Deck 2: Neurobiologic Theories and Psychopharmacology

Question 1

The nurse is assessing a patient suffering a head injury as a result of an altercation with two other individuals. The patient has difficulty accurately reporting the events of the altercation and appears very emotional during the assessment. The nurse suspects which part of the brain received the greatest amount of injury?

A) Cerebrum
B) Cerebellum
C) Medulla
D) Amygdala

Answer 1

Cerebrum

Question 2

An abnormality of which of the following structures of the cerebrum would be associated with schizophrenia?

A) Parietal lobes
B) Frontal lobe
C) Occipital lobe
D) Temporal lobes

Answer 2

Frontal lobe

Question 3

A patient with bipolar disorder asks the nurse, Why did I get this illness? I don't want to be sick. The nurse would best respond with,

A) People who develop mental illnesses often had very traumatic childhood experiences.
B) There is some evidence that contracting a virus during childhood can lead to mental disorders.
C) Sometimes people with mental illness have an overactive immune system.
D) We don't fully understand the cause, but mental illnesses do seem to run in families.

Answer 3

We don't fully understand the cause, but mental illnesses do seem to run in families.

Question 4

Which of the following statements about the neurobiologic causes of mental illness is most accurate?

A) Genetics and heredity can explain all causes of mental illness.
B) Viral infection has been proven to be the cause of schizophrenia.
C) There is no evidence that the immune system is related to mental illness.
D) Several mental disorders may be linked to genetic and nongenetic factors.

Question 5

Which of the following is a neuromodulator?

A) Neuropeptides
B) Glutamate
C) Dopamine
D) GABA

Question 6

A nurse is leading a medication education group for patients with depression. A patient states he has read that herbal treatments are just as effective as prescription medications. The best response is,

A) When studies are published they can be trusted to be accurate.
B) We need to look at the research very closely to see how reliable the studies are.
C) Your prescribed medication is the best for your condition, so you should not read those studies.
D) Switching medications will alter the course of your illness. It is not advised.

Question 7

The nurse is preparing a patient for an MRI scan of the head. The nurse should ask the patient,

A) Have you ever had an allergic reaction to radioactive dye?
B) Have you had anything to eat in the last 24 hours?
C) Does your insurance cover the cost of this scan?
D) Are you anxious about being in tight spaces?

Question 8

How should the nurse respond to a family member who asks how Alzheimer's disease is diagnosed?

A) It is impossible to know for certain that a person has Alzheimer's disease until the person dies and his or her brain can be examined via autopsy.
B) Positron emission tomography (PET) scans can identify the amyloid plaques and tangles of Alzheimer's disease in living clients.
C) Alzheimer's disease can be diagnosed by using chemical markers that demonstrate decreased cerebral blood flow.
D) It will be necessary for the patient to undergo positron emission tomography (PET) scans regularly for a long period of time to know if the patient has Alzheimer's disease.

Question 9

A patient is being seen in the crisis unit reporting that poison letters are coming in the mail. The patient has no history of psychiatric illness. Which of the following medications would the patient most likely be started on?

A) Aripiprazole (Abilify)
B) Risperidone (Risperdal Consta)
C) Fluphenazine (Prolixin)
D) Fluoxetine (Prozac)

Question 10

Which one of the following types of antipsychotic medications is most likely to produce extrapyramidal effects?

A) Atypical antipsychotic drugs
B) First-generation antipsychotic drugs
C) Third-generation antipsychotic drugs
D) Dopamine system stabilizers

Question 11

A patient with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg. daily. The patient asks the nurse how this medicine works. The nurse explains that the mechanism by which the olanzapine controls the patient's psychotic symptoms is believed to be

A) increasing the amount of serotonin and norepinephrine in the brain.
B) decreasing the amount of an enzyme that breaks down neurotransmitters.
C) normalizing the levels of serotonin, norepinephrine, and dopamine.
D) blocking dopamine receptors in the brain.

Question 12

A patient with depression has been taking paroxetine (Paxil) for the last 3 months and has noticed improvement of symptoms. Which of the following side effects would the nurse expect the patient to report?

