EAQ Ch. 3 Psychopharmacology

Which action would be taken for an inpatient prescribed an antidepressant that blocks acetylcholine? Select all that apply. One, some, or all responses may be correct. a. Request a salivary stimulant b. Recommend a mild sedative at bedtime. c. Offer a mild laxative. d. Institute cardiac monitoring. e. Advise to report blurred vision.

a. Request a salivary stimulant c. Offer a mild laxative. d. Institute cardiac monitoring. e. Advise to report blurred vision. Rationale Possible side effects resulting from the use of an acetylcholine blocker include dry mouth, constipation, sinus tachycardia, and blurred vision. Sleep dysfunction is not associated with the use of this type of medication.

Which physiological action is carried out by the neuron? Select all that apply. One, some, or all responses may be correct. a. Responding to stimuli b. Releasing neurotransmitters c. Stimulating hormonal release d. Conducting electrical impulses e. Producing adenosine triphosphate (ATP)

a. Responding to stimuli b. Releasing neurotransmitters d. Conducting electrical impulses Rationale The neuron responds to stimuli, releases neurotransmitters, and conducts electrical impulses. Neurons do not stimulate the release of hormones. Hormones are released as a result of a neural, hormonal, or humoral stimulus. A set of cellular processes generates ATP.

Which effect would a drug that enhances γ-aminobutyric acid (GABA) receptor activity have on a patient? a. Sedation b. Pain relief c. Gastric secretion stimulation d. Cognitive performance improvement

a. Sedation Rationale Drugs that stimulate the GABA receptors produce a sedative, hypnotic effect on the brain. Stimulation of GABA receptor activity does not cause pain relief, increase gastric secretion, or improve cognitive performance. Pain relief is caused by increased receptor activity of substance P. Gastric secretion is increased by enhanced activity of histamine receptors. Cognitive performance is improved by increased activity of glutamate receptors.

Which neurotransmitter is selectively blocked as citalopram exerts its antidepressant effect? a. Serotonin b. Dopamine c. Glutamate d. γ-Aminobutyric acid (GABA)

a. Serotonin Rationale Selective serotonin reuptake inhibitors (SSRIs), such as citalopram, preferentially block the reuptake and degradation of serotonin, thereby improving depression. Dopamine regulation is involved in thought processes and movement. Glutamate regulation is involved in memory and learning. GABA is involved in anxiety responses.

Which neurotransmitter is responsible for the hallucinations, anxiety, and altered thought processes experienced by a patient having a schizophrenic psychotic episode? Select all that apply. One, some, or all responses may be correct. a. Dopamine (DA) b. Serotonin (5-HT) c. Acetylcholine (ACh) d. Norepinephrine (NE) e. γ-Aminobutyric acid (GABA)

a. Dopamine (DA) d. Norepinephrine (NE) e. γ-Aminobutyric acid (GABA) Rationale The characteristic increases in DA and NE combined with the decrease in GABA are responsible for the classic symptoms of a schizophrenic psychotic episode. 5-HT and ACh are not related to this disorder.

Which lobe of the cerebrum could have a lesion when a patient experiences loss of sensation and proprioception in the left upper and lower limbs? a. Frontal b. Parietal c. Occipital d. Temporal

b. Parietal Rationale Sensory perception, proprioception, and the ability to distinguish between right and left are the functions of the parietal lobe of the cerebral cortex. The frontal lobe of the cerebrum is responsible for voluntary motor ability of the body. The functions of the temporal lobe include language comprehension and storing sounds in memory (language, speech). The occipital lobe functions to interpret visual images, visual association, and visual memories.

Which neurotransmitter is targeted by medication prescribed for the treatment of depression? a. Histamine b. Serotonin c. Dopamine d. γ-Aminobutyric acid (GABA)

b. Serotonin Rationale Antidepressant medication targets serotonin and norepinephrine. Histamine is associated with allergic reactions. Increased dopamine is implicated in schizophrenia, and decreased dopamine is implicated in Parkinson's disease. GABA is implicated in anxiety disorders.

Which neuromodulator is involved in regulating mood and anxiety? a. Dopamine b. Substance P c. Neurotensin d. Somatostatin

b. Substance P Rationale Substance P is involved in regulating mood and anxiety. Dopamine is a monoamine neurotransmitter. Neurotensin and somatostatin are neuromodulators, but they are not involved in regulating mood and anxiety.

Which location indicates where a specialized chemical is transported between two neurons during the process of conduction? a. Transmitter b. Synapse c. Receptor d. Postsynaptic cell

b. Synapse Rationale Neurotransmitters are chemicals released from the axon terminal at the presynaptic neuron on excitation. This neurotransmitter then diffuses across a space, or synapse, to an adjacent postsynaptic neuron, where it attaches to receptors on the neuron's surface.

A patient with major depressive disorder newly diagnosed with diabetic peripheral nephropathy asks the nurse why their prescription for venlafaxine has been replaced with duloxetine. Which response would the nurse provide? a. "Duloxetine helps lower your blood sugars." b. "Venlafaxine can worsen diabetic nephropathy." c. "Duloxetine helps manage the pain of diabetic nephropathy." d. "Venlafaxine can exacerbate the pain associated with diabetic nephropathy."

c. "Duloxetine helps manage the pain of diabetic nephropathy." Rationale Venlafaxine and duloxetine are serotonin norepinephrine reuptake inhibitors (SNRIs). Individual SNRIs have unique characteristics. Duloxetine has a number of US Food and Drug Administration (FDA)-approved indications for pain management, including diabetic peripheral neuropathy. Duloxetine does not help lower blood sugars. Venlafaxine does not worsen diabetic nephropathy or exacerbate the pain associated with diabetic nephropathy.

The nurse is evaluating a patient for the side effects of sertraline prescribed for major depressive disorder. Which question would the nurse include in the assessment? a. "Have you experienced any weight gain?" b. "Have you had any trouble with constipation?" c. "How many hours of sleep a night do you get?" d. Have you experienced any changes in your vision?"

c. "How many hours of sleep a night do you get?" Rationale Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI) that is the first-line medication for the treatment of major depressive disorder and anxiety disorders. Common side effects of the medication include nausea, restlessness or jitteriness, sleep disturbances, and sexual dysfunction. The question "How many hours of sleep a night do you get?" is an appropriate question to ask the patient to evaluate for side effects of the medication. Weight gain, constipation, and visual changes are not side effects of sertraline.

