Link full download test bank for essentials of psychiatric mental health nursing 1st edition by varcarolis

DIF: Cognitive Level: Application REF: Page: 53 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 2.. DIF: Cognitive Level: Application REF: Page: 51 TOP: Nursin

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Test Bank for Essentials of Psychiatric Mental

Test Bank

Chapter 4: Biological Basis for Understanding Psychopharmacology

MULTIPLE CHOICE

1 A patient asks a nurse, “What are neurotransmitters? My doctor says mine are out of balance.” The best reply would be:

a “You must feel relieved to know that your problem has a physical basis.”

b “It is a high-level concept to explain You should ask the doctor to tell you more.”

c “Neurotransmitters are substances we eat daily that influence memory and mood.”

d “Neurotransmitters are chemicals that pass messages between brain cells.”

ANS: D

Stating that neurotransmitters are chemicals that pass messages between brain cells gives the most accurate information Neurotransmitters are chemical substances that function as messengers in the central nervous system They are released from the axon terminal, diffuse across the synapse, and attach to specialized receptors on the postsynaptic neuron The first response does not answer the patient’s question The second response does not answer the patient’s question and is somewhat demeaning The third response provides untrue, misleading information

DIF: Cognitive Level: Application REF: Page: 53

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

2 The parent of an adolescent with schizophrenia asks a nurse, “My child’s doctor ordered

a PET What kind of test is that?” Select the nurse’s best reply

a “This test uses a magnetic field and gamma waves to identify problems areas in the brain Does your teenager have any metal implants?”

b “It’s a special type of x-ray that shows structures of the brain and whether there has ever been a brain injury.”

c “PET means positron emission tomography It’s a scan that involves an injection and lying still It shows blood flow and activity in the brain.”

d “PET scans pass an electrical current through the brain and show brain wave activity PET can help diagnose seizures.”

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ANS: C

The parent is seeking information about PET scans It’s important to use terms the parent can understand, so the nurse should identify what the initials mean The third option is the only option that provides factual information relevant to PET scans The first option describes MRI, the second describes CT scans, and the fourth describes EEG

3 A patient has dementia The health care provider wants to make a differential diagnosis between Alzheimer’s disease or multiple infarcts Which diagnostic procedure should a nurse expect to prepare the patient for first? a Computed tomography (CT) scan

b Functional magnetic resonance imaging (fMRI)

c PET scan

d Single-photon emission computed tomography (SPECT)

ANS: A

A CT scan shows the presence or absence of structural changes, including cortical

atrophy, ventricular enlargement, and areas of infarct, information that would be helpful

to the health care provider The other tests show brain activity rather than structure and may be ordered later

DIF: Cognitive Level: Analysis REF: Page: 51 TOP: Nursing Process:

Planning

MSC: NCLEX: Physiological Integrity

4 A patient has delusions and hallucinations Before beginning treatment with psychotropic drugs, the health care provider wishes to rule out the presence of a brain tumor For

which test will a nurse need to prepare the patient? a CT scan or MRI

b PET or SPECT

c Cerebral arteriogram

d fMRI

ANS: A

CT and MRI scans visualize neoplasms and other structural abnormalities PET, SPECT,

or fMRI scans, which give information about brain function, are not called for, and an arteriogram would not be appropriate

DIF: Cognitive Level: Application REF: Page: 44 TOP: Nursing Process:

Planning

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5 A patient being admitted for depression should be assessed for disturbances in circadian rhythms Which question best implements this assessment? a “What are your worst and best times of day?”

b “Do you ever see or hear things that others do not?”

c “How would you describe your thinking?”

d “Would you say your memory is failing?”

ANS: A

Mood changes throughout the day are related to circadian rhythms Questions about sleep pattern would also be relevant to circadian rhythms The question about seeing or hearing things is relevant to the assessment for illusions and hallucinations The question about thinking is relevant to the assessment of thought processes The fourth question is

relevant to the assessment of memory

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

6 A nurse administers a medication that potentiates the action of GABA Which finding would be expected?

a Reduced anxiety

b Improved memory

c More organized thinking

d Fewer sensory perceptual alterations

ANS: A

Increased levels of GABA reduce anxiety, thus any potentiation of GABA action should result in anxiety reduction Memory enhancement is associated with acetylcholine and substance P Thought disorganization is associated with dopamine GABA is not

associated with sensory perceptual alterations

Evaluation

7 On the basis of current knowledge of neurotransmitter effects, a nurse could anticipate that the treatment plan for a patient with memory difficulties might include medications designed to:

a inhibit GABA

b increase dopamine at receptor sites

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c decrease dopamine at receptor sites.

