MH HESI: Substance Abuse

A client is questioning the nurse about a newly prescribed medication, acamprosate calcium (Campral). Which is the most appropriate reply by the nurse? A. "This medication will help you maintain your abstinence." B. "This medication will cause uncomfortable symptoms if you combine it with alcohol." C. "This medication will decrease the effect alcohol has on your body." D. "This medication will lower your risk of experiencing a complicated withdrawal."

A. "This medication will help you maintain your abstinence." Campral has been approved by the U.S. Food and Drug Administration (FDA) for the maintenance of abstinence from alcohol in clients diagnosed with alcohol dependence who are abstinent at treatment initiation.

Johnette is reviewing her lessons in Pharmacology. She is aware that the general classification of drugs belonging to the opioid category is analgesic and: A. Depressant. B. Hallucinogenic. C. Stimulant. D. Tranquilizing.

A. Depressant. Opiates are both analgesics and CNS depressants because they decrease the effect of neurotransmitters that are excitatory or stimulating. Hallucinogenic and stimulant are categories that do not apply to opiates. Although an opiate can provide a tranquilizing effect; the general category would be that of a depressant.

During an initial assessment of a client admitted to a substance abuse unit for detoxification and treatment, the nurse asks questions to determine patterns of use of substances. Which of the following questions are most appropriate at this time? Select all that apply. A. How long have you used substances? B. How often do you use substances? C. How do you get substances into your body? D. Do you feel bad or guilty about your use of substances? E. How much of each substance do you use? F. Have you ever felt you should cut down substance use? G. What substances do you use?

A. How long have you used substances? B. How often do you use substances? C. How do you get substances into your body? E. How much of each substance do you use? G. What substances do you use? These questions will elicit information about the client's pattern of use of substances. Options D and F are questions related to CAGE, a tool for screening suspected substance abusers.

The ED nurse assesses a confused client diagnosed with alcohol use disorder and notes the use of confabulation. Which complication of alcohol use disorder would the nurse suspect? A. Korsakoff's psychosis B. Vascular neurocognitive disorder C. Wernicke's encephalopathy D. Esophageal varices

A. Korsakoff's psychosis Korsakoff's psychosis is identified by a syndrome of confusion, loss of memory, and confabulation. Confabulation is the creating of imaginary events to fill in memory gaps.

A lonely, depressed divorcée has been self-medicating with cocaine for the past year. Which term should a nurse use to best describe this individual's situation? A. The individual is experiencing psychological dependency. B. The individual is experiencing physical dependency. C. The individual is experiencing substance dependency. D. The individual is experiencing social dependency.

A. The individual is experiencing psychological dependency. The nurse should use the term "psychological dependency" to best describe this client's situation. A client is considered to be psychologically dependent on a substance when there is an overwhelming desire to use a substance in order to produce pleasure or avoid discomfort.

Which is the priority nursing intervention for a client admitted for acute alcohol intoxication? A. Darken the room to reduce stimuli in order to prevent seizures. B. Assess aggressive behaviors in order to intervene to prevent injury to self or others. C. Administer lorazepam (Ativan) to reduce the rebound effects on the central nervous system. D. Teach the negative effects of alcohol on the body.

B. Assess aggressive behaviors in order to intervene to prevent injury to self or others. Symptoms associated with the syndrome of alcohol intoxication include but are not limited to aggressiveness, impaired judgment, impaired attention, and irritability. Safety is a nursing priority in this situation.

The nurse is assessing a client who is a substance abuser. The client states, "I use every day, but it rarely interferes with my work." The nurse determines that the client is using which defense mechanism? A. Projection B. Denial C. Reaction formation D. Displacement

B. Denial Denial is characterized by avoidance of disagreeable realities and unconscious refusal to acknowledge a thought, feeling, need, or desire. By stating that alcohol use rarely interferes with his or her work, the client is denying a substance abuse problem.

A client with chronic alcoholism says to the nurse, "I'm tired of using and I want to stop. Is there a medication that can help me maintain sobriety?" About which medication would the nurse provide information? A. Carbamazepine (Tegretol) B. Clonidine (Catapres) C. Disulfiram (Antabuse) D. Folic acid (Folvite)

C. Disulfiram (Antabuse) Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can cause varying degrees of discomfort. It can even result in death if blood alcohol levels are high enough. It is important that the client understands that all alcohol, oral or topical, and medications that contain alcohol are strictly prohibited when taking this drug.

Nurse Wilma is teaching a client about disulfiram (Antabuse), which the client is taking to deter his use of alcohol. She explains that using alcohol when taking this medication can result in: A. Abdominal cramps and diarrhea. B. Drowsiness and decreased respiration. C. Flushing, vomiting, and dizziness. D. Increased pulse and blood pressure.

C. Flushing, vomiting, and dizziness. Disulfiram (Antabuse) prevents complete alcohol metabolism in the body. Therefore when alcohol is consumed, the client has a hypersensitivity reaction. Flushing, vomiting, and dizziness are associated with the incomplete breakdown of alcohol metabolites. Other choices are not associated with the use of disulfiram along with alcohol.

A client diagnosed with chronic alcohol use disorder complains of feeling tremulous. The client's BP is now 170/110, P 116, R 30, T 97°F. The nurse anticipates which medication would give the client the most immediate relief from these symptoms? A. Benztropine (Cogentin), 2 mg PO B. Oxazepam (Serax), 30 mg PO C. Lorazepam (Ativan), 1 mg IM D. Meperidine (Demerol), 100 mg IM

C. Lorazepam (Ativan), 1 mg IM Ativan is frequently used to treat the symptoms of alcohol withdrawal. Because Ativan is ordered parenterally, this medication would give the client the most immediate relief of symptoms.

When teaching a client diagnosed with alcoholism about nutritional needs, which nutritional concept should the nurse emphasize? A. Eat a high-protein, low-carbohydrate diet to promote lean body mass. B. Increase sodium-rich foods to increase iodine levels. C. Provide multivitamin supplements, including thiamine and folic acid. D. Restrict fluid intake to decrease renal load.

C. Provide multivitamin supplements, including thiamine and folic acid. Vitamin B deficiencies contribute to the nervous system disorders seen in chronic alcohol abuse. Supplements of these vitamins are important to prevent complications. It is important that vitamin supplements include both thiamine (vitamin B1) and folic acid.

