MENTAL HEALTH EXAM 2024-2025
WITH ACTUAL EXAM QUESTIONS AND
CORRECT DETAILED SOLUTIONS
ALREADY GRADED A+
. A patient with agoraphobia took alprazolam (Xanax) 0.5 mg t.i.d. for 3 months and
then discontinued it. The next day, the patient called the nurse complaining of insomnia,
shakiness, and sweating. The nurse's assessment questions should focus on whether
the patient:
a. may have also been drinking alcohol or taking antihistamines.
b. has built up tolerance to alprazolam and needs an increased dose.
c. is having withdrawal symptoms from abrupt discontinuation of the drug.
d. has progressed to panic attacks and needs a nonbenzodiazepine medication. -
answers-ANS: C
The patient's symptoms suggest benzodiazepine withdrawal. The nurse knows that
patients often attempt to manage their own care by discontinuing medication when they
begin to feel better. Benzodiazepines should be slowly withdrawn if withdrawal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.
An emergency room patient was very anxious after a serious car accident. Lorazepam
(Ativan) 2 mg IM was administered. One hour later, which finding indicates to the nurse
that the medication was effective?
a. Impaired problem-solving skills
b. Increased alertness and attention
c. Increased verbalization and activity
d. Reduced agitation and environmental scanning - answers-ANS: D
Benzodiazepines mute incoming stimuli and evoke less reaction. The hyperalertness
and environmental scanning that accompany high anxiety are notably decreased when
the drug is effective. Impaired problem solving is a negative outcome. Because of its
sedating properties, the individual might not be more alert, talkative, or active.
5. A patient has taken diazepam (Valium) for one week for back spasms. The patient
complains of "feeling sleepy all the time." The nurse should tell the patient:
a."The dosage probably needs to be decreased."
b."Drowsiness indicates a paradoxical reaction 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." - answers-
ANS: C
Tolerance to most side effects of benzodiazepines, including drowsiness, develops
quickly. There is no need to decrease the dosage. Drowsiness is an expected reaction,
not a paradoxical one. Valium is a benzodiazepine.
6. A patient has taken clonazepam (Klonopin) 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 counseling.
c. Institute a behavior modification program.
d. Prepare to administer flumazenil (Romazicon) - answers-ANS: A
There is evidence to suggest that abrupt withdrawal of clonazepam might precipitate
status epilepticus. With this in mind, withdrawal from long-term use warrants seizure
precautions. The patient does not have an overdose, so flumazenil (Romazicon) is not
indicated. The other options are inappropriate.
7. Which patient has the greatest risk for overdose with a benzodiazepine? A patient
who:
a. takes the drug with antacids
b. takes the drug before meals
c. combines the drug with alcohol
d. experiences depression as well as anxiety - answers-ANS: C
Benzodiazepines taken with alcohol produce marked CNS depression, even death.
Antacids prevent absorption. Larger doses of benzodiazepines by themselves are rarely
lethal. Depression in and of itself is not an indicator of overdose risk. Suicidal ideation
might be present, but benzodiazepines by themselves are rarely lethal.
8. The nurse would expect to administer flumazenil (Romazicon) for a patient:
a.in acute alcohol withdrawal.
b.with a benzodiazepine overdose.
c.with benzodiazepine-resistant anxiety.
d.with anxiety associated with a psychotic disorder. - answers-ANS: B
Flumazenil is a benzodiazepine receptor antagonist. Response occurs within 30 to 60
seconds; however, it might not reverse associated respiratory depression. Because it
has a short duration of action and does not speed metabolism of benzodiazepines,
administration of flumazenil might need to be repeated several times. Flumazenil is not
indicated for treatment of any of the other conditions.
9. A patient received one dose of flumazenil (Romazicon). What is the nurse's next
action?
a. Carefully observe for preflumazenil symptoms.
b. Teach the patient about dietary restrictions.
c. Prevent injury during seizure activity.
,d. Force 500 ml oral fluids over 2 hours. - answers-ANS: A
Flumazenil, which is given to patients who have overdosed with benzodiazepines, is a
benzodiazepine receptor antagonist. Response occurs within 30 to 60 seconds;
however, it might not reverse associated respiratory depression. Because it has a short
duration of action and does not speed metabolism of benzodiazepines, the nurse must
be vigilant for signs that the patient is reverting to the preflumazenil state. Administration
of flumazenil might need to be repeated several times.
