Patho chap 22
15. A 50-year-old woman has experienced devastating consequences in her family and work life as a result of her long-standing alcohol addiction. The levels and pathways of which of the following neurotransmitters in her body are likely to differ from an individual without addiction? A) Dopamine B) Acetylcholine C) Serotonin D) Norepinephrine
A Feedback: Dopamine levels are thought to be altered in addiction and possibly contribute to addiction. Acetylcholine, serotonin, and norepinephrine are not noted to play a central role in the neurophysiology of addiction.
5. A student notices that at certain times during his studying for final exams, he is more awake and his ability to think at a higher level is happening easier. The nurse knows that this experience may be attributed to which of the following neurological functions? A) Release of excitatory neurotransmitters such as glutamate B) Release of GABA, an inhibitory neurotransmitter C) Release of corticotrophin-releasing hormone D) Heightened precortex processes
A Feedback: Excitatory neurotransmitters such as glutamate increase the probability that the target cell will fire an action potential by mediating the depolarization of the target cell. Excitatory transmitters serve as the body's stimulants promoting wakefulness, energy, and activity through regulating many of the body's most basic functions, including thought processes, higher thinking, and sympathetic activity. Distracters B, C, and D do not play a role in this process.
13. A psychiatrist is providing care for a 68-year-old female whose anxiety disorder is significantly decreasing her quality of life. The nurse knows that the client will likely benefit from which of the following pharmacologic therapies listed below? A) A drug that influences gamma-aminobutyric acid (GABA) levels B) An MAO inhibitor to increase the concentration of serotonin and norepinephrine C) An antipsychotic medication that blocks dopamine receptors D) A calcium channel-blocking agent
A Feedback: GABA is often implicated in anxiety disorders, and benzodiazepines address this neurotransmitter. An MAO inhibitor increases the concentration of serotonin and norepinephrine. MAO inhibitors are occasionally prescribed for depression not responding to SSRIs and would not be indicated for an anxiety disorder. Calcium channel blockers are good for lowering BP and minimizing arterial spasms but are usually not prescribed for anxiety.
8. During an acute phase of schizophrenia when the patient is experiencing hallucinations and delusions, the nurse should anticipate that the physician will prescribe which of the following medication categories listed below? A) An antipsychotic like risperidone B) A benzodiazepine like lorazepam C) A cholinesterase inhibitor like donepezil D) An opioid receptor antagonist like naltrexone
A Feedback: Pharmacological treatment with antipsychotics is often helpful particularly with the positive s/s of schizophrenia (delusion, hallucinations, agitation, etc.). The negative s/s of schizophrenia respond more favorably to the atypical antipsychotic drugs. Often antipsychotics are combined with benzodiazepines or antiparkinson agents during the acute phase of treatment to reduce the risk of extrapyramidal effects from large doses of antipsychotic agents. Distracters B and C are prescribed for Alzheimer disease and D is used for alcohol addiction.
12. A 20-year-old college student has presented to his campus medical clinic because of his unshakable despondency in recent months. He has been diagnosed with depression based on his signs, symptoms, and history. The nurse knows that which of the following treatments will likely be prescribed for this student? A) Medication that inhibits the reuptake of serotonin in his presynaptic space B) Drugs that inhibit the accumulation of cyclic adenosine monophosphate (cAMP) C) Benzodiazepines such as clonazepam that modulate his GABA receptors. D) Cholinesterase inhibitors that potentiate the action of available acetylcholine E) Antipsychotics such as olanzapine
A Feedback: SSRIs are common pharmacologic treatment modalities for depression. Drugs that inhibit the accumulation of cyclic adenosine monophosphate (cAMP) (answer B) are usually used in the treatment of bipolar depression. Benzodiazepines address anxiety, while cholinesterase inhibitors are used in the treatment of dementia. Antipsychotics are more often used in cases of schizophrenia.
20. Which of the following is the most likely course of Wernicke syndrome? A) If the symptoms are correctly diagnosed, most of the effects of the disease can be reversed through better nutrition and supplemental thiamine. B) Wernicke syndrome is uniformly fatal, with death most often occurring within a few months of onset. C) Wernicke syndrome has no treatment, but drugs may be used to treat its associated dyskinesias and behavioral disturbances. D) The course of the disease is relentless, and most affected persons will die of infection within 2 to 10 years.
A Feedback: Wernicke syndrome is caused by a deficiency of thiamine (vitamin B1), and many of the symptoms are reversed when nutrition is improved with supplemental thiamine.
19. A 70-year-old woman has been brought to the emergency department by her daughter who noticed the woman is weak, confused, and forgetful in recent months, along with uncoordinated movements and visual disturbances at times. Which of the following questions by the physician are most likely to address her probable diagnosis? Select all that apply. A) "What medications is your mother currently taking?" B) "Does your mother drink alcohol?" C) "Does your mother have a history of stroke?" D) "Is your mother facing significant stressors right now?" E) "Is your mother lonely?"