The nurse administers bromocriptine (Parlodel) to Bryan who is undergoing detoxification for amphetamine abuse. The rationale for this medication is to: A. Aid in GABA inhibition. B. Prevent norepinephrine excess. C. Restore depleted dopamine levels. D. Treat psychotic symptoms.

C. Restore depleted dopamine levels. Amphetamine abuse depletes the neurotransmitter dopamine. When withdrawing from amphetamines, dopamine depletion causes depression, insomnia, and intense craving for the drug. Bromocriptine (Parlodel) is a dopamine agonist that will help restore this neurotransmitter. GABA inhibition, prevention of norepinephrine excess, and treatment of psychotic symptoms are incorrect rationales for the use of this medication. GABA inhibition, prevention of norepinephrine excess, and treatment of psychotic symptoms are incorrect rationales for the use of this medication.

Which medication is commonly used in treatment programs for heroin abusers to produce a non-euphoric state and to replace heroin use? A. Diazepam B. Carbamazepine C. Clonidine D. Methadone

D. Methadone Methadone maintenance programs are used to provide a heroin-depleted individual with a medically controlled dose of methadone to produce a non-euphoric state that will prevent withdrawal symptoms. This method of treatment is advocated to help heroin abusers avoid criminal activities associated with obtaining heroin; it also prevents diseases associated with I.V. use of heroin. Diazepam and carbamazepine may be used for withdrawal from alcohol, barbiturates, and benzodiazepines. Clonidine can be used in acute withdrawal from heroin to avoid norepinephrine rebound when opiates are stopped.

A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse's rationale for this intervention? A. To assess for emotional strength B. To assess for Wernicke-Korsakoff syndrome C. To assess for tachycardia D. To assess for fine tremors

D. To assess for fine tremors The nurse is most likely assessing the client for fine tremors secondary to alcohol withdrawal. Withdrawal from alcohol can also cause headache, insomnia, transient hallucinations, depression, irritability, anxiety, elevated blood pressure, sweating, tachycardia, malaise, coarse tremors, and seizure activity.

What physical signs might indicate that a client is abusing IV drugs?

-Needle tracks -cellulitis at puncture site -poor nutritional status

The nurse notes that a client is experiencing signs of alcohol withdrawal delirium. What should the nurse do?

-contact the HCP immediately and follow facility protocol. -1 to 1 supervision needs provided for safety. ---use non judgmental manner -monitor vitals and neuro assessment every 15 min

A client is admitted for alcohol detoxification. During detoxification, which symptoms should the nurse expect to assess? A. Gross tremors, delirium, hyperactivity, and hypertension B. Disorientation, peripheral neuropathy, and hypotension C. Oculogyric crisis, amnesia, ataxia, and hypertension D. Hallucinations, fine tremors, confabulation, and orthostatic hypotension

A. Gross tremors, delirium, hyperactivity, and hypertension Withdrawal is defined as the physiological and mental readjustment that accompanies the discontinuation of an addictive substance. Symptoms can include gross tremors, delirium, hyperactivity, hypertension, nausea, vomiting, tachycardia, hallucinations, and seizures.

Three days ago, a client was admitted to the medical unit for a gastrointestinal bleed. His BP and pulse rate gradually increased, and he developed a low-grade fever. What kind of anticipatory planning should the nurse develop?

Anticipate withdrawal and delirium tremens. Provide a quiet, safe environment. Place on seizure precautions. Anticipate giving a medication such as chlordiazepoxide (Librium).

A client who is going through alcohol detoxification states, "I see bugs crawling on the wall." Which is the best nursing response? A. "I'll remove the bugs from the wall." B. "You are confused because of your alcoholism." C. "There are no bugs on the wall. I'll stay with you until you feel less anxious." D. "You do not see any bugs on the wall."

C. "There are no bugs on the wall. I'll stay with you until you feel less anxious." This response presents objective reality and may help decrease the client's anxiety by the nurse's therapeutic offering of self.

The nurse believes that a client being admitted for a surgical procedure may have a drinking problem. How should the nurse further evaluate this possibility? A. By asking directly if the client has ever had a problem with alcohol B. By holistically assessing the client using the CIWA scale C. By using a screening tool such as the CAGE questionnaire D. By referring the client for physician evaluation

C. By using a screening tool such as the CAGE questionnaire The CAGE questionnaire is a screening tool used to determine the diagnosis of alcoholism. This questionnaire is composed of four simple questions. Scoring two or three "yes" answers strongly suggests a problem with alcohol.

A nurse is caring for a client who has been prescribed disulfiram (Antabuse) as a deterrent to alcohol relapse. Which information should the nurse include when teaching the client about this medication? A. "Only oral ingestion of alcohol will cause a reaction when taking this drug." B. "It is safe to drink beverages that have only 12% alcohol content." C. "This medication will decrease your cravings for alcohol." D. "Reactions to combining Antabuse with alcohol can occur 2 weeks after stopping the drug."

D. "Reactions to combining Antabuse with alcohol can occur 2 weeks after stopping the drug." If Antabuse is discontinued, it is important for the client to understand that the sensitivity to alcohol may last for as long as 2 weeks.

When a client abuses a CNS depressant, withdrawal symptoms will be caused by which of the following? A. Acetylcholine excess B. Dopamine depletion C. Serotonin inhibition D. Norepinephrine rebound

D. Norepinephrine rebound CNS depressants, when abused, cause depletion of stimulating neurotransmitters. When the CNS depressant is stopped, the result is a rebound of excitatory or stimulating neurotransmitters, such as norepinephrine. Acetylcholine, dopamine, and serotonin are not significant factors in the symptoms of withdrawal from a CNS depressant.

Which is the most serious symptom experienced during alcohol withdrawal? A. Blackout B. Acute withdrawal delirium C. Hypotension D. Seizure

D. Seizure During alcohol withdrawal, the central nervous system (CNS) rebounds from the effects of suppression caused by alcohol intake. This excitation of the CNS can lead to grand mal seizures and other complications, which are life threatening. This is the most serious complication of alcohol withdrawal syndrome.

