Chapter 39- Caring for Persons With Co-occurring Mental Disorders My Nursing Test Banks

 

1.

A client with major depression visits the mental health clinic and tells the nurse that he has recently started using marijuana quite frequently. The nurse determines that the manifestation of the clients co-occurring disorder reflects which of the following?

A)

Primary mental illness with subsequent substance use

B)

Primary substance abuse disorder with psychopathologic sequelae

C)

Dual primary diagnoses

D)

A common etiology

2.

The nurse is planning a presentation for a group of mental health care providers on the topic of co-occurring disorders. The nurse plans to include information about health care providers and their response to these clients. Which of the following would the nurse include as a major reason for these clients being often underserved and undertreated?

A)

Providers often focus treatment on the 12-step programs for substance abuse treatment.

B)

They commonly underdiagnose personality disorders in those who take illicit substances.

C)

Providers commonly ignore the existence of concurrent mental health disorders.

D)

They have difficulty determining which problem is in most immediate need.

3.

The nurse is caring for a female adolescent client diagnosed with depression and substance abuse. Which of the following would be most appropriate for the nurse to do?

A)

Determine if the client is experiencing hyperactivity.

B)

Ask her if she is having thoughts of harming herself.

C)

Determine if the client is exhibiting Wernickes syndrome.

D)

Ask the client if she has had problems with excessive anxiety.

4.

A client with schizophrenia and substance abuse disorder is admitted to a detoxification program. The client has been prescribed neuroleptic medications for schizophrenia. When caring for this client, the nurse would implement interventions to reduce the clients risk for relapse, integrating knowledge that relapse frequently is secondary to which of the following?

A)

Poor social skills

B)

Lack of vocational skills

C)

Medication non-adherence

D)

Dysfunctional family systems

5.

A nurse is teaching a group of hospitalized clients who have co-occurring disorders involving cognitive disorders and alcoholism about the relapse cycle. Which statement would the nurse most likely include during this teaching session?

A)

After you are discharged, there is a tendency to use alcohol rather than your prescribed medications to self-medicate your psychiatric symptoms. This allows your psychiatric symptoms to surface again, and they, in turn, lead to rehospitalization. Your symptoms are again controlled with medications until you are discharged, and the cycle starts all over again.

B)

Your alcoholism causes you to hallucinate, and you need to take prescribed medications to control the hallucinations. When you try to stop drinking and stay abstinent, your hallucinations disappear; consequently, you stop taking your prescribed medications because theyre gone. Then you celebrate with alcohol, and this triggers a relapse; the alcoholism causes hallucinations, and the whole thing starts over again.

C)

Your dependence on alcohol and your psychiatric illness are unrelated. Experiencing disturbing thoughts does not cause alcoholism, and alcoholism does not cause your disturbing thoughts. It all boils down to medication compliance.

D)

The cycle is triggered by repeated attempts to stop drinking. Without the levels of alcohol your system has come to tolerate, you begin to develop psychiatric symptoms. Then you have to be hospitalized and treated for your psychosis again. Everything is fine until the next time you try to stop drinking, and then the cycle repeats itself.

6.

A nurse is interviewing a client who has a co-occurring diagnosis. The client is trying to explain why it is so easy to start drinking again even though hospitalization and prescribed medications can eventually control his mental problems. Which statement by the client would the nurse interpret as reflecting the clients beliefs?

A)

It just seems easier and cheaper to go out and get a bottle or a fix than it does to keep paying for medications with money I dont have.

B)

If I come out of the hospital and keep taking my prescribed medications, I know I will function better, but I wont be able to escape my feelings or feel high like I do when I drink.

C)

I just dont like the side effects my prescribed medications cause, and, besides that, I can never remember to take them at specific times or with food.

D)

I dont like to take them because then my spouse expects me to be more responsible and to help around the house more often. I dont have to be bothered with that when I drink or use.

7.

A nurse is working as part of an interdisciplinary treatment team for a client diagnosed with a mental illness and substance abuse disorder. As part of the recovery process, which of the following would be most important for the team to do initially?

A)

Provide a series of short-term hospitalizations that apply leverage to pressure the client into adhering to a prescribed treatment regimen.

B)

Establish rules that will enhance the clients recognition of staff as authority figures who know what is best for the clients care and well-being.

C)

Use heavy confrontation, intense emotional pressure, and discouragement of the use of medications since all medications have the potential to be addictive.

