MH FINAL REVIEW UPDATED QUESTIONS AND
CORRECT ANSWERS
Question:
1. A patient diagnosed with social phobia begins propranolol. The nurse should teach the patient to
expect what reaction to this therapy?
a. Sympathetic nervous system symptoms
of anxiety will be reduced.
b. A sense of euphoria for 30 minutes after
taking the drug.
c. Experience amnesia for the social situa-
tions that are most intimidating.
d. Feeling a little drowsy but having no or-
thostatic hypotension.
Answer:
ANS: A Propranolol is a beta blocker that inter-rupts the physiologic responses of anxi-ety associated
with social phobias, such as sweaty palms. Bradycardia may be as-sociated with lightheadedness. The
other options are not likely.
Question:
2. The teaching plan for a patient begin-ning oxazepam should include what in-structions? (Select all
that apply.)
a. Take the drug on an empty stomach.
b. Avoid discontinuing the drug abruptly.
c. Stop taking the drug if side effects occur.
d. Drink only moderate amounts of alcohol.
e. Avoid herbal preparations.
Answer:
ANS: B, E Patients must be informed that abrupt discontinuation of benzodiazepines pro-duces
withdrawal symptoms. Use of herbal preparations such as kava-kava and valerian can produce
harmful additive effects. The other options contain infor-mation that is inappropriate to teach
pa-tients.
Question:
3. A patient takes antacids, cimetidine, and phenytoin. The health care provider pre-scribes a
benzodiazepine for anxiety. Which drug interactions is the patient at risk for experiencing? (Select all
that apply.)
a. Increased plasma level of benzodiazepine
related to cimetidine therapy
b. Increased absorption of the benzodi-
azepine if taken with the antacid
c. Euphoria and disinhibition associated
with phenytoin therapy
d. Serotonin syndrome associated with
cimetidine use
e. Potential phenytoin toxicity
,Answer:
ANS: A, E Cimetidine increases the plasma level of benzodiazepines. The benzodiazepine in-terferes
with phenytoin metabolism, thus increasing serum levels of the anticonvul-sants. The distracters do
not reflect actual interactions.
Question:
4. A patient in the emergency room is sus-pected to have an overdose of benzodi-azepines. Which
assessment findings vali-date this diagnosis? (Select all that apply.)
a. Blood pressure 180/94 mm Hg
b. Diminished reflexes
c. Hypervigilance
d. Somnolence
e. Confusion
Answer:
ANS: A, D, E Benzodiazepine toxicity may result from an overdose. Assessment findings in-clude
hypotension, somnolence, confu-sion, and diminished reflexes. *This ques-tion seems wrong and
should be "BDE" but correct me if I am wrong :)*
Question:
5. By what mechanism does lorazepam re-duce anxiety?
a. Increasing serotonin levels
b. Blocking dopamine receptors
c. Depressing norepinephrine levels
d. Potentiating gamma-aminobutyric acid
(GABA)
Answer:
ANS: D Benzodiazepines enhance the effects of the inhibitory neurotransmitter GABA, slowing
neuronal firing. They do not affect dopamine, serotonin, or norepinephrine.
Question:
6. A patient started diazepam 5 mg twice daily 6 months ago. Now, the patient re-quires 10 mg to
achieve the same effect. What phenomenon is responsible for this situation?
a. Addiction
b. Tolerance
c. Dependence
d. Disinhibition
Answer:
ANS: B Tolerance is the need for increasing amounts of a substance to achieve the same effects. The
other terms, defined in the text, do not account for this phenom-enon.
Question:
7. A patient diagnosed with agoraphobia took alprazolam 0.5 mg three times daily for 3 months and
then discontinued it. The next day the patient called the nurse reporting insomnia, shakiness, and
sweating. What should be the focus of the nurse's assess-ment questions?
a. Whether the patient may have also been
drinking alcohol or taking antihistamines.
b. The possibility that the patient has built
up tolerance to alprazolam and needs an increased dose.
c. The likelihood that the patient is having
,withdrawal symptoms from abrupt discon-tinuation of the drug.
d. Whether the patient has progressed to
panic attacks and needs a nonbenzodi-azepine medication.
