mental health nursing QUIZ
1. Antidepressant medication is an initial primary treatment modality for moderate to severe major depressive disorder unless:
a. ECT is planned
b. Patient is less than 18 years of age
c. Patient is admitted to hospital
d. Patient is age 65 and older
2. Dysthymia may be treated with all of the following except:
b. Cognitive behavioral therapy
d. Interpersonal therapy
3. Symptoms of depression in children and adolescents include all of the following except:
a. Persistent depressive or sad mood
4. Prior to initiating bright light therapy for seasonal affective disorder, it is important to:
a. Try a course of antidepressant drugs
b. Consider ophthalmological evaluation for persons with a history of eye disorders
c. Initiate milieu therapy
d. Complete a course of cognitive behavioral therapy
5. All of the following are associated with bipolar disorder except:
a. Functional impairment
b. Manic episodes
c. Rapid cycling
d. Frequent spontaneous resolution of all symptoms
6. Which of the following statement about children and adolescents with bipolar disorder is not true?
a. Most require ongoing treatment to prevent relapse and some require lifelong treatment
b. Many have co-occurring disorders such as substance abuse, suicidality, and psychosocial issues
c. Treatment generally involves a combination of medication and behavioral/psychosocial interventions
d. A significant proportion outgrows the disorder and requires no further follow-up
7. The goals of acute treatment for schizophrenia include all except:
a. Encouraging introspection and reflection
b. Eliminating or reducing symptoms such as disturbed behavior
c. Reducing the severity of psychosis and associated symptoms
d. Preventing harm
8. When may ECT be used to treat adults with schizophrenia or schizoaffective disorder?
a. In both the acute phase and stable phase for psychotic symptoms that have not responded to pharmacological treatment
b. Only during the acute phase
c. Only during the stable phase
d. Only in persons who have not been treated with antipsychotic agents
9. The most common behavioral health problem in adults, adolescents and children is:
d. Thought disorders
10. An effective intervention for many anxiety disorders is:
a. Antipsychotic agents alone
b. Antidepressants alone
c. Behavioral health treatment, especially cognitive behavioral therapy
d. ECT and pharmacotherapy
11. The percentage of persons with generalized anxiety disorder with a comorbid condition is:
12. Symptoms of panic disorder may include all of the following except:
a. Chest pain and tachycardia
b. Feelings of impending doom
c. Dizziness and shortness of breath
d. Fever and shaking chills
13. All of the following are true about panic disorder except:
a. Panic attacks do not occur during sleep
b. It affects an estimated 6 million adults in the United States
c. Twice as many women are affected
d. The tendency to develop panic attacks appears to be heritable
14. Trichotillomania is an impulse control disorder that involves:
a. Disordered eating
b. An irresistible urge to pull out hair
c. Compulsive gambling
d. Harming pets and small animal
15. All of the following statements about oppositional defiant disorder are true except:
a. It involves recurrent patterns of hostility and negative behaviors
b. It arises from a combination of genetic, biological and environmental causes
c. It is a developmentally appropriate behavior displayed by children
d. Early onset is associated with poorer prognosis
16. Persons with intermittent explosive disorder generally display all of the following except:
a. Aggressive outbursts and violence
b. Destruction of property
c. Remorse, regret and embarrassment about their actions
17. All of the following are impulse disorders or disruptive behaviors except:
a. Pathological gambling
18. Naltrexone may be used as pharmacotherapy for which of the following disorders:
a. Mood disorders
b. Impulse and Disruptive Behaviors
c. Schizoaffective disorder
d. Substance use disorders
19. Outpatient detoxification may be contraindicated for all of the following groups except:
a. Persons with a history of delirium tremens or withdrawal seizures
b. Persons with unstable medical conditions such as diabetes, hypertension, or pregnancy
c. Persons whose withdrawal signs and symptoms are sufficiently severe to require 24-hour inpatient care
20. Nearly one-half of patients with schizophrenia have which type of comorbid disorders?
d. Substance use disorders
21. A client with a history of substance abuse has been attending Alcoholics Anonymous meetings regularly in the psychiatric unit. One afternoon, the client tells the nurse, "I'm not going to those meetings anymore. I'm not like the rest of those people. I'm not a drunk. "What is the most appropriate response?
