Mental Health Ch. 8

The nurse is preparing a client for an MRI scan of the head. The nurse should ask the client ...

"Are you anxious about being in tight spaces?"

The nurse knows that the client understands the rationale for dietary restrictions when taking an MAOI when the client makes which of the following statements?

"I should avoid foods that are high in the amino acid tyramine such as aged cheese, meats, and chocolate because this drug causes the level of tyramine to go up to dangerous levels."

The anatomy instructor is discussing the central nervous system. A student asks where the cerebral cortex is located. What is the best answer?

"It is located on the surface of the cerebrum."

A client with bipolar disorder asks the nurse, "Why did I get this illness? I don't want to be sick." The nurse would best respond with ...

"We don't fully understand the cause, but mental illnesses do seem to run in families."

What does a neuron consist of?

A cell body, nucleus, organelles, dendrites, and axons

Which drug classification is the primary medication treatment for schizophrenia?

Antipsychotics

A client is being seen in the crisis unit reporting that poison letters are coming in the mail. The client has no history of psychiatric illness. Which of the following medications would the client most likely be started on?

Aripiprazole (Abilify)

Which of the following was the first nonstimulant medication specifically designed and tested for ADHD?

Atomoxetine (Strattera)

A client diagnosed with a stroke is exhibiting expressive aphasia. Which of the following areas in the frontal lobe is responsible for the motor function of speech?

Broca's area Correct Explanation: 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, done over time, become automatic. Basic emotions, needs, drives, and instinct begin and are modulated in the limbic system.

A client is having difficulty standing without assistance and is exhibiting swaying. He has a history of falls. The Romberg test is completed. Which of the following areas of the brain is affected?

Cerebellum Correct Explanation: The cerebellum regulates postural balance and positioning. The hypothalamus functions in temperature regulation. The thalamus functions as a regulatory structure to relay all sensory information, except smell, sent to the central nervous system from the peripheral nervous system. The hippocampus is involved in storing information, especially the emotions attached to memories.

What part of the brain controls and coordinates muscle movement?

Cerebellum Correct Explanation: The cerebellum, which is located behind and below the cerebrum, controls and coordinates muscle movement.

A client exhibiting an uncoordinated gait has presented at the clinic. The nurse knows that what brain structure has the function of balance and coordination?

Cerebellum Explanation: The cerebellum controls fine movement, balance, position sense, and integration of sensory input. Portions of the pons control the heart, respiration, and blood pressure. Cranial nerves IX through XII connect to the brain in the medulla. Cranial nerves III and IV originate in the midbrain.

The nurse is assessing a client suffering a head injury as a result of an altercation with two other individuals. The client has difficulty accurately reporting the events of the altercation and appears very emotional during the assessment. The nurse suspects which part of the brain received the greatest amount of injury?

Cerebrum Correct Explanation: The frontal lobes of the cerebrum control the organization of thought, body movement, memories, emotions, and moral behavior. The cerebellum is located below the cerebrum and is the center for coordination of movements and postural adjustments. The medulla, located at the top of the spinal cord, contains vital centers for respiration and cardiovascular functions. The hippocampus and amygdala are involved in emotional arousal and memory.

Neurotransmission is important in the function of the CNS. For neurotransmission to occur, how do neurons communicate with other cells? Neurons communicate through the use of synapses. These synapses may link neurons into functional circuits. How do the neurons communicate through the synapses?

Chemically

A client has situational depression which has caused the stimulation of the vagus nerve and increased gastric acid. Which system uses acetylcholine as a neurotransmitter?

Cholinergic Explanation: 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.

What is the role of neurotransmitters?

Communicate information from one cell or cell group to another

What is the function of the thalamus and the hypothalamus?

Coordinate internal and external responses

What part of the neuron carries information into the neuron from other neurons?

Dendrite

An abnormality of which of the following structures of the cerebrum would be associated with schizophrenia?

Frontal lobe

Which of the following is an inhibitory neurotransmitter?

GABA

Neurotransmitters are small molecules that exert their actions through specific proteins, called receptors, embedded in the postsynaptic membrane. Where are neurotransmitters synthesized?

In the axon terminal

The right hemisphere of the cerebrum is the center for which of the following?

Intuition

Neuroplasticity influences psychiatric-mental health outcomes because it is or does what?

Is the ability of nervous tissue to change structure and functioning in response to new experiences

Imbalances in neurotransmitters contribute to the development of mental disorders. Norepinephrine imbalance is implicated in which of the following disorders?

