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Chapter 2. The Neurophysiology of Trauma and Psychotherapy - TB

Terms in this set (35)

A patient asks, What are neurotransmitters? The doctor said mine are imbalanced. Select the nurses best response.

a. How do you feel about having imbalanced neurotransmitters?
b. Neurotransmitters protect us from harmful effects of free radicals.
c. Neurotransmitters are substances we consume that influence memory and mood.
d. Neurotransmitters are natural chemicals that pass messages between brain cells.
ANS: D

The patient asked for information, and the correct response is most accurate. Neurotransmitters are chemical substances that function as messengers in the central nervous system. They are released from the axon terminal, diffuse across the synapse, and attach to specialized receptors on the postsynaptic neuron. The distracters either do not answer the patients question or provide untrue, misleading information.
The parent of an adolescent diagnosed with schizophrenia asks the nurse, My childs doctor ordered a PET. What kind of test is that? Select the nurses best reply.

a. This test uses a magnetic field and gamma waves to identify problem areas in the brain. Does your teenager have any metal implants?
b. PET means positron-emission tomography. It is a special type of scan that shows blood flow and activity in the brain.
c. A PET scan passes an electrical current through the brain and shows brain-wave activity. It can help diagnose seizures.
d. Its a special x-ray that shows structures of the brain and whether there has ever been a brain injury.
ANS: B

The parent is seeking information about PET scans. It is important to use terms the parent can understand, so the nurse should identify what the initials mean. The correct response is the only option that provides information relevant to PET scans. The distracters describe MRI, CT scans, and EEG. See relationship to
audience response question.
A patient with a long history of hypertension and diabetes now develops confusion. The health care provider wants to make a differential diagnosis between Alzheimers disease and multiple infarcts. Which diagnostic procedure should the nurse expect to prepare the patient for first?

a. Skull x-rays
b. Computed tomography (CT) scan
c. Positron-emission tomography (PET)
d. Single-photon emission computed tomography (SPECT)
ANS: B

A CT scan shows the presence or absence of structural changes, including cortical atrophy, ventricular enlargement, and areas of infarct, information that would be helpful to the health care provider. PET and SPECT show brain activity rather than structure and may occur later. See relationship to audience response question.
4. A patients history shows drinking 4 to 6 liters of fluid and eating more than 6,000 calories per day. Which part of the central nervous system is most likely dysfunctional for this patient?

a. Amydala
b. Parietal lobe
c. Hippocampus
d. Hypothalamus
ANS: D

The hypothalamus, a small area in the ventral superior portion of the brainstem, plays a vital role in such basic
drives as hunger, thirst, and sex. See relationship to audience response question.
The nurse prepares to assess a patient diagnosed with major depression for disturbances in circadian rhythms. Which question should the nurse ask this patient?

a. Have you ever seen or heard things that others do not?
b. What are your worst and best times of the day?
c. How would you describe your thinking?
d. Do you think your memory is failing?
ANS: B

Mood changes throughout the day may be related to circadian rhythm disturbances. Questions about sleep
pattern are also relevant to circadian rhythms. The distracters apply to assessment for illusions and hallucinations, thought processes, and memory.
The nurse administers a medication that potentiates the action of gamma-aminobutyric acid (GABA). Which effect would be expected?

a. Reduced anxiety
b. Improved memory
c. More organized thinking
d. Fewer sensory perceptual alterations
ANS: A

Increased levels of GABA reduce anxiety. Acetylcholine and substance P are associated with memory enhancement. Thought disorganization is associated with dopamine. GABA is not associated with sensory perceptual alterations. See relationship to audience response question.
A nurse would anticipate that treatment for a patient with memory difficulties might include medications
designed to:

a. inhibit gamma-aminobutyric acid (GABA).
b. prevent destruction of acetylcholine.
c. reduce serotonin metabolism.
d. increase dopamine activity.
ANS: B