Which antidepressant drug is most suitable for a patient diagnosed with anxiety and depression who reports sexual dysfunction and occasional nausea? a. Fluoxetine b. Citalopram c. Escitalopram d. Mirtazapine

d. Mirtazapine Rationale The most suitable antidepressant drug for this patient would be mirtazapine. This drug has both antianxiety and antidepressant effects with minimal sexual dysfunction. This drug also has antiemetic properties that could relieve the nausea. Fluoxetine, citalopram, and escitalopram are selective serotonin reuptake inhibitor (SSRI) drugs. These drugs bind with 5-HT receptors and can aggravate sexual dysfunction in the patient.

Which nursing assessment is necessary when administering risperidone? a. Observe for memory changes. b. Observe for secondary mania. c. Monitor blood levels to avoid toxicity. d. Monitor for extrapyramidal symptoms.

d. Monitor for extrapyramidal symptoms. Rationale Risperidone has the highest rate of extrapyramidal side effects of the second-generation antipsychotic medications, thus making it imperative to monitor for extrapyramidal side symptoms (EPS). Risperidone is not monitored with blood levels and does not cause mania or memory changes.

Which assessment finding indicates decreased activity of acetylcholine? a. Drooling b. Patient reporting diarrhea c. Pulse rate changing from 70 to 62 beats per minute d. Patient reporting blurred vision

d. Patient reporting blurred vision Rationale Anticholinergic effects result from decreased activity of the neurotransmitter acetylcholine. Usual assessment findings include blurred vision, dry mouth, tachycardia, urinary retention, and constipation. Drooling, diarrhea, and pulse rate change from 70 to 62 beats per minute would not result from decreased activity of acetylcholine.

Which imaging technique can provide information about brain function? a. Skull radiograph b. Computed tomography (CT) scan c. Magnetic resonance imaging (MRI) scan d. Positron emission tomography (PET) scan

d. Positron emission tomography (PET) scan Rationale The PET scan provides information about function; CT scan, MRI scan, and skull radiograph provide information about structure.

Which diagnostic test identifies particularly active parts of the brain? a. Ventriculography b. Electroencephalography c. Computed tomography (CT) scan d. Positron emission tomography (PET) scan

d. Positron emission tomography (PET) scan Rationale A PET scan detects brain activity. A CT scan and ventriculography are limited to visualization of structures, and an electroencephalography measures electrical activity but is not an imaging study.

Which lobe of the cerebral cortex is responsible for expression of emotions? a. Frontal b. Parietal c. Occipital d. Temporal

d. Temporal Rationale The temporal lobe connects to the limbic system to allow expression of emotions. Any injury to the temporal lobe would result in abnormally fluctuating emotions. This lobe is also responsible for language comprehension. The frontal lobe is chiefly responsible for initiating voluntary activities. The occipital lobe interprets visual images and stores visual memories. The parietal lobe is chiefly concerned with the perception of sensations.

Which neurotransmitter is taken back into the presynaptic cell in a process called reuptake? Select all that apply. One, some, or all responses may be correct. a. Serotonin b. Dopamine c. Acetylcholine d. Norepinephrine e. Glutamate

a. Serotonin b. Dopamine d. Norepinephrine e. Glutamate Rationale There are two basic mechanisms by which neurotransmitters are destroyed. Some neurotransmitters (e.g., norepinephrine, dopamine, serotonin, glutamate) are taken back into the presynaptic cell from which they originally were released by a process called cellular reuptake and are either reused or destroyed by intracellular enzymes. Other neurotransmitters (e.g., acetylcholine) are destroyed by specific enzymes at the postsynaptic cell.

Which potential side effect of buspirone is important to include when providing patient teaching? a. Dizziness b. Sleep paralysis c. Behavioral changes d. Drowsiness

a. Dizziness Rationale Dizziness is the potential side effect that the nurse should include in the medication teaching. Buspirone is a drug used to reduce anxiety but does not have strong sedative hypnotic properties. Buspirone's side effects include dizziness and insomnia, not sleep paralysis, behavioral changes, or drowsiness.

Which assessment finding best indicates release of norepinephrine? a. Pulse rate changes from 70 to 62 beats per minute. b. Pupil size changes from 8 to 3 mm. c. Patient reports "intestinal cramping." d. Blood pressure changes from 126/70 to 158/84 mm Hg.

d. Blood pressure changes from 126/70 to 158/84 mm Hg. Rationale The release of norepinephrine is associated with activation of the sympathetic nervous system, which increases blood pressure, increases heart rate and force, dilates bronchioles, increases pupil size, and decreases peristalsis (intestinal movement).

Which statement is true regarding the links between the brain and internal organs and the presence of anxiety? Select all that apply. One, some, or all responses may be correct. a. Anxiety can activate the sympathetic nervous system. b. A rapid heartbeat and sweating may be a result of anxiety. c. Hypotension is a result of sympathetic nervous system activation. d. A woman's menstrual cycle may be disturbed as a result of anxiety. e. The brain may stimulate the release of certain hormones as a result of anxiety.

a. Anxiety can activate the sympathetic nervous system. b. A rapid heartbeat and sweating may be a result of anxiety. d. A woman's menstrual cycle may be disturbed as a result of anxiety. e. The brain may stimulate the release of certain hormones as a result of anxiety. Rationale The link between the brain and internal organs that allows for maintenance of homeostasis also may serve to translate mental disturbances, such as anxiety, into alterations of internal function. For example, anxiety can activate the sympathetic nervous system, leading to symptoms such as increased heart rate and blood pressure, shortness of breath, and sweating. The brain also exerts influence over the internal organs by regulating hormonal secretions of the pituitary gland, which in turn regulates other glands. A specific area of the brain, the hypothalamus, secretes hormones called releasing factors. These hormones act on the pituitary gland to stimulate or inhibit the synthesis and release of pituitary hormones. Once in general circulation, they influence various internal activities, an example of which is the release of gonadotropin-releasing hormone by the hypothalamus at the time of puberty. This hormone stimulates the release of two gonadotropins, follicle-stimulating hormone and luteinizing hormone, that consequently activate the ovaries or testes. This link may explain why anxiety or depression in some women may lead to disturbances of the menstrual cycle. Hypertension, not hypotension, is associated with anxiety.

