Test Bank for Essentials of Psychiatric Mental Health Nursing A Communication Approach to Evidence by zwoho635

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Test Bank for Essentials of Psychiatric Mental Health Nursing A Communication Approach to Evidence Based Care 1st Edition by Varcarolis 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 TOP: Nursing Process: Implementation 2.

REF: Page: 53 MSC: NCLEX: Physiological Integrity

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.”

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

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. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation 3.

REF: Page: 51 MSC: NCLEX: Physiological Integrity

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 Planning MSC: NCLEX: Physiological Integrity 4.

REF: Page: 51

TOP: Nursing Process:

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 Planning

REF: Page: 44

TOP: Nursing Process:

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MSC: NCLEX: Physiological Integrity 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. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment 6.

REF: Page: 48 MSC: NCLEX: Physiological Integrity

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. DIF: Cognitive Level: Application Evaluation MSC: NCLEX: Physiological Integrity 7.

REF: Page: 40

TOP: Nursing Process:

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 Parkinsonâ&#x20AC;&#x2122;s disease rather than improving memory. DIF: Cognitive Level: Comprehension Planning MSC: NCLEX: Physiological Integrity 8.

REF: Page: 55

TOP: Nursing Process:

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. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment 9.

REF: Page: 46 MSC: NCLEX: Physiological Integrity

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 TOP: Nursing Process: Assessment

REF: Page: 51 MSC: NCLEX: Physiological Integrity

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 TOP: Nursing Process: Implementation

REF: Page: 61 MSC: NCLEX: Physiological Integrity

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. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment

REF: Page: 56 MSC: NCLEX: Physiological Integrity

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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? a. GABA 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 TOP: Nursing Process: Assessment

REF: Pages: 55-57 MSC: NCLEX: Physiological Integrity

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 MSC: NCLEX: Physiological Integrity 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 Alzheimerâ&#x20AC;&#x2122;s disease. DIF: Cognitive Level: Application Planning MSC: NCLEX: Physiological Integrity

REF: Page: 55

TOP: Nursing Process:

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. DIF: Cognitive Level: Application Planning MSC: NCLEX: Physiological Integrity

REF: Page: 60

TOP: Nursing Process:

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 TOP: Nursing Process: Assessment

REF: Pages: 57-58 MSC: NCLEX: Physiological Integrity

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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. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation

REF: Page: 58 MSC: NCLEX: Physiological Integrity

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 TOP: Nursing Process: Implementation

REF: Pages: 62-63 MSC: NCLEX: Physiological Integrity

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. DIF: Cognitive Level: Application Planning MSC: NCLEX: Physiological Integrity

REF: Page: 58

TOP: Nursing Process:

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

which instructions? Report sore throat and fever immediately. Avoid foods high in polyunsaturated fat. Use over-the-counter preparations for rashes. Avoid unprotected sex.

a. b. c. d.

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. DIF: Cognitive Level: Application Planning MSC: NCLEX: Physiological Integrity

REF: Page: 59

TOP: Nursing Process:

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. DIF: Cognitive Level: Application Planning

REF: Page: 62

TOP: Nursing Process:

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MSC: NCLEX: Physiological Integrity 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 Planning MSC: NCLEX: Physiological Integrity

REF: Page: 62

TOP: Nursing Process:

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. DIF: Cognitive Level: Application Planning MSC: NCLEX: Physiological Integrity

REF: Page: 62

TOP: Nursing Process:

24. A patientâ&#x20AC;&#x2122;s spouse, who is a chemist, asks a nurse the action by which SSRIs

lift depression. The nurse should explain that SSRIs: make more serotonin available at the synaptic gap. destroy increased amounts of neurotransmitter. increase production of acetylcholine and dopamine. block muscarinic and alpha1 norepinephrine receptors.

a. b. c. d.

ANS: A

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Depression is thought to be related to lowered availability of the neurotransmitter serotonin. SSRIs act by blocking reuptake of serotonin, leaving a higher concentration available at the synaptic cleft; actually prevent destruction of serotonin; have no effect on acetylcholine and dopamine production; and do not produce muscarinic or alpha1 norepinephrine blockade. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation

REF: Page: 62 MSC: NCLEX: Physiological Integrity

25. A patient has taken many conventional antipsychotic drugs over years. The health

care provider, concerned about early signs of tardive dyskinesia, prescribes risperidone (Risperdal). A nurse planning care for this patient understands that atypical antipsychotics: a. are less costly. b. have higher potency. c. are more readily available. d. produce fewer motor side effects.

ANS: D

Atypical antipsychotic drugs often exert their action on the limbic system rather than the basal ganglia. The limbic system is not involved in motor disturbances. Atypical antipsychotics are not more readily available. They are not considered to be of higher potency; rather, they have different modes of action. Atypical antipsychotic drugs tend to be more expensive. DIF: Cognitive Level: Comprehension Planning MSC: NCLEX: Physiological Integrity

REF: Page: 59

TOP: Nursing Process:

26. The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell 3 3 count of 3000 mm and a granulocyte count of 1500 mm . The nurse should: a. report

the laboratory results to the health care provider. b. give the next dose as prescribed. c. repeat the laboratory tests. d. give aspirin and force fluids.

