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Stahl's Essential Psychopharmacology v v




Neuroscientific Basis and Practical Applications TESTBANK/STUDY GUIDE v v v v v v




Chapter 1 Chemical neurotransmission
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MULTIPLE CHOICE v


1. A patient with depression mentions to the nurse, My mother says depression is a
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chemical disorder. What does she mean? The nurses response is based on the theory
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that depression primarily involves which of the following neurotransmitters?
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a. Cortisol and GABA v v




b. COMT and glutamate v v




c. Monamine and glycine v v




d. Serotonin and norepinephrine v v



ANS: D v


One possible cause of depression is thought to involve one or more neurotransmitters.
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Serotonin and norepinephrine have been found to be important in the regulation of
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depression. There is no research to support that the other options play a significant
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role in the development of depression.
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2. A patient has experienced a stroke (cerebral vascular accident) that has resulted in
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damage to the Broca area. Which evaluation does the nurse conduct to reinforce this
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diagnosis?
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a. Observing the patient pick up a spoon v v v v v v




b. Asking the patient to recite the alphabetv v v v v v




c. Monitoring the patients blood pressure v v v v




d. Comparing the patients grip strength in both hands v v v v v v v



ANS: B v


Accidents or strokes that damage Brocas area may result in the inability to speak (i.e.,
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motor aphasia). Fine motor skills, blood pressure control, and muscle strength are not
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controlled by the Broca area of the left frontal lobe.
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3. The patient diagnosed with schizophrenia asks why psychotropic medications are
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always prescribed by the doctor. The nurses answer will be based on information that
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the therapeutic action of psychotropic drugs is the result of their effect on:
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a. The temporal lobe; especially Wernickes area
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b. Dendrites and their ability to transmit electrical impulses
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c. The regulation of neurotransmitters especially dopamine
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d. The peripheral nervous system sensitivity to the psychotropic medications
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,ANS: C v


Medications used to treat psychiatric disorders operate in and around the synaptic cleft
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and have action at the neurotransmitter level, especially in the case of schizophrenia,
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on dopamine. The Wernickes area, dendrite function, or the sensitivity of the
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peripheral nervous system are not relevant to either schizophrenia or psychotropic
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medications.
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4. A student nurse mutters that it seems entirely unnecessary to have to struggle with
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understanding the anatomy and physiology of the neurologic system. The mentor
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would base a response on the understanding that it is:
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Necessary but generally for psychiatric nurses who focus primarily on v v v v v v v v v


a. behavioral interventions
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A complex undertaking that advance practice psychiatric nurses frequently use
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b. in their practice
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Important primarily for the nursing assessment of patients with brain
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c. traumacaused cognitive symptoms
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Necessary for planning psychiatric care for all patients especially those v v v v v v v v v


d. experiencing psychiatric disorders
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ANS: D v


Nurses must understand that many symptoms of psychiatric disorders have a
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neurologic basis, although the symptoms are manifested behaviorally. This
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understanding facilitates effective care planning. The foundation of knowledge is not
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used exclusively by advanced practice psychiatric nurses nor is it relevant for only
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behavior therapies or brain trauma since dealing with the results of normal and
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abnormal brain function is a responsibility of all nurses providing all types of care to
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the psychiatric patient.
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5. A patient asks the nurse, My wife has breast cancer. Could it be caused by her
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chronic depression? Which response is supported by research data?
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a. Too much stress has been proven to cause all kinds of cancer.
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b. There have been no research studies done on stress and disease yet.
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c. Stress does cause the release of factors that suppress the immune system.
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d. There appears to be little connection between stress and diseases of the body
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ANS: C v