A client is brought to the ED. The client is aggressive, has slurred speech, and exhibits impaired motor coordination. Blood alcohol level is 347 mg/dL. Among the physician's orders is thiamine. Which is the rationale for this intervention? A. To prevent nutritional deficits B. To prevent pancreatitis C. To prevent alcoholic hepatitis D. To prevent Wernicke's encephalopathy

D. To prevent Wernicke's encephalopathy Wernicke's encephalopathy is the most serious form of thiamine deficiency in clients diagnosed with alcoholism. If thiamine replacement therapy is not undertaken quickly, death will ensue.

Substance dependence

a pattern of repeated use of a substance, which usually results in tolerance, withdrawal symptoms and compulsive drug-taking behavior

Which nursing intervention relates to rehabilitative care for a recovering alcoholic? A. Providing a safe and supportive environment during alcohol withdrawal B. Teaching about physical symptoms C. Providing client and family education and assistance during treatment D. Encouraging continued participation in AA

D. Encouraging continued participation in AA Because recovery is a long-term process, it is critical that the nurse encourage continuous participation in outpatient support systems such as AA.

Three days ago, a client was admitted to the medical unit for a gastrointestinal bleed. His BP and pulse rate gradually increased, and he developed a low-grade fever. What assessment data should the nurse obtain?

Obtain a drug and alcohol consumption assessment, including type, frequency and time of last dose or drink.

Which interventions are most important for caring for a client in alcohol withdrawal? Select all that apply. A. Monitor vital signs B. Provide a safe environment C. Address hallucinations therapeutically D. Provide stimulation in the environment E. Provide reality orientation as appropriate F. Maintain NPO status

A, B, C, E When the client is experiencing withdrawal from alcohol, the priority care is to prevent the client from harming self or others. The nurse would monitor their vitals and report any abnormalities. The nurse would provide a low-stimulating environment to maintain the client in as calm a state as possible. The nurse would reorient the client to reality frequently and would address hallucinations therapeutically. Adequate nutritional and fluid intake need to be maintained.

Which of the following nursing statements exemplify the cognitive process that must be completed by a nurse prior to caring for clients diagnosed with substance-abuse disorders? (Select all that apply.) A. "I am easily manipulated and need to work on this prior to caring for these clients." B. "Because of my father's alcoholism, I need to examine my attitude toward these clients." C. "I need to review the side effects of the medications used in the withdrawal process." D. "I'll need to set boundaries to maintain a therapeutic relationship." E. "I need to take charge when dealing with clients diagnosed with substance disorders."

A. "I am easily manipulated and need to work on this prior to caring for these clients." B. "Because of my father's alcoholism, I need to examine my attitude toward these clients." D. "I'll need to set boundaries to maintain a therapeutic relationship." The nurse should examine personal bias and preconceived negative attitudes prior to caring for clients diagnosed with substance-abuse disorders. A deficit in this area may affect the nurse's ability to establish therapeutic relationships with these clients.

What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal? A. Risk for injury R/T central nervous system stimulation B. Disturbed thought processes R/T tactile hallucinations C. Ineffective coping R/T powerlessness over alcohol use D. Ineffective denial R/T continued alcohol use despite negative consequences

A. Risk for injury R/T central nervous system stimulation The priority nursing diagnosis for a client experiencing alcohol withdrawal should be risk for injury R/T central nervous system stimulation. Alcohol withdrawal may include the following symptoms: course tremors of hands, tongue, or eyelids; seizures; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood; hallucinations; headache; and insomnia.

Which would the nurse consider a priority intervention when planning care for a medically unstable client diagnosed with alcohol use disorder? A. Simplifying the environment B. Addressing physical needs C. Providing opportunities for success experiences D. Establishing a trusting interpersonal relationship

B. Addressing physical needs Physical problems must be addressed prior to meeting any psychosocial needs of a client who is medically unstable. According to Maslow's hierarchy of needs, physiological needs should be prioritized over all other needs.

Which client and family teaching is most important regarding the cause of substance addiction? A. An individual's social and cultural environment can be implicated in the cause of substance addiction. B. Biological, psychological, and sociocultural factors can all be implicated in the cause of substance addiction. C. Evidence of a genetic link accounts for most cases of substance addiction. D. Reinforcing properties of the substance encourage progression from use to addiction.

B. Biological, psychological, and sociocultural factors can all be implicated in the cause of substance addiction.

A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 24 hours. Which client symptom should the nurse immediate report to the ED physician? A. Tactile hallucinations B. Blood pressure of 180/100 mm Hg C. Mood rating of 2/10 on numeric scale D. Dehydration

B. Blood pressure of 180/100 mm Hg The nurse should recognize that high blood pressure is a symptom of alcohol withdrawal and should promptly report this finding to the physician. Complications associated with alcohol withdrawal may progress to alcohol withdrawal delirium and possible seizure activity on about the second or third day following cessation of prolonged alcohol consumption.

Ryan who is a chronic alcohol abuser is being assessed by Nurse Gina. Which problems are related to thiamin deficiency? A. Cardiovascular symptoms, such as decreased hemoglobin and hematocrit levels B. CNS symptoms, such as ataxia and peripheral neuropathy C. Gastrointestinal symptoms, such as nausea and vomiting D. Respiratory symptoms, such as cough and sore throat

B. CNS symptoms, such as ataxia and peripheral neuropathy Wernicke's encephalopathy is a CNS disorder caused by acute thiamin deficiency in people who abuse alcohol. Other symptoms, besides ataxia and peripheral neuropathy, are acute confusion or delirium. Cardiovascular and gastrointestinal symptoms are associated with alcohol abuse; they are not caused by thiamin deficiency. Respiratory problems are not usually directly related to alcohol.

Kendall, the sister of a client with a substance-related disorder, tells the nurse she calls out sick for her sister Kate occasionally when the latter has too much to drink and cannot work. This behavior can be described as: A. Caretaking. B. Codependent. C. Helpful. D. Supportive.

B. Codependent. Enabling behaviors that inadvertently promote continued use of a substance by the person abusing substances is known as codependency. The sister's behavior is not an example of caretaking or support. She is taking responsibility for the client's behavior and allowing her to avoid the consequences of his abuse problem. The behavior is unhelpful and unsupportive.

Which primary factor is critical in maintaining abstinence for the client diagnosed with alcohol use disorder? A. Attendance at Alcoholics Anonymous (AA) meetings B. Personal commitment to change C. Family involvement D. Compliance with pharmacological therapy

B. Personal commitment to change The first step in the recovery process necessitates that the client accept ownership of the problem and establish a behavioral change commitment to continued abstinence.

