Chapter 3 Questions
The client's family asks whether hypothyroidism and Parkinson's disease are associated with any mental health issues. The nurse answers, "Yes, the main concern is: 1. depression." 2. bipolar disorder." 3. schizophrenia." 4. posttraumatic stress disorder."
1 Hypothyroidism and Parkinson's disease have been correlated with depression. The other mental health disorders in options 2, 3, and 4 have not been connected.
A client with depression mentions to the nurse, "My mother says depression is a chemical disorder. What does she mean?" The nurse's response is based on the theory that depression primarily involves the following neurotransmitters: 1. Serotonin and dopamine 2. Cortisol and GABA 3. COMT and glutamate 4. Monamine and glycine
1 One possible cause of depression is thought to involve one or more neurotransmitters. Serotonin and dopamine have been found to be important in the regulation of depression.
A client with chronic schizophrenia has had a stroke involving the hippocampus. The client will be discharged on low doses of haloperidol. The nurse who must provide medication teaching will need to adjust the teaching plan to account for client problems with: 1. Memory 2. Expressive aphasia 3. Emotional control 4. Poor balance and coordination
1 The hippocampus plays a major role in short-term memory and, hence, in learning. The other defects mentioned (options 2, 3, and 4) originate in other parts of the brain.
Which statement is true as it relates to the history of psychopharmacology? 1. Before 1950, only sedatives and amphetamines were available as psychotropics. 2. Phenothiazines were initially used in pain management for their sedative effect. 3. Atypical antipsychotics were the first medications used to treat the positive symptoms of schizophrenia. 4. Psychotropic medications have assisted health-care providers in their struggle to cure mental illness.
1. Sedatives and amphetamines were the only medications available before 1950, and they were used sparingly because of their toxicity and addictive properties.
Regarding the etiology of schizophrenia spectrum disorders, which of the following support(s) a biological theory? Select all that apply. 1. Dopamine hypothesis. 2. Prenatal exposure to influenza. 3. Ventricular and sulci atrophy. 4. Downward drift hypothesis. 5. Increased level of serotonin.
1. The dopamine hypothesis suggests that an excess of the neurochemical dopamine in the brain causes schizophrenia spectrum disorders. An alteration in neurochemicals is an example of a biological theory. 2. There are studies to suggest that exposure to a viral infection is most significant if it occurs during the second trimester of pregnancy. Further research is required to understand this biological theory better, called psychoimmunology. 5. It has been found that individuals diagnosed with schizophrenia spectrum disorders have increased amounts of serotonin.
Which of the following are true statements about neurotransmitters? Select all that apply. 1. Neurotransmitters are responsible for essential functions in human emotions and behaviors. 2. Neurotransmitters are targets for the mechanism of action of many psychotropic medications. 3. Neurotransmitters are only studied for their effect related to psychiatric disease processes. 4. Neurotransmitters are nerve cells that generate and transmit the body's electrochemical impulses. 5. Neurotransmitters are cholinergics, such as serotonin, norepinephrine, dopamine, and histamine.
1. The message sent through a neurotransmitter plays a role in human emotions and behaviors. 2. Because neurotransmitters send messages specific to emotions and behaviors, they have been found to be useful targets of psychotropic medications.
Which situation supports the biological theory of the development of bipolar affective disorder? 1. A client is prescribed a selective serotonin reuptake inhibitor and then exhibits impulsive behaviors, expansive mood, and flight of ideas. 2. A client has three jobs, which require increased amounts of energy and the ability to multitask. 3. A client experiences thoughts of negative self-image and then expresses grandiosity when discussing abilities at work. 4. A client has been raised in a very chaotic household where there was a lack of impulse control related to excessive spending.
1. When a client diagnosed with bipolar affective disorder (BPAD) is prescribed a selective serotonin reuptake inhibitor, there is potential for alterations in neurochemicals that could generate a manic episode. Alterations in neurochemicals support biological theory in the development of BPAD.
The physician tells the nurse, "The medication I'm prescribing for the client enhances the GABA system." Evaluation will be facilitated if the nurse correctly interprets this statement to mean the medication is expected to: 1. Increase alertness 2. Decrease anxiety 3. Reduce hallucinations 4. Produce mood elevation
2 Medications that increase cell membrane potential are inhibitory in nature and make it harder to stimulate the neuron. GABA is the principle inhibitory neurotransmitter. The medication should provide an antianxiety effect.
A client tells the nurse, "My doctor said my treatment will involve getting my neurotransmitters back in balance. What are neurotransmitters?" In framing a response, the nurse could best characterize neurotransmitters as brain: 1. Neurons 2. Chemicals 3. Lobes 4. Electrical impulses
2 Neurotransmitters are considered to be the brain's chemical messengers. Options 1 and 3: These refer to brain anatomical structures. Option 4: Neurotransmitters stimulate electrical polarization.
The wife of a client with paranoid schizophrenia tells the nurse, "I've learned that my husband has several close relatives with the same disorder. Does this problem run in families?" The response based on recent discoveries in the field of genetics would be: 1. "It's odd, but it's just a coincidence." 2. "Research has identified a gene linked to schizophrenia." 3. "Are you concerned that your children may develop the disorder?" 4. "Only bipolar disorder has been identified to have a genetic component."
2 Option 2 is a factual statement that addresses genetic theory. Options1 and 4 are untrue. Option 3 does not address the wife's spoken question.
