Test Bank Stahl’s Essential Psychopharmacology 5th EditionTable of Contents Chapter 1 Chemical neurotransmission ............................................................................................... 1 Chapter 2 Transporters, Receptors, And Enzymes As Targets Of Psychopharmacological Dru...
Stahl's Essential Psychopharmacology Neuroscientific Basis
and Practical Applications 5th Edition Test bank/ Study Guide
Table of Contents
Chapter 1 Chemical neurotransmission ............................................................................................... 1
Chapter 2 Transporters, Receptors, And Enzymes As Targets Of PsychopharmacologicalDrug Action8
Chapter 3 Ion Channels as Targets Of Psychopharmacological Drug Action ..................................... 15
Chapter 4 Psychosis and schizophrenia ............................................................................................ 21
Chapter 5 Antipsychotic agents ......................................................................................................... 34
Chapter 6 Mood disorders ................................................................................................................. 41
Chapter 7 Antidepressants ................................................................................................................ 49
Chapter 8 Mood stabilizers ................................................................................................................ 57
Chapter 9 Anxiety disorders and Anxiolytics ...................................................................................... 72
Chapter 10 Chronic pain and its treatment......................................................................................... 77
Chapter 11 Disorders Of Sleep And Wakefulness And Their Treatment ............................................ 85
Chapter 12 Attention Deficit Hyperactivity Disorder And Its Treatment............................................... 91
Chapter 13 Dementia and its treatment ............................................................................................. 99
Chapter 14 Impulsivity, Compulsivity, And Addiction ........................................................................ 109
Chapter 1 Chemical neurotransmission
MULTIPLE CHOICE
1. A patient with depression mentions to the nurse, My mother says depression is a chemical
disorder. What does she mean? The nurses response is based on the theorythat depression
primarily involves which of the following neurotransmitters?
a. Cortisol and GABA
b. COMT and glutamate
c. Monamine and glycine
d. Serotonin and norepinephrine
ANS: D
One possible cause of depression is thought to involve one or more neurotransmitters.
Serotonin and norepinephrine have been found to be important in the regulation of depression.
There is no research to support that the other options play a significant role in the development
of depression.
2. A patient has experienced a stroke (cerebral vascular accident) that has resulted in
damage to the Broca area. Which evaluation does the nurse conduct to reinforce this
diagnosis?
a. Observing the patient pick up a spoon
b. Asking the patient to recite the alphabet
c. Monitoring the patients blood pressure
d. Comparing the patients grip strength in both hands
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,ANS: B
Accidents or strokes that damage Brocas area may result in the inability to speak (i.e., motor
aphasia). Fine motor skills, blood pressure control, and muscle strength are not controlled by
the Broca area of the left frontal lobe.
3. The patient diagnosed with schizophrenia asks why psychotropic medications are always
prescribed by the doctor. The nurses answer will be based on information thatthe therapeutic
action of psychotropic drugs is the result of their effect on:
a. The temporal lobe; especially Wernickes area
b. Dendrites and their ability to transmit electrical impulses
c. The regulation of neurotransmitters especially dopamine
d. The peripheral nervous system sensitivity to the psychotropic medications
ANS: C
Medications used to treat psychiatric disorders operate in and around the synaptic cleftand have
action at the neurotransmitter level, especially in the case of schizophrenia, on dopamine. The
Wernickes area, dendrite function, or the sensitivity of the peripheral nervous system are not
relevant to either schizophrenia or psychotropic medications.
4. A student nurse mutters that it seems entirely unnecessary to have to struggle with
understanding the anatomy and physiology of the neurologic system. The mentor would base
a response on the understanding that it is:
Necessary but generally for psychiatric nurses who focus primarily on
a. behavioral interventions
A complex undertaking that advance practice psychiatric nurses frequently usein their
b. practice
Important primarily for the nursing assessment of patients with brain
c. traumacaused cognitive symptoms
Necessary for planning psychiatric care for all patients especially those
d. experiencing psychiatric disorders
ANS: D
Nurses must understand that many symptoms of psychiatric disorders have a neurologic
basis, although the symptoms are manifested behaviorally. This understanding facilitates
effective care planning. The foundation of knowledge is notused exclusively by advanced
practice psychiatric nurses nor is it relevant for only behavior therapies or brain trauma since
dealing with the results of normal and abnormal brain function is a responsibility of all nurses
providing all types of care tothe psychiatric patient.
5. A patient asks the nurse, My wife has breast cancer. Could it be caused by herchronic
depression? Which response is supported by research data?
a. Too much stress has been proven to cause all kinds of cancer.
b. There have been no research studies done on stress and disease yet.
c. Stress does cause the release of factors that suppress the immune system.
d. There appears to be little connection between stress and diseases of the body
ANS: C
Research indicates that stress causes a release of corticotropin-releasing factors that suppress
the immune system. Studies indicate that psychiatric disorders such as mooddisorders are
sometimes associated with decreased functioning of the immune system.Research does not
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,support a connection between many cancers and stress. There is a significant amount of
research about stress and the body. Research has shown that there are some connections
between stress and physical disease.