A. "If you aren't an alcoholic, why do you keep drinking and ending up in the hospital?"
B. "It's your decision. If you don't want to go, you don't have to."
C. "You seem upset about the meetings."
D. "You have to go to the meetings. It's part of your treatment plan."
22. A client is admitted to the inpatient adolescent unit after being arrested for attempting to sell cocaine to an undercover police officer. The nurse plans to write a behavioral contract. To best promote compliance, the contract should be written:
B. by the client alone.
C. jointly by the client and nurse.
D. jointly by the physician and nurse.
23. During which phase of alcoholism is loss of control and physiologic dependence evident?
A. Prealcoholic phase
B. Early alcoholic phase
C. Crucial phase
D. Chronic phase
24. A client who's actively hallucinating is brought to the hospital by friends. They say that the client used either lysergic acid diethylamide (LSD) or angel dust (phencyclidine [PCP]) at a concert. Which of the following common assessment findings indicates that the client may have ingested PCP?
A. Dilated pupils
D. Altered mood
25. A client is admitted for detoxification after a cocaine overdose. The client tells the nurse that he frequently uses cocaine but he can control his use if he chooses. Which coping mechanism is he using?
B. Logical thinking
26. On discharge after treatment for alcoholism, a client plans to take disulfiram (Antabuse) as prescribed. When teaching the client about this drug, the nurse emphasizes the need to:
A. avoid all products containing alcohol.
B. adhere to concomitant vitamin B therapy.
C. return for monthly blood drug level monitoring.
D. limit alcohol consumption to a moderate level.
27. The nurse is providing care for a client undergoing opiate withdrawal. Opiate withdrawal causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with:
28. The nurse is caring for a client who she believes has been abusing opiates. Assessment findings in a client abusing opiates such as morphine include:
A. dilated pupils and slurred speech.
B. rapid speech and agitation.
C. dilated pupils and agitation.
D. euphoria and constricted pupils.
29. Which of the following signs should the nurse expect in a client with known amphetamine overdose?
C. Hot, dry skin
D. Constricted pupils
30. A client is admitted to the psychiatric unit with a diagnosis of alcohol intoxication and suspected alcohol dependence. Other assessment findings include an enlarged liver, jaundice, lethargy, and rambling, incoherent speech. No other information about the client is available. After the nurse completes the initial assessment, what is the first priority?
A. Instituting seizure precautions, obtaining frequent vital signs, and recording fluid intake and output
B. Checking the client's medical records for health history information
C. Attempting to contact the client's family to obtain more information about the client
D. Restricting fluids and leaving the client alone to "sleep off" the episode
31. In group therapy, a client who has used I.V. heroin every day for the past 14 years says, "I don't have a drug problem. I can quit whenever I want. I've done it before." Which defense mechanism is the client using?
32. A client with a history of cocaine addiction is admitted to the coronary care unit for evaluation of substernal chest pain. The electrocardiogram (ECG) shows a 1-mm ST-segment elevation the anteroseptal leads and T-wave inversion in leads V3 to V5. Considering the client's history of drug abuse, the nurse expects the physician to prescribe:
A. lidocaine (Xylocaine).
B. procainamide (Pronestyl).
C. nitroglycerin (Nitro-Bid IV).
33. The client tells the nurse he was involved in a car accident while he was intoxicated. What would be the most therapeutic response from the nurse?
A. "Why didn't you get someone else to drive you?"
B. "Tell me how you feel about the accident."
C. "You should know better than to drink and drive."
D. "I recommend that you attend an Alcoholics Anonymous meeting."
34. A client voluntarily admits himself to the substance abuse unit. He confesses that he drinks 1 qt or more of vodka each day and uses cocaine occasionally. Later that afternoon, he begins to show signs of alcohol withdrawal. What are some early signs of this condition?
