STAHL'S ESSENTIAL PSY n nn
CHOPHARMACOLOGY
NEUROSCIENTIFICnBASISnANDnPRACTICALnAPPLICATIONSnTESTBANK/STUDYnGUID
E
Chapter 1 Chemical neurotransmission
n n n
MULTIPLE CHOICE n
1. A patient with depression mentions to the nurse, My mother says depression is a ch
n n n n n n n n n n n n n n
emical disorder. What does she mean? The nurses response is based on the theory
n n n n n n n n n n n n n
that depression primarily involves which of the following neurotransmitters?
n n n n n n n n
a. Cortisol and GABA n n
b. COMT and glutamate n n
c. Monamine and glycine n n
d. Serotonin and norepinephrine n n n
ANS: D n
One possible cause of depression is thought to involve one or more neurotransmitters.
n n n n n n n n n n n n
Serotonin and norepinephrine have been found to be important in the regulation of d
n n n n n n n n n n n n n
epression. There is no research to support that the other options play a significant rol
n n n n n n n n n n n n n n
e in the development of depression.
n n n n n
2. A patient has experienced a stroke (cerebral vascular accident) that has resulted in damag
n n n n n n n n n n n n n
e to the Broca area. Which evaluation does the nurse conduct to reinforce this diagnosis?
n n n n n n n n n n n n n n
a. Observing the patient pick up a spoon n n n n n n
b. Asking the patient to recite the alphabet
n n n n n n
c. Monitoring the patients blood pressure n n n n
d. Comparing the patients grip strength in both hands n n n n n n n n
ANS: B n
Accidents or strokes that damage Brocas area may result in the inability to speak (i.e.,
n n n n n n n n n n n n n n
motor aphasia). Fine motor skills, blood pressure control, and muscle strength are not controlle
n n n n n n n n n n n n n
d by the Broca area of the left frontal lobe.
n n n n n n n n n
3. The patient diagnosed with schizophrenia asks why psychotropic medications are al
n n n n n n n n n n
ways prescribed by the doctor. The nurses answer will be based on information that the
n n n n n n n n n n n n n n n
therapeutic action of psychotropic drugs is the result of their effect on:
n n n n n n n n n n n
a. The temporal lobe; especially Wernickes area
n n n n n
b. Dendrites and their ability to transmit electrical impulses
n n n n n n n
c. The regulation of neurotransmitters especially dopamine
n n n n n
d. The peripheral nervous system sensitivity to the psychotropic medications
n n n n n n n n
,ANS: C n
Medications used to treat psychiatric disorders operate in and around the synaptic cleft a
n n n n n n n n n n n n n
nd have action at the neurotransmitter level, especially in the case of schizophrenia, on d
n n n n n n n n n n n n n n
opamine. The Wernickes area, dendrite function, or the sensitivity of the peripheral nerv
n n n n n n n n n n n n
ous system are not relevant to either schizophrenia or psychotropic medications.
n n n n n n n n n n
4. A student nurse mutters that it seems entirely unnecessary to have to struggle with u
n n n n n n n n n n n n n n
nderstanding the anatomy and physiology of the neurologic system. The mentor woul
n n n n n n n n n n n
d base a response on the understanding that it is:
n n n n n n n n n
Necessary but generally for psychiatric nurses who focus primarily on n n n n n n n n n
a. behavioral interventions n
A complex undertaking that advance practice psychiatric nurses frequently use in
n n n n n n n n n n n
b. their practice n
Important primarily for the nursing assessment of patients with brain traumacause
n n n n n n n n n n
c. d cognitive symptoms
n n
Necessary for planning psychiatric care for all patients especially those experienc
n n n n n n n n n n
d. ing psychiatric disorders
n n
ANS: D n
Nurses must understand that many symptoms of psychiatric disorders have a neurologic
n n n n n n n n n n n n
basis, although the symptoms are manifested behaviorally. This understanding facilitate
n n n n n n n n n
s effective care planning. The foundation of knowledge is not used exclusively by advan
n n n n n n n n n n n n n
ced practice psychiatric nurses nor is it relevant for only behavior therapies or brain trau
n n n n n n n n n n n n n n
ma since dealing with the results of normal and abnormal brain function is a responsibili
n n n n n n n n n n n n n n
ty of all nurses providing all types of care to the psychiatric patient.
n n n n n n n n n n n n
5. A patient asks the nurse, My wife has breast cancer. Could it be caused by her ch
n n n n n n n n n n n n n n n n
ronic depression? Which response is supported by research data?
