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WorksheetsMental Health and Substance Use Quiz
Total questions: 40
Worksheet time: 13mins
A patient with PTSD reports sleeping only 3–4 hours and waking with panic from nightmares. What’s the best immediate psychoeducation point?
Avoid naps; sleep restriction prevents nightmares.
Limit evening fluids to reduce nocturia.
Create a consistent wind‑down routine and avoid trauma content near bedtime.
Add daily high‑intensity workouts at night.
During a grounding exercise, which cue most directly targets dissociation in PTSD?
Tell me the exact date of your trauma.
Name five things you can see, four you can feel, three you can hear.
Let’s analyze your cognitive distortions.
Try deep sleep right now.
A combat veteran says, “It should have been me.” Which response best addresses survivor guilt?
You’re overreacting.
Let’s explore how guilt fits with the facts of the event.
Think about happier memories.
We’ll avoid talking about guilt.
Which is the safest early‑session exposure strategy for PTSD?
Unplanned full trauma recounting in session 1
Gradual, collaborative hierarchy with coping skills in place
Immediate flooding without breaks
Daily prolonged exposure homework before teaching relaxation
A patient with panic‑level anxiety is hyperventilating. First priority?
Offer long insight‑oriented interpretation
Coach paced breathing and reduce environmental stimuli
Confront the irrationality of panic
Encourage vigorous exercise to “burn it off”
A survivor of intimate partner violence (IPV) asks to switch to a female nurse. Best response?
Assignments can’t change.
Your doctor is a man, so this shouldn’t matter.
I’ll re‑review assignments and arrange a female nurse.
A male aide will do hygiene care instead.
Which step most directly enhances immediate safety planning in IPV?
Discuss long‑term therapy goals first
Identify a code word with trusted contacts
Ask the survivor to confront the partner tonight
Instruct the survivor to stop using social media
Priority documentation element after IPV disclosure?
The nurse’s personal opinion of the partner
Exact patient quotes and objective injury descriptions
Speculation about legal guilt
A promise to keep all information secret
Which example best illustrates avolition?
Inventing new words
Marked lack of initiation for goal‑directed tasks
Sensation that the body is unreal
Pleasure in fewer activities
A patient says, “The cat flat sat the bat—snip snap.” This is most consistent with:
Clang associations
Neologisms
Thought insertion
Perseveration
The safest first response to possible command hallucinations is to:
Ignore them to avoid reinforcing
Ask, “What are the voices telling you to do?”
Argue that voices aren’t real
Increase environmental stimulation
Which intervention best reduces paranoia‑related meal refusal on the unit?
Offer sealed, single‑serve foods and allow some space
Force the patient to eat at the group table
Remove all choices
Start insulin
You observe word salad and extreme disorganization. What’s the priority milieu action?
Group confrontation to increase reality testing
One‑step, brief instructions in a low‑stimulus area
Delayed responses to force patience
Offer abstract tasks to build cognition
Which change is most typical in acute mania rather than schizophrenia?
Decreased need for sleep
Negative symptoms
Persistent auditory hallucinations without mood sx
Long‑standing flat affect
A patient on lithium develops 24 hours of vomiting and profuse diarrhea. What do you do?
Continue lithium; replace fluids later
Hold lithium and notify the provider now
Double the dose to maintain level
Start a diuretic
Which snack fits acute mania nutrition goals?
Salad and steak (sit‑down meal)
Finger sandwiches and a smoothie
Spaghetti with meatballs
Broiled fish with asparagus
Most reliable early indicator that a patient is “revving up” toward hypomania/mania?
Reports feeling cold
Sleeping 2–3 hours and “feeling great”
Eating more vegetables
Increased cooperation in groups
Which limit‑setting approach is best for intrusive, high‑energy manic behavior?
Stop it right now or you’ll lose all privileges.
Clear, brief directions + immediate redirection to a quiet space
Ignore the behavior
Long explanations about unit rules
Therapeutic lithium trough goal for maintenance in many adults is approximately:
0.1–0.3 mEq/L
0.4–0.6 mEq/L
0.6–1.2 mEq/L
2.0–3.0 mEq/L
Classic opioid withdrawal triad includes:
Severe respiratory depression, pinpoint pupils, coma
Lacrimation, yawning, piloerection
Violent agitation, diaphoresis, hyperthermia only
Visual scotomata and ataxia
First medication step for a confused, malnourished patient with severe alcohol use who is N/V and hypoglycemic?