Which time is best to take a drug that has the side effect of drowsiness? a. Before going to bed b. Before going to work c. Before doing physical activities d. After waking up in the morning

a. Before going to bed Rationale Drugs with a sedative-hypnotic effect can blunt the degree to which a person feels alert and focused, and they may cause drowsiness. Therefore the prescribed drug is best taken before going to sleep so that it does not affect the patient's daily activities. Drowsiness can impair a person's ability to do work; therefore it would not be ideal for the patient to take the medication before going to work. Drowsiness while doing physical activities may be dangerous for the patient, particularly if the activity involves driving a car. Asking the patient to take the medication after waking up in the morning is inappropriate, as it would affect the patient's daily activities.

Which symptoms are assessed when a patient experiences anticholinergic side effects? a. Blurred vision, dry mouth, and constipation b. Orthostatic hypotension and memory dysfunction c. Tremors, tachycardia, and ejaculatory dysfunction d. Sedation, drowsiness, hypotension, and weight gain

a. Blurred vision, dry mouth, and constipation Rationale Anticholinergic effects are produced by atropine and include dry mouth, dry eyes, blurred vision, constipation, and urinary retention. Orthostatic hypotension, memory dysfunction, tremors, tachycardia, ejaculatory dysfunction, sedation, drowsiness, hypotension and weigh gain are not considered anticholinergic effects and therefore not associated with the use of antipsychotic medications.

Which diagnostic test would be ordered to diagnose a middle cerebral artery aneurysm? a. Computed tomography (CT) b. Electroencephalography (EEG) c. Magnetic resonance imaging (MRI) d. Functional magnetic resonance imaging (fMRI)

a. Computed tomography (CT) Rationale CT is useful for detecting the presence of lesions, abrasions, and aneurysms. An EEG is useful to find out whether a person is awake, sleeping, or in an anesthetized state. MRI and fMRI can detect the presence of brain edema, ischemia, infection, neoplasm, or trauma.

Which neuroimaging technique demonstrates structural rather than functional problems? Select all that apply. One, some, or all responses may be correct. a. Computed tomography (CT) b. Electroencephalograph (EEG) c. Magnetic resonance imaging (MRI) d. Positron emission tomography (PET) e. Single-photon emission computed tomography (SPECT)

a. Computed tomography (CT) c. Magnetic resonance imaging (MRI) Rationale CT and MRI scans show brain structure with overall images and layers of the brain. EEG shows electrical activity. Functional imaging techniques (e.g., PET and SPECT) reveal physiological activity in the brain.

Which hormone may be responsible for severe depression induced by stress? a. Cortisol b. Gonadotropin c. Clomipramine d Luteinizing hormone

a. Cortisol Rationale Cortisol is a hormone released during periods of stress. Gonadotropins include luteinizing hormone and follicle-stimulating hormone and are essential for reproduction, but would not be components of a stress-induced hormonal imbalance. Luteinizing hormone is responsible for triggering ovulation during the female menstrual cycle and Leydig cell production of testosterone in men. Clomipramine is a tricyclic antidepressant medication and is therefore not a hormone found in the body.

Which abnormality in the levels of the neurotransmitters could be the possible cause of depression? Select all that apply. One, some, or all responses may be correct. a. Deficient production of serotonin b. Excessive transmission of dopamine c. Excessive production of glutamate d. Deficient production of norepinephrine e. Deficient production of γ-aminobutyric acid (GABA)

a. Deficient production of serotonin d. Deficient production of norepinephrine Rationale A deficiency of norepinephrine, serotonin, or both causes depression. Excess transmission of dopamine causes schizophrenia. Glutamate will directly influence the activity of dopamine-releasing cells. Excess glutamate production would cause excess production of dopamine, which can cause psychosis. Deficient production of GABA decreases neuronal excitability and causes anxiety.

Which assessment is expected when a tumor of the cerebellum is present? a. Disequilibrium b. Abnormal eye movement c. Impaired social judgment d. Blood pressure irregularities

a. Disequilibrium Rationale The cerebellum is the organ primarily responsible for symptoms of equilibrium or imbalance. The cranial nerves (III, IV, and V) that control the ocular muscles responsible for eye movement are located in the midbrain and pons, not the cerebellum. Impaired social judgement would be associated with a tumor of the frontal lobe of the brain. Blood pressure regulation is controlled by the medulla oblongata, not the cerebellum.

Which area of safety would be discussed with a patient who has just been prescribed a benzodiazepine (BZD)? Select all that apply. One, some, or all responses may be correct. a. Drug interaction b. Impaired judgement c. Poor concentration d. Sensory hallucinations e. Impaired motor function

a. Drug interaction b. Impaired judgement c. Poor concentration e. Impaired motor function Rationale Any drug that inhibits electrical activity in the brain can interfere with motor ability, attention, and judgment. A patient taking BZDs must be cautioned about engaging in activities that could be dangerous if reflexes and attention are impaired. When used alone, even at high dosages, these drugs rarely inhibit the brain to the degree that respiratory depression, coma, and death result. However, when combined with other central nervous system (CNS) depressants, such as alcohol, opiates, or tricyclic antidepressants, the inhibitory actions of the BZDs can lead to life-threatening CNS depression. Hallucinations typically are not associated with BZD use.

Which areas of safety should be discussed with a patient who has just been prescribed a benzodiazepine (BZD)? a. Drug interaction b. Impaired judgment c. Poor concentration d. Sensory hallucinations e. Impaired motor function

a. Drug interaction b. Impaired judgment c. Poor concentration e. Impaired motor function Rationale Any drug that inhibits electrical activity in the brain can interfere with motor ability, attention, and judgment. A patient taking BZDs must be cautioned about engaging in activities that could be dangerous if reflexes and attention are impaired. When used alone, even at high dosages, these drugs rarely inhibit the brain to the degree that respiratory depression, coma, and death result. However, when combined with other central nervous system (CNS) depressants, such as alcohol, opiates, or tricyclic antidepressants, the inhibitory actions of the benzodiazepines can lead to life-threatening CNS depression. Hallucinations typically are not associated with BZD use.

