Galen College of Nursing — NSG 3500 Exam 4 Study Guide (2026/2027 Update) With Complete Solutions
Galen College of Nursing — NSG 3500
Exam 4 Study Guide
Summary Study Guide — 2026/2027 Update — With Complete Solutions
75 Multiple-Choice Questions | 7 Sections | Mental Health Nursing
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
Style: 75% Scenario-Based | 25% Direct Recall / Terminology
Instructions: Select the single best answer for each question. Each question includes a complete rationale
explaining why the correct option is best and why the distractors represent common NSG 3500 Exam 4
pitfalls (substance withdrawal syndrome confusion, eating disorder subtype misidentification, personality
disorder cluster confusion, somatic vs. factitious differentiation, sleep disorder classification errors, crisis
intervention priority errors, suicide risk misinterpretation, psychotropic medication side effect confusion, and
legal/ethical standard misapplication). Use the rationales as a study guide for Galen NSG 3500 Exam 4
topics including substance use disorders, eating disorders, personality disorders, somatic symptom disorders,
sleep-wake disorders, crisis/grief/end-of-life care, psychopharmacology, and legal/ethical issues.
Section 1: Substance Use Disorders
Alcohol, Opioids, Stimulants, Sedatives, and Withdrawal Management (Q1–Q18)
Q1. A 48-year-old male is admitted to the medical-surgical unit for alcohol withdrawal. The nurse plans to use the
CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol-Revised) protocol. Which CIWA-Ar score
range indicates SEVERE withdrawal requiring aggressive pharmacologic intervention?
A. 0-8 points (no withdrawal or very mild).
B. 8-15 points (moderate withdrawal, consider medication).
C. 15-20 points or higher (severe withdrawal; risk of seizures and delirium tremens; immediate
benzodiazepine therapy required). **[CORRECT]**
D. 20-25 points is the only score that requires intervention; below 20 needs only supportive care.
Correct Answer: C
Rationale: The CIWA-Ar assesses 10 withdrawal symptoms (nausea, tremor, paroxysmal sweats, anxiety,
agitation, tactile/auditory/visual disturbances, orientation, headache) with a maximum score of 67. Score 0-8 =
no or mild withdrawal (monitor); 8-15 = moderate (medication often considered); 15-20+ = severe withdrawal
with high risk of seizures and delirium tremens (DTs), requiring immediate benzodiazepine therapy per provider
order. Option D is incorrect—intervention is indicated at 8-10+ depending on protocol; waiting until 20 risks
seizures. CIWA-Ar-guided symptom-triggered dosing reduces total benzodiazepine use compared with
fixed-schedule dosing and is the standard of care per ASAM 2026 guidelines.
Q2. A 52-year-old patient with chronic alcohol use disorder presents with confusion, ataxia, nystagmus, and
ophthalmoplegia. Which of the following is the PRIORITY nursing intervention?
A. Administer a glucose infusion immediately to correct hypoglycemia.
B. Administer IV thiamine (vitamin B1) BEFORE any glucose-containing solution to prevent
worsening of Wernicke's encephalopathy. **[CORRECT]**
Galen NSG 3500 Mental Health Nursing — Exam 4 Page 1
,Galen College of Nursing — NSG 3500 Exam 4 Study Guide (2026/2027 Update) With Complete Solutions
C. Administer IV lorazepam to prevent seizures.
D. Restrict fluids and administer IV furosemide.
Correct Answer: B
Rationale: The classic triad of Wernicke's encephalopathy is confusion, ataxia, and ophthalmoplegia
(nystagmus, lateral rectus palsy). Wernicke's results from thiamine (B1) deficiency due to chronic alcohol use
and poor nutrition. IV thiamine 100 mg MUST be administered BEFORE glucose, because giving glucose alone
will precipitate or worsen Wernicke's encephalopathy by exhausting residual thiamine in glycolysis. Untreated
Wernicke's progresses to Korsakoff syndrome (irreversible anterograde amnesia, confabulation). Option A is
dangerous without thiamine. Option C is for alcohol withdrawal, not Wernicke's. Option D is unrelated. The
Galen NSG 3500 standard: 'Thiamine before glucose in any patient with suspected alcohol use disorder.'