Increased acetylcholine plays a role in learning and memory. Preventing destruction of acetylcholine by
acetylcholinesterase would result in higher levels of acetylcholine, with the potential for improved memory. GABA affects anxiety rather than memory. Increased dopamine would cause symptoms associated with schizophrenia or mania rather than improve memory. Decreasing dopamine at receptor sites is associated with
Parkinsons disease rather than improving memory.
A patient has disorganized thinking associated with schizophrenia. Neuroimaging would likely show
dysfunction in which part of the brain?

a. Hippocampus
b. Frontal lobe
c. Cerebellum
d. Brainstem
ANS: B

The frontal lobe is responsible for intellectual functioning. The hippocampus is involved in emotions and learning. The cerebellum regulates skeletal muscle coordination and equilibrium. The brainstem regulates
internal organs.
The nurse should assess a patient taking a drug with anticholinergic properties for inhibited function of the:

a. parasympathetic nervous system.
b. sympathetic nervous system.
c. reticular activating system.
d. medulla oblongata.
ANS: A

Acetylcholine is the neurotransmitter found in high concentration in the parasympathetic nervous system. When
anticholinergic drugs inhibit acetylcholine action, blurred vision, dry mouth, constipation, and urinary retention commonly occur.
The therapeutic action of neurotransmitter inhibitors that block reuptake cause:

a. decreased concentration of the blocked neurotransmitter in the central nervous
system.
b. increased concentration of the blocked neurotransmitter in the synaptic gap.
c. destruction of receptor sites specific to the blocked neurotransmitter.
d. limbic system stimulation.
ANS: B

If the reuptake of a substance is inhibited, it accumulates in the synaptic gap, and its concentration increases,
permitting ease of transmission of impulses across the synaptic gap. Normal transmission of impulses across
synaptic gaps is consistent with normal rather than depressed mood. The other options are not associated with blocking neurotransmitter reuptake.
A patient taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. Which drug action causes these symptoms to develop?

a. Anticholinergic effects
b. Dopamine-blocking effects
c. Endocrine-stimulating effects.
d. Ability to stimulate spinal nerves
ANS: B

Medication that blocks dopamine often produces disturbances of movement, such as akathisia, because dopamine affects neurons involved in both thought processes and movement regulation. Anticholinergic effects include dry mouth, blurred vision, urinary retention, and constipation. Akathisia is not caused by endocrine stimulation or spinal nerve stimulation.
A patient has fear as well as increased heart rate and blood pressure. The nurse suspects increased activity of which neurotransmitter?

a. Gamma-aminobutyric acid (GABA)
b. Norepinephrine
c. Acetylcholine
d. Histamine
ANS: B

Norepinephrine is the neurotransmitter associated with sympathetic nervous system stimulation, preparing the
individual for fight or flight. GABA is a mediator of anxiety level. A high concentration of histamine is
associated with an inflammatory response. A high concentration of acetylcholine is associated with
parasympathetic nervous system stimulation.
A patient has acute anxiety related to an automobile accident 2 hours ago. The nurse should teach the patient about medication from which group?

a. Tricyclic antidepressants
b. Antipsychotic drugs
c. Antimanic drugs
d. Benzodiazepines
ANS: D

Benzodiazepines provide anxiety relief. Tricyclic antidepressants are used to treat symptoms of depression. Antimanic drugs are used to treat bipolar disorder. Antipsychotic drugs are used to treat psychosis.
A patient is hospitalized for severe depression. Of the medications listed below, the nurse can expect to
provide the patient with teaching about:

a. chlordiazepoxide (Librium).
b. clozapine (Clozaril).
c. sertraline (Zoloft).
d. tacrine (Cognex).
ANS: C

Sertraline (Zoloft) is an SSRI. This antidepressant blocks the reuptake of serotonin, with few anticholinergic
and sedating side effects. Clozapine is an antipsychotic. Chlordiazepoxide is an anxiolytic. Tacrine treats Alzheimers disease.
A patient diagnosed with bipolar disorder has an unstable mood, aggressiveness, agitation, talkativeness, and irritability. The nurse expects the health care provider to prescribe a medication from which group?

a. Psychostimulants
b. Mood stabilizers
c. Anticholinergics
d. Antidepressants
ANS: B

