Question 1

Which of the following statements best captures the current understanding of the etiology of mental illness?

Accepted Answer

Mental illness is currently thought to be the outcome of anatomical and/or physiological influences and psychosocial factors. Neither factor can attribute for 100% of the diagnoses and manifestations of mental illness. Both biologic psychiatry and psychosocial psychiatry have their merits and demerits; neither is wholly incorrect.

Question 2

As part of a diagnostic workup of a 22-year-old male with recently diagnosed schizophrenia, a neurologist wants to examine the levels of metabolic activity in particular areas of the client's brain. Which of the following diagnostic procedures is the physician most likely to order?

Accepted Answer

PET is rooted in the selective brain uptake of radiolabeled isotopes. As such, it can measure brain metabolic activity. CT and MRI offer visualization of structural components, while EEG measures electrical activity.

Question 3

An adult, who was sexually abused as a child, has been displaying some stress. She seems to complain of increasing medical problems when she is under more stress. The nurse would classify this as an example of

Accepted Answer

The stress-diathesis model of psychiatric disorders evolved from a recognition that genetics (diathesis) and environment (stress) both contribute to the development of psychiatric disorders. Adults who report significant traumatic experiences such as an emotional, physical, or sexual abuse as children show a graded positive response; that is, the more trauma experienced, the more both medical and mental illness occur later in life. Vitamin deficiency has not been implicated as a cause of increasing medical complaints when experiencing stress. Mendelian research studies genetics and describes the way in which genes modulate behavior and psychological traits. Parental nurturing mediates this epigenetic response, but in the absence of nurturing (dissociation), children have difficulties with attention and following directions. As teenagers, they are more likely to engage in high-risk behaviors and, as adults, show increased aggression, impulsive behavior, weakened cognition, and an inability to discriminate between real and imagined threats.

Question 4

A toddler brought up in a chaotic, nonnurturing environment may suffer neurological consequences if the parent does not achieve attachment with the child. The nurse knows that which of the following nervous systems listed below is the first to respond to the safety needs of the child?

Accepted Answer

If the ventral vagus is utilized and fails to provide safety, the SNS is recruited first. The other distracters are not the first to respond.

Question 5

A student notices that at certain times during his studying for final exams, he is more awake and his ability to think at a higher level is happening easier. The nurse knows that this experience may be attributed to which of the following neurological functions?

Accepted Answer

Excitatory neurotransmitters such as glutamate increase the probability that the target cell will fire an action potential by mediating the depolarization of the target cell.Excitatory transmitters serve as the body's stimulants promoting wakefulness, energy, and activity through regulating many of the body's most basic functions, including thought processes, higher thinking, and sympathetic activity. Distracters B, C, and D do not play a role in this process.

Question 6

Parents of a 16-year-old male who has been behaving in increasingly bizarre ways in recent months are distraught that he has been diagnosed with schizophrenia. Which of the mother's following statements about her son's diagnosis demonstrates an accurate understanding of the disease?

Accepted Answer

The risk of developing schizophrenia is much higher in individuals with a first-degree relative who has the disease. Prenatal behavior and child-rearing techniques are not strongly linked with the development of schizophrenia, and therapy and support alone are not likely to eliminate symptoms. Delusions are not normally amenable to reason.

Question 7

Which of the following is the most likely course of Wernicke syndrome?

Accepted Answer

^{Wernicke syndrome is caused by a deficiency of thiamine (vitamin B}1^{), and many of the}symptoms are reversed when nutrition is improved with supplemental thiamine.

Question 8

During an acute phase of schizophrenia when the patient is experiencing hallucinations and delusions, the nurse should anticipate that the physician will prescribe which of the following medication categories listed below?

Accepted Answer

Pharmacological treatment with antipsychotics is often helpful particularly with the positive s/s of schizophrenia (delusion, hallucinations, agitation, etc.). The negative s/s of schizophrenia respond more favorably to the atypical antipsychotic drugs. Often antipsychotics are combined with benzodiazepines or antiparkinson agents during the acute phase of treatment to reduce the risk of extrapyramidal effects from large doses of antipsychotic agents. Distracters B and C are prescribed for Alzheimer disease and D is used for alcohol addiction.

Question 9

Which of the following clinical manifestations would the nurse assess in the patient with bipolar disorder who is experiencing mania? Select all that apply.

Accepted Answer

Clinical manifestations of mania include decreased need for food and sleep, labile mood, irritability, racing thoughts, high distractibility, rapid and pressured speech, inflated self-esteem, and excessive involvement with pleasurable activities.
Despondency is a symptom of the depressive phase.

Question 10

A 44-year-old female has been diagnosed with major depression. Which of the following neuroimaging findings is most congruent with the woman's diagnosis?

