PassPoint - Substance Abuse, Eating, Disorders, Impulse Control Disorder

When doing discharge planning for a hospitalized client with impulse control disorder, a nurse explains how family members can participate effectively in the client's ongoing care. What instruction should the nurse include?

"Consistently reward positive behavior and reinforce consequences of negative behavior."

The nurse teaches a client about preventing alcohol relapse. Which client statement indicates an understanding of the risk for alcohol relapse?

"Stopping support groups and not expressing feelings can lead to relapse."

A client in treatment for alcohol dependency begins to talk about not having a problem with alcohol. What is the best approach for the nurse to use?

Point out the consequences of the client's drinking behaviors.

A client is admitted to the emergency department with an elevated blood alcohol level. The authorities state the client was driving on the wrong side of the road. The client is transferred to the acute care unit where they awaken the next morning. Vital signs are stable, and the client has a headache. What action should the nurse take first when caring for this client?

Work through personal feelings related to substance use disorder.

A client's face is flushed and they are swearing, yelling, and pushing chairs around the day room of a mental health center. The nurse judges the client to be in which phase of the assault cycle?

escalation

A clinic nurse is assigned to care for a suicidal client. During the preinteraction phase, what should the nurse's priority be?

exploring the nurse's own feelings about suicide

A new nurse has transferred to the chemical dependency rehabilitation unit. Which action if performed by the new nurse would warrant the charge nurse to intervene?

exploring the nurse's own feelings about suicide

For the client with a substance abuse problem, which intervention would be most helpful to aid the client in dealing with feelings and concerns related to alcohol and drugs?

group sessions

A couple seeks emergency crisis intervention because one client slapped the other client repeatedly the night before. The first client who inflicted the violence reports a childhood marred by an abusive relationship with a parent. To assess for the likelihood of further violence and abuse, the nurse should determine that the first client:

has learned violence as an acceptable behavior.

A nurse is caring for a client who is experiencing alcohol withdrawal. Which assessment finding indicates the need for an as-needed dose of chlordiazepoxide?

heart rate of 120 to 140 beats/minute

A nurse is caring for a client diagnosed with bulimia nervosa. The most appropriate initial goal for this client is to:

identify a connection between anxiety and eating behaviors.

One of the goals for a client with anorexia nervosa is for the client to demonstrate increased individual coping by responding to stress in constructive ways. Which intervention will the nurse discuss with the client as the best way to work toward meeting the goal?

keeping a personal journal and discussing it with the nurse

When monitoring a client recently admitted for treatment of cocaine addiction, a nurse notes sudden increases in the arterial blood pressure and heart rate. Which medication should the nurse prepare to administer?

nifedipine

A client begins to experience alcoholic hallucinosis. After administering medication, what is the best nursing intervention?

providing a quiet environment

When collaborating with the health care provider (HCP) to develop a plan of care for a child diagnosed with attention deficit hyperactivity disorder (ADHD), the treatment plan will likely include which treatments?

psychostimulant medications, such as methylphenidate, and behavior modification

A client is voluntarily admitted to a substance use disorder unit. The client admits to drinking at least 1 qt (1 L) of vodka each day and occasionally using cocaine. Several hours after admission, a nurse suspects that the client is likely experiencing early alcohol withdrawal. What assessment findings will the nurse document as evidence of alcohol withdrawal?

pulse of 135 beats/minute, blood pressure of 160/90 mmHg, and nervousness

A client recently admitted to the hospital with sharp, substernal chest pain suddenly reports palpitations. The client ultimately admits to using cocaine 1 hour before admission. The nurse should immediately assess the client's:

pulse rate and character.

The nurse is planning care for a client who has a history of making verbal threats and acting violently toward family members. The client is currently displaying intense anger toward the staff. What nursing diagnosis is most appropriate?

risk for other-directed violence

Flumazenil has been ordered for a client who has overdosed on oxazepam. Before administering the medication, the nurse should be prepared for which common adverse effect?

seizures

In a toddler, which injury is most likely the result of child abuse?

several small, dime-sized circular burns on the child's back

A client was discharged from an alcohol rehabilitation program on clonazepam 0.5 mg three times a day. Several months later, the client reports having insomnia, shakiness, sweating, and one seizure. The nurse should first assess the client for which possible cause of these symptoms?

stopping the clonazepam suddenly

A nurse performing an assessment determines that a client with anorexia nervosa is currently unemployed and has a family history of affective disorders, obesity, and infertility. Based on this information, the nurse should monitor the client for which health concern?

suicide potential

The nurse assesses a client experiencing alcohol withdrawal. Which symptom(s) would indicate that a client has alcohol withdrawal delirium? Select all that apply.

tachycardia tachypnea hypertension

The nurse provides care to a client brought to the emergency department with injuries from a motor vehicle collision. An intravenous line was established by paramedics. The client is now refusing bloodwork, and the nurse suspects the client may have been driving while intoxicated. How should the nurse best address the client?

"Can I help answer any questions about having your blood drawn?"

A nurse assists a student nurse conducting an interview with the family of a 4-year-old child who is often disruptive in preschool class, is difficult to engage, and rarely speaks. Which question, if asked by the student, would require intervention by the nurse?

"Has your child received all their childhood immunizations? There is evidence that childhood immunizations play a role in the development of autism."

A client is brought to the psychiatric clinic by family members, who tell the admitting nurse that the client repeatedly drives while intoxicated despite their pleas for the client to stop doing so. During an interview with the nurse, which client statement most strongly supports a diagnosis of a substance use disorder?

"I have been arrested for drunk driving three times, but I never had an accident."