The symptoms describe mania, which is effectively treated by mood stabilizers, such as lithium, and selected
anticonvulsants (carbamazepine, valproic acid, and lamotrigine). Drugs from the other classifications listed are
not effective in the treatment of mania.
A drug causes muscarinic receptor blockade. The nurse will assess the patient for:

a. dry mouth.
b. gynecomastia.
c. pseudoparkinsonism.
d. orthostatic hypotension.
ANS: A

Muscarinic receptor blockade includes atropine-like side effects, such as dry mouth, blurred vision, and
constipation. Gynecomastia is associated with decreased prolactin levels. Movement defects are associated with dopamine blockade. Orthostatic hypotension is associated with 1 antagonism.
A patient begins therapy with a phenothiazine medication. What teaching should the nurse provide related to the drugs strong dopaminergic effect?

a. Chew sugarless gum.
b. Increase dietary fiber.
c. Arise slowly from bed.
d. Report changes in muscle movement.
ANS: D

Phenothiazines block dopamine receptors in both the limbic system and basal ganglia. Movement disorders and
motor abnormalities (extrapyramidal side effects), such as parkinsonism, akinesia, akathisia, dyskinesia, and
tardive dyskinesia, are likely to occur early in the course of treatment. They are often heralded by sensations of
muscle stiffness. Early intervention with antiparkinsonism medication can increase the patients comfort and
prevent dystonic reactions. The distracters are related to anticholinergic effects.
A patient tells the nurse, My doctor prescribed Paxil (paroxetine) for my depression. I assume Ill have side
effects like I had when I was taking Tofranil (imipramine). The nurses reply should be based on the knowledge that paroxetine is a(n):

a. selective norepinephrine reuptake inhibitor.
b. tricyclic antidepressant.
c. MAO inhibitor.
d. SSRI.
ANS: D

Paroxetine is an SSRI and will not produce the same side effects as imipramine, a tricyclic antidepressant. The patient will probably not experience dry mouth, constipation, or orthostatic hypotension.
A nurse can anticipate anticholinergic side effects are likely when a patient takes:

a. lithium (Lithobid).
b. buspirone (BuSpar).
c. imipramine (Tofranil).
d. risperidone (Risperdal).
ANS: C

Imipramine (Tofranil) is a tricyclic antidepressant with strong anticholinergic properties, resulting in dry mouth, blurred vision, constipation, and urinary retention. Lithium therapy is more often associated with fluid-balance problems, including polydipsia, polyuria, and edema. Risperidone therapy is more often associated with
movement disorders, orthostatic hypotension, and sedation. Buspirone is associated with anxiety reduction without major side effects.
Which instruction has priority when teaching a patient about clozapine (Clozaril)?

a. Avoid unprotected sex.
b. Report sore throat and fever immediately.
c. Reduce foods high in polyunsaturated fats.
d. Use over-the-counter preparations for rashes.
ANS: B

Clozapine therapy may produce agranulocytosis; therefore, signs of infection should be immediately reported to the health care provider. In addition, the patient should have white blood cell levels measured weekly. The other options are not relevant to clozapine.
A nurse cares for a group of patients receiving various medications, including haloperidol (Haldol),
carbamazepine (Tegretol), trazodone (Desyrel), and phenelzine (Nardil). The nurse will order a special diet for the patient who takes:

a. carbamazepine.
b. haloperidol.
c. phenelzine.
d. trazodone.
ANS: C

Patients taking phenelzine, an MAO inhibitor, must be on a low tyramine diet to prevent hypertensive crisis. There are no specific dietary precautions associated with the distracters.
A nurse instructs a patient taking a drug that inhibits monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of:

a. cardiac dysrhythmia.
b. hypotensive shock.
c. hypertensive crisis.
d. hypoglycemia.
ANS: C

