Chapter 4 Flashcards
- 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. “Neurotransmitters are chemicals that pass messages between brain cells.”
c. “It is a high-level concept to explain. You should ask the doctor to tell you more.”
d. “Neurotransmitters are substances we eat daily that influence memory and mood.”
ANS: B
Stating that neurotransmitters are chemicals that pass messages between brain cells gives the most accurate information. Neurotransmitters are 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 incorrect responses do not answer the patient’s question, are demeaning, and provide untrue and misleading information.
- The parent of an adolescent diagnosed with schizophrenia asks a nurse, “My child’s doctor ordered a positron-emission tomography (PET) scan. What is that?” Select the nurse’s best reply.
a. “PET 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 image that shows structures of the brain and whether a brain injury has ever occurred.”
c. “PET is a scan that passes an electrical current through the brain and shows brain wave activity. PET can help diagnose seizures.”
d. “PET is a special scan that shows blood flow and activity in the brain.”
ANS: D
The parent is seeking information about PET scans. It is important to use terms the parent can understand. The correct option is the only reply that provides factual information relevant to PET scans. The incorrect responses describe magnetic resonance imaging (MRI), computed tomographic (CT) scans, and electroencephalography (EEG).
- A patient has dementia. The health care provider wants to make a differential diagnosis between Alzheimer disease and multiple infarctions. Which diagnostic procedure should a nurse expect to prepare the patient for first?
a. Computed tomography (CT) scan
b. Positron emission tomography (PET) scan
c. Functional magnetic resonance imaging (fMRI)
d. Single-photon emission computed tomography (SPECT) scan
ANS: A
A CT scan shows the presence or absence of structural changes, including cortical atrophy, ventricular enlargement, and areas of infarction—information that will be helpful to the health care provider. The other tests focus on brain activity and are more expensive; they may be ordered later.
- A patient has delusions and hallucinations. Before beginning treatment with a psychotropic medication, the health care provider wants to rule out the presence of a brain tumor. For which test will a nurse need to prepare the patient?
a. Cerebral arteriogram
b. Functional magnetic resonance imaging (fMRI)
c. Computed tomography (CT) scan or magnetic resonance imaging (MRI)
d. Positron emission tomography (PET) or single-photon emission computed tomography (SPECT)
ANS: C
A CT scan and an MRI visualize neoplasms and other structural abnormalities. A PET scan, SPECT scan, and fMRI, which give information about brain function, are not indicated. An arteriogram would not be appropriate.
- The nurse wants to assess for disturbances in circadian rhythms in a patient admitted for major depressive disorder. Which question best implements this assessment?
a. “Do you ever see or hear things that others do not?”
b. “Do you have problems with short-term memory?”
c. “What are your worst and best times of day?”
d. “How would you describe your thinking?”
ANS: C
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 other question is relevant to assessment of memory.
- A nurse administers a medication that potentiates the action of gamma-aminobutyric acid (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.
- On the basis of current knowledge of neurotransmitter effects, a nurse anticipates that the treatment plan for a patient with memory difficulties may include medications designed to:
a. inhibit GABA production.
b. increase dopamine sensitivity.
c. decrease dopamine at receptor sites.
d. prevent destruction of acetylcholine.
ANS: D
Increased acetylcholine plays a role in learning and memory. Preventing the destruction of acetylcholine by acetylcholinesterase results in higher levels of acetylcholine, with the potential for improved memory. GABA is known to affect anxiety level rather than memory. Increased dopamine causes symptoms associated with schizophrenia or mania rather than improves memory. Decreasing dopamine at receptor sites is associated with Parkinson disease rather than improving memory.
- A patient has disorganized thinking associated with schizophrenia. Neuroimaging would most likely show dysfunction in which part of the brain?
a. Brainstem
b. Cerebellum
c. Temporal lobe
d. Prefrontal cortex
ANS: D
The prefrontal cortex 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.
- A nurse should assess a patient taking a medication 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 retention appear. The functions of the sympathetic nervous system, the reticular activating system, and the medulla oblongata are not affected by anticholinergic medications.
- The therapeutic action of monoamine oxidase inhibitors (MAOIs) blocks neurotransmitter reuptake, causing:
a. increased concentration of neurotransmitters in the synaptic gap.
b. decreased concentration of neurotransmitters in serum.
c. destruction of receptor sites.
d. limbic system stimulation.
ANS: A
If the reuptake of a substance is inhibited, then it accumulates in the synaptic gap and its concentration increases, permitting the ease of the transmission of impulses across the synaptic gap. Normal transmission of impulses across synaptic gaps is consistent with a normal rather than a depressed mood. The other options are not associated with blocking neurotransmitter reuptake.
- 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. Anticholinergic effects
b. Dopamine-blocking effects
c. Endocrine-stimulating effects
d. Ability to stimulate spinal nerves
ANS: B
Medications that block dopamine often produce disturbances of movement such as akathisia because dopamine affects neurons involved in both the 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.
- A patient has 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 the “fight or flight” response. 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.
- A patient has symptoms of acute anxiety related to the death of a parent in an automobile accident 2 hours earlier. The nurse should anticipate administering a medication from which group?
a. Tricyclic antidepressants
b. Atypical antipsychotics
c. Anticonvulsants
d. Benzodiazepines
ANS: D
Benzodiazepines provide anxiety relief. Tricyclic antidepressants are used to treat symptoms of depression. Anticonvulsants are used to treat bipolar disorder or seizures. Antipsychotic drugs are used to treat psychosis.
- A patient is hospitalized for major depressive disorder. Of the medications listed, a nurse can expect to provide the patient with teaching about:
a. chlordiazepoxide (Librium).
b. fluoxetine (Prozac).
c. clozapine (Clozaril).
d. tacrine (Cognex).
ANS: B
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI), an antidepressant that blocks the reuptake of serotonin with few anticholinergic and sedating side effects; clozapine (Clozaril) is an antipsychotic medication; chlordiazepoxide (Librium) is an anxiolytic drug; and tacrine (Cognex) is used to treat Alzheimer disease.
- A patient hospitalized with a mood disorder has aggression, agitation, talkativeness, and irritability. A nurse begins the care plan 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. tricyclic 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.