A, B Feedback: The client's symptoms are characteristic of Wernicke-Korsakoff syndrome, which is associated with alcohol abuse. Medications can cause numerous cognitive and motor disturbances in elderly clients. Prior CVA and stress are less likely to contribute to her symptomatology.
9. Which of the following clinical manifestations would the nurse assess in the patient with bipolar disorder who is experiencing mania? Select all that apply. A) Labile mood B) Highly distractible C) Inflated self-esteem D) Despondent when asked questions E) Excessive sleepiness
A, B, C Feedback: Clinical manifestations of mania include decreased need for food and sleep, labile mood, irritability, racing thoughts, high distractibility, rapid and pressured speech, inflated self-esteem, and excessive involvement with pleasurable activities. Despondency is a symptom of the depressive phase.
16. The nurse knows that the patient admitted for opioid addiction may benefit from which of the following treatment modalities? Select all that apply. A) Prescription for dolophine (Methadone) B) Administration of a long-term pain reliever like duragesic (Fentanyl) C) Involvement in a self-help group like Opioid Anonymous (an offshoot of Alcoholics Anonymous) D) Intense exercise therapy under supervision of a body builder E) Administering beta-blocking medications to minimize agoraphobia symptoms
A, C Feedback: Methadone, used in opiate addictions, has the narcotic properties of addiction and sedation, but lacks the euphoric effects of heroin. Naltrexone is used in treatment of alcohol and opiate addictions and works by blocking the opioid receptors and euphoric effects. Fentanyl is a pain medication, and Benadryl is an antihistamine.
10. A 44-year-old female has been diagnosed with major depression. Which of the following neuroimaging findings is most congruent with the woman's diagnosis? A) Decreased brain activity in the pons and brain stem B) Reduced activity and gray matter volume in the prefrontal cortex C) Atrophy and decreased blood flow in the amygdala D) Enlargement of the lateral and third ventricles and reduction in frontal and temporal volumes
B Feedback: In some cases of familial major depressive disorder and bipolar disorder, PET and MRI studies have demonstrated a reduction in the volume of gray matter in the prefrontal cortex, with an associated decrease in activity in the region. Brain stem involvement is not common, and the amygdala tends to have increased blood flow and oxygen consumption during depression. Enlargement of the lateral and third ventricles and reduction in frontal and temporal volumes are associated with schizophrenia.
17. Which of the following statements on the final diagnostic report regarding a computerized tomography (CT) of the head with contrast would lead health care providers to diagnose a patient with Alzheimer disease? A) Large area of ischemia noted in the temporal lobe B) Too numerous to count beta-amyloid (βA) deposits noted C) Ninety percent obstruction in the posterior cerebral artery D) Mural thrombus of vertebrobasilar arteries
B Feedback: The major microscopic features of Alzheimer disease are the presence of neuritic (senile) plaques, neurofibrillary tangles, and amyloid angiopathy. Distracters A, C, and D are causes for a stroke.
3. An adult, who was sexually abused as a child, has been displaying some stress. She seems to complain of increasing medical problems when she is under more stress. The nurse would classify this as an example of A) vitamin deficiency. B) the stress-diathesis theory. C) mendelian research. D) parental disassociation.
B Feedback: The stress-diathesis model of psychiatric disorders evolved from a recognition that genetics (diathesis) and environment (stress) both contribute to the development of psychiatric disorders. Adults who report significant traumatic experiences such as an emotional, physical, or sexual abuse as children show a graded positive response; that is, the more trauma experienced, the more both medical and mental illness occur later in life. Vitamin deficiency has not been implicated as a cause of increasing medical complaints when experiencing stress. Mendelian research studies genetics and describes the way in which genes modulate behavior and psychological traits. Parental nurturing mediates this epigenetic response, but in the absence of nurturing (dissociation), children have difficulties with attention and following directions. As teenagers, they are more likely to engage in high-risk behaviors and, as adults, show increased aggression, impulsive behavior, weakened cognition, and an inability to discriminate between real and imagined threats.
18. A geriatrician and social worker are facilitating a family meeting for the children and wife of a 79-year-old man who has been diagnosed with Alzheimer disease. What goal of treatment will the clinicians most likely prioritize in their interactions with the family? A) Modest reversal of brain plaque formation and improved symptomatology through cholinesterase inhibitors B) Surgical treatment of the underlying ischemic changes that underlie the manifestations of the man's disease C) The use of medications such as donepezil and rivastigmine to slow the progression of the disease D) Cognitive and behavioral therapy to counteract the agitation, depression, and suspiciousness associated with Alzheimer disease
C Feedback: Cholinesterase inhibitors like donepezil and rivastigmine may slow the progression of Alzheimer's but do not reverse the organic brain changes that characterize the etiology. Ischemic changes are associated with vascular dementia, and cognitive therapy is of limited use in treatment.
