Stahl's Essential Psychopharmacology

Question 1

1-01. A patient with depression mentions to the nurse, My mother says depression is a
chemical disorder. What does she mean? The nurses response is based on the theory
that depression primarily involves which of the following neurotransmitters?
a. Cortisol and GABA
b. COMT and glutamate
c. Monamine and glycine
d. Serotonin and norepinephrine

Answer 1

ANS: D
One possible cause of depression is thought to involve one or more neurotransmitters.
Serotonin and norepinephrine have been found to be important in the regulation of
depression. There is no research to support that the other options play a significant
role in the development of depression.

Question 2

1-02. A patient has experienced a stroke (cerebral vascular accident) that has resulted in
damage to the Broca area. Which evaluation does the nurse conduct to reinforce this
diagnosis?
a. Observing the patient pick up a spoon
b. Asking the patient to recite the alphabet
c. Monitoring the patients blood pressure
d. Comparing the patients grip strength in both hands

Answer 2

ANS: B
Accidents or strokes that damage Brocas area may result in the inability to speak (i.e.,
motor aphasia). Fine motor skills, blood pressure control, and muscle strength are not
controlled by the Broca area of the left frontal lobe.

Question 3

1-03. The patient diagnosed with schizophrenia asks why psychotropic medications are
always prescribed by the doctor. The nurses answer will be based on information that
the therapeutic action of psychotropic drugs is the result of their effect on:
a. The temporal lobe; especially Wernickes area
b. Dendrites and their ability to transmit electrical impulses
c. The regulation of neurotransmitters especially dopamine
d. The peripheral nervous system sensitivity to the psychotropic medications

Answer 3

ANS: C
Medications used to treat psychiatric disorders operate in and around the synaptic cleft
and have action at the neurotransmitter level, especially in the case of schizophrenia,
on dopamine. The Wernickes area, dendrite function, or the sensitivity of the
peripheral nervous system are not relevant to either schizophrenia or psychotropic
medications.

Question 4

1-04. A student nurse mutters that it seems entirely unnecessary to have to struggle with
understanding the anatomy and physiology of the neurologic system. The mentor
would base a response on the understanding that it is:
a.
Necessary but generally for psychiatric nurses who focus primarily on
behavioral interventions
b.
A complex undertaking that advance practice psychiatric nurses frequently use
in their practice
c.
Important primarily for the nursing assessment of patients with brain
traumacaused cognitive symptoms
d.
Necessary for planning psychiatric care for all patients especially those
experiencing psychiatric disorders

Answer 4

ANS: D
Nurses must understand that many symptoms of psychiatric disorders have a
neurologic basis, although the symptoms are manifested behaviorally. This
understanding facilitates effective care planning. The foundation of knowledge is not
used exclusively by advanced practice psychiatric nurses nor is it relevant for only
behavior therapies or brain trauma since dealing with the results of normal and
abnormal brain function is a responsibility of all nurses providing all types of care to
the psychiatric patient.

Question 5

1-05. A patient asks the nurse, “My wife has breast cancer. Could it be caused by her
chronic depression?” Which response is supported by research data?
a. Too much stress has been proven to cause all kinds of cancer.
b. There have been no research studies done on stress and disease yet.
c. Stress does cause the release of factors that suppress the immune system.
d. There appears to be little connection between stress and diseases of the body

Answer 5

ANS: C
Research indicates that stress causes a release of corticotropin-releasing factors that
suppress the immune system. Studies indicate that psychiatric disorders such as mood
disorders are sometimes associated with decreased functioning of the immune system.
Research does not support a connection between many cancers and stress. There is a
significant amount of research about stress and the body. Research has shown that
there are some connections between stress and physical disease.

Question 6

1-06. A patient who has a parietal lobe injury is being evaluated for psychiatric
rehabilitation needs. Of the aspects of functioning listed, which will the nurse identify
as a focus of nursing intervention?
a. Expression of emotion
b. Detecting auditory stimuli
c. Receiving visual images
d. Processing associations

Answer 6

ANS: D
The parietal lobe is responsible for associating and processing sensory information
that allows for functions such as following directions on a map, reading a clock,
dressing self, keeping appointments, and distinguishing right from left. Emotional
expression is associated with frontal lobe function. Detecting auditory stimuli is a
temporal lobe function. Receiving visual images is related to occipital lobe function.

