TEST BANK FOR STAHL'S ESSENTIAL PSYCHOPHARMACOLOGY: NEUROSC
b b b b b bb
IENTIFIC BASIS AND PRACTICAL APPLICATIONS 4TH EDITION b b b b b b
Stahl's Essential Psychopharmacology b b
NeuroscientificbBasisbandbPracticalbApplicationsbTESTBANK/STUDYbGUIDE
Chapter 1 Chemical neurotransmissionb b b
MULTIPLE CHOICE b
1. A patient with depression mentions to the nurse, My mother says depression is a
b b b b b b b b b b b b b b
chemical disorder. What does she mean? The nurses response is based on the theor
b b b b b b b b b b b b b
ythat depression primarily involves which of the following
b b b b b b b
neurotransmitters?
a. Cortisol and GABA b b
b. COMT and glutamate b b
c. Monamine and glycine b b
d. Serotonin and norepinephrine b b
ANS: D b
One possible cause of depression is thought to involve one or more neurotransmitte
b b b b b b b b b b b b
rs.Serotonin and norepinephrine have been found to be important in the regulation
b b b b b b b b b b b b
of depression. There is no research to support that the other options play a significa
b b b b b b b b b b b b b b
nt role in the development of depression.
b b b b b b
2. A patient has experienced a stroke (cerebral vascular accident) that has resulte
b b b b b b b b b b b
d in damage to the Broca area. Which evaluation does the nurse conduct to reinforce this
b b b b b b b b b b b b b b b
diagnosis?
a. Observing the patient pick up a spoon b b b b b b
b. Asking the patient to recite the alphabet b b b b b b
c. Monitoring the patients blood pressure b b b b
d. Comparing the patients grip strength in both hands b b b b b b b
ANS: B b
Accidents or strokes that damage Brocas area may result in the inability to speak (i.e.
b b b b b b b b b b b b b b
, motor aphasia). Fine motor skills, blood pressure control, and muscle strength are n
b b b b b b b b b b b b b
otcontrolled by the Broca area of the left frontal lobe. b b b b b b b b b
3. The patient diagnosed with schizophrenia asks why psychotropic medications a
b b b b b b b b b
re always prescribed by the doctor. The nurses answer will be based on informatio
b b b b b b b b b b b b b
n thatthe therapeutic action of psychotropic drugs is the result of their effect on:
b b b b b b b b b b b b b
a. The temporal lobe; especially Wernickes area b b b b b
b. Dendrites and their ability to transmit electrical impulses b b b b b b b
c. The regulation of neurotransmitters especially dopamine
b b b b b
d. The peripheral nervous system sensitivity to the psychotropic medications
b b b b b b b b
,ANS: C b
Medications used to treat psychiatric disorders operate in and around the synaptic cle
b b b b b b b b b b b b
ftand have action at the neurotransmitter level, especially in the case of schizophreni
b b b b b b b b b b b b
a, on dopamine. The Wernickes area, dendrite function, or the sensitivity of the perip
b b b b b b b b b b b b b
heral nervous system are not relevant to either schizophrenia or psychotropic medica
b b b b b b b b b b b
tions.
4. A student nurse mutters that it seems entirely unnecessary to have to struggle w
b b b b b b b b b b b b b
ithunderstanding the anatomy and physiology of the neurologic system. The men b b b b b b b b b b
tor would base a response on the understanding that it is:
b b b b b b b b b b
Necessary but generally for psychiatric nurses who focus primarily onbehaviora b b b b b b b b b
a. l interventions b
A complex undertaking that advance practice psychiatric nurses frequently usei
b b b b b b b b b
b. n their practice b b
Important primarily for the nursing assessment of patients with braintraumacaus b b b b b b b b b
c. ed cognitive symptoms b b
Necessary for planning psychiatric care for all patients especially thoseexperien b b b b b b b b b
d. cing psychiatric disorders b b
ANS: D b
Nurses must understand that many symptoms of psychiatric disorders have a neuro
b b b b b b b b b b b
logic basis, although the symptoms are manifested behaviorally. This understandin
b b b b b b b b b
g facilitates effective care planning. The foundation of knowledge is notused exclu
b b b b b b b b b b b
sively by advanced practice psychiatric nurses nor is it relevant for only behavior th
b b b b b b b b b b b b b
erapies or brain trauma since dealing with the results of normal and abnormal brain
b b b b b b b b b b b b b b
function is a responsibility of all nurses providing all types of care tothe psychiatric
b b b b b b b b b b b b b b
patient.