ANS: A

These laboratory values indicate the possibility of agranulocytosis, a serious side effect of clozapine therapy. These results must be immediately reported to the health care provider. The drug should be withheld because the health care provider will discontinue it. The health care provider may repeat the laboratory test, but in the meantime the drug

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should be withheld. Giving aspirin and forcing fluids are measures that are less important than stopping administration of the drug. DIF: Cognitive Level: Analysis TOP: Nursing Process: Implementation

REF: Page: 59 MSC: NCLEX: Physiological Integrity

27. A nurse administering psychotropic medications should be prepared to intervene when

giving a drug that blocks the attachment of norepinephrine to alpha1 receptors because the patient may experience: a. increased psychotic symptoms. b. a hypertensive crisis. c. orthostatic hypotension. d. severe appetite disturbance.

ANS: C

Sympathetic mediated vasoconstriction is essential for maintaining normal blood pressure in the upright position. Blockage of alpha1 receptors leads to vasodilation and orthostatic hypotension. Orthostatic hypotension may cause fainting and falls. Patients should be taught ways of minimizing this phenomenon. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation

REF: Page: 58 MSC: NCLEX: Physiological Integrity

28. A nurse cares for four patients who are receiving clozapine, lithium, fluoxetine, and

venlafaxine, respectively. For which patient should the nurse be most alert for alterations in cardiac or cerebral electrical conductivity as well as fluid and electrolyte imbalance? The patient receiving: a. lithium (Lithobid) b. clozapine (Clozaril) c. fluoxetine (Prozac) d. venlafaxine (Effexor)

ANS: A

Lithium is known to alter electrical conductivity, producing cardiac dysrhythmias, tremor, convulsions, polyuria, edema, and other symptoms of fluid and electrolyte imbalance. Patients receiving clozapine should be monitored for agranulocytosis. Patients receiving fluoxetine should be monitored for acetylcholine block. Patients receiving venlafaxine should be monitored for heightened feelings of anxiety. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment

REF: Page: 60 MSC: NCLEX: Physiological Integrity

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29. During a care planning meeting for an obese patient with schizophrenia, the nurse

suggests to the health care provider that it would be appropriate to select a medication that does not block the receptors for: a. H1. b. GABA. c. Acetylcholine. d. 5 HT2.

ANS: A

H1 receptor blockade results in weight gain, which is undesirable for an obese patient. Blocking of the other receptors would have little or no effect on the patient’s weight. DIF: Cognitive Level: Application Planning MSC: NCLEX: Physiological Integrity

REF: Page: 58

TOP: Nursing Process:

30. Which patient is most likely to have the best therapeutic effect from citalopram (Celexa)? a. An African American patient b. A Korean American patient c. A white patient d. Ethnicity is unrelated to medication effects.

ANS: C

Many white individuals have a genetic variation that favors a positive therapeutic response to citalopram. This genetic variation is not likely to be present in African Americans or Korean Americans. DIF: Cognitive Level: Application Planning MSC: NCLEX: Physiological Integrity MULTIPLE RESPONSE

REF: Page: 65

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1. A nurse prepares to administer antipsychotic medication to a patient with schizophrenia.

Additional monitoring of the medication’s effects and side effects will be most important if the patient is also diagnosed with which health problem? (More than one answer is correct.) a. Diabetes b. Parkinson’s disease c. Osteoarthritis d. Graves’ disease e. Epilepsy

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ANS: A, B, E

Antipsychotic medications may produce weight gain, which would complicate care of a patient with diabetes and/or lower the seizure threshold, which would complicate care of a patient with epilepsy. Parkinson’s disease involves changes in transmission of dopamine and acetylcholine, so these drugs would also complicate care of a patient with the disorder. Osteoarthritis and Graves’ disease should have no synergistic effect with this medication. DIF: Cognitive Level: Analysis Planning MSC: NCLEX: Physiological Integrity

REF: Page: 58

TOP: Nursing Process:

2. The spouse of a patient with schizophrenia asks, “Which neurotransmitters are more

active when a person has schizophrenia?” The nurse should state, “The current thinking is that the thought disturbances are related to increased activity of: (More than one answer is correct.) a. dopamine.” b. substance P.” c. histamine.” d. increased GABA.” e. norepinephrine.”

ANS: A, E

Dopamine plays a role in integration of thoughts and emotions, and excess dopamine is implicated in the thought disturbances of schizophrenia. Increased activity of norepinephrine also occurs. Substance P is most related to the pain experience. Histamine decrease is associated with depression. Increased GABA is associated with anxiety reduction. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation

REF: Page: 55 MSC: NCLEX: Physiological Integrity

3. An individual is experiencing problems associated with memory. Which cerebral structures

are most likely to be involved in this deficit? (More than one answer is correct.) a. Frontal lobe b. Parietal lobe c. Occipital lobe d. Temporal lobe e. Basal ganglia

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ANS: A, B, D

The frontal, parietal, and temporal lobes of the cerebrum play a key role in the storage and processing of memories. The occipital lobe is predominantly involved with vision. The basal ganglia influence integration of physical movement, as well as some thoughts and emotions. DIF: Cognitive Level: Comprehension TOP: Nursing Process: Assessment

REF: Pages: 46-48 MSC: NCLEX: Physiological Integrity