Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications 4th Edition Test Bank

Preview (31 of 121 Pages)

100%

Purchase to unlock

Loading page image...

Stahl's Essential PsychopharmacologyNeuroscientific Basis and Practical ApplicationsTESTBANK/STUDY GUIDEChapter 1 Chemical neurotransmissionMULTIPLECHOICE1.Apatientwithdepressionmentionstothenurse,Mymothersaysdepressionisachemicaldisorder.Whatdoesshemean?Thenursesresponseisbasedonthetheorythatdepressionprimarilyinvolveswhichofthefollowingneurotransmitters?a.CortisolandGABAb.COMTandglutamatec.Monamineandglycined.SerotoninandnorepinephrineANS:DOnepossiblecauseofdepressionisthoughttoinvolveoneormoreneurotransmitters.Serotoninandnorepinephrinehavebeenfoundtobeimportantintheregulationofdepression.Thereisnoresearchtosupportthattheotheroptionsplayasignificantroleinthedevelopmentofdepression.2.Apatienthasexperiencedastroke(cerebralvascularaccident)thathasresultedindamagetotheBrocaarea.Whichevaluationdoesthenurseconducttoreinforcethisdiagnosis?a.Observingthepatientpickupaspoonb.Askingthepatienttorecitethealphabetc.Monitoringthepatientsbloodpressured.ComparingthepatientsgripstrengthinbothhandsANS:BAccidentsorstrokesthatdamageBrocasareamayresultintheinabilitytospeak(i.e.,motoraphasia).Finemotorskills,bloodpressurecontrol,andmusclestrengtharenotcontrolledbytheBrocaareaoftheleftfrontallobe.3.Thepatientdiagnosedwithschizophreniaaskswhypsychotropicmedicationsarealwaysprescribedbythedoctor.Thenursesanswerwillbebasedoninformationthatthetherapeuticactionofpsychotropicdrugsistheresultoftheireffecton:a.Thetemporallobe;especiallyWernickesareab.Dendritesandtheirabilitytotransmitelectricalimpulsesc.Theregulationofneurotransmittersespeciallydopamined.Theperipheralnervoussystemsensitivitytothepsychotropicmedications

Loading page image...

ANS:CMedicationsusedtotreatpsychiatricdisordersoperateinandaroundthesynapticcleftandhaveactionattheneurotransmitterlevel,especiallyinthecaseofschizophrenia,ondopamine.TheWernickesarea,dendritefunction,orthesensitivityoftheperipheralnervoussystemarenotrelevanttoeitherschizophreniaorpsychotropicmedications.4.Astudentnursemuttersthatitseemsentirelyunnecessarytohavetostrugglewithunderstandingtheanatomyandphysiologyoftheneurologicsystem.Thementorwouldbasearesponseontheunderstandingthatitis:a.Necessarybutgenerallyforpsychiatricnurseswhofocusprimarilyonbehavioralinterventionsb.Acomplexundertakingthatadvancepracticepsychiatricnursesfrequentlyuseintheirpracticec.Importantprimarilyforthenursingassessmentofpatientswithbraintraumacausedcognitivesymptomsd.NecessaryforplanningpsychiatriccareforallpatientsespeciallythoseexperiencingpsychiatricdisordersANS:DNursesmustunderstandthatmanysymptomsofpsychiatricdisordershaveaneurologicbasis,althoughthesymptomsaremanifestedbehaviorally.Thisunderstandingfacilitateseffectivecareplanning.Thefoundationofknowledgeisnotusedexclusivelybyadvancedpracticepsychiatricnursesnorisitrelevantforonlybehaviortherapiesorbraintraumasincedealingwiththeresultsofnormalandabnormalbrainfunctionisaresponsibilityofallnursesprovidingalltypesofcaretothepsychiatricpatient.5.Apatientasksthenurse,Mywifehasbreastcancer.Coulditbecausedbyherchronicdepression?Whichresponseissupportedbyresearchdata?a.Toomuchstresshasbeenproventocauseallkindsofcancer.b.Therehavebeennoresearchstudiesdoneonstressanddiseaseyet.c.Stressdoescausethereleaseoffactorsthatsuppresstheimmunesystem.d.ThereappearstobelittleconnectionbetweenstressanddiseasesofthebodyANS:CResearchindicatesthatstresscausesareleaseofcorticotropin-releasingfactorsthatsuppresstheimmunesystem.Studiesindicatethatpsychiatricdisorderssuchasmooddisordersaresometimesassociatedwithdecreasedfunctioningoftheimmunesystem.Researchdoesnotsupportaconnectionbetweenmanycancersandstress.Thereisasignificantamountofresearchaboutstressandthebody.Researchhasshownthattherearesomeconnectionsbetweenstressandphysicaldisease.

Loading page image...

6.Apatientwhohasaparietallobeinjuryisbeingevaluatedforpsychiatricrehabilitationneeds.Oftheaspectsoffunctioninglisted,whichwillthenurseidentifyasafocusofnursingintervention?a.Expressionofemotionb.Detectingauditorystimulic.Receivingvisualimagesd.ProcessingassociationsANS:DTheparietallobeisresponsibleforassociatingandprocessingsensoryinformationthatallowsforfunctionssuchasfollowingdirectionsonamap,readingaclock,dressingself,keepingappointments,anddistinguishingrightfromleft.Emotionalexpressionisassociatedwithfrontallobefunction.Detectingauditorystimuliisatemporallobefunction.Receivingvisualimagesisrelatedtooccipitallobefunction.7.Atadmission,thenurselearnsthatsometimeagothepatienthadaninfarctintherightcerebralcortex.Duringassessment,thenursewouldexpecttofindthatthepatient:a.Demonstratesmajordeficienciesinspeechb.Isunabletoeffectivelyholdaspooninthelefthandc.Hasdifficultyexplaininghowtogoaboutusingthetelephoned.CannotusehisrighthandtoshavehimselforcombhisownhairANS:BThecerebralhemispheresareresponsibleforfunctionssuchascontrolofmuscles.Therighthemispheremainlycontrolsthemotorandsensoryfunctionsontheleftsideofthebody.Damagetotherightsidewouldresultinimpairedfunctionontheleftsideofthebody.Themotorcortexcontrolsvoluntarymotoractivity.Brocasareacontrolsmotorspeech.Cognitivefunctionsareattributedtotheassociationcortex.Therightsideofthebodysmotoractivityiscontrolledbytheleftcerebralcortex.8.Apatientwithchronicschizophreniahadastrokeinvolvingthehippocampus.Thepatientwillbedischargedonlowdosesofhaloperidol.Thenursewillneedtoindividualizethepatientsmedicationteachingby:a.Includingthepatientscaregiverintheeducationb.Beingcarefultostresstheimportanceoftakingthemedicationasprescribedc.Providingtheeducationatatimewhenthepatientisemotionallycalmandrelaxedd.EncouragingthepatienttocrushordissolvethemedicationtohelpwithswallowingANS:A

Loading page image...