n n n n n n n n
a. Too much stress has been proven to cause all kinds of cancer. n n n n n n n n n n n
b. There have been no research studies done on stress and disease yet.
n n n n n n n n n n n
c. Stress does cause the release of factors that suppress the immune system. n n n n n n n n n n n
d. There appears to be little connection between stress and diseases of the body A
n n n n n n n n n n n n n
NS: C n
Research indicates that stress causes a release of corticotropin-releasing factors that
n n n n n n n n n n
suppress the immune system. Studies indicate that psychiatric disorders such as mood di
n n n n n n n n n n n n
sorders are sometimes associated with decreased functioning of the immune system. Res
n n n n n n n n n n n
earch does not support a connection between many cancers and stress. There is a signific
n n n n n n n n n n n n n n
ant amount of research about stress and the body. Research has shown that there are som
n n n n n n n n n n n n n n n
e connections between stress and physical disease.
n n n n n n
,6. A patient who has a parietal lobe injury is being evaluated for psychiatric rehabilitati
n n n n n n n n n n n n n
on needs. Of the aspects of functioning listed, which will the nurse identify as a focus of
n n n n n n n n n n n n n n n n n
nursing intervention? n
a. Expression of emotion n n
b. Detecting auditory stimuli n n
c. Receiving visual images n n
d. Processing associations n
nANS: D n
The parietal lobe is responsible for associating and processing sensory information
n n n n n n n n n n
that allows for functions such as following directions on a map, reading a clock, dressing
n n n n n n n n n n n n n n
nself, keeping appointments, and distinguishing right from left. Emotional expression is
n n n n n n n n n n n
associated with frontal lobe function. Detecting auditory stimuli is a temporal lobe funct
n n n n n n n n n n n n
ion. Receiving visual images is related to occipital lobe function.
n n n n n n n n n
7. At admission, the nurse learns that some time ago the patient had an infarct in the ri
n n n n n n n n n n n n n n n n
ght cerebral cortex. During assessment, the nurse would expect to find that the patient
n n n n n n n n n n n n n
:
a. Demonstrates major deficiencies in speech n n n n
b. Is unable to effectively hold a spoon in the left hand
n n n n n n n n n n
c. Has difficulty explaining how to go about using the telephone
n n n n n n n n n
d. Cannot use his right hand to shave himself or comb his own hair A n n n n n n n n n n n n n
NS: B n
The cerebral hemispheres are responsible for functions such as control of muscles.
n n n n n n n n n n n
The right hemisphere mainly controls the motor and sensory functions on the left side of
n n n n n n n n n n n n n n
nthe body. Damage to the right side would result in impaired function on the left side of t
n n n n n n n n n n n n n n n n n
he body. The motor cortex controls voluntary motor activity. Brocas area controls moto
n n n n n n n n n n n n
r speech. Cognitive functions are attributed to the association cortex.
n n n n n n n n n
The right side of the bodys motor activity is controlled by the left cerebral cortex.
n n n n n n n n n n n n n n
8. A patient with chronic schizophrenia had a stroke involving the hippocampus. The p
n n n n n n n n n n n n
atient will be discharged on low doses of haloperidol. The nurse will need to individua
n n n n n n n n n n n n n n
lize the patients medication teaching by:
n n n n n
a. Including the patients caregiver in the education n n n n n n
b. Being careful to stress the importance of taking the medication as prescribed P
n n n n n n n n n n n n
roviding the education at a time when the patient is emotionally calm and
n n n n n n n n n n n n
c. relaxed
Encouraging the patient to crush or dissolve the medication to help with swallowi
n n n n n n n n n n n n
d. ng
ANS: A n
, The hippocampus plays a major role in short-
n n n n n n n
term memory and, hence, in learning. Taking the medication as prescribed and providin
n n n n n n n n n n n n
g the education at a time when the patient is calm and relaxed is information or considera
n n n n n n n n n n n n n n n n
tions that all patients should be given. The medication does not necessarily need to be cr
n n n n n n n n n n n n n n n
ushed or dissolved since the stroke would not have caused difficulty with swallowing.
n n n n n n n n n n n n
9. The physician tells the nurse, The medication Im prescribing for the patient en
n n n n n n n n n n n n
hances the g- n n
aminobutyric acid (GABA) system. Which patient behavior will provide evidenc
n n n n n n n n n
e that the medication therapy is successful?
n n n n n n
a. The patient is actively involved in playing cards with other patients.
n n n n n n n n n n
b. The patient reports that, I dont feel as anxious as I did a couple of days ago.