Question 7

1-07. At admission, the nurse learns that some time ago the patient had an infarct in the
right cerebral cortex. During assessment, the nurse would expect to find that the
patient:
a. Demonstrates major deficiencies in speech
b. Is unable to effectively hold a spoon in the left hand
c. Has difficulty explaining how to go about using the telephone
d. Cannot use his right hand to shave himself or comb his own hair

Answer 7

ANS: B
The cerebral hemispheres are responsible for functions such as control of muscles.
The right hemisphere mainly controls the motor and sensory functions on the left side
of the body. Damage to the right side would result in impaired function on the left
side of the body. The motor cortex controls voluntary motor activity. Brocas area
controls motor speech. Cognitive functions are attributed to the association cortex.
The right side of the bodys motor activity is controlled by the left cerebral cortex.

Question 8

1-08. A patient with chronic schizophrenia had a stroke involving the hippocampus. The
patient will be discharged on low doses of haloperidol. The nurse will need to
individualize the patients medication teaching by:
a. Including the patients caregiver in the education
b. Being careful to stress the importance of taking the medication as prescribed
c.
Providing the education at a time when the patient is emotionally calm and
relaxed
d.
Encouraging the patient to crush or dissolve the medication to help with
swallowing

Answer 8

ANS: A
The hippocampus plays a major role in short-term memory and, hence, in learning.
Taking the medication as prescribed and providing the education at a time when the
patient is calm and relaxed is information or considerations that all patients should be
given. The medication does not necessarily need to be crushed or dissolved since the
stroke would not have caused difficulty with swallowing.

Question 9

1-09. The physician tells the nurse, The medication Im prescribing for the patient
enhances the g-aminobutyric acid (GABA) system. Which patient behavior will
provide evidence that the medication therapy is successful?
a. The patient is actively involved in playing cards with other patients.
b. The patient reports that, I dont feel as anxious as I did a couple of days ago.
c. The patient reports that both auditory and visual hallucinations have decreased.
d. The patient says that, I am much happier than before I came to the hospital.

Answer 9

ANS: B
GABA is the principle inhibitory neurotransmitter. The medication should provide an
antianxiety effect. Alertness, psychotic behaviors, and mood elevation are not
generally affected by g-aminobutyric acid.

Question 10

1-10. The patients family asks whether a diagnosis of Parkinsons disease creates an
increased risk for any mental health issues. What question would the nurse ask to
assess for such a comorbid condition?
a. Has your father exhibited any signs of depression?
b. Does your father seem to experience mood swings?
c. Have you noticed your father talking about seeing things you cant see?
d. Is your dad preoccupied with behaviors that he needs to repeat over and over?

Answer 10

ANS: A
Serotonin and its close chemical relatives, dopamine and norepinephrine, are the
neurotransmitters that are most widely involved in various forms of depression. Most
researchers agree that the immediate cause of parkinsonism is a deficiency of
dopamine and so a patient with Parkinsons disease should be monitored for
depression, The other mental health disorders (bipolar disorder, hallucinations, and
obsessive compulsive disorder) have not been connected to Parkinsons disease.

Question 11

1-11. Which explanation for the prescription of donepezil (Aricept) would the nurse
provide for a patient in the early stage of Alzheimers disease?
a. It will increase the metabolism of excess GABA.
b. Excess dopamine will be prevented from attaching to receptor sites.
c. Serotonin deficiency will be managed through a prolonged reuptake period.
d. The acetylcholine deficiency will be managed by inhibiting cholinesterase.

Answer 11

ANS: D
Decreased levels of acetylcholine are thought to produce many of the behavioral
symptoms of Alzheimers disease. The inhibiting action the drug has on cholinesterase
will slow down the breakdown of acetylcholine and so delay the onset of symptoms.
The other neurotransmitters (GABA, dopamine, and serotonin) are not currently
believed to play a role in Alzheimers disease.

