Biological Basis for Understanding Psychopharmacology

MULTIPLE CHOICE

1. A patient asks a nurse, “What are neurotransmitters? My doctor says mine are out of balance.” The best reply would be:
a. “You must feel relieved to know that your problem has a physical basis.”
b. “Neurotransmitters are chemicals that pass messages between brain cells.”
c. “It is a high-level concept to explain. You should ask the doctor to tell you more.”
d. “Neurotransmitters are substances we eat daily that influence memory and mood.”
ANS: B
Stating that neurotransmitters are chemicals that pass messages between brain cells gives the most accurate information. Neurotransmitters are 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 incorrect responses do not answer the patient’s question, are demeaning, and provide untrue and misleading information.

DIF: Cognitive Level: Comprehension (Understanding) REF: Pages: 50-51
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

2. The parent of an adolescent diagnosed with schizophrenia asks a nurse, “My child’s doctor ordered a positron-emission tomography (PET) scan. What is that?” Select the nurse’s best reply.
a. “PET uses a magnetic field and gamma waves to identify problems areas in the brain. Does your teenager have any metal implants?”
b. “It’s a special type of x-ray image that shows structures of the brain and whether a brain injury has ever occurred.”
c. “PET is a scan that passes an electrical current through the brain and shows brain wave activity. PET can help diagnose seizures.”
d. “PET is a special scan that shows blood flow and activity in the brain.”
ANS: D
The parent is seeking information about PET scans. It is important to use terms the parent can understand. The correct option is the only reply that provides factual information relevant to PET scans. The incorrect responses describe magnetic resonance imaging (MRI), computed tomographic (CT) scans, and electroencephalography (EEG).

DIF: Cognitive Level: Application (Applying) REF: Page: 49 | Pages: 51-52
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

3. A patient has dementia. The health care provider wants to make a differential diagnosis between Alzheimer disease and multiple infarctions. Which diagnostic procedure should a nurse expect to prepare the patient for first?
a. Computed tomography (CT) scan
b. Positron emission tomography (PET) scan
c. Functional magnetic resonance imaging (fMRI)
d. Single-photon emission computed tomography (SPECT) scan
ANS: A
A CT scan shows the presence or absence of structural changes, including cortical atrophy, ventricular enlargement, and areas of infarction—information that will be helpful to the health care provider. The other tests focus on brain activity and are more expensive; they may be ordered later.

DIF: Cognitive Level: Analysis (Analyzing) REF: Page: 49 | Pages: 51-52
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

4. A patient has delusions and hallucinations. Before beginning treatment with a psychotropic medication, the health care provider wants to rule out the presence of a brain tumor. For which test will a nurse need to prepare the patient?
a. Cerebral arteriogram
b. Functional magnetic resonance imaging (fMRI)
c. Computed tomography (CT) scan or magnetic resonance imaging (MRI)
d. Positron emission tomography (PET) or single-photon emission computed tomography (SPECT)
ANS: C
A CT scan and an MRI visualize neoplasms and other structural abnormalities. A PET scan, SPECT scan, and fMRI, which give information about brain function, are not indicated. An arteriogram would not be appropriate.

DIF: Cognitive Level: Application (Applying) REF: Page: 49 | Pages: 51-52
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

5. The nurse wants to assess for disturbances in circadian rhythms in a patient admitted for major depressive disorder. Which question best implements this assessment?
a. “Do you ever see or hear things that others do not?”
b. “Do you have problems with short-term memory?”
c. “What are your worst and best times of day?”
d. “How would you describe your thinking?”
ANS: C
Mood changes throughout the day are related to circadian rhythms. Questions about sleep pattern would also be relevant to circadian rhythms. The question about seeing or hearing things is relevant to the assessment for illusions and hallucinations. The question about thinking is relevant to the assessment of thought processes. The other question is relevant to assessment of memory.

DIF: Cognitive Level: Application (Applying) REF: Page: 49
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

6. A nurse administers a medication that potentiates the action of gamma-aminobutyric acid (GABA). Which finding 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; thus any potentiation of GABA action should result in anxiety reduction. Memory enhancement is associated with acetylcholine and substance P. Thought disorganization is associated with dopamine. GABA is not associated with sensory perceptual alterations.