A client with a history of insomnia has been taking chlordiazepoxide (Librium) 15 mg at night for the past year. The client currently reports getting to sleep. Which nursing diagnosis appropriately documents this problem? A. Ineffective coping R/T unresolved anxiety AEB substance abuse B. Anxiety R/T poor sleep AEB difficulty falling asleep C. Disturbed sleep pattern R/T Librium tolerance AEB difficulty falling asleep D. Risk for injury R/T addiction to Librium

C. Disturbed sleep pattern R/T Librium tolerance AEB difficulty falling asleep Tolerance is defined as the need for increasingly larger or more frequent doses of a substance in order to obtain the desired effects originally produced by a lower dose.

Upon admission for symptoms of alcohol withdrawal a client states, "I haven't eaten in 3 days." Assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97F (36C) with dry skin, dry mucous membranes, and poor skin turgor. What should be the priority nursing diagnosis? A. Knowledge deficit B. Fluid volume excess C. Imbalanced nutrition: less than body requirements D. Ineffective individual coping

C. Imbalanced nutrition: less than body requirements The nurse should assess that the priority nursing diagnosis is imbalanced nutrition: less than body requirements. The client is exhibiting signs and symptoms of malnutrition as well as alcohol withdrawal. The nurse should consult a dietitian, restrict sodium intake to minimize fluid retention, and provide small, frequent feedings of nonirritating foods.

Nurse Julie recommends that the family of a client with substance-related disorder attend a support group, such as Al-Anon and Alateen. The purpose of these groups is to help family members understand the problem and to: A. Change the problem behaviors of the abuser. B. Learn how to assist the abuser in getting help. C. Maintain focus on changing their own behaviors. D. Prevent substance problems in vulnerable family members.

C. Maintain focus on changing their own behaviors. Family support groups, such as Al-Anon and Alateen, emphasize the importance of changing one's own behavior rather than trying to change the behavior of the individual with a substance abuse problem. Trying to change the abuser's behavior or learning ways to find help for the abuser would be viewed as codependent behaviors, and thus would not be advocated by family support groups. Learning about substance abuse may help a vulnerable family member to avoid this problem; however, that is not the purpose of these groups.

Nurse Rob has observed a co-worker arriving to work drunk at least three times in the past month. Which action by Nurse Rob would best ensure client safety and obtain necessary assistance for the co-worker? A. Ignore the co worker's behavior, and frequently assess the clients assigned to the co-worker. B. Make general statements about safety issues at the next staff meeting. C. Report the coworker's behavior to the appropriate supervisor. D. Warn the co-worker that this practice is unsafe.

C. Report the coworker's behavior to the appropriate supervisor. The nurse is obligated by ethical considerations of client safety, as well as by nurse practice acts in many states, to report substance abuse in health care workers. Most healthcare facilities have an employee assistance program to help workers with substance abuse problems.

Which client statement indicates a knowledge deficit related to substance abuse? A. "Although it's legal, alcohol is one of the most widely abused drugs in our society." B. "Tolerance to heroin develops quickly." C. "Flashbacks from LSD use may reoccur spontaneously." D. "Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless."

D. "Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless." The nurse should determine that the client has a knowledge deficit related to substance abuse when the client compares marijuana to smoking cigarettes and claims it to be harmless. Cannabis is the second most widely abused drug in the United States.

Which client statement demonstrates positive progress toward recovery from substance abuse? A. "I have completed detox and therefore am in control of my drug use." B. "I will faithfully attend Narcotic Anonymous (NA) when I can't control my carvings." C. "As a church deacon, my focus will now be on spiritual renewal." D. "Taking those pills got out of control. It cost me my job, marriage, and children."

D. "Taking those pills got out of control. It cost me my job, marriage, and children." A client who takes responsibility for the consequences of substance abuse/dependence is making positive progress toward recovery. This client would most likely be in the working phase of the counseling process in which acceptance of the fact that substance abuse causes problems occurs.

Which medication orders should a nurse anticipate for a client who has a history of complicated withdrawal from benzodiazepines? A. Haloperidol (Haldol) and fluoxetine (Prozac) B. Carbamazepine (Tegretol) and donepezil (Aricept) C. Disulfiram (Antabuse) and lorazepan (Ativan) D. Chlordiazepoxide (Librium) and phenytoin (Dilantin)

D. Chlordiazepoxide (Librium) and phenytoin (Dilantin) The nurse should anticipate that a physician would order chlordiazepoxide (Librium) and phenytoin (Dilantin) for a client who has a history of complicated withdrawal from benzodiazepines. It is common for long-lasting benzodiazepines to be prescribed for substitution therapy. Phenytoin (Dilantin) is an anticonvulsant that would be indicated for a client who has experienced a complicated withdrawal. Complicated withdrawals may progress to seizure activity.

The nurse is monitoring a hospitalized client who abuses alcohol. Which findings should alert the nurse to the potential risk for alcohol withdrawal delirium? A. Hypertension, ataxia, hunger B. Stupor, lethargy, muscular rigidity C. Hypotension, course hand tremors, lethargy D. Hypertension, change in level of consciousness, hallucinations

D. Hypertension, change in level of consciousness, hallucinations Symptoms associated with alcohol withdrawal delirium typically include anxiety, insomnia, anorexia, hypertension, disorientation, hallucinations, change in consciousness, agitation, fever and delusions.

On admission, a client experienced severe alcohol withdrawal symptoms. Four days later, the nurse notes a decrease in withdrawal symptoms. Which nursing intervention is most appropriate? A. Withhold potentially addictive as needed (prn) medications. B. Increase prn medications because potentially fatal complications can still occur. C. Ask the doctor to prescribe a less addictive medication to reduce potential for dependence. D. Monitor for withdrawal complications and administer medications on the basis of client symptoms.

D. Monitor for withdrawal complications and administer medications on the basis of client symptoms. The nurse must remain vigilant because withdrawal complications can occur days after initial withdrawal symptoms appear. Medication dosages for withdrawal should be based on an objective assessment of symptoms. This is usually done by the use of an assessment tool such as Clinical Institute Withdrawal Assessment (CIWA).