A. Vomiting, diarrhea, and bradycardia
B. Dehydration, temperature above 101° F (38.3° C), and pruritus
C. Hypertension, diaphoresis, and seizures
D. Diaphoresis, tremors, and nervousness
35. When monitoring a client recently admitted for treatment of cocaine addiction, the nurse notes sudden increases in the arterial blood pressure and heart rate. To correct these problems, the nurse expects the physician to prescribe:
A. norepinephrine (Levophed) and lidocaine (Xylocaine).
B. nifedipine (Procardia) and lidocaine.
C. nitroglycerin (Nitro-Bid IV) and esmolol (Brevibloc).
D. nifedipine and esmolol
36. A client experiencing alcohol withdrawal is upset about going through detoxification. Which of the following goals is a priority?
A. The client will commit to a drug-free lifestyle.
B. The client will work with the nurse to remain safe.
C. The client will drink plenty of fluids daily.
D. The client will make a personal inventory of strengths
37. A client is brought to the psychiatric clinic by family members, who tell the admitting nurse that the client repeatedly drives while intoxicated despite their pleas to stop. During an interview with the nurse, which statement by the client most strongly supports a diagnosis of psychoactive substance abuse?
A. "I'm not addicted to alcohol. In fact, I can drink more than I used to without being affected."
B. "I only spend half of my paycheck at the bar."
C. "I just drink to relax after work."
D. "I know I've been arrested three times for drinking and driving, but the police are just trying to hassle me."
38. A client recently admitted to the hospital with sharp, substernal chest pain suddenly complains of palpitations. The nurse notes a rise in the client's arterial blood pressure and a heart rate of 144 beats/minute. On further questioning, the client admits to having used cocaine recently after previously denying use of the drug. The nurse concludes that the client is at high risk for which complication of cocaine use?
A. Coronary artery spasm
C. Neurobehavioral deficits
D. Panic disorder
39. A client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink 6 hours before admission. Based on this response, the nurse should expect early withdrawal symptoms to:
A. begin after 7 days.
B. not occur at all because the time period for their occurrence has passed.
C. begin anytime within the next 1 to 2 days.
D. begin within 2 to 7 days.
40. Which assessment finding is most consistent with early alcohol withdrawal?
A. Heart rate of 120 to 140 beats/minute
B. Heart rate of 50 to 60 beats/minute
C. Blood pressure of 100/70 mm Hg
D. Blood pressure of 140/80 mm Hg
41. A high school student is referred to the school nurse for suspected substance abuse. Following the nurse's assessment and interventions, what would be the most desirable outcome?
A. The student discusses conflicts over drug use.
B. The student accepts a referral to a substance abuse counselor.
C. The student agrees to inform his parents of the problem.
D. The student reports increased comfort with making choices.
42. A client who reportedly consumes 1 qt of vodka daily is admitted for alcohol detoxification. To try to prevent alcohol withdrawal symptoms, the physician is most likely to prescribe which drug?
A. clozapine (Clozaril)
B. thiothixene (Navane)
C. lorazepam (Ativan)
D. lithium carbonate (Eskalith)
43. A client is being treated for alcoholism. After a family meeting, the client's spouse asks the nurse about ways to help the family deal with the effects of alcoholism. The nurse should suggest that the family join which organization?
B. Make Today Count
C. Emotions Anonymous
D. Alcoholics Anonymous
44. A client has approached the nurse asking for advice on how to deal with his alcohol addiction. The nurse should tell the client that the only effective treatment for alcoholism is:
B. total abstinence.
C. Alcoholics Anonymous (AA).
D. aversion therapy.
45. Flumazenil (Romazicon) has been ordered for a client who has overdosed on oxazepam (Serax). Before administering the medication, the nurse should be prepared for which common adverse effect?
D. Chest pain
46. A client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is the nurse most likely to administer to reduce the symptoms of alcohol withdrawal?
A. naloxone (Narcan)
B. haloperidol (Haldol)
C. magnesium sulfate
D. chlordiazepoxide (Librium)
47. A client admitted to the psychiatric unit for treatment of substance abuse says to the nurse, "It felt so wonderful to get high." Which of the following is the most appropriate response?