6. A patient who has a parietal lobe injury is being evaluated for psychiatric rehabilitation
needs. Of the aspects of functioning listed, which will the nurse identifyas a focus of nursing
intervention?
a. Expression of emotion
b. Detecting auditory stimuli
c. Receiving visual images
d. Processing associations
ANS: D
The parietal lobe is responsible for associating and processing sensory information that allows
for functions such as following directions on a map, reading a clock, dressing self, keeping
appointments, and distinguishing right from left. Emotional expression is associated with frontal
lobe function. Detecting auditory stimuli is a temporal lobe function. Receiving visual images is
related to occipital lobe function.
7. At admission, the nurse learns that some time ago the patient had an infarct in theright
cerebral cortex. During assessment, the nurse would expect to find that the patient:
a. Demonstrates major deficiencies in speech
b. Is unable to effectively hold a spoon in the left hand
c. Has difficulty explaining how to go about using the telephone
d. Cannot use his right hand to shave himself or comb his own hair
ANS: B
The cerebral hemispheres are responsible for functions such as control of muscles. The right
hemisphere mainly controls the motor and sensory functions on the left sideof the body.
Damage to the right side would result in impaired function on the left side of the body. The
motor cortex controls voluntary motor activity. Brocas area controls motor speech. Cognitive
functions are attributed to the association cortex.
The right side of the bodys motor activity is controlled by the left cerebral cortex.
8. A patient with chronic schizophrenia had a stroke involving the hippocampus. Thepatient
will be discharged on low doses of haloperidol. The nurse will need to individualize the
patients medication teaching by:
a. Including the patients caregiver in the education
b. Being careful to stress the importance of taking the medication as prescribed
Providing the education at a time when the patient is emotionally calm andrelaxed
c.
Encouraging the patient to crush or dissolve the medication to help with
d.
swallowing
ANS: A
The hippocampus plays a major role in short-term memory and, hence, in learning. Taking the
medication as prescribed and providing the education at a time when the patient is calm and
relaxed is information or considerations that all patients should begiven. The medication does
not necessarily need to be crushed or dissolved since the 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 enhances
the g-aminobutyric acid (GABA) system. Which patient behavior willprovide evidence
that the medication therapy is successful?
a. The patient is actively involved in playing cards with other patients.
b. The patient reports that, I dont feel as anxious as I did a couple of days ago.
c. The patient reports that both auditory and visual hallucinations have decreased.
d. The patient says that, I am much happier than before I came to the hospital.
ANS: B
GABA is the principle inhibitory neurotransmitter. The medication should provide anantianxiety
effect. Alertness, psychotic behaviors, and mood elevation are not generally affected by g-
aminobutyric acid.
10. The patients family asks whether a diagnosis of Parkinsons disease creates an
increased risk for any mental health issues. What question would the nurse ask to assess
for such a comorbid condition?
a. Has your father exhibited any signs of depression?
b. Does your father seem to experience mood swings?
c. Have you noticed your father talking about seeing things you cant see?
d. Is your dad preoccupied with behaviors that he needs to repeat over and over?
ANS: A
Serotonin and its close chemical relatives, dopamine and norepinephrine, are the
neurotransmitters that are most widely involved in various forms of depression. Most
researchers agree that the immediate cause of parkinsonism is a deficiency of dopamine and
so a patient with Parkinsons disease should be monitored for depression, The other mental
health disorders (bipolar disorder, hallucinations, and obsessive compulsive disorder) have not
been connected to Parkinsons disease.
11. Which explanation for the prescription of donepezil (Aricept) would the nurseprovide
for a patient in the early stage of Alzheimers disease?
a. It will increase the metabolism of excess GABA.
b. Excess dopamine will be prevented from attaching to receptor sites.
c. Serotonin deficiency will be managed through a prolonged reuptake period.
d. The acetylcholine deficiency will be managed by inhibiting cholinesterase.
ANS: D
Decreased levels of acetylcholine are thought to produce many of the behavioral symptoms of
Alzheimers disease. The inhibiting action the drug has on cholinesterasewill slow down the
breakdown of acetylcholine and so delay the onset of symptoms. The other neurotransmitters
(GABA, dopamine, and serotonin) are not currently believed to play a role in Alzheimers
disease.
12. There remains a stigma attached to psychiatric illnesses. The psychiatric nursemakes
the greatest impact on this sociological problem when:
a. Providing educational programming for patients and the public
b. Arranging for adequate and appropriate social support for the patient
c. Assisting the patient to achieve the maximum level of independent functioning
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