DIF: Cognitive Level: Application (Applying) REF: Pages: 59-60
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

7. On the basis of current knowledge of neurotransmitter effects, a nurse anticipates that the treatment plan for a patient with memory difficulties may include medications designed to:
a. inhibit GABA production.
b. increase dopamine sensitivity.
c. decrease dopamine at receptor sites.
d. prevent destruction of acetylcholine.
ANS: D
Increased acetylcholine plays a role in learning and memory. Preventing the destruction of acetylcholine by acetylcholinesterase results in higher levels of acetylcholine, with the potential for improved memory. GABA is known to affect anxiety level rather than memory. Increased dopamine causes symptoms associated with schizophrenia or mania rather than improves memory. Decreasing dopamine at receptor sites is associated with Parkinson disease rather than improving memory.

DIF: Cognitive Level: Comprehension (Understanding) REF: Pages: 52-53 | Pages: 55-56
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

8. A patient has disorganized thinking associated with schizophrenia. Neuroimaging would most likely show dysfunction in which part of the brain?
a. Brainstem
b. Cerebellum
c. Temporal lobe
d. Prefrontal cortex
ANS: D
The prefrontal cortex is responsible for intellectual functioning. The temporal lobe is responsible for the sensation of hearing. The cerebellum regulates skeletal muscle coordination and equilibrium. The brainstem regulates internal organs.

DIF: Cognitive Level: Application (Applying) REF: Pages: 46-47
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

9. A nurse should assess a patient taking a medication 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 acetylcholine action is inhibited by anticholinergic drugs, parasympathetic symptoms such as blurred vision, dry mouth, constipation, and urinary retention appear. The functions of the sympathetic nervous system, the reticular activating system, and the medulla oblongata are not affected by anticholinergic medications.

DIF: Cognitive Level: Comprehension (Understanding)
REF: Page: 50 | Pages: 52-53 | Pages: 55-56
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

10. The therapeutic action of monoamine oxidase inhibitors (MAOIs) blocks neurotransmitter reuptake, causing:
a. increased concentration of neurotransmitters in the synaptic gap.
b. decreased concentration of neurotransmitters in serum.
c. destruction of receptor sites.
d. limbic system stimulation.
ANS: A
If the reuptake of a substance is inhibited, then it accumulates in the synaptic gap and its concentration increases, permitting the ease of the transmission of impulses across the synaptic gap. Normal transmission of impulses across synaptic gaps is consistent with a normal rather than a depressed mood. The other options are not associated with blocking neurotransmitter reuptake.

DIF: Cognitive Level: Comprehension (Understanding) REF: Pages: 57-58
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

11. A patient taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. A nurse can correctly analyze that these symptoms are related to which drug action?
a. Anticholinergic effects
b. Dopamine-blocking effects
c. Endocrine-stimulating effects
d. Ability to stimulate spinal nerves
ANS: B
Medications that block dopamine often produce disturbances of movement such as akathisia because dopamine affects neurons involved in both the 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.

DIF: Cognitive Level: Application (Applying) REF: Pages: 57-58 | Pages: 61-62
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

12. A patient has anxiety, increased heart rate, and fear. The nurse would suspect the presence of a high concentration of which neurotransmitter?
a. GABA
b. Histamine
c. Acetylcholine
d. Norepinephrine
ANS: D
Norepinephrine is the neurotransmitter associated with sympathetic nervous system stimulation, preparing the individual for the “fight or flight” response. 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.

DIF: Cognitive Level: Application (Applying) REF: Pages: 55-56
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

13. A patient has symptoms of acute anxiety related to the death of a parent in an automobile accident 2 hours earlier. The nurse should anticipate administering a medication from which group?
a. Tricyclic antidepressants
b. Atypical antipsychotics
c. Anticonvulsants
d. Benzodiazepines
ANS: D
Benzodiazepines provide anxiety relief. Tricyclic antidepressants are used to treat symptoms of depression. Anticonvulsants are used to treat bipolar disorder or seizures. Antipsychotic drugs are used to treat psychosis.

DIF: Cognitive Level: Application (Applying) REF: Pages: 59-60
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

14. A patient is hospitalized for major depressive disorder. Of the medications listed, a nurse can expect to provide the patient with teaching about:
a. chlordiazepoxide (Librium).
b. fluoxetine (Prozac).
c. clozapine (Clozaril).
d. tacrine (Cognex).
ANS: B
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI), an antidepressant that blocks the reuptake of serotonin with few anticholinergic and sedating side effects; clozapine (Clozaril) is an antipsychotic medication; chlordiazepoxide (Librium) is an anxiolytic drug; and tacrine (Cognex) is used to treat Alzheimer disease.

