NUR 384
EXAM 4
(Mental Health Nursing)
Actual Questions with Correct Answers
Concordia University’s
What’s Included:
• 100+ verified questions with Correct answers with
Rationales.
• NCLEX-style multiple-choice questions
• select-all-that-apply (SATA) questions
• Case Studies / Scenario-Based questions
• Ideal for exam preparation and concept reinforcement.
,1. What is the priority nursing diagnosis for a client experiencing alcohol
withdrawal?
A. Ineffective coping related to powerlessness over alcohol use
B. Disturbed thought processes related to tactile hallucinations
C. Risk for injury related to central nervous system stimulation
D. Ineffective denial related to continued alcohol use despite negative consequences
Correct Answer:
C. Risk for injury related to central nervous system stimulation
Expert Rationale:
Alcohol withdrawal can cause tremors, agitation, hypertension, hallucinations, seizures,
and delirium tremens. Because these manifestations place the client at immediate risk for
physical harm, safety and injury prevention take priority.
2. A nurse evaluates a client’s patient-controlled analgesia pump and notices 100
attempts within a 30-minute period. What is the best rationale for assessing the
client for substance dependence?
A. Clients dependent on alcohol or benzodiazepines may develop cross-tolerance and
require larger analgesic doses for effective pain control.
B. Narcotic pain medication is contraindicated for every client with an active substance
use disorder.
C. The excessive attempts prove that the PCA pump has malfunctioned.
D. Clients with substance use disorders generally have a higher pain tolerance and require
less medication.
Correct Answer:
A. Clients dependent on alcohol or benzodiazepines may develop cross-tolerance
and require larger analgesic doses for effective pain control.
Expert Rationale:
Cross-tolerance may occur between alcohol, benzodiazepines, and certain central nervous
system depressants. A client may therefore require careful reassessment and
individualized dosing rather than being automatically denied adequate pain control.
3. On the first day of alcohol detoxification, which nursing intervention should
receive priority?
,A. Educate the client about the biopsychosocial effects of alcohol misuse.
B. Administer vitamin B1 to reduce the risk of Wernicke encephalopathy.
C. Encourage attendance at 90 Alcoholics Anonymous meetings in 90 days.
D. Administer prescribed chlordiazepoxide according to the withdrawal protocol.
Correct Answer:
D. Administer prescribed chlordiazepoxide according to the withdrawal protocol.
Expert Rationale:
A benzodiazepine such as chlordiazepoxide reduces central nervous system
hyperexcitability and helps prevent seizures and delirium tremens. Immediate
stabilization during acute withdrawal takes priority over long-term education and
recovery planning.
4. Which client statement demonstrates a knowledge deficit regarding substance
use?
A. “Tolerance to heroin may develop rapidly.”
B. “Marijuana is essentially harmless because many people use it.”
C. “Flashbacks associated with LSD may recur unexpectedly.”
D. “Although alcohol is legal, it is widely misused.”
Correct Answer:
B. “Marijuana is essentially harmless because many people use it.”
Expert Rationale:
Widespread use does not make a substance harmless. Cannabis can impair judgment,
coordination, memory, motivation, and driving ability and may worsen anxiety, psychosis,
or substance-related problems in susceptible individuals.
5. A lonely, depressed client has been using small amounts of cocaine to produce
pleasure and avoid emotional discomfort. Which term best describes this pattern?
A. Substance-induced disorder
B. Social dependence
C. Psychological dependence
D. Codependency
Correct Answer:
C. Psychological dependence
, Expert Rationale:
Psychological dependence involves a strong emotional desire to use a substance to create
pleasure, relieve distress, or avoid discomfort. It may occur even when marked physical
withdrawal symptoms are absent.
6. Which term describes administering a central nervous system depressant to
reduce the manifestations of alcohol withdrawal?
A. Substitution therapy
B. Antagonist therapy
C. Codependency therapy
D. Deterrent therapy
Correct Answer:
A. Substitution therapy
Expert Rationale:
Substitution therapy uses a safer, longer-acting medication with similar central nervous
system effects to control withdrawal. Benzodiazepines are commonly used during alcohol
withdrawal to prevent serious complications.
7. Which discharge outcome related to Alcoholics Anonymous is most appropriate
for a client completing alcohol detoxification?
A. The client will obtain all deterrent medications directly through AA.
B. The client will depend entirely on a sponsor to control cravings.
C. The client will require every family member to attend AA.
D. The client will begin attending 90 AA meetings in 90 days.
Correct Answer:
D. The client will begin attending 90 AA meetings in 90 days.
Expert Rationale:
Frequent meeting attendance can provide structure, peer support, accountability, and
reinforcement of abstinence during early recovery. A sponsor supports recovery but does
not assume responsibility for controlling the client’s behavior.
8. A client with a history of heavy alcohol use has consumed no alcohol for 48
hours. Which assessment finding requires the nurse’s immediate attention?
