Question 1

The nurse is assessing the client for signs and symptoms of brain dysfunction. If the limbic system function is disrupted, you expect the client to have difficulty with:

Accepted Answer

The limbic system is responsible for regulating emotional responses such as fear, pleasure, and anger. If this system is disrupted, the client may have difficulty with emotional regulation and exhibit mood swings, anxiety, or depression. They may have trouble processing emotional information and responding appropriately to emotional stimuli. Auditory hallucinations are more closely associated with dysfunction in the auditory cortex or certain neural pathways, while disruptions to vital life functions such as breathing and heart rate are typically associated with dysfunction in the brainstem. Consciousness is governed by several different areas of the brain and disruption to any of those areas can impact the level of consciousness. Overall, disruption to the limbic system would have the most significant impact on emotional functioning.

Question 2

A client is hospitalized for psychotic symptoms including auditory hallucinations and paranoid delusions. Based on an understanding of neurobiology, the nurse knows the psychotic symptoms arise from disruptions in which neurotransmitter?

Accepted Answer

Psychotic symptoms including auditory hallucinations and paranoid delusions arise from disruptions in dopamine neurotransmission in the brain, specifically in the mesolimbic and mesocortical pathways. Excess dopamine activity in these pathways is thought to be a major contributor to the development of positive symptoms of psychosis.

Question 3

When focusing on psychobiology, what is most important for the client's family to understand?

Accepted Answer

Understanding the underlying neurobiology of behavior is crucial in psychobiology, as it can help the family understand the causes and mechanisms behind the client's symptoms and potential treatment options. While knowledge of the client's symptoms and medication regimen can also be important, understanding the underlying neurobiology can provide a more comprehensive understanding of the client's condition. The client's phenotype may also be relevant, but it is not necessarily the most important factor for the family to understand.

Question 4

A client is administered the dexamethasone suppression test (DST), which attempts to assess the hypothalamic-pituitary-adrenal (HPA) axis. How will the results of the test be used?

Accepted Answer

The dexamethasone suppression test (DST) is used to identify pathology in the HPA axis function. It involves measuring cortisol levels in response to the administration of dexamethasone, which should suppress cortisol production. Abnormal results can indicate various endocrine disorders or psychiatric illness. However, the test is not used to identify genetic predisposition or to determine appropriate treatment.

Question 5

A new nurse in a psychiatric program tells the charge nurse "I'm not sure I feel safe working with all of these crazy people." Select the best reply by the charge nurse.

Accepted Answer

The charge nurse should address the new nurse's concerns and suggest seeking support from a clinical supervisor. It is important to address any discomfort or uncertainty in order to ensure patient safety and quality of care, and the clinical supervisor is a valuable resource for addressing these concerns. Simply telling the new nurse to "get used to it" or suggesting transferring to another unit may not be addressing the root issue and could compromise patient care. Option D is also not a helpful response as it can further exacerbate the new nurse's anxiety and fear.

Question 6

An involuntary client being treated for an acute exacerbation of paranoid schizophrenia refuses the morning dose of medication. The nurse is frustrated and wonders if the client will ever develop insight. What aspects of psychobiology could help reframe the client's behavior for the nurse?

Accepted Answer

It is important for the nurse to understand that the illness itself can cause the client to lack insight into their condition or the need for medication. Understanding the effects of the illness on the brain can help the nurse refrain from blaming the client for their refusal to take medication and instead focus on providing appropriate support and education.

Question 7

Stress-related symptoms account for 60% of all primary care visits. What are the implications for practice?

Accepted Answer

Since stress-related symptoms account for a majority of primary care visits, understanding how stress influences disease can inform appropriate treatment options. This can include both traditional medical treatments as well as complementary therapies that address the root causes of stress. Identifying stressors and offering stress reduction techniques can also be helpful, but the primary focus should be on addressing the underlying health issues that result from stress.

Question 8

The client of Asian extraction asks the nurse why the client's own dose of antipsychotic medication is effective yet so much lower than other clients who are mostly from European extraction. Which nursing response is correct?

Accepted Answer

There is evidence to suggest that people of Asian extraction may have lower metabolic rates which can affect how they process medication. This can result in them requiring lower doses of medication compared to people from other ethnic backgrounds. Therefore, option C is the correct answer. Option A is incorrect because there is some evidence of correlation between ethnic background and medication dosages. Option B is incorrect as there is no evidence to suggest that people of Asian extraction have higher expressed emotionality. Option D is incorrect as there is no evidence to suggest that people of European extraction have more side effects from medication than those of Asian extraction.

Question 9

The nurse evaluates which of the following client statements as validation that the teaching on lithium was effective?

Accepted Answer

Lithium requires regular monitoring of blood levels to ensure therapeutic effectiveness and prevent toxicity. Option B is incorrect as abruptly stopping lithium can cause withdrawal symptoms and trigger a relapse. Option C is incorrect as there is no need to restrict fluids while on lithium. Option D is incorrect as liver function tests are not necessary for lithium monitoring.

Question 10

An older client with mild dementia of the Alzheimer's type is started on donepezil (Aricept). The client's daughter asks the nurse how long it will take for her mother to be cured. Which response by the nurse is correct?