DIF: Cognitive Level: Application (Applying) REF: Page: 53 |Pages: 58-59
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

15. A patient hospitalized with a mood disorder has aggression, agitation, talkativeness, and irritability. A nurse begins the care plan based on the expectation that the health care provider is most likely to prescribe a medication classified as a(n):
a. anticholinergic.
b. mood stabilizer.
c. psychostimulant.
d. tricyclic antidepressant.
ANS: B
The symptoms describe a manic attack. Mania is effectively treated by the antimanic drug lithium and selected anticonvulsants such as carbamazepine, valproic acid, and lamotrigine. No drugs from the other classifications listed are effective in the treatment of mania.

DIF: Cognitive Level: Application (Applying) REF: Pages: 60-61
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

16. A drug causes muscarinic-receptor blockade. A 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 alpha1-receptor antagonism.

DIF: Cognitive Level: Application (Applying) REF: Pages: 61-62
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

17. A patient begins therapy with a phenothiazine medication. What teaching should a nurse provide related to the drug’s strong dopaminergic effect?
a. Chew sugarless gum.
b. Increase dietary fiber.
c. Arise slowly from bed.
d. Report muscle stiffness.
ANS: D
Phenothiazines are conventional antipsychotic medications that block dopamine receptors in both the limbic system and basal ganglia. Dystonia is likely to occur early in the course of treatment and is often heralded by sensations of muscle stiffness. Early intervention with an antiparkinsonian medication can increase the patient’s comfort and prevent dystonic reactions.

DIF: Cognitive Level: Application (Applying) REF: Pages: 61-62
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

18. A nurse can anticipate anticholinergic side effects are likely to occur when a patient is taking:
a. lithium (Lithobid).
b. buspirone (BuSpar).
c. risperidone (Risperdal).
d. fluphenazine (Prolixin).
ANS: D
Fluphenazine, a first-generation antipsychotic medication, exerts muscarinic blockade, 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.

DIF: Cognitive Level: Application (Applying) REF: Pages: 61-62
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

19. Priority teaching for a patient taking clozapine (Clozaril) should include which instruction?
a. Report sore throat and fever immediately.
b. Avoid foods high in polyunsaturated fat.
c. Use water-based lotions for rashes.
d. Avoid unprotected sex.
ANS: A
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 administration.

DIF: Cognitive Level: Application (Applying) REF: Page: 62
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

20. A nurse cares for patients taking various medications, including buspirone (BuSpar), haloperidol (Haldol), trazodone (Desyrel), and phenelzine (Nardil). The nurse will order a special diet for the patient taking:
a. buspirone.
b. haloperidol.
c. trazodone.
d. phenelzine.
ANS: D
Patients taking phenelzine, an MAOI, must be on a tyramine-free diet to prevent hypertensive crisis.

DIF: Cognitive Level: Application (Applying) REF: Page: 57
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

21. A nurse caring for a patient taking a serotonin reuptake inhibitor (SSRI) will develop outcome criteria related to:
a. mood improvement.
b. logical thought processes.
c. reduced levels of motor activity.
d. decreased extrapyramidal symptoms.
ANS: A
SSRIs affect mood, relieving depression in many patients. SSRIs do not act to reduce thought disorders. SSRIs reduce depression but have little effect on motor hyperactivity. SSRIs do not produce extrapyramidal symptoms.

DIF: Cognitive Level: Application (Applying) REF: Pages: 57-59
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

22. A patient’s spouse, who is a chemist, asks a nurse how serotonin reuptake inhibitors (SSRIs) lift depression. The nurse should explain that SSRIs:
a. destroy increased amounts of neurotransmitters.
b. make more serotonin available at the synaptic gap.
c. increase production of acetylcholine and dopamine.
d. block muscarinic and alpha1-norepinephrine receptors.
ANS: B
Depression is thought to be related to the lowered availability of the neurotransmitter serotonin. SSRIs act by blocking the reuptake of serotonin, leaving a higher concentration available at the synaptic cleft. They actually prevent the destruction of serotonin, have no effect on acetylcholine and dopamine production, and do not block muscarinic or alpha1-norepinephrine receptors.