Thehippocampusplaysamajorroleinshort-termmemoryand,hence,inlearning.Takingthemedicationasprescribedandprovidingtheeducationatatimewhenthepatientiscalmandrelaxedisinformationorconsiderationsthatallpatientsshouldbegiven.Themedicationdoesnotnecessarilyneedtobecrushedordissolvedsincethestrokewouldnothavecauseddifficultywithswallowing.9.Thephysiciantellsthenurse,ThemedicationImprescribingforthepatientenhancestheg-aminobutyricacid(GABA)system.Whichpatientbehaviorwillprovideevidencethatthemedicationtherapyissuccessful?a.Thepatientisactivelyinvolvedinplayingcardswithotherpatients.b.Thepatientreportsthat,IdontfeelasanxiousasIdidacoupleofdaysago.c.Thepatientreportsthatbothauditoryandvisualhallucinationshavedecreased.d.Thepatientsaysthat,IammuchhappierthanbeforeIcametothehospital.ANS:BGABAistheprincipleinhibitoryneurotransmitter.Themedicationshouldprovideanantianxietyeffect.Alertness,psychoticbehaviors,andmoodelevationarenotgenerallyaffectedbyg-aminobutyricacid.10.ThepatientsfamilyaskswhetheradiagnosisofParkinsonsdiseasecreatesanincreasedriskforanymentalhealthissues.Whatquestionwouldthenurseasktoassessforsuchacomorbidcondition?a.Hasyourfatherexhibitedanysignsofdepression?b.Doesyourfatherseemtoexperiencemoodswings?c.Haveyounoticedyourfathertalkingaboutseeingthingsyoucantsee?d.Isyourdadpreoccupiedwithbehaviorsthatheneedstorepeatoverandover?ANS:ASerotoninanditsclosechemicalrelatives,dopamineandnorepinephrine,aretheneurotransmittersthataremostwidelyinvolvedinvariousformsofdepression.MostresearchersagreethattheimmediatecauseofparkinsonismisadeficiencyofdopamineandsoapatientwithParkinsonsdiseaseshouldbemonitoredfordepression,Theothermentalhealthdisorders(bipolardisorder,hallucinations,andobsessivecompulsivedisorder)havenotbeenconnectedtoParkinsonsdisease.11.Whichexplanationfortheprescriptionofdonepezil(Aricept)wouldthenurseprovideforapatientintheearlystageofAlzheimersdisease?a.ItwillincreasethemetabolismofexcessGABA.b.Excessdopaminewillbepreventedfromattachingtoreceptorsites.c.Serotonindeficiencywillbemanagedthroughaprolongedreuptakeperiod.d.Theacetylcholinedeficiencywillbemanagedbyinhibitingcholinesterase.ANS:D

Loading page image...

DecreasedlevelsofacetylcholinearethoughttoproducemanyofthebehavioralsymptomsofAlzheimersdisease.Theinhibitingactionthedrughasoncholinesterasewillslowdownthebreakdownofacetylcholineandsodelaytheonsetofsymptoms.Theotherneurotransmitters(GABA,dopamine,andserotonin)arenotcurrentlybelievedtoplayaroleinAlzheimersdisease.12.Thereremainsastigmaattachedtopsychiatricillnesses.Thepsychiatricnursemakesthegreatestimpactonthissociologicalproblemwhen:a.Providingeducationalprogrammingforpatientsandthepublicb.Arrangingforadequateandappropriatesocialsupportforthepatientc.Assistingthepatienttoachievethemaximumlevelofindependentfunctioningd.RegularlypraisingthepatientforseekingandcomplyingwithappropriatetreatmentANS:AMuchofthestigmaattachedtopsychiatricillnessisduetoalackofunderstandingofthebiologicbasisofthesedisorders.Therefore,effectivepatient,family,andpublicteachingisanimportantfunctionoftheroleofthepsychiatricmentalhealthnurse.Whiletheremainingoptionsareappropriate,theyarenotdirectedtowardseliminatingsocialstigmabutratherempoweringthepatient.13.Thewifeofapatientwithparanoidschizophreniatellsthenurse,Ivelearnedthatmyhusbandhasseveralcloserelativeswiththesamedisorder.Doesthisproblemruninfamilies?Theresponsebasedonrecentdiscoveriesinthefieldofgeneticswouldbe:a.Yourchildrenshouldbemonitoredcloselyforthedisorder.b.Researchtendstosupportafamiliartendencytoschizophrenia.c.Thereisnoconcreteevidence;itisjustaslikelyacoincidence.d.Onlybipolardisorderhasbeenidentifiedtohaveageneticcomponent.ANS:BFamilialtendenciesappearwithseveralpsychiatricdisordersincludingschizophrenia.Toinsinuatethatthechildrenareatsuchriskwouldnotbesupportedbyresearch.14.Apatientwhosesymptomsofmilddepressionhavebeenmanagedwithantidepressantsisconcernedabouttheaffectofacceptingapromotionthatwillrequireworkingthenightshift.Whatwillbethebasisoftheresponsethenursegivestoaddressthepatientsconcern?a.Theconnectionbetweenanewjobandpossibledepressiondoesexist.b.Themedicationcanbeadjustedtomanageanyincreaseindepression.c.Theinterruptioninnormalwake-sleeppatternscaninfluencemooddisorders.

Loading page image...

d.Thechangeinsleeproutinecanbemanagedwithahealthysleephygieneroutine.ANS:CManypsychiatricandmedicaldisordersoccurmorefrequentlyorareexacerbatedwhensleeppatternsandbiologicrhythmsaredisrupted.Whiletheremainingoptionscontaintrueinformationregardingthemanagementofdepressionthatisaresultofsleepdisruption,theydonoteffectivelyaddressthepatientsconcern.15.Thenurseisdiscouragedbecausethepatientexhibitingnegativesymptomsofschizophreniahasshownnoimprovementwiththeplannedinterventionstoreducethesymptoms.Thementorsremarkthathelpsplacetheprobleminperspectiveis:a.Youarentresponsibleforthebehaviorofanyotherperson.b.Patientscanbeperverseandclingtosymptomsdespiteourefforts.c.Negativesymptomshavebeenassociatedwithgeneticpathology.d.Itwilltakeseveraltrailanderrorattemptstogettherightcombinationcare.ANS:CAcomplexdisorder,suchasschizophrenia,mostlikelyhasmultiplecontributingfactors,includinggeneticpredisposition,prenataldevelopment,andtheenvironment.Nursefrustrationcanbealleviatedbyhelpingthenurserealizethatnegativesymptomsmaybetheresultofactualbraindysfunction,ratherthanpsychologicallydeterminedbehaviors;thustheremainingoptionsarenotappropriatesincetheydonotaddressthecomplexityoftheproblem.MULTIPLERESPONSE1.Whatassessmentdatawouldreinforcethediagnosisoftemporallobeinjuryinpatientwhoexperiencedheadtrauma?Selectallthatapply.a.Inabilitytobalanceacheckbookb.Uncharacteristicallyaggressivec.Affectfluctuatesdramaticallyd.Increasedinterestinsexualbehaviorse.DifficultyrememberingthenamesoffamilymembersANS:C,D,EThetemporallobeisinvolvedwithmemoryaswellasincreasedsexualfocusandalteredemotionalresponses.Personalityandintellectualfunctionisnotcenteredinthetemporallobe.2.Apatienthasbegunexperiencingdysfunctionofthehypothalamus.Whatnursinginterventionswillthenurseincludeinthepatientsplanofcare?Selectallthatapply.a.Reinforcingclearphysicalboundariesb.Assistingthepatientwithcompletingdailymenus