At admission, the nurse learns that some time ago the client had an infarct in the right motor cortex. During assessment, the nurse would expect to find that: 1. Motor activity on the right side of the body is impaired 2. Motor activity on the left side of the body is impaired 3. The client has impaired reasoning and planning skills 4. The client demonstrated motor aphasia
2 The motor cortex controls voluntary motor activity. However, decussation occurs at the intersection of the medulla and spinal cord, explaining why the right motor cortex actually controls voluntary motor activity on the left side of the body. 3. These functions are attributed to the association cortex. 4. Broca's area controls motor speech.
A patient with depression tells the nurse, "I don't think I want to take that SSRI medication the doctor told me she would prescribe. I don't understand what it will do." Which of the following would be the most helpful response? 1. "Medications help your brain; they don't mess things up." 2. "The medication will correct a deficiency of one of the chemicals needed to maintain a normal mood." 3. "SSRIs are a new classification of drugs that are getting good results while having very few unpleasant side effects." 4. "What is it you are afraid of?"
2 This response directly addresses the concern the client has expressed. Option 1 offers meaningless reassurance. Option 3 does not explain the desired drug action. Option 4 makes an unwarranted assumption.
A client is hearing voices saying, "Kill mother soon." The client states, "I am a prophet." The nurse understands that these symptoms are exhibited because of which brain alteration? 1. A decrease in dopamine in the mesocortical dopamine pathway. 2. An increase in dopamine in the mesolimbic dopamine pathway. 3. An increase in dopamine in the nigrostriatal dopamine pathway. 4. A decrease in dopamine in the tuberoinfundibular dopamine pathway
2. An increase in dopamine in the mesolimbic dopamine pathway is thought to have an important role in emotional behaviors, especially auditory hallucinations, delusions, and altered thoughts. Medications prescribed for these symptoms decrease the amount of dopamine in the mesolimbic pathway and decrease positive symptoms.
A client with severe depression has sleep disturbance and anorexia. The nurse's planning will be enhanced by understanding that these symptoms may be attributed to dysfunction of the: 1. Cerebellum 2. Basal ganglia 3. Hypothalamus 4. Occipital lobe
3 The hypothalamus is responsible for regulation of sleep-rest patterns, body temperature, and physical drives of hunger and sex. None of the other structures are responsible for modulating these functions.
A client with schizophrenia is described as "having difficulty with executive functions." What can the nurse expect to assess behaviorally? 1. Inability to speak 2. Inhibited behaviors 3. Poor response to social cues 4. Uncoordinated movements
3 Executive functions include reasoning, planning, prioritizing, sequencing behavior, insight, flexibility, judgment, focusing on tasks, responding to social cues, and attending in appropriate ways to incoming stimuli. Executive functions arise from the association cortex of the frontal lobe.
The client asks how psychotropic drugs work. The nurse's answer will be based on information that the therapeutic action of psychotropic drugs is the result of their effect on the activity of: 1. The cerebellum 2. Dendrites 3. Neurotransmitters 4. The peripheral nervous system
3 Medications used to treat psychiatric disorders operate in and around the synaptic cleft and have action at the neurotransmitter level
The unit physicians have ordered MRI tests for four clients. For which client would the nurse decline to make test arrangements without further discussion with the physician? The client who: 1. Is breast-feeding 2. Is allergic to iodine 3. Has had a total knee replacement 4. Has taken neuroleptic medication for 2 weeks
3 Metal implants are contraindications for MRIs. Option 1 is a contraindication for SPECT. Option 2 is a contraindication for some CTs. Option 4 is a contraindication for PET scanning.
The nurse is discouraged because his plan to reduce negative symptoms of schizophrenia (apathy, avolition, inattentiveness, poor socialization, poor eye contact and flat affect, etc.) in a client is not working. The mentor's remark that helps place the problem in perspective is: 1. "You aren't responsible for the behavior of any other person." 2. "Clients can be perverse and cling to symptoms despite our efforts." 3. "Negative symptoms have been associated with prefrontal cortical pathology." 4. "Negative symptoms can be improved by manipulating psychosocial and environmental factors. The problem is finding the right combination."
3 Nurse frustration can be alleviated by helping the nurse realize that negative symptoms may be the result of actual brain dysfunction, rather than psychologically determined behaviors; thus options 1, 2, and 4 are not helpful.
A friend has just taken a night shift job and complains about increasing depression. The nurse responds, knowing that: 1. There is no connection between the new job and mental health 2. Medication will cure the depression, no matter what caused it 3. Interrupted wake-sleep patterns can influence mood 4. It will take 4 months to adjust to the new chronobiology
3 Option 1 is incorrect because it is likely that a change to night work could influence mood. Option 2 is incorrect because medication does not always cure depression. Option 3 is correct because sleep influences mood, and option 4 is incorrect because there is no set time for adjustment.
Which type of brain-imaging techniques will provide information about brain activity based on the use of glucose in the brain? 1. CT scans 2. EEG 3. PET scans 4. MRI images
3 PET scans show uptake of glucose by brain cells that are active at a particular time.
A client asks the nurse, "My wife has breast cancer. Could it be caused by too much stress?" The nurse responds with the knowledge that: 1. Too much stress causes all kinds of cancer 2. There are really no research findings about stress and disease yet 3. Stress causes the release of factors that suppress the immune system 4. There is no connection between stress and diseases of the body
3 Research indicates that stress causes a release of corticotrophin-releasing factors that suppress the immune system. Research does not support option 1. Option 2 is incorrect because there is a significant amount of research about stress and the body. Option 4 is incorrect because there are some connections between stress and physical disease.