Q3. A patient with alcohol use disorder is asked the four CAGE questions during screening. Which response
pattern indicates a POSITIVE screen requiring further assessment?
A. Two or more 'yes' responses to: Cut down, Annoyed, Guilty, Eye-opener. **[CORRECT]**
B. One 'yes' response to any of the four questions.
C. Three 'no' responses to the four questions.
D. All four 'yes' responses only.
Correct Answer: A
Rationale: The CAGE questionnaire (Cut down, Annoyed by criticism, Guilty, Eye-opener) is a validated
alcohol use disorder screening tool. A score of 2 or more 'yes' responses is considered clinically significant and
indicates a high likelihood of alcohol use disorder warranting further assessment. A single 'yes' response
warrants further exploration but is not diagnostic. Option B is incorrect—one 'yes' alone is subthreshold. Option
C indicates a negative screen. Option D is overly restrictive; 2 of 4 is the established threshold. CAGE has
sensitivity ~75% and specificity ~85% in primary care settings but is less effective for detecting early
problematic drinking.
Q4. A nurse is caring for a patient withdrawing from short-acting opioids (e.g., heroin). Using the Clinical Opiate
Withdrawal Scale (COWS), which findings would indicate moderate withdrawal?
A. COWS score 5-12 (mild withdrawal with slight restlessness).
B. COWS score 13-24 (moderate withdrawal with piloerection, tremor, mild tachycardia, restless, yawning,
lacrimation).
C. COWS score 13-36 range with gooseflesh, muscle twitches, vomiting, anxiety, restlessness, dilated
pupils—typically moderate (13-24) to moderately severe (25-36). **[CORRECT]**
D. COWS score >36 (severe withdrawal with severe vomiting, diarrhea, fever, tachycardia).
Correct Answer: C
Rationale: COWS scoring: 5-12 = mild; 13-24 = moderate; 25-36 = moderately severe; 36+ = severe.
Withdrawal from short-acting opioids (heroin, immediate-release oxycodone) typically begins 6-12 hours after
last use, peaks at 36-72 hours, and resolves in 5-7 days. Symptoms include anxiety, restlessness, diaphoresis,
rhinorrhea, lacrimation, mydriasis, piloerection, muscle aches, vomiting, diarrhea, yawning, and insomnia.
Although intensely uncomfortable, opioid withdrawal is rarely life-threatening in healthy adults, unlike alcohol
or sedative withdrawal. Medication-assisted treatment (methadone, buprenorphine) and α₂-agonists (clonidine,
lofexidine) are first-line for symptom management per ASAM 2026 guidelines.
Q5. A 35-year-old patient with opioid use disorder is starting medication-assisted treatment (MAT). The provider
prescribes buprenorphine. Which statement by the patient indicates understanding of this medication?
A. "I will continue to feel the same high I get from heroin when I take this medication."
B. "Buprenorphine is a partial opioid agonist; it relieves cravings and withdrawal without producing
the full euphoric high. I must be in mild withdrawal before my first dose to avoid precipitated
Galen NSG 3500 Mental Health Nursing — Exam 4 Page 2
,Galen College of Nursing — NSG 3500 Exam 4 Study Guide (2026/2027 Update) With Complete Solutions
withdrawal." **[CORRECT]**
C. "I can take buprenorphine at any time, even while I still have heroin in my system."
D. "Buprenorphine is the same as methadone and works the same way."
Correct Answer: B
Rationale: Buprenorphine is a partial μ-opioid agonist (and κ-antagonist) with a ceiling effect on respiratory
depression—safer than full agonists. Patients must be in mild to moderate withdrawal (COWS ≥8) before the
first buprenorphine dose; otherwise, the partial agonist displaces full agonists from receptors, causing
precipitated withdrawal. Option A is incorrect—buprenorphine does not produce the full high of heroin due to
its partial agonist property and ceiling effect. Option C is the critical error that leads to precipitated withdrawal.