Question 12

1-12. There remains a stigma attached to psychiatric illnesses. The psychiatric nurse
makes the greatest impact on this sociological problem when:
a. Providing educational programming for patients and the public
b. Arranging for adequate and appropriate social support for the patient
c. Assisting the patient to achieve the maximum level of independent functioning
d.
Regularly praising the patient for seeking and complying with appropriate
treatment

Answer 12

ANS: A
Much of the stigma attached to psychiatric illness is due to a lack of understanding of
the biologic basis of these disorders. Therefore, effective patient, family, and public
teaching is an important function of the role of the psychiatric mental health nurse.
While the remaining options are appropriate, they are not directed towards eliminating
social stigma but rather empowering the patient.

Question 13

1-13. The wife of a patient with paranoid schizophrenia tells the nurse, Ive learned that
my husband has several close relatives with the same disorder. Does this problem run
in families? The response based on recent discoveries in the field of genetics would
be:
a. Your children should be monitored closely for the disorder.
b. Research tends to support a familiar tendency to schizophrenia.
c. There is no concrete evidence; it is just as likely a coincidence.
d. Only bipolar disorder has been identified to have a genetic component.

Answer 13

ANS: B
Familial tendencies appear with several psychiatric disorders including schizophrenia.
To insinuate that the children are at such risk would not be supported by research.

Question 14

1-14. A patient whose symptoms of mild depression have been managed with
antidepressants is concerned about the affect of accepting a promotion that will
require working the night shift. What will be the basis of the response the nurse gives
to address the patients concern?
a. The connection between a new job and possible depression does exist.
b. The medication can be adjusted to manage any increase in depression.
c. The interruption in normal wake-sleep patterns can influence mood disorders.
d.
The change in sleep routine can be managed with a healthy sleep hygiene
routine.

Answer 14

ANS: C
Many psychiatric and medical disorders occur more frequently or are exacerbated
when sleep patterns and biologic rhythms are disrupted. While the remaining options
contain true information regarding the management of depression that is a result of
sleep disruption, they do not effectively address the patients concern.

Question 15

1-15. The nurse is discouraged because the patient exhibiting negative symptoms of
schizophrenia has shown no improvement with the planned interventions to reduce the
symptoms. The mentors remark that helps place the problem in perspective is:
a. You aren’t responsible for the behavior of any other person.
b. Patients can be perverse and cling to symptoms despite our efforts.
c. Negative symptoms have been associated with genetic pathology.
d. It will take several trail and error attempts to get the right combination care.

Answer 15

ANS: C
A complex disorder, such as schizophrenia, most likely has multiple contributing
factors, including genetic predisposition, prenatal development, and the environment.
Nurse frustration can be alleviated by helping the nurse realize that negative
symptoms may be the result of actual brain dysfunction, rather than psychologically
determined behaviors; thus the remaining options are not appropriate since they do not
address the complexity of the problem.

Question 16

1-01. What assessment data would reinforce the diagnosis of temporal lobe injury in
patient who experienced head trauma? Select all that apply.
a. Inability to balance a checkbook
b. Uncharacteristically aggressive
c. Affect fluctuates dramatically
d. Increased interest in sexual behaviors
e. Difficulty remembering the names of family members

Answer 16

ANS: C, D, E
The temporal lobe is involved with memory as well as increased sexual focus and
altered emotional responses. Personality and intellectual function is not centered in the
temporal lobe.

Question 17

1-02. A patient has begun experiencing dysfunction of the hypothalamus. What nursing
interventions will the nurse include in the patients plan of care? Select all that apply.
a. Reinforcing clear physical boundaries
b. Assisting the patient with completing daily menus
c. Learning about healthy sleep hygiene habits
d. Monitoring and recording temperature every 4 hours
e. Monitoring and recording blood pressure every 4 hours

Answer 17

ANS: B, C, D
The hypothalamus is responsible for regulation of sleep-rest patterns, body
temperature, and physical drives of hunger. Social appropriateness and blood pressure
is not controlled by the hypothalamus.

