Stahl: Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications 5th Edition

,Chapter 1 Chemical neurotransmission
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Stahl: Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications 5t
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h Edition
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MULTIPLE CHOICE VX




1. A patient with depression mentions to the nurse, My mother says depression is a c
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hemical disorder. What does she mean? The nurses response is based on the theory th
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at depression primarily involves which of the following neurotransmitters?
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a. Cortisol and GABA VX VX




b. COMT and glutamate VX VX




c. Monamine and glycine VX VX




d. Serotonin and norepinephrine VX VX




ANS: D VX




One possible cause of depression is thought to involve one or more neurotransmitters. S
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erotonin and norepinephrine have been found to be important in the regulation of depr
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ession. There is no research to support that the other options play a significant role in t
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he development of depression.
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2. A patient has experienced a stroke (cerebral vascular accident) that has resulted in d
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amage to the Broca area. Which evaluation does the nurse conduct to reinforce this di
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agnosis?
a. Observing the patient pick up a spoon VX VX VX VX VX VX




b. Asking the patient to recite the alphabet
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c. Monitoring the patients blood pressure VX VX VX VX




d. Comparing the patients grip strength in both hands VX VX VX VX VX VX VX




ANS: B VX




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
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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 a
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lways prescribed by the doctor. The nurses answer will be based on information that th
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e therapeutic action of psychotropic drugs is the result of their effect on:
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a. The temporal lobe; especially Wernickes area VX VX VX VX VX




b. Dendrites and their ability to transmit electrical impulses
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c. The regulation of neurotransmitters especially dopamine
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d. The peripheral nervous system sensitivity to the psychotropic medications
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,ANS: C VX




Medications used to treat psychiatric disorders operate in and around the synaptic cleft a
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nd have action at the neurotransmitter level, especially in the case of schizophrenia, on
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dopamine. The Wernickes area, dendrite function, or the sensitivity of the peripheral n
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ervous system are not relevant to either schizophrenia or psychotropic medications.
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4. A student nurse mutters that it seems entirely unnecessary to have to struggle with u
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nderstanding the anatomy and physiology of the neurologic system. The mentor wou VX VX VX VX VX VX VX VX VX VX VX




ld base a response on the understanding that it is:
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Necessary but generally for psychiatric nurses who focus primarily on behavior VX VX VX VX VX VX VX VX VX VX




a. al interventions VX




A complex undertaking that advance practice psychiatric nurses frequently use i
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b. n their practice
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Important primarily for the nursing assessment of patients with brain traumacaused
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c. cognitive symptoms
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Necessary for planning psychiatric care for all patients especially those experiencin
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d. g psychiatric disorders
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ANS: D VX




Nurses must understand that many symptoms of psychiatric disorders have a neurologi
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c basis, although the symptoms are manifested behaviorally. This understanding facilit
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ates effective care planning. The foundation of knowledge is not used exclusively by ad
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vanced practice psychiatric nurses nor is it relevant for only behavior therapies or brai
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n trauma since dealing with the results of normal and abnormal brain function is a resp
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onsibility 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 c
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hronic depression? Which response is supported by research data?
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a. Too much stress has been proven to cause all kinds of cancer. VX VX VX VX VX VX VX VX VX VX VX




b. There have been no research studies done on stress and disease yet.
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c. Stress does cause the release of factors that suppress the immune system.
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d. There appears to be little connection between stress and diseases of the body
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ANS: C VX




Research indicates that stress causes a release of corticotropin-
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releasing factors that suppress the immune system. Studies indicate that psychiatric dis
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orders such as mood disorders are sometimes associated with decreased functioning of t
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he immune system. Research does not support a connection between many cancers and
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stress. There is a significant amount of research about stress and the body. Research h
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as 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 rehabilitat
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ion needs. Of the aspects of functioning listed, which will the nurse identify as a focus o
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f nursing intervention?
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a. Expression of emotion VX VX




b. Detecting auditory stimuli VX VX




c. Receiving visual images VX VX




d. Processing associations VX




ANS: D VX




The parietal lobe is responsible for associating and processing sensory information tha
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t allows for functions such as following directions on a map, reading a clock, dressing
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self, keeping appointments, and distinguishing right from left. Emotional expression is
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associated with frontal lobe function. Detecting auditory stimuli is a temporal lobe fun
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ction. Receiving visual images is related to occipital lobe function.
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7. At admission, the nurse learns that some time ago the patient had an infarct in the ri
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ght cerebral cortex. During assessment, the nurse would expect to find that the patie
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nt:
a. Demonstrates major deficiencies in speech VX VX VX VX




b. Is unable to effectively hold a spoon in the left hand
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c. Has difficulty explaining how to go about using the telephone
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d. Cannot use his right hand to shave himself or comb his own hair
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ANS: B VX




The cerebral hemispheres are responsible for functions such as control of muscles. The
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right hemisphere mainly controls the motor and sensory functions on the left side of the
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body. Damage to the right side would result in impaired function on the left side of the
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body. The motor cortex controls voluntary motor activity. Brocas area controls motor
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speech. Cognitive functions are attributed to the association cortex.
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The right side of the bodys motor activity is controlled by the left cerebral cortex.
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8. A patient with chronic schizophrenia had a stroke involving the hippocampus. The p
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atient will be discharged on low doses of haloperidol. The nurse will need to individu
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alize the patients medication teaching by:
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a. Including the patients caregiver in the education VX VX VX VX VX VX




b. Being careful to stress the importance of taking the medication as prescribed
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Providing the education at a time when the patient is emotionally calm and relax
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c. ed
Encouraging the patient to crush or dissolve the medication to help with swallowing VX VX VX VX VX VX VX VX VX VX VX VX




d.
ANS: A VX