Chapter 5: Biological Context of Psychiatric Nursing Care

Question 1

1. When a patient asks the nurse, “What are neurotransmitters?” The nurse replies that neurotransmitters are:
   a. “the chemical messengers that cause brain cells to turn on or off.”
   b. “small clumps of cells that alert the other brain cells to receive messages.”
   c. “tiny areas of the brain that are responsible for controlling our emotions.”
   d. “weblike structures that provide connections among various parts of the brain.”

Answer 1

ANS: A
Neurotransmitters are chemicals manufactured in the brain responsible for exciting or inhibiting brain cells in the production of an action.

Question 2

2. A patient tells a nurse, “My doctor says my problem may be with the neurotransmitters in my brain but I don’t understand what that means.” The nurse responds:
   a. “Let’s begin with exploring what your doctor has told you about your problem.”
   b. “We should start with a discussion about any concerns you have about having a neurotransmitter disorder.”
   c. “First let me say that neurotransmitter problems can usually be treated or cured with medication therapy.”
   d. “What you need to understand is that neurotransmitters are chemical messengers in the brain responsible for brain communication.”

Answer 2

ANS: A
The correct option assesses the patient’s understanding of his condition, the initial step in any educationally focused discussion. None of the remaining options—defining the role of a neurotransmitter, exploring the patient’s concerns, or providing an explanation of a typical treatment plan—address the patient’s question concerning a lack of understanding.

Question 3

3. Which part of the brain is responsible for fine motor coordination?
   a. Medulla
   b. Thalamus
   c. Cerebellum
   d. Temporal lobe

Answer 3

ANS: C

The cerebellum is responsible for fine motor coordination, posture, balance, and integration of emotional processes.

Question 4

4. Which neurotransmitter is located only in the brain, particularly in the raphe nuclei of the brainstem, and is implicated in depression?
   a. Norepinephrine
   b. Acetylcholine
   c. Dopamine
   d. Serotonin

Answer 4

ANS: D
Serotonin, also called 5-HT, is derived from tryptophan, a dietary amino acid. It is located only in the brain, particularly in the raphe nuclei of the brainstem. It plays a role in regulation of mood through its mood-elevating capacity.

Question 5

5. What part of the brain is responsible for regulating pituitary hormones and is known to regulate the body’s temperature?
   a. Thalamus
   b. Cerebellum
   c. Limbic system
   d. Hypothalamus

Answer 5

ANS: D

The hypothalamus is responsible for regulation of metabolism, temperature, and emotions.

Question 6

6. Which neurotransmitter is involved in the movement disorders seen in Parkinson disease and in the deficits seen in schizophrenia and other psychoses?
   a. Dopamine
   b. Melatonin
   c. Serotonin
   d. Norepinephrine

Answer 6

ANS: A
Dopamine is derived from tyrosine, is located mostly in the brainstem, and is involved in control of complex movements, motivation, and cognition. It is involved in movement disorders such as Parkinson disease and in many of the deficits seen in schizophrenia and other forms of psychosis. This is not necessarily true of the other options.

Question 7

7. A nurse explains to a patient undergoing diagnostic testing which brain imaging technique measures brain structure?
   a. Computed tomography (CT)
   b. Positron emission tomography (PET)
   c. Brain electrical activity mapping (BEAM)
   d. Single-photon emission computed tomography (SPECT)

Answer 7

ANS: A
CT can image brain structures through a series of radiographs that are computer constructed into “slices” of the brain that can be stacked by the computer, giving the image a three-dimensional appearance. PET and SPECT image brain activity and function through the tracking of radioactive substances as they travel through the brain. BEAM images brain activity and function through recordings of the brain’s electrical activity.

Question 8

8. The objective information that has helped mental health professionals understand that schizophrenia has a biological component has been obtained primarily from which of the following?
   a. Genetic studies
   b. Patient histories
   c. Comparisons of blood chemistries
   d. Magnetic resonance imaging (MRI) studies

Answer 8

ANS: D
When results of studies such as MRI are coupled with neuropsychological test results, the deficits in a person’s performance, such as language or cognitive or sensory information processing, can be linked to the activity in the region of the brain responsible for those functions.

Question 9

9. A genetic counselor is called to see patients with genetic questions or concerns. With which patient would it be most appropriate for the counselor to speak?
   a. A pregnant patient with sickle cell anemia
   b. A patient who has made a recent suicide attempt
   c. A patient prescribed the most drugs for the treatment of chronic disorders
   d. A patient with schizophrenia who had multiple hospital admissions in the last year

Answer 9

ANS: A
Several hundred genetic tests are in clinical use for illnesses such as muscular dystrophies, cystic fibrosis, and sickle cell anemia. Although research is being conducted, there is no proof of a definitive genetic cause for schizophrenia. The remaining options do not deal with conditions that have a proven link to a genetic cause.

