Mental Health Chapter 6
A client is scheduled for a challenge test. Which of the following would a nurse include when explaining this test to the client? A) Intravenous administration of a substance to induce symptoms B) Application of electrodes to the scalp for monitoring C) Evaluation of electrical impulses recorded on graph paper D) Exposure to a flashing strobe light to elicit abnormal activity
Ans: A Feedback: A challenge test is usually conducted by intravenously administering a chemical known to produce a specific set of psychiatric symptoms. The application of electrodes for monitoring and the evaluation of electrical impulses recorded on graph paper are involved with electroencephalography (EEG). Using a flashing strobe light may be used to gather additional information when EEG is done.
A nurse is caring for a hospitalized client who has a disorder of the hypothalamus. When developing the client'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
Ans: A Feedback: Disorders of the hypothalamus produce common psychiatric symptoms such as sleep and appetite problems. The hypothalamus is not involved with bowel elimination, speech, or motor activity.
A group of nursing students is 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
Ans: A Feedback: Melatonin is classified as a neuropeptide. Serotonin is classified as a biogenic amine. Glutamate and gamma-aminobutyric acid are amino acids.
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) Hypothalamic-pituitary-thyroid 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
Ans: A, B, D Feedback: Psychoneuroimmunology addresses possible explanations for the development of psychiatric disorders based on the interaction of the neurologic, endocrine, and immune systems. Areas addressed include immune dysregulation caused by neurotoxins affecting the brain tissue at locations such as receptor sites; disruption of the hypothalamic-pituitary-thyroid axis feedback system; and immune system dysfunction resulting from damage to the hypothalamus, hippocampus, or pituitary gland. Another area being studied is the role of natural killer cell function, which shows that natural killer cell activity varies in response to many emotional, cognitive, and physiologic stressors.
A nurse is caring for a client who has experienced damage to the parietal lobes of the brain. The nurse anticipates that the client will 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
Ans: B Feedback: A client who has experienced damage to the parietal lobes of the brain most likely will be unable to calculate a math problem. Damage to this area produces complex sensory deficits. The parietal lobes contribute to the ability to recognize objects by touch, calculate, write, draw, and organize spatial stimuli. Damage to the occipital lobe would lead to difficulty in vision, color vision, object and facial recognition, and the ability to perceive objects in motion. The frontal lobe, specifically Broca's area, would be involved if the client had difficulty speaking fluently.
A nurse is developing a plan of care for a client 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
Ans: B Feedback: Abnormally high activity of dopamine has been associated with schizophrenia. Loss of cholinergic neurons is associated with Alzheimer's disease. Decreased norepinephrine is associated with depression; excessive norepinephrine is associated with manic symptoms. Increased serotonin is associated with mania; decreased serotonin is associated with depression and insomnia.
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
Ans: B Feedback: Acetylcholine is the primary cholinergic neurotransmitter. Biogenic amines include dopamine, norepinephrine, and serotonin.
A client 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 the client's use of prescribed and illicit drugs D) Giving the client a noncaffeinated beverage of her choice
Ans: B Feedback: If a sleep-deprivation EEG is to be done, caffeine or other stimulants that might assist the client in staying awake should be withheld because they may change EEG patterns. In addition, many medications change the wave patterns on an EEG. For example, the benzodiazepine class of drugs increases the rapid and fast beta activity. Therefore benzodiazepines should be avoided. Noncaffeinated beverages would be allowed. Explaining about the procedure would help to alleviate the client's anxiety. A thorough history about prescribed drug use would be important because it may reveal medications that could change the EEG wave patterns.
A client with depression tells a 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
Ans: B Feedback: Polysomnography is a special procedure that involves recording an EEG throughout a night of sleep. A sleep deprivation EEG involves keeping a client awake the night before the EEG evaluation. Evoked potentials measure changes in electrical activity of the brain as a response to a given stimulus. Functional magnetic resonance imaging creates images of changes in blood flow.
A nurse is developing a plan of care for a client experiencing expressive aphasia. The nurse incorporates knowledge that the client most likely has sustained damage to which of the following? A) The postcentral gyrus B) Broca's area C) Basal ganglia D) The hippocampus
Ans: B Feedback: The frontal lobe also contains Broca's area, which controls the motor function of speech. Damage to Broca's area produces expressive aphasia, or difficulty with the motor movements of speech. The postcentral gyrus, immediately behind the central sulcus, contains the primary somatosensory area. The basal ganglia are involved with motor functions and are associated with the learning and programming of behaviors/activities that are repetitive and that, done over time, become automatic. The hippocampus is involved in storing information, especially the emotions attached to a memory.
