Substance Abuse and Abuse NCLEX Practice Quiz: 55 Questions

Personality and Mood Disorders NCLEX Practice Quiz: 110 Questions 1. 1. Question The nursing diagnosis that would be most appropriate for a 22-year old client who uses ritualistic behavior would be: o A. Ineffective coping o B. Impaired adjustment o C. Personal identity disturbance o D. Sensory/perceptual alterations Incorrect Correct Answer: A. Ineffective coping Ineffective coping is the impairment of a person’s adaptive behaviors and problem-solving abilities in meeting life’s demands; ritualistic behavior fits under this category as a defining characteristic. During the beginning of treatment, allow plenty of time for rituals. Do not be judgmental or verbalize disapproval of the behavior. To deny the client this activity can precipitate panic level of anxiety. • Option B: Gradually limit the amount of time allotted for ritualistic behavior as the client becomes more involved in unit activities. Anxiety is minimized when the client is able to replace ritualistic behaviors with more adaptive ones. Encourage independence and give positive reinforcement for independent behaviors. Positive reinforcement enhances self-esteem and encourages repetition of desired behaviors. • Option C: Personal identity disturbance is not a priority diagnosis for the client. Assess client’s level of anxiety. Investigate the types of situations that increase anxiety and result in ritualistic behaviors. Helping the client recognize the precipitating factors is the first step in teaching the client to interrupt the escalating anxiety. Initially meet the client’s dependency needs as necessary. Sudden and complete elimination of avenues for dependency would create anxiety and will burden the client more. • Option D: This nursing diagnosis is appropriate, but it is not the priority. Encourage the recognition of situations that provoke obsessive thoughts or ritualistic behaviors. Recognition of precipitating factors is the first step in teaching the client to interrupt escalation of anxiety. Provide positive reinforcement for non-ritualistic behaviors. Positive reinforcement enhances self-esteem and encourages repetition of desired behaviors. 2. 2. Question A psychiatrist prescribes an anti-obsessional agent for a client who is using ritualistic behavior. A common anti-anxiety medication used for this type of client would be: • A. fluvoxamine (Luvox) • B. benztropine (Cogentin) • C. amantadine (Symmetrel) • D. diphenhydramine (Benadryl) Incorrect Correct Answer: A. fluvoxamine (Luvox). This drug blocks the uptake of serotonin. Fluvoxamine is used to treat obsessive-compulsive disorder (bothersome thoughts that won’t go away and the need to perform certain actions over and over) and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). Fluvoxamine is in a class of medications called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance. • Option B: Benztropine belongs to the synthetic class of muscarinic receptor antagonists (anticholinergic drug). Thus, it has a structure similar to that of diphenhydramine and atropine. However, it is long-acting so that its administration can be with less frequency than diphenhydramine. It also induces less CNS stimulation effect compared to that of trihexyphenidyl, making it a preferable drug of choice for geriatric patients. Moreover, benztropine is FDA approved as adjunctive therapy of all forms of parkinsonism. • Option C: Amantadine is now used mostly for Parkinson’s disease. Clinical trials have shown that amantadine decreases symptoms of bradykinesia, rigidity, and tremor. There is a combined synergistic effect with added levodopa, which is converted to dopamine by striatal enzymes in the CNS. There can be a transient benefit to the drug, so short-term therapy for patients with the mild disease is best.