Exam 3: NURS 660 / NURS660 (2026–2027 Updated) Psychopharmacology & Advanced Mental Health | Complete Questions & Answers | Verified Solutions | 100% Accurate | Grade A – Maryville

Exam 3: NURS 660 / NURS660 (2026–2027 Updated) Psychopharmacology & Advanced Mental Health | Complete Questions & Answers | Verified Solutions | 100% Accurate | Grade A – Maryville Q. Neurotransmitters Involved in Wakefulness ANSWERS Histamine, dopamine, norepinephrine, acetylcholine, and serotonin Q. Neurotransmitters Involved in Sleep/Wake Switch ANSWERS Histamine from the TMN GABA from the VLPO Q. A-beta fibers ANSWERS Detect small movements, light touch, hair movement, and vibrations (Non-noxious) Q. C fibers ANSWERS Bare nerve endings only stimulated by noxious mechanical, thermal, or chemical stimuli C=chemical Q. A delta fibers ANSWERS Senses noxious mechanical stimuli and subnoxious thermal stimuli Q. Peripheral Neuropathy pain ANSWERS Damage to/dysfunction of peripheral nervous system. Responds to peripherally and centrally acting drugs, NSAIDs and opioids. Ex: diabetic neuropathy, post herpetic neuralgia Q. Pathophysiology of chronic pain ANSWERS Chronic pain results from changes in sensitivity in both ascending and descending (PGA, RVM, DLPT) pathways. Can lead to grey matter loss and central sensitization. Can be inflammatory or degenerative in nature. Peripheral, can become centralized, or mixture of both. Q. Medications for falling asleep ANSWERS Need medications with short half life Ramelteon Roserem Sonata (middle insomnia, need 4 hours to dedicate) Q. Medications for staying asleep ANSWERS Zolpidem ER, temazepam, belsomra, eszopiclone (lunesta) Q. Areas of brain involved in anxiety ANSWERS Amygdala, periaquductal grey, hippocampus Q. Areas of brain involved in sleep ANSWERS Pituitary gland, pineal gland (melatonin), Q. Two types of anxiety ANSWERS Amgdala-centered circuit: -Fear -Panic -phobia -Gi symptoms, fight or flight -CV symptoms, -Peribrachial- respiratory CSTC-centered circuit: -Worry/obsession loop -anxious misery -apprehension -expectation -ThalamusstriatumDLPFC Q. Neurotransmitters associated with worry ANSWERS Serotonin, GABA, dopamine, norepinephrine, glutamate, voltage gated ion-channels Q. Alprazolam (Xanax) ANSWERS GABA positive allosteric modulator Benzodiazepine anxiolytic Used for generalized anxiety disorder, panic disorder, anxiety associated with depression. High risk for withdrawal, short half life, high potency, quick onset creates high risk for abuse and dependence. Q. Keys of Sleepiness and Wakefulness ANSWERS The hypothalamus is a key control center for sleep and wake, and the specific circuitry that regulates sleep/wake is called the sleep/wake switch. The "off" setting, or sleep promoter, is localized within the ventrolateral preoptic nucleus (VLPO) of the hypothalamus, while "on"—the wake promoter—is localized within the tuberomammillary nucleus (TMN) of the hypothalamus. Two key neurotransmitters regulate the sleep/wake switch: histamine from the TMN and GABA from the VLPO. Q. Modafinil (Provigil) ANSWERS CNS stimulant Dopamine reuptake inhibitor Narcolepsy, obstructive sleep apnea, shift work sleep disorder Activates TMN which releases histamine which increases alertness Q. Pregabalin (Lyrica) ANSWERS Glutamate voltage gated calcium channel blocker Used for fibromyalgia, neuropathic pain, some use in GAD, social anxiety. Binds to the alpha 2 delta subunit of voltage-sensitive calcium channels (VSCCs). In fact, pregabalin binds preferentially to the open conformation of these channels and thus may be particularly effective in blocking channels that are the most active, with a "use-dependent" form of inhibition. Q. Duloxetine (Cymbalta) ANSWERS SNRI antidepressant Best documented to have efficacy in pain conditions. diabetic peripheral neuropathic pain, fibromyalgia, GAD, chronic musculoskeletal pain Duloxetine targets both descending noradrenergic and serotonergic projections and the patient may benefit from an antidepressant with dual mechanisms, which may help alleviate chronic pain. Risk of elevation of serum transaminase levels and is not recommended for use in individuals with hepatic insufficiency Q. Milnacipran (Savella) ANSWERS SNRI antidepressant Great for fibromyalgia Documented efficacy for treating neuropathic pain. In addition, it can also improve cognitive symptoms through its potent norepinephrine reuptake binding property. Can treat "fibro fog" and cognitive