A nurse is assessing a client experiencing anxiety and observes increased sweating and goose flesh. The nurse understands that these are the result of which substance? A) Acetylcholine B) Norepinephrine C) Serotonin D) Histamine
Ans: B Feedback: The sympathetic response associated with anxiety that leads to piloerection and sweating results from norepinephrine. Acetylcholine has no effect on the pilomotor muscles and sweat glands. Serotonin plays a role in the control of appetite, sleep, and mood states. Histamine controls gastric secretions and the smooth muscle of the gastrointestinal tract.
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
Ans: B Feedback: The synaptic cleft, a junction between one nerve and another, is the space where the electrical intracellular signal becomes a chemical intracellular signal. The soma is the neuron's cell body. A terminal is the end of an axon. A receptor site is the area of the postsynaptic membrane that accepts the released neurotransmitter.
A nurse is caring for an older adult who has experienced damage to the frontal lobe after an automobile accident. The nurse anticipates that the client will have difficulty with which of the following? A) Smell B) Concept formation C) Receptive speech D) Hearing
Ans: B Feedback: Working memory is an important aspect of frontal lobe function. The nurse can anticipate that the client will have difficulty with concept formation, insight, judgment, and reasoning. The temporal lobes contain the primary auditory and olfactory areas. Wernicke's area, located at the posterior aspect of the superior temporal gyrus, is primarily responsible for receptive speech.
A nurse is teaching a medication class to a group of psychiatric clients. One of them asks, "Why am I having so much more trouble learning now that I am 60 than I did when I 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
Ans: C Feedback: Neuroplasticity is the brain's ability to change structure and function to compensate for a changing neuronal environment (Mohr & Mohr, 2001). With age, brains become less plastic, which explains why it is easier to learn a second language at the age of 5 years than at 55 years. The extrapyramidal motor system controls muscle tone, common reflexes, and automatic voluntary motor function. The amygdala provides an emotional component to memory and is involved in modulating aggression and sexuality. Psychoneuroimmunology involves the connection between the immune system and stress.
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 of twins B) Occurrence among first-degree relatives C) Risk factor analysis D) Adoption studies
Ans: C Feedback: Risk factor analysis is evaluated when determining genetic susceptibility, that is, predicting who is more likely to experience psychiatric disorders or certain conditions. Population genetics evaluates family studies that analyze the occurrence of a disorder among first-degree relatives, twin studies that analyze the presence (or absence) of a disorder in pairs of twins using concordance rates, and adoption studies that compare the risk of a disorder developing in offspring raised in different environments.
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 callosum 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.
Ans: D Feedback: Chronobiology involves the study and measure of time structures or biologic rhythms. Zeitgebers are specific events that function as time givers or synchronizers and that set biologic rhythms. Some theorists think that psychiatric disorders may result from one or more biologic rhythm dysfunctions. For example, depression may be, in part, a phase advance disorder, including early morning awakening and a decreased time of onset of REM sleep.
A client has been diagnosed with memory dysfunction associated with Alzheimer's disease. The nurse determines that damage to the client'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
Ans: D Feedback: Deterioration of the nerves of the hippocampus and other related temporal lobe structures are associated with Alzheimer's disease. The basal ganglia are involved with motor functions; the frontal lobe contains the primary motor area, Broca's area (for speech), personality, and working memory. The limbic system modulates basic emotions, needs, drives, and instinct.
A group of nursing students is 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) Mania C) Panic disorder D) Schizophrenia
Ans: D Feedback: Schizophrenia is associated with abnormally high activity of dopamine, not serotonin. Therefore, the students would need additional review. Whereas depression and insomnia have been associated with decreased levels of 5-HT, mania has been associated with increased 5-HT. Some of the most well-known antidepressant medications, such as fluoxetine and sertraline, function by increasing serotonin concentrations within certain areas of the central nervous system..
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
Ans: D Feedback: The area of the brain involved with verbal language function, including areas for both receptive and expressive speech, is the left hemisphere. The right hemisphere provides input into receptive nonverbal communication, spatial orientation, and recognition. The parietal lobe is involved with coordinating visual and somatosensory information. The occipital lobe is primarily involved with vision.
A group of students is 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
Ans: D Feedback: The receptors for acetylcholine are muscarinic and nicotinic receptors. Serotonin receptors are grouped in families such as 5HT 1a, 1b, and so on. Specific receptors for GABA are named A, B, and C. Dopamine receptors are named D1, D2, D3, and so on.
