Chapter 18 PrepU
Thought and memory pass across synapses in the brain. What are the neural circuits transmitted by new or reactivated pathways called?
Neuronal networks
The nurse is teaching clients about psychiatric disorders. What can the nurse include in her education to help reduce the stigma toward the client with a psychiatric disorder?
Encourage an understanding of the effect of the client's environment on brain functioning
The nurse is educating the husband about his wife's Alzheimer disease. Which statements by the husband demonstrates the nurse has given him an accurate understanding of his wife's medication regimen?
"I'm really hoping these medications will slow down her mental losses."
The spouse of a client diagnosed with Alzheimer disease asks the nurse why the client often neglects to take a shower. The spouse states that the client was always diligent with hygiene in the past; however, over the past few months that has not been the case. What is the nurse's best response?
"You should remind the client to shower."
Schizophrenia is a complex disease that strikes men and women equally. What is a common sign or symptom of schizophrenia in its early stages?
Enhancement of senses
Panic attacks that are unexpected and not related to external events most often last for how long?
15 to 30 minutes
What percentage of people with Parkinson disease (PD) develop dementia?
20 percent
Although no definite genetic links for specific psychiatric disorders have been identified, which disorder is thought to be heritable?
Schizophrenia
A health care provider has diagnosed a client with Wernicke-Korsakoff syndrome based on the client's discrete memory impairment and confabulation. Which assessment finding by the nurse would correspond with the confabulation finding?
Making up information the client can't remember to fill in gaps in the conversation
What is the task of the prefrontal area of the brain?
Manage information
A first episode of depression that occurs after what age can be a precursor to dementia?
65
Alzheimer-type dementia follows a progressive course. What is the average length of survival after diagnosis?
8 to 10 years
Which person has the greatest risk for developing Alzheimer disease?
A 56-year-old client with a diagnosis of Down syndrome
A psychiatrist is providing care for a client whose quality of life is suffering because of an anxiety disorder. Which treatment is most likely to benefit the woman?
A drug that influences gamma-aminobutyric acid (GABA) levels
The nurse is caring for a client who has a history of significant childhood trauma. The client has never been able to describe the trauma during therapy and demonstrates physical discomfort when questioned about the past events. Which action should the nurse take?
Accept that the client may not have the ability to describe the trauma using words.
A client with depression has a lack of emotional expression. What terminology will the health care provider document in the record?
Affective flattening
What is the most common cause of progressive dementia?
Alzheimer disease
Panic attacks may result from a "fear network" that has become abnormally sensitive. Where is this "fear network" centered?
Amygdala
What is the term used to identify a person's inability to experience pleasure in things that use to result in pleasure?
Anhedonia
A nurse caring for a client with severe bipolar disorder who received several electroconvulsive therapy (ECT) treatments would suspect the client is suffering from an episode of mania based on which manifestations? Select all that apply. Talking fast Irritability Anorexia Insomnia Attentiveness
Anorexia Irritability Insomnia Talking fast
Psychopharmacology has become a popular and effective treatment for mood disorders. The nurse will include which information to her client to explain how antidepressants alleviate depressive symptoms?
Antidepressants increase norepinephrine.
A client hospitalized with a third heart attack shows a lack of interest in the treatment plan. The client states, "it really doesn't matter anyway because I just sit around all day, eat, and sleep." The nurse is concerned this client might be suffering from which mood disorder?
Atypical depression
What are the most common mental health problems in the United States? Select all that apply. Depression Schizophrenia Anxiety Substance abuse
Depression Anxiety Substance abuse
A nurse caring for a client with obsessive-compulsive disorder (OCD) is evaluating the treatment regimen. Which data indicate effective treatment?
Client ordered and ate lunch at a new restaurant.
A client is being evaluated for schizophrenia. Which assessment data are consistent with the diagnosis? Select all that apply. Blood analysis shows hyponatremia. Client stands with hands in the air for 1 hour. Client speaks very rapidly in response to questions. Client states that the wall clock ticks too loudly. Client reports hearing voices criticizing personal actions.
Client states that the wall clock ticks too loudly. Client stands with hands in the air for 1 hour. Client reports hearing voices criticizing personal actions.
A client who has chronic alcoholism has developed Wernicke-Korsakoff syndrome with associated deficiency in thiamine (vitamin B12). Which manifestation is most distinctive of this syndrome?