Question 18

1-03. The nurse is preparing a patient for a positron emission tomography (PET) scan.
Which instructions will the nurse include? Select all that apply.
a.
There will likely be a 30 to 45 minute wait between the injection and the
beginning of the scan.
b.
A blindfold and earplugs may be used to help decrease reaction to the
environment during the scan.
c.
Make every attempt to lie still during the scan because movement will affect
the imaging produced.
d.
No food or fluids are to be ingested for at least 8 full hours before the scan and
none during the scan.
e.
Staying awake during the scan is important since the results are altered when
the patient is in any phase of the sleep state.

Answer 18

ANS: A, B, C, E
Appropriate patient preparation for a PET scan would include information regarding
the time interval between injection of the isotope and the actual scan, the fact that
steps will be taken to minimize the effects of sights and sounds during the scan, lying
still is critical to achieving a quality image, and that being asleep during the scan will
alter the results. It is not necessary to fast before or during the scan.

Question 19

1-04. A patient with schizophrenia is described as having difficulty with executive
functions. What patient dysfunction can the nurse expect to assess behaviorally?
Select all that apply.
a. Invades the personal space of others frequently
b. Consistently fails to bring money when going to buy snacks
c. Cannot remember the names of staff who often provide care
d. Requires repeated reinforcement on how to make a sandwich
e. Frequently speaks of hurting himself or of hurting other patients

Answer 19

ANS: A, B, D
Executive functions include reasoning, planning, prioritizing, sequencing behavior,
insight, flexibility, judgment, focusing on tasks, responding to social cues, and
attending in appropriate ways to incoming stimuli. Memory is not considered an
executive function and risk for harm to self and others is not generally a diagnosis
appropriate for such a patient.

Question 20

1-05. The unit physicians have ordered magnetic resonance imaging (MRI) tests for the
following patients. For which patients would the nurse decline to make test
arrangements without further discussion with the physician? Select all that apply.
a. A patient who is claustrophobic
b. A patient who is breastfeeding
c. A patient who has an allergy to iodine
d. A patient who had a total knee replacement
e. A patient who is taking a neuroleptic medication

Answer 20

ANS: A, D
Patients with claustrophobia are often unable to complete this type of study, because
the MRI machine is enclosed, and patients are required to remain motionless. Metal
implants are contraindications for MRIs since metal affects the scan. Breastfeeding,
iodine sensitivity, and neuroleptic medication therapy are not contraindications for an
MRI.

Question 21

2-01. The somatic nervous system provides sensory and motor innervation for:
A) peripheral nerves.
B) abdominal viscera.
C) secretory glands.
D) smooth muscle.

Answer 21

ANS. A

Question 22

2-02. The proteins and other materials used by the axon are synthesized _____ and
then flow down the axon through its cytoplasm.
A) in the cell body
B) by Nissl bodies
C) through dendrites
D) across synapses

Answer 22

ANS. A

Question 23

2-03. Supporting cells of the nervous system, such as Schwann cells, satellite cells,
and types of glial cells, function to provide neurons with:
A) local protection.
B) control functions.
C) membrane permeability.
D) integrative metabolism.

Answer 23

ANS. A

Question 24

2-04. Neurons are characterized by the ability to communicate with other neurons
and body cells through:
A) astrocytes.
B) axon hillocks.
C) nodes of Ranvier.
D) action potentials.

Answer 24

ANS. D

Question 25

2-05. Chemical synapses rely on \_\_\_\_ in order to provide communication
between neurons.
A) diffusion
B) gap junctions
C) satellite cells
D) transmitter molecules

Answer 25

ANS. D

Question 26

2-06. The blood-brain and CSF-brain barriers control the chemical environment of
the brain by allowing easy entrance to only a few chemicals that include:
A) oxygen.
B) protein.
C) glutamate.
D) potassium.

Answer 26

ANS. A

Question 27

2-07. The perception of where a stimulus is in space and in relation to body parts is a
function of the:
A) occipital lobe.
B) parietal lobe.
C) hypothalamus.
D) prefrontal cortex.