A hospitalized client with a history of alcohol abuse tells the nurse, "I am leaving now. I have to go. I don't want anymore treatment. I have things that I have to do right away." The client has not been discharged and is scheduled for an important diagnostic test to be performed in 1 hour. After the nurse discusses the client's concern s with the client, the client dresses and begins to walk out of the hospital room. What action should the nurse take? A. Call the nursing supervisor B. Call security to block all exit areas C. Restrain the client until the health care provider can be can be reached D. Tell the client that the client cannot return to this hospital again if the client leaves now

A. Call the nursing supervisor Most healthcare facilities have documents that the client is asked to sign relaying to the client's responsibilities when the client leaves against medical advise. The client should be asked to wait to speak to the HCP before leaving and to sign the "against medical advice" documented before leaving. If the client refuses to do so, the nurse cannot hold the client against their will. Therefore, in this situation, the nurse should call the nursing supervisor. The nurse can be charged with false imprisonment if a client is made to believe wrongfully that they cannot leave the hospital. Restraining the client and calling security to block exits constitutes false imprisonment. All clients have a right to health care and cannot be told otherwise.

A client who is unable to control binge drinking requires increased amounts of alcohol to achieve the same level of intoxication. The client is experiencing marital strife and legal problems. The client's behaviors meet the criteria for which DSM-5 diagnostic category? A. Dual diagnosis B. Alcohol use disorder C. Neurocognitive disorder D. Alcohol intoxication

B. Alcohol use disorder This client has developed tolerance, cannot control alcohol intake, and has continued use despite persistent problems related to drinking. These symptoms meet the criteria for the diagnosis of alcohol use disorder in the DSM-5.

A client is being discharged from an alcohol treatment program. The client's wife states, "I'm so afraid that when my husband leaves here, he'll relapse. How can I deal with this?" Which nursing statement would be most appropriate? A. "Many family members of alcoholics find the Al-Anon support group to be helpful." B. "You could try going out and having a few beers with him when he gets the urge to drink." C. "Just make sure he doesn't drink at home. Find all of his hidden bottles and empty them." D. "Tell your husband that if he drinks again, you will leave him."

A. "Many family members of alcoholics find the Al-Anon support group to be helpful." Al-Anon is a nonprofit organization that provides group support for the family and close friends of alcoholics.

Paula is attending an education class on addictive disorders. She suspects that her husband may be abusing opiates since he has been taking pills given to him by his brother and she knows the brother had been taking oxycodone for back pain. She asks the nurse how to interpret her husband's behaviors. Which of the following observations by Paula are consistent with opioid intoxication? Select all that apply. A. "Sometimes he seems euphoric and other times he acts like he doesn't care about anything." B. "Last night he went out without a coat on and it was 15 degrees outside." C. "While we were talking at dinner his speech was rapid and he seemed hyperalert to everything in the environment." D. "He's been having trouble remembering things." E. "Sometimes it looks like his pupils are very small."

A. "Sometimes he seems euphoric and other times he acts like he doesn't care about anything." B. "Last night he went out without a coat on and it was 15 degrees outside." D. "He's been having trouble remembering things." E. "Sometimes it looks like his pupils are very small." One manifestation of opioid intoxication is an initial period of euphoria followed by apathy, which is indicated by her statement that "sometimes he acts like he doesn't care about anything." Going outside without a coat in subfreezing weather could be inferred as impaired judgment, which is consistent with opioid intoxication. Impairment in attention and memory is consistent with opioid intoxication. Paula is describing pupillary constriction, which is consistent with opioid intoxication. Rapid speech and hypervigilance are more consistent with stimulant intoxication. In opioid intoxication one would expect to see mental cloudiness.

A client is preparing to attend a Gamblers Anonymous meeting for the first time. The nurse should tell the client that which is the first step in this 12-step program? A. Admitting to have a problem B. Substituting other activities for gambling C. Stating that the gambling will be stopped D. Discontinuing relationships with people who gamble

A. Admitting to having a problem The first step in the 12-step program is to admit that a problem exists. Substituting other activities for gambling may be a strategy, but it is not the first step. The remaining options are not realistic strategies for the initial step in a 12-step program.

The community nurse practicing primary prevention of alcohol abuse would target which groups for educational efforts? A. Adolescents in their late teens and young adults in their early twenties B. Elderly men who live in retirement communities C. Women working in careers outside the home D. Women working in the home

A. Adolescents in their late teens and young adults in their early twenties High-risk groups for alcohol abuse include individuals between ages 18 and 25 and the unemployed. There is no evidence that elderly men in retirement communities have increased rates of alcohol abuse. Men have 2 to 3 times increased risk than women of abusing alcohol.

A client diagnosed with chronic alcohol dependency is being discharged from an inpatient treatment facility after detoxification. Which client outcome related to Alcoholics Anonymous (AA) would be most appropriate for a nurse to discuss with the client during discharge teaching? A. After discharge, the client will immediately attend 90 AA meetings in 90 days. B. After discharge, the client will rely on an AA sponsor to help control alcohol cravings. C. After discharge, the client will incorporate family in AA attendance. D. After discharge, the client will seek appropriate deterrent medications through AA.

A. After discharge, the client will immediately attend 90 AA meetings in 90 days. The most appropriate client outcome for the nurse to discuss during discharge teaching is attending 90 AA meetings in 90 days after discharge. AA is a major self-help organization for the treatment of alcoholism. It accepts alcoholism as an illness and promotes total abstinence as the only cure.

Nurse Tara is teaching a community group about substance abuse. She explains that a genetic component has been implicated in which of the following commonly abused substances? A. Alcohol B. Barbiturates C. Heroin D. Marijuana

A. Alcohol Several chromosomes (1, 3, and 7) have been implicated in increased vulnerability to alcohol abuse. Statistics have shown that risk for alcohol abuse in first-degree relatives of alcohol abusers is as high as 40% to 60%. Most of the genetic research has been done related to alcohol. B, C, and D: Definitive data regarding genetic transmission is not available at this time for barbiturates, heroin, and marijuana.