Patients taking MAO-inhibiting drugs must be on a low tyramine diet to prevent hypertensive crisis. In the
presence of MAO inhibitors, tyramine is not destroyed by the liver and in high levels produces intense vasoconstriction, resulting in elevated blood pressure.
A nurse caring for a patient taking a selective serotonin reuptake inhibitor (SSRI) will develop outcome criteria related to:

a. coherent thought processes.
b. improvement in depression.
c. reduced levels of motor activity.
d. decreased extrapyramidal symptoms.
ANS: B

SSRIs affect mood, relieving depression in many cases. SSRIs do not act to reduce thought disorders. SSRIs reduce depression but have little effect on motor hyperactivity. SSRIs do not produce extrapyramidal symptoms.
By which mechanism do selective serotonin reuptake inhibitors (SSRI) improve depression?

a. Destroying increased amounts of serotonin
b. Making more serotonin available at the synaptic gap
c. Increasing production of acetylcholine and dopamine
d. Blocking muscarinic and 1 norepinephrine receptors
ANS: B

Depression is thought to be related to lowered availability of the neurotransmitter serotonin. SSRIs act by
blocking reuptake of serotonin, leaving a higher concentration available at the synaptic cleft. SSRIs prevent destruction of serotonin. SSRIs have little or no effect on acetylcholine and dopamine production. SSRIs do not produce muscarinic or 1 norepinephrine blockade.
The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000 mm3. Select the nurses best action.

a. Report the results to the health care provider immediately.
b. Administer the next dose as prescribed.
c. Give aspirin and force fluids.
d. Repeat the laboratory test.
ANS: A

These laboratory values indicate the possibility of agranulocytosis, a serious side effect of clozapine therapy.
These results must be immediately reported to the health care provider, and the drug should be withheld. The
health care provider may repeat the test, but in the meantime, the drug should be withheld. Caution: This
question requires students to apply previous learning regarding normal and abnormal values of white blood cell
counts.
A drug blocks the attachment of norepinephrine to 1 receptors. The patient may experience:

a. hypertensive crisis.
b. orthostatic hypotension.
c. severe appetite disturbance.
d. an increase in psychotic symptoms.
ANS: B

Sympathetic-mediated vasoconstriction is essential for maintaining normal blood pressure in the upright position. Blockage of 1 receptors leads to vasodilation and orthostatic hypotension. Orthostatic hypotension
may cause fainting and falls. Teach patients ways of minimizing this phenomenon.
A nurse cares for four patients who are receiving clozapine, lithium, fluoxetine, and venlafaxine,
respectively. With which patient should the nurse be most alert for problems associated with fluid and
electrolyte imbalance? The patient receiving:

a. lithium (Lithobid).
b. clozapine (Clozaril).
c. fluoxetine (Prozac).
d. venlafaxine (Effexor).
ANS: A

Lithium is a salt and known to alter fluid and electrolyte balance, producing polyuria, edema, and other symptoms of imbalance. Patients receiving clozapine should be monitored for agranulocytosis. Patients receiving fluoxetine should be monitored for acetylcholine block. Patients receiving venlafaxine should be monitored for heightened feelings of anxiety.
An obese patient has a diagnosis of schizophrenia. Medications that block which receptors would contribute to further weight gain?

a. H1
b. 5 HT2
c. Acetylcholine
d. Gamma-aminobutyric acid (GABA)
ANS: A

H1 receptor blockade results in weight gain, which is undesirable for an obese patient. Blocking of the other receptors would have little or no effect on the patients weight.
29. An individual hiking in the forest encounters a large poisonous snake on the path. Which change in this individuals vital signs is most likely?

a. Pulse rate changes from 90 to 72.
b. Respiratory rate changes from 22 to 18.
c. Complaints of intestinal cramping begin.
d. Blood pressure changes from 114/62 to 136/78.
ANS: D

This frightening experience would stimulate the sympathetic nervous system, causing a release of
norepinephrine, an excitatory neurotransmitter. It prepares the body for fight or flight. Increased blood pressure, pupil size, respiratory rate, and pulse rate signify release of norepinephrine. Intestinal cramping would be associated with stimulation of the parasympathetic nervous system.
Consider these medications: carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin). Which medication below also belongs with this group?