n n n n n n n n n n n n n n n n
c. The patient reports that both auditory and visual hallucinations have decreased.
n n n n n n n n n n
d. The patient says that, I am much happier than before I came to the hospital. A
n n n n n n n n n n n n n n n
NS: B n
GABA is the principle inhibitory neurotransmitter. The medication should provide an
n n n n n n n n n n
antianxiety effect. Alertness, psychotic behaviors, and mood elevation are not generally
n n n n n n n n n n
naffected by g-aminobutyric acid. n n n
10. The patients family asks whether a diagnosis of Parkinsons disease creates an i
n n n n n n n n n n n n
ncreased risk for any mental health issues. What question would the nurse ask to as
n n n n n n n n n n n n n n
sess for such a comorbid condition?
n n n n n
a. Has your father exhibited any signs of depression? n n n n n n n
b. Does your father seem to experience mood swings?
n n n n n n n
c. Have you noticed your father talking about seeing things you cant see?
n n n n n n n n n n n
d. Is your dad preoccupied with behaviors that he needs to repeat over and over? A
n n n n n n n n n n n n n n
NS: A n
Serotonin and its close chemical relatives, dopamine and norepinephrine, are the
n n n n n n n n n n
neurotransmitters that are most widely involved in various forms of depression. Most re n n n n n n n n n n n n
searchers agree that the immediate cause of parkinsonism is a deficiency of dopamine a
n n n n n n n n n n n n n
nd so a patient with Parkinsons disease should be monitored for depression, The other
n n n n n n n n n n n n n n
mental health disorders (bipolar disorder, hallucinations, and obsessive compulsive dis
n n n n n n n n n
order) have not been connected to Parkinsons disease.
n n n n n n n
11. Which explanation for the prescription of donepezil (Aricept) would the nurse p
n n n n n n n n n n n
rovide for a patient in the early stage of Alzheimers disease?
n n n n n n n n n n
a. It will increase the metabolism of excess GABA.
n n n n n n n
b. Excess dopamine will be prevented from attaching to receptor sites.
n n n n n n n n n
c. Serotonin deficiency will be managed through a prolonged reuptake period. n n n n n n n n n
d. The acetylcholine deficiency will be managed by inhibiting cholinesterase.
n n n n n n n n n
ANS: D n
CHOPHARMACOLOGY
NEUROSCIENTIFICnBASISnANDnPRACTICALnAPPLICATIONSnTESTBANK/STUDYnGUID
E
Chapter 1 Chemical neurotransmission
n n n
MULTIPLE CHOICE n
1. A patient with depression mentions to the nurse, My mother says depression is a ch
n n n n n n n n n n n n n n
emical disorder. What does she mean? The nurses response is based on the theory
n n n n n n n n n n n n n
that depression primarily involves which of the following neurotransmitters?
n n n n n n n n
a. Cortisol and GABA n n
b. COMT and glutamate n n
c. Monamine and glycine n n
d. Serotonin and norepinephrine n n n
ANS: D n
One possible cause of depression is thought to involve one or more neurotransmitters.
n n n n n n n n n n n n
Serotonin and norepinephrine have been found to be important in the regulation of d
n n n n n n n n n n n n n
epression. There is no research to support that the other options play a significant rol
n n n n n n n n n n n n n n
e in the development of depression.
n n n n n
2. A patient has experienced a stroke (cerebral vascular accident) that has resulted in damag
n n n n n n n n n n n n n
e to the Broca area. Which evaluation does the nurse conduct to reinforce this diagnosis?
n n n n n n n n n n n n n n
a. Observing the patient pick up a spoon n n n n n n
b. Asking the patient to recite the alphabet
n n n n n n
c. Monitoring the patients blood pressure n n n n
d. Comparing the patients grip strength in both hands n n n n n n n n
ANS: B n
Accidents or strokes that damage Brocas area may result in the inability to speak (i.e.,
n n n n n n n n n n n n n n
motor aphasia). Fine motor skills, blood pressure control, and muscle strength are not controlle
n n n n n n n n n n n n n
d by the Broca area of the left frontal lobe.