Accepted Answer

Donepezil is a medication that improves memory and cognitive function in individuals with mild to moderate dementia, but it does not cure the underlying disease process. Therefore, option D is the correct response. Option A is incorrect because the neurochemical effects of the medication occur within hours or days, not weeks. Option B is incorrect because donepezil does not provide a complete resolution of symptoms, only an improvement in function. Option C is incorrect because there is no cure for dementia, and the effectiveness of donepezil should be assessed over several months, not weeks.

Question 11

The client reports that the medication must be effective since the hallucinations are now markedly diminished. The nurse documents that the client is responding positively to which of the following medications?

Accepted Answer

Olanzapine (Zyprexa) is an atypical antipsychotic medication often used to treat hallucinations in clients with psychotic disorders such as schizophrenia. The fact that the client's hallucinations are markedly diminished suggests that olanzapine is effective in this case. Zolpidem (Ambien) is a medication used to treat insomnia, methylphenidate (Ritalin) is a medication used to treat ADHD, and paroxetine (Paxil) is a medication used to treat depression and anxiety. None of these medications are typically used to treat hallucinations in clients with psychotic disorders.

Question 12

Because venlaxafine (Effexor) increases norepinephrine, the nurse assesses for what symptom in the client, especially when the client is on the higher doses of this medication?

Accepted Answer

Venlafaxine increases norepinephrine, which can lead to elevated blood pressure. This is especially seen at higher doses of the medication. Sedation, hypothermia, and bradycardia are not typical side effects of this medication.

Question 13

When the nurse reviews the effectiveness of the client's lithium level, the nurse should take into account which of the following client factors?

Accepted Answer

The answer of When the nurse reviews the effectiveness of...

Question 14

The client with bipolar disorder has been on lamotrigine (Lamictal) for three years and has had a stable mood for one year and asks what the risks would be of just stopping all the lamotrigine at once. Which nursing response is the most important point?

Accepted Answer

Lamotrigine should not be abruptly discontinued because of the risk of seizures. Gradual tapering is necessary over a period of at least two weeks. A sudden cessation of the medication may result in an abrupt spike in mood symptoms or even a more severe manic or depressive episode. Therefore, the most important point to communicate to the client is the risk of seizures.

Question 15

A client with newly diagnosed breast cancer states that her fate is in God's hands and that she will accept whatever the future holds. The nurse is aware that a sense of coherence helps people cope successfully with life's challenges, but the nurse is concerned about the woman's continuation with medical treatment. What might the nurse think is lacking in this client's coping?

Accepted Answer

The nurse might think that the client lacks motivation or the feeling of investing time and energy in life, as she is leaving everything to fate and not actively engaging in her treatment plan.

Question 16

A nurse is leading a support group for girls who were sexually abused by their stepfathers. Each girl made a statement to the group about the experience. The nurse recognizes intellectualization in one of the girls' remarks. Which statement did the girl make?

Accepted Answer

Intellectualization is a defense mechanism in which the individual avoids emotions by focusing on logic and reasoning. In this statement, the girl is rationalizing the abuse by stating that it happens commonly in families with stepfathers, which is an intellectualization of the emotional impact of the abuse.

Question 17

A team meeting is scheduled to teach nurses about communicating with clients who are using defense mechanisms. The instructor understands that more teaching is needed when a nurse says which of the following?

Accepted Answer

Option D is incorrect as it suggests that defense mechanisms are not helpful and need to be challenged, whereas in reality, defense mechanisms are a natural coping mechanism that is often helpful in managing stress and anxiety. A better approach for nurses would be to help clients recognize and understand their defense mechanisms and help them develop alternative coping strategies. Options A, B, and C are all correct and aligned with the goal of the meeting.

Question 18

During a peer group support session, a teenager shares that her little sister destroyed a valued collection of glass animals. Another member of the group says, "I would have killed her." The teenager quickly denies angry feelings towards the little sister and states, "She didn't do it on purpose." This is an example of the defense mechanism of:

Accepted Answer

This is an example of reaction formation, where the teenager is denying their true angry feelings and instead expressing the opposite emotions.

Question 19

A home care nurse is teaching an older client about colostomy care. The client's wife is taking charge of the irrigations. Both are very anxious. During the procedure, the wife continually watches the nurse, asking "Is this correct?" and waits for approval before continuing. Both the client and his wife express how glad they are that the nurse is coming and that they don't know what they will do without the help. Knowing that the goal of care is to promote independence, how will the nurse address these behaviors?
Select all that apply.

Accepted Answer

Reinforcing the wife's competency and encouraging the couple to gradually do the procedure on their own while providing support are effective strategies to promote independence and confidence in their ability to manage colostomy care.

Question 20

A nurse determines that a client slated for a cardiac procedure in the morning is experiencing severe anxiety. Which behavior was observed?

Accepted Answer

The answer of A nurse determines that a client slated...

Quiz 1: The Strength and Structure of Psychiatric Mental Health Nursing; Theoretical Basis for Psychiatric-Mental Health Nursing Practice and Process