5. A patient asks the nurse, My wife has breast cancer. Could it be caused by he
b b b b b b b b b b b b b b b
rchronic depression? Which response is supported by research data?
b b b b b b b b
a. Too much stress has been proven to cause all kinds of cancer.
b b b b b b b b b b b
b. There have been no research studies done on stress and disease yet.
b b b b b b b b b b b
c. Stress does cause the release of factors that suppress the immune system.
b b b b b b b b b b b
d. There appears to be little connection between stress and diseases of the body
b b b b b b b b b b b b
ANS: C b
Research indicates that stress causes a release of corticotropin-
b b b b b b b b
releasing factors that suppress the immune system. Studies indicate that psychiatric
b b b b b b b b b b b
disorders such as mooddisorders are sometimes associated with decreased function
b b b b b b b b b
ing of the immune system.Research does not support a connection between many c
b b b b b b b b b b b b
ancers and stress. There is a significant amount of research about stress and the bod
b b b b b b b b b b b b b b
y.
Research has shown that there are some connections between stress and physical di
b b b b b b b b b b b b
sease.
,6. A patient who has a parietal lobe injury is being evaluated for psychiatric reh
b b b b b b b b b b b b b
abilitation needs. Of the aspects of functioning listed, which will the nurse ident
b b b b b b b b b b b b
ifyas a focus of nursing intervention?
b b b b b
a. Expression of emotion b b
b. Detecting auditory stimuli b b
c. Receiving visual images b b
d. Processing associations b
ANS: D b
The parietal lobe is responsible for associating and processing sensory information th
b b b b b b b b b b b
at allows for functions such as following directions on a map, reading a clock, dressi
b b b b b b b b b b b b b b
ng self, keeping appointments, and distinguishing right from left. Emotional express
b b b b b b b b b b
ion is associated with frontal lobe function. Detecting auditory stimuli is a temporal l
b b b b b b b b b b b b b
obe function. Receiving visual images is related to occipital lobe function.
b b b b b b b b b b
7. At admission, the nurse learns that some time ago the patient had an infarct in th
b b b b b b b b b b b b b b b
eright cerebral cortex. During assessment, the nurse would expect to find that the
b b b b b b b b b b b b b
patient:
a. Demonstrates major deficiencies in speech b b b b
b. Is unable to effectively hold a spoon in the left hand
b b b b b b b b b b
c. Has difficulty explaining how to go about using the telephone
b b b b b b b b b
d. Cannot use his right hand to shave himself or comb his own hair b b b b b b b b b b b b
ANS: B b
The cerebral hemispheres are responsible for functions such as control of muscles. T
b b b b b b b b b b b b
he right hemisphere mainly controls the motor and sensory functions on the left side
b b b b b b b b b b b b b
of the body. Damage to the right side would result in impaired function on the left sid
b b b b b b b b b b b b b b b b
e of the body. The motor cortex controls voluntary motor activity. Brocas area contro
b b b b b b b b b b b b b
ls motor speech. Cognitive functions are attributed to the association cortex.
b b b b b b b b b b
The right side of the bodys motor activity is controlled by the left cerebral cortex.
b b b b b b b b b b b b b b
8. A patient with chronic schizophrenia had a stroke involving the hippocampus. T
b b b b b b b b b b b
hepatient will be discharged on low doses of haloperidol. The nurse will need to indi
b b b b b b b b b b b b b b
vidualize the patients medication teaching by:
b b b b b
a. Including the patients caregiver in the education b b b b b b
b. Being careful to stress the importance of taking the medication as prescribed
b b b b b b b b b b b
Providing the education at a time when the patient is emotionally calm andrelaxe
b b b b b b b b b b b b
c. d
Encouraging the patient to crush or dissolve the medication to help withswallowi
b b b b b b b b b b b
d. ng
ANS: A b
, The hippocampus plays a major role in short-
b b b b b b b
term memory and, hence, in learning. Taking the medication as prescribed and pro
b b b b b b b b b b b b
viding the education at a time when the patient is calm and relaxed is information or
b b b b b b b b b b b b b b b b
considerations that all patients should begiven. The medication does not necessaril
b b b b b b b b b b
y need to be crushed or dissolved since the stroke would not have caused difficulty
b b b b b b b b b b b b b b b
with swallowing.b
9. The physician tells the nurse, The medication Im prescribing for the pati
b b b b b b b b b b b
ent enhances the g-
b b b
aminobutyric acid (GABA) system. Which patient behavior willprovide ev
b b b b b b b b
idence that the medication therapy is successful?
b b b b b b
a. The patient is actively involved in playing cards with other patients.