n n n n n n n n n
3. The patient diagnosed with schizophrenia asks why psychotropic medications are al
n n n n n n n n n n
ways prescribed by the doctor. The nurses answer will be based on information that the
n n n n n n n n n n n n n n n
therapeutic action of psychotropic drugs is the result of their effect on:
n n n n n n n n n n n
a. The temporal lobe; especially Wernickes area
n n n n n
b. Dendrites and their ability to transmit electrical impulses
n n n n n n n
c. The regulation of neurotransmitters especially dopamine
n n n n n
d. The peripheral nervous system sensitivity to the psychotropic medications
n n n n n n n n
,ANS: C n
Medications used to treat psychiatric disorders operate in and around the synaptic cleft a
n n n n n n n n n n n n n
nd have action at the neurotransmitter level, especially in the case of schizophrenia, on d
n n n n n n n n n n n n n n
opamine. The Wernickes area, dendrite function, or the sensitivity of the peripheral nerv
n n n n n n n n n n n n
ous system are not relevant to either schizophrenia or psychotropic medications.
n n n n n n n n n n
4. A student nurse mutters that it seems entirely unnecessary to have to struggle with u
n n n n n n n n n n n n n n
nderstanding the anatomy and physiology of the neurologic system. The mentor woul
n n n n n n n n n n n
d base a response on the understanding that it is:
n n n n n n n n n
Necessary but generally for psychiatric nurses who focus primarily on n n n n n n n n n
a. behavioral interventions n
A complex undertaking that advance practice psychiatric nurses frequently use in
n n n n n n n n n n n
b. their practice n
Important primarily for the nursing assessment of patients with brain traumacause
n n n n n n n n n n
c. d cognitive symptoms
n n
Necessary for planning psychiatric care for all patients especially those experienc
n n n n n n n n n n
d. ing psychiatric disorders
n n
ANS: D n
Nurses must understand that many symptoms of psychiatric disorders have a neurologic
n n n n n n n n n n n n
basis, although the symptoms are manifested behaviorally. This understanding facilitate
n n n n n n n n n
s effective care planning. The foundation of knowledge is not used exclusively by advan
n n n n n n n n n n n n n
ced practice psychiatric nurses nor is it relevant for only behavior therapies or brain trau
n n n n n n n n n n n n n n
ma since dealing with the results of normal and abnormal brain function is a responsibili
n n n n n n n n n n n n n n
ty of all nurses providing all types of care to the psychiatric patient.
n n n n n n n n n n n n
5. A patient asks the nurse, My wife has breast cancer. Could it be caused by her ch
n n n n n n n n n n n n n n n n
ronic depression? Which response is supported by research data?
n n n n n n n n
a. Too much stress has been proven to cause all kinds of cancer. n n n n n n n n n n n
b. There have been no research studies done on stress and disease yet.
n n n n n n n n n n n
c. Stress does cause the release of factors that suppress the immune system. n n n n n n n n n n n
d. There appears to be little connection between stress and diseases of the body A
n n n n n n n n n n n n n
NS: C n
Research indicates that stress causes a release of corticotropin-releasing factors that
n n n n n n n n n n
suppress the immune system. Studies indicate that psychiatric disorders such as mood di
n n n n n n n n n n n n
sorders are sometimes associated with decreased functioning of the immune system. Res
n n n n n n n n n n n
earch does not support a connection between many cancers and stress. There is a signific
n n n n n n n n n n n n n n
ant amount of research about stress and the body. Research has shown that there are som
n n n n n n n n n n n n n n n
e connections between stress and physical disease.
n n n n n n
,6. A patient who has a parietal lobe injury is being evaluated for psychiatric rehabilitati
n n n n n n n n n n n n n
on needs. Of the aspects of functioning listed, which will the nurse identify as a focus of
n n n n n n n n n n n n n n n n n
nursing intervention? n
a. Expression of emotion n n
b. Detecting auditory stimuli n n
c. Receiving visual images n n
d. Processing associations n
nANS: D n
The parietal lobe is responsible for associating and processing sensory information
n n n n n n n n n n
that allows for functions such as following directions on a map, reading a clock, dressing
n n n n n n n n n n n n n n
nself, keeping appointments, and distinguishing right from left. Emotional expression is
n n n n n n n n n n n
associated with frontal lobe function. Detecting auditory stimuli is a temporal lobe funct
n n n n n n n n n n n n
ion. Receiving visual images is related to occipital lobe function.
n n n n n n n n n
7. At admission, the nurse learns that some time ago the patient had an infarct in the ri
n n n n n n n n n n n n n n n n
ght cerebral cortex. During assessment, the nurse would expect to find that the patient
n n n n n n n n n n n n n
:
a. Demonstrates major deficiencies in speech n n n n
b. Is unable to effectively hold a spoon in the left hand
n n n n n n n n n n
c. Has difficulty explaining how to go about using the telephone
n n n n n n n n n
d. Cannot use his right hand to shave himself or comb his own hair A n n n n n n n n n n n n n
NS: B n
The cerebral hemispheres are responsible for functions such as control of muscles.