Answer:
ANS: C The patient's symptoms suggest benzo-diazepine withdrawal. The nurse knows that patients
often attempt to manage their own care by discontinuing medica-tion when they begin to feel better.
Ben-zodiazepines should be slowly withdrawn if withdrawal symptoms are to be avoided. Drinking
alcohol would result in different symptoms. Development of tolerance and panic attack symptoms
would be different from those mentioned.
Question:
8. An emergency room patient was very anxious after a serious car accident. Lo-razepam 2 mg
intramuscularly was admin-istered. One hour later, which finding indi-cates to the nurse that the
medication was effective?
a. Improved problem-solving skills
b. Increased alertness
c. Increased verbalization
d. Reduced environmental scanning
Answer:
ANS: D Benzodiazepines mute incoming stimuli and evoke less reaction. The hyperalert-ness and
environmental scanning that ac-company high anxiety are notably de-creased when the drug is
effective. Im-paired problem-solving is a negative out-come. Because of its sedating properties, the
individual might not be more alert, talkative, or active.
Question:
9. A patient has taken diazepam for 1 week for back spasms. The patient reports "feel-ing sleepy all
the time." Which response will best address the patient's concern?
a. "The dosage probably needs to be de-
creased."
b. "Drowsiness indicates a paradoxical reac-
tion to the drug."
c. "Tolerance to the sedative effect of the
drug will develop quickly."
d. "Sleepiness is an unavoidable side effect
of nonbenzodiazepine drugs."
Answer:
ANS: C Tolerance to most side effects of benzodi-azepines, including drowsiness, develops quickly.
There is no need to decrease the dosage. Drowsiness is an expected reac-tion, not a paradoxical one.
Valium is a benzodiazepine.
Question:
10. A patient has taken clonazepam for years to manage panic attacks but impulsively stopped the
drug. Thirty hours later, the patient comes to the emergency room in distress. What is the nurse's
priority action?
a. Begin seizure precautions.
b. Refer the patient for addiction counsel-
ing.
c. Institute a behavior modification pro-
gram.
, d. Prepare to administer flumazenil.
Answer:
ANS: A There is evidence to suggest that abrupt withdrawal of clonazepam might precipi-tate status
epilepticus. With this in mind, withdrawal from long-term use warrants seizure precautions. The
patient does not have an overdose, so flumazenil is not in-dicated. The other options are
inappro-priate.
Question:
11. Which patient behavior should the nurse identify as the greatest risk for overdose with a
benzodiazepine?
a. Taking the drug with antacids
b. Taking the drug before meals
c. Combining the drug with alcohol
d. Experiencing depression as well as anxi-
ety
Answer:
ANS: C Benzodiazepines taken with alcohol pro-duce marked central nervous system (CNS)
depression, even death. Antacids prevent absorption. Larger doses of ben-zodiazepines by themselves
are rarely lethal. Depression in and of itself is not an indicator of overdose risk. Suicidal ideation
might be present, but benzodi-azepines by themselves are rarely lethal.
Question:
12. The nurse would expect to administer flumazenil for a patient with which diagno-sis?
a. Acute alcohol withdrawal
b. Benzodiazepine overdose
c. Benzodiazepine-resistant anxiety
d. Psychotic disorder
Answer:
ANS: B Flumazenil is a benzodiazepine receptor antagonist. Response occurs within 30 to 60
seconds; however, it might not re-verse associated respiratory depression. Because it has a short
duration of action and does not speed metabolism of ben-zodiazepines, administration of flumazenil
might need to be repeated several times. Flumazenil is not indicated for treatment of any of the other
conditions.
Question:
13. A patient received one dose of flumazenil. What is the nurse's next action?
a. Carefully observe for benzodiazepine
overdose symptoms.
b. Teach the patient about dietary restric-
tions.
c. Prevent injury during seizure activity.
d. Force 500 mL oral fluids over 2 hours.
Answer:
ANS: A Flumazenil, which is given to patients who have overdosed with benzodiazepines and so the
nurse must be vigilant for signs that the patient is reverting to the pre-flumazenil state. None of the
other op-tions are relevant to this medication.
