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STAHLS ESSENTIAL PSYCHOPATHOLOGYStahl's BASIS
NEUROSCIENTIFIC Essential ANDPsychopharmacology
PRACTICE APPLICATION 5TH
EDITION TEST BANK
Neuroscientific Basis and Practical Applications 5th Edition Testbank/Study Guide
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 theory
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that depression primarily involves which of the following neurotransmitters?
a. Cortisol and GABA
.c
b. COMT and glutamate
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c. Monamine and glycine
d. Serotonin and norepinephrine
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ANS: D
One possible cause of depression is thought to involve one or more neurotransmitters.
st
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
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role in the development of depression.
ng
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?
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a. Observing the patient pick up a spoon
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b. Asking the patient to recite the alphabet
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c. Monitoring the patients blood pressure
d. Comparing the patients grip strength in both hands
.m
ANS: B
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
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
the 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
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,ANS: C
Medications used to treat psychiatric disorders operate in and around the synaptic cleft
and 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
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would base a response on the understanding that it is:
Necessary but generally for psychiatric nurses who focus primarily on
a. behavioral interventions
.c
A complex undertaking that advance practice psychiatric nurses frequently use
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b. in their practice
Important primarily for the nursing assessment of patients with brain
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c. traumacaused cognitive symptoms
Necessary for planning psychiatric care for all patients especially those
d. experiencing psychiatric disorders
st
te
ANS: D
Nurses must understand that many symptoms of psychiatric disorders have a
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neurologic basis, although the symptoms are manifested behaviorally. This
understanding facilitates effective care planning. The foundation of knowledge is not
si
used 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
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abnormal brain function is a responsibility of all nurses providing all types of care to
the psychiatric patient.
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5. A patient asks the nurse, My wife has breast cancer. Could it be caused by her
chronic depression? Which response is supported by research data?
.m
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.
w
c. Stress does cause the release of factors that suppress the immune system.
w
d. There appears to be little connection between stress and diseases of the body
w
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 mood
disorders are sometimes associated with decreased functioning of the immune system.
Research does not 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.
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,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 identify
as a focus of nursing intervention?
a. Expression of emotion
b. Detecting auditory stimuli
c. Receiving visual images
d. Processing associations
om
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,
.c
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
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 the
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right cerebral cortex. During assessment, the nurse would expect to find that the
patient:
a.
st
Demonstrates major deficiencies in speech
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b. Is unable to effectively hold a spoon in the left hand
ng
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
si
ANS: B
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
side of the body. The motor cortex controls voluntary motor activity. Brocas area
controls motor speech. Cognitive functions are attributed to the association cortex.
.m
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. The
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patient will be discharged on low doses of haloperidol. The nurse will need to
individualize the patients medication teaching by:
w
a. Including the patients caregiver in the education
w
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 and
c. relaxed
Encouraging the patient to crush or dissolve the medication to help with
d. swallowing
ANS: A
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, 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 be
given. The medication does not necessarily need to be crushed or dissolved since the
stroke would not have caused difficulty with swallowing.
9. The physician tells the nurse, The medication Im prescribing for the patient
enhances the g-aminobutyric acid (GABA) system. Which patient behavior will
provide evidence that the medication therapy is successful?
om
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
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.
ep
ANS: B
GABA is the principle inhibitory neurotransmitter. The medication should provide an
pr
antianxiety effect. Alertness, psychotic behaviors, and mood elevation are not
generally affected by g-aminobutyric acid.
st
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
assess for such a comorbid condition?
ng
a. Has your father exhibited any signs of depression?
b. Does your father seem to experience mood swings?
si
c. Have you noticed your father talking about seeing things you cant see?
ur
d. Is your dad preoccupied with behaviors that he needs to repeat over and over?
yn
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
.m
researchers agree that the immediate cause of parkinsonism is a deficiency of
dopamine and so a patient with Parkinsons disease should be monitored for
w
depression, The other mental health disorders (bipolar disorder, hallucinations, and
obsessive compulsive disorder) have not been connected to Parkinsons disease.
w
11. Which explanation for the prescription of donepezil (Aricept) would the nurse
w
provide 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
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