Psych Exam 1 - Ch. 3 (Psychobiology & Psychopharmacology)
A man diagnosed with schizophrenia has taken risperidone (Risperdal) for 6 weeks. Which comment by this patient relates to the adverse effect of hyperprolactinemia?
"I am embarrassed to wear knit shirts." Second generation antipsychotics, such as risperidone, decrease D2 activity, which can decrease psychosis but cause adverse effects elsewhere. Decreased D2 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. p. 58
Neurons are the basic functional unit of the nervous system responsible for sending and receiving messages as electrochemical events. p. 40
2 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. p. 40
A patient who is extremely alert is startled every time the nurse enters the room. The patient is unable to sleep. What type of drug should be prescribed to the patient?
A drug that inhibits norepinephrine activity The patient is extremely alert and is startled every time the nurse enters the room. This indicates that the patient's sympathetic nervous system is hyperactive. Norepinephrine is primarily responsible for causing attention and arousal. It stimulates the sympathetic branch of the autonomic nervous system for "fight or flight" in response to stress. Therefore this patient should be prescribed a drug that inhibits norepinephrine activity, such as atomoxetine (Strattera). Dopamine is involved in fine muscle movement and integration of emotions and thoughts, and it is inhibited by drugs such as amineptine (Survector). Histamine is involved in the inflammatory process and stimulates gastric secretion. It is inhibited by drugs such as fexofenadine (Allegra). Substance P is associated with the modulation of pain sensation. p. 39
Treatment of mental illnesses with psychotropic drugs is directed toward which of the following?
Altering brain neurochemistry Psychotropic drugs act to increase or decrease neurotransmitter substances within the brain, thus altering brain neurochemistry. Psychotropic drugs will not alter actual brain anatomy in any way. They also are not effective in regulating social behavior; cognitive and/or behavior therapy is used to achieve that outcome. 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. p. 49
A nurse is discussing diazepam (Valium) with a patient with anxiety. What specific instruction should the nurse give to prevent complications of this prescribed medication due to excessive central nervous system (CNS) depression?
Avoid consuming alcohol while on the drug. Diazepam (Valium) is a benzodiazepine drug. If benzodiazepines are combined with other central nervous system (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. p. 49
A nurse plans care for an adult with a tumor in the cerebellum. Initial interventions should focus on the patient's anticipated problems with which of the following?
Balance and equilibrium 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. pp. 42, 43, Figure 3.4
The nurse is discussing prescription drugs with a patient. The side effect of one of the patient's prescribed drugs is drowsiness. What would the nurse explain is the most appropriate time to take this drug so that the side effects are reduced?
Before going to bed 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. p. 49
When interviewing a patient who takes psychotropic drugs, the nurse finds that the patient has side effects such as dry mouth, constipation, and blurred vision. What is the most likely cause of these side effects?
Blocking of acetylcholine (ACh) receptors The blocking of acetylcholine (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 1 receptor blockers include postural hypotension, dizziness, reflex tachycardia, and memory dysfunction. Drugs that block 5-HT 2 receptors may cause side effects such as hypotension and ejaculatory dysfunction. Drugs that block H 1 receptors cause sedation or drowsiness, hypotension, and weight gain. p. 51, Figure 3.12
Which assessment finding best indicates release of norepinephrine?
Blood pressure changes from 126/70 to 158/84 mm Hg. 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). p. 53
Which of the identified areas on the graphic of the brain is responsible for regulating skeletal muscle coordination? (FIG. 3.4, p. 43)
Cerebellum The cerebellum is involved primarily in the regulation of skeletal muscle coordination and contraction 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. p. 42
A patient is suspected of having a middle-cerebral artery aneurysm. Which diagnostic test would the nurse expect to be ordered for the patient?
Computed tomography (CT) Computed tomography is useful for detecting the presence of lesions, abrasions, and aneurysms. An electroencephalogram is useful to find out whether a person is awake, sleeping, or in an anesthetized state. Magnetic resonance imaging (MRI) and functional MRI can detect the presence of brain edema, ischemia, infection, neoplasm, or trauma. p. 45, Table 3.2
A nurse is assessing a patient who has been diagnosed with severe depression. On assessment, the nurse finds that the patient is diabetic and has a loss of sensation in the extremities. Which drug would the nurse expect to have included in the patient's treatment?
Duloxetine (Cymbalta) The patient is diabetic and has impaired sensation in the extremities, so the patient most likely has diabetic neuropathy. Duloxetine (Cymbalta) is a serotonin-norepinephrine reuptake inhibitor drug (SNRI), which is indicated to treat both depression and diabetic peripheral neuropathy. Venlafaxine (Effexor) and desvenlafaxine (Pristiq) are also SNRI drugs but are not useful to treat diabetic neuropathy. Bupropion (Wellbutrin) is an antidepressant drug that is not useful to treat diabetes; this drug can, however, be useful for smoking cessation. p. 53
While performing a follow-up assessment of a patient treated for insomnia, the nurse finds that the patient's sleep quality has improved. However, the patient complains of an unpleasant taste in the morning after waking up, which causes the patient to want to skip breakfast. Which drug should the nurse consider replacing for the patient?
Eszopiclone (Lunesta) Unpleasant taste is a side effect associated with eszopiclone (Lunesta), which is a short-acting sedative hypnotic drug (Z drug). If this drug causes discomfort to the patient, the nurse should ask the primary health care provider to replace it. Triazolam (Halcion) and estazolam (Prosom) 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 (Sonata) is yet another short-acting sedative hypnotic drug (Z drug). Unpleasant taste is not a side effect associated with this drug. pp. 49-50
An adult complains of frequent anxiety. Which neurotransmitter is related to this complaint most?
Gamma aminobutyric acid (GABA) 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. p. 47
The medication prescribed for a patient acts by blocking reuptake of both serotonin and norepinephrine. The nurse evaluates the treatment as successful when observing which of the following?
Laughing at a joke Depression is thought to be at least in part caused by lowered levels of serotonin and norepinephrine. Increasing the amount of these transmitters in the brain by blocking reuptake may result in mood elevation. p. 51, Figure 3.12
Administration of which medication calls for careful nursing assessment of fluid and electrolyte balance?
Lithium (Eskalith, Lithobid) 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; it is important to monitor for agranulocytosis. Lamotrigine is an anticonvulsant used as a mood stabilizer. It modulates the release of glutamate and aspartate. It is important to monitor for skin rashes. p. 55
What is the basic functional unit of the nervous system is called?
Neuron 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. p. 40
What are the cells that respond to stimuli, conduct electrical impulses, and release neurotransmitters?
Neurons Neurons are the basic functional unit of the nervous system responsible for sending and receiving messages as electrochemical events. p. 40
A patient being medicated for both hallucinations and delusions reports being drowsy. The nurse will interpret this symptom correctly as related to the drug's effect on the brain's ability to regulate which of the following?
Sleep A number of psychotropic drugs have side effects that interfere with the brain's ability to regulate sleep alertness. These side effects range from lethargy to extreme drowsiness. As the patient's body becomes accustomed to the drug, the drowsiness should dissipate. p. 45
When interviewing a patient who takes psychotropic drugs, the nurse finds that the patient has side effects such as dry mouth, constipation, and blurred vision. What is the most likely cause of these side effects?
Sleep A number of psychotropic drugs have side effects that interfere with the brain's ability to regulate sleep alertness. These side effects range from lethargy to extreme drowsiness. As the patient's body becomes accustomed to the drug, the drowsiness should dissipate. p. 45
The nurse is assessing a patient with insomnia who has been prescribed doxepin (Silenor). After the assessment the nurse requests the primary health care provider to change this medication. What finding in the patient would have led the nurse to take this action?
The patient has an enlarged bladder due to urinary retention. The patient having an enlarged bladder with urinary retention indicates that the urinary retention is severe. Doxepin (Silenor) 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 (Silenor). Sexual dysfunction is a side effect associated with the long-term use of ramelteon (Rozerem). Headache and dizziness are also side effects associated with ramelteon (Rozerem). Impaired cerebellar function (ataxia) is a side effect associated with benzodiazepine drugs. p. 50
A patient has been prescribed a sedative drug. The patient reports to the nurse that he or she erroneously took the drug after eating breakfast. What instruction should the nurse give the patient in such a situation?
"Do not drive right away." Sedative hypnotic drugs blunt the alertness of a patient. Therefore, the patient is cautioned against performing high-precision activities like driving after taking the drug. If the patient drives after taking the drug, accidents can occur. The patient would feel drowsy after the drug, and sleeping would not harm the patient in any way. The patient can eat food after taking the drug as the food would not interact with the drug and cause any effects. Taking a bath immediately after taking the drug would not harm the patient. pp. 49-50
A patient is prescribed buspirone for anxiety. Which statement is important for the nurse to include in the medication teaching?