b b b b b b b b b b
b. The patient reports that, I dont feel as anxious as I did a couple of days ago.
b b b b b b b b b b b b b b b b
c. The patient reports that both auditory and visual hallucinations have decrease
b b b b b b b b b b
d.
d. The patient says that, I am much happier than before I came to the hospital.
b b b b b b b b b b b b b b
ANS: B b
GABA is the principle inhibitory neurotransmitter. The medication should provide a
b b b b b b b b b b
nantianxiety effect. Alertness, psychotic behaviors, and mood elevation are not gene
b b b b b b b b b b
rally affected by g-aminobutyric acid.
b b b b
10. The patients family asks whether a diagnosis of Parkinsons disease creates a
b b b b b b b b b b b
n increased risk for any mental health issues. What question would the nurse ask
b b b b b b b b b b b b b
btoassess for such a comorbid condition?b b b b b
a. Has your father exhibited any signs of depression? b b b b b b b
b. Does your father seem to experience mood swings? b b b b b b b
c. Have you noticed your father talking about seeing things you cant see?
b b b b b b b b b b b
d. Is your dad preoccupied with behaviors that he needs to repeat over and over?
b b b b b b b b b b b b b
ANS: A b
Serotonin and its close chemical relatives, dopamine and norepinephrine, are the ne
b b b b b b b b b b b
urotransmitters that are most widely involved in various forms of depression. Most
b b b b b b b b b b b
researchers agree that the immediate cause of parkinsonism is a deficiency of dopa
b b b b b b b b b b b b
mine and so a patient with Parkinsons disease should be monitored for depression,
b b b b b b b b b b b b b
The other mental health disorders (bipolar disorder, hallucinations, and obsessive c
b b b b b b b b b b
ompulsive disorder) have not been connected to Parkinsons disease.
b b b b b b b b
11. Which explanation for the prescription of donepezil (Aricept) would the n
b b b b b b b b b b
urseprovide for a patient in the early stage of Alzheimers disease?
b b b b b b b b b b
a. It will increase the metabolism of excess GABA.
b b b b b b b
b. Excess dopamine will be prevented from attaching to receptor sites. b b b b b b b b b
c. Serotonin deficiency will be managed through a prolonged reuptake period. b b b b b b b b b
d. The acetylcholine deficiency will be managed by inhibiting cholinesterase.
b b b b b b b b
ANS: D b
b b b b b bb
IENTIFIC BASIS AND PRACTICAL APPLICATIONS 4TH EDITION b b b b b b
Stahl's Essential Psychopharmacology b b
NeuroscientificbBasisbandbPracticalbApplicationsbTESTBANK/STUDYbGUIDE
Chapter 1 Chemical neurotransmissionb b b
MULTIPLE CHOICE b
1. A patient with depression mentions to the nurse, My mother says depression is a
b b b b b b b b b b b b b b
chemical disorder. What does she mean? The nurses response is based on the theor
b b b b b b b b b b b b b
ythat depression primarily involves which of the following
b b b b b b b
neurotransmitters?
a. Cortisol and GABA b b
b. COMT and glutamate b b
c. Monamine and glycine b b
d. Serotonin and norepinephrine b b
ANS: D b
One possible cause of depression is thought to involve one or more neurotransmitte
b b b b b b b b b b b b
rs.Serotonin and norepinephrine have been found to be important in the regulation
b b b b b b b b b b b b
of depression. There is no research to support that the other options play a significa
b b b b b b b b b b b b b b
nt role in the development of depression.
b b b b b b
2. A patient has experienced a stroke (cerebral vascular accident) that has resulte
b b b b b b b b b b b
d in damage to the Broca area. Which evaluation does the nurse conduct to reinforce this
b b b b b b b b b b b b b b b
diagnosis?
a. Observing the patient pick up a spoon b b b b b b
b. Asking the patient to recite the alphabet b b b b b b
c. Monitoring the patients blood pressure b b b b
d. Comparing the patients grip strength in both hands b b b b b b b
ANS: B b
Accidents or strokes that damage Brocas area may result in the inability to speak (i.e.
