Nursing Fundamentals Final Exam

You enter a residents room and the resident has a new onset bedsore. You feel you need to document this in the medical record but also have a discussion with the nurse. Where would you opt to have this discussion? a. In the patients room b. In the hallway with the family c. In private d. At the local bar

To prevent shampoo from getting into your residents eyes, you should: a. Use a hand held nozzle b. Use dry shampoo c. Rinse the hair throughly d. Use a washcloth to cover the eyes

Bath water temperature should be at what temperature: a. 110- 115 degrees F b. 110- 120 degrees F c. 105 degrees F d. 105- 109 degrees F

The word ACUTE when used to define illness means: a. an illness for which there is no reasonable expectation of recovery b. an ongoing illness for which there is no cure c. a sudden onset to an illness d. an illness that is gradual

In your role as a nursing assistant, you are able to: a. You can take verbal orders over the phone from doctors b. Give medications c. Insert a foley in the patients vagina or penis d. Report changes in the residents condition to the nurse

An assisted living facility provides all of the following except: a. Housing b. Personal care c. Social activities d. 24 hour skilled nursing care

Those persons who provide basic nursing care under the supervision of a registered nurse or a licensed practical nurse are: a. Licensed practical nurse b. Case managers c. Assistive personnel d. The "health care team"

A federal insurance plan providing benefits for older persons and some younger persons with disabilities is called: a. Medicaid b. Medicare c. Blue Cross/ Blue Shield d. Coventry

Which nursing care pattern focuses on tasks and jobs? a. Functional nursing b. Team nursing c. Primary nursing d. Care management

You promote quality of life by: a. Delegating tasks to your coworkers b. Making sure you bring your resident chocolate and Starbucks c. Doing everything for the patient, they don't need to lift a finger d. Speaking to individuals in a respectful manner

Your patient has left sided weakness, how do you put on their shirt? a. Clients choice b. Right sleeve c. Left sleeve d. Both sleeve together

Exercises that move each muscle and joint care called? a. Rotation b. Adduction c. Range of Motion d. Abduction

Your patient's roommate has just died, how can you BEST help the client with the loss? a. Discourage individual activity b. Encourage the client talk c. Convince the client its no big loss. The roommate was a complainer d. Leave the client alone

You go to check on Mrs. Jones, she is very agitated. Your task is to give her a bed bath, When you walk in the room, she tells you "Get out of here. I do not want a bed bath". What should you do? a. Speak loudly because maybe Mrs. Jones didn't hear or understand you. b. Run c. Tell the client they have no choice, shut up and lets get cleaned up d. Talk calmly, slowly, reassure the client. Do not force them. Report the refusal to the nurse.

Padding side rails on a bed serves a purpose. The purpose is: a. Restrain the patient b. Have somewhere to put the call button c. Keep the client warm d. Protect your client from possible injury

Which of the following stages of dying is usually the final stage for the client? a. Anger b. Acceptance c. Bargaining d. Depression

Which is more correct measure of urinary output? a. 30 oz b. 300ml or cc c. 2 cups d. 1 gallon

The role of the ombudsman is: a. Work with the nursing home to protect the clients rights b. Control the nursing home budget c. Prepare classes that nurses aides take to learn hygiene d. Run a group of nursing homes

The BEST time to prepare for a disaster is: a. During your lunch b. When everyone has gone to bed c. During a tornado or hurricane d. Before it happens

Which temperature is considered MOST accurate? a. Oral b. Axillary (A) c. Temporal d. Rectal (R)

The beginning sign of a pressure sore is: a. Coolness b. Discoloration c. Swelling d. Numbness

What Act did Congress pass in 1987, to protect the quality of life, health and safety of nursing home residents? a. MedicareAct of 1987 b. Patients Bill of Rights c. EMTALA d. Omnibus Budget Reconciliation Act

Your resident is wealthy. He offers you a "little gift" in the form of cash for providing expert care. You should: a. Accept and say nothing b. Accept like a tip and share it with your coworkers c. Refuse graciously d. Look to see if anyone is listening or watching

Retirement usually results in: a. Physical changes from aging b. Financial security c. Less Free Time d. Typically a lower income

After urinating, the resident is assisted to: a. Wash their hands b. Get back in bed c. GIven something to drink d. Put in a diaper