d prevent destruction of acetylcholine

ANS: D

Increased acetylcholine plays a role in learning and memory Preventing destruction of acetylcholine by acetylcholinesterase would result in higher levels of acetylcholine, with the potential for improved memory GABA is known to affect anxiety level rather than memory Increased dopamine would cause symptoms associated with schizophrenia or mania rather than improve memory Decreasing dopamine at receptor sites is associated with Parkinson’s disease rather than improving memory

DIF: Cognitive Level: Comprehension REF: Page: 55 TOP: Nursing Process:

Planning

8 A patient has disorganized thinking associated with schizophrenia A PET scan would most likely show dysfunction in which part of the brain? a Temporal lobe

b Cerebellum

c Brainstem

d Frontal lobe

ANS: D

The frontal lobe is responsible for intellectual functioning The temporal lobe is

responsible for the sensation of hearing The cerebellum regulates skeletal muscle

coordination and equilibrium The brainstem regulates internal organs

9 A nurse should assess a patient taking a drug with anticholinergic properties for inhibited function of the:

a parasympathetic nervous system

b sympathetic nervous system

c reticular activating system

d medulla oblongata

ANS: A

Acetylcholine is the neurotransmitter found in high concentration in the parasympathetic nervous system When acetylcholine action is inhibited by anticholinergic drugs,

parasympathetic symptoms such as blurred vision, dry mouth, constipation, and urinary

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retention appear The functions of the sympathetic nervous system, the reticular

activating system, and the medulla oblongata are not affected by anticholinergics

DIF: Cognitive Level: Comprehension REF: Page: 51

10 The therapeutic action of monoamine oxidase inhibitors (MAOIs) blocks

neurotransmitter reuptake, causing:

a increased concentration of neurotransmitter in the synaptic gap

b decreased concentration of neurotransmitter in the synaptic gap

c destruction of receptor sites

d limbic system stimulation

ANS: A

If the reuptake of a substance is inhibited, it accumulates in the synaptic gap and its

concentration increases, permitting ease of transmission of impulses across the synaptic gap Normal transmission of impulses across synaptic gaps is consistent with normal rather than depressed mood The other options are not associated with blocking

neurotransmitter reuptake

DIF: Cognitive Level: Comprehension REF: Page: 61

11 A patient taking medication for mental illness develops restlessness and an uncontrollable need to be in motion A nurse can correctly analyze that these symptoms are related to which drug action?

a Dopamine-blocking effects

b Anticholinergic effects

c Endocrine-stimulating effects

d Ability to stimulate spinal nerves

ANS: A

Medication that blocks dopamine often produces disturbances of movement such as

akathisia because dopamine affects neurons involved in both thought processes and

movement regulation Anticholinergic effects include dry mouth, blurred vision, urinary retention, and constipation Akathisia is not caused by endocrine stimulation or spinal nerve stimulation

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12 A nurse assesses that a patient demonstrates anxiety, increased heart rate, and fear The nurse would suspect the presence of a high concentration of which neurotransmitter?

b Histamine

c Acetylcholine

d Norepinephrine

ANS: D

Norepinephrine is the neurotransmitter associated with sympathetic nervous system

stimulation, preparing the individual for “fight or flight.” GABA is a mediator of anxiety level A high concentration of histamine is associated with an inflammatory response A high concentration of acetylcholine is associated with parasympathetic nervous system stimulation

DIF: Cognitive Level: Application REF: Pages: 55-57

13 A patient has symptoms of acute anxiety related to the death of a parent in an automobile accident 2 hours ago The patient will need teaching about a drug from which group? a

Tricyclic antidepressants

b Antimanic drugs

c Benzodiazepines

d Antipsychotic drugs

ANS: C

Benzodiazepines provide anxiety relief Tricyclic antidepressants are used to treat

symptoms of depression Antimanic drugs are used to treat bipolar disorder

Antipsychotic drugs are used to treat psychosis

DIF: Cognitive Level: Application REF: Page: 63 TOP: Nursing Process: Planning

14 A patient is hospitalized for severe depression Of the medications listed below, a nurse can expect to provide the patient with teaching about: a clozapine (Clozaril)

b chlordiazepoxide (Librium)

c tacrine (Cognex)

d fluoxetine (Prozac)

ANS: D

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Fluoxetine is an SSRI It is an antidepressant that blocks the reuptake of serotonin with few anticholinergic and sedating side effects Clozapine is an antipsychotic

Chlordiazepoxide is an anxiolytic Tacrine is used to treat Alzheimer’s disease

Planning

15 A patient hospitalized with a mood disorder has an elevated unstable mood,

aggressiveness, agitation, talkativeness, and irritability A nurse begins care planning based on the expectation that the health care provider is most likely to prescribe a

medication classified as a(n): a anticholinergic

b mood stabilizer

c psychostimulant

d antidepressant

ANS: B

The symptoms describe a manic attack Mania is effectively treated by the antimanic drug lithium and selected anticonvulsants such as carbamazepine, valproic acid, and

lamotrigine No drugs from the other classifications listed are effective in the treatment of mania