Confabulation
A nurse is caring for an older adult with mild dementia who is hospitalized due to pneumonia. The client, who has been alert and oriented, suddenly becomes very confused and agitated. Which intervention should the nurse take?
Contact the health care provider due to the client's onset of delirium
During a 3-day diet recall, the nurse asks an 80-year-old client what she had for breakfast yesterday. The client cannot remember. Which action should the nurse take?
Continue with completion of the 3-day diet recall
The nurse is caring for a client with a rapid degenerative form of dementia. The client has abnormalities of visual-spatial coordination and impaired memory and judgement. The nurse understands that which disorder may be the cause of these symptoms?
Creutzfeldt-Jakob disease
What is the term used to describe the mood fluctuations between mild elation and depression in a client with bipolar disorder?
Cyclothymia
A nurse is caring for an older adult with mild dementia who is hospitalized due to pneumonia. The client, who has been alert and oriented, suddenly becomes very confused and agitated. Which intervention should the nurse take?
Delirium
A nurse working with an older adult for the past 2 days has assessed sudden, fluctuating confusional state and decreased consciousness. Which diagnosis would these assessment findings support?
Delirium
Depression has various subclassifications distinguished by symptom patterns. Which is that key clinical manifestation of depression with psychotic features?
Delusions or hallucinations
An older adult client with Parkinson disease has been diagnosed with neurocognitive disorder. Which assessment finding would the nurse correlate with this new diagnosis?
Dementia and slowness of movement and thought
The nurse is evaluating a client for possible signs of depression. What are clinical manifestations of major depressive disorder? Select all that apply. Anhedonia Decreased concentration Depressed mood Increased libido
Depressed mood Anhedonia Decreased concentration
The nurse is evaluating a client for possible signs of depression. What are clinical manifestations of major depressive disorder? Select all that apply. Anhedonia Decreased concentration Increased libido Depressed mood
Depressed mood Anhedonia Decreased concentration
The nurse is evaluating a client for possible signs of depression. What are clinical manifestations of major depressive disorder? Select all that apply. Decreased concentration Anhedonia Increased libido Depressed mood
Depressed mood Anhedonia Decreased concentration
The diagnosis of dementia is based on assessment of the presenting problem. The American Academy of Neurology practice parameters recommend screening for which disorder when assessing a client for dementia?
Depression
A client has been diagnosed with stage 5 Alzheimer dementia. The nurse would note which manifestation while assessing this client?
Disorientation to time and place
Which clinical manifestations will the nurse ask the client about when she is evaluating the client for panic disorder? Select all that apply. Dizziness Chest pain Bradycardia Headache Fainting
Dizziness Fainting Chest pain
Which chemical in the body is associated with the need to continue to abuse addictive substances?
Dopamine
When it comes to obsessive-compulsive disorder (OCD), which neurophysiology disorder is being investigated as a possible cause of OCD?
Dysfunction of the caudate nucleus
What are the precipitant factors that are likely to cause a relapse of addictive, abusive behavior? Select all that apply. Cultural beliefs Easy access to the substance of choice Environmental triggers Emotional stress Physical stress
Easy access to the substance of choice Environmental triggers Emotional stress Physical stress
The spouse of a client with schizophrenia asks the nurse why the client claims to "hear bad voices" when no one is around. The most accurate response is that the client is most likely undergoing which manifestation?
Experiencing auditory hallucinations
What are the clinical manifestations of mania? Select all that apply. Increased need for food Flight of ideas Fatigue Irritability Labile mood
Flight of ideas Labile mood Irritability
The stress diathesis model of psychiatric disorders evolved from a recognition that which of the following contributes to the development of psychiatric disorders?
Genetics and environment
A client with memory loss is concerned about the possibility that it may be inherited. Which disorder will the nurse teach the client is considered an inherited cause of dementia?
Huntington disease
An adult client with a long history of alcohol abuse has been diagnosed with Wernicke disease. Which is the most likely course of this client's health problem?
If the symptoms are correctly diagnosed, most of the effects of the disease can be reversed through better nutrition with supplemental thiamine.
A nurse is caring for a client who is experiencing a decrease in memory. The nurse assesses for which signs or symptoms of major depressive disorder?