Option D is wrong—methadone is a full μ-agonist with higher overdose risk, dispensed only through OTPs,
while buprenorphine can be prescribed in office-based settings under the MAT Act (DATA-2000/X-waiver
eliminated in 2023).
Q6. A patient is brought to the ED unconscious with miosis, bradypnea (RR 6), and unresponsiveness. The nurse
prepares to administer which medication?
A. IV flumazenil.
B. IV or IM naloxone (opioid antagonist), titrated to restore adequate respiratory rate (target RR
>12), not full consciousness. **[CORRECT]**
C. IV dextrose 50%.
D. IV thiamine only.
Correct Answer: B
Rationale: The presentation (miosis, bradypnea, unresponsiveness) is classic opioid overdose. Naloxone, a pure
μ-opioid antagonist, rapidly reverses opioid-induced respiratory depression. The 2026 AMA/CDC
recommendation is to titrate naloxone to restore adequate respiration (RR >10-12) rather than full
consciousness, to avoid precipitating acute withdrawal and to minimize required dose. Intranasal naloxone 4-8
mg is also effective in the community setting. Option A (flumazenil) is for benzodiazepine overdose and is
contraindicated in chronic benzodiazepine users due to seizure risk. Option C is for hypoglycemia. Option D is
for Wernicke's encephalopathy. Naloxone has a shorter half-life (30-80 min) than most opioids, so continuous
monitoring and repeat dosing or infusion may be needed.
Q7. A patient using intravenous heroin is being transitioned to methadone maintenance therapy. Which statement
by the patient indicates a NEED for further teaching?
A. "I will need to visit a licensed Opioid Treatment Program daily for observed dosing initially."
B. "Methadone is a long-acting full opioid agonist that prevents withdrawal and reduces cravings for 24-36
hours."
C. "Once I'm stable on methadone, I can stop suddenly whenever I want without withdrawal
symptoms." **[CORRECT]**
D. "Methadone can prolong the QTc interval, so I'll need periodic ECGs and avoid combining with other
QT-prolonging drugs."
Correct Answer: C
Rationale: Methadone is a long-acting full μ-opioid agonist (half-life 8-59 hours) used for opioid use disorder
treatment and chronic pain. Sudden discontinuation causes prolonged, severe withdrawal. Methadone is
dispensed only at SAMHSA-certified Opioid Treatment Programs (OTP), with observed daily dosing initially
and take-home privileges earned over time. Methadone prolongs the QTc and can cause torsades de pointes, so
baseline and periodic ECG monitoring is required, and combination with other QT-prolonging drugs (e.g.,
certain antidepressants, antipsychotics) must be reviewed. Option C requires teaching—methadone cessation
should be slow and supervised. The goal of methadone maintenance is long-term stabilization, not rapid taper.
Q8. A patient with alcohol use disorder is prescribed disulfiram. Which teaching is MOST critical to include?
Galen NSG 3500 Mental Health Nursing — Exam 4 Page 3
, Galen College of Nursing — NSG 3500 Exam 4 Study Guide (2026/2027 Update) With Complete Solutions
A. Take disulfiram only when experiencing cravings.
B. Avoid ALL sources of alcohol—including mouthwash, cough syrups, aftershave, vinegars, and
certain hand sanitizers—because disulfiram blocks aldehyde dehydrogenase, causing
acetaldehyde accumulation with nausea, vomiting, flushing, hypotension, and potentially death.
**[CORRECT]**
C. Disulfiram will reduce cravings and prevent withdrawal.
D. Disulfiram works the same way as naltrexone.
Correct Answer: B
Rationale: Disulfiram inhibits aldehyde dehydrogenase (ALDH), the second enzyme in alcohol metabolism.
When alcohol is consumed, acetaldehyde accumulates, causing the disulfiram-alcohol reaction: flushing,
headache, nausea, vomiting, palpitations, hypotension, and in severe cases cardiovascular collapse and death.