10. The nurse would expect a patient with which comorbid diagnosis to have a
magnified response to the usual dose of a benzodiazepine drug?
a. Rheumatoid arthritis
b. Migraine headache
c. Hepatic cirrhosis
d. Osteoporosis - answers-ANS: C
Benzodiazepines are metabolized in the liver. The cirrhotic liver will slow the
metabolism rate of the drugs, leading to an exaggerated response. The distracters are
not associated with decreased hepatic function.
11. A patient in the emergency room has status epilepticus. The nurse should anticipate
administration of:
a. diazepam (Valium).
b. buspirone (BuSpar).
c. clorazepate (Tranxene).
d. chlordiazepoxide (Librium). - answers-ANS: A
Valium is the drug of choice in status epilepticus because of its rapid action. Each of the
other benzodiazepines has a slower onset of action. Buspirone is not indicated to treat
seizures.
The teaching plan for a patient beginning buspirone (BuSpar) should include information
identifying this drug as a:
a. norepinephrine inhibitor.
b. serotonergic antagonist.
c. serotonin agonist.
d. GABA inhibitor. - answers-ANS: C
It is believed that buspirone is a serotonin agonist. Because buspirone is not a
benzodiazepine, it does not bind to benzodiazepine receptor sites, affect GABA, or
affect norepinephrine. This accounts for its different effects and lack of CNS depression
as side effects.
13. A patient seeking treatment for anxiety says, "I can't think. My job depends on my
ability to think. I need medicine, but the drugs I took a few years ago made me too
sleepy. I could lose my job." What information is most important for the nurse to
consider when formulating a response?
a. All antianxiety medication has sedating properties.
b. Buspirone (BuSpar) alleviates anxiety without sedation or cognitive clouding.
c. The patient's description of anxiety does not warrant treatment with medication.
, d. The patient may be trying to manipulate the nurse to assist with getting the desired
prescription. - answers-ANS: B
Buspirone's action is entirely different from that of the benzodiazepines. It reduces
anxiety, with its accompanying concentration and cognitive problems, but without CNS
depression. The patient's description of anxiety indicates that it is interfering with daily
life, so medication may be helpful. There is no evidence that the patient is trying to
manipulate the nurse.
14. A patient diagnosed with social phobia begins propranolol (Inderal). The nurse
should teach the patient to expect:
a. that sympathetic nervous system symptoms of anxiety will be reduced.
b. to experience a sense of euphoria for 30 minutes after taking the
: drug.
c. to have amnesia for the social situations that are most intimidating. answers-ANS
d. to feel a little drowsy but have no orthostatic hypotension. - A
Propranolol is a beta blocker that interrupts the physiologic responses of anxiety
associated with social phobias, such as sweaty palms. Bradycardia may be associated
with lightheadedness. The other options are not likely.
15. A patient complains, "I have the same thoughts over and over. I feel compelled to
count all my footsteps." The nurse can expect the health care provider to prescribe:
a. alprazolam (Xanax).
b. propranolol (Inderal).
c. clonazepam (Klonopin).
d. clomipramine (Anafranil). - answers-ANS: D
Clomipramine is an antidepressant that has proven effective for obsessive-compulsive
disorder (OCD). The other drugs have no proven effectiveness in treating OCD.
16. A patient is to receive lorazepam (Ativan) 1 mg PO t.i.d. for 4 days. The nurse
understands that this drug was prescribed for a short period because:
a. hypoglycemic reactions occur with continued use.
b. therapeutic dose dependence develops quickly.
c. neutropenia is likely with long-term use.
d. glaucoma results from long-term therapy. - answers-ANS: B
Dependence to benzodiazepines develops rather quickly. Even when taking prescribed
doses, individuals develop a psychological need for the drug. Prescribing for only
several days circumvents this problem. The other options are incorrect.
17. A patient took a benzodiazepine for 4 weeks but will now change to buspirone
(BuSpar) for long-term treatment of anxiety. The benzodiazepine is tapered off as the
buspirone is begun. Important information the patient should receive about buspirone is
that it:
a. produces profound sedation.
b. will be effective in 7 to 10 days.
c. has a high risk for development of dependence.