a. Galantamine (Reminyl)
b. Valproate (Depakote)
c. Buspirone (BuSpar)
d. Tacrine (Cognex)
ANS: B

The medications listed in the stem are mood stabilizers, anticonvulsant types. Valproate (Depakote) is also a member of this group. The distracters are drugs for treatment of Alzheimers disease and anxiety.
A professional football player is seen in the emergency department after losing consciousness from an illegal block. Prior to discharge, the nurse assists the patient to schedule an outpatient computed tomography (CT) scan for the next day. Which strategy should the nurse use to ensure the patient remembers the appointment?

a. Write the appointment day, time, and location on a piece of paper and give it to the player.
b. Log the appointment day, time, and location into the players cell phone calendar feature.
c. Ask the health care provider to admit the patient to the hospital overnight.
d. Verbally inform the patient of the appointment day, time, and location.
ANS: B

This player may have suffered repeated head injuries with damage to the hippocampus. The hippocampus has
significant role in maintaining memory. Logging the appointment into the players cell phone calendar will remind him of the appointment the next day. Paper will be lost, and the patient is unlikely to remember verbal instruction. Hospitalization is unnecessary. See relationship to audience response question. Caution: This question requires students to apply previous learning regarding central nervous system anatomy and physiology.
A nurse prepares to administer a second-generation antipsychotic medication to a patient diagnosed with
schizophrenia. Additional monitoring for adverse effects will be most important if the patient has which comorbid health problems?

Select all that apply.
a. Parkinsons disease
b. Graves disease
c. Hyperlipidemia
d. Osteoarthritis
e. Diabetes
ANS: A, C, E

Antipsychotic medications may produce weight gain, which would complicate care of a patient with diabetes,
and increase serum triglycerides, which would complicate care of a patient with hyperlipidemia. Parkinsons disease involves changes in transmission of dopamine and acetylcholine, so these drugs would also complicate care of this patient. Osteoarthritis and Graves disease should have no synergistic effect with this medication.
Questions the nurse could ask that would be nonjudgmental when obtaining information about patient use of herbal remedies include:

Select all that apply.
a. You dont regularly take herbal remedies, do you?
b. What herbal medicines have you used to relieve your symptoms?
c. What over-the-counter medicines and nutritional supplements do you use?
d. What differences in your symptoms do you notice when you take herbal supplements?
e. Have you experienced problems from using herbal and prescription drugs at the same time?
ANS: B, C, D, E

The correct responses are neutral in tone and do not express bias for or against the use of herbal medicines. The
distracter, worded in a negative way, makes the nurses bias evident.
An individual is experiencing problems with memory. Which of these structures are most likely to be
involved in this deficit?

Select all that apply.
a. Amygdala
b. Hippocampus
c. Occipital lobe
d. Temporal lobe
e. Basal ganglia
ANS: A, B, D

The frontal, parietal, and temporal lobes of the cerebrum play a key role in the storage and processing of memories. The amygdala and hippocampus also play roles in memory. The occipital lobe is predominantly involved with vision. The basal ganglia influence integration of physical movement, as well as some thoughts and emotions.
A patients sibling says, My brother has a mental illness, but the doctor ordered a functional magnetic
resonance image (fMRI) test. That test is too expensive and will just increase the hospital bill. Select the nursesm best responses.

Select all that apply.
a. Sometimes there are physical causes for psychiatric symptoms. This test will help us understand whether that is the situation.
b. Some mental illnesses are evident on fMRIs. This test will give information to help us plan the best care for your brother.
c. Tell me more about what kinds of tests your brothers health insurance plan covers.
d. It sounds like you do not truly believe your brother had a mental illness.
e. It would be better for you to discuss your concerns with the doctor.
ANS: A, B

The correct responses provide information to the sibling. Modern imaging techniques are important tools in assessing molecular changes in mental disease and marking the receptor sites of drug action, which can help in treatment planning. Psychiatric symptoms can be caused by anatomical or physiologic abnormalities. There is
no evidence of denial in the siblings comment. The nurse can answer this question rather than referring it to the
physician. It would be inappropriate to discuss finances with the patients sibling.
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