Inability to concentrate and difficulty making decisions
A nurse assessing an older adult client for signs and symptoms of depression would assess for which manifestations? Select all that apply. Inability to make decisions Fatigue Feelings of worthlessness Increased energy
Inability to make decisions Fatigue Feelings of worthlessness
A client in a skilled nursing facility, who is usually alert and oriented, becomes confused and experiences manifestations of dementia. The nurse contacts the health care provider due to the client potentially experiencing which reversible cause of dementia?
Infection
Which clinical manifestations are associated with melancholic features of depression? Select all that apply. Psychomotor retardation or agitation Depression which becomes worse in the evening Excessive sleepiness Insomnia with early morning awakening Anorexia with significant weight loss
Insomnia with early morning awakening Anorexia with significant weight loss Psychomotor retardation or agitation
An older adult is being evaluated for dementia. Which assessments are not considered part of normal aging? Select all that apply. Is easily agitated when routines are not followed Is unable to explain the meaning of a proverb Recalls items in short-term memory more slowly Has intact long-term memory with cueing Needs cues to perform hygiene activities
Is easily agitated when routines are not followed Is unable to explain the meaning of a proverb Needs cues to perform hygiene activities
There are several sources and effects of brain neurochemicals. What is the proposed action of serotonin?
It has a role in control of appetite.
Which items would be included in implicit memory? Select all that apply. It includes emotional memories. It is largely unconscious It is the processing of factual knowledge. It includes motor memories. It includes somatic memories.
It is largely unconscious It includes motor memories. It includes somatic memories.
Which statement is true regarding schizophrenia?
It presents with disorganized, positive, and negative symptoms.
A 35-year-old client taking an atypical antipsychotic for schizophrenia for the past year has had control of both positive and negative symptoms but has gained 30 pounds. What assessments should the nurse prioritize for this client? Select all that apply. Lipid profile 24-hour urine for creatinine clearance Blood pressure Complete blood count Blood glucose level
Lipid profile Blood glucose level Blood pressure
Anticonvulsive medications are used in the treatment of bipolar depression. What other drug is used to treat bipolar disorder?
Lithium
A nurse is teaching a client and family about best practice to minimize the cycling of bipolar disorder. Which instruction should be included in this teaching plan?
Maintain a steady pattern of sleep and activity.
A client who experienced a myocardial infarction 2 weeks ago reports awakening early, loss of appetite, difficulty sitting still or concentrating, and loss of interest in personal hobbies. What mental health disorder do these manifestations represent?
Major depression
A client has been experiencing insomnia, loss of appetite, feelings of guilt, feelings of worthlessness, and loss of interest in normal activities. What type of depression does the nurse theorize this client is experiencing?
Major depressive disorder
Huntington disease is a genetic disorder that does not usually manifest itself until the client is in his or her 40s or 50s. What are the most common early psychological changes that occur with Huntington disease? Select all that apply. Heightened sensory awareness Personality changes Impulsive behavior Moodiness Mania
Moodiness Impulsive behavior Personality changes
A client diagnosed with vascular dementia should be assessed for which closely associated condition?
Myocardial infarction
Which major neurotransmitters are most important for psychiatric disorders? Select all that apply. Norepinephrine Succinylcholine Serotonin Gamma-aminobutyric acid Dopamine
Norepinephrine Gamma-aminobutyric acid Serotonin Dopamine
Which assessment findings would support the diagnosis of dementia? Select all that apply. Seeming bewildered when told it was "raining cats and dogs" Failing to correctly identify a pencil when asked to do so Symptoms occurring while being hospitalized for pneumonia Not recalling the family's telephone number Frequently observed crying when alone in room
Not recalling the family's telephone number Failing to correctly identify a pencil when asked to do so Seeming bewildered when told it was "raining cats and dogs"
A client being treated for schizophrenia has paucity of speech, flat affect, and lack of motivation. Which medication should the nurse anticipate receiving an order?
Olanzapine
A client comes to the emergency department complaining of dizziness, rapid breathing, sweating, palpitations, and a feeling of dying. The client has normal laboratory values and has had a cardiac workup. The symptoms persist for 30 minutes and then subside. Which condition is the client exhibiting?
Panic disorder
A client in the emergency department tells the nurse that he feels short of breath, dizzy, and has tingling sensations in both hands when he finds himself in a stressful situation. What condition is the client likely experiencing?