symptoms of fibromyalgia as well. Q. Paroxtine (Paxil) ANSWERS SSRI approved for use in PTSD Works on H2 receptors, sedating. Sexual SE, weight gain. Q. Buspirone (Buspar) ANSWERS Serotonin receptor partial agonist Anxiolytic that does not produce CNS depression like benzodiazepines; indicated for treatment of anxiety and is always given on a scheduled basis, not PRN. Only contraindication is allergy. Onset of action is 2-3 weeks. Serotonin 5-HT1A receptor partial agonist Buspirone's partial agonist actions at presynaptic somatodendritic serotonin autoreceptors may theoretically enhance serotonergic activity and contribute to antidepressant actions. It does not produce significant sedation, hypnotic, anticonvulsant, or musculoskeletal relaxing effects. Not a good drug for panic disorder. Q. How Z drugs work ANSWERS Primarily work on alpha 1 subunit of GABA receptor Q. Ramelteon (Rozerem) ANSWERS Melatonin receptor agonist, targets MT1 and MT2 Helps with circadian rhythm. Short duration, helps with falling asleep Good for patients with hx of drug addiction Q. Doxepin (Sinequan) ANSWERS TCA H1 blockade aids with insomnia. High doses targets alpha-1 adrenergic and muscarinic antagonism, which can cause dizzy spells and constipation. Q. Suvorexant (Belsomra) ANSWERS Makes you less awake, cuts off wake cycle Dual orexin antagonist Takes effect in less than an hour. Safety in those that can't take hypnotics. Lower risk for dependency or abuse potential. Dayvigo (lemborexant) same class. Q. Flumazenil (Romazicon) ANSWERS Antidote for benzodiazepine overdose. Q. Lorazepam (Ativan) ANSWERS GABA-PAM Benzodiazepine anxiolytic LOT, Doesn't have active metabolites Simpler timeline, predictable half-life. Can be used with patients with liver issues. Q. Librium (chlordiazepoxide) ANSWERS GABA-PAM Benzodiazepine Antianxiety Used for alcohol withdrawal. Long half-life, used in detox setting due to this. Q. Hydroxyzine (Atarax, Vistaril) ANSWERS Histamine-receptor antagonist Antihistamine, anxiolytic. drowsiness, dizziness, dry mouth. Tx of pruritus, anxiety, post-op n/v. avoid alcohol and CNS depressant. caution with hazardous activities. High doses can affect QTc Q. SSRIs for anxiety ANSWERS Long-term treatment for anxiety. - escitalopram (Lexapro) - citalopram (Celexa) - fluoxetine (Prozac) - paroxetin (Paxil) - sertraline (Zoloft) Amitriptyline (Elavil) TCA. NE/5HT re-uptake inhibitor. Second line tx for fibromyalgia, neuropathic pain. Used for insomnia Anticholinergic SE Eszopiclone (Lunesta) GABA-PAM Z drug, for insomnia. Targets GABA alpha 1 isomer. Temazepam (Restoril) GABA-PAM Benzodiazepine (insomnia) Doesn't have metabolites, predictable, can be used in alcohol withdrawal (LOT) Cyclobenzaprine (Flexeril) Muscle relaxant/antispasmodic Enhances GABA Used for muscle spasms due to injury Causes CNS depression Physical dependence - do not d/c abruptly Zolpidem (Ambien) GABA-PAM Sedative-hypnotic (non-benzodiazepine) Enhance GABA Can cause daytime sleepiness Low risk of abuse, tolerance, dependence Avoid CNS depressants Diazepam (Valium) GABA-PAM Benzodiazepine anxiolytic Naltrexone (ReVia) Antagonist that blocks euphoric effects of opioids Reduces or eliminates alcohol craving Naloxone (Narcan) Opioid antagonist, treatment for overdose. Allodynia Pain due to a stimulus which does not normally provoke pain Hyperalgesia Excessive sensitivity to painful stimuli Neuropathic pain pain from damage to neurons of either the peripheral or central nervous system Nociceptive Pain Direct activation of pain nerve fibers, either due to chemical, inflammatory or mechanical mediators, and is usually due to tissue irritation, impending injury, or actual injury. Amygdala Plays a role in FEAR response w. overstim - "Remembers the stimuli" that leads to anxiety or panic. It does this by increasing the efficiency of the neurotransmission at glutaminergic synapses in the lateral amygdala as sensory input about the stimuli comes in from the thalamus or sensory cortex. The input is then relayed to the central amygdala where fear conditioning occurs, further strengthening the circuit at NMDA receptors (where learning is embedded). Therefore, when similar input from the sensory cortex and thalamus occurs, the central amygdala has a quicker response producing fear anterior pituitary gland Involved with feelings of anxiety and depression. - Anticipatory anxiety and generalized anxiety disorders activate both the hypothalamic-pituitary-adrenal