Test Bank Stahl’s Essential Psychopharmacology 5th EditionTable of Contents Chapter 1 Chemical neurotransmission....................................................................................................................................... 1 Chapter 2 Transporters, Receptors, And Enzymes ...
Stahl's Essential Psychopharmacology Neuroscientific Basis and
Practical Applications 5th Edition Test bank/ Study Guide
Table of Contents
Chapter 1 Chemical neurotransmission....................................................................................................................................... 1
Chapter 2 Transporters, Receptors, And Enzymes As Targets Of PsychopharmacologicalDrug Action ....................... 8
Chapter 3 Ion Channels as Targets Of Psychopharmacological Drug Action.................................................................... 15
Chapter 4 Psychosis and schizophrenia .................................................................................................................................... 21
Chapter 5 Antipsychotic agents .................................................................................................................................................. 33
Chapter 6 Mood disorders........................................................................................................................................................... 40
Chapter 7 Antidepressants........................................................................................................................................................... 48
Chapter 8 Mood stabilizers.......................................................................................................................................................... 56
Chapter 9 Anxiety disorders and Anxiolytics ........................................................................................................................... 71
Chapter 10 Chronic pain and its treatment............................................................................................................................... 76
Chapter 11 Disorders Of Sleep And Wakefulness And Their Treatment ........................................................................... 84
Chapter 12 Attention Deficit Hyperactivity Disorder And Its Treatment .......................................................................... 89
Chapter 13 Dementia and its treatment .................................................................................................................................... 96
Chapter 14 Impulsivity, Compulsivity, And Addiction ........................................................................................................ 106
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 theorythat 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 thisdiagnosis?
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
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,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 thatthe 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 cleftand 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 withunderstanding 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 onbehavioral
a. interventions
A complex undertaking that advance practice psychiatric nurses frequently usein their practice
b.
Important primarily for the nursing assessment of patients with braintraumacaused
c. cognitive symptoms
Necessary for planning psychiatric care for all patients especially thoseexperiencing
d. 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 notused 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 tothe psychiatric patient.
5. A patient asks the nurse, My wife has breast cancer. Could it be caused by herchronic 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 mooddisorders 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 identifyas a focus of nursing intervention?
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, 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 theright 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 sideof 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. Thepatient 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 andrelaxed
c.
Encouraging the patient to crush or dissolve the medication to help withswallowing
d.
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 begiven. 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 willprovide 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.
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, ANS: B
GABA is the principle inhibitory neurotransmitter. The medication should provide anantianxiety 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 toassess 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. Mostresearchers 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 nurseprovide 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 levels of acetylcholine are thought to produce many of the behavioral symptoms of Alzheimers
disease. The inhibiting action the drug has on cholinesterasewill slow down the breakdown of acetylcholine
and so delay the onset of symptoms. The other neurotransmitters (GABA, dopamine, and serotonin) are not
currently believed to play a role in Alzheimers disease.
12. There remains a stigma attached to psychiatric illnesses. The psychiatric nursemakes the greatest
impact on this sociological problem when:
a. Providing educational programming for patients and the public
b. Arranging for adequate and appropriate social support for the patient
c. Assisting the patient to achieve the maximum level of independent functioning
Regularly praising the patient for seeking and complying with appropriatetreatment
d.
ANS: A
Much of the stigma attached to psychiatric illness is due to a lack of understanding ofthe biologic basis of
these disorders. Therefore, effective patient, family, and public teaching is an important function of the role
of the psychiatric mental health nurse.
While the remaining options are appropriate, they are not directed towards eliminatingsocial stigma but rather
empowering the patient.
13. The wife of a patient with paranoid schizophrenia tells the nurse, Ive learned that my husband has
several close relatives with the same disorder. Does this problem runin families? The response based on
recent discoveries in the field of genetics would be:
a. Your children should be monitored closely for the disorder.
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