CORRECT ANSWERS
Question:
1. A patient diagnosed with social phobia begins propranolol. The nurse should teach the patient to
expect what reaction to this therapy?
a. Sympathetic nervous system symptoms
of anxiety will be reduced.
b. A sense of euphoria for 30 minutes after
taking the drug.
c. Experience amnesia for the social situa-
tions that are most intimidating.
d. Feeling a little drowsy but having no or-
thostatic hypotension.
Answer:
ANS: A Propranolol is a beta blocker that inter-rupts the physiologic responses of anxi-ety associated
with social phobias, such as sweaty palms. Bradycardia may be as-sociated with lightheadedness. The
other options are not likely.
Question:
2. The teaching plan for a patient begin-ning oxazepam should include what in-structions? (Select all
that apply.)
a. Take the drug on an empty stomach.
b. Avoid discontinuing the drug abruptly.
c. Stop taking the drug if side effects occur.
d. Drink only moderate amounts of alcohol.
e. Avoid herbal preparations.
Answer:
ANS: B, E Patients must be informed that abrupt discontinuation of benzodiazepines pro-duces
withdrawal symptoms. Use of herbal preparations such as kava-kava and valerian can produce
harmful additive effects. The other options contain infor-mation that is inappropriate to teach
pa-tients.
Question:
3. A patient takes antacids, cimetidine, and phenytoin. The health care provider pre-scribes a
benzodiazepine for anxiety. Which drug interactions is the patient at risk for experiencing? (Select all
that apply.)
a. Increased plasma level of benzodiazepine
related to cimetidine therapy
b. Increased absorption of the benzodi-
azepine if taken with the antacid
c. Euphoria and disinhibition associated
with phenytoin therapy
d. Serotonin syndrome associated with
cimetidine use
e. Potential phenytoin toxicity
,Answer:
ANS: A, E Cimetidine increases the plasma level of benzodiazepines. The benzodiazepine in-terferes
with phenytoin metabolism, thus increasing serum levels of the anticonvul-sants. The distracters do
not reflect actual interactions.
Question:
4. A patient in the emergency room is sus-pected to have an overdose of benzodi-azepines. Which
assessment findings vali-date this diagnosis? (Select all that apply.)
a. Blood pressure 180/94 mm Hg
b. Diminished reflexes
c. Hypervigilance
d. Somnolence
e. Confusion
Answer:
ANS: A, D, E Benzodiazepine toxicity may result from an overdose. Assessment findings in-clude
hypotension, somnolence, confu-sion, and diminished reflexes. *This ques-tion seems wrong and
should be "BDE" but correct me if I am wrong :)*
Question:
5. By what mechanism does lorazepam re-duce anxiety?
a. Increasing serotonin levels
b. Blocking dopamine receptors
c. Depressing norepinephrine levels
d. Potentiating gamma-aminobutyric acid
(GABA)
Answer:
ANS: D Benzodiazepines enhance the effects of the inhibitory neurotransmitter GABA, slowing
neuronal firing. They do not affect dopamine, serotonin, or norepinephrine.
Question:
6. A patient started diazepam 5 mg twice daily 6 months ago. Now, the patient re-quires 10 mg to
achieve the same effect. What phenomenon is responsible for this situation?
a. Addiction
b. Tolerance
c. Dependence
d. Disinhibition
Answer:
ANS: B Tolerance is the need for increasing amounts of a substance to achieve the same effects. The
other terms, defined in the text, do not account for this phenom-enon.
Question:
7. A patient diagnosed with agoraphobia took alprazolam 0.5 mg three times daily for 3 months and
then discontinued it. The next day the patient called the nurse reporting insomnia, shakiness, and
sweating. What should be the focus of the nurse's assess-ment questions?
a. Whether the patient may have also been
drinking alcohol or taking antihistamines.
b. The possibility that the patient has built
up tolerance to alprazolam and needs an increased dose.
c. The likelihood that the patient is having
,withdrawal symptoms from abrupt discon-tinuation of the drug.
d. Whether the patient has progressed to
panic attacks and needs a nonbenzodi-azepine medication.