WITH ACTUAL EXAM QUESTIONS AND
CORRECT DETAILED SOLUTIONS
ALREADY GRADED A+
. A patient with agoraphobia took alprazolam (Xanax) 0.5 mg t.i.d. for 3 months and
then discontinued it. The next day, the patient called the nurse complaining of insomnia,
shakiness, and sweating. The nurse's assessment questions should focus on whether
the patient:
a. may have also been drinking alcohol or taking antihistamines.
b. has built up tolerance to alprazolam and needs an increased dose.
c. is having withdrawal symptoms from abrupt discontinuation of the drug.
d. has progressed to panic attacks and needs a nonbenzodiazepine medication. -
answers-ANS: C
The patient's symptoms suggest benzodiazepine withdrawal. The nurse knows that
patients often attempt to manage their own care by discontinuing medication when they
begin to feel better. Benzodiazepines 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.
An emergency room patient was very anxious after a serious car accident. Lorazepam
(Ativan) 2 mg IM was administered. One hour later, which finding indicates to the nurse
that the medication was effective?
a. Impaired problem-solving skills
b. Increased alertness and attention
c. Increased verbalization and activity
d. Reduced agitation and environmental scanning - answers-ANS: D
Benzodiazepines mute incoming stimuli and evoke less reaction. The hyperalertness
and environmental scanning that accompany high anxiety are notably decreased when
the drug is effective. Impaired problem solving is a negative outcome. Because of its
sedating properties, the individual might not be more alert, talkative, or active.
5. A patient has taken diazepam (Valium) for one week for back spasms. The patient
complains of "feeling sleepy all the time." The nurse should tell the patient:
a."The dosage probably needs to be decreased."
b."Drowsiness indicates a paradoxical reaction 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." - answers-
ANS: C
Tolerance to most side effects of benzodiazepines, including drowsiness, develops
quickly. There is no need to decrease the dosage. Drowsiness is an expected reaction,
not a paradoxical one. Valium is a benzodiazepine.
6. A patient has taken clonazepam (Klonopin) 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 counseling.
c. Institute a behavior modification program.
d. Prepare to administer flumazenil (Romazicon) - answers-ANS: A
There is evidence to suggest that abrupt withdrawal of clonazepam might precipitate
status epilepticus. With this in mind, withdrawal from long-term use warrants seizure
precautions. The patient does not have an overdose, so flumazenil (Romazicon) is not
indicated. The other options are inappropriate.
7. Which patient has the greatest risk for overdose with a benzodiazepine? A patient
who:
a. takes the drug with antacids
b. takes the drug before meals
c. combines the drug with alcohol
d. experiences depression as well as anxiety - answers-ANS: C
Benzodiazepines taken with alcohol produce marked CNS depression, even death.
Antacids prevent absorption. Larger doses of benzodiazepines by themselves are rarely
lethal. Depression in and of itself is not an indicator of overdose risk. Suicidal ideation
might be present, but benzodiazepines by themselves are rarely lethal.
8. The nurse would expect to administer flumazenil (Romazicon) for a patient:
a.in acute alcohol withdrawal.
b.with a benzodiazepine overdose.
c.with benzodiazepine-resistant anxiety.
d.with anxiety associated with a psychotic disorder. - answers-ANS: B
Flumazenil is a benzodiazepine receptor antagonist. Response occurs within 30 to 60
seconds; however, it might not reverse associated respiratory depression. Because it
has a short duration of action and does not speed metabolism of benzodiazepines,
administration of flumazenil might need to be repeated several times. Flumazenil is not
indicated for treatment of any of the other conditions.
9. A patient received one dose of flumazenil (Romazicon). What is the nurse's next
action?
a. Carefully observe for preflumazenil symptoms.
b. Teach the patient about dietary restrictions.
c. Prevent injury during seizure activity.
,d. Force 500 ml oral fluids over 2 hours. - answers-ANS: A
Flumazenil, which is given to patients who have overdosed with benzodiazepines, is a
benzodiazepine receptor antagonist. Response occurs within 30 to 60 seconds;
however, it might not reverse associated respiratory depression. Because it has a short
duration of action and does not speed metabolism of benzodiazepines, the nurse must
be vigilant for signs that the patient is reverting to the preflumazenil state. Administration
of flumazenil might need to be repeated several times.