DIF: Cognitive Level: Comprehension (Understanding) REF: Pages: 57-59
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

23. A patient has taken many conventional antipsychotic drugs over years. The health care provider, who is concerned about early signs of tardive dyskinesia, prescribes risperidone (Risperdal). A nurse planning care for this patient understands that atypical antipsychotics:
a. are less costly.
b. have higher potency.
c. are more readily available.
d. produce fewer motor side effects.
ANS: D
Atypical antipsychotic drugs often exert their action on the limbic system rather than the basal ganglia. The limbic system is not involved in motor disturbances. Atypical antipsychotic medications are not more readily available. They are not considered to be of higher potency; rather, they have different modes of action. Atypical antipsychotic drugs tend to be more expensive.

DIF: Cognitive Level: Comprehension (Understanding) REF: Page: 51 | Pages: 61-63
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

24. The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000 mm3 and a granulocyte count of 1500 mm3. The nurse should:
a. report the laboratory results to the health care provider.
b. give the next dose as prescribed.
c. administer aspirin and force fluids.
d. repeat the laboratory tests.
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. The drug should be withheld because the health care provider will discontinue it. The health care provider may repeat the laboratory test, but, in the meantime, the drug should be withheld. Giving aspirin and forcing fluids are measures that are less important than stopping the administration of the drug.

DIF: Cognitive Level: Analysis (Analyzing) REF: Page: 62
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

25. A nurse administering psychotropic medications should be prepared to intervene when giving a drug that blocks the attachment of norepinephrine to alpha1 receptors because the patient may experience:
a. increased psychotic symptoms.
b. severe appetite disturbance.
c. orthostatic hypotension.
d. hypertensive crisis.
ANS: C
Sympathetic-mediated vasoconstriction is essential for maintaining normal blood pressure in the upright position. Blockage of alpha1 receptors leads to vasodilation and orthostatic hypotension. Orthostatic hypotension may cause fainting and falls. Patients should be taught ways of minimizing this phenomenon.

DIF: Cognitive Level: Application (Applying)
REF: Pages: 50-51 | Pages: 55-56 | Page: 59
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. A nurse prepares to administer an antipsychotic medication to a patient diagnosed with schizophrenia. Additional monitoring of the medication’s effects and side effects will be most important if the patient is also diagnosed with which health problem? Select all that apply.
a. Parkinson disease
b. Graves disease
c. Osteoarthritis
d. Epilepsy
e. Diabetes
ANS: A, D, E
Antipsychotic medications may produce weight gain, which complicates the care of a patient with diabetes or lowers the seizure threshold or both, which complicates the care of a patient with epilepsy. Parkinson disease involves changes in transmission of dopamine and acetylcholine; therefore these drugs also complicate the care of a patient with the disorder. Osteoarthritis and Graves disease should have no synergistic effect with this medication.

DIF: Cognitive Level: Analysis (Analyzing) REF: Pages: 61-63
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

2. The spouse of a patient diagnosed with schizophrenia asks, “Which neurotransmitters are more active when a person has schizophrenia?” The nurse should state, “The current thinking is that the thought disturbances are related to increased activity of: (Select all that apply.)
a. GABA.”
b. substance P.”
c. histamine.”
d. dopamine.”
e. norepinephrine.”
ANS: D, E
Dopamine plays a role in the integration of thoughts and emotions, and excess dopamine is implicated in the thought disturbances of schizophrenia. Increased activity of norepinephrine also occurs. Substance P is most related to the pain experience. Histamine decrease is associated with depression. Increased GABA is associated with anxiety reduction.

DIF: Cognitive Level: Application (Applying) REF: Pages: 51-56
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

3. An individual is experiencing problems associated with memory. Which cerebral structures are most likely to be involved in this deficit? Select all that apply.
a. Prefrontal cortex
b. Occipital lobe
c. Temporal lobe
d. Parietal lobe
e. Basal ganglia
ANS: A, C, D
The prefrontal cortex, parietal, and temporal lobes of the cerebrum play a key role in the storage and processing of memories. The occipital lobe is predominantly involved with vision. The basal ganglia influence the integration of physical movement, as well as some thoughts and emotions.

DIF: Cognitive Level: Comprehension (Understanding) REF: Pages: 46-49
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity