HESI Specialty Test Review: Psychiatric/Mental Health Nursing
Study online at https://quizlet.com/_8c8ytj
1. Your patient has an admitting diagnosis of alcohol withdrawal syndrome.
You receive a phone call at the nurses' station from a person who says he
is the patient's minister and wants to know if the patient "fell off the wagon
again" and when visitation hours are. What is your best response?
A: "Yes, the patient drank too much, but he should be fine in a few
days. Visiting hours are 9 A.M. to 6 P.M."
B: "We do not give out any information. Visitation hours in the hospital
are from 9 A.M. to 6 P.M. daily."
C: "Please pray for the patient; he is in bad shape. You can visit him
anytime between 9 A.M. and 6 P.M. daily."
D: "Please contact the hospital's chief executive officer, who can give
you the information you are requesting.": B: "We do not give out any information.
Visitation hours
in the hospital are from 9 A.M. to 6 P.M. daily."
(+) Patient confidentiality is required, and there is no
way to verify the identity of the person calling.
2. Your patient has been hospitalized for acute alcohol withdrawal. It is the fifth
day, and he is having visual hallucinations followed by a seizure. What is the
most likely source of the patient's problem?
A: Autonomic dysreflexia (AD)
B: A brain tumor
C: Sleep deprivation
D: Delirium tremens (DTs): D: Delirium tremens (DTs)
(+) Delirium tremens occurs as acute alcohol withdrawal
progresses. It includes symptoms such as clouding
of sensorium, hallucinations, seizures, and autonomic
hyperactivity.
3. Which of the following assessments is used to confirm alcohol intake?
A: Pupil dilation
B: Serum sample
C: Hair shaft analysis
D: Sputum sample: B: Serum sample
, HESI Specialty Test Review: Psychiatric/Mental Health Nursing
Study online at https://quizlet.com/_8c8ytj
(+) Urine and serum samples are toxicology specimens used to assess and monitor
alcohol withdrawal.
4. Which of the following questions is most appropriate to ask in screening for
a potential problem of high alcohol intake?
A: "Have you felt you should cut down on your alcohol
consumption?"
B: "Do you enjoy getting smashed?"
C: "Have you ever thought about killing someone?"
D: "In the last week, have you had a glass of wine?": A: "Have you felt you should
cut down on your alcohol
consumption?"
(+) Screening requires questions associated with cutting down, feelings of guilt about
drinking, and having a first drink in the morning.
5. Your patient in the Emergency Department has a diagnosis of acute alcohol
withdrawal syndrome (AWS). He is acting euphoric, yet shy. The APN has
prescribed the following care: CAGE questionnaire, serum for toxicology, IV
of D5 1/2 NS and 1 amp multivitamin (MVI) at 75 mL/h, neuro check q 1 h. What
is your first priority?
A: Administer the CAGE questionnaire
B: Start the IV
C: Do the neuro check
D: Obtain a serum blood sample: D: Obtain a serum blood sample
(+) Obtain a toxicology sample, as the patient is too euphoric to answer the CAGE
questionnaire. The IV and neuro checks can wait.
6. Your patient sees you at a preplanned postoperative visit 4 weeks after
being hospitalized for acute alcohol withdrawal. Upon questioning, she states
that her husband is abusive, so she drinks to "drown out his yelling." The
patient also complains of depression and severe pain in the epigastric region
that radiates to her back and has been constant since yesterday. She has
vomited twice in the past 12 hours. What is your first priority?
A: Refer her immediately for treatment of depression
B: Call social services and report spousal abuse
C: Assess her for pancreatitis
D: Administer a test or scale that assesses alcohol withdrawal: C: Assess her
, HESI Specialty Test Review: Psychiatric/Mental Health Nursing
Study online at https://quizlet.com/_8c8ytj
for pancreatitis
Approximately 65% of cases of pancreatitis are related to alcohol. This patient is
exhibiting the classic symptoms of this disease.
7. Prolonged alcohol ingestion can cause disorders of the liver such as:
A: Pancreatitis
B: Hypomagnesemia
C: Cirrhosis
D: Colitis: C: Cirrhosis
(+) Cirrhosis is a liver disorder that can result from
prolonged ingestion of alcohol.
8. Adolescent suicide has increased over the past and is among the top five
causes of death in U.S. adolescents.
A: TRUE
B: FALSE: A: TRUE
(+) Adolescent suicides have quadrupled since 1950 and
are the third leading cause of death in U.S.
adolescents.