Which side effect is likely with an antidepressant drug that blocks serotonin (5-HT2) and acetylcholine receptors? Select all that apply. One, some, or all responses may be correct. a. Dry mouth b. Tachycardia c. Hypotension d. Urinary retention e. Gastric disturbances f. Ejaculatory dysfunction

a. Dry mouth b. Tachycardia c. Hypotension d. Urinary retention f. Ejaculatory dysfunction Rationale The antidepressant effects of the drug are because of the blockage of the 5-HT2 receptors. The drug also blocks acetylcholine receptors. Dry mouth, sinus tachycardia, and urinary retention are side effects associated with the blockage of acetylcholine receptors. Hypotension and ejaculatory dysfunction are possible side effects associated with 5-HT2 receptor blocking. Gastric disturbances are not side effects associated with this antidepressant drug. Gastric disturbance is a side effect of drugs that inhibit 5-HT2 reuptake.

Which part of the body secretes a hormone that is a normal component of the body's general response to stress? Select all that apply. One, some, or all responses may be correct. a. Hypothalamus b. Adrenal glands c. Pituitary gland d. Pancreas e. Parathyroid gland

a. Hypothalamus b. Adrenal glands c. Pituitary gland Rationale The hypothalamus, pituitary, and adrenal glands act as a system called the hypothalamic-pituitary-adrenal axis (HPA axis) that responds to mental and physical stress. The three hormones secreted (corticotropin-releasing hormone, corticotropin, and cortisol) influence the function of nerve cells of the brain and play an important role in the normal and abnormal mental function. The pancreas is responsible for regulating blood sugar levels, and the parathyroid gland secretes a hormone that regulates calcium levels in the blood.

Which anomaly on a positron emission tomography (PET) scan supports a diagnosis of depression? a. Increase in black areas b. Absence of yellow areas c. Presence of pinkish-red outlines d. Enlargement of the posterior notch

a. Increase in black areas Rationale PET scans of individuals with depression show decreased brain activity in the prefrontal cortex (represented by dark/black areas). The exhibit shows the results of a PET scan taken after a form of radioactively tagged glucose was used as a tracer to visualize brain activity. The diagnosis is not based on enlargement of the posterior notch, absence of yellow areas, or the presence of pinkish-red outlines.

Which antipsychotic medication would be prescribed when a patient with bipolar disorder is diagnosed with depression? a. Lurasidone b. Brexpiprazole c. Chlorprothixene d. Fluphenazine

a. Lurasidone Rationale Lurasidone, a second-generation antipsychotic, is approved for depression associated with bipolar disorder. Brexpiprazole is a second-generation antipsychotic approved for major depressive disorder as adjuncts to antidepressant medications. Chlorprothixene is a thioxanthene, which is a first-generation antipsychotic. Fluphenazine is a phenothiazine, a first-generation antipsychotic.

Which term defines the basic functional unit of the nervous system? a. Neuron b. Synapse c. Receptor d. Neurotransmitter

a. Neuron Rationale Neurons are nerve cells. Cells are the basic unit of function. A neurotransmitter is a chemical substance that functions as a neuromessenger. This neurotransmitter then diffuses across a space, or synapse, to an adjacent postsynaptic neuron, where it attaches to receptors on the neuron's surface.

Which type of cell responds to stimuli, conducts electrical impulses, and releases neurotransmitters? a. Neurons b. Synapses c. Receptors d. Dendrites

a. Neurons Rationale Neurons are the basic functional unit of the nervous system responsible for sending and receiving messages as electrochemical events. Neurotransmitters cross the synapse to the postsynaptic neuron, where they attach to receptors on the neuron's surface. Dendrites are projections of neurons that receive signals from other neurons.

Which interaction of monoamine oxidase with norepinephrine is responsible for relieving depression when tricyclic antidepressants are prescribed? a. Prevention of destruction of norepinephrine b. Stimulation of production of norepinephrine c. Prevention of destruction of monoamine oxidase d. Stimulation of production of monoamine oxidase

a. Prevention of destruction of norepinephrine Rationale Norepinephrine binds to the receptors of the postsynaptic neurons, which causes excitation of the postsynaptic neuron. On interaction with the monoamine oxidase enzyme, norepinephrine is removed from the receptors and is destroyed. The excitatory effect in the postsynaptic neuron also disappears. To prolong the action of norepinephrine, the interaction of norepinephrine with monoamine oxidase is inhibited. This is the mechanism of action of tricyclic antidepressants. Stimulation of norepinephrine production, prevention of monoamine oxidase destruction, and stimulation of monoamine oxidase production are not responsible for relieving depression in the presence of tricyclic antidepressants.

Which information would the nurse include when teaching a patient who was newly prescribed zaleplon? Select all that apply. One, some, or all responses may be correct. a. Works by helping the patient fall asleep. b. Is associated with sleep-related behaviors c. Helps the patient stay asleep throughout the night d. Is a controlled substance associated with misuse e. May result in an unpleasant bitter taste on awakening

a. Works by helping the patient fall asleep. b. Is associated with sleep-related behaviors Rationale Zaleplon is a short-acting sedative-hypnotic sleep agent. Zaleplon has the shortest half-life, approximately 1 hour, and helps patients fall asleep. The US Food and Drug Administration (FDA) has issued warnings on all approved hypnotic medications regarding complex sleep-related behaviors, which include sleepwalking, driving, cooking, or eating. Behaviors occur while the patient is not fully awake, and patients may have no memory of the event. Zaleplon is short-acting, so it would not help the patient stay asleep through the night. Zaleplon is not a controlled substance. Patients taking eszopiclone may experience an unpleasant bitter taste on awakening.

Which area of the brain is responsible for regulating skeletal muscle coordination? a. Midbrain b. Medulla c. Pons d. Cerebellum

d. Cerebellum The cerebellum is involved primarily in the regulation of skeletal muscle coordination and the maintenance of equilibrium. It plays a crucial role in coordinating contractions so that movement is accomplished in a smooth and directed manner. Muscle coordination is not associated directly with the midbrain, pons, or medulla.

Which comment relates to the adverse effect of hyperprolactinemia? a. "My beard has gotten very heavy." b. "I am embarrassed to wear knit shirts." c. "I feel achy and feverish, like I have the flu." d. "My partner complains about my increased interest in sex."

b. "I am embarrassed to wear knit shirts." Rationale Second-generation antipsychotics, such as risperidone, decrease dopamine (D ) activity, which can decrease psychosis but cause adverse effects elsewhere. Decreased D can increase the hormone prolactin, leading to gynecomastia (development of the male mammary glands), galactorrhea (breast milk flow), amenorrhea in women, and low libido. Gynecomastia can seriously disturb a man's body image. Agranulocytosis is suggested by flu-like symptoms. A heavy beard would result from increased testosterone.