The newly hired nurse at Nurseslabs Medical Center is assessing a client who abuses barbiturates and benzodiazepine. The nurse would observe for evidence of which withdrawal symptoms? A. Anxiety, tremors, and tachycardia B. Respiratory depression, stupor, and bradycardia C. Muscle aches, cramps, and lacrimation D. Paranoia, depression, and agitation

A. Anxiety, tremors, and tachycardia Barbiturates and benzodiazepine are CNS depressants; therefore, withdrawal symptoms are related to CNS stimulation caused by the rebounding of neurotransmitters (norepinephrine). Symptoms include increased anxiety, tremors, and vital sign changes (such as tachycardia and hypertension). Respiratory depression, stupor, and bradycardia are typically associated with an overdose—not withdrawal—of barbiturates or benzodiazepine. Muscle aches, cramps, and lacrimation are most commonly associated with withdrawal from opiates. Paranoia, depression, and agitation are usually associated with withdrawal from CNS stimulants, such as amphetamines or cocaine.

A client has a history of daily bourbon drinking for the past 6 months. He is brought to an emergency department by family who report that his last drink was 1 hour ago. It is now 12 midnight. When should a nurse expect this client to exhibit withdrawal symptoms? A. Between 3 a.m. and 11 a.m. B. Shortly after a 24-hour period C. At the beginning of the third day D. Withdrawal is individualized and cannot be predicted.

A. Between 3 a.m. and 11 a.m. The nurse should expect that this client will begin experiencing withdrawal symptoms from alcohol between 3 a.m. and 11 a.m. Symptoms of alcohol withdrawal usually occur within 4 to 12 hours of cessation or reduction in heavy and prolonged alcohol use.

Which issues influence an individual's predisposition to substance-related disorders? Select all that apply. A. Genetic history B. Fixation at the oral stage of psychosexual development C. Punitive ego D. Personality traits E. Behavior modeling

A. Genetic history B. Fixation at the oral stage of psychosexual development D. Personality traits E. Behavior modeling Research has indicated that an apparent hereditary factor is involved in the development of substance-use disorders. This is especially evident with alcoholism. Theories of psychosexual development state that anxiety in people fixated at the oral stage may be reduced by their consumption of substances such as alcohol. Certain personality traits, such as low self-esteem, depression, and passivity, are thought to increase a tendency toward addictive behavior. Studies have shown that children and adolescents are more likely to use substances if they have parents who provide a model for substance use. A psychodynamic approach to the etiology of substance abuse focuses on a punitive superego, not ego. According to psychodynamic theory, individuals with punitive superegos turn to alcohol to diminish unconscious anxiety.

Paul, a 65-year-old Caucasian, is being seen at the health clinic for hypertension and has a history of alcohol use disorder. Which of the following observations by the nurse are consistent with physical complications associated with chronic alcohol use disorders? Select all that apply. A. His skin is yellow. B. He has a butterfly-shaped rash on his cheeks and nose. C. His abdomen is distended. D. He is coughing up blood. E. He complains of acute pain in his left eye.

A. His skin is yellow. C. His abdomen is distended. D. He is coughing up blood. Yellowish skin is evidence of jaundice, which is secondary to cirrhosis of the liver. Cirrhosis of the liver is a common manifestation of end-stage alcoholic liver disease. Abdominal distention can be a manifestation of alcoholic hepatitis, cirrhosis of the liver, and pancreatitis, all of which are complications of alcohol use disorder. Further assessment is warranted. Coughing up blood may be evidence of several complications of alcoholism, including esophageal varices, which can culminate in potentially fatal hemorrhage. Further assessment is warranted to evaluate for these as well as other potential causes of coughing up blood. Although facial flushing is a common manifestation in chronic alcohol use disorders, a distinctly butterfly-shaped rash may be indicative of other autoimmune conditions such as lupus erythematosis. Further assessment is warranted. A complaint of pain or pressure in or behind one's eyes is not directly associated with alcoholism but suggests a potentially emergent concern that requires further assessment.

A client diagnosed with depression and substance abuse has an altered sleep pattern and demands that a psychiatrist prescribe a sedative. Which rationale explains why a nurse should encourage the client to first try non-pharmacological interventions? A. Sedative-hypnotics are potentially addictive and will lose their effectiveness due to tolerance. B. Sedative-hypnotics are expensive and have numerous side effects. C. Sedative-hypnotics interfere with necessary REM (rapid eye movement) sleep. D. Sedative-hypnotics are not as effective to promote sleep as antidepressant medications.

A. Sedative-hypnotics are potentially addictive and will lose their effectiveness due to tolerance. The nurse should recommend non-pharmacological interventions to this client because sedative-hypnotics are potentially addictive and will lose their effectiveness due to tolerance. The effects of central nervous system depressants are additive with one another and are capable of producing physiological and psychological dependence.

Janice is a nurse whose husband is in rehab for alcohol use disorder. While attending a family group, Janice makes several statements about their relationship. Which of these statements would suggest Janice is exhibiting codependent behavior? Select all that apply. A. "My husband has to accept responsibility for his behavior and the consequences of his drinking." B. "I know I shouldn't go out drinking with him, but I'm afraid he'll leave me if I don't." C. "My father was the same way and I learned its better just to keep your mouth shut so you don't get hit." D. "If he didn't have me monitoring his every move he'd probably be dead already." E. "I need to make sure I'm protecting myself and my children."

B. "I know I shouldn't go out drinking with him, but I'm afraid he'll leave me if I don't." C. "My father was the same way and I learned its better just to keep your mouth shut so you don't get hit." D. "If he didn't have me monitoring his every move he'd probably be dead already." People-pleasing, fear of abandonment, and neediness, as evidenced in this statement, are all characteristic codependent behaviors. The sense of helplessness and a history of abuse or neglect as a child are consistent with codependency. This statement suggests an unrealistic need to be in control and may also suggest that Janice's self-worth is rooted in her need to be needed. Both of these are evidence of codependency. This statement is an example of healthy boundaries rather than codependent behavior. Janice's expression of concern for her own safety and her clear identification of her responsibilities as a parent are examples of healthy rather than codependent behaviors.

The spouse of a client admitted to the mental health unit for alcohol withdrawal says to the nurse, "I should get out of this bad situation." Which is the most helpful response by the nurse? A. "Why don't you tell your spouse about this?" B. "What do you find difficult about this submission? C. "This is not the best time to make that decision?" D. "I agree with you. You should get out of this situation."

B. "What do you find difficult about this submission?" The most helpful response is one that encourages the client to solve problems. Giving advice implies that the nurse knows what's best and can foster dependency. The nurse should not agree with the client, and the nurse should not request that the client provide an explanation.