and the sympathoadrenal axes Hippocampus MEMORY Anxiety is triggered not only by external stimuli but also internally from traumatic memories stored in the hippocampus.These traumatic memories activate the amygdala, causing it in turn, to activate other brain regions to generate a fear response. This is termed re-experiencing, and it is a particular feature of PTSD. Additionally, the α5 subtype located mostly in the hippocampus have been linked to cognition and sedation (sleep). -Hippocampus stores memories. With PTSD, they are re-experiencing their trauma and horrible memories. So hippocampus is responsible as it reminds them of those bad memories - involved in memory, coding, and retrieval - "The hippocampus: internal fearmonger and re-experiencing" Hypothalamus - Sleep-wake switch: histamine and GABA regulated in hypothalamus; both hyper and hypoarousal can cause cognitive dysfunction - It is a control center for neuroendocrine secretion and homeostasis for autonomic functions needed for survival. - temperature regulation Parabrachial nucleus- - ANXIETY ATTACK w/ overstim -the activation of the parabrachial nucleus causes a person to have difficulty breathing and an increased heart rate during an anxiety attack. Changes in respiration may occur during a fear response; these changes are regulated by activation of the parabrachial nucleus (PBN) via the amygdala. Inappropriate or excessive activation of the PBN can lead not only to increases in the rate of respiration but also to symptoms such as shortness of breath, exacerbation of asthma, or a sense of being smothered. respiratory rate shortness of breath asthma Periaqueductal gray (PAG) Functions of PAG: /regulation of the heart rate and blood pressure, Autonomic Process (e.g. bladder control and contraction), Production of vocalizations, Production of fearful and defensive reactions, ** BEST known for the role in analgesia and pain reduction. Motor response to anxiety- "Flight or fight" -50 shades of grey movie fight / flight / freeze Avoidance Posterior Pituitary Gland -is a store house for vasopressin (anti-diuretic hormone) and oxytocin. ADH is directly released from the pituitary gland into the blood stream and targets the kidneys - to control fluid volume. Posterior pituitary gland also secretes oxytocin which acts on the uterine (contractions during childbirth) and milk let down. - Prefrontal Cortex -responsible for high order thinking, planning, decision-making - associated with "worry" in stress-- linked to cortico-striato-thalamo-cortical (CSTC) feedback loop: excessive dopamine leads to increased worry Neurotransmitters involved: serotonin, GABA, dopamine, norepinephrine, glutamate, voltage-gated ion channels -Sleep disorders—Stahl, p 466 Patients with excessive sleepiness— unable to activate/sustain DLPFC normally (leads to poor cognitive function) - Add stimulant= dopamine increased, cognitive functions improved -Pain disorders— Stahl, p 430 Chronic pain may cause shrinkage of PFC, which can cause "fog", decreased cognitive functions as seen in fibromyalgia Constant pain signals may lead to cell death, causing cognitive dysfunctions Thalamus locus coeruleus CARDIO EFFECTS- beta blockers come in handy atherosclerosis cardiac ischemia BP HR variability MI sudden death MOA of Benzos Benzodiazepine Binds to benzo receptors on postsynaptic GABA-A neuron within CNS including limbic system. This increases frequency of opening of inhibitory chloride channels but not to increase conductance of Cl- across the channel nor increase duration of channel opening-Stahl. Enhance GABA actions at the level of the amygdala and PFC to relieve anxiety-Stahl Excessive amygdala activity is reduced by enhancing phasic inhibitory actions of benzos at postsynaptic GABA-A receptors-Stahl Benzos modulate excessive output from worry loops by enhancing actions of inhibitory GABA interneurons within PFC-Stahl 'PAM' positive allosteric modulator Benzo antagonist MOA (Flumazenil) Inhibits the activity at the benzo receptor site. Blocks benzo receptors at GABA-A ligand-gated chloride channel complex preventing benzos from binding there MOA of Buspar (non benzo- anxiolytic) Enhanced serotonergic activity in projections to the amygdala, PFC, Striatum, and thalamus Prefrontal cortex (PFC)[Mania] Part of the brain responsible for the following mania symptoms: risks, racing thoughts, grandiosity, distractibility,talkative/pressured speech Amygdala (A) and PFC[Mania] Part