10. The nurse would expect a patient with which comorbid diagnosis to have a
magnified response to the usual dose of a benzodiazepine drug?
a. Rheumatoid arthritis
b. Migraine headache
c. Hepatic cirrhosis
d. Osteoporosis - answers-ANS: C
Benzodiazepines are metabolized in the liver. The cirrhotic liver will slow the
metabolism rate of the drugs, leading to an exaggerated response. The distracters are
not associated with decreased hepatic function.
11. A patient in the emergency room has status epilepticus. The nurse should anticipate
administration of:
a. diazepam (Valium).
b. buspirone (BuSpar).
c. clorazepate (Tranxene).
d. chlordiazepoxide (Librium). - answers-ANS: A
Valium is the drug of choice in status epilepticus because of its rapid action. Each of the
other benzodiazepines has a slower onset of action. Buspirone is not indicated to treat
seizures.
The teaching plan for a patient beginning buspirone (BuSpar) should include information
identifying this drug as a:
a. norepinephrine inhibitor.
b. serotonergic antagonist.
c. serotonin agonist.
d. GABA inhibitor. - answers-ANS: C
It is believed that buspirone is a serotonin agonist. Because buspirone is not a
benzodiazepine, it does not bind to benzodiazepine receptor sites, affect GABA, or
affect norepinephrine. This accounts for its different effects and lack of CNS depression
as side effects.
13. A patient seeking treatment for anxiety says, "I can't think. My job depends on my
ability to think. I need medicine, but the drugs I took a few years ago made me too
sleepy. I could lose my job." What information is most important for the nurse to
consider when formulating a response?
a. All antianxiety medication has sedating properties.
b. Buspirone (BuSpar) alleviates anxiety without sedation or cognitive clouding.
c. The patient's description of anxiety does not warrant treatment with medication.
, d. The patient may be trying to manipulate the nurse to assist with getting the desired
prescription. - answers-ANS: B
Buspirone's action is entirely different from that of the benzodiazepines. It reduces
anxiety, with its accompanying concentration and cognitive problems, but without CNS
depression. The patient's description of anxiety indicates that it is interfering with daily
life, so medication may be helpful. There is no evidence that the patient is trying to
manipulate the nurse.
14. A patient diagnosed with social phobia begins propranolol (Inderal). The nurse
should teach the patient to expect:
a. that sympathetic nervous system symptoms of anxiety will be reduced.
b. to experience a sense of euphoria for 30 minutes after taking the
: drug.
c. to have amnesia for the social situations that are most intimidating. answers-ANS
d. to feel a little drowsy but have no orthostatic hypotension. - A
Propranolol is a beta blocker that interrupts the physiologic responses of anxiety
associated with social phobias, such as sweaty palms. Bradycardia may be associated
with lightheadedness. The other options are not likely.
15. A patient complains, "I have the same thoughts over and over. I feel compelled to
count all my footsteps." The nurse can expect the health care provider to prescribe:
a. alprazolam (Xanax).
b. propranolol (Inderal).
c. clonazepam (Klonopin).
d. clomipramine (Anafranil). - answers-ANS: D
Clomipramine is an antidepressant that has proven effective for obsessive-compulsive
disorder (OCD). The other drugs have no proven effectiveness in treating OCD.
16. A patient is to receive lorazepam (Ativan) 1 mg PO t.i.d. for 4 days. The nurse
understands that this drug was prescribed for a short period because:
a. hypoglycemic reactions occur with continued use.
b. therapeutic dose dependence develops quickly.
c. neutropenia is likely with long-term use.
d. glaucoma results from long-term therapy. - answers-ANS: B
Dependence to benzodiazepines develops rather quickly. Even when taking prescribed
doses, individuals develop a psychological need for the drug. Prescribing for only
several days circumvents this problem. The other options are incorrect.
17. A patient took a benzodiazepine for 4 weeks but will now change to buspirone
(BuSpar) for long-term treatment of anxiety. The benzodiazepine is tapered off as the
buspirone is begun. Important information the patient should receive about buspirone is
that it:
a. produces profound sedation.
b. will be effective in 7 to 10 days.
c. has a high risk for development of dependence.