9. Your patient has just received his sixth electroconvulsant therapy outpa-
tient treatment. He tells you that he plans to drive himself home because his
wife is working at her part-time job today. What is your best response?
A: "Be careful and drive slowly."
B: "You need to wait 30 minutes and then you will be safe to drive."
C: "Let me take your vital signs; if they are stable, then you can drive."
D: "You cannot drive. I can call you a cab, or would you prefer to call
your wife or someone for a ride home?": D: "You cannot drive. I can call you a
cab, or would you
prefer to call your wife or someone for a ride home?"
(+) Patients cannot drive after ECT, as its effects can
include disorientation, muscle pain, central nervous
system depression, and cardiac dysrhythmias.
10. Alcohol tolerance develops as a result of the central nervous system's
adaptive mechanisms.
, HESI Specialty Test Review: Psychiatric/Mental Health Nursing
Study online at https://quizlet.com/_8c8ytj
A: TRUE
B: FALSE: A: TRUE
(+) The central nervous system adapts, so more alcohol
is needed to obtain the initial effects of alcohol
ingestion, especially euphoria.
11. Your patient experienced alcohol withdrawal syndrome and now admits he
"needs help." Which of the following is the most appropriate resource to which
you should direct the patient?
A: Reach to Recovery
B: Alcoholics Anonymous
C: Depression support group
D: Suicide support group: B: Alcoholics Anonymous.
(+) Alcoholics Anonymous is the most appropriate
resource for alcoholism, although depression may or
may not be involved in this case.
12. Which of the following is a common symptom of a major depressive
episode?
A: Loss of hearing
B: Increased energy
C: Hopelessness
D: Recurrent thoughts of well-being: C: Hopelessness
(+) Hopelessness, loss of pleasure, and a profound
sense of sadness are symptoms of a major
depressive episode.
13. Which of the following statements would indicate a depressed mood?
A: "I can't wait to go to the ballgame today; it should be fun."
B: "I feel sad today, just like yesterday."
C: "I feel like going to the gym for a workout today, then maybe to a
movie."
D: "Since it's raining outside, how about a game of chess?": B: "I feel sad today,
just like yesterday."
Study online at https://quizlet.com/_8c8ytj
1. Your patient has an admitting diagnosis of alcohol withdrawal syndrome.
You receive a phone call at the nurses' station from a person who says he
is the patient's minister and wants to know if the patient "fell off the wagon
again" and when visitation hours are. What is your best response?
A: "Yes, the patient drank too much, but he should be fine in a few
days. Visiting hours are 9 A.M. to 6 P.M."
B: "We do not give out any information. Visitation hours in the hospital
are from 9 A.M. to 6 P.M. daily."
C: "Please pray for the patient; he is in bad shape. You can visit him
anytime between 9 A.M. and 6 P.M. daily."
D: "Please contact the hospital's chief executive officer, who can give
you the information you are requesting.": B: "We do not give out any information.
Visitation hours
in the hospital are from 9 A.M. to 6 P.M. daily."
(+) Patient confidentiality is required, and there is no
way to verify the identity of the person calling.
2. Your patient has been hospitalized for acute alcohol withdrawal. It is the fifth
day, and he is having visual hallucinations followed by a seizure. What is the
most likely source of the patient's problem?
A: Autonomic dysreflexia (AD)
B: A brain tumor
C: Sleep deprivation
D: Delirium tremens (DTs): D: Delirium tremens (DTs)
(+) Delirium tremens occurs as acute alcohol withdrawal
progresses. It includes symptoms such as clouding
of sensorium, hallucinations, seizures, and autonomic
hyperactivity.
3. Which of the following assessments is used to confirm alcohol intake?
A: Pupil dilation
B: Serum sample
C: Hair shaft analysis
D: Sputum sample: B: Serum sample
, HESI Specialty Test Review: Psychiatric/Mental Health Nursing
Study online at https://quizlet.com/_8c8ytj
(+) Urine and serum samples are toxicology specimens used to assess and monitor
alcohol withdrawal.
4. Which of the following questions is most appropriate to ask in screening for
a potential problem of high alcohol intake?
A: "Have you felt you should cut down on your alcohol
consumption?"
B: "Do you enjoy getting smashed?"
C: "Have you ever thought about killing someone?"