of the brain responsible for the following mania symptom: mood Thalamus (T),Hypothalamus (HY) and Basal Forebrain (BF)[Mania] Part of the brain responsible for the following mania symptom: decreased sleep/arousal Nucleus accumbens (NA)[Mania] Part of the brain responsible for the following mania symptoms: racing thoughts, goal-directed grandiosity Striatum (S) [Mania] Part of the brain responsible for the following mania symptoms: motor/agitation Prefrontal cortex (PFC) and Amygdala (A) [Depression] Part of the brain responsible for the following depressive symptoms: concentration interest/pleasure, psychomotor fatigue (mental), guilt, SI, worthlessness, mood Striatum (S) [Depression] Part of the brain responsible for the following depressive symptoms: Psychomotor fatigue (physical) Nucleus accumbens (NA)[Depression] Part of the brain responsible for the following depressive symptoms: Pleasure, interests, fatigue/energy Spinal cord (SC) Part of the brain responsible for the following depressive symptoms: physical fatigue Hypothalamus (HY) [Depression] Part of the brain responsible for the following depressive symptoms: Sleep, appetitie Steps of Stress Activation of the Hypothalamic-Pituitary-Adrenal Axis (HPA) When we experience something stressful, the hypothalamus releases a hormone called corticotropin-releasing hormone (or CRH). CRH signals the pituitary gland to secrete a hormone called adrenocorticotropic hormone, or ACTH into the bloodstream. ACTH travels down to the adrenal glands where it prompts the release of a hormone called cortisol from the cortex, or outer layer, of the adrenal glands. The release of cortisol causes a number of changes that help the body to deal with stress. Mania symptoms Inflated self-esteem or grandiosity Decreased need for sleep Pressured speech Flight of ideas Distractibility Excessive pleasure-seeking involvement Increase in goal-directed activity Dexamethasone Challenge Patient is given a glucocorticoid to see if the it shuts down the HPA axis. Advantages of 2nd Generation Antidepressants possess almost no anticholinergic effects or potential for cardiac dysrhythmias. Fluoxetine (Prozac)[DC] Fluoxetine is the only SSRI that does not require gradual and slow tapering because of its long half-life and active metabolites. In fact, a single dose of fluoxetine as the last step in tapering off other SSRIs is helpful in avoiding withdrawal symptoms. Lamotrigine (Lamictal)MOA affects voltage-sensitive sodium channels and inhibits presynaptic release of glutamate and aspartate in the neuro Lamotrigine DC should be withdrawn slowly (over at least 2 weeks) to prevent seizures. Carbamazepine (Tegretol) MOA are thought to affect the sodium channels, slowing influx of sodium in the cortical neurons and slowing the spread of abnormal activity. Carbamazepine exerts its effect by depressing transmission in the nucleus ventralis anterior of the thalamus. This area is associated with the spread of seizure discharge. Lithium MOA replaces sodium during depolarization in neuronal pathways, effectively stopping the transmission of electrical impulses. Additionally, it is suspected that lithium acts on the second messenger system postsynaptically to inhibit either the inositol monophosphatase enzyme to modulate the G proteins or the messenger RNA to alter the protein kinase C Lithium therapeutic range Therapeutic range is 0.7 to 1.2 mM of lithium blood concentration; blood levels must be monitored, and toxicity occurs at 2.0 mM and levels above 3.0mM can lead to seizures, coma and even death BiPolar Structural changes in the brain with imbalance of serotonin, norepinephrine & dopamine. Caused by heredity/environment. Bipolar 1 Mania followed by severe depression with possible psychosis Bipolar 2 Hypomania episodes with at least one major depressive episode, no psychosis. Cyclothymia Hypomanic episodes alternating with minor depressive episodes. Tend to have irritable hypomanic episodes. Bipolar unspecified Have bipolar features but do not meet criteria for a specific bipolar disorder. Rapid Cycling bipolar disorder experience fast cycling between mood episodes. Mixed Episode Bipolar Experience depressive symptoms while in the midst of a full bipolar or hypomanic episode. Lithium drowsiness, dizzy, thirst, fatigue, fine tremor, weight gain -LABS: Kidney & thyroid function, lithium and calcium blood levels -No other antipsychotics until lithium levels are even 2nd Generation antipsychotics (clozapine, quetiapine, risperidone, aripipazole) weight gain, hormone (erectile) dysfunction, hyperglycemia, restlessness, anxious, trouble sleeping, GI issues, blurred vision, excess saliva, vision problems, drowsiness, tremors, headache, agitation -LABS: Glucose, CBC, bp, weight, cholesterol/triglyceride levels periodically, EKG Haloperidol Adverse Effects difficulty speaking/swallowing, eye paralysis, loss of balance, restlessness, muscle spasms or stiffness, weakness Haloperidol Monitor for Tardive dyskinesia Milieu For Bipolar Disorder Homey atmosphere, calming, boundaries/limits Therapies For Bipolar Disorder Psychoeducation, Cognitive Behavioral therapy, Psychopharmacology, Behavioral Therapy, Group Therapy, Recovery Model, ECT Education For Bipolar Disorder diagnosis, prognosis, treatment options, importance of taking medication even when feel good, coping skills, recognizing triggers, behavioral techniques Nursing Considerations With Bipolar Disorder Family History Support system Medication Interactions and Side Effects Learning Styles Coping Styles Transportation Issues Financial Issues/Insurance Co-Morbid disorders both psychological and physical Bipolar Disorder You will need to set boundaries and limits for patients with this disorder. Monitor physiological symptoms especially if mania and not eating/sleeping Positive S/S For Schizophrenia hallucinations; delusions; associative looseness; bizarre behavior Negative S/S For Schizophrenia blunted affect; poverty of thought (alogia); loss of motivation (avolition); inability to experience pleasure or joy (aphedonia) Cognitive S/S For Schizophrenia inattention; impaired memory; poor problem solving skills; poor decision making skills; illogical thinking; impaired judgment Effective S/S For Schizophrenia dysphoria; suicidality; hopelessness Schizophrenia increased amount of dopamine (also involves Serotonin and Glutamate); affecting thinking, language, emotions, social behavior, and reality perceptions Medication For Schizophrenia Conventional (first generation) antipsychotic -dopamine antagonist; side effect EPS and Tardive Dyskinesia, neuroleptic malignant syndrome (NMS), agranulocytosis. Treat positive symptoms only! Medication For Schizophrenia Atypical (second generation) antipsychotic- serotonin and dopamine antagonist; advantage alleviates + and -symptom's; produces minimal EPS; improves cognitive deficits; improves anxiety; disadvantages weight gain, risk for diabetes, cardiovascular disease, HTN, more expensive than conventional antipsychotic. Treats positive, negative, and cognitive issues! Milieu For Patients With Schizophrenia safety (protect patient and others), structured routine, use of group therapy, supervised activity, individual counseling; rehabilitation; specialized training Assertive community treatment (ACT) for patients with schizophrenia prevents relapse, maximize social and vocational functions, keep individual in community Treatments/Therapies For Schizophrenia -Family therapy -Psychotherapy (CBT) helps reduce frequency and intensity of delusions and hallucinations -Social skills training improve level of social functioning -Antipsychotic medications Nursing Considerations For A Patient With Schizophrenia -Patient teaching -Thorough assessment Focused assessment for command hallucinations Threat to themselves or others? -Medical workup to rule out substance abuse or medical cause -Determine support system -Assess for psychiatric comorbidity D Police bring a patient to the ER who had been standing on the edge of a busy street directing traffic and shouting rhymes. The patient's spouse reports that the patient has had non-adherence with lithium therapy for 3 weeks and has not slept or eaten for 3 days. Which assessment findings will have priority concern for this patient's plan of care? a. Pressured speech and grandiosity b. Poor concentration and decision making c. Insulting, provocative behavior directed at staff d. Hyperactivity, ignoring eating and sleeping D A client with bipolar disorder tells you, "I am thinking of switching to an alternating day/night shift because it pays more and will give me more time with my children." Your reply is based on the knowledge of which of the following? a. The client should contact the nurse if prodromal symptoms of the bipolar disorder occur. b. The client's priority is steady employment c. Biologic rhythms do not influence mood disorders d. Disruptions in biologic rhythms