During postprandial monitoring, a client with bulimia nervosa tells the nurse, "You can sit with me, but you're just wasting your time. After you sat with me yesterday, I was still able to purge. Today, my goal is to do it twice." What is the nurse's best response?

"I know it's important for you to feel in control, but I'll monitor you for 90 minutes after you eat."

A nurse works in a suicide crisis clinic. The clients that represent the highest risk for suicide are those who state:

"I'm thinking of driving my car into a tree on the way home."

A client recovering from narcotic addiction states to the nurse, "I'm not going anymore to support group meetings. I felt out of place there." Which response by the nurse is best?

"Try attending a meeting at a different location; you may feel more comfortable there."

A client struggling with a binge eating disorder tells a nurse, "I don't know why I eat the way I do each night." What question would be most helpful for the nurse to ask this client?

"What do you do when you feel stressed or upset?"

A client is entering rehabilitation for alcohol dependency as an alternative to going to jail for multiple arrests for driving under the influence. While obtaining the client's history, the nurse asks about the amount of alcohol the client consumes daily. The client responds, "I just have a few drinks with my friends after work." Which response by the nurse is most therapeutic?

"You say you have a few drinks, but you have multiple arrests."

On admission a client reports taking disulfiram as part of their home medications. What would the nurse need to be aware of when coordinating the client's other medications?

Avoid all products containing alcohol.

The nurse is working with a highly culturally diverse group of mostly young adult clients who have substance abuse issues. Many clients in the group have had difficult social circumstances and experience relapses. What would be the most appropriate nursing intervention in dealing with these clients?

Encourage motivation and confidence so that the clients can better deal with the triggers that cause them to repeat their behaviors.

A client diagnosed with bulimia tells the nurse that they only eat excessively when upset with their best friend, and then they vomit to avoid gaining a lot of weight. What should the nurse do next?

Enroll the client in a coping skills group.

A client is beginning to participate in the alcohol treatment program. Which nursing approach would be most effective in decreasing their denial about their alcoholism?

Point out concrete problems that are a direct consequence of his alcoholism.

A school nurse is completing height and weight screenings. A young client appears underweight for their height and also appears to have hair loss. As the client steps on to the scale, the client begins to cry. Which nursing intervention is most appropriate?

Request that the client stand backward on the scale when being weighed.

A nurse is developing a care plan for a client with anorexia nervosa. Which action should the nurse include in the plan?

Set up a strict eating plan with the client.

The nurse provides care to a client with chemical dependency. What are the primary nursing considerations for this client? Select all that apply.

Teach the client to deal with life stressors through coping skills. Support the client's decision to stop substance use. Promote family interaction and involvement in the rehabilitation process.

A client is admitted to the hospital after sustaining a fracture of the femur sustained while intoxicated. The client's condition is stable; however, the client is shaky, irritable, and anxious. The next day the nurse finds the client restless and perspiring, with an elevated pulse. The client cries, "There are bugs crawling on my bed. I've got to get out of here," and begins to thrash about. What knowledge does the nurse use to manage the client's immediate care?

The client is experiencing withdrawal delirium.

For a client with anorexia nervosa, which goal takes the highest priority?

The client will establish adequate daily nutritional intake.

A nurse must restrain a client to ensure the safety of other clients. When using restraints, which principle is a priority?

Use an organized, efficient team approach to apply and secure the restraints.

A nurse is employed at an outpatient rehabilitation facility caring for clients withdrawing from opioids. When assessing clients who present for their counseling session, which findings are anticipated at this time? Select all that apply.

abdominal cramps rhinorrhea dilated pupils

A client with alcohol dependency is started on a regimen of disulfiram. Which statement should the nurse include when teaching the client about the intended effects of the drug?

acts to deter alcohol consumption.

Eighteen hours after undergoing an emergency appendectomy, a client with a reported history of social drinking displays these vital signs: temperature, 101.6° F (38.7° C); heart rate, 126 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 140/96 mm Hg. The client exhibits gross hand tremors and is screaming for someone to kill the bugs in the bed. The nurse should suspect:

alcohol withdrawal.

A client admits to using cocaine and says, "When I stop using, I feel bad." Which effect is the client most likely to describe as occurring after they stop using cocaine?

depression

When developing a therapeutic relationship with a client who has withdrawn from alcohol, the nurse should first set goals with the client that involve which behavior?

developing effective coping skills

When teaching a client with bulimia nervosa about possible complications, which condition should the nurse emphasize?

diabetes mellitus

A physician orders naltrexone for a client participating in an outpatient drug and alcohol rehabilitation program. Which action reflects the nurse's knowledge about this medication and the client's informed consent?

discussing the health risks related to this medication

Before hospitalization, a client needed increasingly larger doses of barbiturates to achieve the same euphoric effect that they initially realized from the barbiturate use. From this information, the nurse develops a plan of care that considers the client is likely experiencing what problem?

drug tolerance

A severely dehydrated adolescent admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. The client's history includes anorexia nervosa and a 20-lb (9.1-kg) weight loss in the past month. She is 5′ 7″ (1.7 m) tall and weighs 80 lb (36.3 kg). Which nursing intervention takes highest priority?

initiating caloric and nutritional therapy as ordered

A client experiencing alcohol withdrawal exhibits tremors, diaphoresis, and hyperactivity. Blood pressure is 190/87 mm Hg, and pulse is 92 bpm. Which medication should the nurse expect to administer?

lorazepam

A nurse is assessing a 15-year-old adolescent who's being admitted for treatment of anorexia nervosa. Which clinical manifestation is the nurse most likely to find?

muscle weakness

An attorney who throws books and furniture around the office after losing a case is referred to the psychiatric nurse in the law firm's employee assistance program. The nurse knows that the client's behavior most likely represents the use of which defense mechanism?

regression