D: "In the last week, have you had a glass of wine?": A: "Have you felt you should
cut down on your alcohol
consumption?"
(+) Screening requires questions associated with cutting down, feelings of guilt about
drinking, and having a first drink in the morning.
5. Your patient in the Emergency Department has a diagnosis of acute alcohol
withdrawal syndrome (AWS). He is acting euphoric, yet shy. The APN has
prescribed the following care: CAGE questionnaire, serum for toxicology, IV
of D5 1/2 NS and 1 amp multivitamin (MVI) at 75 mL/h, neuro check q 1 h. What
is your first priority?
A: Administer the CAGE questionnaire
B: Start the IV
C: Do the neuro check
D: Obtain a serum blood sample: D: Obtain a serum blood sample
(+) Obtain a toxicology sample, as the patient is too euphoric to answer the CAGE
questionnaire. The IV and neuro checks can wait.
6. Your patient sees you at a preplanned postoperative visit 4 weeks after
being hospitalized for acute alcohol withdrawal. Upon questioning, she states
that her husband is abusive, so she drinks to "drown out his yelling." The
patient also complains of depression and severe pain in the epigastric region
that radiates to her back and has been constant since yesterday. She has
vomited twice in the past 12 hours. What is your first priority?
A: Refer her immediately for treatment of depression
B: Call social services and report spousal abuse
C: Assess her for pancreatitis
D: Administer a test or scale that assesses alcohol withdrawal: C: Assess her
, HESI Specialty Test Review: Psychiatric/Mental Health Nursing
Study online at https://quizlet.com/_8c8ytj
for pancreatitis
Approximately 65% of cases of pancreatitis are related to alcohol. This patient is
exhibiting the classic symptoms of this disease.
7. Prolonged alcohol ingestion can cause disorders of the liver such as:
A: Pancreatitis
B: Hypomagnesemia
C: Cirrhosis
D: Colitis: C: Cirrhosis
(+) Cirrhosis is a liver disorder that can result from
prolonged ingestion of alcohol.
8. Adolescent suicide has increased over the past and is among the top five
causes of death in U.S. adolescents.
A: TRUE
B: FALSE: A: TRUE
(+) Adolescent suicides have quadrupled since 1950 and
are the third leading cause of death in U.S.
adolescents.
9. Your patient has just received his sixth electroconvulsant therapy outpa-
tient treatment. He tells you that he plans to drive himself home because his
wife is working at her part-time job today. What is your best response?
A: "Be careful and drive slowly."
B: "You need to wait 30 minutes and then you will be safe to drive."
C: "Let me take your vital signs; if they are stable, then you can drive."
D: "You cannot drive. I can call you a cab, or would you prefer to call
your wife or someone for a ride home?": D: "You cannot drive. I can call you a
cab, or would you
prefer to call your wife or someone for a ride home?"
(+) Patients cannot drive after ECT, as its effects can
include disorientation, muscle pain, central nervous
system depression, and cardiac dysrhythmias.
10. Alcohol tolerance develops as a result of the central nervous system's
adaptive mechanisms.
, HESI Specialty Test Review: Psychiatric/Mental Health Nursing
Study online at https://quizlet.com/_8c8ytj
A: TRUE
B: FALSE: A: TRUE
(+) The central nervous system adapts, so more alcohol
is needed to obtain the initial effects of alcohol
ingestion, especially euphoria.
11. Your patient experienced alcohol withdrawal syndrome and now admits he
"needs help." Which of the following is the most appropriate resource to which
you should direct the patient?
A: Reach to Recovery
B: Alcoholics Anonymous
C: Depression support group
D: Suicide support group: B: Alcoholics Anonymous.
(+) Alcoholics Anonymous is the most appropriate
resource for alcoholism, although depression may or
may not be involved in this case.
12. Which of the following is a common symptom of a major depressive
episode?
A: Loss of hearing
B: Increased energy
C: Hopelessness
D: Recurrent thoughts of well-being: C: Hopelessness
(+) Hopelessness, loss of pleasure, and a profound
sense of sadness are symptoms of a major
depressive episode.
13. Which of the following statements would indicate a depressed mood?
A: "I can't wait to go to the ballgame today; it should be fun."
B: "I feel sad today, just like yesterday."
C: "I feel like going to the gym for a workout today, then maybe to a
movie."
D: "Since it's raining outside, how about a game of chess?": B: "I feel sad today,
just like yesterday."
