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TEST BANK FOR STAHL'S ESSENTIAL PSYCHOPHARMACOLOGY: NEUROSCIENTIFIC BASIS AND PRACTICAL APPLICATIONS 4TH EDITION, ISBN:6465-1. 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 that depre...
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TEST BANK FOR STAHL'S ESSENTIAL PSYCHOPHARMACOLOGY:
NEUROSCIENTIFIC BASIS AND PRACTICAL APPLICATIONS 4TH EDITION
Stahl's Essential Psychopharmacology
Neuroscientific Basis and Practical Applications 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
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 thisdiagnosis?
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
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 notcontrolled 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
,Updated Solutions
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
withunderstanding 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
a. onbehavioral interventions
A complex undertaking that advance practice psychiatric nurses frequently
b. usein their practice
Important primarily for the nursing assessment of patients with
c. braintraumacaused cognitive symptoms
Necessary for planning psychiatric care for all patients especially
d. thoseexperiencing 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 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.
,Updated Solutions
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
c. andrelaxed
Encouraging the patient to crush or dissolve the medication to help
d. withswallowing
ANS: A
, Updated Solutions
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.
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 toassess 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.
Mostresearchers 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
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