Loading page image...

c.Learningabouthealthysleephygienehabitsd.Monitoringandrecordingtemperatureevery4hourse.Monitoringandrecordingbloodpressureevery4hoursANS:B,C,DThehypothalamusisresponsibleforregulationofsleep-restpatterns,bodytemperature,andphysicaldrivesofhunger.Socialappropriatenessandbloodpressureisnotcontrolledbythehypothalamus.3.Thenurseispreparingapatientforapositronemissiontomography(PET)scan.Whichinstructionswillthenurseinclude?Selectallthatapply.a.Therewilllikelybea30to45minutewaitbetweentheinjectionandthebeginningofthescan.b.Ablindfoldandearplugsmaybeusedtohelpdecreasereactiontotheenvironmentduringthescan.c.Makeeveryattempttoliestillduringthescanbecausemovementwillaffecttheimagingproduced.d.Nofoodorfluidsaretobeingestedforatleast8fullhoursbeforethescanandnoneduringthescan.e.Stayingawakeduringthescanisimportantsincetheresultsarealteredwhenthepatientisinanyphaseofthesleepstate.ANS:A,B,C,EAppropriatepatientpreparationforaPETscanwouldincludeinformationregardingthetimeintervalbetweeninjectionoftheisotopeandtheactualscan,thefactthatstepswillbetakentominimizetheeffectsofsightsandsoundsduringthescan,lyingstilliscriticaltoachievingaqualityimage,andthatbeingasleepduringthescanwillaltertheresults.Itisnotnecessarytofastbeforeorduringthescan.4.Apatientwithschizophreniaisdescribedashavingdifficultywithexecutivefunctions.Whatpatientdysfunctioncanthenurseexpecttoassessbehaviorally?Selectallthatapply.a.Invadesthepersonalspaceofothersfrequentlyb.Consistentlyfailstobringmoneywhengoingtobuysnacksc.Cannotrememberthenamesofstaffwhooftenprovidecared.Requiresrepeatedreinforcementonhowtomakeasandwiche.FrequentlyspeaksofhurtinghimselforofhurtingotherpatientsANS:A,B,DExecutivefunctionsincludereasoning,planning,prioritizing,sequencingbehavior,insight,flexibility,judgment,focusingontasks,respondingtosocialcues,andattendinginappropriatewaystoincomingstimuli.Memoryisnotconsideredan

Loading page image...

executivefunctionandriskforharmtoselfandothersisnotgenerallyadiagnosisappropriateforsuchapatient.5.Theunitphysicianshaveorderedmagneticresonanceimaging(MRI)testsforthefollowingpatients.Forwhichpatientswouldthenursedeclinetomaketestarrangementswithoutfurtherdiscussionwiththephysician?Selectallthatapply.a.Apatientwhoisclaustrophobicb.Apatientwhoisbreastfeedingc.Apatientwhohasanallergytoiodined.Apatientwhohadatotalkneereplacemente.ApatientwhoistakinganeurolepticmedicationANS:A,DPatientswithclaustrophobiaareoftenunabletocompletethistypeofstudy,becausetheMRImachineisenclosed,andpatientsarerequiredtoremainmotionless.MetalimplantsarecontraindicationsforMRIssincemetalaffectsthescan.Breastfeeding,iodinesensitivity,andneurolepticmedicationtherapyarenotcontraindicationsforanMRI.

Loading page image...

Chapter 2 Transporters, receptors, and enzymes as targets of psychopharmacologicaldrug action1.Thesomaticnervoussystemprovidessensoryandmotorinnervationfor:A)peripheralnerves.B)abdominalviscera.C)secretoryglands.D)smoothmuscle.2.ANS.ATheproteinsandothermaterialsusedbytheaxonaresynthesized_____andthenflowdowntheaxonthroughitscytoplasm.A)inthecellbodyB)byNisslbodiesC)throughdendritesD)acrosssynapses3.ANS.ASupportingcellsofthenervoussystem,suchasSchwanncells,satellitecells,andtypesofglialcells,functiontoprovideneuronswith:A)localprotection.B)controlfunctions.C)membranepermeability.D)integrativemetabolism.4.ANS.ANeuronsarecharacterizedbytheabilitytocommunicatewithotherneuronsandbodycellsthrough:A)astrocytes.B)axonhillocks.C)nodesofRanvier.D)actionpotentials.ANS.D

Loading page image...

5.Chemicalsynapsesrelyon____inordertoprovidecommunicationbetweenneurons.A)diffusionB)gapjunctionsC)satellitecellsD)transmittermolecules6.ANS.DTheblood-brainandCSF-brainbarrierscontrolthechemicalenvironmentofthebrainbyallowingeasyentrancetoonlyafewchemicalsthatinclude:A)oxygen.B)protein.C)glutamate.D)potassium.7.ANS.ATheperceptionofwhereastimulusisinspaceandinrelationtobodypartsisafunctionofthe:A)occipitallobe.B)parietallobe.C)hypothalamus.D)prefrontalcortex.8.ANS.BThepiamaterisaconnectivetissuesheaththatcoversthespinalcordandalsocontains:A)spinalfluid.B)fibrocartilage.C)bloodvessels.D)segmentalnerves.ANS.B

Loading page image...

9.Whichofthefollowingistheneurotransmitterformostpostganglionsympatheticneurons?A)EnkephalinB)GlutamicacidC)CatecholaminesD)Acetylcholine10.ANS.CIncontrasttothesympatheticnervoussystem,thefunctionsoftheparasympatheticnervoussysteminclude:A)sweating.B)anabolism.C)pupildilation.D)vasoconstriction.11.ANS.BWhichofthefollowingsubstancesprovidesthemajorityofthefuelneedsoftheneurologicsystem?A)GlycogenB)GlucoseC)AminoacidsD)Triglycerides12.ANS.BA60-year-oldwomanhasbeenrecentlydiagnosedwithmultiplesclerosis,adiseaseinwhichtheoligodendrocytesofthepatientscentralnervoussystem(CNS)areprogressivelydestroyed.Whichphysiologicprocesswithintheneurologicsystemismostlikelybeaffectedbythisdiseaseprocess?A)OxygenmetabolismB)NeurotransmittersynthesisC)NerveconductionD)Productionofcerebrospinalfluid

Loading page image...