Patients must avoid all hidden alcohol sources (mouthwash, cough/cold preparations, aftershave, certain
vinegars, fermented foods, hand sanitizers if ingested). Disulfiram is contraindicated in cardiovascular disease,
severe psychiatric illness, and pregnancy. It is aversive therapy—not a craving reducer (Option C) and works
through enzyme inhibition, not opioid antagonism (Option D, naltrexone). Adherence is the major limitation;
supervised administration improves outcomes.
Q9. A 28-year-old patient presents to the ED with acute cocaine intoxication. Which assessment finding requires
IMMEDIATE nursing intervention?
A. Dilated pupils and elevated mood.
B. Chest pain with ST elevations on ECG, tachycardia (HR 130), BP 180/110, and diaphoresis.
**[CORRECT]**
C. Nasal congestion and runny nose.
D. Increased energy and talkativeness.
Correct Answer: B
Rationale: Cocaine is a powerful sympathomimetic that blocks reuptake of dopamine, norepinephrine, and
serotonin, causing intense vasoconstriction, hypertension, tachycardia, and increased myocardial oxygen
demand. Chest pain with ST elevations indicates acute myocardial infarction—a life-threatening complication
requiring immediate cardiac monitoring, aspirin, nitroglycerin (use caution with cocaine-induced coronary
vasospasm; benzodiazepines are first-line to reduce sympathetic surge), and possible reperfusion.
Cocaine-induced chest pain has a 6% risk of MI within 12 hours. Beta-blockers are relatively contraindicated in
acute cocaine toxicity due to unopposed α-mediated vasoconstriction (though this remains debated in 2026
literature). Options A, C, D are expected findings that require monitoring but are not emergencies.
Q10. A patient is withdrawing from long-term methamphetamine use. Which clinical presentation is expected
during the 'crash' phase?
A. Hyperactivity, agitation, and euphoria.
B. Hypersomnia, hyperphagia, depression, anhedonia, and profound fatigue lasting days to weeks.
**[CORRECT]**
C. Tachycardia, hypertension, and dilated pupils.
D. Visual hallucinations and delusions.
Correct Answer: B
Galen NSG 3500 Mental Health Nursing — Exam 4 Page 4
Galen College of Nursing — NSG 3500
Exam 4 Study Guide
Summary Study Guide — 2026/2027 Update — With Complete Solutions
75 Multiple-Choice Questions | 7 Sections | Mental Health Nursing
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
Style: 75% Scenario-Based | 25% Direct Recall / Terminology
Instructions: Select the single best answer for each question. Each question includes a complete rationale
explaining why the correct option is best and why the distractors represent common NSG 3500 Exam 4
pitfalls (substance withdrawal syndrome confusion, eating disorder subtype misidentification, personality
disorder cluster confusion, somatic vs. factitious differentiation, sleep disorder classification errors, crisis
intervention priority errors, suicide risk misinterpretation, psychotropic medication side effect confusion, and
legal/ethical standard misapplication). Use the rationales as a study guide for Galen NSG 3500 Exam 4
topics including substance use disorders, eating disorders, personality disorders, somatic symptom disorders,
sleep-wake disorders, crisis/grief/end-of-life care, psychopharmacology, and legal/ethical issues.
Section 1: Substance Use Disorders
Alcohol, Opioids, Stimulants, Sedatives, and Withdrawal Management (Q1–Q18)
Q1. A 48-year-old male is admitted to the medical-surgical unit for alcohol withdrawal. The nurse plans to use the
CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol-Revised) protocol. Which CIWA-Ar score
range indicates SEVERE withdrawal requiring aggressive pharmacologic intervention?