Panic disorder
A client states, "I am the most famous rock star in the country and all the other stars are trying to kill me." What type of distorted thinking is the client likely experiencing?
Paranoid
A group of nursing students is studying mental health concepts and discussing how trauma differs from stress. The students determine that which experiences correlate to being a traumatic event? Select all that apply. Parental neglect Sexual abuse Dysfunctional relationships Illness Physical abuse
Parental neglect Sexual abuse Dysfunctional relationships Physical abuse
When monitoring a client who may have Huntington disease (HD), what is one of the early manifestations the nurse would look for?
Personality changes and depression
The nurse plans care for a client with Alzheimer's disease. Which treatment has shown great success in decreasing agitated behavior in this population of clients?
Personalized music playlists
Dementia is a syndrome of acquired, persistent decline over the life span. Which aspect of aging is not affected in a person with dementia?
Physical changes of aging
What are the precipitant factors that are likely to cause a relapse of addictive, abusive behavior? Select all that apply. Cultural beliefs Physical stress Easy access to the substance of choice Emotional stress Environmental triggers
Physical stress Easy access to the substance of choice Emotional stress Environmental triggers
What are the precipitant factors that are likely to cause a relapse of addictive, abusive behavior? Select all that apply. Cultural beliefs Physical stress Emotional stress Easy access to the substance of choice Environmental triggers
Physical stress Emotional stress Environmental triggers Easy access to the substance of choice
At the present time there is only one diagnosis in the DSM-5 that has a causative factor. Which diagnosis has a causative factor?
Posttraumatic stress disorder
The older adult client who recently had an ischemic stroke is now exhibiting symptoms of anhedonia, fatigue, decreased appetite, and a diminished ability to concentrate. Which treatment measure would the provider recommend for this client?
Prescribing citalopram, a serotonin reuptake inhibitor (SSRI)
The psychiatrist recommends electroconvulsive therapy (ECT) for an older adult client. The nurse understands that this therapy is effective for which disorder?
depression
Which attribute is correct about Creutzfeldt-Jakob disease (CJD)?
Rare, rapidly progressive form of dementia
Although there are over 40 neurotransmitters, those that are the most familiar and important for psychiatric disorders are all of the following except:
Renin
A nurse is evaluating client histories for potential substance abuse. Which factors in a client's history may indicate an increased risk for substance abuse? Select all that apply. Female gender Schizophrenia Liver disease Heart failure Major depression
Schizophrenia Major depression
A client is diagnosed with panic disorder. The provider knows that as a child he may have experienced:
Separation anxiety
Which presenting symptoms are commonly typical of vascular dementia? Difficulty with language Loss of short-term memory Slow psychomotor function Depression Social withdrawal
Slow psychomotor function Depression
Recent animal and human studies strongly indicate which genetic factors may predispose an individual to a psychiatric disorder? Select all that apply. Stress reactivity Impulsivity Aggressiveness Attentional difficulties Temperament toward reactivity
Stress reactivity Temperament toward reactivity
Which statement does the nurse know is true concerning substance use disorder in adolescence?
Substance use disorder in teenagers can change the development of the brain.
Sensory input from the external environment is received by what area of the brain?
Thalamus
The client tells a nurse that "many voices in his head are telling him what he should do." The nurse thinks he may be experiencing:
a hallucination
Based on recent signs and symptoms, an adult client is strongly suspected of having depression. Which findings from the client's admission interview support a clinical diagnosis of major depression? Select all that apply. The client has always been an avid golfer, but no longer golfs. The client states, "I have to admit, my eating has gotten out of control." The client describes having nearly no interest in sex anymore. The client typically sleeps between 11 and 12 hours a day. The client admits being impatient, and even hostile, with coworkers.
The client typically sleeps between 11 and 12 hours a day. The client states, "I have to admit, my eating has gotten out of control." The client describes having nearly no interest in sex anymore. The client has always been an avid golfer, but no longer golfs.
A client who is receiving care for schizophrenia has been experiencing an exacerbation of negative symptoms in recent days. Which aspect of the client's behavior is most consistent with this trend?
The client's statements and expressions show an absence of emotion.
After surviving an ischemic stroke, a client has demonstrated significant changes in his emotional behavior, with his family noting that he now experiences wide mood swings and exaggerated responses of empathy, anger, and sadness to situations. His care team would most likely attribute these responses to ischemic changes in which brain structure?