ANS.C13.Aneuronhasbeenhyperpolarized.Howwillthisaffecttheexcitabilityoftheneuron?A)Theneuronwillhaveamembranepotentialfartherfromthethreshold.B)Theneuronwillbemoredifficulttorepolarizeafterfiring.C)Themembranepotentialoftheneuronwillbeclosertothethreshold.D)Theneuronsexcitabilitywillbesignificantlyincreased.14.ANS.AApregnantwomansmostrecentultrasoundissuggestiveofspinabifida,andherprimarycareproviderhassubsequentlyorderfurtherdiagnostictesting.Thepathophysiologiceffectsofthisdiseasearedueto:A)malformationofthemesoderm.B)abnormalclosureoftheneuraltube.C)lesionsinthedorsalrootganglia.D)hypertrophyoftheprimaryvesicles.15.ANS.BWhichofthefollowingmessagesismostlikelytobecarriedbygeneralsomaticafferent(GSA)neurons?A)ThesensationofcoldwhentouchingiceB)ThemessagetomoveafingerandthumbC)ThemessagetomovethelarynxduringspeechD)Informationaboutthepositionofajoint16.ANS.AWhichofthefollowingprocessesismostlikelytooccurasaresultofaspinalreflex?A)PeristalsisofthesmallandlargebowelB)ControlofoculomotorfunctioninchanginglightlevelsC)PainsensationfromapotentiallydamagingkneemovementD)Withdrawalofahandfromahotstoveelement

Loading page image...

ANS.D17.Apatienthasrequiredmechanicalventilationfollowingatraumaticheadinjurysustainedinamotorcyclecrash,duringwhichhesustaineddamagetohisrespiratorycenter.Whichofthepatientsbrainstructureshasbeeninjured?A)BrainstemB)MidbrainC)DiencephalonD)Frontallobe18.ANS.AApatientwithadiagnosisofepilepsyhasrequiredsurgicalremovalofpartofherprefrontalcortex.Whichofthefollowingeffectsshouldherfamilyandcareteamanticipate?A)LapsesinbalanceandcoordinationB)DeficitsinregulationoftheendocrinesystemC)SensorylossesD)Changesinbehaviorandjudgment19.ANS.DApatientsprimarycareproviderhasprescribedab-adrenergicreceptorblocker.Whichofthefollowingtherapeuticeffectsdothepatientandcareproviderlikelyseek?A)ReductioninheartrateandbloodpressureB)SlowingofgastrointestinalmotilityC)IncreaseinmentalacuityD)Decreasedproductionofgastricacid20.ANS.ANeurotrophicfactorscontributetothemaintenanceofhomeostasisinwhichofthefollowingways?A)BycatalyzingtheeffectsofneurotransmittersB)ByincreasingthesensitivityofreceptorsonpostsynapticcellsC)BypromotingthegrowthandsurvivalofneuronsD)ByselectivelyincreasingordecreasingthereleaseofneurotransmittersANS.C

Loading page image...

Chapter 3Ion channels as targets of psychopharmacological drug action1.Anurseisteachingamedicationclasstoagroupofpsychiatricpatients.Oneofthemasksthenursewhyhehassomuchmoretroublelearningnowwhenhesinhis60sthanhedidwhenhewasyounger.Whichofthefollowingconceptswouldthenurseintegrateintotheresponse?A)TheextrapyramidalmotorsystemB)TheamygdalaC)NeuroplasticityD)Psychoneuroimmunology2.ANS.CWhichofthefollowingwouldanursinginstructoridentifywhendescribingtheareaofthebraininvolvedwithverballanguagefunction,includingareasforbothreceptiveandexpressivespeech?A)RighthemisphereB)ParietallobeC)OccipitallobeD)Lefthemisphere3.ANS.DAnurseisdevelopingaplanofcareforapatientexperiencingexpressiveaphasia.Thenurseincorporatesknowledgethatthepatientmostlikelyhassustaineddamagetowhichofthefollowing?A)ThepostcentralgyrusB)BrocasareaC)BasalgangliaD)Thehippocampus4.ANS.BThenurseiscaringforanolderadultwhohasexperienceddamagetothefrontallobeafteranautomobileaccident.Thenurseanticipatesthatthepatientwillhavedifficultywithwhichofthefollowing?A)Smell

Loading page image...

B)ConceptformationC)ReceptivespeechD)Hearing5.ANS.BThenurseiscaringforapatientwhohasexperienceddamagetotheparietallobesofthebrain.Thenurseanticipatesthatthepatientwithhavedifficultywithwhichofthefollowing?A)PerceivingsensoryinputB)CalculatingamathproblemC)SeeingobjectsinfrontofhimD)Speakingfluently6.ANS.BApatienthasbeendiagnosedwithmemorydysfunctionassociatedwithAlzheimersdisease.Thenursedeterminesthatdamagetothepatientsbrainincludesdeteriorationoftemporallobestructuresandthenervesofwhichofthefollowing?A)BasalgangliaB)LimbicsystemC)FrontallobeD)Hippocampus7.ANS.DThenurseiscaringforahospitalizedpatientwhohasadisorderofthehypothalamus.Whendevelopingthepatientsplanofcare,inwhichofthefollowingareaswouldthenurseanticipateaproblem?A)SleepB)ConstipationC)Speech

Loading page image...

D)Motoractivity8.ANS.AApatientwhoisscheduledtoundergoasleepdeprivationelectroencephalogram(EEG)inthemorningisexperiencingmoderateanxietyabouttheprocedure.Basedonanunderstandingofthistest,whichofthefollowingwouldthenurseavoid?A)ExplainingindepthwhattoexpectduringtheupcomingprocedureB)AdministeringabenzodiazepinemedicationprescribedforanxietyC)TakingathoroughhistoryofheruseofprescribedandillicitdrugsD)Givingheranoncaffeinatedbeverageofherchoice9.ANS.BAnursinginstructorasksastudenttoexplaintheinfluenceofchronobiologyondepression.Whichofthefollowingwouldthestudentincludewhenresponding?A)Theexactlocationofgenesleadstoidentifyingthegeneresponsibleforcausingdepression.B)Abreakinthecorpuscoliseumblocksinformationexchangebetweentherightandlefthemispheres.C)Damagetotheposteriorareasoftheparietallobeleadstoaltereddiscriminativesensoryfunction.D)Internalandexternaltriggerscanelicitbiologicrhythmchangesindicativeofclinicaldepression.10.ANS.DWhendescribingthevariousneurotransmitters,whichofthefollowingwouldthenurseidentifyastheprimarycholinergicneurotransmitter?A)DopamineB)AcetylcholineC)Norepinephrine

Loading page image...

D)Serotonin11.ANS.BAgroupofnursingstudentsarereviewingthevariousneurotransmitters.Thestudentsdemonstrateunderstandingwhentheyidentifywhichofthefollowingasaneuropeptide?A)MelatoninB)SerotoninC)GlutamateD)Gamma-aminobutyricacid12.ANS.AThenurseisassessingapatientexperiencinganxietyandobservesincreasedsweatingandgooseflesh.Thenurseunderstandsthatthesearetheresultofwhichsubstance?A)AcetylcholineB)NorepinephrineC)SerotoninD)Histamine13.ANS.BAnurseisdevelopingaplanofcareforapatientdiagnosedwithschizophrenia.Thenurseintegratesknowledgeofthisdisorder,identifyingwhichneurotransmitterasbeingprimarilyinvolved?A)AcetylcholineB)DopamineC)NorepinephrineD)SerotoninANS.B

Loading page image...