Which advice is appropriate to offer to a healthcare worker trying to communicate with a patient diagnosed with schizophrenia? a. "Try talking early in the day to get the best results. Fatigue disorganizes thinking." b. "Medication targets disturbed thought and speech patterns. To maximize improvement, positive interactions and support are needed." c. "Make sure comfort foods are offered and served because they increase serotonin production and will help normalize thoughts and speech." d. "Schizophrenia and Alzheimer's disease both cause irreversible brain damage, so keep your conversations short when you talk to a patient with either disorder."

b. "Medication targets disturbed thought and speech patterns. To maximize improvement, positive interactions and support are needed." Rationale The response, "Medication targets disturbed thought and speech patterns. To maximize improvement, positive interactions and support are needed," will help the nursing assistant understand that improvement can be expected in the patient's condition and that this improvement can be maximized by therapeutic interactions with staff. It establishes the expectation that the nursing assistant will interact in a therapeutic manner. Manipulating interaction based on time of day, distracting the patient with comfort foods, or shortening the duration of the communication do not establish an environment of trust or reflect a therapeutic approach.

Which response would the nurse provide when explaining to a patient with anxiety why temazepam has not been prescribed? a. "Temazepam may increase your anxiety." b. "Temazepam is not approved to treat anxiety." c. "Temazepam is more addictive than antianxiety medications." d. "Temazepam has more side effects than antianxiety medications."

b. "Temazepam is not approved to treat anxiety." Rationale Temazepam is not approved by the US Food and Drug Administration (FDA) to treat anxiety; it has a predominantly hypnotic effect. Increased anxiety associated with benzodiazepines such as temazepam is a symptom of withdrawal. Temazepam is not more addictive than antianxiety medications and does not have more side effects than antianxiety medications.

Which possible aspect of patient history requires prescription of an alternative drug other than doxepin? Select all that apply. One, some, or all responses may be correct. a. Advanced age b. Alcoholism c. Severe urinary retention d. Difficulty in maintaining sleep e. Prescription for monoamine oxidase inhibitor (MAOI) drugs

b. Alcoholism c. Severe urinary retention e. Prescription for monoamine oxidase inhibitor (MAOI) drugs Rationale Silenor is a low-dose formulation of the antidepressant doxepin. The drug causes central nervous system (CNS) depression and, if given with other depressants such as alcohol, it could cause lethal side effects, such as coma. The sedative effect of the drug is most likely from a histamine-1 blockade. It should be avoided in patients with severe urinary retention or in those on MAOI drugs. Doxepin is known to improve sleep duration in older adults and can be prescribed safely to older people. Doxepin is used for treating insomnia characterized by difficulty in maintaining sleep.

Which action explains how psychotropic drugs treat mental illnesses? a. Regulate social behaviors. b. Alter brain neurochemistry. c. Correct brain anatomical defects. d. Activate the body's normal response to stress.

b. Alter brain neurochemistry. Rationale Psychotropic drugs act to increase or decrease neurotransmitter substances within the brain, thus altering brain neurochemistry. Psychotropic drugs are not effective in regulating social behavior; cognitive and/or behavior therapy is used to achieve that outcome. Psychotropic drugs will not alter actual brain anatomy in any way. The body's normal response to stress is mediated via a series of naturally occurring hormones and is not stimulated by the use of psychotropic medications.

Which specific instruction would be given to prevent complications of diazepam owing to excessive central nervous system (CNS) depression? a. Take the drug before going to sleep. b. Avoid consuming alcohol while on the drug. c. Perform activities that require a high degree of alertness. d. Take the drug in conjunction with a tricyclic antidepressant.

b. Avoid consuming alcohol while on the drug. Rationale Diazepam is a benzodiazepine drug. If benzodiazepines are combined with other CNS depressants such as alcohol, then the inhibitory actions of the benzodiazepines can lead to life-threatening CNS depression, such as coma. Taking the drug before going to sleep, avoiding activities requiring a high degree of alertness, or taking the drug in conjunction with a tricyclic antidepressant are not instructions given to avoid CNS depression. The drug should ideally be taken before going to sleep to prevent drowsiness from affecting daily activities. Benzodiazepines impair alertness; therefore it should not be taken while doing activities that require a high degree of attention such as driving a car. Benzodiazepines should never be consumed with tricyclic antidepressants drugs, as their interaction may cause serious CNS depression symptoms, such as coma and respiratory distress.

Which function would be the focus of care for an adult with a tumor in the cerebellum? a. Social judgment b. Balance and equilibrium c. Proprioception and body awareness d. Regulation of pupil size and reflexes

b. Balance and equilibrium Rationale The cerebellum is involved primarily in regulation of skeletal muscle coordination and contraction as well as maintenance of equilibrium. It coordinates muscle contractions, so movement is smooth and purposeful. The frontal lobe manages social judgment. The parietal lobe directs proprioception and body awareness. The midbrain regulates pupil size and reflexes.

Which neurotransmitter imbalance is associated with depression? Select all that apply. One, some, or all responses may be correct. a. Increased histamine b. Decreased serotonin c. Decreased glutamate d. Decreased dopamine e. Increased acetylcholine

b. Decreased serotonin d. Decreased dopamine e. Increased acetylcholine Rationale The neurotransmitter imbalances associated with depression include decreased serotonin, decreased dopamine, and increased acetylcholine. Histamines are associated with alertness, inflammatory response, and gastric secretion. Decreased glutamate is associated with psychosis.

Which information would be provided to a patient who asks why a cholinesterase inhibitor has been prescribed to treat Alzheimer's disease? a. Restores memory b. Delays symptoms of the disease c. Slows the destruction of nerve cells d. Lifts potential depression

b. Delays symptoms of the disease Rationale The best information the nurse can provide is that the medication helps delay the symptoms of the disease. Acetylcholine is decreased in patients with Alzheimer's disease, which affects the patient's memory and ability to think clearly. Cholinesterase inhibits the enzymes from breaking down acetylcholine, which may help delay the symptoms of the disease. Cholinesterase cannot restore memory, slow the destruction of the nerve cells, or treat depression.