Mood disorders Explanation: Norepinephrine is implicated in mood disorders. Dopamine is implicated in schizophrenia; gamma-aminobutyric acid (GABA) is implicated in dementia, schizophrenia, and anxiety disorders; and high levels of serotonin are implicated in anxiety disorders.

A client with bipolar disorder has been taking lithium, and today his serum blood level is 2.0 mEq/L. What effects would the nurse expect to see?

Nausea, diarrhea, and confusion. Serum lithium levels of less than 0.5 mEq/L are rarely therapeutic, and levels of more than 1.5 mEq/L are usually considered toxic. The client would show signs of toxicity with a lithium level of 2.0 mEq/L. Toxic effects of lithium are severe diarrhea, vomiting, drowsiness, muscle weakness, and lack of coordination.

Which of the following is a neuromodulator?

Neuropeptides

A client has a lithium level of 1.2 mEq/L. Which of the following interventions by the nurse is indicated?

No intervention is necessary at this time.

Which of the following is the most prevalent neurotransmitter in the nervous system?

Norepinephrine

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?

Occipital Explanation: 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.

A neuroimaging technique used to examine brain functioning, including glucose metabolism, blood flow, and neurotransmitter-receptor activity, is known as what?

PET scan

How should the nurse respond to a family member who asks how Alzheimer's disease is diagnosed?

PET scans can identify the amyloid plaques and tangles of Alzheimer's disease in living clients.

Which lobe of the brain assists in spatial perception?

Parietal

Which of the following is a sympathetic response on the lungs?

Relaxation of bronchial muscles Explanation: The sympathetic effect on the lungs includes relaxation of bronchial muscles. The parasympathetic response includes bronchoconstriction and secretion from the bronchial glands. Dilation of blood vessels is not a sympathetic response of the lungs.

Which of the following antidepressant drugs is a preferred drug for clients at high risk of suicide?

Sertraline. SSRIs, venlafaxine, nefazodone, and bupropion are often better choices for those who are potentially suicidal or highly impulsive because they carry no risk of lethal overdose, in contrast to the cyclic compounds and the MAOIs.

For a client taking clozapine (Clozaril), which of the following symptoms should the nurse report to the physician immediately as it may be indicative of a potentially fatal side effect?

Sore throat and malaise; potentially fatal side effect of agranulocytosis

A graduate of a nursing program is scheduled to take the NCLEX today. He wakes up and is noticing his heart is racing and his pupils are dilated. What can he attribute to this reaction?

Sympathetic nervous system Explanation: The sympathetic nervous system is stimulated by physical or emotional stress, such as strenuous exercise or work, pain hemorrhage, intense emotions, and temperature extremes. The specific body responses include: increased arterial blood pressure and cardiac output and pupil dilation to aid vision. The autonomic nervous system affects the cardiovascular function to decrease heart rate responses. The patient does not suffer from a cardiac irregularity. The release of dopamine will not affect pupillary response.

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?

The client will develop an attachment with the infant.

Which of the following medications rarely causes extrapyramidal side effects (EPS)?

Ziprasidone (Geodon) Explanation: First-generation antipsychotic drugs cause a greater incidence of EPS than do atypical antipsychotic drugs, with ziprasidone (Geodon) rarely causing EPS. Thorazine, Haldol, and Prolixin are all first-generation antipsychotic drugs.

A client with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg. daily. The client asks the nurse how this medicine works. The nurse explains that the mechanism by which the olanzapine controls the client's psychotic symptoms is believed to be ...

blocking dopamine receptors in the brain.

A client suffers from mental depression and insomnia. A client with these complaints could have an abnormality of which of the following neurotransmitters?

serotonin

A client with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The nurse observes that the client's behavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of ...

tardive dyskinesia

Which of the following disorders are extrapyramidal symptoms that may be caused by antipsychotic drugs? Select all that apply.

• Akathisia • Pseudoparkinsonism • Dystonia

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 temporal lobe. • It has an occipital lobe.

Which of the following structures are components of the brain stem? Select all that apply.

• Midbrain • Pons • Medulla

Which of the following are controlled by the extrapyramidal motor system? Select all that apply.

• Muscle tone • Common reflexes • Automatic voluntary motor functioning

Serotonin plays a role in which of the following areas? Select all that apply.

• Sensory perceptions • Cognition • Emotion

Which of the following side effects of lithium are frequent causes of noncompliance? Select all that apply.

• Weight gain • Lethargy