Answer:
ANS: C The patient's symptoms suggest benzo-diazepine withdrawal. The nurse knows that patients
often attempt to manage their own care by discontinuing medica-tion when they begin to feel better.
Ben-zodiazepines should be slowly withdrawn if withdrawal symptoms are to be avoided. Drinking
alcohol would result in different symptoms. Development of tolerance and panic attack symptoms
would be different from those mentioned.
Question:
8. An emergency room patient was very anxious after a serious car accident. Lo-razepam 2 mg
intramuscularly was admin-istered. One hour later, which finding indi-cates to the nurse that the
medication was effective?
a. Improved problem-solving skills
b. Increased alertness
c. Increased verbalization
d. Reduced environmental scanning
Answer:
ANS: D Benzodiazepines mute incoming stimuli and evoke less reaction. The hyperalert-ness and
environmental scanning that ac-company high anxiety are notably de-creased when the drug is
effective. Im-paired problem-solving is a negative out-come. Because of its sedating properties, the
individual might not be more alert, talkative, or active.
Question:
9. A patient has taken diazepam for 1 week for back spasms. The patient reports "feel-ing sleepy all
the time." Which response will best address the patient's concern?
a. "The dosage probably needs to be de-
creased."
b. "Drowsiness indicates a paradoxical reac-
tion to the drug."
c. "Tolerance to the sedative effect of the
drug will develop quickly."
d. "Sleepiness is an unavoidable side effect
of nonbenzodiazepine drugs."
Answer:
ANS: C Tolerance to most side effects of benzodi-azepines, including drowsiness, develops quickly.
There is no need to decrease the dosage. Drowsiness is an expected reac-tion, not a paradoxical one.
Valium is a benzodiazepine.
Question:
10. A patient has taken clonazepam for years to manage panic attacks but impulsively stopped the
drug. Thirty hours later, the patient comes to the emergency room in distress. What is the nurse's
priority action?
a. Begin seizure precautions.
b. Refer the patient for addiction counsel-
ing.
c. Institute a behavior modification pro-
gram.
, d. Prepare to administer flumazenil.
Answer:
ANS: A There is evidence to suggest that abrupt withdrawal of clonazepam might precipi-tate status
epilepticus. With this in mind, withdrawal from long-term use warrants seizure precautions. The
patient does not have an overdose, so flumazenil is not in-dicated. The other options are
inappro-priate.
Question:
11. Which patient behavior should the nurse identify as the greatest risk for overdose with a
benzodiazepine?
a. Taking the drug with antacids
b. Taking the drug before meals
c. Combining the drug with alcohol
d. Experiencing depression as well as anxi-
ety
Answer:
ANS: C Benzodiazepines taken with alcohol pro-duce marked central nervous system (CNS)
depression, even death. Antacids prevent absorption. Larger doses of ben-zodiazepines by themselves
are rarely lethal. Depression in and of itself is not an indicator of overdose risk. Suicidal ideation
might be present, but benzodi-azepines by themselves are rarely lethal.
Question:
12. The nurse would expect to administer flumazenil for a patient with which diagno-sis?
a. Acute alcohol withdrawal
b. Benzodiazepine overdose
c. Benzodiazepine-resistant anxiety
d. Psychotic disorder
Answer:
ANS: B Flumazenil is a benzodiazepine receptor antagonist. Response occurs within 30 to 60
seconds; however, it might not re-verse associated respiratory depression. Because it has a short
duration of action and does not speed metabolism of ben-zodiazepines, administration of flumazenil
might need to be repeated several times. Flumazenil is not indicated for treatment of any of the other
conditions.
Question:
13. A patient received one dose of flumazenil. What is the nurse's next action?
a. Carefully observe for benzodiazepine
overdose symptoms.
b. Teach the patient about dietary restric-
tions.
c. Prevent injury during seizure activity.
d. Force 500 mL oral fluids over 2 hours.
Answer:
ANS: A Flumazenil, which is given to patients who have overdosed with benzodiazepines and so the
nurse must be vigilant for signs that the patient is reverting to the pre-flumazenil state. None of the
other op-tions are relevant to this medication.
