as adrenaline, epinephrine is a hormone secreted by the medulla of the adrenal glands. Strong emotions such as fear or anger cause epinephrine to be released into the bloodstream, which causes an increase in heart rate, muscle strength, blood pressure, and sugar metabolism.

In which way do neurons communicate through the use of synapses? A.) indirectly B.) excitatorily C.) electrochemically D.) inhibitorily

Answer: C.) electrochemically

After attending an anatomy and physiology review class on the nervous system, a group of nurses demonstrate understanding of the information when the group identifies which function as associated with the thalamus? A.) Relays sensory information to the central nervous system B.) Is responsible for voluntary movement C.) Continually adjusts body temperature and heart rate D.) Helps maintain red blood cell production

Answer; A.) Relays sensory information to the central nervous system Rationale: Sometimes called the "relay-switching center of the brain," the thalamus functions as a regulatory structure to relay all sensory information, except smell, sent to the CNS from the PNS. From the thalamus, the sensory information is relayed mostly to the cerebral cortex. The thalamus relays and regulates by filtering incoming information and determining what to pass on or not pass on to the cortex. In this fashion, the thalamus prevents the cortex from becoming overloaded with sensory stimulus. It is not responsible for voluntary movement, adjusting body temperature and heart rate, or maintaining red blood cell production.

The nurse is caring for a mental health client who has developed difficulty with balance and muscle tone after a car accident that involved a head injury. Based on this information, what area of the brain was most likely injured in the accident? A.) Diencephalon B.) Brain stem C.) Cerebellum D.) Pons

Answer; C.) Cerebellum

Which is the primary role of neurotransmitters? A.) Excite the receptor cell located inside the synaptic cleft B.) Inhibit the receptor cell found inside of glial cells C.) Communicate information within the receptor cell D.) Communicate information from one cell or cell group to another

Answer; D.) Communicate information from one cell or cell group to another Rationale; Neurotransmitters are referred to as first messengers, which means molecules that communicate information or change from one cell or cell group to another, cause an immediate effect, and are typically found in circuitry that produces behavior.

A 34-year-old woman is three months postpartum and being treated for mild depression following the birth of her child. She states that she misses her career and was not ready to become a full-time mother. Her husband tries to help her, but she admits that she resents the time she still has to devote to the baby. The infant looks well fed and cared for, but the mother clearly seems burdened by the child. Basing her plan of care on concepts about brain development and neuroplasticity, the nurse identifies which of the following goals as most critical? A.) The client will receive physical and emotional support from her husband. B.) The client will resume her job on a part-time basis. C.) The client will develop an attachment with the infant. D.) The client will use daycare or other services to allow her more time to herself.

Answer: C.) The client will develop an attachment with the infant. Rationale: Neuroplasticity means that the brain adapts to new conditions during its constant interaction with the environment. Our brains continue to grow connections, and exposure to new learning results in brain changes, even into advanced old age. The mother can learn to embrace her new role as mother and develop an attachment with the infant.

The nurse is working with a client that has not been diagnosed yet. The client is aggressive, unable to control anger, and violent at times. The client was brought to the emergency deparment by local police. The nurse selects what system as the etiology for the clients' behavior? Classify the symptoms according to origin in the body. A.) circulatory system B.) peripheral nervous system C.) limbic system D.) endocrine system

Answer: C.) limbic system Rationale: The limbic system that includes the thalamus, hypothalamus, hippocampus, and amygdala. The thalamus regulates activity, sensation, and emotion. The hypothalamus is involved in temperature regulation, appetite control, endocrine function, sexual drive, and impulsive behavior associated with feelings of anger, rage, or excitement. Not only does the limbic system function as the seat of emotions, but the limbic system also is involved with aspects of memory. The endocrine system is the collection of glands that produce hormones that regulate metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood. The endocrine system influences how the heart beats, how bones and tissues grow, even the ability to make a baby. It plays a vital role in the development of diabetes, thyroid disease, growth disorders, sexual dysfunction, and a host of other hormone-related disorders. The human circulatory system functions to transport blood and oxygen from the lungs to the various tissues of the body. The heart pumps the blood throughout the body. The lymphatic system is an extension of the human circulatory system that includes cell-mediated and antibody-mediated immune systems. Common diseases of the cardiovascular system include: coronary artery disease, stroke, hypertension, and heart failure. The peripheral nervous system includes all of the nerves that branch out from the brain and spinal cord and extend to other parts of the body including muscles and organs. The three major forms of nerve damage are: peripheral neuropathy, autonomic neuropathy, and mono-neuropathy. The most common form is peripheral neuropathy, which mainly affects the feet and legs. Sciatica is pain, tingling, or numbness produced by an irritation of the sciatic nerve.