D)

Provide immediate help with a situational crisis the client is experiencing to promote trust in the client and have the client buy into the treatment process.

8.

A client has a co-occurring diagnosis of alcoholism and bipolar disorder. He was brought to the emergency department by two policemen who had broken up a fight that the client had gotten into in a neighborhood bar. The client is intrusive and verbose about having diplomatic immunity and his pressing need to tour the bistate area to promote his bid for the presidency. The client has had multiple admissions to the hospitals psychiatric unit, and he has almost always experienced alcohol withdrawal syndrome immediately after his previous admissions. Which of the following would be a priority for this client?

A)

Administering prescribed mood-stabilizing medications to control his delusional thinking because doing so will curtail his desire to drink

B)

Taking baseline vital signs and then monitoring them on an ongoing basis to ascertain if the client is exhibiting early signs of alcohol withdrawal

C)

Suggesting that client refrain from being intrusive and annoying others with his constant chatter about his delusional thinking

D)

Referring the client to an outpatient community substance abuse treatment center because his addiction has to be adequately addressed before his bipolar problems can be effectively treated

9.

The parents of a client with schizophrenia who also abuses alcohol asks the nurse, What can we do to help our son from relapsing after he is discharged from the hospital? Which response by the nurse would be most appropriate?

A)

Theres really not much you can do; your son is responsible for maintaining his own sobriety.

B)

Avoid letting him take any mood-altering chemicals because they may trigger his delusional thinking.

C)

Make sure he goes to at least two Alcoholics Anonymous meetings a week, gets a sponsor, and calls his sponsor on a daily basis.

D)

Report any side effects he develops so they can be treated and therefore wont tempt him to stop taking his prescribed medications.

10.

A nurse is readmitting a client with a co-occurring diagnoses of schizophrenia and alcohol abuse who has relapsed. The client says, Im just a failure. Ill never be anything but just a drunk. Which response by the nurse would be most appropriate?

A)

Relapse is a normal part of recovery; you can learn from this experience so it will be easier to avoid it or a similar one in the future.

B)

Face it, you will always be an alcoholic, and relapse is inevitable because it is part of the illness.

C)

If you didnt have disturbed thoughts from your schizophrenia, you wouldnt be tempted to drink.

D)

Please clarify something for me. When you say, just a drunk, what exactly are you trying to say?

11.

A group of nursing students are reviewing information about co-occurring disorders and risks for substance abuse. The students demonstrate understanding of the information when they identify which psychiatric disorder as being associated with the highest risk for substance abuse?

A)

Mania

B)

Panic disorder

C)

Antisocial personality disorder

D)

Phobias

12.

When describing the relapse cycle to a group of families of clients experiencing co-occurring disorders, which of the following would the nurse identify as occurring first?

A)

Hospitalization

B)

Decompensation

C)

Stabilization

D)

Discharge

13.

The nurse is reviewing a clients medical record and finds that he has received treatment for his co-occurring disorders in the primary health care setting. The nurse interprets this as which quadrant of care?

A)

Category I

B)

Category II

C)

Category III

D)

Category IV

14.

A nurse is working with a client with co-occurring disorders who is in the early stages of recovery. The client has been abstained from using alcohol for the past 3 weeks. During a follow-up visit, the nurse is working on teaching the client about the effects of alcohol on his body. Which of the following would be most important for the nurse to keep in mind about the client?

A)

The client will be highly suggestible to information, being unable to reason critically.

B)

The alcohol abuse has destroyed the brain cells that are necessary for learning.

C)

Some cognitive impairment may be present that hinders his ability to learn new things.

D)

The underlying effects of the substance abuse will prevent him from being able to learn.

15.

A nurse is working with a client with depression and substance abuse on ways to promote recovery. Which of the following would be most important for the nurse to include? Select all that apply.

A)

A positive social network

B)

Compliance to treatment

C)

Avoidance of hospitalization

D)

Supportive housing

E)

Community vocational rehabilitation

16.

A client with co-occurring disorders of schizophrenia and substance abuse is admitted for treatment. Which of the following would the nurse be least likely to identify as a priority for this client?

A)

Assessment

B)

Group therapy

C)

Control of psychiatric symptoms

D)

Treatment of withdrawal symptoms

Answer Key

1.

A

2.

D

3.

B

4.

C

5.

A

6.

B

7.

D

8.

B

9.

D

10.

A

11.

C

12.

B

13.

A

14.

C

15.

A, B, D, E

16.

B

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