Question 10

10. A patient tells a nurse, “My daughter is pregnant with our first grandchild and my son-in-law has a sibling with cystic fibrosis. Is there a chance the baby might have this disease?” Which response is best?
    a. “This is not an inherited disorder.”
    b. “You should speak to a genetic counselor.”
    c. “Science has not yet developed gene testing for this disease.”
    d. “There are new treatments for this illness that are readily available.”

Answer 10

ANS: B
Genetic counselors are trained to diagnose and explain disorders from a genetic perspective. They can review available options for testing and treatment and provide emotional support to individuals or families who have genetic disorders, are at risk for them, or need information about risks to their offspring.

Question 11

11. Pharmacogenetics will eventually allow researchers to do which of the following?
    a. Remove the genes that cause illness.
    b. Allow the design of custom drugs.
    c. Develop foods that fight disease.
    d. Splice genes to improve health.

Answer 11

ANS: B
Pharmacogenetics is a discipline that blends pharmacology with genomic capabilities and will eventually allow researchers to match DNA variants with individual responses to medical treatments. It will allow for custom drugs based on individual genetic profiles.

Question 12

12. A patient tells a nurse, “My doctor thinks my problem is serious but it can be treated with medications. Does that mean I’ll always have to be treated with drugs?” The nurse replies:
    a. “How would you feel about being on medications for a lifetime?”
    b. “What concerns do you have about having a serious mental disorder?”
    c. “Did your doctor suggest your problem was related to neurotransmitter problems?”
    d. “What do you know about this condition that the doctor is preparing to treat with medications?”

Answer 12

ANS: A
The initial concern expressed by the patient is being prescribed medications for a lifetime. The correct option explores this concern.

Question 13

13. The function of the limbic system is to:
    a. regulate emotional behavior.
    b. perform abstract reasoning.
    c. facilitate critical decision making.
    d. coordinate stress-related responses.

Answer 13

ANS: A
The limbic system is concerned with subjective emotional experiences and with changes in body functions associated with emotional states.

Question 14

14. A patient states, “I’m going to have a positron emission tomography (PET) scan. What are the doctors going to learn from it?” The best reply would be that they focus on:
    a. “identifying structures like tumors and scars.”
    b. “highlighting activity in various portions of the brain.”
    c. “outlining the structures of the brain more clearly.”
    d. “providing data to support new treatment modalities.”

Answer 14

ANS: B
PET scanning allows for the imaging of brain activity and function with the use of an injected radioactive substance that travels to the brain and shows up as a bright spot on the scan.

Question 15

15. A patient mentions, “My doctor told me I was going to have a PET scan that would show where my brain has bright spots. Does that mean I’m getting an electrical jolt like in electroconvulsive therapy (ECT)?” The best reply would be:
    a. “PET scans and ECT treatments are entirely different.”
    b. “A PET scan is a diagnostic test, and an ECT treatment is a form of therapy.”
    c. “A PET scan involves a substance, not electricity, that travels to the brain and produces a bright spot where the brain is active.”
    d. “PET scans show us the electrical activity of the brain in the form of light bands.”

Answer 15

ANS: C
PET scanning allows for the imaging of brain activity and function with the use of an injected radioactive substance that travels to the brain and shows up as a bright spot on the scan. There is no electrical “jolt” involved. Two of the options address an assumption made by the nurse that the patient is referring to ECT, and PET scans do not produce light bands of measurable degrees of brightness.

Question 16

16. A patient diagnosed with depression tells a nurse, “I don’t feel rested. It’s as though I didn’t sleep at all.” Comments by night shift staff show that the patient slept through most of the night. How can these two observations be reconciled?
    a. The patient is considered the more accurate reporter.
    b. The staff observations are more objective than the patient’s statement.
    c. Studies show that people with depression have disturbed sleep cycles that can result in sleep deprivation.
    d. People with depression characteristically underreport sleep satisfaction because of cognition flaws.

Answer 16

ANS: C
Studies show that with depression, REM sleep is excessive, the deeper stages of sleep are decreased, and dreams may be unusually intense, leading to patient reports of fatigue, poor concentration, and irritability associated with sleep deprivation.