A. 0-8 points (no withdrawal or very mild).
B. 8-15 points (moderate withdrawal, consider medication).
C. 15-20 points or higher (severe withdrawal; risk of seizures and delirium tremens; immediate
benzodiazepine therapy required). **[CORRECT]**
D. 20-25 points is the only score that requires intervention; below 20 needs only supportive care.
Correct Answer: C
Rationale: The CIWA-Ar assesses 10 withdrawal symptoms (nausea, tremor, paroxysmal sweats, anxiety,
agitation, tactile/auditory/visual disturbances, orientation, headache) with a maximum score of 67. Score 0-8 =
no or mild withdrawal (monitor); 8-15 = moderate (medication often considered); 15-20+ = severe withdrawal
with high risk of seizures and delirium tremens (DTs), requiring immediate benzodiazepine therapy per provider
order. Option D is incorrect—intervention is indicated at 8-10+ depending on protocol; waiting until 20 risks
seizures. CIWA-Ar-guided symptom-triggered dosing reduces total benzodiazepine use compared with
fixed-schedule dosing and is the standard of care per ASAM 2026 guidelines.
Q2. A 52-year-old patient with chronic alcohol use disorder presents with confusion, ataxia, nystagmus, and
ophthalmoplegia. Which of the following is the PRIORITY nursing intervention?
A. Administer a glucose infusion immediately to correct hypoglycemia.
B. Administer IV thiamine (vitamin B1) BEFORE any glucose-containing solution to prevent
worsening of Wernicke's encephalopathy. **[CORRECT]**
Galen NSG 3500 Mental Health Nursing — Exam 4 Page 1
,Galen College of Nursing — NSG 3500 Exam 4 Study Guide (2026/2027 Update) With Complete Solutions
C. Administer IV lorazepam to prevent seizures.
D. Restrict fluids and administer IV furosemide.
Correct Answer: B
Rationale: The classic triad of Wernicke's encephalopathy is confusion, ataxia, and ophthalmoplegia
(nystagmus, lateral rectus palsy). Wernicke's results from thiamine (B1) deficiency due to chronic alcohol use
and poor nutrition. IV thiamine 100 mg MUST be administered BEFORE glucose, because giving glucose alone
will precipitate or worsen Wernicke's encephalopathy by exhausting residual thiamine in glycolysis. Untreated
Wernicke's progresses to Korsakoff syndrome (irreversible anterograde amnesia, confabulation). Option A is
dangerous without thiamine. Option C is for alcohol withdrawal, not Wernicke's. Option D is unrelated. The
Galen NSG 3500 standard: 'Thiamine before glucose in any patient with suspected alcohol use disorder.'
Q3. A patient with alcohol use disorder is asked the four CAGE questions during screening. Which response
pattern indicates a POSITIVE screen requiring further assessment?
A. Two or more 'yes' responses to: Cut down, Annoyed, Guilty, Eye-opener. **[CORRECT]**
B. One 'yes' response to any of the four questions.
C. Three 'no' responses to the four questions.
D. All four 'yes' responses only.
Correct Answer: A
Rationale: The CAGE questionnaire (Cut down, Annoyed by criticism, Guilty, Eye-opener) is a validated
alcohol use disorder screening tool. A score of 2 or more 'yes' responses is considered clinically significant and
indicates a high likelihood of alcohol use disorder warranting further assessment. A single 'yes' response
warrants further exploration but is not diagnostic. Option B is incorrect—one 'yes' alone is subthreshold. Option
C indicates a negative screen. Option D is overly restrictive; 2 of 4 is the established threshold. CAGE has
sensitivity ~75% and specificity ~85% in primary care settings but is less effective for detecting early
problematic drinking.
Q4. A nurse is caring for a patient withdrawing from short-acting opioids (e.g., heroin). Using the Clinical Opiate
Withdrawal Scale (COWS), which findings would indicate moderate withdrawal?
A. COWS score 5-12 (mild withdrawal with slight restlessness).
B. COWS score 13-24 (moderate withdrawal with piloerection, tremor, mild tachycardia, restless, yawning,
lacrimation).
C. COWS score 13-36 range with gooseflesh, muscle twitches, vomiting, anxiety, restlessness, dilated
pupils—typically moderate (13-24) to moderately severe (25-36). **[CORRECT]**
D. COWS score >36 (severe withdrawal with severe vomiting, diarrhea, fever, tachycardia).
Correct Answer: C
Rationale: COWS scoring: 5-12 = mild; 13-24 = moderate; 25-36 = moderately severe; 36+ = severe.