4. A toddler brought up in a chaotic, nonnurturing environment may suffer neurological consequences if the parent does not achieve attachment with the child. The nurse knows that which of the following nervous systems listed below is the first to respond to the safety needs of the child? A) Parasympathetic nervous system B) Autonomic nervous system C) Sympathetic nervous system D) Limbic system
C Feedback: If the ventral vagus is utilized and fails to provide safety, the SNS is recruited first. The other distracters are not the first to respond.
1. Which of the following statements best captures the current understanding of the etiology of mental illness? A) The role of "nurture," experiences, and relationships has been largely disproven. B) Mental illness can be attributed to organic brain changes and pathophysiological processes. C) Mental illness exists from the interplay of biologic factors and psychosocial influences. D) Current understanding of mental illness has shown that both biologic psychiatry and psychosocial psychiatry are incorrect.
C Feedback: Mental illness is currently thought to be the outcome of anatomical and/or physiological influences and psychosocial factors. Neither factor can attribute for 1
6. Parents of a 16-year-old male who has been behaving in increasingly bizarre ways in recent months are distraught that he has been diagnosed with schizophrenia. Which of the mother's following statements about her son's diagnosis demonstrates an accurate understanding of the disease? A) "It's disturbing to know that what I did when I was pregnant and the way we raised him contributed to this." B) "We are somewhat relieved that psychotherapy and a supportive environment will resolve most of the positive and negative symptoms." C) "This makes us even more worried about his younger brother and whether he might develop schizophrenia." D) "We're committed to lovingly but firmly convincing him that his delusions aren't based in reality."
C Feedback: The risk of developing schizophrenia is much higher in individuals with a first-degree relative who has the disease. Prenatal behavior and child-rearing techniques are not strongly linked with the development of schizophrenia, and therapy and support alone are not likely to eliminate symptoms. Delusions are not normally amenable to reason.
14. A woman has a long-running compulsion to repeatedly check if the doors of her home are locked and has received a diagnosis of obsessive-compulsive disorder (OCD). Her husband is at a loss to understand her irrational behavior and has sought help from a therapist himself to deal with the effect that his wife's OCD is having on their daily lives. Which of the husband's following statements would require correction? A) "It's a relief to know that this can be changed if she continues with therapy and the medications she's been prescribed." B) "It's odd that someone like her and someone who's depressed might both respond positively to the same drugs." C) "I thought that this was something exceedingly rare, but I'm actually a bit relieved to learn that others have this disorder as well." D) "I'm glad that this is something that's a result of life stressors and is not associated with any dysfunction in her brain."
D Feedback: OCD is thought to have a neurophysiological component and is not a consequence of stress. Medications combined with behavioral therapy provide a good prognosis, and SSRI antidepressants are often used. OCD has a prevalence of 2%.
2. As part of a diagnostic workup of a 22-year-old male with recently diagnosed schizophrenia, a neurologist wants to examine the levels of metabolic activity in particular areas of the client's brain. Which of the following diagnostic procedures is the physician most likely to order? A) Computed tomography (CT) B) Electroencephalography (EEG) C) Magnetic resonance imaging (MRI) D) Positron emission tomography (PET)
D Feedback: PET is rooted in the selective brain uptake of radiolabeled isotopes. As such, it can measure brain metabolic activity. CT and MRI offer visualization of structural components, while EEG measures electrical activity.
7. Which of the following is a negative symptom of schizophrenia? A) Hallucinations B) Incoherence C) Word salad D) Affective flattening
D Feedback: The negative symptoms of schizophrenia reflect the absence of normal social and interpersonal behaviors and include alogia (tendency to speak very little), avolition (lack of motivation for goal-oriented activity), apathy, affective flattening (lack of emotional expression), and anhedonia (an inability to experience pleasure in things that ordinarily are pleasurable). Positive symptoms are those that reflect the presence of abnormal behaviors and include disorganized, incomprehensible speech; delusions (e.g., that one is being controlled by an outside force); hallucinations (hearing voices is the most common); and grossly disorganized or catatonic behavior.
11. After surviving an ischemic stroke, a 79-year-old male has demonstrated significant changes in his emotional behavior, with his family noting that he now experiences wide mood swings with exaggerated responses of empathy, anger, and sadness to situations. His care team would most likely attribute these responses to ischemic changes in which of the following brain structures? A) The man's occipital lobe B) The client's temporal lobe in general and Wernicke area in particular C) The man's parietal lobe D) The components of the client's limbic system
D Feedback: The neural structures that constitute the limbic system are primarily responsible for the regulation of emotion. Clinical studies have suggested that this area of the brain is important for mood states and has extensive connections with the limbic system. The occipital lobe interprets visual information, while language is the domain of the Wernicke area. The parietal lobe processes sensory input.