Which antianxiety medication would the nurse anticipate administering to a patient experiencing alcohol withdrawal? a. Triazolam b. Diazepam c. Clonazepam d. Flurazepam

b. Diazepam Rationale Benzodiazepines reduce the neuronal overexcitation of alcohol withdrawal. Diazepam is commonly prescribed to prevent alcohol withdrawal seizures. Clonazepam is not prescribed to prevent alcohol seizures but is prescribed to treat anxiety or panic symptoms. Triazolam and flurazepam are benzodiazepines prescribed to treat insomnia.

Which drug would the nurse expect to be included on the medication administration record of a patient diagnosed with depression and diabetes who also reports the loss of sensation in their extremities? a. Venlafaxine b. Duloxetine c. Bupropion d. Desvenlafaxine

b. Duloxetine Rationale The patient is diabetic and has impaired sensation in the extremities, so the patient most likely has diabetic neuropathy. Duloxetine is a serotonin norepinephrine reuptake inhibitor drug (SNRI) and is indicated to treat both depression and diabetic peripheral neuropathy. Venlafaxine and desvenlafaxine are also SNRI drugs but are not useful to treat diabetic neuropathy. Bupropion is an antidepressant drug that is not useful to treat diabetes; this drug can, however, be useful for smoking cessation.

Which side effect associated with the D2 receptor blockade occurs with butyrophenone? a. Anovulation b. Galactorrhea c. Menorrhagia d. Dysmenorrhea

b. Galactorrhea Rationale First-generation antipsychotics such as butyrophenones, also known as typical antipsychotics, decrease dopamine activity in the central nervous system by blocking D2 receptors. This blockade can lead to galactorrhea in men and women. Anovulation (the absence of ovulation), menorrhagia (a heavy menstrual period), and dysmenorrhea (a painful menstrual period) are not side effects of blocking the D2 receptors.

Which medical condition may exist when a patient displays mild symptoms of mania? a. Diabetes b. Graves' disease c. Encephalopathy d. Transient ischemic attack (TIA)

b. Graves' disease Rationale Hyperthyroidism, or Graves' disease, is linked to mania, and the patient must be treated for the hyperthyroidism before it progresses to thyrotoxicosis. A patient with diabetes, encephalopathy, or a TIA may present with other mental alterations secondary to the medical diagnosis, but does not typically present with mania.

Which physiological process of the brain is needed to increase blood pressure? Select all that apply. One, some, or all responses may be correct. a. Blood vessels dilate. b. Heart pumps more blood. c. Blood vessels constrict. d. Heart reduces the heart rate. e. Heart contracts with less force.

b. Heart pumps more blood. c. Blood vessels constrict. Rationale If the blood pressure has dropped, the brain directs the heart to pump more blood in the heart and increase the cardiac output. The brain also directs the blood vessels to constrict to increase peripheral resistance. These mechanisms are responsible for increasing the blood pressure to a normal level. If the blood vessels were to dilate, then the peripheral resistance would reduce and the blood pressure would be further reduced. If the heart rate or contracting force were to reduce, cardiac output would be further decreased and would lessen blood pressure.

A patient wants to understand why quetiapine, an antipsychotic as prescribed to treat their symptoms of depression. After providing education about the neurotransmitters in the brain, which information would the nurse include about quetiapine? Select all that apply. One, some, or all responses may be correct. a. Blocks the histamine receptors b. Increases the uptake of serotonin c. Increases the uptake of acetylcholine d. Interferes with the reuptake of norepinephrine e. Causes the release of dopamine from the neurons.

b. Increases the uptake of serotonin d. Interferes with the reuptake of norepinephrine e. Causes the release of dopamine from the neurons. Rationale In addition to treating psychosis and mania, several second-generation antipsychotics, such as quetiapine, are approved by the US Food and Drug Administration (FDA) to treat depressive symptoms. Possible mechanisms explaining the antidepressant actions of antipsychotics include 5-HT2A receptor antagonism, which causes the release of dopamine from the neurons, partial 5-HT2A receptor agonism, and serotonin and norepinephrine reuptake inhibition. Firs-generation antipsychotics work by blocking the histamine receptors and uptake of acetylcholine.

Which neurotransmitter potentiates the therapeutic effects of ramelteon? a. Serotonin b. Melatonin (MT) c. Norepinephrine d. γ-Aminobutyric acid (GABA)

b. Melatonin (MT) Rationale MT is a hormone excreted only at night as part of the normal circadian rhythm. Ramelteon is an MT receptor agonist and has a high selectivity and potency at the MT receptor sites, which regulate sleepiness and circadian rhythms. Potentiating action of serotonin and norepinephrine improves depression. Potentiating action of GABA reduces anxiety.

Which order accurately describes the brainstem structures according to their anatomical position, beginning with the most superior? a. Pons b. Midbrain c. Medulla oblongata

b. Midbrain a. Pons c. Medulla oblongata Rationale The brainstem is composed of the midbrain, which is most superior, followed by the pons and medulla oblongata.

Which function problem is anticipated in a patient diagnosed with a tumor in the brain's frontal lobe? a. Hearing b. Motor function c. Interpretation of visual stimuli d. Sensory abilities

b. Motor function Rationale The premotor cortex is responsible for the coordinated movement of multiple muscles, and the somatic association cortex integrates motor commands. The somatic association cortex is the area of the brain responsible for coordinating learned motor skills. Cognition, memory, and analytic functions are largely related to the third region of the frontal lobe known as the prefrontal cortex. Damage to this area of the frontal lobe may cause changes in personality. Sounds are processed in the temporal lobe. Vision is housed in the occipital lobe. The sensation of touch resides in the parietal lobe.

Which structure or function of the brain influences secretion of the neurotransmitters norepinephrine and serotonin? a. Hypothalamus b. Limbic system c. Circadian rhythm d. Sleep and wakefulness

c. Circadian rhythm Rationale The circadian rhythm, which is the fluctuation of various physiological and behavioral patterns over a 24-hour cycle, influences the secretion of norepinephrine and serotonin. The hypothalamus is responsible for secreting hormones called releasing factors that act on the pituitary gland to stimulate or inhibit the synthesis and release of pituitary hormones. The limbic system is involved in modulating the emotional value of sensory material and uses norepinephrine, serotonin, and dopamine. The cycle of sleep and wakefulness is regulated and controlled by various parts of the brain and is affected by neurotransmitters.

