TEST BANK
,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 theory
that 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 this
diagnosis?
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 not
controlled 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 that
the 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
,ANS: C
Medications used to treat psychiatric disorders operate in and around the synaptic cleft
and 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 with
understanding 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 on
a. behavioral interventions
A complex undertaking that advance practice psychiatric nurses frequently use
b. in their practice
Important primarily for the nursing assessment of patients with brain
c. traumacaused cognitive symptoms
Necessary for planning psychiatric care for all patients especially those
d. experiencing 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 not
used 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 to
the psychiatric patient.
5. A patient asks the nurse, My wife has breast cancer. Could it be caused by her
chronic 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 mood
disorders 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.
,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 identify
as 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 the
right 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 side
of 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. The
patient 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 and
c. relaxed
Encouraging the patient to crush or dissolve the medication to help with
d. swallowing
ANS: A
,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 be
given. 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 will
provide 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 an
antianxiety 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 to
assess 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. Most
researchers 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 nurse
provide 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
,Decreased qlevels qof qacetylcholine qare qthought qto qproduce qmany qof qthe
qbehavioral qsymptoms qof qAlzheimers qdisease. qThe qinhibiting qaction qthe qdrug
qhas qon qcholinesterase qwill qslow qdown qthe qbreakdown qof qacetylcholine qand
qso qdelay qthe qonset qof qsymptoms. qThe qother qneurotransmitters q(GABA,
qdopamine, qand qserotonin) qare qnot qcurrently qbelieved qto qplay qa qrole qin
qAlzheimers qdisease.
12. There qremains qa qstigma qattached qto qpsychiatric qillnesses. qThe
qpsychiatric qnurse qmakes qthe qgreatest qimpact qon qthis qsociological qproblem
qwhen:
a. Providing qeducational qprogramming qfor qpatients qand qthe qpublic
b. Arranging qfor qadequate qand qappropriate qsocial qsupport qfor qthe qpatient
c. Assisting qthe qpatient qto qachieve qthe qmaximum qlevel qof qindependent
qfunctioning qRegularly qpraising qthe qpatient qfor qseeking qand qcomplying
qwith qappropriate
d. treatment
ANS:
qA
Much qof qthe qstigma qattached qto qpsychiatric qillness qis qdue qto qa qlack qof
qunderstanding qof qthe qbiologic qbasis qof qthese qdisorders. qTherefore, qeffective
qpatient, qfamily, qand qpublic qteaching qis qan qimportant qfunction qof qthe qrole qof
qthe qpsychiatric qmental qhealth qnurse.
While qthe qremaining qoptions qare qappropriate, qthey qare qnot qdirected qtowards
qeliminating qsocial qstigma qbut qrather qempowering qthe qpatient.
13. The qwife qof qa qpatient qwith qparanoid qschizophrenia qtells qthe qnurse, qIve
qlearned qthat qmy qhusband qhas qseveral qclose qrelatives qwith qthe qsame qdisorder.
qDoes qthis qproblem qrun qin qfamilies? qThe qresponse qbased qon qrecent
qdiscoveries qin qthe qfield qof qgenetics qwould qbe:
a. Your qchildren qshould qbe qmonitored qclosely qfor qthe qdisorder.
b. Research qtends qto qsupport qa qfamiliar qtendency qto qschizophrenia.
c. There qis qno qconcrete qevidence; qit qis qjust qas qlikely qa qcoincidence.
d. Only qbipolar qdisorder qhas qbeen qidentified qto qhave qa qgenetic
qcomponent. qANS: qB
Familial qtendencies qappear qwith qseveral qpsychiatric qdisorders qincluding
qschizophrenia.
To qinsinuate qthat qthe qchildren qare qat qsuch qrisk qwould qnot qbe qsupported qby
qresearch.
14. A qpatient qwhose qsymptoms qof qmild qdepression qhave qbeen qmanaged qwith
qantidepressants qis qconcerned qabout qthe qaffect qof qaccepting qa qpromotion qthat
qwill qrequire qworking qthe qnight qshift. qWhat qwill qbe qthe qbasis qof qthe
qresponse qthe qnurse qgives qto qaddress qthe qpatients qconcern?
a. The qconnection qbetween qa qnew qjob qand qpossible qdepression qdoes qexist.
b. The qmedication qcan qbe qadjusted qto qmanage qany qincrease qin qdepression.
, c. The qinterruption qin qnormal qwake-sleep qpatterns qcan qinfluence qmood
qdisorders.