EXAM 4
(Mental Health Nursing)
Actual Questions with Correct Answers
Concordia University’s
What’s Included:
• 100+ verified questions with Correct answers with
Rationales.
• NCLEX-style multiple-choice questions
• select-all-that-apply (SATA) questions
• Case Studies / Scenario-Based questions
• Ideal for exam preparation and concept reinforcement.
,1. What is the priority nursing diagnosis for a client experiencing alcohol
withdrawal?
A. Ineffective coping related to powerlessness over alcohol use
B. Disturbed thought processes related to tactile hallucinations
C. Risk for injury related to central nervous system stimulation
D. Ineffective denial related to continued alcohol use despite negative consequences
Correct Answer:
C. Risk for injury related to central nervous system stimulation
Expert Rationale:
Alcohol withdrawal can cause tremors, agitation, hypertension, hallucinations, seizures,
and delirium tremens. Because these manifestations place the client at immediate risk for
physical harm, safety and injury prevention take priority.
2. A nurse evaluates a client’s patient-controlled analgesia pump and notices 100
attempts within a 30-minute period. What is the best rationale for assessing the
client for substance dependence?
A. Clients dependent on alcohol or benzodiazepines may develop cross-tolerance and
require larger analgesic doses for effective pain control.
B. Narcotic pain medication is contraindicated for every client with an active substance
use disorder.
C. The excessive attempts prove that the PCA pump has malfunctioned.
D. Clients with substance use disorders generally have a higher pain tolerance and require
less medication.
Correct Answer:
A. Clients dependent on alcohol or benzodiazepines may develop cross-tolerance
and require larger analgesic doses for effective pain control.
Expert Rationale:
Cross-tolerance may occur between alcohol, benzodiazepines, and certain central nervous
system depressants. A client may therefore require careful reassessment and
individualized dosing rather than being automatically denied adequate pain control.
3. On the first day of alcohol detoxification, which nursing intervention should
receive priority?
,A. Educate the client about the biopsychosocial effects of alcohol misuse.
B. Administer vitamin B1 to reduce the risk of Wernicke encephalopathy.
C. Encourage attendance at 90 Alcoholics Anonymous meetings in 90 days.
D. Administer prescribed chlordiazepoxide according to the withdrawal protocol.
Correct Answer:
D. Administer prescribed chlordiazepoxide according to the withdrawal protocol.
Expert Rationale:
A benzodiazepine such as chlordiazepoxide reduces central nervous system
hyperexcitability and helps prevent seizures and delirium tremens. Immediate
stabilization during acute withdrawal takes priority over long-term education and
recovery planning.
4. Which client statement demonstrates a knowledge deficit regarding substance
use?
A. “Tolerance to heroin may develop rapidly.”
B. “Marijuana is essentially harmless because many people use it.”
C. “Flashbacks associated with LSD may recur unexpectedly.”
D. “Although alcohol is legal, it is widely misused.”
Correct Answer:
B. “Marijuana is essentially harmless because many people use it.”
Expert Rationale:
Widespread use does not make a substance harmless. Cannabis can impair judgment,
coordination, memory, motivation, and driving ability and may worsen anxiety, psychosis,
or substance-related problems in susceptible individuals.
5. A lonely, depressed client has been using small amounts of cocaine to produce
pleasure and avoid emotional discomfort. Which term best describes this pattern?
A. Substance-induced disorder
B. Social dependence
C. Psychological dependence
D. Codependency
Correct Answer:
C. Psychological dependence
, Expert Rationale:
Psychological dependence involves a strong emotional desire to use a substance to create
pleasure, relieve distress, or avoid discomfort. It may occur even when marked physical
withdrawal symptoms are absent.
6. Which term describes administering a central nervous system depressant to
reduce the manifestations of alcohol withdrawal?
A. Substitution therapy
B. Antagonist therapy
C. Codependency therapy
D. Deterrent therapy
Correct Answer:
A. Substitution therapy
Expert Rationale:
Substitution therapy uses a safer, longer-acting medication with similar central nervous
system effects to control withdrawal. Benzodiazepines are commonly used during alcohol
withdrawal to prevent serious complications.
7. Which discharge outcome related to Alcoholics Anonymous is most appropriate
for a client completing alcohol detoxification?
A. The client will obtain all deterrent medications directly through AA.
B. The client will depend entirely on a sponsor to control cravings.
C. The client will require every family member to attend AA.
D. The client will begin attending 90 AA meetings in 90 days.
Correct Answer:
D. The client will begin attending 90 AA meetings in 90 days.
Expert Rationale:
Frequent meeting attendance can provide structure, peer support, accountability, and
reinforcement of abstinence during early recovery. A sponsor supports recovery but does
not assume responsibility for controlling the client’s behavior.
8. A client with a history of heavy alcohol use has consumed no alcohol for 48
hours. Which assessment finding requires the nurse’s immediate attention?