Accepted Answer

In some cases of familial major depressive disorder and bipolar disorder, PET and MRI studies have demonstrated a reduction in the volume of gray matter in the prefrontal cortex, with an associated decrease in activity in the region. Brain stem involvement is not common, and the amygdala tends to have increased blood flow and oxygen consumption during depression. Enlargement of the lateral and third ventricles and reduction in frontal and temporal volumes are associated with schizophrenia.

Question 11

After surviving an ischemic stroke, a 79-year-old male has demonstrated significant changes in his emotional behavior, with his family noting that he now experiences wide mood swings with exaggerated responses of empathy, anger, and sadness to situations. His care team would most likely attribute these responses to ischemic changes in which of the following brain structures?

Accepted Answer

The neural structures that constitute the limbic system are primarily responsible for the regulation of emotion. Clinical studies have suggested that this area of the brain is important for mood states and has extensive connections with the limbic system. The occipital lobe interprets visual information, while language is the domain of the Wernicke area. The parietal lobe processes sensory input.

Question 12

A 20-year-old college student has presented to his campus medical clinic because of his unshakable despondency in recent months. He has been diagnosed with depression based on his signs, symptoms, and history. The nurse knows that which of the following treatments will likely be prescribed for this student?

Accepted Answer

SSRIs are common pharmacologic treatment modalities for depression. Drugs that inhibit the accumulation of cyclic adenosine monophosphate (cAMP) (answer B) are usually used in the treatment of bipolar depression. Benzodiazepines address anxiety, while cholinesterase inhibitors are used in the treatment of dementia. Antipsychotics are more often used in cases of schizophrenia.

Question 13

A psychiatrist is providing care for a 68-year-old female whose anxiety disorder is significantly decreasing her quality of life. The nurse knows that the client will likely benefit from which of the following pharmacologic therapies listed below?

Accepted Answer

GABA is often implicated in anxiety disorders, and benzodiazepines address this neurotransmitter. An MAO inhibitor increases the concentration of serotonin and norepinephrine. MAO inhibitors are occasionally prescribed for depression not responding to SSRIs and would not be indicated for an anxiety disorder. Calcium channel blockers are good for lowering BP and minimizing arterial spasms but are usually not prescribed for anxiety.

Question 14

A woman has a long-running compulsion to repeatedly check if the doors of her home are locked and has received a diagnosis of obsessive-compulsive disorder (OCD). Her husband is at a loss to understand her irrational behavior and has sought help from a therapist himself to deal with the effect that his wife's OCD is having on their daily lives. Which of the husband's following statements would require correction?

Accepted Answer

OCD is thought to have a neurophysiological component and is not a consequence of stress. Medications combined with behavioral therapy provide a good prognosis, and SSRI antidepressants are often used. OCD has a prevalence of 2%.

Question 15

A 50-year-old woman has experienced devastating consequences in her family and work life as a result of her long-standing alcohol addiction. The levels and pathways of which of the following neurotransmitters in her body are likely to differ from an individual without addiction?

Accepted Answer

Dopamine levels are thought to be altered in addiction and possibly contribute to addiction. Acetylcholine, serotonin, and norepinephrine are not noted to play a central role in the neurophysiology of addiction.

Question 16

The nurse knows that the patient admitted for opioid addiction may benefit from which of the following treatment modalities? Select all that apply.

Accepted Answer

Methadone, used in opiate addictions, has the narcotic properties of addiction and sedation, but lacks the euphoric effects of heroin. Naltrexone is used in treatment of alcohol and opiate addictions and works by blocking the opioid receptors and euphoric effects. Fentanyl is a pain medication, and Benadryl is an antihistamine.

Question 17

Which of the following statements on the final diagnostic report regarding a computerized tomography (CT) of the head with contrast would lead health care providers to diagnose a patient with Alzheimer disease?

Accepted Answer

The major microscopic features of Alzheimer disease are the presence of neuritic (senile) plaques, neurofibrillary tangles, and amyloid angiopathy. Distracters A, C, and D are causes for a stroke.

Question 18

A geriatrician and social worker are facilitating a family meeting for the children and wife of a 79-year-old man who has been diagnosed with Alzheimer disease. What goal of treatment will the clinicians most likely prioritize in their interactions with the family?

Accepted Answer

Cholinesterase inhibitors like donepezil and rivastigmine may slow the progression of Alzheimer's but do not reverse the organic brain changes that characterize the etiology. Ischemic changes are associated with vascular dementia, and cognitive therapy is of limited use in treatment.

Question 19

A 70-year-old woman has been brought to the emergency department by her daughter who noticed the woman is weak, confused, and forgetful in recent months, along with uncoordinated movements and visual disturbances at times. Which of the following questions by the physician are most likely to address her probable diagnosis? Select all that apply.

Accepted Answer

The client's symptoms are characteristic of Wernicke-Korsakoff syndrome, which is associated with alcohol abuse. Medications can cause numerous cognitive and motor disturbances in elderly clients. Prior CVA and stress are less likely to contribute to her symptomatology.

Quiz 21: Blood Cells and the Hematopoietic System