Which functions does the limbic system regulate? 1. Perceptions and interpretations of most sensory information. 2. Auditory functions and short-term memory. 3. Emotional experiences. 4. Visual reception and interpretation.
3. The limbic system, which has some connection with the frontal lobe, plays a role in emotional experiences, as evidenced by changes in mood and character after damage to this area. These alterations include, but are not limited to, fear, rage, aggressiveness, apathy, irritability, and euphoria.
For a client who has experienced a temporal lobe injury, the nurse would anticipate assessing problems with: 1.Personality and intellectual function 2.Attention selectivity and span 3.Form and color recognition 4.Motivation and memory
4 The temporal lobe is involved with motivation and memory.
For client and family teaching, the nurse will rely on information that Alzheimer's disease is currently best explained as being related to: 1. GABA excess 2. Dopamine excess 3. Serotonin deficiency 4. Acetylcholine deficiency
4 Decreased levels of acetylcholine are thought to produce many of the behavioral symptoms of Alzheimer's disease. The other conditions have not been implicated in Alzheimer's disease.
A student nurse mutters that it seems entirely unnecessary to have to struggle with understanding the anatomy and physiology of the neurologic system. The mentor would base a response on the understanding that it is: 1. Not necessary for psychiatric nurses who focus primarily on behavioral intervention 2. A complex undertaking that nurses seldom use in their practice 3. Important for nursing assessment, but not relevant during treatment 4. Necessary for planning psychiatric care
4 Nurses must understand that many symptoms of psychiatric disorders have a neurologic basis, although the symptoms are manifested behaviorally. This understanding facilitates effective care planning.
A client who has a parietal lobe injury is being evaluated for psychiatric rehabilitation needs. Of the aspects of functioning listed, which will the nurse identify as a focus of nursing intervention? 1. Expression of emotion 2. Detecting auditory stimuli 3. Receiving visual images 4. Processing associations
4 The parietal lobe is responsible for associating and processing sensory information that allows for functions such as following directions on a map, reading a clock, dressing self, keeping appointments, and distinguishing right from left. 1. Emotional expression is associated with frontal lobe function. 2. Detecting auditory stimuli is a temporal lobe function. 3. Receiving visual images is related to occipital lobe function.
A group of nursing students are reviewing the various neurotransmitters. The students demonstrate understanding when they identify which of the following as a neuropeptide? A) Melatonin B) Serotonin C) Glutamate D) Gamma-aminobutyric acid
A
A patient is scheduled for a challenge test. Which of the following would the nurse include when explaining this test to the patient? A) Intravenous administration of a substance to induce symptoms B) Application of electrodes to the scalp for monitoring C) Evaluation electrical impulses recorded on graph paper D) Exposure to a flashing strobe light to elicit abnormal activity
A
The nurse is caring for a hospitalized patient who has a disorder of the hypothalamus. When developing the patient's plan of care, in which of the following areas would the nurse anticipate a problem? A) Sleep B) Constipation C) Speech D) Motor activity
A
Which of the following hormones has been implicated in the etiology of mood disorder with seasonal affective disorder? a. Increased levels of melatonin b. Decreased levels of oxytocin c. Decreased levels of prolactin d. Increased levels of thyrotropin
A
Which of the following parts of the brain is associated with voluntary body movement, thinking and judgment, and expression of feeling? a. Frontal lobe b. Parietal lobe c. Temporal lobe d. Occipital lobe
A
Which of the following parts of the brain is concerned with hearing, short-term memory, and sense of smell? a. Temporal lobe b. Parietal lobe c. Cerebellum d. Hypothalamus
A
Psychotropic medications may act at the neural synapse to accomplish which of the following? (Select all that apply.) a. Inhibit the reuptake of certain neurotransmitters, creating more availability b. Inhibit catabolic enzymes, promoting more availability of a neurotransmitter c. Block receptors, resulting in less neurotransmitter activity d. Add synthetic neurotransmitters found in the drug
A, B, C
A nurse is reading a journal article about psychoneuroimmunology. Which information would the nurse most likely find? Select all that apply. A) Neurotoxin's role in receptor site damage B) Hypothalamicpituitarythyroid axis disruption C) Static activity of natural killer cells in response to stress D) Hypothalamic damage leading to immune dysfunction E) Interruption in the typical circadian rhythm cycle
A, B, D
A nurse prepares to administer a second-generation antipsychotic medication to a patient diagnosed with schizophrenia. Additional monitoring for adverse effects will be most important if the patient has which co-morbid health problems? (Select all that apply.) a. Parkinson's disease b. Grave's disease c. Hyperlipidemia d. Osteoarthritis e. Diabetes
A, C, E Antipsychotic medications may produce weight gain, which would complicate care of a patient with diabetes, and increase serum triglycerides, which would complicate care of a patient with hyperlipidemia. Parkinson's disease involves changes in transmission of dopamine and acetylcholine, so these drugs would also complicate care of this patient. Osteoarthritis and Grave's disease should have no synergistic effect with this medication.
A depressed client states, "I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again." Which nursing response is appropriate? A. "Medications only address biological factors. Environmental and interpersonal factors must also be considered." B. "Because biological factors are the sole cause of depression, medications will improve your mood." C. "Environmental factors have been shown to exert the most influence in the development of depression." D. "Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment)."
ANS: A The nurse should advise the client that medications address biological factors, but there are other factors that affect mood. The nurse should educate the client on environmental and interpersonal factors that can lead to depression.
