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The spouse of a patient diagnosed with schizophrenia asks, 'Which neurotransmitters are more active when a person has schizophrenia?' The nurse's response will focus on which neurotransmitters? (Select all that apply.)
- A. GABA
- B. Substance P
- C. Histamine
- D. Dopamine
- E. Norepinephrine
Correct Answer: D,E
Rationale: 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.
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A patient is demonstrating signs of dementia. The health care provider wants to make a differential diagnosis between Alzheimer's 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
Correct Answer: A
Rationale: 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.
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)
Correct Answer: C
Rationale: 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.
A patient hospitalized with a mood disorder has demonstrated 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 from what classification?
- A. Anticholinergic
- B. Mood stabilizer
- C. Psychostimulant
- D. Tricyclic antidepressant
Correct Answer: B
Rationale: The symptoms describe a manic episode. Mania is effectively treated by the mood stabilizing medication, 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.
The laboratory report for a patient taking clozapine indicates the patient is experiencing agranulocytosis. The nurse should implement which intervention first?
- A. Report the laboratory results to the health care provider.
- B. Give the next dose of the medication as prescribed.
- C. Administer aspirin and force fluids.
- D. Repeat the laboratory tests.
Correct Answer: A
Rationale: 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.
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. How would you describe your sleep pattern?
- D. How would you describe your thinking?
Correct Answer: C
Rationale: 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.