The components of the client's limbic system
What assessment data would be collected by the nurse working with a client with a decline in cognitive abilities if the nurse is using the mnemonic DEMENTIA? Select all that apply. The drugs the client is currently prescribed Decreased appetite No changes in sexual performance Whether there are any signs of emotional distress A decline in hearing
The drugs the client is currently prescribed Whether there are any signs of emotional distress A decline in hearing
While caring for a client with Alzheimer dementia, the family asks about the medication. Which advantage of the cholinesterase inhibitors should the nurse mention?
They have been shown to slow the progression of the disease.
The nurse is presenting information about various causes of dementia to a group of clients in a senior facility. What will the nurse include as the major cause of Wernicke-Korsakoff syndrome?
This form of progressive dementia commonly results from chronic alcoholism.
A client with a long history of cigarette smoking and poorly controlled hypertension is experiencing psychomotor deficits due to hemorrhagic brain damage. Which diagnosis is likely for the onset of progressive dementia?
Vascular dementia
For the past 2 years, a client has had increasing difficulty remembering the events of the day, but has been able to recall events from the distant past. The client's motor skills have slowed, despite the absence of arthritis. Recent echocardiography showed the presence of atherosclerosis and the client experienced a myocardial infarction earlier this year. Which neurologic condition does the client most likely have?
Vascular dementia
Which form of progressive dementia is often a result of chronic alcoholism?
Wernicke-Korsakoff syndrome
A nurse caring for a client who has issues with substance abuse states, "I don't know what is wrong with this person; he is here every month for the same reason!" A peer suggests that to better determine the most overall therapeutic plan of action for this client, the client needs to try to answer which question?
What happened to this client
The nurse is educating a group of clients at a senior residence about memory. Which will she include as an example of immediate memory?
Writing down a telephone number someone has just recited
A client with a diagnosis of bipolar disorder has chosen to discontinue her medication. She is now not eating or sleeping, very irritable, has racing thoughts, and is easily distracted. The nurse should understand that the client is now experiencing:
a manic episode.
The family of an older adult reports increasing inability to perform basic activities of daily living. After evaluation, the client is diagnosed with Alzheimer disease. What intervention will be implemented to slow cognitive decline?
cholinesterase inhibitors
A client is concerned about memory loss and the possibility of having Alzheimer disease (AD). Which diagnostic assessment will the nurse teach the client is most important in diagnosing AD?
collecting a detailed clinical history
What factors play a role in the body's response and long-term consequences of a disturbing event? Select all that apply. Coping skills Type of physical exercise Social support Cognitive deficits Financial security
coping skills social support cognitive deficits
A pathologist is examining the brain of a recently deceased client who was thought to have developed Alzheimer disease shortly before death. Which pathology finding would confirm the diagnosis?
cortical atrophy in the temporal lobes
A 90-year-old client is experiencing an increased difficulty with memory and tells the nurse that it must be dementia. The difficulty began after the death of a spouse last year and continues to present day. The nurse anticipates that the health care provider will initially rule out which most likely condition before considering dementia?
depression
Which result is an expected outcome when unipolar and bipolar disorders are treated with an selective serotonin reuptake inhibitor (SSRI) antidepressant?
inhibiting the reuptake of serotonin
Which result is an expected outcome when unipolar and bipolar disorders are treated with an selective serotonin reuptake inhibitor (SSRI) antidepressant? inhibiting the reuptake of norepinephrine blocking the degradation of serotonin inhibiting the reuptake of serotonin blocking the degradation of norepinephrine
inhibiting the reuptake of serotonin
The nurse is caring for a client who admits to long-term substance use disorder. For which type of coexisting condition should the nurse prioritize assessing?
mental health disorders
Which risk factor has been associated with the diagnosis of schizophrenia?
poverty
An older adult client is diagnosed with depression. Which medication category will the nurse anticipate will be prescribed for this client?
selective serotonin reuptake inhibitor (SSRI)
The community health nurse contacts a client by phone to arrange for a home visit. The client reports feeling overwhelming anxiety at the thought of the nurse coming into the client's home. For which mental health disorder will the nurse prioritize assessing the client?
social anxiety disorder
Which lobe of the brain houses the cerebral cortical structure responsible for language comprehension?
temporal