b b b b b b b b b b b b b b
, motor aphasia). Fine motor skills, blood pressure control, and muscle strength are n
b b b b b b b b b b b b b
otcontrolled by the Broca area of the left frontal lobe. b b b b b b b b b
3. The patient diagnosed with schizophrenia asks why psychotropic medications a
b b b b b b b b b
re always prescribed by the doctor. The nurses answer will be based on informatio
b b b b b b b b b b b b b
n thatthe therapeutic action of psychotropic drugs is the result of their effect on:
b b b b b b b b b b b b b
a. The temporal lobe; especially Wernickes area b b b b b
b. Dendrites and their ability to transmit electrical impulses b b b b b b b
c. The regulation of neurotransmitters especially dopamine
b b b b b
d. The peripheral nervous system sensitivity to the psychotropic medications
b b b b b b b b
,ANS: C b
Medications used to treat psychiatric disorders operate in and around the synaptic cle
b b b b b b b b b b b b
ftand have action at the neurotransmitter level, especially in the case of schizophreni
b b b b b b b b b b b b
a, on dopamine. The Wernickes area, dendrite function, or the sensitivity of the perip
b b b b b b b b b b b b b
heral nervous system are not relevant to either schizophrenia or psychotropic medica
b b b b b b b b b b b
tions.
4. A student nurse mutters that it seems entirely unnecessary to have to struggle w
b b b b b b b b b b b b b
ithunderstanding the anatomy and physiology of the neurologic system. The men b b b b b b b b b b
tor would base a response on the understanding that it is:
b b b b b b b b b b
Necessary but generally for psychiatric nurses who focus primarily onbehaviora b b b b b b b b b
a. l interventions b
A complex undertaking that advance practice psychiatric nurses frequently usei
b b b b b b b b b
b. n their practice b b
Important primarily for the nursing assessment of patients with braintraumacaus b b b b b b b b b
c. ed cognitive symptoms b b
Necessary for planning psychiatric care for all patients especially thoseexperien b b b b b b b b b
d. cing psychiatric disorders b b
ANS: D b
Nurses must understand that many symptoms of psychiatric disorders have a neuro
b b b b b b b b b b b
logic basis, although the symptoms are manifested behaviorally. This understandin
b b b b b b b b b
g facilitates effective care planning. The foundation of knowledge is notused exclu
b b b b b b b b b b b
sively by advanced practice psychiatric nurses nor is it relevant for only behavior th
b b b b b b b b b b b b b
erapies or brain trauma since dealing with the results of normal and abnormal brain
b b b b b b b b b b b b b b
function is a responsibility of all nurses providing all types of care tothe psychiatric
b b b b b b b b b b b b b b
patient.
5. A patient asks the nurse, My wife has breast cancer. Could it be caused by he
b b b b b b b b b b b b b b b
rchronic depression? Which response is supported by research data?
b b b b b b b b
a. Too much stress has been proven to cause all kinds of cancer.
b b b b b b b b b b b
b. There have been no research studies done on stress and disease yet.
b b b b b b b b b b b
c. Stress does cause the release of factors that suppress the immune system.
b b b b b b b b b b b
d. There appears to be little connection between stress and diseases of the body
b b b b b b b b b b b b
ANS: C b
Research indicates that stress causes a release of corticotropin-
b b b b b b b b
releasing factors that suppress the immune system. Studies indicate that psychiatric
b b b b b b b b b b b
disorders such as mooddisorders are sometimes associated with decreased function
b b b b b b b b b
ing of the immune system.Research does not support a connection between many c
b b b b b b b b b b b b
ancers and stress. There is a significant amount of research about stress and the bod
b b b b b b b b b b b b b b
y.
Research has shown that there are some connections between stress and physical di
b b b b b b b b b b b b
sease.
,6. A patient who has a parietal lobe injury is being evaluated for psychiatric reh
b b b b b b b b b b b b b
abilitation needs. Of the aspects of functioning listed, which will the nurse ident
b b b b b b b b b b b b
ifyas a focus of nursing intervention?
b b b b b
a. Expression of emotion b b
b. Detecting auditory stimuli b b
c. Receiving visual images b b
d. Processing associations b
ANS: D b
The parietal lobe is responsible for associating and processing sensory information th
b b b b b b b b b b b
at allows for functions such as following directions on a map, reading a clock, dressi
b b b b b b b b b b b b b b
ng self, keeping appointments, and distinguishing right from left. Emotional express
b b b b b b b b b b
ion is associated with frontal lobe function. Detecting auditory stimuli is a temporal l
b b b b b b b b b b b b b
obe function. Receiving visual images is related to occipital lobe function.