A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness? A. Schizophrenia B. Depression C. Body dysmorphic disorder D. Parkinson's disease
ANS: A The nurse should expect that an increase in dopamine activity might play a significant role in the development of schizophrenia. Dopamine functions include regulation of emotions, coordination, and voluntary decision-making ability. Increased dopamine activity is also associated with mania.
Which of the following symptoms should a nurse associate with increased levels of thyroid-stimulating hormone (TSH) in a newly admitted client? (Select all that apply.) A. Depression B. Fatigue C. Increased libido D. Mania E. Hyperexcitability
ANS: A, B The nurse should associate depression and fatigue with increased levels of TSH. TSH is only increased when thyroid levels are low as in the diagnosis of hypothyroidism. In addition to depression and fatigue, other symptoms such as decreased libido, memory impairment, and suicidal ideation are also associated with chronic hypothyroidism.
Which of the following information should a nurse include when explaining causes of anorexia nervosa to a client? (Select all that apply.) A. There is a possible correlation between abnormal secretion of growth hormone and anorexia nervosa. B. There is a possible correlation between antidiuretic hormone levels and anorexia nervosa. C. There is a possible correlation between low levels of gonadotropin and anorexia nervosa. D. There is a possible correlation between increased levels of prolactin and anorexia nervosa. E. There is a possible correlation between altered levels of oxytocin and anorexia nervosa.
ANS: A, C The nurse should explain to the client that there is a possible correlation between anorexia nervosa and decreased levels of growth hormones and gonadotropin. Anorexia nervosa has also been correlated with increased cortisol levels.
Which of the following symptoms should a nurse expect to assess in a client experiencing elevated levels of thyroid hormone? (Select all that apply.) A. Emotional lability B. Depression C. Insomnia D. Restlessness E. Apathy
ANS: A, C, D The nurse should assess the client with an elevated level of thyroid hormone for evidence of emotional lability, insomnia, and restlessness. Elevated levels of thyroid hormone indicate a diagnosis of hyperthyroidism or Grave's disease that is also associated with the symptoms of irritability, anxiety, and weight loss.
Which mental illness should a nurse identify as being associated with a decrease in prolactin hormone level? A. Major depression B. Schizophrenia C. Anorexia nervosa D. Alzheimer's disease
ANS: B Although the exact mechanism is unknown, there may be some correlation between decreased levels of the hormone prolactin and the diagnosis of schizophrenia. Some studies have shown an inverse relationship between prolactin concentrations and symptoms of schizophrenia.
Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective? A. The study of neuroendocrinology B. The study of psychoimmunology C. The study of diagnostic technology D. The study of neurophysiology
ANS: B Psychoimmunology is the branch of medicine that studies the effects of social and psychological factors on the functioning of the immune system. Studies of the biological response to stress hypothesize that individuals become more susceptible to physical illness following exposure to stressful stimuli
During a sleep study, a delta rhythm has been recorded for a client experiencing sleep apnea. The nurse recognizes the characteristic that is associated with this rhythm. What stage of sleep activity would be documented? A. Delta rhythm is a period of dozing occurring in stage 1 of sleep activity. B. Delta rhythm is a period of deep and restful sleep occurring in stage 3 of sleep activity. C. Delta rhythm is a period of relaxed waking occurring in stage 0 of sleep activity. D. Delta rhythm is a period of dreaming occurring in stage 2 of sleep activity.
ANS: B Stage 3—delta rhythm is a period of deep and restful sleep. Muscles are relaxed, heart rate and blood pressure fall, and breathing slows. No eye movement occurs.
A nursing instructor is teaching about the monoamine category of neurotransmitters. Which student statement indicates that learning about the function of norepinephrine has occurred? A. Norepinephrine functions to regulate movement, coordination, and emotions. B. Norepinephrine functions to regulate mood, cognition, and perception. C. Norepinephrine functions to regulate arousal, libido, and appetite. D. Norepinephrine functions to regulate pain, inflammatory response, and wakefulness.
ANS: B The functions of norepinephrine include the regulation of mood, cognition, perception, locomotion, and cardiovascular function. Norepinephrine has also been implicated in certain mood disorders such as depression and mania, anxiety states, and schizophrenia.
Which cerebral structure should a nursing instructor describe to students as the "emotional brain"? A. The cerebellum B. The limbic system C. The cortex D. The left temporal lobe
ANS: B The limbic system is often referred to as the "emotional brain." The limbic system is largely responsible for one's emotional state and is associated with feelings, sexuality, and social behavior.
A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the client's neurotransmitters should a nurse expect to be elevated? A. Serotonin B. Dopamine C. Gamma-aminobutyric acid (GABA) D. Histamine
ANS: B The nurse should expect that elevated dopamine levels might be an attributing factor to the client's current level of functioning. Dopamine functions include regulation of movements and coordination, emotions, and voluntary decision-making ability.
An instructor is teaching nursing students about neurotransmitters. Which term best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron? A. Regeneration B. Reuptake C. Recycling D. Retransmission
ANS: B The nursing instructor should best explain that the process by which neurotransmitters are released into the synaptic cleft and returned to the presynaptic neuron is by reuptake. Reuptake is the process by which neurotransmitters are stored for reuse.
A nurse understands that the abnormal secretion of growth hormone may play a role in which illness? A. Acute mania B. Schizophrenia C. Anorexia nervosa D. Alzheimer's disease
ANS: C A nurse should understand that research has found a correlation between abnormal levels of growth hormone and anorexia nervosa. The growth hormone is responsible for growth in children, as well as continued protein synthesis throughout life.