What can happen is constipation is not relieved? a. Enema b. Diarrhea c. Incontinence d. Fecal Impaction

When removing soiled linens, you must wear: a. A gown b. Face Mask c. Eye Protection d. Gloves

Information that you can see, hear, feel or smell is called: a. Assessment b. Observation c. Objective data d. Subjective data

A resident continues to ask you the same question over and over again each time you come into the room. You should: a. Tell the person you are tired of answering the same question b. Yell at the resident c. Report the behavior d. Be patient

Before leaving on for lunch, you need to: a. Use the bathroom and wash your hands b. Turn off the computer c. Call home and check on your children d. Tell the nurse

The most common cause of COPD/emphysema is: a. Pollution b. Family History c. Asthma d. Smoking

When you assist a person to ambulate/walk, what should would do first: a. Apply braces to the legs b. Get crutches, cane or walker c. Apply a gait belt d. Get the patients glasses

Before putting your patients feet on the floor for ambulation, you want to ensure: a. They wear whatever they want b. Slippers c. Cowboy boots d. Non skid footwear

You are asked to collect a sputum specimen from your resident by the nurse. it is easier: a. After an activity b. After a meal c. Before a meal d. Upon awakening in the morning

An older persons ability to sense pain is: a. Decreased b. Increased c. The same as every other adult d. the same as a baby

When transferring a resident to a wheelchair: a. The brakes must be locked b. Hold the handgrips c. Put your foot on the back of the wheels to hold in place d. Stand on the footplates

Your resident is "comatose" you should assume: a. They can hear b. They can see c. They can touch d. They can speak

Your resident has a history of a stroke with residual weakness, you are asked to ambulate them. You should: a. Assist on weak side b. Assist on strong side c. Put them in a wheelchair d. Stand in front of them like you are a walker

What is the term for a device used to take the place of a missing body part? a. Pronation b. External rotation c. Amputation d. Prosthesis

True of False Accidents or errors in giving care should be reported to the nurse at the end of the shift.

True or False A married couple is admitted to a nursing facility. They should be assigned to separate rooms.

Laws that deal with relationships between people are called? a. Criminal lwas b. Torts c. Responsibilities d. Civil laws

The nurse tells you to perform a procedure. Which is not true? a. The nurse must be available to answer questions and supervise b. Do whatever the nurse tells you to do c. The procedure must be in your job description d. Your state must allow nursing assistants to perform the procedure

To residents share a room. One family wants to take pictures of the two residents together. A persons picture taken without permission is called: a. Assault b. Malpractice c. Negligence d. Invasion of Privacy

An official record of persons who have completed a Nursing Assistant training and competency evaluation programs. a. OBRA b. Civil law c. Protected nursing assistants records d. Nursing Assistant Registry

True or False You can never refuse to perform a delegated task.

True or False Nursing Assistants supervise other Nursing Assistants

A rule of conduct made by the government body is called: a. A law b. Libel c. Tort d. Informed Consent

Spreading rumors or talking about the private matters of others is: a. Harassment b. Gossip c. Loads of fun d. Confidentiality

Looking at things from another's point of view is called: a. Politeness b. Work ethic c. Empathy d. Courtesy

True or False Always use medical terms when you talk to the patient or resident.

True or False Everyone who works at an agency as the right to read the patient.residents records

True or False Medical diagnosis and the nursing diagnosis are always the same

True or False Reporting and recording are done before you give the patient care

True or False The nursing progress never ends

True or False Conflict in the workplace can impact the quality of the care provided.

It is 4:00pm. In a 24- hour clock, how do you record time? a. 2400 b.4000 c.1600 d.0004

During which step of the nursing process is care provided? a. Assessment b. Evaluation c. Implementation d. Planning

True or False A flowsheet is only used by RNS and used to record frequent measurements or observations.