b b b b b b b b b b
7. At admission, the nurse learns that some time ago the patient had an infarct in th
b b b b b b b b b b b b b b b
eright cerebral cortex. During assessment, the nurse would expect to find that the
b b b b b b b b b b b b b
patient:
a. Demonstrates major deficiencies in speech b b b b
b. Is unable to effectively hold a spoon in the left hand
b b b b b b b b b b
c. Has difficulty explaining how to go about using the telephone
b b b b b b b b b
d. Cannot use his right hand to shave himself or comb his own hair b b b b b b b b b b b b
ANS: B b
The cerebral hemispheres are responsible for functions such as control of muscles. T
b b b b b b b b b b b b
he right hemisphere mainly controls the motor and sensory functions on the left side
b b b b b b b b b b b b b
of the body. Damage to the right side would result in impaired function on the left sid
b b b b b b b b b b b b b b b b
e of the body. The motor cortex controls voluntary motor activity. Brocas area contro
b b b b b b b b b b b b b
ls motor speech. Cognitive functions are attributed to the association cortex.
b b b b b b b b b b
The right side of the bodys motor activity is controlled by the left cerebral cortex.
b b b b b b b b b b b b b b
8. A patient with chronic schizophrenia had a stroke involving the hippocampus. T
b b b b b b b b b b b
hepatient will be discharged on low doses of haloperidol. The nurse will need to indi
b b b b b b b b b b b b b b
vidualize the patients medication teaching by:
b b b b b
a. Including the patients caregiver in the education b b b b b b
b. Being careful to stress the importance of taking the medication as prescribed
b b b b b b b b b b b
Providing the education at a time when the patient is emotionally calm andrelaxe
b b b b b b b b b b b b
c. d
Encouraging the patient to crush or dissolve the medication to help withswallowi
b b b b b b b b b b b
d. ng
ANS: A b
, The hippocampus plays a major role in short-
b b b b b b b
term memory and, hence, in learning. Taking the medication as prescribed and pro
b b b b b b b b b b b b
viding the education at a time when the patient is calm and relaxed is information or
b b b b b b b b b b b b b b b b
considerations that all patients should begiven. The medication does not necessaril
b b b b b b b b b b
y need to be crushed or dissolved since the stroke would not have caused difficulty
b b b b b b b b b b b b b b b
with swallowing.b
9. The physician tells the nurse, The medication Im prescribing for the pati
b b b b b b b b b b b
ent enhances the g-
b b b
aminobutyric acid (GABA) system. Which patient behavior willprovide ev
b b b b b b b b
idence that the medication therapy is successful?
b b b b b b
a. The patient is actively involved in playing cards with other patients.
b b b b b b b b b b
b. The patient reports that, I dont feel as anxious as I did a couple of days ago.
b b b b b b b b b b b b b b b b
c. The patient reports that both auditory and visual hallucinations have decrease
b b b b b b b b b b
d.
d. The patient says that, I am much happier than before I came to the hospital.
b b b b b b b b b b b b b b
ANS: B b
GABA is the principle inhibitory neurotransmitter. The medication should provide a
b b b b b b b b b b
nantianxiety effect. Alertness, psychotic behaviors, and mood elevation are not gene
b b b b b b b b b b
rally affected by g-aminobutyric acid.
b b b b
10. The patients family asks whether a diagnosis of Parkinsons disease creates a
b b b b b b b b b b b
n increased risk for any mental health issues. What question would the nurse ask
b b b b b b b b b b b b b
btoassess for such a comorbid condition?b b b b b
a. Has your father exhibited any signs of depression? b b b b b b b
b. Does your father seem to experience mood swings? b b b b b b b
c. Have you noticed your father talking about seeing things you cant see?
b b b b b b b b b b b
d. Is your dad preoccupied with behaviors that he needs to repeat over and over?
b b b b b b b b b b b b b
ANS: A b
Serotonin and its close chemical relatives, dopamine and norepinephrine, are the ne
b b b b b b b b b b b
urotransmitters that are most widely involved in various forms of depression. Most
b b b b b b b b b b b
researchers agree that the immediate cause of parkinsonism is a deficiency of dopa
b b b b b b b b b b b b
mine and so a patient with Parkinsons disease should be monitored for depression,
b b b b b b b b b b b b b
The other mental health disorders (bipolar disorder, hallucinations, and obsessive c
b b b b b b b b b b
ompulsive disorder) have not been connected to Parkinsons disease.
b b b b b b b b
11. Which explanation for the prescription of donepezil (Aricept) would the n
b b b b b b b b b b
urseprovide for a patient in the early stage of Alzheimers disease?
b b b b b b b b b b
a. It will increase the metabolism of excess GABA.
b b b b b b b
b. Excess dopamine will be prevented from attaching to receptor sites. b b b b b b b b b
c. Serotonin deficiency will be managed through a prolonged reuptake period. b b b b b b b b b
d. The acetylcholine deficiency will be managed by inhibiting cholinesterase.
b b b b b b b b
ANS: D b