14.Agroupofstudentsarereviewinginformationaboutneurotransmittersubtypes.Thegroupdemonstratesunderstandingoftheinformationwhentheyidentifywhichneurotransmitterashavingmuscarinicandnicotinicreceptors?A)SerotoninB)Gamma-aminobutyricacid(GABA)C)DopamineD)Acetylcholine15.ANS.DAnurseisinvolvedingatheringinformationabouttheinheritanceofmentaldisordersusingpopulationgenetics.Whichofthefollowingwouldthenursebeleastlikelytobeevaluating?A)ConcordanceratesB)Occurrenceinfirst-degreerelativesC)RiskfactoranalysisD)Adoptionsstudies16.ANS.CAnurseisreadingajournalarticleaboutpsychoneuroimmunology.Whichinformationwouldthenursemostlikelyfind?Selectallthatapply.A)NeurotoxinsroleinreceptorsitedamageB)HypothalamicpituitarythyroidaxisdisruptionC)StaticactivityofnaturalkillercellsinresponsetostressD)HypothalamicdamageleadingtoimmunedysfunctionE)Interruptioninthetypicalcircadianrhythmcycle17.ANS.A,B,DApatientisscheduledforachallengetest.Whichofthefollowingwouldthenurseincludewhenexplainingthistesttothepatient?A)IntravenousadministrationofasubstancetoinducesymptomsB)Applicationofelectrodestothescalpformonitoring

Loading page image...

C)EvaluationelectricalimpulsesrecordedongraphpaperD)Exposuretoaflashingstrobelighttoelicitabnormalactivity18.ANS.AApatientwithdepressiontellsthenursethatheistohaveatestthatinvolvestherecordingofanelectroencephalogram(EEG)throughoutthenight.Thenursemostlikelyidentifiesthistestingaswhichofthefollowing?A)SleepdeprivationEEGB)PolysomnographyC)EvokedpotentialsD)Functionalmagneticresonanceimaging19.ANS.BAgroupofnursingstudentsarereviewingtheroleofserotonininpsychiatricdisorders.Thestudentsdemonstrateaneedforadditionalstudywhentheyidentifywhichdisorderasbeingassociatedwithitsdysfunction?A)DepressionB)Obsessive-compulsivedisorderC)PanicdisorderD)Schizophrenia20.ANS.DWhendescribingneuronaltransmission,aninstructordescribestheareawheretheelectricalintracellularsignalbecomesachemicalone.Theinstructorisdescribingwhichofthefollowing?A)SomaB)SynapticcleftC)TerminalD)ReceptorsiteANS.BChapter 4Psychosis and schizophrenia

Loading page image...

MULTIPLECHOICE1.Anewlyadmittedpatienthasthediagnosisofcatatonicschizophrenia.Whichbehaviorobservedinthepatientsupportsthatdiagnosis?a.Usesarhymingformofspeechb.Refusestoeatanyunwrappedfoodsc.Laughswhenwatchingasadmovied.MaintainsanimmobilizedstateforhoursANS:DCatatonicschizophreniaischaracterizedbyextremesofpsychomotoractivityrangingfromfrenziedbehaviortoimmobilizationandmayincludeechopraxiaandposturing.Paranoidthinkingischaracteristicofparanoidschizophrenia.Inappropriateaffectandclangingareseenindisorganizedschizophrenia.2.Whatwouldbeanappropriateshort-termoutcomeforapatientdiagnosedwithresidualschizophreniawhoexhibitsambivalence?a.Decidetheirowndailyschedule.b.Decidewhichunitgroupstheywillattend.c.Choosewhichclinicstaffmembertoworkwith.d.Choosebetweentwooutfitstoweareachmorning.ANS:DAnearlystepwouldbetomakechoicesaboutnonthreateningmatterswhenpresentedwithlimitedalternatives.Theremainingoptionsrepresentdecisionsthataretoocomplicatedforthepatienttomakeinitially.3.Whatistheprioritynursingdiagnosisforacatatonicpatient?a.Ineffectivecopingb.Impairedphysicalmobilityc.Impairedsocialinteractiond.RiskfordeficientfluidvolumeANS:DThehighestpriorityforthepatientismaintenanceofbasicphysiologicneeds,suchashydration.Mobilityisoflesserphysiologicalimportancethanfluidvolume.Theremainingoptionsdonothavepriorityoveraphysiologicalneed.4.WhichnursingdiagnosisisappropriateforapatientwhoinsistsbeingcalledYourHighnessanddemonstrateslooselyassociatedthoughts?a.Riskforviolenceb.Defensivecopingc.Impairedmemory

Loading page image...

d.DisturbedthoughtprocessesANS:DDelusionsandlooseassociationssuggestdisturbedthoughtprocesses.Theotheroptionsarenotsupportedbydatainthescenario.5.Whichinitialshort-termoutcomewouldbeappropriateforapatientwhowasadmittedexpressingdelusionalthoughts?a.Acceptthatdelusionisillogical.b.Distinguishexternalboundaries.c.Explainthebasisforthedelusions.d.Engageinreality-orientedconversation.ANS:DDelusionsarenotrealityoriented;thusanappropriateoutcomewouldbethatpatientwillengageinreality-orientedconversationratherthandiscussingdelusionalbeliefs.Delusionsarefixed,falsebeliefs.Patientsrarelyacceptanyoneusinglogictodisputethem.Dataarenotpresenttosuggestboundarydisturbance.Explainingthedelusionisnotprogress;itsuggeststhepatientstillholdstothebelief.6.Whichofthefollowinginterventionsshouldthenurseplantousetoreducepatientfocusondelusionalthinking?a.Confrontingthedelusionb.Refutingthedelusionwithlogicc.Exploringreasonsthepatienthasthedelusiond.FocusingonfeelingssuggestedbythedelusionANS:DFocusingonfeelingssuggestedbythedelusionwillhelpmeetpatientneedsandhelpthepatientstaybasedinreality.Thistechniquefostersrapportandtrustwhilediscouragingthebeliefwithoutchallengingorrefutingit.7.Whichassessmentobservationsupportsapatientsdiagnosisofdisorganizedschizophrenia?a.Reportssuicidalideationsb.Lastrelapsewas6yearsagoc.Consistentinappropriatelaughingd.BelievesthatthegovernmentisouttogetmeANS:CThepresenceofdisorganizationandinappropriateaffectidentifiesthisdisorderasdisorganizedschizophrenia.Thesymptomsofresidualschizophreniahavelongperiodsofremission.Schizoaffectivedisorderpresentswithseveremooddisorders

Loading page image...