Planning

16 A drug causes muscarinic receptor blockade A nurse will assess the patient for: a

gynecomastia

b pseudoparkinsonism

c orthostatic hypotension

d dry mouth

ANS: D

Muscarinic receptor blockade includes atropine-like side effects such as dry mouth,

blurred vision, and constipation Gynecomastia is associated with decreased prolactin levels Movement defects are associated with dopamine blockade Orthostatic

hypotension is associated with alpha1 antagonism

DIF: Cognitive Level: Application REF: Pages: 57-58

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17 A patient begins therapy with a phenothiazine medication What teaching should a nurse provide related to the drug’s strong dopaminergic effect? a Chew sugarless gum

b Increase fiber in the diet

c Arise slowly from bed

d Report muscle stiffness

ANS: D

Phenothiazines block dopamine receptors in both the limbic system and basal ganglia The movement disorder dystonia is likely to occur early in the course of treatment and is often heralded by sensations of muscle stiffness Early intervention with antiparkinsonian medication can increase the patient’s comfort and prevent dystonic reactions

18 A patient tells a nurse, “My doctor prescribed Paxil [paroxetine] for my depression I suppose I’ll have side effects like I had when I was taking Tofranil [imipramine].” The nurse’s reply should be based on the knowledge that paroxetine is a(n): a tricyclic

antidepressant

b MAOI

c selective serotonin reuptake inhibitor

d selective norepinephrine reuptake inhibitor

ANS: C

Paroxetine is a selective serotonin reuptake inhibitor and will not produce the same side effects as imipramine, a tricyclic antidepressant The patient will probably not experience dry mouth, constipation, or orthostatic hypotension

DIF: Cognitive Level: Comprehension REF: Pages: 62-63

19 A nurse can anticipate anticholinergic side effects are likely when a patient is taking: a

lithium (Lithobid)

b risperidone (Risperdal)

c buspirone (BuSpar)

d fluphenazine (Prolixin)

ANS: D

Fluphenazine, a first-generation antipsychotic, exerts muscarinic blockade, resulting in dry mouth, blurred vision, constipation, and urinary retention Lithium therapy is more

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often associated with fluid balance problems, including polydipsia, polyuria, and edema Risperidone therapy is more often associated with movement disorders, orthostatic

hypotension, and sedation Buspirone is associated with anxiety reduction without major side effects

Planning

20 Priority teaching for a patient taking clozapine (Clozaril) should include which

instructions?

a Report sore throat and fever immediately

b Avoid foods high in polyunsaturated fat

c Use over-the-counter preparations for rashes

d Avoid unprotected sex

ANS: A

Clozapine therapy may produce agranulocytosis; therefore, signs of infection should be immediately reported to the health care provider In addition, the patient should have white blood cell levels measured weekly The other options are not relevant to clozapine administration

Planning

21 A nurse cares for patients taking various medications, including buspirone (BuSpar), haloperidol (Haldol), carbamazepine (Tegretol), trazodone (Desyrel), and phenelzine (Nardil) The nurse must ensure that a special diet is ordered for the patient taking: a

buspirone

b haloperidol

c carbamazepine

d trazodone

e phenelzine

ANS: E

Patients taking phenelzine, an MAOI, must be on a tyramine-free diet to prevent

hypertensive crisis

Planning

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22 A nurse instructs a patient taking a drug that inhibits monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of: a hypotensive shock

b hypertensive crisis

c cardiac dysrhythmia

d cardiogenic shock

ANS: B

Patients taking MAO-inhibiting drugs must be on a tyramine-free diet to prevent

hypertensive crisis In the presence of MAOIs, tyramine is not destroyed by the liver and

in high levels produces intense vasoconstriction, resulting in elevated blood pressure

DIF: Cognitive Level: Comprehension REF: Page: 62 TOP: Nursing Process:

Planning

23 A nurse caring for a patient taking an SSRI will develop outcome criteria related to:

a mood improvement

b logical thought processes

c reduced levels of motor activity

d decreased extrapyramidal symptoms

ANS: A

SSRIs affect mood, relieving depression in many cases SSRIs do not act to reduce

thought disorders SSRIs reduce depression but have little effect on motor hyperactivity SSRIs do not produce extrapyramidal symptoms

Planning

24 A patient’s spouse, who is a chemist, asks a nurse the action by which SSRIs lift

depression The nurse should explain that SSRIs:

a make more serotonin available at the synaptic gap

b destroy increased amounts of neurotransmitter

c increase production of acetylcholine and dopamine

d block muscarinic and alpha1 norepinephrine receptors

ANS: A

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