3 - Biological Basis for Understanding Psychiatric Disorders and Treatments

Question 1

You are caring for Vanessa, a 38-year-old patient with major depression. She has just met with her provider. She states to you, “my provider said something about the medicine she is ordering working on my neurotransmitters. What exactly are neurotransmitters?” Your best response is:

a. ) “Neurotransmitters are chemical messengers in the brain that help regulate specific functions.”
b. ) “Neurotransmitters are too complicated to explain easily. Just know that the medication will help your mood.”
c. ) “Neurotransmitters are the reason you are depressed.”
d. ) “I will ask your provider to give you a more in-depth explanation.”

Answer 1

a.) “Neurotransmitters are chemical messengers in the brain that help regulate specific functions.”

Neurotransmitters are chemicals released from neurons that function as a neuromessenger and influence brain functions.

Telling the patient that the answer is too complicated belittles the patient by implying she cannot understand, while stating that neurotransmitters are the reason she is depressed is too simplistic.

Asking the provider to give the education abdicates your responsibility to provide patient education.

Question 2

Vanessa’s provider writes orders including medication to treat her depression. Based on current understanding of brain physiology, which of the following neurotransmitters would you expect to see targeted with the medication ordered?

a. ) dopamine
b. ) GABA
c. ) serotonin/norepinephrine
d. ) Acetylcholine

Answer 2

c.) serotonin/norepinephrine

Antidepressant medication targets serotonin and norepinephrine.

Dopamine is implicated in schizophrenia (increase) and Parkinson’s disease (decrease).

GABA is implicated in anxiety disorders.

Acetylcholine is implicated in Alzheimer’s disease as well as Huntington’s disease and Parkinson’s disease.

Question 3

The term pharmacodynamics refers to the effect of the drug on the body, while pharmacokinetics refers to:

a. ) the effect of the drug specifically on the brain and movement.
b. ) the effect of the person on the drug.
c. ) the effect of the drug on children and adolescents.
d. ) the effect of the drug on the half-life and ability of the liver to excrete.

Answer 3

b.) the effect of the person on the drug.

Pharmacokinetics refers to the effect of the person on the drug and helps to guide dosing. The other options are incorrect.

Question 4

Which of the following patients would need monitoring for potential development of the side effect of hypothyroidism?

a. ) Janelle, who is taking Prozac
b. ) Travis, who is taking Depakote
c. ) Shelly, who is taking lithium
d. ) Anna, who is taking Risperdal

Answer 4

c.) Shelly, who is taking lithium

Long-term use of lithium may cause hypothyroidism. The other options refer to drugs whose long-term use do not cause hypothyroidism.

Question 5

Julie, a 49-year-old patient diagnosed with schizophrenia at 22 years old, is taking risperidone (Risperdal). Which of the following nursing assessments is the priority assessment with Julie?

a. ) Monitoring blood levels to avoid toxicity
b. ) Monitoring for abnormal involuntary movements
c. ) Observing for secondary mania
d. ) Observing for memory changes

Answer 5

b.) Monitoring for abnormal involuntary movements

Risperidone has the highest rate of extrapyramidal side effects (EPSs) of the second-generation antipsychotic medications, thus making it imperative to monitor for EPSs. Risperidone is not monitored with blood levels and does not cause mania or memory changes.

Question 6

The basic functional unit of the nervous system is called a

a. ) neuron.
b. ) synapse.
c. ) receptor.
d. ) neurotransmitter.

Answer 6

a.) neuron.

Neurons are nerve cells. Cells are the basic unit of function. A neurotransmitter is a chemical substance that functions as a neuromessenger. This neurotransmitter then diffuses across a space, or synapse, to an adjacent postsynaptic neuron, where it attaches to receptors on the neuron’s surface.

Question 7

The incoherent thought and speech patterns of the client with schizophrenia are related to the brain’s inability to

a. ) regulate conscious mental activity.
b. ) retain and recall past experience.
c. ) regulate social behavior.
d. ) maintain homeostasis.

Answer 7

a.) regulate conscious mental activity.

When the brain cannot regulate conscious mental activity, the individual’s speech patterns demonstrate incoherence and lack of reality orientation.

Question 8

Homeostasis is promoted by interaction between the brain and internal organs mediated by

a. ) conscious behavior.
b. ) the autonomic nervous system.
c. ) the sympathetic nervous system.
d. ) the parasympathetic nervous system.

Answer 8

b.) the autonomic nervous system.

The function of the autonomic nervous system is to transmit messages between the brain and the internal organs. This linkage promotes the maintenance of homeostasis.

Question 9

Cells that respond to stimuli, conduct electrical impulses, and release neurotransmitters are called

a. ) neurons.
b. ) synapses.
c. ) dendrites.
d. ) receptors.