Large rings are dangerous because: a. They can fall off and can be lost b. They can scratch the resident c. They can damage equipment d. patients can pull them off your finger

The goal of the healthcare team is to: a. Carry out the MDs orders b. Develop plans of care for residents c. Provide quality care d. Complain about the workload

True or False Listen and use silence when dealing with an angry person

True or False Inappropriate sexual behaviors by the resident are always on purpose

True or False Everyone likes to be touched

True or False Giving your opinion, positive or negative, promotes effective communication

True or False Residents do not feel safe if you tell them what you are doing

Direct Questions are used to: a. show the person you care about them b. make sure you understand what was said c. focus on specific information d. allow the person time to think

Communication that uses written/spoken word is: a. nonverbal b. focusing c. body language d. verbal communication

What does not promote effective listening? a. sitting back in the chair with your arms crossed b. making eye contact c. facing the person d. asking appropriate questions

The type of bone that bears weight of the body is called: a. long bone b. flat bone c. irregular bone d. short bone

The largest art of the brain and the center of thought and intelligence is: a. midbrain b. brainstem c. cerebellum d. cerebellum

Where does digestion begin? a. stomach b. esophagus c. mouth d. intestines

You must check the MSDS a. before using a hazardous substance b. after cleaning up a leak or spill c. at the beginning of the shift d. at the end of the shift

True or False If you call the resident by name and the respond. You know it is them.

True or False Restraints are safe and are always used to prevent falls

True or False The most serious risk of restraint use is death

True or False Restraints can increase a person's confusion or agitation

The following statements are about restraint use. Which is false? a. the least restrictive method is used b. restraints require a doctors order c. restraints can cause serious harm d. restraints are used to discipline a person who is uncooperative with care

A microbe that is harmful and causes infection is called: a. reservoir b.pathogen c. a non- pathogen d. host

The process of becoming "unclean" is called: a. asepsis b. disinfection c. contamination d. immunity

Mrs. Cooper is on isolation precautions. Which is false? a. say hello from the doorway every 15 minutes b. spend as little time as you can in her room c. provide her with hobby materials d. treat her with respect, kindness and dignity

You are doing a dressing change on a resident. You notice that the dressing has a red/yellow body fluid on it. The dressing is called: a. Gross b. Biohazards waste c. Bloody pus d. use droplet precautions

True or False When transferring a patient, the weak side moves first

True or False Proper positioning prevents pressure ulcers and contractures

True or False The bed should be placed in low with the call bell in reach when providing patient care.

Your resident is in back lying position. This is called: a. prone b. supine c. High Fowlers d. dorsal recumbent position

When logrolling a resident, you must: a. make sure the bed is in Fowlers position b. make sure the bed is in the lowest position c. make sure that both bed rails are up d. turn the person as a unit, in alignment, with one motion

The spread of cancer to other body parts is called: a. gangrene b. Benign tumor c. metastasis d. malignant tumor

You come into a room and find a patient having a seizure. You should: a. leave and find help b. remove any object the patient may hit c. restrain the patient's movements d. raise the foot of the bed

What are the most obvious indications of hearing impairment? a. resident speaks loudly b. resident leans forward to hear c. resident turns or cups their better ear toward the speaker

The apical pulse is located? Choose One. a. in the neck b. at the wrist c. in the second finger d. below the left nipple

Blood vessels that carry blow away from the heart are called: a. arteries b. veins c. venulee d. capillaries

Which of following medical problems frequently develop in residents with diabetes? a. kidney failure b. stroke c. decreased vision d. all of the above

You walk into check on your resident. They are in the bed, sweaty, seem really "out of sorts", and clutching their chest. You suspect: a. Stroke b. Heart attack c. TIA d. COPD

Which of the following changes in the skin growth should be reported immediately to the nurse. a. change in color b.bleeding c. change in size d. all of the above

Difficulty swallowing may be associated with: a. Congestive Heart Failure b. Parkinson's Disease c. Stroke d. Multiple Sclerosis

When taking an oral temperature with a glass thermometer. The thermometer must be left in place: a. 15 seconds b. 3 minutes c. 45 seconds d. 8 minutes

Which of the following is an important function of the skin: a. prevents pressure on the subcutaneous tissue b. provides support to the internal organs c. first line defense against infection d. all of the above

Which of the following vital signs should you report to the nurse immediately. a. 37.1, 78, 16, 118/64 b. 36.9 (r), 90, 20, 138/70 c. 36.4 (a), 158, 22, 90/46 d. 36.6, 100, 16, 120/88

The call bell or signal light should ALWAYS be: a. on the bedrail b. attached to the pillow c. within the patients reach d. on the arm of the chair

When performing perineal care, you should clean the: a. labia b. urethra to the anal area c. anal area to the urethra d. buttocks to the urethra