A client brings a spouse to the mental health clinic with reports that the spouse has been exhibiting a tendency to self-mutilate, experiences fits of intense rage, and is increasingly aggressive toward others. How should the nurse elaborate on the type of symptoms this client is demonstrating? A.) "Lack of norepinephrine in the body produces symptoms such as obesity, fibromyalgia, and panic attacks." B.) "Lack of histamine in the body produces symptoms such as anxiety, hypertension, and difficulty regulating body temperature." C.) "Lack of dopamine in the body produces symptoms such as depression, fatigue, and lack of motivation." D.) "Lack of serotonin in the body produces symptoms such as aggression, hostility, and compulsiveness."

Answer: D.) "Lack of serotonin in the body produces symptoms such as aggression, hostility, and compulsiveness." Rationale: Serotonin plays a role in emotions, cognition, sensory perceptions, and essential biologic functions such as sleep and appetite. Serotonin also controls food intake, irritability, sleep and wakefulness, compulsiveness, temperature regulation, pain control, sexual behaviors, and regulation of emotions. Norepinephrine, histamine, and dopamine are not correct. Lack of norepinephrine may lead to conditions such as attention deficit hyperactivity disorder, depression, and hypotension. Lack of histamine means dopamine levels will be elevated and this may result in anxiety, paranoia, being suspicious, and hallucinations. Lack of dopamine may lead to imbalance difficulties, speech problems, and postural changes.

The body's first line of neurological defense against stressors involves what? A.) Norepinephrine B.) Pituitary gland C.) Arginine vasopressin D.) Autonomic nervous system

Answer: D.) Autonomic nervous system

The client has difficulty with motor coordination and walks with an unsteady gait. Of the following brain structures, which is most likely affected in the client's brain? A.) Cerebrum B.) Medulla oblongata C.) Hippocampus D.) Cerebellum

Answer: D.) Cerebellum

A nurse is reading a journal article about neurotransmitters. The nurse demonstrates understanding of the information by identifying which substance as an inhibitory amino acid? A.) Norepinephrine B.) Acetylcholine C.) Glutamate D.) Glycine

Answer: D.) Glycine Rationale: Inhibitory amino acids include gamma-aminobutyric acid (GABA) and glycine; glutamate is an excitatory amino acid. Norepinephrine and acetylcholine are excitatory neurotransmitters.

A client is returning from military service and has been diagnosed with post-traumatic stress disorder (PTSD). Dysfunction in which brain structure contributes to the rage and fear experienced in PTSD? A.) Basal ganglia B.) Pons C.) Corpus callosum D.) Hypothalamus

Answer: D.) Hypothalamus Rationale: The hypothalamus is a part of the limbic system, which is sometimes called the emotional brain. The hypothalamus is involved in impulsive behavior associated with feelings of anger, rage, or excitement. The pons connects the cerebellum and the brainstem. The basal ganglia initiates motor function. The corpus callosum is the pathway that connects the two hemispheres of the brain.

A nurse is teaching a patient about how impulses are transmitted and describes the factors that can impact this transmission. Which factor would the nurse most likely identify as increasing synaptic transmission? A.) Reduction of chemicals B.) Electrical impulse C.) Calcium reaction D.) Neurotransmitter

Answer: D.) Neurotransmitter Rationale: As the electrical action potential reaches the ends of the axons, called terminals, calcium ion channels are opened, allowing an influx of Ca++ ions into the neuron. This increase in calcium stimulates the release of neurotransmitters into the synapse. Rapid signaling among neurons requires a ready supply of neurotransmitter. These neurotransmitters are stored in small vesicles grouped near the cell membrane at the end of the axon. When stimulated, the vesicles containing the neurotransmitter fuse with the cell membrane, and the neurotransmitter is released into the synapse. The neurotransmitter then crosses the synaptic cleft to a receptor site on the postsynaptic neuron and stimulates adjacent neurons.

A neuroimaging technique used to examine brain functioning, including glucose metabolism, blood flow, and neurotransmitter-receptor activity, is known as what? A.) Magnetic resonance imaging (MRI) B.) Electroencephalogram (EEG) C.) Ultrasonography D.) Positron emission tomography (PET) scan

Answer: D.) Positron emission tomography (PET) scan Rationale: The positron emission tomography (PET) scan is used to examine brain functioning, including glucose metabolism, blood flow, and neurotransmitter-receptor activity. Magnetic resonance imaging (MRI) can detect demyelinization. The electroencephalogram (EEG) is used to assess brain activity. Ultrasonography is used to examine vasculature.

Two nursing students are giving a presentation on the limbic system. Which can they accurately include as actions of this brain structure? A.) intellect B.) engorgement C.) suppression D.) behavior

Answer: D.) behavior

Sensory deprivation in infancy and childhood can adversely affect brain development. Which characteristic of the brain is involved in this process? A.) Neuroplasticity B.) Reactive plasticity C.) Adaptive plasticity D.) Synaptic plasticity

Answer; A.) Neuroplasticity