Withdrawal from short-acting opioids (heroin, immediate-release oxycodone) typically begins 6-12 hours after
last use, peaks at 36-72 hours, and resolves in 5-7 days. Symptoms include anxiety, restlessness, diaphoresis,
rhinorrhea, lacrimation, mydriasis, piloerection, muscle aches, vomiting, diarrhea, yawning, and insomnia.
Although intensely uncomfortable, opioid withdrawal is rarely life-threatening in healthy adults, unlike alcohol
or sedative withdrawal. Medication-assisted treatment (methadone, buprenorphine) and α₂-agonists (clonidine,
lofexidine) are first-line for symptom management per ASAM 2026 guidelines.
Q5. A 35-year-old patient with opioid use disorder is starting medication-assisted treatment (MAT). The provider
prescribes buprenorphine. Which statement by the patient indicates understanding of this medication?
A. "I will continue to feel the same high I get from heroin when I take this medication."
B. "Buprenorphine is a partial opioid agonist; it relieves cravings and withdrawal without producing
the full euphoric high. I must be in mild withdrawal before my first dose to avoid precipitated
Galen NSG 3500 Mental Health Nursing — Exam 4 Page 2
,Galen College of Nursing — NSG 3500 Exam 4 Study Guide (2026/2027 Update) With Complete Solutions
withdrawal." **[CORRECT]**
C. "I can take buprenorphine at any time, even while I still have heroin in my system."
D. "Buprenorphine is the same as methadone and works the same way."
Correct Answer: B
Rationale: Buprenorphine is a partial μ-opioid agonist (and κ-antagonist) with a ceiling effect on respiratory
depression—safer than full agonists. Patients must be in mild to moderate withdrawal (COWS ≥8) before the
first buprenorphine dose; otherwise, the partial agonist displaces full agonists from receptors, causing
precipitated withdrawal. Option A is incorrect—buprenorphine does not produce the full high of heroin due to
its partial agonist property and ceiling effect. Option C is the critical error that leads to precipitated withdrawal.
Option D is wrong—methadone is a full μ-agonist with higher overdose risk, dispensed only through OTPs,
while buprenorphine can be prescribed in office-based settings under the MAT Act (DATA-2000/X-waiver
eliminated in 2023).
Q6. A patient is brought to the ED unconscious with miosis, bradypnea (RR 6), and unresponsiveness. The nurse
prepares to administer which medication?
A. IV flumazenil.
B. IV or IM naloxone (opioid antagonist), titrated to restore adequate respiratory rate (target RR
>12), not full consciousness. **[CORRECT]**
C. IV dextrose 50%.
D. IV thiamine only.
Correct Answer: B
Rationale: The presentation (miosis, bradypnea, unresponsiveness) is classic opioid overdose. Naloxone, a pure
μ-opioid antagonist, rapidly reverses opioid-induced respiratory depression. The 2026 AMA/CDC
recommendation is to titrate naloxone to restore adequate respiration (RR >10-12) rather than full
consciousness, to avoid precipitating acute withdrawal and to minimize required dose. Intranasal naloxone 4-8
mg is also effective in the community setting. Option A (flumazenil) is for benzodiazepine overdose and is
contraindicated in chronic benzodiazepine users due to seizure risk. Option C is for hypoglycemia. Option D is
for Wernicke's encephalopathy. Naloxone has a shorter half-life (30-80 min) than most opioids, so continuous
monitoring and repeat dosing or infusion may be needed.
Q7. A patient using intravenous heroin is being transitioned to methadone maintenance therapy. Which statement
by the patient indicates a NEED for further teaching?
A. "I will need to visit a licensed Opioid Treatment Program daily for observed dosing initially."
B. "Methadone is a long-acting full opioid agonist that prevents withdrawal and reduces cravings for 24-36
hours."
C. "Once I'm stable on methadone, I can stop suddenly whenever I want without withdrawal
symptoms." **[CORRECT]**
D. "Methadone can prolong the QTc interval, so I'll need periodic ECGs and avoid combining with other
QT-prolonging drugs."