Which client statement reflects an understanding of the effect of circadian rhythms on psychopathology? A. "When I dream about my mother's horrible train accident, I become hysterical." B. "I get really irritable during my menstrual cycle." C. "I'm a morning person. I get my best work done in the a.m." D. "Every February, I tend to experience periods of sadness."
ANS: C By stating, "I am a morning person." the client demonstrates an understanding that circadian rhythms may influence a variety of regulatory functions, including the sleep-wake cycle, regulation of body temperature, and patterns of activity. Most humans follow a 24-hour cycle that is largely affected by light and darkness.
Which client diagnosis should a nurse associate with a decrease in gamma-aminobutyric acid (GABA)? A. Alzheimer's disease B. Schizophrenia C. Panic disorder D. Depression
ANS: C The nurse should associate a decrease in GABA with panic disorder. Enhancement of the GABA system is the mechanism of action by which benzodiazepines produce a calming effect, thus reducing anxiety. Alterations in the GABA system are also associated with movement disorders and epilepsy.
Which part of the nervous system should a nurse identify as playing a major role during stressful situations? A. Peripheral nervous system B. Somatic nervous system C. Sympathetic nervous system D. Parasympathetic nervous system
ANS: C The nurse should identify that the sympathetic nervous system plays a major role during stressful situations. The sympathetic nervous system prepares the body for the fight-or-flight response. The parasympathetic nervous system is dominant when an individual is in a nonstressful state.
A withdrawn client diagnosed with schizophrenia expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being responsible for this behavior? A. Dendrites B. Axons C. Neurotransmitters D. Synapses
ANS: C The nurse should recognize that neurotransmitters play an essential function in the role of human emotion and behavior. Neurotransmitters are targeted and affected by many psychotropic medications.
A student nurse is studying the effect of the drug isocarboxazid (Marplan) on neurobiology. The student should recognize that the neurotransmitter serotonin is catabolized by which enzyme? A. Glycosyltransferase B. Peptidase C. Polymerase D. Monoamine oxidase
ANS: D Serotonin that is not returned to be stored in the axon terminal vesicles is catabolized by the enzyme monoamine oxidase. A monoamine oxidase inhibitor, such as Marplan, inhibits this catabolism providing more available serotonin at the neuron synapse.
A nurse concludes that a restless, agitated client is manifesting a "fight-or-flight" response. The nurse should associate this response with which neurotransmitter? A. Acetylcholine B. Dopamine C. Serotonin D. Norepinephrine
ANS: D The nurse should associate the neurotransmitter norepinephrine with the "fight-or-flight" response. Norepinephrine produces activity in the sympathetic postsynaptic nerve terminal and is associated with the regulation of mood, cognition, perception, locomotion, sleep, and arousal.
A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the presentation of these symptoms? A. Abnormal levels of serotonin B. Decreased levels of dopamine C. Increased levels of norepinephrine D. Decreased levels of acetylcholine
ANS: D The nurse should correlate memory deficits and decreased motor function with decreased levels of acetylcholine. Acetylcholine is a major effector chemical of the autonomic nervous system. Functions of acetylcholine include sleep regulation, pain perception, the modulation and coordination of movement, and memory.
A client diagnosed with major depressive disorder asks, "What part of my brain controls my emotions?" Which nursing response is appropriate? A. "The occipital lobe governs perceptions, judging them as positive or negative." B. "The parietal lobe has been linked to depression." C. "The medulla regulates key biological and psychological activities." D. "The limbic system is largely responsible for one's emotional state."
ANS: D The nurse should explain to the client that the limbic system is largely responsible for one's emotional state. This system is often called the "emotional brain" and is associated with feelings, sexuality, and social behavior. The occipital lobes are the area of visual reception and interpretation. Somatosensory input (touch, taste, temperature, etc.) occurs in the parietal lobes. The medulla contains vital centers that regulate heart rate and reflexes.
A nurse should recognize that a decrease in norepinephrine levels would play a significant role in which mental illness? A. Mania B. Schizophrenia C. Anxiety D. Depression
ANS: D The nurse should recognize that a decrease in norepinephrine levels would play a significant role in generating the symptoms of depression. The functions of norepinephrine include the regulation of mood, cognition, perception, locomotion, cardiovascular functioning, and sleep and arousal.
A client's wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The client's therapist encourages open discussion of feelings, proper nutrition, and exercise. What is the best rationale for the therapist's advice? A. The therapist is using an interpersonal approach. B. The client has an alteration in neurotransmitters. C. It is routine practice to remind clients about nutrition, exercise, and rest. D. The client is susceptible to illness due to effects of stress on the immune system.
ANS: D The therapist's advice should be based on the knowledge that the client has been exposed to stressful stimuli and is at an increased risk of developing illness due to the effects of stress on the immune system. The study of this branch of medicine is called psychoimmunology.
Which types of adoption studies should a nurse recognize as providing useful information for the psychiatric community? A. Studies in which children with mentally ill biological parents are raised by adoptive parents who were mentally healthy B. Studies in which children with mentally healthy biological parents are raised by adoptive parents who were mentally ill C. Studies in which monozygotic twins from mentally ill parents were raised separately by different adoptive parents D. Studies in which monozygotic twins were raised together by mentally ill biological parents E. All of the above
ANS: E The nurse should determine that all of the studies could possibly benefit the psychiatric community. The studies may reveal research findings relating genetic links to mental illness. Adoption studies allow comparisons to be made of the influences of the environment versus genetics.
6. Which of the following is a neuromodulator? A) Neuropeptides B) Glutamate C) Dopamine D) GABA
Ans: A Feedback: Neuropeptides are neuromodulators. Glutamate and dopamine are excitatory neurotransmitters. GABA is an inhibitory neurotransmitter.