Which classification of medication requires careful assessment for development of abnormal movement disorders? a. Anticonvulsant b. Mood stabilizer c. First-generation antipsychotic d. Selective serotonin reuptake inhibitor (SSRI)

c. First-generation antipsychotic Rationale First-generation antipsychotic medications have a high likelihood of producing abnormal movements, which may include pseudoparkinsonism, dystonia, and tardive dyskinesia. Patients taking anticonvulsants for mood stabilization should be monitored closely for skin rashes and disturbances in hepatic function. Mood stabilizers, such as lithium, cause disturbances in fluid balance in various body compartments. SSRIs have a minimal effect on abnormal movements.

Which imaging technique requires an injection of a substance that then is traced to gather data regarding brain function? Select all that apply. One, some, or all responses may be correct. a. Electroencephalograph (EEG) b. Magnetic resonance imaging (MRI) c. Positron emission tomography (PET) d. Axial computed tomography (CT) e. Single-photon emission computed tomography (SPECT)

c. Positron emission tomography (PET) e. Single-photon emission computed tomography (SPECT) Rationale PET uses an injected radioactive substance (tracer) that travels to the brain and shows up as bright spots on the scan. Data collected by the detectors are relayed to a computer. Similar to PET, SPECT uses radionuclides that emit gamma radiation (photons). This allows for the measuring of various aspects of brain functioning and provides images of multiple layers of the central nervous system (CNS). No injection is required of an EEG, CT, or MRI.

Which statement by the sibling of a person diagnosed with depression demonstrates effective learning about the disorder? a. "If our family had better health insurance, we could afford better treatments for this disorder." b. "This problem probably resulted from our mother's frequent alcohol use during pregnancy." c. "This problem is the result of personality flaws. My sibling has always had difficulty getting along with others." d. "This problem probably was caused by certain genes. There are several members of our family who also have depression."

d. "This problem probably was caused by certain genes. There are several members of our family who also have depression." Rationale There is often a genetic predisposition for psychiatric disorders. The incidence of both thought and mood disorders are higher in relatives of people with these diseases than in the general population. The quality of health insurance is not a cause for depression. Maternal use of alcohol during pregnancy causes learning and behavioral problems. Personality characteristics may contribute to the problem but are not the cause.

A patient who has been taking flurazepam for insomnia has been prescribed zolpidem. Which information would the nurse include int he patient's education? a. "Zolpidem is a longer-acting sleep agent/" b. "Zolpidem will help decrease you anxiety." c. "Zolpidem will help treat your muscle spasms." d. "Zolpidem causes less tolerance than flurazepam."

d. "Zolpidem causes less tolerance than flurazepam." Rationale Zolpidem is a nonbenzodiazepine receptor agonist that is a short-acting sleep agent. Zolpidem has caused less tolerance and dependence than benzodiazepines like flurazepam. Zolpidem does not have an antianxiety or muscle relaxant effect.

Which receptor is blocked as a result of psychotropic drugs when a patient reports dry mouth, constipation, and blurred vision? a. Alpha (α ) 1 b. Histamine (H ) 1 c. Serotonin (5-HT ) 2 d. Acetylcholine (ACh)

d. Acetylcholine (ACh) Rationale The blocking of ACh receptors causes symptoms such as dry mouth, constipation, and blurred vision. Therefore, the drug most likely blocks the ACh receptors. Side effects of α receptor blockers include postural hypotension, dizziness, reflex tachycardia, and memory dysfunction. Drugs that block 5-HT2 receptors may cause side effects such as hypotension and ejaculatory dysfunction. Drugs that block H receptors cause sedation or drowsiness, hypotension, and weight gain.

Which finding in a positron emission tomography (PET) scan would confirm the diagnosis of schizophrenia? a. Reduction of the temporal lobe b. Enlargement of the third ventricle c. Enlargement of the prefrontal lobe d. Decreased glucose utilization in the frontal lobes

d. Decreased glucose utilization in the frontal lobes Rationale A PET scan is a functional imaging technique that reveals the physiological activity of the brain. In a patient with schizophrenia, the scan would reveal decreased glucose utilization in the frontal lobes. Reduction of the temporal lobe and enlargement of the third ventricle are findings associated with schizophrenia and are revealed by structural imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT). The prefrontal lobe is atrophied in schizophrenia. An enlarged prefrontal lobe is not a finding associated with schizophrenia.

Which preliminary finding is expected for a patient diagnosed with schizophrenia who is evaluated with single-photon emission computed tomography (SPECT)? a. Cerebral edema b. Areas of lesions in the brain c. Abnormal electrical activity in the brain d. Decreased use of glucose in the frontal lobe

d. Decreased use of glucose in the frontal lobe Rationale In a patient diagnosed with schizophrenia who is evaluated with SPECT, the preliminary expected finding is decreased glucose metabolism in the frontal lobe. The SPECT scan is used to examine the physiological activity of the brain. A structural assessment with magnetic resonance imaging is used to detect cerebral edema. A computed tomography scan provides a structural assessment of the brain and can be used to detect lesions in the brain. The electroencephalograph is used to assess electrical activity in the brain.

Which neurotransmitter imbalance occurs in a patient with schizophrenia? a. Increased somatostatin b. Increased acetylcholine c. Decreased norepinephrine d. Decreased γ-aminobutyric acid

d. Decreased γ-aminobutyric acid Rationale A decrease in γ-aminobutyric acid occurs with schizophrenia. An imbalance of somatostatin and acetylcholine are not related to schizophrenia. Increased levels of norepinephrine are related to schizophrenia.

Which order correctly defines the process of neurotransmission? a. Excitation of the postsynaptic neuron b. Removal and destruction of the neurotransmitters c. Binding of the neurotransmitters to the receptors d. Electric impulse reaching the presynaptic neuron e. Release of neurotransmitters from the presynaptic neuron f. Diffusion of the neurotransmitters into the synapse

d. Electric impulse reaching the presynaptic neuron e. Release of neurotransmitters from the presynaptic neuron f. Diffusion of the neurotransmitters into the synapse c. Binding of the neurotransmitters to the receptors a. Excitation of the postsynaptic neuron b. Removal and destruction of the neurotransmitters Rationale When an electrical impulse reaches the end of a neuron, the neurotransmitters are released from the presynaptic terminal. These neurotransmitters then diffuse into the synapse or the postsynaptic terminal and bind to the receptor sites. The binding causes excitation of the postsynaptic neuron. The neurotransmitters are then removed from the receptor sites and are destroyed owing to the action of enzymes.