Answer 27

ANS. B

Question 28

2-08. The pia mater is a connective tissue sheath that covers the spinal cord and also
contains:
A) spinal fluid.
B) fibrocartilage.
C) blood vessels.
D) segmental nerves.

Answer 28

ANS. B

Question 29

2-09. Which of the following is the neurotransmitter for most postganglion
sympathetic neurons?
A) Enkephalin
B) Glutamic acid
C) Catecholamines
D) Acetylcholine

Answer 29

ANS. C

Question 30

2-10. In contrast to the sympathetic nervous system, the functions of the
parasympathetic nervous system include:
A) sweating.
B) anabolism.
C) pupil dilation.
D) vasoconstriction.

Answer 30

ANS. B

Question 31

2-11. Which of the following substances provides the majority of the fuel needs of
the neurologic system?
A) Glycogen
B) Glucose
C) Amino acids
D) Triglycerides

Answer 31

ANS. B

Question 32

2-12. A 60-year-old woman has been recently diagnosed with multiple sclerosis, a
disease in which the oligodendrocytes of the patients central nervous system
(CNS) are progressively destroyed. Which physiologic process within the
neurologic system is most likely be affected by this disease process?
A) Oxygen metabolism
B) Neurotransmitter synthesis
C) Nerve conduction
D) Production of cerebrospinal fluid

Answer 32

ANS. C

Question 33

2-13. A neuron has been hyperpolarized. How will this affect the excitability of
the neuron?
A) The neuron will have a membrane potential farther from the threshold.
B) The neuron will be more difficult to repolarize after firing.
C) The membrane potential of the neuron will be closer to the threshold.
D) The neurons excitability will be significantly increased.

Answer 33

ANS. A

Question 34

2-14. A pregnant woman’s most recent ultrasound is suggestive of spina bifida, and
her primary care provider has subsequently order further diagnostic testing.
The pathophysiologic effects of this disease are due to:
A) malformation of the mesoderm.
B) abnormal closure of the neural tube.
C) lesions in the dorsal root ganglia.
D) hypertrophy of the primary vesicles.

Answer 34

ANS. B

Question 35

2-15. Which of the following messages is most likely to be carried by general
somatic afferent (GSA) neurons?
A) The sensation of cold when touching ice
B) The message to move a finger and thumb
C) The message to move the larynx during speech
D) Information about the position of a joint

Answer 35

ANS. A

Question 36

2-16. Which of the following processes is most likely to occur as a result of a
spinal reflex?
A) Peristalsis of the small and large bowel
B) Control of oculomotor function in changing light levels
C) Pain sensation from a potentially damaging knee movement
D) Withdrawal of a hand from a hot stove element

Answer 36

ANS. D

Question 37

2-17. A patient has required mechanical ventilation following a traumatic head
injury sustained in a motorcycle crash, during which he sustained damage to
his respiratory center. Which of the patients brain structures has been injured?
A) Brain stem
B) Midbrain
C) Diencephalon
D) Frontal lobe

Answer 37

ANS. A

Question 38

2-18. A patient with a diagnosis of epilepsy has required surgical removal of part of
her prefrontal cortex. Which of the following effects should her family and
care team anticipate?
A) Lapses in balance and coordination
B) Deficits in regulation of the endocrine system
C) Sensory losses
D) Changes in behavior and judgment

Answer 38

ANS. D

Question 39

2-19. A patients primary care provider has prescribed a b-adrenergic receptor
blocker. Which of the following therapeutic effects do the patient and care
provider likely seek?
A) Reduction in heart rate and blood pressure
B) Slowing of gastrointestinal motility
C) Increase in mental acuity
D) Decreased production of gastric acid

Answer 39

ANS. A

Question 40

2-20. Neurotrophic factors contribute to the maintenance of homeostasis in which
of the following ways?
A) By catalyzing the effects of neurotransmitters
B) By increasing the sensitivity of receptors on postsynaptic cells
C) By promoting the growth and survival of neurons
D) By selectively increasing or decreasing the release of neurotransmitters

Answer 40

ANS. C