Answer 9

a.) neurons.

Neurons are the basic functional unit of the nervous system responsible for sending and receiving messages as electrochemical events.

Question 10

Which imaging technique can provide information about brain function?

a. ) Computed tomography (CT) scan
b. ) Positron emission tomography (PET) scan
c. ) Magnetic resonance imaging (MRI) scan
d. ) Skull radiograph

Answer 10

b.) Positron emission tomography (PET) scan

The positron emission tomography scan provides information about function; the other imaging techniques provide information about structure.

Question 11

When a tumor of the cerebellum is present, the nurse should expect that the client would initially demonstrate

a. ) disequilibrium.
b. ) abnormal eye movement.
c. ) impaired social judgment.
d. ) blood pressure irregularities.

Answer 11

a.) disequilibrium.

The cerebellum is the organ primarily responsible for symptoms of equilibrium or imbalance.

Question 12

Which organs secrete hormones that are a normal component of the body’s general response to stress?

a. ) Brain, thyroid gland, pancreas
b. ) Brain, pituitary gland, adrenal glands
c. ) Pituitary gland, pancreas, thyroid gland
d. ) Adrenal glands, parathyroid glands

Answer 12

b.) Brain, pituitary gland, adrenal glands

The hypothalamus, pituitary, and adrenal glands act as a system that responds to mental and physical stress. The three hormones secreted—corticotropin-releasing hormone, corticotropin, and cortisol—influence the function of nerve cells of the brain.

Question 13

The behavior of an individual who seems unable to learn right from wrong and who repeatedly violates laws and lies demonstrates problems related to the brain’s inability to

a. ) regulate conscious mental activity.
b. ) retain and recall past experience.
c. ) regulate social behavior.
d. ) maintain homeostasis.

Answer 13

c.) regulate social behavior.

The inability to regulate social behavior usually results in antisocial behaviors such as lying, cheating, taking advantage of others, and breaking laws.

Question 14

A client being medicated for both hallucinations and delusions reports being drowsy. The nurse will correctly interpret this symptom as related to the drug’s effect on the brain’s ability to regulate

a. ) mood.
b. ) thought.
c. ) memory.
d. ) sleep.

Answer 14

d.) sleep.

A number of psychotropic drugs have side effects that interfere with the brain’s ability to regulate sleep alertness. These side effects range from lethargy to extreme drowsiness. As the client’s body becomes accustomed to the drug, the drowsiness should dissipate.

Question 15

A client’s communication is marked by loose associations and word salad. Dysfunction of which portion of the brain is responsible for these symptoms?

a. ) Cerebrum
b. ) Cerebellum
c. ) Brainstem
d. ) Basal ganglia

Answer 15

a.) Cerebrum

The ability to think and speak logically is controlled by the cerebrum.

Question 16

A nursing assistant shares with the nurse that a client with schizophrenia is as difficult to communicate with as “someone with Alzheimer’s.” The nurse offers the following advice:

a. ) “Try talking to him early in the day to get the best results. Fatigue disorganizes his thinking.”
b. ) “Schizophrenia and Alzheimer’s disease both cause irreversible brain damage, so keep your conversations short when you talk to a client with either disorder.”
c. ) “His medication targets his disturbed thought and speech patterns. To maximize improvement he will need positive interactions and support.”
d. ) “Make sure he eats the comfort foods he is served because they increase serotonin production and will help normalize his thoughts and speech.”

Answer 16

c.) “His medication targets his disturbed thought and speech patterns. To maximize improvement he will need positive interactions and support.”

This response will help the nursing assistant understand that improvement can be expected in the client’s condition and that this improvement can be maximized by therapeutic interactions with staff. It establishes the expectation that the nursing assistant will interact in a therapeutic manner.

Question 17

The nurse caring for a client taking risperidone (Risperidal) observes the client carefully for

a. ) napping during the day, a weight gain, and reports of dizziness.
b. ) reports of falls, heartburn, and nausea.
c. ) a rapid heartbeat, red rash, and hives.
d. ) dry mouth, poor urinary output, and constipation.

Answer 17

a.) napping during the day, a weight gain, and reports of dizziness.

H₁ blockade has the potential to produce sedation, weight gain, and hypotension.

Question 18

The medication prescribed for a client acts by blocking reuptake of both serotonin and norepinephrine. The nurse evaluates the treatment as successful when observing

a. ) laughing at a joke.
b. ) exercising a sore shoulder.
c. ) writing down his telephone number.
d. ) going to his room to “calm down.”

Answer 18

a.) laughing at a joke.

Depression is thought to be at least in part caused by lowered levels of serotonin and norepinephrine. Increasing the amount of these transmitters in the brain by blocking reuptake may result in mood elevation.