,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 theory
that 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 this
diagnosis?
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 not
controlled 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 that
the 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
,ANS: C
Medications used to treat psychiatric disorders operate in and around the synaptic cleft
and 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 with
understanding 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 on
a. behavioral interventions
A complex undertaking that advance practice psychiatric nurses frequently use
b. in their practice
Important primarily for the nursing assessment of patients with brain
c. traumacaused cognitive symptoms
Necessary for planning psychiatric care for all patients especially those
d. experiencing 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 not
used 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 to
the psychiatric patient.
5. A patient asks the nurse, My wife has breast cancer. Could it be caused by her
chronic 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 mood
disorders 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.
,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 identify
as 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 the
right 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 side
of 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. The
patient 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 and
c. relaxed
Encouraging the patient to crush or dissolve the medication to help with
d. swallowing
ANS: A
,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 be
given. 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 will
provide 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 an
antianxiety 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 to
assess 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. Most
researchers 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 nurse
provide 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
,Decreased qlevels qof qacetylcholine qare qthought qto qproduce qmany qof qthe
qbehavioral qsymptoms qof qAlzheimers qdisease. qThe qinhibiting qaction qthe qdrug
qhas qon qcholinesterase qwill qslow qdown qthe qbreakdown qof qacetylcholine qand
qso qdelay qthe qonset qof qsymptoms. qThe qother qneurotransmitters q(GABA,
qdopamine, qand qserotonin) qare qnot qcurrently qbelieved qto qplay qa qrole qin
qAlzheimers qdisease.
12. There qremains qa qstigma qattached qto qpsychiatric qillnesses. qThe
qpsychiatric qnurse qmakes qthe qgreatest qimpact qon qthis qsociological qproblem
qwhen:
a. Providing qeducational qprogramming qfor qpatients qand qthe qpublic
b. Arranging qfor qadequate qand qappropriate qsocial qsupport qfor qthe qpatient
c. Assisting qthe qpatient qto qachieve qthe qmaximum qlevel qof qindependent
qfunctioning qRegularly qpraising qthe qpatient qfor qseeking qand qcomplying
qwith qappropriate
d. treatment
ANS:
qA
Much qof qthe qstigma qattached qto qpsychiatric qillness qis qdue qto qa qlack qof
qunderstanding qof qthe qbiologic qbasis qof qthese qdisorders. qTherefore, qeffective
qpatient, qfamily, qand qpublic qteaching qis qan qimportant qfunction qof qthe qrole qof
qthe qpsychiatric qmental qhealth qnurse.
While qthe qremaining qoptions qare qappropriate, qthey qare qnot qdirected qtowards
qeliminating qsocial qstigma qbut qrather qempowering qthe qpatient.
13. The qwife qof qa qpatient qwith qparanoid qschizophrenia qtells qthe qnurse, qIve
qlearned qthat qmy qhusband qhas qseveral qclose qrelatives qwith qthe qsame qdisorder.
qDoes qthis qproblem qrun qin qfamilies? qThe qresponse qbased qon qrecent
qdiscoveries qin qthe qfield qof qgenetics qwould qbe:
a. Your qchildren qshould qbe qmonitored qclosely qfor qthe qdisorder.
b. Research qtends qto qsupport qa qfamiliar qtendency qto qschizophrenia.
c. There qis qno qconcrete qevidence; qit qis qjust qas qlikely qa qcoincidence.
d. Only qbipolar qdisorder qhas qbeen qidentified qto qhave qa qgenetic
qcomponent. qANS: qB
Familial qtendencies qappear qwith qseveral qpsychiatric qdisorders qincluding
qschizophrenia.
To qinsinuate qthat qthe qchildren qare qat qsuch qrisk qwould qnot qbe qsupported qby
qresearch.
14. A qpatient qwhose qsymptoms qof qmild qdepression qhave qbeen qmanaged qwith
qantidepressants qis qconcerned qabout qthe qaffect qof qaccepting qa qpromotion qthat
qwill qrequire qworking qthe qnight qshift. qWhat qwill qbe qthe qbasis qof qthe
qresponse qthe qnurse qgives qto qaddress qthe qpatients qconcern?
a. The qconnection qbetween qa qnew qjob qand qpossible qdepression qdoes qexist.
b. The qmedication qcan qbe qadjusted qto qmanage qany qincrease qin qdepression.
, c. The qinterruption qin qnormal qwake-sleep qpatterns qcan qinfluence qmood
qdisorders.