will impact the client's bipolar disorder C A young man brings his girlfriend to ER due to her stated depression and suicide ideation. During the assessment process, he says, "We just started dating 3 months ago. I met her at a fraternity party. She was so full of life, exciting, and fun to be around when we first started dating. Now she can hardly get out of bed and started talking about killing herself this afternoon. I don't know what's wrong with her." You suspect she is suffering from which of the following? a. Cyclothymia (hypomania, minor depression) b. Bipolar I (mania with psychosis, major depression) c. Bipolar II (hypomania, major depression) d. Schizophrenia A A patient with Schizophrenia in a catatonic state is admitted to the Crisis unit. To determine if she has waxy flexibility, you... a. Position her arm in an awkward position to see if it remains in that same position b. Try to feed her some broth to see if she will take it c. Give her a series of commands to see if she will follow them d. Talk to her in a calm, soothing voice to see if she repeats your words A You are working 7p - 7a on the Stress unit. The tech comes up and is a little frustrated with a patient. He says that every time he says something to the patient, the patient does not follow his direction and just repeats his words back to him. You document this incident using the term... a. Echolalia b. Echopraxia c. Word salad d. Ideas of reference B Which of the following statements that address the typical age of onset for schizophrenia is true? a. The typical age of onset for schizophrenia is early adolescence in both males and females b. The typical age of onset for schizophrenia is late adolescence to mid-thirties c. The typical age of onset for late-onset schizophrenia is age 60 d. They typical age of onset for schizophrenia is late thirties to early forties C While observing on the Crisis unit, a patient with Bipolar in a manic phase comes to you and states in a very rapid voice, "I drew a picture for you. I only have 4 crayons. I don't know why I have 4 crayons. The crayons are different colors. I copied the drawing from a magazine. I did a good job. I might copy some more for you later. I like to draw and color, but I only have 4 crayons." This is a good example of: a. Clang association b. Associative looseness c. Pressured speech d. Ideas of reference A,B,E Which suggestions are appropriate for the family of a patient with bipolar disorder who is being treated as an outpatient during a hypomanic episode? Select all that apply. a. Provide structure. b. Limit credit card access. c. Encourage group-social interaction. d. Suggest limiting work to half days. e. Monitor the patient's sleep patterns. C You are working the night shift on Med-Surg when you discover one of your patients attempting to leave the unit. She tells you "Please let me go. I trust you. The Mafia is going to kill me tonight". You remember from mental health class that the best response would be: a. "Nobody is trying to kill you. I'll come with you back to your room." b. "Thank you for trusting me. Maybe you can trust me to tell you that no one can kill you while you are here." c. "You are frightened. Come with me to your room and we can talk about it." d. "Come with me to your room. I'll lock the door and no one will get in to harm you" D A patient diagnosed with disorganized schizophrenia says, "It's beat. Scramble those eggs. No room for the chicken. Chickens are brown and white. Snow is white." What type of verbalization is evident? a. Neologism b. Idea of reference c. Thought broadcasting d. Associative looseness C A hospitalized patient, injured in a fall while intoxicated, believes spiders are spinning entrapping webs in the room. The patient is anxious, agitated, and diaphoretic. Which nursing intervention has priority? a. Check the patient every 15 minutes. b. Rigorously encourage fluid intake. c. Provide one-on-one supervision. d. Keep the room dimly lit. D The nurse evaluates which of the following client statements as validation that the teaching on lithium was effective? a. I will have liver function tests every 6 months b. I will restrict fluids to 100ml per 8 hours c. I will quit taking lithium if I get depressed d. I will have my blood levels checked every 2 to 3 months B A client is hospitalized for psychotic symptoms including auditory hallucinations and paranoid delusions. Based on an understanding of neurobiology, the nurse knows