Which assessment finding in a patient with insomnia who has been prescribed doxepin would lead the nurse to ask for a medication change? a. Sexual dysfunction b. Headache and dizziness c. Impaired cerebellar function d. Enlarged bladder as a result of urinary retention

d. Enlarged bladder as a result of urinary retention Rationale The patient having an enlarged bladder indicates severe urinary retention. Doxepin is to be avoided in patients with severe urinary retention as it can cause adverse effects. Sexual dysfunction, headache, dizziness, and impaired cerebellar function are not associated with doxepin. Sexual dysfunction is a side effect associated with the longterm use of ramelteon. Headache and dizziness are also side effects associated with ramelteon. Impaired cerebellar function (ataxia) is a side effect associated with benzodiazepine drugs.

Which drug may cause an unpleasant taste? a. Zaleplon b. Triazolam c. Etizolam d. Eszopiclone

d. Eszopiclone Rationale Unpleasant taste is a side effect associated with eszopiclone, which is a short-acting sedative hypnotic drug (Z drug). If this drug causes discomfort to the patient, the nurse should ask the primary healthcare provider to replace it. Triazolam and etizolam are benzodiazepine drugs that do not have unpleasant taste as a side effect. The side effects associated with benzodiazepine drugs are impaired attention, judgment, and ataxia. Zaleplon is yet another short-acting sedative hypnotic drug (Z drug). Unpleasant taste is not a side effect associated with this drug.

Which neurotransmitter effect occurs with anxiolytic medication? a. Increases the release of serotonin b. Facilitates the transmission of glutamate c. Decreases excess dopamine from the presynaptic neuron d. Increases the effectiveness of γ-aminobutyric acid (GABA)

d. Increases the effectiveness of γ-aminobutyric acid (GABA) Rationale Anxiolytics act by increasing the effectiveness of GABA, which plays a role in modulating neuronal excitability and anxiety. Anxiolytics do not increase the release of serotonin, facilitate the transmission of glutamate, or decrease excess dopamine.

Which medication calls for careful nursing assessment of fluid and electrolyte balance? a. Clozapine b. Fluvoxamine c. Lamotrigine d. Lithium

d. Lithium Rationale Lithium can cause disturbances in fluid balance in various body compartments. Sodium and potassium play a strong role in regulating fluid balance. Hyponatremia can increase the risk of lithium toxicity because increased renal reabsorption of sodium leads to increased reabsorption of lithium. Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) and has minimal effect on fluid and electrolyte balance. Clozapine is a second-generation antipsychotic medication; patients taking this medication should be monitored for agranulocytosis. Lamotrigine is an anticonvulsant used as a mood stabilizer and modulates the release of glutamate and aspartate. Patients taking this medication should be monitored for skin rashes.

Which symptoms reported by a patient prescribed risperidone are considered side effects of the medication? a. Rapid heartbeat, red rash, and hive b. Reports of falls, heartburn, and nausea c. Dry mouth, poor urinary output, and constipation d. Tiredness during the day, weight gain, and reports of dizziness

d. Tiredness during the day, weight gain, and reports of dizziness Rationale Histamine (H1) blockade, as is seen with risperidone, has the potential to produce sedation, weight gain, and hypotension. Risperidone has not been documented as a direct cause for falls but can cause dyspepsia and nausea. Tachycardia and hives are not associated with use of risperidone, but rash is possible. Dry mouth and constipation can be side effects of risperidone use, but decrease in urinary output is not typical.

Which symptoms reported by a patient prescribed risperidone are considered side effects of the medication? a. Rapid heartbeat, red rash, and hives b. Reports of falls, heartburn, and nausea c. Dry mouth, poor urinary output, and constipation d. Tiredness during the day, weight gain, and reports of dizziness

d. Tiredness during the day, weight gain, and reports of dizziness Rationale Histamine (H ) blockade, as is seen with risperidone, has the potential to produce sedation, weight gain, and hypotension. Risperidone has not been documented as a direct cause for falls but can cause dyspepsia and nausea. Tachycardia and hives are not associated with use of risperidone, but rash is possible. Dry mouth and constipation can be side effects of risperidone use, but decrease in urinary output is not typical.

Which neurotransmitter is implicated with panic attacks? a. Serotonin b. Acetylcholine c. Norepinephrine d. γ-Aminobutyric acid (GABA)

d. γ-Aminobutyric acid (GABA) Rationale GABA is derived chemically from glutamate and is the brain's principal inhibitory neurotransmitter. Nerve cells stimulated by inhibitory neurotransmitters, such as GABA, will be turned off, which slows or stops actions completely in postsynaptic neurons. GABA is directly involved in regulation of muscle tone. Norepinephrine innervates smooth muscles in blood vessels, increases blood pressure, and is present in the fight or flight response. Acetylcholine acts throughout the autonomic nervous system (ANS) and usually has an antiexcitatory action; however, it can have excitatory action at neuromuscular junctions. Serotonin is similar in action to norepinephrine and is involved in maintaining body temperature, eating patterns, sleep/wake cycles, and regulating mood.

Which neurotransmitter is related to frequent anxiety? a. Dopamine b. Glutamate c. Monoamine oxidase d. γ-Aminobutyric acid (GABA)

d. γ-Aminobutyric acid (GABA) Rationale The neurotransmitter GABA plays a role in modulating neuronal excitability and anxiety. Many antianxiety (anxiolytic) drugs increase the effectiveness of this neurotransmitter, primarily by increasing receptor responsiveness. Dopamine is involved in thought processes and regulation of movement. Glutamate is associated with memory and learning. Monoamine oxidase is an enzyme involved in regulating metabolism of norepinephrine.

Which neurotransmitter does diazepam bind with to relieve anxiety? a. α receptors b. Dopamine (D 2) receptors c. Serotonin (5-HT 1) receptors d. γ-Aminobutyric acid (GABA) receptors

d. γ-Aminobutyric acid (GABA) receptors Rationale Diazepam belongs to the class of benzodiazepines. These drugs relieve anxiety by binding to GABA receptors. GABA is the major inhibitory neurotransmitter in the central nervous system. Therefore, blocking the GABA receptors would prevent inhibition of the central nervous system and relieve anxiety. Diazepam does not bind with α, 5-HT , or D receptors. Blocking α and 5-HT receptors (norepinephrine and serotonin receptors) would cause depression. Blocking D receptors would relieve symptoms of schizophrenia, such as hallucinations and delusions.