TEST BANK STAHL PSYCHOPHARM EXAM

Stahl's Essential Psychopharmacology

Neuroscientific Basis and Practical Applications TESTBANK/STUDY

GUIDE

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

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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:

a.

Necessary but generally for psychiatric nurses who focus primarily on

behavioral interventions

b.

A complex undertaking that advance practice psychiatric nurses frequently use

in their practice

c.

Important primarily for the nursing assessment of patients with brain

traumacaused cognitive symptoms

d.

Necessary for planning psychiatric care for all patients especially those

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.

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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

c.

Providing the education at a time when the patient is emotionally calm and

relaxed

d.

Encouraging the patient to crush or dissolve the medication to help with

swallowing

ANS: A

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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

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