TEST BANK FOR STAHL'S ESSENTIAL PSYCHOPHARMACOLOGY:
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NEUROSCIENTIFIC BASIS AND PRACTICAL APPLICATIONS 5TH EDITION
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Stahl's Essential Psychopharmacology u u
Neuroscientific Basis and Practical Applications TESTBANK/STUDY GUIDE u u u u u u
Chapter 1 Chemical neurotransmission
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MULTIPLE CHOICE u
1. A patient with depression mentions to the nurse, My mother says depression isa
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chemical disorder. What does she mean? The nurses response is based on the
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theorythat depression primarily involves which of the following
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neurotransmitters?
a. Cortisol and GABA u u
b. COMT and glutamate u u
c. Monamine and glycine u u
d. Serotonin and norepinephrine u u
ANS: D u
One possible cause of depression is thought to involve one or more
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uneurotransmitters.Serotonin and norepinephrine have been found to be important u u u u u u u u
in the regulation of depression. There is no research to support that the other
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uoptions play a significant role in the development of depression.
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2. A patient has experienced a stroke (cerebral vascular accident) that has
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uresulted in damage to the Broca area. Which evaluation does the nurse conduct to
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ureinforce thisdiagnosis? u
a. Observing the patient pick up a spoon u u u u u u
b. Asking the patient to recite the alphabet u u u u u u
c. Monitoring the patients blood pressure u u u u
d. Comparing the patients grip strength in both hands u u u u u u u
ANS: B u
Accidents or strokes that damage Brocas area may result in the inability to speak
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u(i.e., motor aphasia). Fine motor skills, blood pressure control, and muscle strength
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are notcontrolled by the Broca area of the left frontal lobe.
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3. The patient diagnosed with schizophrenia asks why psychotropic medications
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are always prescribed by the doctor. The nurses answer will be based on
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uinformation thatthe therapeutic action of psychotropic drugs is the result of their
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effect on: u
a. The temporal lobe; especially Wernickes area
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b. Dendrites and their ability to transmit electrical impulses u u u u u u u
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 u
Medications used to treat psychiatric disorders operate in and around the synaptic
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cleftand have action at the neurotransmitter level, especially in the case of
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schizophrenia, on dopamine. The Wernickes area, dendrite function, or the
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sensitivity of the peripheral nervous system are not relevant to either schizophrenia
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or psychotropic medications.
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4. A student nurse mutters that it seems entirely unnecessary to have to struggle
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withunderstanding the anatomy and physiology of the neurologic system. The
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mentor would base a response on the understanding that it is:
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Necessary but generally for psychiatric nurses who focus primarily u u u u u u u u
a. onbehavioral interventions
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A complex undertaking that advance practice psychiatric nurses frequently
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b. usein their practice
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Important primarily for the nursing assessment of patients with u u u u u u u u
c. braintraumacaused cognitive symptoms
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Necessary for planning psychiatric care for all patients especially u u u u u u u u
d. thoseexperiencing psychiatric disorders
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ANS: D u
Nurses must understand that many symptoms of psychiatric disorders have a
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neurologic basis, although the symptoms are manifested behaviorally. This
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understanding facilitates effective care planning. The foundation of knowledge is
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notused exclusively by advanced practice psychiatric nurses nor is it relevant for
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only behavior therapies or brain trauma since dealing with the results of normal
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and abnormal brain function is a responsibility of all nurses providing all types of
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care tothe psychiatric patient.
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5. A patient asks the nurse, My wife has breast cancer. Could it be caused by
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herchronic 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.
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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 u
Research indicates that stress causes a release of corticotropin-releasing factors
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that suppress the immune system. Studies indicate that psychiatric disorders suchas
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mooddisorders are sometimes associated with decreased functioning of the
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immune system.Research does not support a connection between many cancers
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and stress. There is a significant amount of research about stress and the body.
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Research has shown that there are some connections between stress and physical
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disease.
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,6. A patient who has a parietal lobe injury is being evaluated for psychiatric
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urehabilitation needs. Of the aspects of functioning listed, which will the nurse
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identifyas a focus of nursing intervention?
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a. Expression of emotion u u
b. Detecting auditory stimuli u u
c. Receiving visual images u u
d. Processing associations u
ANS: D u
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,
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udressing self, keeping appointments, and distinguishing right from left. Emotional
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uexpression is associated with frontal lobe function. Detecting auditory stimuli is a
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utemporal lobe function. Receiving visual images is related to occipital lobe
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ufunction.
7. At admission, the nurse learns that some time ago the patient had an infarct in
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theright cerebral cortex. During assessment, the nurse would expect to find that
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uthe patient:
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a. Demonstrates major deficiencies in speech u u u u
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 u u u u u u u u u u u u
ANS: B u
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
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usideof the body. Damage to the right side would result in impaired function on the
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left side of the body. The motor cortex controls voluntary motor activity. Brocas
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uarea controls motor speech. Cognitive functions are attributed to the association
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ucortex.
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.
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uThepatient will be discharged on low doses of haloperidol. The nurse will need to
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individualize the patients medication teaching by:
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a. Including the patients caregiver in the education u u u u u u
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
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c. andrelaxed
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Encouraging the patient to crush or dissolve the medication to help u u u u u u u u u u
d. withswallowing
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ANS: A u
, The hippocampus plays a major role in short-term memory and, hence, in learning.
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Taking the medication as prescribed and providing the education at a time when
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the patient is calm and relaxed is information or considerations that allpatients
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should begiven. The medication does not necessarily need to be crushed or
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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
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patient enhances the g-aminobutyric acid (GABA) system. Which patient
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behavior willprovide evidence 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
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decreased.
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d. The patient says that, I am much happier than before I came to the hospital.
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ANS: B u
GABA is the principle inhibitory neurotransmitter. The medication should provide
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anantianxiety effect. Alertness, psychotic behaviors, and mood elevation are not
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generally affected by g-aminobutyric acid.
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10. The patients family asks whether a diagnosis of Parkinsons disease creates
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an increased risk for any mental health issues. What question would the nurse
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ask toassess for such a comorbid condition?
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a. Has your father exhibited any signs of depression? u u u u u u u
b. Does your father seem to experience mood swings? u u u u u u u
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?
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ANS: A u
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.
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Mostresearchers agree that the immediate cause of parkinsonism is a deficiency
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of dopamine and so a patient with Parkinsons disease should be monitored for
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depression, The other mental health disorders (bipolar disorder, hallucinations,
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and obsessive compulsive disorder) have not been connected to Parkinsons
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disease.
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11. Which explanation for the prescription of donepezil (Aricept) would the
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nurseprovide 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. u u u u u u u u u
c. Serotonin deficiency will be managed through a prolonged reuptake period. u u u u u u u u u
d. The acetylcholine deficiency will be managed by inhibiting cholinesterase.
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ANS: D u
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