A) A headache after eating wine and cheese
B) A decrease in sexual pleasure during intimacy
C) An intense need to move about
D) Persistent runny nose

Question 13

Which one of the following drugs should the nurse expect the patient to require serum level monitoring?

A) Anticonvulsants
B) Wellbutrin
C) Lithium
D) Prozac

Question 14

Which of the following disorders are extrapyramidal symptoms that may be caused by antipsychotic drugs? Select all that apply.

A) Akathisia
B) Pseudoparkinsonism
C) Neuroleptic malignant syndrome
D) Dystonia
E) Anticholinergic effects
F) Breast tenderness in men and women

Question 15

Which of the following antidepressant drugs is a preferred drug for clients at high risk of suicide?

A) Tranylcypromine (Parnate)
B) Sertraline (Zoloft)
C) Imipramine (Tofranil)
D) Phenelzine (Nardil)

Question 16

The nurse knows that the client understands the rationale for dietary restrictions when taking MAOI when the client makes which of the following statements?

A) I am now allergic to foods that are high in the amino acid tyramine such as aged cheese, organ meats, wine, and chocolate.
B) Certain foods will cause me to have sexual dysfunction when I take this medication.
C) Foods that are high in tyramine will reduce the medication's effectiveness.
D) I should avoid foods that are high in the amino acid tyramine such as aged cheese, meats, and chocolate because this drug causes the level of tyramine to go up to dangerous levels.

Question 17

A client who is taking paroxetine (Paxil) reports to the nurse that he has been nauseated since beginning the medication. Which of the following actions is indicated initially?

A) Instruct the client to stop the medication for a few days to see if the nausea goes away.
B) Reassure the client that this is an expected side effect that will improve with time.
C) Suggest that the client take the medication with food.
D) Tell the client to contact the physician for a change in medication.

Question 18

In planning for a client's discharge, the nurse must know that the most serious risk for the client taking a tricyclic antidepressant is which of the following?

A) Hypotension
B) Narrow-angle glaucoma
C) Seizures
D) Suicide by overdose

Question 19

A client with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The nurse observes that the client's behavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of

A) extrapyramidal side effects
B) loss of voluntary muscle control
C) posturing
D) tardive dyskinesia

Question 20

A client is seen in the clinic with clinical manifestations of an inability to sit still and a rigid posture. These side effects would be correctly identified as which of the following?

A) Tardive dyskinesia
B) Neuroleptic malignant syndrome
C) Dystonia
D) Akathisia

Question 21

Which of the following is a term used to describe the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia?

A) Opisthotonus
B) Oculogyric crisis
C) Torticollis
D) Pseudoparkinsonism

Question 22

Which of the following medications rarely causes extrapyramidal side effects (EPS)?

A) Ziprasidone (Geodon)
B) Chlorpromazine (Thorazine)
C) Haloperidol (Haldol)
D) Fluphenazine (Prolixin)

Question 23

Which of the following increases the risk for neuroleptic malignant syndrome (NMS)?

A) Overhydration
B) Intake of vitamins
C) Dehydration
D) Vegetarian diet

Question 24

Which of the following was the first nonstimulant medication specifically designed and tested for ADHD?

A) Methylphenidate (Ritalin)
B) Amphetamine (Adderall)
C) Atomoxetine (Strattera)
D) Pemoline (Cylert)

Question 25

Which of the following is the primary consideration with clients taking antidepressants?

A) Decreased mobility
B) Emotional changes
C) Suicide
D) Increased sleep

Question 26

Which of the following would not be included as a symptom of drug-induced parkinsonism?

A) Stooped posture
B) Cogwheel rigidity
C) Drooling
D) Tachycardia

Question 27

Which drug classification is the primary medication treatment for schizophrenia?

A) Anticoagulants
B) Antidepressants
C) Antimanics
D) Antipsychotics

Question 28

A client on the unit suddenly cries out in fear. The nurse notices that the client's head is twisted to one side, his back is arched, and his eyes have rolled back in their sockets. The client has recently begun drug therapy with haloperidol (Haldol). Based on this assessment, the first action of the nurse would be to

A) get a stat. order for a serum drug level.
B) hold the client's medication until the symptoms subside.
C) place an urgent call to the client's physician.
D) give a PRN dose of benztropine (Cogentin) IM.

