Test Bank For Prescriber's Guide Stahl's Essential Psychopharmacology 7th Edition By Stephen M. Stahl 9781108926010 Chapter 1-152 Complete Guide .

STAHL'S ESSENTIAL PSY n nn



CHOPHARMACOLOGY
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Chapter 1 Chemical neurotransmission
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MULTIPLE CHOICE n


1. A patient with depression mentions to the nurse, My mother says depression is a ch
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emical 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?
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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.
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Serotonin and norepinephrine have been found to be important in the regulation of d
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epression. There is no research to support that the other options play a significant rol
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e in the development of depression.
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2. A patient has experienced a stroke (cerebral vascular accident) that has resulted in damag
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e 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 n n n n n n



b. Asking the patient to recite the alphabet
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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.,
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motor aphasia). Fine motor skills, blood pressure control, and muscle strength are not controlle
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d by the Broca area of the left frontal lobe.
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3. The patient diagnosed with schizophrenia asks why psychotropic medications are al
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ways prescribed by the doctor. The nurses answer will be based on information that the
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therapeutic action of psychotropic drugs is the result of their effect on:
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a. The temporal lobe; especially Wernickes area
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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 n


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 d
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opamine. The Wernickes area, dendrite function, or the sensitivity of the peripheral nerv
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ous 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 woul
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d base a response on the understanding that it is:
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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
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b. their practice n



Important primarily for the nursing assessment of patients with brain traumacause
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c. d cognitive symptoms
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Necessary for planning psychiatric care for all patients especially those experienc
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d. ing psychiatric disorders
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ANS: D n


Nurses must understand that many symptoms of psychiatric disorders have a neurologic
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basis, although the symptoms are manifested behaviorally. This understanding facilitate
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s effective care planning. The foundation of knowledge is not used exclusively by advan
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ced practice psychiatric nurses nor is it relevant for only behavior therapies or brain trau
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ma since dealing with the results of normal and abnormal brain function is a responsibili
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ty 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 ch
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ronic 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. n n n n n n n n n n n



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. 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
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NS: C n


Research indicates that stress causes a release of corticotropin-releasing factors that
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suppress the immune system. Studies indicate that psychiatric disorders such as mood di
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sorders are sometimes associated with decreased functioning of the immune system. Res
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earch does not support a connection between many cancers and stress. There is a signific
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ant amount of research about stress and the body. Research has shown that there are som
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e connections between stress and physical disease.
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,6. A patient who has a parietal lobe injury is being evaluated for psychiatric rehabilitati
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on needs. Of the aspects of functioning listed, which will the nurse identify as a focus of
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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
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that allows for functions such as following directions on a map, reading a clock, dressing
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nself, 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 funct
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ion. 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 patient
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:
a. Demonstrates major deficiencies in speech n n n n



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 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.
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The right hemisphere mainly controls the motor and sensory functions on the left side of
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nthe body. Damage to the right side would result in impaired function on the left side of t
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he body. The motor cortex controls voluntary motor activity. Brocas area controls moto
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r 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 individua
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lize the patients medication teaching by:
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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
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roviding the education at a time when the patient is emotionally calm and
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c. relaxed
Encouraging the patient to crush or dissolve the medication to help with swallowi
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d. ng
ANS: A n

, The hippocampus plays a major role in short-
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term memory and, hence, in learning. Taking the medication as prescribed and providin
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g the education at a time when the patient is calm and relaxed is information or considera
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tions that all patients should be given. The medication does not necessarily need to be cr
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ushed or dissolved since the stroke would not have caused difficulty with swallowing.
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9. The physician tells the nurse, The medication Im prescribing for the patient en
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hances the g- n n


aminobutyric acid (GABA) system. Which patient behavior will provide evidenc
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e that the medication therapy is successful?
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a. The patient is actively involved in playing cards with other patients.
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b. The patient reports that, I dont feel as anxious as I did a couple of days ago.
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c. The patient reports that both auditory and visual hallucinations have decreased.
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d. The patient says that, I am much happier than before I came to the hospital. A
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NS: B n


GABA is the principle inhibitory neurotransmitter. The medication should provide an
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antianxiety effect. Alertness, psychotic behaviors, and mood elevation are not generally
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naffected by g-aminobutyric acid. n n n


10. The patients family asks whether a diagnosis of Parkinsons disease creates an i
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ncreased risk for any mental health issues. What question would the nurse ask to as
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sess for such a comorbid condition?
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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?
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c. Have you noticed your father talking about seeing things you cant see?
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d. Is your dad preoccupied with behaviors that he needs to repeat over and over? A
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NS: A n


Serotonin and its close chemical relatives, dopamine and norepinephrine, are the
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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
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nd so a patient with Parkinsons disease should be monitored for depression, The other
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mental health disorders (bipolar disorder, hallucinations, and obsessive compulsive dis
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order) have not been connected to Parkinsons disease.
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11. Which explanation for the prescription of donepezil (Aricept) would the nurse p
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rovide for a patient in the early stage of Alzheimers disease?
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a. It will increase the metabolism of excess GABA.
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b. Excess dopamine will be prevented from attaching to receptor sites.
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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.
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ANS: D n