A. "If you continue to talk like that, I'm going to stop speaking to you."
B. "You told me you got fired from your last job for missing too many days after taking drugs all night."
C. "Tell me more about how it felt to get high."
D. "Don't you know it's illegal to use drugs?"
48. The nurse is caring for a client being treated for alcoholism. Before initiating therapy with disulfiram (Antabuse), the nurse teaches the client that he must read labels carefully on which of the following products?
A. Carbonated beverages
B. Aftershave lotion
49. A client is hospitalized with fractures of the right femur and right humerus sustained in a motorcycle accident. Police suspect the client was intoxicated at the time of the accident. Laboratory tests reveal a blood alcohol level of 0.2 % (200 mg/dl). The client later admits to drinking heavily for years. During hospitalization, the client periodically complains of tingling and numbness in the hands and feet. The nurse realizes that these symptoms probably result from:
A. acetate accumulation.
B. thiamine deficiency.
C. triglyceride buildup.
D. a below-normal serum potassium level
50. When planning care for a client who has ingested phencyclidine (PCP), which of the following is the highest priority?
A. Client's physical needs
B. Client's safety needs
C. Client's psychosocial needs
D. Client's medical needs
51. Eighteen hours after undergoing an emergency appendectomy, a client with a reported history of social drinking displays these vital signs: temperature, 101.6° F (38.7° C); heart rate, 126 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 140/96 mm Hg. The client exhibits gross hand tremors and is screaming for someone to kill the bugs in the bed. The nurse should suspect:
A. a postoperative infection.
B. alcohol withdrawal.
C. acute sepsis.
52. Clonidine (Catapres) can be used to treat conditions other than hypertension. For which of the following conditions might the drug be administered?
A. Phencyclidine (PCP) intoxication
B. Alcohol withdrawal
C. Opiate withdrawal
D. Cocaine withdrawal
53. The nurse in the substance abuse unit is trying to encourage a client to attend Alcoholics Anonymous meetings. When the client asks the nurse what he must do to become a member, the nurse should respond:
A. "You must first stop drinking."
B. "Your physician must refer you to this program."
C. "Admit you're powerless over alcohol and that you need help."
D. "You must bring along a friend who will support you."
54. After completing chemical detoxification and a 12-step program to treat crack addiction, a client is being prepared for discharge. Which remark by the client indicates a realistic view of the future?
A. "I'm never going to use crack again."
B. "I know what I have to do. I have to limit my crack use."
C. "I'm going to take 1 day at a time. I'm not making any promises."
D. "I will substitue crack for something else"
55. The nurse is assessing a client on admission to the chemical dependency unit for alcohol detoxification. When the nurse asks about alcohol use, this client is most likely to:
A. accurately describe the amount consumed.
B. underestimate the amount consumed.
C. overestimate the amount consumed.
D. deny any consumption of alcohol.
56. A 38-year-old client is admitted for alcohol withdrawal. The most common early sign or symptom that this client is likely to experience is:
A. impending coma.
B. manipulating behavior.
D. perceptual disorders.
57. A client with a history of polysubstance abuse is admitted to the facility. She complains of nausea and vomiting 24 hours after admission. The nurse assesses the client and notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through which of the following withdrawals?
A. Alcohol withdrawal
B. Cannibis withdrawal
C. Cocaine withdrawal
D. Opioid withdrawal
58. A client is admitted for an overdose of amphetamines. When assessing this client, the nurse should expect to see:
A. tension and irritability.
B. slow pulse.
59. Which of the following drugs may be abused because of tolerance and physiologic dependence.
A. lithium (Lithobid) and divalproex (Depakote).
B. verapamil (Calan) and chlorpromazine (Thorazine)
C. alprazolam (Xanax) and phenobarbital (Luminal)
D. clozapine (Clozaril) and amitriptyline (Elavil)
60. A patient with a diagnosis of major depression who has attenpted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." Which response demonstrates therapeutic communication?
A. "You have everything to live for"
B. "Why do you see yourself as a failiure?"
C. "Feeling like this is all part of being depressed."
D. "You've been feeling like a failure for a while?"