The home health nurse visits a client at home and determines that the client is dependent on drugs. During the assessment, which action should the nurse take to plan appropriate nursing care? A. Ask the client why he started taking illegal drugs B. Ask the client about the amount of drug use and its effect C. Ask the client how long he thought that he could take drugs without someone finding out. D. Not ask any questions for fear that the client is in denial and will throw the nurse out of the home.

B. Ask the client about the amount of drug use and its effect Whenever the nurse carries out and assessment for a client who is dependent of drugs, it is best for the nurse to attempt to elicit information by being nonjudgmental and direct.

A nurse evaluates a client's patient-controlled analgesia (PCA) pump and notices 100 attempts within a 30-minute period. Which is the best rationale for assessing this client for substance dependence? A. Narcotic pain medication is contraindicated for all clients with active substance-abuse problems. B. Clients who are dependent on alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. C. There is no need to assess the client for substance dependence. There is an obvious PCA malfunction. D. The client is experiencing symptoms of withdrawal and needs to be accurately assessed for lorazepam (Ativan) dosage.

B. Clients who are dependent on alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. The nurse should assess the client for substance dependence because clients who are dependent on alcohol or benzodiazepines may have developed cross-tolerance to analgesics, and require increased doses to achieve effective pain control. Cross-tolerance occurs when one drug lessened the client's response to another drug.

Pamela has sought treatment for ongoing substance use disorder. She asks the nurse what treatment options are available to help her combat this problem. Which of these options would be accurate for the nurse to include in patient education? Select all that apply. A. ECT B. Self-help groups C. Deterrent therapy D. Substitution pharmacotherapy E. Vitamin supplements

B. Self-help groups C. Deterrent therapy D. Substitution pharmacotherapy Self-help groups such as Alcoholics Anonymous are commonly recommended as a treatment option for substance use disorders. Deterrent therapy, such as Antabuse to deter alcohol use, is a recognized option for some substance use disorders. Substitution therapy, such as methadone for heroin users, is a recognized option for some substance use disorders. ECT is primarily indicated for the treatment of depression. There is no evidence of its benefit in preventing relapse in substance use disorders. Vitamin supplements are beneficial in reversing nutritional deficiencies in alcoholism and other substance use disorders but do not combat the problem of substance use disorder itself.

A client's wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "His problems at work are my fault." Which is the appropriate nursing response? A. "Why do you assume responsibility for his behaviors?" B. "Codependency is a typical behavior of spouses of alcoholics." C. "Your husband needs to deal with the consequences of his drinking." D. "Do you understand what the term 'enabler' means?"

C. "Your husband needs to deal with the consequences of his drinking." The appropriate nursing response is to use confrontation with caring. The nurse should understand that the client's wife may be in denial and enabling the husband's behavior. Partners of clients with substance abuse must come to realize that the only behavior they can control is their own.

A recovering alcoholic relapses and drinks a glass of wine. The client presents in the emergency department (ED) experiencing severe throbbing headache, tachycardia, flushed face, dyspnea, and continuous vomiting. What may these symptoms indicate to the ED nurse? A. Alcohol poisoning B. Cardiovascular accident (CVA) C. A reaction to disulfiram (Antabuse) D. A reaction to tannins in the red wine

C. A reaction to disulfiram (Antabuse) Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can produce a good deal of discomfort for the individual. Symptoms may include but are not limited to flushed skin, throbbing in the head and neck, respiratory difficulty, dizziness, nausea and vomiting, confusion, hypotension, and tachycardia.

On the first day of a client's alcohol detoxification, which nursing intervention should take priority? A. Strongly encourage the client to attend 90 Alcoholics Anonymous meetings in 90 days. B. Educate the client about the biopsychosocial consequences of alcohol abuse. C. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. D. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.

C. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. The priority nursing intervention for this client should be to administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. Chlordiazepoxide (Librium) is a benzodiazepine and is often used for substitution therapy in alcohol withdrawal. Substitution therapy may be required to reduce life-threatening effects of the rebound stimulation of the central nervous system that occurs during withdrawal.

A client diagnosed with alcohol abuse joins a community 12-step program and states, "My life is unmanageable." How should the nurse interpret this client's statement? A. The client is using minimization as an ego defense. B. The client is ready to sign an Alcoholics Anonymous contract for sobriety. C. The client has accomplished the first of 12 steps advocated by Alcoholics Anonymous. D. The client has met the requirements to be designated as an Alcoholics Anonymous sponsor.

C. The client has accomplished the first of 12 steps advocated by Alcoholics Anonymous. The first step of the 12-step program advocated by Alcoholics Anonymous is that clients must admit powerlessness over alcohol and that their lives have become unmanageable.

A client is diagnosed with stimulant use disorder: cocaine and antisocial personality disorder. The client eagerly participates in therapy and becomes charming and ingratiating to the primary nurse. Which best describes these client behaviors? A. The client has not completed the cocaine withdrawal process. B. The client is probably hiding something. C. The client is exhibiting characteristics of antisocial personality disorder. D. The client is exhibiting symptoms of cocaine dependence.

C. The client is exhibiting characteristics of antisocial personality disorder. The client is exhibiting characteristics of antisocial personality disorder.

During group therapy, a client diagnosed with chronic alcohol dependence states, "I would not have boozed it up if my wife hadn't been nagging me all the time to get a job. She never did think that I was good enough for her." How should a nurse interpret this statement? A. The client is using denial by avoiding responsibility. B. The client is using displacement by blaming his wife. C. The client is using rationalization to excuse his alcohol dependence. D. The client is using reaction formation by appealing to the group for sympathy.

C. The client is using rationalization to excuse his alcohol dependence. The nurse should interpret that the client is using rationalization to excuse his alcohol dependence. Rationalization is the defense mechanism by which people avoid taking responsibility for their actions by making excuses for the behavior.

An impaired nurse is admitted to an inpatient substance abuse treatment facility. Which applies to his situation? A. The nurse must relinquish his driver's license to the office of motor vehicles. B. The nurse is mandated to comply with treatment and prescribed therapies. C. The nurse is not mandated to meet specific requirements, because all civil rights are ensured. D. The nurse must relinquish his registered nurse (RN) license to the state board of nursing.