Question 17

17. The spouse of a patient recently diagnosed with cancer asks, “What do you think about the relationship of stress and the development of cancer? My spouse has been under a huge amount of stress at work, and now they’ve diagnosed cancer.” The answer that best reflects the current thinking about psychoneuroimmunology is:
    a. “It’s thought that the immune system is negatively affected by high stress.”
    b. “The research hasn’t been focused directly on the link between cancer and stress.”
    c. “Your spouse’s situation may reflect a coincidence. There is little concrete evidence that stress makes one prone to physical illness.”
    d. “Grief and depression are known to cause physical illness, but other types of stress have not been implicated as illness producers.”

Answer 17

ANS: A
Natural killer cells, which are believed to play a role in tumor surveillance and the control of viral infections, seem to decrease with increasing levels of stress.

Question 18

18. A patient’s spouse asks a nurse, “Why are they wasting money doing all these tests on my spouse? The hallucinations and delusions make the mental illness obvious!” The best reply would be:
    a. “Don’t be upset. We are using the most modern approach to caring for your spouse.”
    b. “I know you must be worried about costs, but having these tests is very necessary.”
    c. “Physical illnesses can cause psychiatric symptoms. We must be sure of what we are treating.”
    d. “I think that you are upset about your spouse’s illness and not thinking clearly. To avoid harm, physical illness must be ruled out.”

Answer 18

ANS: C
Only after a patient has been carefully screened can it be determined that the problems are amenable to psychiatric intervention. These symptoms can be a result of a physiological problem and this situation must be assessed appropriately. It is never appropriate to be disrespectful or demeaning to a patient or family members.

Question 19

19. A couple tells a nurse that they are concerned about having children because there is bipolar disorder in first-degree relatives of each of them. What advice should the nurse give?
    a. “Do not have children.”
    b. “Seek genetic counseling.”
    c. “Do as your conscience dictates.”
    d. “Bipolar disorder is not hereditary.”

Answer 19

ANS: B
Current evidence suggests that there is a significant genetic role in the cause of recurrent depression and bipolar disorder. A genetic counselor is well prepared to discuss the concerns of these individuals.

Question 20

20. A patient demonstrates disoriented thinking and irrational ideas. A nurse can anticipate that a PET scan would most likely show dysfunction in the brain’s _____ lobe.
    a. frontal
    b. parietal
    c. occipital
    d. temporal

Answer 20

ANS: A
The frontal lobe is responsible primarily for intellectual functioning, including learning, abstracting, reasoning, and inhibition of impulses.

Question 21

21. A family member asks a mental health nurse, “I am reading a lot of information about gene therapy in the news lately. Will gene therapy be able to help my spouse, who has schizophrenia?” Which response by the nurse is best?
    a. “Gene therapy for schizophrenia is common in Europe but has not yet become popular in the United States.”
    b. “Gene therapy for schizophrenia is available, but the high cost prohibits most people from taking advantage of it.”
    c. “Gene therapy is still an experimental field and is not likely to be used to treat mental health disorders in the near future.”
    d. “Gene therapy has already shown promise in treating schizophrenia, but not enough large-scale studies have been carried out to date.”

Answer 21

ANS: C
Gene therapy is still an experimental field. It holds potential for treating or even curing genetic and acquired diseases such as cancer or AIDS, but it is not likely to be clinically applicable in psychiatry in the near future.

Question 22

22. A patient with a history of depression reports not feeling well rested in recent weeks. Before making the assumption that the complaint is related to depression, a nurse should investigate whether the patient has had any recent changes in:
    a. work schedule that affect the hours of sleep.
    b. vacations taken within the same time zone.
    c. fluid intake with reduced overall intake of water.
    d. food intake with decreased intake of heavy foods before bedtime.

Answer 22

ANS: A
Changes in schedule that affect circadian rhythms, such as work shifts that alter usual sleep patterns, can result in fatigue that is not related to mental health status. Other factors that alter sleep include changes in light and darkness and temperature changes. Vacations in the same time zone should not affect sleep, whereas food and fluid intake should enhance sleep by reducing risk of nocturia or indigestion.

Question 23

MULTIPLE RESPONSE

1. A depressed patient scheduled for an MRI asks about the purpose of the test and whether it will hurt. The response would include that the test: (Select all that apply.) a. takes a picture of the brain. b. is used to diagnose mental illness. c. should not produce any physical pain. d. may be uncomfortable if tight spaces bother you. e. machinery produces loud noises while the test is being conducted.

Answer 23

ANS: A, C, D, E
The function of an MRI is to visualize brain structure and detect abnormal brain formations. MRIs are not painful but require that the patient lie still in a confined space. The MRI machine produces a loud noise during the test. MRIs are not used in the diagnosis of mental illness.