n n n n n n n n n n n
The right hemisphere mainly controls the motor and sensory functions on the left side of
n n n n n n n n n n n n n n
nthe body. Damage to the right side would result in impaired function on the left side of t
n n n n n n n n n n n n n n n n n
he body. The motor cortex controls voluntary motor activity. Brocas area controls moto
n n n n n n n n n n n n
r speech. Cognitive functions are attributed to the association cortex.
n n n n n n n n n
The right side of the bodys motor activity is controlled by the left cerebral cortex.
n n n n n n n n n n n n n n
8. A patient with chronic schizophrenia had a stroke involving the hippocampus. The p
n n n n n n n n n n n n
atient will be discharged on low doses of haloperidol. The nurse will need to individua
n n n n n n n n n n n n n n
lize the patients medication teaching by:
n n n n n
a. Including the patients caregiver in the education n n n n n n
b. Being careful to stress the importance of taking the medication as prescribed P
n n n n n n n n n n n n
roviding the education at a time when the patient is emotionally calm and
n n n n n n n n n n n n
c. relaxed
Encouraging the patient to crush or dissolve the medication to help with swallowi
n n n n n n n n n n n n
d. ng
ANS: A n
, The hippocampus plays a major role in short-
n n n n n n n
term memory and, hence, in learning. Taking the medication as prescribed and providin
n n n n n n n n n n n n
g the education at a time when the patient is calm and relaxed is information or considera
n n n n n n n n n n n n n n n n
tions that all patients should be given. The medication does not necessarily need to be cr
n n n n n n n n n n n n n n n
ushed or dissolved since the stroke would not have caused difficulty with swallowing.
n n n n n n n n n n n n
9. The physician tells the nurse, The medication Im prescribing for the patient en
n n n n n n n n n n n n
hances the g- n n
aminobutyric acid (GABA) system. Which patient behavior will provide evidenc
n n n n n n n n n
e that the medication therapy is successful?
n n n n n n
a. The patient is actively involved in playing cards with other patients.
n n n n n n n n n n
b. The patient reports that, I dont feel as anxious as I did a couple of days ago.
n n n n n n n n n n n n n n n n
c. The patient reports that both auditory and visual hallucinations have decreased.
n n n n n n n n n n
d. The patient says that, I am much happier than before I came to the hospital. A
n n n n n n n n n n n n n n n
NS: B n
GABA is the principle inhibitory neurotransmitter. The medication should provide an
n n n n n n n n n n
antianxiety effect. Alertness, psychotic behaviors, and mood elevation are not generally
n n n n n n n n n n
naffected by g-aminobutyric acid. n n n
10. The patients family asks whether a diagnosis of Parkinsons disease creates an i
n n n n n n n n n n n n
ncreased risk for any mental health issues. What question would the nurse ask to as
n n n n n n n n n n n n n n
sess for such a comorbid condition?
n n n n n
a. Has your father exhibited any signs of depression? n n n n n n n
b. Does your father seem to experience mood swings?
n n n n n n n
c. Have you noticed your father talking about seeing things you cant see?
n n n n n n n n n n n
d. Is your dad preoccupied with behaviors that he needs to repeat over and over? A
n n n n n n n n n n n n n n
NS: A n
Serotonin and its close chemical relatives, dopamine and norepinephrine, are the
n n n n n n n n n n
neurotransmitters that are most widely involved in various forms of depression. Most re n n n n n n n n n n n n
searchers agree that the immediate cause of parkinsonism is a deficiency of dopamine a
n n n n n n n n n n n n n
nd so a patient with Parkinsons disease should be monitored for depression, The other
n n n n n n n n n n n n n n
mental health disorders (bipolar disorder, hallucinations, and obsessive compulsive dis
n n n n n n n n n
order) have not been connected to Parkinsons disease.
n n n n n n n
11. Which explanation for the prescription of donepezil (Aricept) would the nurse p
n n n n n n n n n n n
rovide for a patient in the early stage of Alzheimers disease?
n n n n n n n n n n
a. It will increase the metabolism of excess GABA.
n n n n n n n
b. Excess dopamine will be prevented from attaching to receptor sites.
n n n n n n n n n
c. Serotonin deficiency will be managed through a prolonged reuptake period. n n n n n n n n n
d. The acetylcholine deficiency will be managed by inhibiting cholinesterase.
n n n n n n n n n
ANS: D n