You are giving mouth care to an unconscious resident. You must be especially careful to prevent the resident from: a. Talking during the procedure b. Biting down on the toothbrush c. Eating the toothpaste d. Aspirating fluid

An uncircumcised male resident needs perineal care. Which of the following statements is true? a. the foreskin should be retracted. After cleaning, the foreskin is returned to its natural position. b. you should perform the procedures as if the resident were circumcised c. the labia are separated Downward strokes from front to back are used the area d. there is no difference

When changing an unsterile dressing, the nurse aide should wash hands: a. before the procedure b. after the procedure c. before and after the procedure d. before, after the removal of the soiled dressing, and after the procedure

A safety device used to transfer a dependent resident from the bed to chair is called: a. posey vest b. hand roll c. transfer/gait belt d. foot board

When making an occupied bed, the nursing assistant should: a. raise the side rail on the unattended side b. lower both side rails before changing the bed c. help the client to sit in a chair while the bed is made d. put the dirty sheets on the floor

What is the besy way to promote the resident independence in bathing a resident who has had a stroke? a. Limit the client to washing her hands b. Leave the client alone and assume the client will do as much as she can c. Encourage the client to do as much as possible and assist as needed d. Give the client a complete bed bath only if requested

You enter a patients room and the resident states they are in pain. What should you do? a. ignore the clients statements b. tell the clients to suck it up the pain will go away c. report it to the nurse d. tell the client they will feel better if they just get out the bed

Men often times have difficulty urinating because: a. kidneys atrophy b. bladder increases in size c. prostate gland enlarges d. urethra loses tone

Development is a. an involuntary movement b. a skill that must be completed c. changes in mental, emotional, and social function d. the physical changes that can be measured and that occur in steady, orderly manner

You go to check on a resident and the gown is soiled. The next action should be: a. clean the patient and put the soiled gown back on b. leave the patient dirty and change the gown c. clean the patient and put on a clean gown d. walk out of the room

Mr. Kline is bedbound. How often should reposition him? a. at least every hour b. at least every two hours c. at least every four hours d. at least every shift

Your resident wears dentures. What should you check the dentures for when providing oral care? a. bleeding gums b. irritation or watch patches in the mouth c. dryness and cracks in the oral mucousa d. rough, sharp or chipped areas

Anxiety is a. false belief b. feelings and emotions c. a persistent thought or idea d. a vague, uneasy feeling in response to stress

Your personal feelings about death a. affect the care you give b. are shared with the dying person c. do not matter while you are working d. are shared with the resident and their family

Rectal temperatures are taken: a. a person has a diarrhea b. a person has had rectal surgery c. the person has trauma to their face d. the person has a heart problem

The period of heart muscle relaxation is called a. diastole b. systole c. blood pressure d. mean arterial pressure

You are measuring vital signs on a resident. What do you report to the nurse immediately? a. the apical pulse b. any vital sign that is changed from a prior reading c. when you took the measurement d. vital signs within the normal range

True or False Respirations are counted immediately after taking a pulse. The resident should not know you are counting respirations.

True or False Before using your stethoscope on a resident you should wipe the earpieces and diaphragm with antiseptic wipes.

True or False Rectal temperatures are not taken if your resident has heart disease. Why?

True or False Axillary temperatures are more reliable than oral temperatures.

True or False Taking an apical pulse requires a stethoscope and some sort of clock

True or False The blood pressure cuff works best if applied over clothing

True or False Pain subjective and different for each individual

True or False Unless otherwise ordered, take vital signs with the resident standing

The normal body temperature range for the rectal site is: a. 98.6 to 100.6 degrees F b. 96.6 to 98.6 degrees F c. 97.6 to 99.6 degrees F d. 99.6 to 101 degrees F

You are giving your resident a back massage. Which statement is false. a. Warm the lotion before applying it b. the massage should last about 1 minute c. use firm strokes d. always keep your hands in contact with his skin

Which statement below is not a safety measure for tub baths and showers? a. clean the tub or shower before after use b. turn hot water on first, then cold c. place needed items within the person's reach d. fill the tub before the person gets in it

Oral hygiene: a. is only done once daily b. is not important for the unconscious person c. causes pyorrhea d. prevents mouth odor and infection

To prevent aspiration when providing oral care to the unconscious person, you should a. place a kidney basin under the persons chin b. clean the mouth using sponge swabs moistened with a cleaning agent c. explain the procedure to the persons and provide for privacy d. position the resident in a side-lying position with the head turned to the side.