C. The nurse is not mandated to meet specific requirements, because all civil rights are ensured. Although some variations occur from state to state, currently psychiatric clients maintain all of their civil rights. This nurse is not mandated by law to meet specific requirements, because all civil rights are ensured.

9 known classes of psychoactive disorders (according to DSM-5)

1. Alcohol 2. Caffeine 3. Cannabis 4. Hallucinogens (phencyclidine or other hallucinogens) 5. Inhalants 6. Opioids 7. Sedatives 8. Hypnotics 9. Anxiolytics, stimulants and tobacco

A nurse is reviewing STAT laboratory data of a client presenting in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur? A. 50 mg/dL B. 100 mg/dL C. 250 mg/dL D. 300 mg/dL

B. 100 mg/dL The nurse should expect that 100 mg/dL is the minimum blood alcohol level at which intoxication occurs. Intoxication usually occurs between 100 and 200 mg/dL. Death has been reported at levels ranging from 400 to 700 mg/dL.

A mother who has a history of chronic heroin use has lost custody of her children due to abuse and neglect. She has been admitted to an inpatient substance-abuse program. Which client statement should a nurse associate with a positive prognosis for this client? A. "I'm not going to use heroin ever again. I know I've got the willpower to do it this time." B. "I cannot control my use of heroin. It's stronger than I am." C. "I'm going to get all my children back. They need their mother." D. "Once I deal with my childhood physical abuse, recovery should be easy."

B. "I cannot control my use of heroin. It's stronger than I am." A positive prognosis is more likely when a client admits that he or she is addicted to a substance and has a loss of control. One of the first steps in accepting treatment is for the client to admit powerlessness over the substance.

Elsa is being treated in a chemical dependency unit. She tells the nurse that she only uses drugs when under stress and therefore does not have a substance problem. Which defense mechanism is the client using? A. Compensation B. Denial C. Suppression D. Undoing

B. Denial Individuals who have substance problems often use denial.

In assessing a client diagnosed with polysubstance abuse, the nurse should recognize that withdrawal from which substance may require a life-saving emergency intervention? A. Dextroamphetamine (Dexedrine) B. Diazepam (Valium) C. Morphine (Astramorph) D. Phencyclidine (PCP)

B. Diazepam (Valium) If large doses of central nervous system (CNS) depressants (like Valium) are repeatedly administered over a prolonged duration, a period of CNS hyperexcitability occurs on withdrawal of the drug. The response can be quite severe, even leading to convulsions and death.

Which symptom would the nurse expect to observe in a client experiencing opioid intoxication? A. Insomnia B. Abdominal cramps C. Muscle aches D. Impaired judgment

D. Impaired judgment Impaired judgment; initial euphoria followed by apathy; dysphoria; and psychomotor agitation or retardation are all symptoms of opioid intoxication.

Nurse Christine is teaching an adolescent health class about the dangers of inhalant abuse; the nurse warns about the possibility of: A. Contracting an infectious disease, such as hepatitis or AIDS B. Recurrent flashback events C. Psychological dependence after initial use D. Sudden death from cardiac or respiratory depression

D. sudden death from cardiac or respiratory depression Inhalants are CNS depressants; if taken in an excess amount, they can cause cardiac and respiratory depressions. It is impossible to control the inhalant dosage; therefore, death can occur. Contracting an infectious disease, recurrent flashback events, and psychological dependence after initial use are not associated with inhalant abuse.

Substance abuse disorder

regular use of psychoactive substances that affect the central nervous system, resulting in significant impairment or distress occurring in a 12-month time frame. Clients diagnosed with substance abuse disorders demonstrate problematic pattern of behaviors

The nurse determines that the wife of an alcoholic client is benefiting from attending an al-anon group if the nurse hears the wife make which statement? A. "I no longer feel that I deserve the beatings my husband inflicts on me" B. "My attendance at the meeting has helped me to see that I provoke my husband's violence." C. "I enjoy attending the meetings because they get me out of the house and away from my husband" D. "I can tolerate my husband's destructive behaviors now that I know they are common among alcoholics"

A, "I no longer feel that I deserve the beatings my husband inflicts on me" Al-Anon support groups are a protected, supportive opportunity for spouses and significant others to learn what to expect and to obtain excellent pointers about successful behavioral changes. The correct option id the healthiest response because it exemplifies an understanding that the alcoholic partner is responsible for his behavior and is cannot be allowed to blame family members for loss of control.

Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during alcohol withdrawal? A. Antagonist therapy B. Deterrent therapy C. Codependency therapy D. Substitution therapy

D. Substitution therapy A CNS depressant such as Ativan is used during alcohol withdrawal as substitution therapy to prevent life-threatening symptoms that occur because of the rebound reaction of the central nervous system.

A nursing instructor is teaching students about cirrhosis of the liver. Which of the following student statements about the complications of hepatic encephalopathy should indicate that further student teaching is needed? (Select all that apply.) A. "A diet rich in protein will promote hepatic healing." B. "This condition leads to a rise in serum ammonia resulting in impaired mental functioning." C. "In this condition, blood accumulates in the abdominal cavity." D. "Neomycin and lactulose are used in the treatment of this condition." E. "This condition is caused by the inability of the liver to convert ammonia to urea."

A. "A diet rich in protein will promote hepatic healing." C. "In this condition, blood accumulates in the abdominal cavity." The nursing instructor should understand that further teaching is needed if the nursing student states that a diet rich in protein will promote hepatic healing and that this condition causes blood to accumulate in the abdominal cavity (ascites), because these are incorrect statements. The treatment of hepatic encephalopathy requires abstention from alcohol, temporary elimination of protein from the diet, and reduction of intestinal ammonia using neomycin or lactulose. This condition occurs in response to the inability of the liver to convert ammonia to urea for excretion.

A nurse is interviewing a client in an outpatient substance-abuse clinic. To promote success in the recovery process, which outcome should the nurse expect the client to initially accomplish? A. The client will identify one person to turn to for support. B. The client will give up all old drinking buddies. C. The client will be able to verbalize the effects of alcohol on the body. D. The client will correlate life problems with alcohol use.

D. The client will correlate life problems with alcohol use. To promote the recovery process the nurse should expect that the client would initially correlate life problems with alcohol use. Acceptance of the problem is the first step of the recovery process.