10. A patient is being seen in the crisis unit reporting that poison letters are coming in the mail. The patient has no history of psychiatric illness. Which of the following medications would the patient most likely be started on? A) Aripiprazole (Abilify) B) Risperidone (Risperdal Consta) C) Fluphenazine (Prolixin) D) Fluoxetine (Prozac)
Ans: A Feedback: New-generation antipsychotics are preferred over conventional antipsychotics because they control symptoms without some of the side effects. Injectable antipsychotics, such as Risperdal Consta, are indicated after the client's condition is stabilized with oral doses of these medications. Prozac is an antidepressant and is not indicated to relieve of psychotic symptoms.
1. The nurse is assessing a patient suffering a head injury as a result of an altercation with two other individuals. The patient 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? A) Cerebrum B) Cerebellum C) Medulla D) Amygdala
Ans: A Feedback: 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.
15. Which of the following disorders are extrapyramidal symptoms that may be caused by antipsychotic drugs? Select all that apply. A) Akathisia B) Pseudoparkinsonism C) Neuroleptic malignant syndrome D) Dystonia E) Anticholinergic effects F) Breast tenderness in men and women
Ans: A, B, D Feedback: Extrapyramidal symptoms include dystonia, pseudoparkinsonism, and akathisia. Neuroleptic malignant syndrome is also a side effect of antipsychotic drugs but is an idiosyncratic reaction to an antipsychotic drug, not an extrapyramidal symptom. Breast tenderness in men and women is also a potential side effect of antipsychotic drugs that cause elevated prolactin levels, but it is not an extrapyramidal symptom.
2. An abnormality of which of the following structures of the cerebrum would be associated with schizophrenia? A) Parietal lobes B) Frontal lobe C) Occipital lobe D) Temporal lobes
Ans: B Feedback: Abnormalities in the frontal lobes are associated with schizophrenia, attention deficit hyperactivity disorder (ADHD), and dementia. The parietal lobes interpret sensations of taste and touch and assist in spatial orientation. The temporal lobes are centers for the senses of smell and hearing and for memory and emotional expression. The occipital lobe assists in coordinating language generation and visual interpretation, such as depth perception.
5. Which of the following is an inhibitory neurotransmitter? A) Dopamine B) GABA C) Norepinephrine D) Epinephrine
Ans: B Feedback: GABA is the major inhibitory neurotransmitter in the brain and has been found to modulate other neurotransmitter systems rather than to provide a direct stimulus. Dopamine, norepinephrine, and epinephrine are excitatory neurotransmitters.
7. A nurse is leading a medication education group for patients with depression. A patient states he has read that herbal treatments are just as effective as prescription medications. The best response is, A) ìWhen studies are published they can be trusted to be accurate.î B) ìWe need to look at the research very closely to see how reliable the studies are.î C) ìYour prescribed medication is the best for your condition, so you should not read those studies.î D) ìSwitching medications will alter the course of your illness. It is not advised.î
Ans: B Feedback: Often, reports in the media regarding new research and studies are confusing, contradictory, or difficult for clients and their families to understand. The nurse must ensure that clients and families are well informed about progress in these areas and must also help them to distinguish between facts and hypotheses. The nurse can explain if or how new research may affect a client's treatment or prognosis. The nurse is a good resource for providing information and answering questions.
9. How should the nurse respond to a family member who asks how Alzheimer's disease is diagnosed? A) It is impossible to know for certain that a person has Alzheimer's disease until the person dies and his or her brain can be examined via autopsy. B) Positron emission tomography (PET) scans can identify the amyloid plaques and tangles of Alzheimer's disease in living clients. C) Alzheimer's disease can be diagnosed by using chemical markers that demonstrate decreased cerebral blood flow. D) It will be necessary for the patient to undergo positron emission tomography (PET) scans regularly for a long period of time to know if the patient has Alzheimer's disease.
Ans: B Feedback: Positron emission tomography (PET) scans can identify the amyloid plaques and tangles of Alzheimer's disease in living clients. These conditions previously could be diagnosed only through autopsy. Some persons with schizophrenia also demonstrate decreased cerebral blood flow. A limitation of PET scans is that the use of radioactive substances limits the number of times a person can undergo these tests.
16. Which of the following antidepressant drugs is a preferred drug for clients at high risk of suicide? A) Tranylcypromine (Parnate) B) Sertraline (Zoloft) C) Imipramine (Tofranil) D) Phenelzine (Nardil)
Ans: B Feedback: 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. Parnate and Nardil are MAOIs. Tofranil is a cyclic compound.
13. A patient with depression has been taking paroxetine (Paxil) for the last 3 months and has noticed improvement of symptoms. Which of the following side effects would the nurse expect the patient to report? A) A headache after eating wine and cheese B) A decrease in sexual pleasure during intimacy C) An intense need to move about D) Persistent runny nose
Ans: B Feedback: Sexual dysfunction can result from enhanced serotonin transmission associated with SSRI use. Headache caused by hypertension can result when combining MAOIs with foods containing tyramine, such as aged cheeses and alcoholic beverages. SSRIs cause less weight gain than other antidepressants. Dry mouth and nasal passages are common anticholinergic side effects associated with all antidepressants. An intense need to move about (akathisia) is an extrapyramidal side effect that would be expected of an antipsychotic medication. Furthermore, sedation is a common side effect of Paxil.