Correct Answer: C
Rationale: Methadone is a long-acting full μ-opioid agonist (half-life 8-59 hours) used for opioid use disorder
treatment and chronic pain. Sudden discontinuation causes prolonged, severe withdrawal. Methadone is
dispensed only at SAMHSA-certified Opioid Treatment Programs (OTP), with observed daily dosing initially
and take-home privileges earned over time. Methadone prolongs the QTc and can cause torsades de pointes, so
baseline and periodic ECG monitoring is required, and combination with other QT-prolonging drugs (e.g.,
certain antidepressants, antipsychotics) must be reviewed. Option C requires teaching—methadone cessation
should be slow and supervised. The goal of methadone maintenance is long-term stabilization, not rapid taper.
Q8. A patient with alcohol use disorder is prescribed disulfiram. Which teaching is MOST critical to include?
Galen NSG 3500 Mental Health Nursing — Exam 4 Page 3
, Galen College of Nursing — NSG 3500 Exam 4 Study Guide (2026/2027 Update) With Complete Solutions
A. Take disulfiram only when experiencing cravings.
B. Avoid ALL sources of alcohol—including mouthwash, cough syrups, aftershave, vinegars, and
certain hand sanitizers—because disulfiram blocks aldehyde dehydrogenase, causing
acetaldehyde accumulation with nausea, vomiting, flushing, hypotension, and potentially death.
**[CORRECT]**
C. Disulfiram will reduce cravings and prevent withdrawal.
D. Disulfiram works the same way as naltrexone.
Correct Answer: B
Rationale: Disulfiram inhibits aldehyde dehydrogenase (ALDH), the second enzyme in alcohol metabolism.
When alcohol is consumed, acetaldehyde accumulates, causing the disulfiram-alcohol reaction: flushing,
headache, nausea, vomiting, palpitations, hypotension, and in severe cases cardiovascular collapse and death.
Patients must avoid all hidden alcohol sources (mouthwash, cough/cold preparations, aftershave, certain
vinegars, fermented foods, hand sanitizers if ingested). Disulfiram is contraindicated in cardiovascular disease,
severe psychiatric illness, and pregnancy. It is aversive therapy—not a craving reducer (Option C) and works
through enzyme inhibition, not opioid antagonism (Option D, naltrexone). Adherence is the major limitation;
supervised administration improves outcomes.
Q9. A 28-year-old patient presents to the ED with acute cocaine intoxication. Which assessment finding requires
IMMEDIATE nursing intervention?
A. Dilated pupils and elevated mood.
B. Chest pain with ST elevations on ECG, tachycardia (HR 130), BP 180/110, and diaphoresis.
**[CORRECT]**
C. Nasal congestion and runny nose.
D. Increased energy and talkativeness.
Correct Answer: B
Rationale: Cocaine is a powerful sympathomimetic that blocks reuptake of dopamine, norepinephrine, and
serotonin, causing intense vasoconstriction, hypertension, tachycardia, and increased myocardial oxygen
demand. Chest pain with ST elevations indicates acute myocardial infarction—a life-threatening complication
requiring immediate cardiac monitoring, aspirin, nitroglycerin (use caution with cocaine-induced coronary
vasospasm; benzodiazepines are first-line to reduce sympathetic surge), and possible reperfusion.
Cocaine-induced chest pain has a 6% risk of MI within 12 hours. Beta-blockers are relatively contraindicated in
acute cocaine toxicity due to unopposed α-mediated vasoconstriction (though this remains debated in 2026
literature). Options A, C, D are expected findings that require monitoring but are not emergencies.
Q10. A patient is withdrawing from long-term methamphetamine use. Which clinical presentation is expected
during the 'crash' phase?
A. Hyperactivity, agitation, and euphoria.
B. Hypersomnia, hyperphagia, depression, anhedonia, and profound fatigue lasting days to weeks.
**[CORRECT]**
C. Tachycardia, hypertension, and dilated pupils.
D. Visual hallucinations and delusions.
Correct Answer: B
Galen NSG 3500 Mental Health Nursing — Exam 4 Page 4