Research indicates that stress causes a release of corticotropin-releasing factors that
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suppress the immune system. Studies indicate that psychiatric disorders such as mood
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disorders are sometimes associated with decreased functioning of the immune system.
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Research does not support a connection between many cancers and stress. There is a
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significant amount of research about stress and the body. Research has shown that
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there are some connections between stress and physical disease.
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,6. A patient who has a parietal lobe injury is being evaluated for psychiatric
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rehabilitation needs. Of the aspects of functioning listed, which will the nurse identify
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as a focus of nursing intervention?
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a. Expression of emotion v v




b. Detecting auditory stimuli v v




c. Receiving visual images v v




d. Processing associations v



ANS: D v


The parietal lobe is responsible for associating and processing sensory information
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that allows for functions such as following directions on a map, reading a clock,
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dressing self, keeping appointments, and distinguishing right from left. Emotional
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expression is associated with frontal lobe function. Detecting auditory stimuli is a
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temporal lobe function. Receiving visual images is related to occipital lobe function.
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7. At admission, the nurse learns that some time ago the patient had an infarct in the
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right cerebral cortex. During assessment, the nurse would expect to find that the
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patient:
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a. Demonstrates major deficiencies in speech v v v v




b. Is unable to effectively hold a spoon in the left hand
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c. Has difficulty explaining how to go about using the telephone
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d. Cannot use his right hand to shave himself or comb his own hair v v v v v v v v v v v v



ANS: B v


The cerebral hemispheres are responsible for functions such as control of muscles.
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The right hemisphere mainly controls the motor and sensory functions on the left side
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of the body. Damage to the right side would result in impaired function on the left
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side of the body. The motor cortex controls voluntary motor activity. Brocas area
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controls motor speech. Cognitive functions are attributed to the association cortex.
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The right side of the bodys motor activity is controlled by the left cerebral cortex.
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8. A patient with chronic schizophrenia had a stroke involving the hippocampus. The
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patient will be discharged on low doses of haloperidol. The nurse will need to
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individualize the patients medication teaching by:
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a. Including the patients caregiver in the education v v v v v v




b. Being careful to stress the importance of taking the medication as prescribed
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Providing the education at a time when the patient is emotionally calm and relaxed
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c.
Encouraging the patient to crush or dissolve the medication to help with v v v v v v v v v v v



d. swallowing
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ANS: A v

, The hippocampus plays a major role in short-term memory and, hence, in learning.
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Taking the medication as prescribed and providing the education at a time when the
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patient is calm and relaxed is information or considerations that all patients should be
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given. The medication does not necessarily need to be crushed or dissolved since the
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stroke would not have caused difficulty with swallowing.
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9. The physician tells the nurse, The medication Im prescribing for the patient
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enhances the g-aminobutyric acid (GABA) system. Which patient behavior will
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provide evidence that the medication therapy is successful?
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a. The patient is actively involved in playing cards with other patients.
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b. The patient reports that, I dont feel as anxious as I did a couple of days ago.
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c. The patient reports that both auditory and visual hallucinations have decreased.
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d. The patient says that, I am much happier than before I came to the hospital.
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ANS: B v


GABA is the principle inhibitory neurotransmitter. The medication should provide an
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antianxiety effect. Alertness, psychotic behaviors, and mood elevation are not
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generally affected by g-aminobutyric acid.
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10. The patients family asks whether a diagnosis of Parkinsons disease creates an
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increased risk for any mental health issues. What question would the nurse ask to
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assess for such a comorbid condition?
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a. Has your father exhibited any signs of depression?
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b. Does your father seem to experience mood swings?
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c. Have you noticed your father talking about seeing things you cant see?
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d. Is your dad preoccupied with behaviors that he needs to repeat over and over?
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ANS: A v


Serotonin and its close chemical relatives, dopamine and norepinephrine, are the
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neurotransmitters that are most widely involved in various forms of depression. Most
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researchers agree that the immediate cause of parkinsonism is a deficiency of
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dopamine and so a patient with Parkinsons disease should be monitored for
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depression, The other mental health disorders (bipolar disorder, hallucinations, and
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obsessive compulsive disorder) have not been connected to Parkinsons disease.
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11. Which explanation for the prescription of donepezil (Aricept) would the nurse
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provide for a patient in the early stage of Alzheimers disease?
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a. It will increase the metabolism of excess GABA.
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b. Excess dopamine will be prevented from attaching to receptor sites.
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c. Serotonin deficiency will be managed through a prolonged reuptake period.
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d. The acetylcholine deficiency will be managed by inhibiting cholinesterase.
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ANS: D v