True or False The skin is the body's first line of defense against disease

True or False Follow Standard Precautions and the Bloodborne Pathogen Standard when giving oral care

True or False A back massage is safe for everyone

True or False You are giving male perineal care. To clean the tip of the penis, start at the meatus of the urethra and work outward.

True or False The towel bar is the best place for the resident to hold on for support when the resident gets in or out of tub.

You are unsure of a vital sign measurement taken by you. You must: a. promptly ask the nurse to take it again b. ask another nursing assistant to check it for you c. report what you think d. wait an hour and then try again

Mr. Poole's blood pressure measure remains above 150/100 mmHg. This is called. a. tachycardia b. hypertension c. hypotension d. anxiety

True or False You shouldn't tell the nurse if you are unable to hear a blood oxygen

True or False An oral temperature is the best route for a patient on oxygen

True or False Pain that is described as "chronic" means it is sudden onset

Which statement about foot care is not true? a. feet are easily injured b. follow standard precautions and Blood borne Pathogen Standard c. Dirty feet and socks harbor microbes d. Cleaning toenails is easier in the morning

You are caring for Mr. Gomez. He requested to be shaved. Which statement is false? a. report nicks or cuts to the nurse at once b. shave away from the direction of hair growth c. soften the skin before shaving d. hold the skin taut as necessary

Name on major contraindication to shaving a male resident with a straight razor ___________________.

Infestation of the body with lice is called: a. dandruff b. pediculosis corporis c. pediculosis pubis d. pediculosis capitis

True or False It is best practice to cut toenails with scissors

True or False Women in nursing homes are not interested in shaving their underarms and legs

True or False To brush ones hair start at the scalp and brush toward the hair ends

True or False Foley catheters treat the cause of urinary incontinence

True or False Persons with foley catheters are at high risk for urinary infection

True or False Urinary urgency is the loss of bladder control

Painful or difficult urination is called a. dysuria b. micturition c. urinary urgency d. oliguria

The loss of urine in response to a sudden, urgent need to void is called: a. mixed incontinence b. functional incontience c. overflow incontinence d. urge incontinence

Which of the following measures will not help prevent urinary tract infection? a. encouraging the resident to do pelvic muscle exercises b. having the resident wear cotton underwear c. keeping the perineal area clean and dry d. promoting fluid intake as directed

Frequent urination at night is: a. dysuria b. nocturia c. urinary urgency d. polyuria

True or False Urinals when full should be placed on the overbed table

True or False The healthy adult produces about 1500ml urine per day

True or False The goal of bladder training programs is control of urination

True or False When using a fracture pan, the larger end is placed under the buttocks

Hemoptysis is: a. mucous from the respiratory tract b. a black tarry stoll c. bloody stool d. infection

What type of specimen is collected for a basic routine urinalysis: a. random urine specimen b. 24 hour urine specimen c. a clean cath urine specimen d. a midstream specimen

Which is not a rule for collecting specimen? a. use a clean container for each specimen b. use the correct container c. label the container accurately d. collect the specimen as soon as you have it

To use reagent strips correctly, you should: a. ask the nurse b. check the plan of care c. check your assignment flow sheet d. read and follow manufactures

True or False Hematuria means blood in the stool

True or False Everyone has a bowel movement everyday

True or False Use of narcotic pain medications can cause constipation

True or False All colostomies are permanent

True or False The enema tubing is usually inserted 6 inches into the adult rectum

The nurse asks you to give Mrs. Jones a milk and molasses enema. Should you give the enema?

True or False A resident can have a diagnosis of constipation and still stool

Which of the following would not be a cause of constipation? a. medications b. decreased fluid intake c. high fiber diet d. inactivity

Your resident has an ileostomy. Which statement is fake? a. the ostomy pouch must fit well b. food skin care is needed c. the entire large intestine has been removed d. the stool is formed

True or False Most residents enjoy enemas

Which of the word below best describes of apetite: a. gavage b. regurgitation c. dysphagia d. anorexia

Ms. Schnieder has an order for NPO after midnight. This means: a. fluids are restricted b. accurate records are kept of oral intake c. she can eat whatever she wants or drink whatever she wants d. she is encouraged to drink a variety of fluids