"The medication may make you feel dizzy." The statement that is important for the nurse to include in the medication teaching is, "The medication may make you feel dizzy." Buspirone is a drug that is 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. p. 50
The healthcare provider orders a cholinesterase inhibitor for a patient diagnosed with Alzheimer disease. The patient asks the nurse, "How is this going to help me?" What is the nurse's best response?
"This drug will help delay the symptoms of the disease." The nurse's best response is, "This drug will help delay the symptoms of the disease." Acetylcholine is decreased in patients with Alzheimer 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 down the destruction of the nerve cells, or treat depression. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question. p. 60
Which neuroimaging techniques demonstrate structural rather than functional problems?
-Computed tomography (CT) -Magnetic resonance imaging (MRI) 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. p. 45, Table 3.2
Which neuroimaging techniques demonstrate structural rather than functional problems? (SATA)
-Computed tomography (CT) -Magnetic resonance imaging (MRI) 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. p. 45, Table 3.2
Which neurotransmitter imbalances are associated with depression? (SATA)
-Decreased serotonin -Decreased dopamine -Increased acetylcholine 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. p. 41
Which areas of safety should be discussed with a patient who has just been prescribed a benzodiazepine (BZD)? (SATA)
-Drug interaction -Impaired judgment -Poor concentration -Impaired motor function 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. p. 49
The nurse is studying a drug monograph of an antidepressant drug before explaining the drug to the patient. The nurse finds that the drug blocks the 5-HT2 and acetylcholine receptors. Based on this information, which are the most likely side effects of the drug? (SATA)
-Dry mouth -Hypotension -Urinary retention -Ejaculatory dysfunction The antidepressant effects of the drug are due to blockage of the 5-HT2 receptors. The drug also blocks acetylcholine receptors. Hypotension is a side effect associated with 5-HT2 receptor blocking. Dry mouth is a side effect associated with blockage of acetylcholine receptors. Urinary retention is a side effect associated with blocking the acetylcholine receptors. Ejaculatory dysfunction is a possible side effect of blocking the 5HT2 receptors. Tachycardia and gastric disturbances are not side effects associated with this antidepressant drug. Tachycardia is a side effect of drugs that cause norepinephrine reuptake inhibition. Gastric disturbance is a side effect of drugs that inhibit 5-HT reuptake. p. 57, Figure 3.18
A patient prescribed an antidepressant that blocks acetylcholine is likely to require which intervention? (SATA)
-Low-fat diet -A mild laxative -Cardiac monitoring -Instructions to report blurred vision Possible side effects resulting from the use of an acetylcholine blocker include blurred vision, dry mouth, constipation, sinus tachycardia, and urinary retention. Sleep dysfunction is not associated with the use of this type of medication. p. 51, Figure 3.12
A nurse plans to give relaxation therapy to a patient who is extremely anxious. What symptoms in a patient would have led the nurse to make this decision? (SATA)
-The patient is breathing rapidly. -The patient is sweating profusely. Increased respiratory rate and profuse sweating indicate that the patient is anxious. The symptoms are caused by stimulation of the sympathetic nervous system. An overactive sympathetic nervous system may cause an increased level of cortisol, resulting in increased respiratory rate and sweating. Lethargy, depression, and anger are not manifestations of activation of the sympathetic nervous system. p. 38
Which parts of the body secrete hormones that are a normal component of the body's general response to stress?
Brain, pituitary gland, adrenal glands The hypothalamus, pituitary, and adrenal glands act as a system 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. p. 39
A patient suspected of having schizophrenia has been referred for a positron emission tomography (PET) scan. What findings in the PET scan would confirm the diagnosis in this patient?
Decreased glucose utilization in the frontal lobes A positron emission tomography (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, which 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. p. 44
The nurse administers medication from each of the following drug groups to various patients. The patient who receives a medication from which group should be assessed most carefully for development of abnormal movement disorders?