IV glucose first
Thiamine before glucose
Haloperidol IM
Naloxone IV
Alcohol withdrawal typically begins within:
2–4 days after last drink
6–12 hours after last drink
2 weeks after last drink
Immediately after last sip
Which finding most strongly suggests stimulant (cocaine/amphetamine) intoxication rather than opioid intoxication?
Bradycardia, miosis, hypoventilation
Euphoria, mydriasis, tachycardia, hypertension
Hypothermia, bradypnea, pinpoint pupils
Sedation, constipation
Primary cause of cirrhosis emphasized in substance teaching:
Alcohol
Caffeine
Cocaine
Inhalants
Which assessment raises red flags for refeeding syndrome during inpatient weight restoration?
Rising phosphorus
Hypophosphatemia with edema and arrhythmia risk
Low fiber intake
Increased thirst only
Most consistent finding in anorexia nervosa (restricting type)?
Tachycardia and hyperkalemia
Bradycardia and lanugo
Hirsutism and hypertension
Polycythemia and fever
For a patient who over‑exercises to purge calories, the most effective behavioral agreement is to:
Allow exercise after each meal
Replace exercise with scheduled nursing check‑ins when urges rise
Ignore exercise because it reduces anxiety
Praise weight loss to build alliance
Best staff strategy to reduce splitting on the unit (e.g., “You’re the only good nurse”)?
Rotate rules based on patient preference
Unified, consistent team communication and limits
Give extra exceptions to build trust
Avoid discussing behavior in report
Priority group‑therapy boundary for histrionic personality disorder:
Encourage center‑stage storytelling without limits
Enforce time limits and redirect attention‑seeking behavior
Allow flirtatious behavior if consenting
Let peers handle disruptions
Which trait best fits antisocial personality disorder?
Fear of abandonment with frantic efforts to avoid it
Disregard for rights of others and lack of remorse
Perfectionism, orderliness, control
Social inhibition from fear of criticism
A patient becomes verbally abusive and moves closer. The nurse’s first action?
Speak slowly, low, and maintain ~2 arm’s‑length distance
Threaten loss of privileges
Block the exit
Touch the patient’s shoulder to calm them
In an acute crisis with flooded affect, which intervention comes first?
Insight‑oriented therapy
Ensure immediate safety, reduce stimuli, use short directives
Assign extensive journaling
Explore childhood roots
Most specific bedside clue that favors delirium over dementia in a hospitalized elder?
Months of gradual memory decline
Acute onset with waxing/waning attention
Long history of language difficulties
Personality exaggeration over years
Which room setup best supports a cognitively impaired inpatient?
Windowless room with dim lighting
Room next to a busy nurses’ station
Room with personal belongings and clear day‑night cues
Constantly rotating staff to increase stimulation
Most concerning medication pattern for delirium risk in older adults?
Stable SSRI at low dose
Multiple anticholinergic meds and benzodiazepines
Vitamin D supplementation
Single daily acetaminophen
Best initial response to sundowning (evening agitation) in dementia?
Confront the delusion directly
Increase evening stimulation
Maintain routine, reduce evening stimuli, use night‑lights
Remove clocks and calendars
A patient with Alzheimer’s gives an inaccurate but confident story about the morning’s therapy. This is most consistent with:
Lying
Confabulation
Delusion
Perseveration
Family education that best reduces agitation during ADLs in dementia:
Offer many choices to enhance autonomy
Use short, one‑step instructions and limit choices
Test memory repeatedly to stimulate cognition
Correct every error to maintain reality orientation
Which behavior management tactic is most likely to escalate aggression in dementia?
Distraction with a preferred activity
Calm redirection to a quiet space
Confrontation and arguing the facts
Offering a rummage box
Safest early step when an older adult abruptly becomes agitated and tries to leave the day room?
Send a peer to follow them
Assume attention‑seeking; ignore
Follow to assess for immediate risk and de‑escalate
Discuss with the group what just happened