Question 29

One week after beginning therapy with thiothixene (Navane), the client demonstrates muscle rigidity, a temperature of 103?F, an elevated serum creatinine phosphokinase level, stupor, and incontinence. The nurse should notify the physician because these symptoms are indicative of

A) acute dystonic reaction.
B) extrapyramidal side effects.
C) neuroleptic malignant syndrome.
D) tardive dyskinesia.

Question 30

A client with bipolar disorder has been taking lithium, and today his serum blood level is 2.0 mEq/L. What effects would the nurse expect to see?

A) Constipation and postural hypotension
B) Fever, muscle rigidity, and disorientation
C) Nausea, diarrhea, and confusion
D) None; the serum level is in therapeutic range

Question 31

For a client taking clozapine (Clozaril), which of the following symptoms should the nurse report to the physician immediately as it may be indicative of a potentially fatal side effect?

A) Inability to stand still for 1 minute
B) Mild rash
C) Photosensitivity reaction
D) Sore throat and malaise

Question 32

A patient with bipolar disorder takes lithium 300 mg three times daily. The nurse evaluates that the dose is appropriate when the patient reports

A) feeling sleepy and less energetic.
B) weight gain of 7 pounds in the last 6 months.
C) minimal mood swings.
D) increased feelings of self-worth.

Question 33

When the client experiences facial flushing, a throbbing headache, nausea and vomiting after consuming alcohol while taking Disulfiram (Antabuse), the nurse is aware that this is due to which of the following?

A) A mild side effect of the medication.
B) The intended therapeutic result.
C) An idiosyncratic reaction
D) A severe allergy to the medication.

Question 34

When the client asks the nurse how long it will take before the SSRI antidepressant medication will be effective, which of the following replies is most accurate and therapeutic?

A) This is a good medication! It will be effective within 20 minutes of the first dose.
B) You will have gradual improvement in symptoms over the next few weeks, but the changes may be so subtle that you may not notice them for a while. It is important for you to keep taking the medication.
C) It will probably take months for the medication to work. In the meantime, you should work on improving your attitude.
D) If you believe it will work, then it will. You have to have faith!

Question 35

A client has a lithium level of 1.2 mEq/L. Which of the following interventions by the nurse is indicated?

A) Call the physician for an increase in dosage.
B) Do not give the next dose, and call the physician.
C) Increase fluid intake for the next week.
D) No intervention is necessary at this time.

Question 36

A patient is seen for frequent exacerbation of schizophrenia due to nonadherence to medication regimen. The nurse should assess for which of the following common contributors to nonadherence?

A) The patient is symptom-free and therefore does not need to adhere to the medication regimen.
B) The patient cannot clearly see the instructions written on the prescription bottle.
C) The patient dislikes the weight gain associated with antipsychotic therapy.
D) The patient sells the antipsychotics to addicts in the neighborhood.

Question 37

Which of the following side effects of lithium are frequent causes of noncompliance? Select all that apply.

A) Metallic taste in the mouth
B) Weight gain
C) Acne
D) Thirst
E) Lethargy

Question 38

The nurse is educating a patient and family about strategies to minimize the side effects of antipsychotic drugs. Which of the following should be included in the plan? Select all that apply.

A) Drink plenty of fruit juice.
B) Developing an exercise program is important.
C) Increase foods high in fiber.
D) Laxatives can be used as needed.
E) Use sunscreen when outdoors.
F) For missed doses, take double the dose at the next scheduled time.

Question 39

The nurse has completed health teaching about dietary restrictions for a client taking a monoamine oxidase inhibitor. The nurse will know that teaching has been effective by which of the following client statements?

A) I'm glad I can eat pizza since it's my favorite food.
B) I must follow this diet or I will have severe vomiting.
C) It will be difficult for me to avoid pepperoni.
D) None of the foods that are restricted are part of a regular daily diet.

Question 40

When teaching a client about restrictions for tranylcypromine (Parnate), the nurse will tell the client to avoid which of the following foods?

A) Broad beans
B) Citrus fruit
C) Egg products
D) Fried foods