alongwithsymptomsofschizophrenia.Paranoidschizophreniaischaracterizedbypersecutoryorgrandiosedelusions.8.Apatienttriedtogougeouthiseyeinresponsetoauditoryhallucinationscommanding,Ifthineeyeoffendsthee,pluckitout.Thenursewouldanalyzethisbehaviorasindicating:a.Derealizationb.Inappropriateaffectc.Impairedimpulsecontrold.InabilitytomanageangerANS:CCommandhallucinationsmaybesointensethatthepatientcannotcontroltheimpulsetodowhatthehallucinationtellshimtodo;thusthepatienthasimpairedimpulsecontrol.Thisisnotanangermanagementproblem.Derealizationisafeelingthattheenvironmentisdistortedorunrealandnotsuggestedinthescenario.Noevidenceofinappropriateaffectisgiven.9.Anappropriateinterventionforapatientwithanidentifiednursingdiagnosisofsituationallowself-esteemwouldbe:a.Providinglargemuscleactivitiestorelievestressb.Attemptingtodeterminetriggerstohallucinationsc.Engagingpatientinactivitiesdesignedtopermitsuccessd.EncouragingverbalizationoffeelingsinasafeenvironmentANS:CAllareusefulinterventionsforapatientwithschizophrenia;however,engagingthepatientinspecificallydesignedactivitiesistheonlyoptionthataddressesimprovingself-esteem.10.A19-year-oldpatientisadmittedforthesecondtimein9monthsandisacutelypsychoticwithadiagnosisofundifferentiatedschizophrenia.Thepatientsitsalonerubbingherarmsandsmiling.Shetellsthenurseherthoughtscauseearthquakesandthattheworldisburning.Thenurseassessestheprimarydeficitassociatedwiththepatientsconditionas:a.Socialisolationb.Disturbedthinkingc.Alteredmoodstatesd.PoorimpulsecontrolANS:B

Loading page image...

Thenurseinterpretsthepatientsstatementsthatwerenotreality-basedasindicatingdisturbedthoughtprocesses.Socialisolationisnottheprimarypatientproblem.Nodataexisttosupporttheotheroptions.11.Apatienthasbeenadmittedwithdisorganizedtypeschizophrenia.Thenurseobservesbluntedaffectandsocialisolation.Heoccasionallycursesorcallsanotherpatientajerkwithoutprovocation.Thenurseasksthepatienthowheisfeeling,andheresponds,Everybodypicksonme.Theyfrobitzme.Thepatientscommunicationexhibits:a.Aneologismb.Looseassociationsc.Delusionalthinkingd.CircumstantialspeechANS:AAnewlycoinedwordhavingmeaningonlyforthepatientiscalledaneologism(meaning,newword).Itisassociatedwithautisticthinking.Thepatientsspeechdoesnotshowassociativeloosenessorcircumstantiality.Theuseofaneologismisnotdelusionalinandofitself,butitsuggestsdelusionalthinkingmaybepresent.12.Apatienthasbeenadmittedwithdisorganizedtypeschizophrenia.Thenurseasksthepatienthowheisfeeling,andheresponds,Everybodypicksonme.Theyfrobitzme.Thebestresponseforthenursetomakewouldbe:a.Thatsreallytoobadthatyouarebeingtreatedthatway.b.Whodoyoumeanwhenyousayeverybody?c.Whatdifferencedoesfrobitzingmake?d.Whydotheyfrobitz?ANS:BThisresponsewillhelpclarifythepatientsthinkingandchangethefocusfromglobaltospecific.Inthissituation,sympathizingwiththepatientisanonproductiveresponse.Theremainingoptionsappeartoaccepttheneologismthussupportingthepatientsdelusionalthinking.13.Whichpatientbehaviorwouldsupportthediagnosisofresidualschizophreniawithnegativesymptoms?a.Communicatingusingonlyrhymingphasesb.Claimsthatwormsarecrawlinginmybrainc.Maintainingbotharmssuspendedawkwardlyoverheadd.ShowsnoemotionwhentellingthestoryofasistersrecentdeathANS:D

Loading page image...

Bluntedaffectisconsideredanegativesymptom.Theothersymptomswouldbeclassifiedaspositivesymptoms.14.Bydischarge,whichoutcomeisappropriateforapatientwhohearsvoicestellinghimheisevil?a.Respondverballytothevoices.b.Verbalizethereasonthevoicessayheisevil.c.Identifyeventsthatincreaseanxietyandpromotehallucinations.d.Integratethevoicesintohispersonalitystructureinapositivemanner.ANS:CAnappropriateoutcomeforapatientwithhallucinationsisrecognitionofeventsthatprecedetheonsetofhallucinations.Triggereventsorsituationsusuallycauseincreasedfeelingsofanxiety.Theremainingoptionsareneitherdesirablenorappropriate.15.Whichresponsebythenursewouldbestassistapatientinde-escalatingaggressivebehavior?a.Tellmewhatsgoingon.b.Whyareyougettingsoupset?c.Ifyouthrowsomething,youwillberestrained.d.Itstimeforgrouptherapy.Youcantalkthere.ANS:AUsinghow,what,andwhentogatherinformationisanonthreateningapproach.Itwillpromotepatientverbalizationandexplanationofeventswithoutcausingthepatienttobecomedefensive.Mentioningrestraintssoundsthreateningeventhoughitmaybemeanttoremindthepatientoflimits.Whyquestionsaredemandingandthreateningtopatients.Sendingthepatientintogrouptherapysidestepstheproblem.16.A34-year-oldmaleadmittedwithcatatonicschizophreniahasbeenmuteandmotionlessforseveraldayswhileathomepriortoadmission.Hestillappearsstuporousinthehospital.Whichnursinginterventionwouldbeaninitialpriority?a.Orientingthepatienttotheunitb.Reinforcingrealitywiththepatientc.Establishinganonthreateningrelationshipd.AssessingthepatientforphysicalproblemsANS:DPatientswhoaremuteandmotionlessandinattentivetoenvironmentalstimuliareatriskforanumberofphysicalproblems.Further,theyareunabletocommunicateexistingproblems.Thenursemustmakethoroughandastuteassessmentsbeforecreatingplanstomeetthepatientsneeds.Apatientwhoisstuporousmaynotbeable

Loading page image...