11. Which one of the following types of antipsychotic medications is most likely to produce extrapyramidal effects? A) Atypical antipsychotic drugs B) First-generation antipsychotic drugs C) Third-generation antipsychotic drugs D) Dopamine system stabilizers
Ans: B Feedback: The conventional, or first-generation, antipsychotic drugs are potent antagonists of D2, D3, and D4. This makes them effective in treating target symptoms but also produces many extrapyramidal side effects because of the blocking of the D2 receptors. Newer, atypical or second-generation antipsychotic drugs are relatively weak blockers of D2, which may account for the lower incidence of extrapyramidal side effects. The third generation of antipsychotics, called dopamine system stabilizers, is being developed. These drugs are thought to stabilize dopamine output that results in control of symptoms without some of the side effects of other antipsychotic medications.
14. Which one of the following drugs should the nurse expect the patient to require serum level monitoring? A) Anticonvulsants B) Wellbutrin C) Lithium D) Prozac
Ans: C Feedback: Toxicity is closely related to serum lithium levels and can occur at therapeutic doses. For clients taking lithium and the anticonvulsants, monitoring blood levels periodically is important.
17. The nurse knows that the client understands the rationale for dietary restrictions when taking MAOI when the client makes which of the following statements? A) ìI am now allergic to foods that are high in the amino acid tyramine such as aged cheese, organ meats, wine, and chocolate.î B) ìCertain foods will cause me to have sexual dysfunction when I take this medication.î C) ìFoods that are high in tyramine will reduce the medication's effectiveness.î D) ìI 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.î
Ans: D Feedback: Because the enzyme MAO is necessary to break down the tyramine in certain foods, its inhibition results in increased serum tyramine levels, causing severe, hypertension, hyperpyrexia, tachycardia, diaphoresis, tremulousness, and cardiac dysrhythmias. Taking an MAOI does not confer allergy to tyramine. Sexual dysfunction is a common side effect of MAOIs. There is no evidence that foods high in tyramine will increase sexual dysfunction or reduce the medication's effectiveness.
3. A patient with bipolar disorder asks the nurse, ìWhy did I get this illness? I don't want to be sick.î The nurse would best respond with, A) ìPeople who develop mental illnesses often had very traumatic childhood experiences.î B) ìThere is some evidence that contracting a virus during childhood can lead to mental disorders.î C) ìSometimes people with mental illness have an overactive immune system.î D)ìWe don't fully understand the cause, but mental illnesses do seem to run in families.î
Ans: D Feedback: Current theories and studies indicate that several mental disorders may be linked to a specific gene or combination of genes, but that the source is not solely genetic; nongenetic factors also play important roles. A compromised immune system could contribute to the development of a variety of illnesses, particularly in populations already genetically at risk. Maternal exposure to a virus during critical fetal development of the nervous system may contribute to mental illness.
12. A patient with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg. daily. The patient asks the nurse how this medicine works. The nurse explains that the mechanism by which the olanzapine controls the patient's psychotic symptoms is believed to be A) increasing the amount of serotonin and norepinephrine in the brain. B) decreasing the amount of an enzyme that breaks down neurotransmitters. C) normalizing the levels of serotonin, norepinephrine, and dopamine. D) blocking dopamine receptors in the brain.
Ans: D Feedback: The major action of all antipsychotics in the nervous system is to block receptors for the neurotransmitter dopamine. SSRIs and TCSs act by blocking the reuptake of serotonin and norepinephrine. MAOIs prevent the breakdown of MAO, an enzyme that breaks down neurotransmitters. Lithium normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine, and dopamine.
8. The nurse is preparing a patient for an MRI scan of the head. The nurse should ask the patient, A) ìHave you ever had an allergic reaction to radioactive dye?î B) ìHave you had anything to eat in the last 24 hours?î C) ìDoes your insurance cover the cost of this scan?î D) ìAre you anxious about being in tight spaces?î
Ans: D Feedback: The person undergoing an MRI must lie in a small, closed chamber and remain motionless during the procedure, which takes about 45 minutes. Those who feel claustrophobic or have increased anxiety may require sedation before the procedure. PET scans require radioactive substances to be injected into the bloodstream. A patient is not required to fast before brain imaging studies. Verifying insurance benefits is not a primary role of the nurse
4. Which of the following statements about the neurobiologic causes of mental illness is most accurate? A) Genetics and heredity can explain all causes of mental illness. B) Viral infection has been proven to be the cause of schizophrenia. C) There is no evidence that the immune system is related to mental illness. D) Several mental disorders may be linked to genetic and nongenetic factors.
Ans: D Feedback: Current theories and studies indicate that several mental disorders may be linked to a specific gene or combination of genes, but that the source is not solely genetic; nongenetic factors also play important roles. Most studies involving viral theories have focused on schizophrenia, but so far none has provided specific or conclusive evidence. A compromised immune system could contribute to the development of a variety of illnesses, particularly in populations already genetically at risk. So far, efforts to link a specific stressor with a specific disease have been unsuccessful. When the inflammatory response is critically involved in illnesses such as multiple sclerosis or lupus erythematosus, mood dysregulation and even depression are common.