the psychotic symptoms arise from disruptions in which neurotransmitter? a. Norepinephrine b. Dopamine c. Serotonin d. Acetylcholine C Which of the following questions would the nurse ask a woman to assess for hyperprolactinemia as a side effect of an antipsychotic medication? a. Do you have a dry mouth? b. Are you having trouble sitting still? c. Are you having any discharge from your breasts? d. Are you constipated? A An involuntary client being treated for an acute exacerbation of paranoid schizophrenia refuses the morning dose of medication. The nurse is frustrated and wonders if the client will ever develop insight. What aspects of psychobiology could help reframe the client's behavior for the nurse? a. The pre-frontal cortex involvement in schizophrenia can cause an unawareness of the illness or the need to take medications b. The client is not responsible for the behavior c. The client's brain chemistry is altered and medications will help d. Adhering to the client's medication regimen is a priority to the nursing care C Which of the following tools is used to assess for tardive dyskinesia? a. The CAGE assessment tool b. Global Assessment Functioning (GAF) scale c. The Abnormal Involuntary Movement Scale (AIMS) d. Hamilton A screening tool D What is the rationale for a person taking lithium to have enough water and salt in his or her diet? a. Excess salt and water are necessary to dilute lithium to avoid toxicity b. Water and salt convert lithium into a usable solute c. Lithium is metabolized in the liver, necessitating increased water and salt d. Lithium is a salt that has greater affinity for receptor sites than sodium chloride Anorexia nervosa Individuals have an intense fear of gaining weight and will demonstrate self starvation, they may restrict their intake or engage in binge eating and purging. Bulimia Nervosa These individuals engage in repeated binge eating and then compensatory behaviors such as purging or the use of laxatives, excessive exercise or fasting. Binge eating disorder These individuals when under excessive distress will have episodes of binge eating. Cachectic Severely underweight with muscle wasting Refeeding syndrome A potentially catastrophic treatment complication in which the demands of a replenished circulatory system overwhelm the capacity of a nutritionally depleted cardiac muscle leading to cardiovascular collapse. Lanugo The growth of fine, downy hair on the face and back. Acute dystonia An EPS side effect noted by muscle cramps of the head and neck Affect The observable behavior that expresses a person's emotions Akathisia Internal restlessness and external restless pacing or fidgeting Associative looseness The connections or associations from one thought or concept to another are missing or interrupted Clang association The meaningless rhyming of words, often in forceful manner, the rhyming is more important than the context of the word Delusions Alterations in thinking false beliefs that cannot be corrected by reasoning Echolalia Persistently repeating the words of others Echopraxia Mimicking a movement or gesture of others Extrapyramidal symptoms A group of side effects from using conventional antipsychotics that block dopamine receptors Hallucinations Sensory perceptions for which no external stimulus exists Ideas of reference The patient frequently misinterprets the messages of others or gives private meaning to the communications of others Illusions Misperceptions or misinterpretations of a real experience Neuroleptic malignant syndrome (NMS) Condition that is a medical emergency marked by decreased level of consciousness, greatly increased muscle tone and autonomic dysfunction, including hyperpyrexia, labile hypertension, and tachycardia and drooling Pseudoparkinsonism Stiffening of muscular activity in the face, body, arms, and legs. Paranoia Any intense and strongly defended irrational suspicion they cannot be modified by facts or reality Psychotic Refers to delusions, any prominent hallucinations, disorganized speech or disorganized catatonic behaviors Tardive dyskinesia Usually appears after prolonged treatment it is serious and not always reversible consisting of involuntary tonic muscular spasms that typically involve the tongue, fingers, toes, neck, trunk or pelvis Waxy flexibility Excessive maintenance of posture by holding unusual postures for long periods Word salad A term used to identify a jumble of words that is meaningless to the listener