toattendtoinformationgivenaboutunitrulesandprotocols.Whileestablishingatherapeuticnurse-patientrelationshipisanimportantintervention,itdoesnothavepriorityaccordingtoMaslowshierarchy.Becausethepatientismute,onecanonlysuspectlackofrealityorientation.Whileanappropriateintervention,itisnotthepriorityaccordingtoMaslowshierarchy.17.Whichresponseisappropriatewhenapatientsmotherexpressesguiltovercausingmychildtobeschizophrenic?a.Icanseehowyouwouldbeupsetoverthisturnofevents.b.Newfindingssuggestthisdisorderisbiologicalinnature.c.Dontbesohardonyourself;yourdaughterneedsyoutobestrong.d.Itsdifficulttoseewhatproducesstressforthechildatthetimeitsoccurring.ANS:BManyindividualsinthementalhealthfieldattributethedevelopmentofschizophreniatomultiplecausescenteringonbiologicaltheories.Theremainingoptionsdolittletoprovidethemotherwithnewinformation.18.Whichresponsedemonstratesbothempathyandunderstandingoftherelationshipgeneticshastothedevelopmentofschizophreniaintwins?a.Infraternaltwins,thechanceoftheothertwindevelopingthedisorderisquitesmall.b.Studiesshowthat50%oftwinsdevelopschizophreniawhenitispresentintheothertwin.c.Noonecansaywhatwillhappen,sowewillhopeforthebestforyouandbothofyoursons.d.Youpoorwoman!IwishIcouldtellyouthatyourothersonhewillbefreeofthedisorder.ANS:ACurrentresearchsupportsthecorrectoption,whereastheremainingoptionsarenotfactualandshowexpressedsympathyratherthanempathy.19.Thewifeofapatientdiagnosedwithparanoidschizophreniaasks,Ivebeentoldthatmyhusbandsillnessisprobablyrelatedtoimbalancedbrainchemicals.Canyoubemorespecific?Theresponsebasedonthedopaminehypothesisis:a.BreakdownofdopamineproducesLSD,whichinlargeamountsproducespsychosis.b.Anincreaseinthebrainchemicaldopamineexplainsthepresenceofdelusionsandhallucinations.c.Decreasedamountsofthebrainchemicaldopamineexplainthepresenceofdelusionsandhallucinations.

Loading page image...

d.Anincreaseinthebrainchemicaldopamineexplainsthepresenceoflackofmotivationanddisorderedaffect.ANS:BThestatementiscorrectlybasedonthedopaminehypotheseswhiletheremainingoptionsareneitherknowntobetruenorbasedonthattheory20.Whatisthebasisforthereductionindisturbedthoughtprocesseswhenapatientisadministeredhaloperidol(Haldol)?a.Reductioninthenumberofbraincellsthatcravedopamineb.Dopaminereceptorsareblocked,makingdopaminelessavailablec.Dopaminereceptorsareenhanced,makingmoredopamineavailabled.MedicationcausesanincreasedcellularproductionofdopamineANS:BExcessdopamineisresponsibleforsymptomsofpsychosissuchasdelusionsandhallucinations.Blockingdopaminereceptorswillresultinreductionofprimarysymptoms.Theotheroptionsdonotreflecttheactionoftypicalantipsychoticmedications.21.Duringatreatmentteammeeting,thepointismadethatapatientwithschizophreniahasrecoveredfromtheacutepsychosisbutcontinuestodemonstrateapathy,avolition,andbluntedaffect.Thenursewhorelatesthesesymptomstoserotonin(5HT2)excesswillsuggestthatthepatientreceive:a.Haloperidol(Haldol)b.Chlorpromazine(Thorazine)c.Olanzapine(Zyprexa)d.Phenelzine(Nardil)ANS:COlanzapineisanatypicalantipsychotic.Atypicalantipsychoticmedicationsaremoreeffectivethantypicalantipsychoticsinblockingserotoninreceptorsandreducingthenegativesymptomsofschizophrenia.Haloperidol(Haldol)andchlorpromazine(Thorazine)aretypicalantipsychoticmedicationswhilephenelzine(Nardil)isanMAOIantidepressant.22.Whatresponsewouldbeanticipatedwhenapatientwhoreceivedchlorpromazine(Thorazine)for15yearstotreatschizophreniaisswitchedtoSeroquel(quetiapine)?a.Developmentofpseudoparkinsonismb.Developmentofdystonicreactionsc.Improvementintardivedyskinesiad.WorseningofanticholinergicsymptomsANS:C

Loading page image...

Atypicalantipsychoticshavebeennotedtoblockoraldyskinesiaandimprovetardivedyskinesiaaswellasimprovebothpositiveandnegativesymptomsofschizophrenia.Pseudoparkinsonismanddystonicreactionsareassociatedwithtypicalantipsychoticmedication.Anticholinergicsymptomsarenotintensewiththeuseofatypicalantipsychoticmedication.23.ApatientadmittedwiththediagnosisofschizophreniformdisorderR/Oorganicpathology.Basedonthisinformation,thenursecanexpectthatthepatientwill:a.Bescheduledforamagneticresonanceimaging(MRI)testb.Seeamentalhealthspecialistforextensivepsychologicaltestingc.Haveanimmunologicassayperformedwithin2daysoftheadmissiond.Participateinadexamethasonesuppressiontest(DST)administeredbythestaffANS:ATheMRIwillrevealstructuralchangesinthebrainthatmightberesponsibleforsymptomsofpsychosis(e.g.,abscess,tumor).Psychologictestingmaybeperformedbutwillbelessdefinitiveinrulingoutorganicpathology.Immunologicstudiesarenotindicated.TheDSTisrelatedtodepression.24.Inplanningaftercareforapatientwithschizophreniaandwhoseinsurancebenefitshavebeenexhausted,thenursewhoisconcernedaboutovercomingnegativesymptomswillmakeprovisionsforthepatienttohavestimulation,structure,socialization,andsupport.Whichoptionwouldbestincorporatethesefactors?a.Dayhospitalizationb.Attendingapsychosocialclubc.Livingwithhiselderlymotherd.SpendingfreetimeinthemallANS:BApsychosocialclubisorganizedtoprovidethe4Ssandisnotcostlytopatients.Dayhospitalizationwouldnotbepossiblebecauseofthelackofinsurancebenefits.Livingwithhismothermightfallshortofstimulationandsupport.Spendingtimeinthemalllacksstructure,socialization,andsupport.25.Apatientwithcatatonicschizophreniahasbeenstandingwithhisleftarmupraisedandhisrightfootoffthefloorforthemajorityofthelast20hours,eatingonlywhenallowedtoeatstandingup.Whichnursinginterventionhaspriorityforthispatient?a.Providinghigh-caloriedrinkshourlyb.Assessingforlowerextremityedemabidc.Takingthepatienttoactivitiestherapyoncedaily

Loading page image...