First generation antipsychotic First generation antipsychotic medications have a high likelihood of producing abnormal movements, which may include pseudoparkinonsism, dystonia, and tardive dyskinesia. Patients taking anticonvulsants used as a mood stabilizer should be monitored closely for disturbances in hepatic function and skin rashes. Mood stabilizers, such as lithium, cause disturbances in fluid balance in various body compartments. SSRIs have a minimal effect on abnormal movements. p. 56
A healthcare provider orders an anxiolytic for a patient. What neurotransmitter effect does the anxiolytic have?
Increases the effectiveness of gamma-aminobutyric acid (GABA) 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. p. 48
A nurse administering ramelteon (Rozerem) should understand that therapeutic effects result from potentiating which neurotransmitter?
Melatonin (MT) Melatonin is a hormone excreted only at night as part of the normal circadian rhythm. Ramelteon is an MT receptor agonist. It has a high selectivity and potency at the MT receptor sites, which regulate sleepiness and circadian rhythms. Potentiating action of GABA reduces anxiety. Potentiating action of serotonin and norepinephrine improves depression. p. 50
The nurse is assessing a patient with anxiety and depression. The patient also has sexual dysfunction and occasional nausea. Which antidepressant drug would be most suitable for this patient?
Mirtazapine (Remeron) The most suitable antidepressant drug for this patient would be mirtazapine (Remeron). This drug has both antianxiety and antidepressant effects, with minimal sexual dysfunction. This drug also has antiemetic properties that could relieve the nausea. Fluoxetine (Prozac), citalopram (Celexa), and escitalopram (Lexapro) are selective serotonin reuptake inhibitor drugs. These drugs bind with 5-HT receptors and can aggravate sexual dysfunction in the patient. p. 53
Which nursing assessment is the priority assessment when administering risperidone (Risperdal)?
Monitoring for abnormal involuntary movements Risperidone has the highest rate of extrapyramidal side effects (EPS) of the second-generation antipsychotic medications, thus making it imperative to monitor for EPS. Risperidone is not monitored with blood levels and does not cause mania or memory changes. p. 58
A nurse plans the care for an adult with a tumor in the brain's frontal lobe. Initial interventions should focus on the patient's anticipated problems with what function?
Motor function and judgment 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 functions of a third region of the frontal lobe, known as the prefrontal cortex. Damage to this area of the frontal lobe may cause changes in personality. pp. 43, 44, Figure 3.5
A nurse is assessing a stroke patient and finds that there is loss of sensation and proprioception in the left upper and lower limbs. The patient has lost the ability to distinguish between left and right side. What part of the cerebrum could potentially have a lesion?
Parietal lobe 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. p. 43
Which imaging technique can provide information about brain function?
Positron emission tomography (PET) scan The positron emission tomography scan provides information about function; CT scan, MRI scan, and skull radiograph provide information about structure. p. 45, Table 3.2
The incoherent thought and speech patterns of the patient with schizophrenia are related to the brain's inability to do which of the following?
Regulate conscious mental activity When the brain cannot regulate conscious mental activity, the individual's speech patterns demonstrate incoherence and lack of reality orientation. p. 39
The behavior of an individual who seems unable to learn right from wrong, who repeatedly violates laws, and who lies demonstrates problems related to the brain's inability to do which of the following?
Regulate social behavior The inability to regulate social behavior usually results in antisocial behaviors such as lying, cheating, taking advantage of others, and breaking laws. p. 39
The nurse is assessing a patient with insomnia who has been taking temazepam (Restoril) for 2 weeks. The nurse finds that the patient has a wide-based gait (ataxia). The nurse explains to the caregivers that this is a side effect of the drug. What anatomical characteristic of the brain promotes development of ataxia as a side effect of the drug?
The cerebellum has numerous gamma-aminobutyric acid (GABA) receptors. Temazepam (Restoril) is a benzodiazepine drug that enhances the activity of the GABA receptors and causes sedation. There are numerous GABA receptors in the cerebellum, which are stimulated by benzodiazepine drugs, causing ataxia. Increased glutamate receptor activity has an excitatory effect on the central nervous system. This can cause neurodegeneration in Alzheimer's disease. Benzodiazepines do not act on glutamate receptors (NMDA and AMPA receptors). Ataxia is a movement disorder caused by cerebellar dysfunction; frontal lobe dysfunction does not cause ataxia. p. 49
An adult has panic attacks. Which neurotransmitter is most implicated in this problem?
γ-Aminobutyric acid (GABA) 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. It 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. It is involved in maintaining body temperature, eating patterns, sleep/wake cycles, and regulating mood. p. 47