True or False Sodium causes the body to retain water

True or False You should always make yourself at home and sit on the resident bed while feeding

True or False As a nursing assistant it is your responsibility to check IV flow rates

True or False When residents are sick they are hungrier

Your task is to help Mrs. Morris to eat lunch. Which statement below is incorrect? a. use a spoon for safety b. serve solid foods first and then liquids c. serve the foods in order she prefers d. tell her what food and fluids are on the tray

A tube inserted into the stomach through a surgically create opening is called: a. a gastrostomy tube b. a jejunostomy tube c. a PEG tube d. a nasogastric tube

Mr. Edwards is on strict bedrest. Which of the following statements is correct? a. he has a contracture b. good body alignment is important c. he can get up to use the bathroom only d. he has orthostatic hypotension

A resident uses crutches to walk. Which does not promote safety? a. a physical therapist measures and fits the person with crutches b. comfortable bedroom slippers won c. clothes fit well d. crutch tips are attached to the end of crutches

True or False You should pick your residents daily activities and make them go

True or False Trochanter rolls prevent the hips from turning inward

True or False If your resident starts to fall, move out of the way so you don't get hurt

True or False The plan of care for a resident tells you when to apply and remove heat/ice

Muscle Atrophy is: a. the abnormal shortening of a muscle b. bending backward c. the decrease in size or wasting away of a muscle d. excessive straightening of a body part

Which of the following statements is false: a. OBRA requires activity programs for nursing home residents b. Activities are important for physical and emotional health c. personal choice is protected d. Each resident by law to participate in at least two activities daily

True or False Traction is removed when you make the persons bed

True or False Stroke is leading cause of disability in adults

True or False Multiple sclerosis is cured with diet and medications

True or False A malignant tumor grows slowly and does not invade healthy tissue

Inflammation of the mouth is called: a. aphasia b. metastasis c. benign d. stomatitis

The surgical replacement of a joint is called: a. open reduction b. healing fracture c. osteoporosis d. arthroplasty

True or False Even with residents of nursing facilities, use of condoms will prevent STDs.

The absence of breathing is called? a. apnea b. hypoxia c. orthopnea d. dyspnea

True or False In healthy adults, respirations should be between 24-30

True or False Nursing Assistants are responsible for starting oxygen therapy

Which statement is false about coughing and deep breathing a. they are done during bedrest b. they help remove mucous c. they move air into most parts of the lungs d. they are done after surgery because the are too painful.

The following are risk factors for coronary artery disease. Which risk factor can not be changed a. lack of exercise b. smoking c. being overweight d. your mother and father both had heart attacks at 40 and 48

An infection of the bladder is called: a. cystitis b. pyelonephritis c. renal calculi d. dialysis

HIV can be spread by a. sneezing coughing b. insects c. holding hands and hugging d. unprotected anal, vaginal or oral sex as well as blood exposure to unbroken skin

True or False HIV medications can make you very sick

True or False Battery is threatening to touch a person's body without their consent

Standard Precautions apply to: a. the health care team b. everyone c. nursing center residents d. persons only with infections

Phantom pain is a. suddenly felt b. constant and severe c. felt at the site of tissue damage and in nearby areas d. is felt in the body part which is no longer there

Increased signs, symptoms and behaviors of Alzheimers Disease during the hours of darkness is called a. night time fatigue b. sleep deprivation c. delirium d. sundowning

A document about personal choices regarding life support when death is likely is a. a durable healthcare power of attorney b. a Do Not Resuscitate Order c. a living will d. Hospice Care

Stiffness or rigidity of skeletal muscles that occurs after death is called: a. DNR b. peristalsis c. postmortem d. rigor mortis

Mrs Jansen is dying. She is very very sad, She cries a lot. She rings her call bell at 2 a.m. and asks for the priest. You should: a. Ask her why she wants to see the patient b. Tell her to go back to sleep c. Tell her you will ask the nurse to call the priest in the morning d. Report her request to the nurse

True or False I will document appropriately, date, time, event and not leave anything out!

True or False Dementia is a normal part of aging

True or False Acute confusion is usually permanent

Catastrophic reactions involve a. false beliefs b. restless behavior c. seeing something that is not there d. extreme responses

The most common mental health problem is a. delirium b. alcoholism c. depression d. anxiety