d.Encouragingthepatienttositorliedownfor30minuteshourlyANS:BPatientswhomaintainonepositionforlongperiodsoftimeshouldbeassessedfordependentedema.Inthiscase,thenursewouldlookforedemaofthelowerextremitiesandwouldbeconcernedaboutthepressureexertedbystandingononefootforlongperiodsoftime.Suchencouragementwouldprobablybemetwithresistancebythepatient.High-caloriedrinkswouldbenecessaryifthepatientfailedtoeatatmeals.Thepatientprobablywouldnotbeabletocognitivelyprocesswhatisrequiredtoparticipateinactivities.26.Whichnursingactionbestaddressestheneedsofaparanoidpatientwhobelievesthefoodispoisoned?a.Explainingthatotherseatthefoodandarenotharmedb.Allowingthepatienttoselectfoodfromvendingmachinesc.Encouragingthepatienttodiscusswhysomeonewouldpoisonthefoodd.TakingstepstopreventthepatientfromverbalizingthedelusionalthoughtsANS:BPatientswhothinkhospitalfoodisbeingpoisonedwillsometimeseatwrappedfoodsthathavenotbeenopened,andoccasionally,theymayeatfoodbroughtfromtheoutsidebyatrustedperson.Delusionsarefixed,falsebeliefsthatcannotberefutedbylogic.Thepatientwillprobablystatethattheothershavebeengiventheantidotetothepoison.Encouragingdiscussionaboutthedelusionisnottherapeutic.Althoughitiswisetominimizetheamountofdiscussionaboutdelusions,refusingtoallowthepatienttospeakaboutthedelusionswillnotfosteratherapeuticalliance.27.Priortodischarge,thenurseplanstoteachthepatientandfamilyaboutrelapse.Whichitemswillthenurseincludeintheteaching?a.Recognizingwarningsignsofrelapseb.Usingstreetdrugsjudiciouslyandonlyinsmallamountsc.Loweringmedicationdosagetomanageemergingsideeffectsd.NotifyingthenurseofwarningsignspresentformorethanonemonthANS:AThepatientandfamilymustbeawareofsignsofimpendingrelapse.Thesesignsareusuallysimilartothosethatthepatientexperiencedpriortohospitalizationandwillbepatient-specific.ThenurseshouldbenotifiedASAP,ratherthanwaitingtwoweeks.Patientsshouldneveradjustmedicationdosage.Streetdruguseoftenprecipitatesrelapsesincemanystreetdrugsaredopaminergic.28.Becauseofthecognitivedisturbancesassociatedwithschizophrenia,whichtechniquewillbeusefulasthenurseteachesapatientaboutself-management?a.Useonlyverbalinstruction.

Loading page image...

b.Teachmaterialinsmallsegments.c.Offeropportunitiesformakingnumerouschoices.d.Plantheteachingforatimewhenthepatienthasbeenrecentlymedicated.ANS:BPatientswithcognitivedisturbancesshouldbetaughtsmallblocksofinformationatatimeandgivenfrequentreinforcement.Bothverbalandvisualmaterialsshouldbeusedsinceprocessingofverbalstimulimaybemoreimpaired.Teachingshouldbescheduledwhenthepatientismostalert.Alargenumberofchoicesmaybeconfusingfortheperson,butafewsimplechoicesmaybeincluded.29.Thewifeofapatientnewlydiagnosedwithparanoidschizophreniaisconcernedthatherhusbandwillbethissickfortherestofhislife.Whatinformationcanthenurseprovidetothewife?a.Thisdisordergenerallyrespondswellwithtreatmentandfollow-up.b.Alltypesofschizophreniabytheirnaturearechronicrelapsingdisorders.c.Outcomesarerelatedtothepatientspre-hospitalsymptomsofdisorganization.d.Thetypicaloutcomeforthisdiagnosisisthattotalremissionisnotachievable.ANS:ATheprognosisforparanoidschizophreniaisgoodwithappropriatetreatmentandeffectivefollow-up.Theremainingoptionsarenotcorrectwhenconsideringthistypeofschizophrenia30.Apatientisexhibitingauditoryhallucinationsinadditiontobeingforgetfulandeasilyconfused.Whichdiagnosisdoesthenursebasethispatientsinterventionson?a.Socialisolationb.Deficientknowledgec.Situationallowself-esteemd.ImpairedcognitivefunctioningANS:DSchizophreniamayaltercognitivefunctioning,includingmemory,retention,attention,andtheprocessingofincominginformation.Alteredcognitionaccountsformanyofthesymptomsmentionedinthescenario.Knowingthatcognitionisaltered,thenursecanadjustplanstotakethedeficitsintoaccount.Thepatientisnotexhibitingsymptomsthatwouldwarrantanyoftheotheroptions.31.Apatientexperiencesintrusive,insultingauditoryhallucinations.Whichindependentbehavioraltechniquecanthenurseteachthepatienttoemploywhenthevoicesaretroublesome?a.Introduceadistractionlikereading.b.Usepositivetalktooffsettheinsults.

Loading page image...

c.Singorwhistletocompetewiththevoices.d.Increasethedailydoseofanantipsychoticmedication.ANS:CThisactionprovidesanalternativetolisteningtothevoicesandgivesthepatientasenseofcontrol.Thepatientshouldnotadjustmedicationindependently.Readingwillnotbeparticularlyeffective,becausethevoicesareuncontestedinaquietatmosphere.Positivetalkisgenerallyusedtopositivelyaffectself-esteem.32.Apatientwithschizophreniatellsthenurseastheysitinthedayroom,Ihearvoicestellingmebadthings.Themosttherapeuticresponsethenursecanmakeis:a.Tellmewhatthevoicesaresaying.b.Ibelieveyouhearvoices,butIdonthearthemmyself.c.Thevoicesarenotreal.Theyreaproductofyourimagination.d.Doyouthinkthevoiceswouldgoawayifwewentintoyourroomtotalk?ANS:BByvoicinghisorherownrealityrelatedtothevoices,thenursedoesnotdenythepatientsexperiencesbuthelpsthepatientdistinguishactualvoicesfromthoseresultingfrominternalstimulation.Discussingwhatthevoicesaresayingservesonlytovalidatetherealityofthevoices.Challengingthevoiceswillcausethepatienttodefendhisperceptionsandtherebyreinforcetheimportanceofthehallucination.Askingtomovevalidatestherealityofthevoicesandisnotahelpfulactionsincethevoicesgowherethepatientgoes.33.Apatienttellsthenurse,WhenIminthedayroom,Ihearpeoplewhisperingaboutme,andthatmakesmewanttopunchthem.Whatdirectionwillthenurseprovidethestaffregardinginteractingwiththispatient?a.Tominimizetheneedtowhisper,utilizenonverbaltechniqueswhenpossible.b.Stayphysicallyclosetothispatientandusetouchasatooltointeractwithhim.c.Treatthispatientmatter-of-factly.Bedirect;donttalkabouthimorothersinhispresence.d.Interactwiththispatientonlywhennecessary.Thefewerinteractions,thefewermisinterpretationstherewillbe.ANS:CThisapproachisimportantwhenprovidingcareforapatientwhoismisinterpretingrealityandissuspiciousofthemotivesofothers.Ostracizingthepatientisnon-therapeutic.Patientsoftenmisinterprettouchasthreatening.Thismightpromotelossofcontrol.Usingnonverbalcommunicationtechniqueswouldbenontherapeuticasitwouldincreasepatientanxietyandpromotelossofcontrol.

Preview Mode

This document has 121 pages. Sign in to access the full document!

Report

Study Now!

Document Details

Related Documents

Med and Patho

NSG318 Drug Calculation Medication Math Competency

Pharm Quiz Cholestorol

MHACB599 Video Presentation

Pharmacological and Parenteral Therapies

Pharm Unit 6 Book Quiz

Comprehensive Guide to Addiction Medications and T

NUR 2474 Pharmacology Final Exam NCLEX Style Pract

Evaluating Pharmaceutical Patents: Challenges in Drug Marketing, Accessibility, and Cost Recovery

Test Bank For Integrated Cardiopulmonary Pharmacology, 3rd Edition, 3rd Edition

Company

Explore

Study Tools