A decrease in which of the following neurotransmitters has been implicated in depression? a. Gamma-aminobutyric acid, acetylcholine, and aspartate b. Norepinephrine, serotonin, and dopamine c. Somatostatin, substance P, and glycine d. Glutamate, histamine, and opioid peptides
B
A nurse is developing a plan of care for a patient diagnosed with schizophrenia. The nurse integrates knowledge of this disorder, identifying which neurotransmitter as being primarily involved? A) Acetylcholine B) Dopamine C) Norepinephrine D) Serotonin
B
A nurse is developing a plan of care for a patient experiencing expressive aphasia. The nurse incorporates knowledge that the patient most likely has sustained damage to which of the following? A) The postcentral gyrus B) Broca's area C) Basal ganglia D) The hippocampus
B
A patient who is scheduled to undergo a sleep deprivation electroencephalogram (EEG) in the morning is experiencing moderate anxiety about the procedure. Based on an understanding of this test, which of the following would the nurse avoid? A) Explaining in depth what to expect during the upcoming procedure B) Administering a benzodiazepine medication prescribed for anxiety C) Taking a thorough history of her use of prescribed and illicit drugs D) Giving her a noncaffeinated beverage of her choice
B
A patient with depression tells the nurse that he is to have a test that involves the recording of an electroencephalogram (EEG) throughout the night. The nurse most likely identifies this testing as which of the following? A) Sleep deprivation EEG B) Polysomnography C) Evoked potentials D) Functional magnetic resonance imaging
B
The nurse is assessing a patient experiencing anxiety and observes increased sweating and gooseflesh. The nurse understands that these are the result of which substance? A) Acetylcholine B) Norepinephrine C) Serotonin D) Histamine
B
The nurse is caring for a patient who has experienced damage to the parietal lobes of the brain. The nurse anticipates that the patient with have difficulty with which of the following? A) Perceiving sensory input B) Calculating a math problem C) Seeing objects in front of him D) Speaking fluently
B
The nurse is caring for an older adult who has experienced damage to the frontal lobe after an automobile accident. The nurse anticipates that the patient will have difficulty with which of the following? A) Smell B) Concept formation C) Receptive speech D) Hearing
B
When describing neuronal transmission, an instructor describes the area where the electrical intracellular signal becomes a chemical one. The instructor is describing which of the following? A) Soma B) Synaptic cleft C) Terminal D) Receptor site
B
When describing the various neurotransmitters, which of the following would the nurse identify as the primary cholinergic neurotransmitter? A) Dopamine B) Acetylcholine C) Norepinephrine D) Serotonin
B
Which of the following parts of the brain integrates all sensory input (except smell) on the way to the cortex? a. Temporal lobe b. Thalamus c. Limbic system d. Hypothalamus
B
Psychoneuroimmunology is a branch of science that involves which of the following? (Select all that apply.) a. The impact of psychoactive medications at the neural synapse b. The relationships between the immune system, the nervous system, and psychological processes including mental illness c. The correlation between psychosocial stress and the onset of illness d. The potential role of viruses in the onset of schizophrenia e. The genetic factors that influence the prevention of mental illness
B, C, D
A nurse is involved in gathering information about the inheritance of mental disorders using population genetics. Which of the following would the nurse be least likely to be evaluating? A) Concordance rates B) Occurrence in first-degree relatives C) Risk factor analysis D) Adoptions studies
C
A nurse is teaching a medication class to a group of psychiatric patients. One of them asks the nurse why he has so much more trouble learning now when he's in his 60s than he did when he was younger. Which of the following concepts would the nurse integrate into the response? A) The extrapyramidal motor system B) The amygdala C) Neuroplasticity D) Psychoneuroimmunology
C
At a synapse, the determination of further impulse transmission is accomplished by means of which of the following? a. Potassium ions b. Interneurons c. Neurotransmitters d. The myelin sheath
C
Which of the following parts of the brain deals with sensory perception and interpretation? a. Hypothalamus b. Cerebellum c. Parietal lobe d. Hippocampus
C
A group of nursing students are reviewing the role of serotonin in psychiatric disorders. The students demonstrate a need for additional study when they identify which disorder as being associated with its dysfunction? A) Depression B) Obsessive-compulsive disorder C) Panic disorder D) Schizophrenia
D
A group of students are reviewing information about neurotransmitter subtypes. The group demonstrates understanding of the information when they identify which neurotransmitter as having muscarinic and nicotinic receptors? A) Serotonin B) Gamma-aminobutyric acid (GABA) C) Dopamine D) Acetylcholine
D
A nursing instructor asks a student to explain the influence of chronobiology on depression. Which of the following would the student include when responding? A) The exact location of genes leads to identifying the gene responsible for causing depression. B) A break in the corpus coliseum blocks information exchange between the right and left hemispheres. C) Damage to the posterior areas of the parietal lobe leads to altered discriminative sensory function. D) Internal and external triggers can elicit biologic rhythm changes indicative of clinical depression.
D
A patient has been diagnosed with memory dysfunction associated with Alzheimer's disease. The nurse determines that damage to the patient's brain includes deterioration of temporal lobe structures and the nerves of which of the following? A) Basal ganglia B) Limbic system C) Frontal lobe D) Hippocampus
D
Which of the following parts of the brain has control over the pituitary gland and autonomic nervous system, as well as regulation of appetite and temperature? a. Temporal lobe b. Parietal lobe c. Cerebellum d. Hypothalamus
D
Which of the following parts of the brain is associated with multiple feelings and behaviors and is sometimes referred to as the "emotional brain"? a. Frontal lobe b. Thalamus c. Hypothalamus d. Limbic system
D
Which of the following parts of the brain is concerned with visual reception and interpretation? a. Frontal lobe b. Parietal lobe c. Temporal lobe d. Occipital lobe
D
Which of the following would a nursing instructor identify when describing the area of the brain involved with verbal language function, including areas for both receptive and expressive speech? A) Right hemisphere B) Parietal lobe C) Occipital lobe D) Left hemisphere
D
