Substance Abuse

The nurse assesses a patient with a history of alcoholism who is hospitalized with anorexia, dysphagia, odynophagia, and chest pressure after eating. Which nursing diagnosis is a priority for this patient? 1) Ineffective Coping 2) Imbalanced Nutrition: Less Than Body Requirements 3) Disturbed Sensory Perception 4) Disturbed Thought Processes

1) Ineffective Coping is a potential diagnosis used in substance abuse; however, there is another diagnosis that takes priority. 2) An alcoholic patient with anorexia is at risk for Imbalanced Nutrition: Less Than Body Requirements. This is a physiological diagnosis; therefore, this is the priority. 3) Disturbed Thought Processes and Disturbed Sensory Perceptions are diagnoses used for delusions, hallucinations, and illusions that may occur during delirium tremens. 4) Disturbed Thought Processes and Disturbed Sensory Perceptions are diagnoses used for delusions, hallucinations, and illusions that may occur during delirium tremens.

____ 4. Which client statement indicates a knowledge deficit related to a substance use disorder? 1. "Although it's legal, alcohol is one of the most widely abused drugs in our society." 2. "Tolerance to heroin develops quickly." 3. "Flashbacks from lysergic acid diethylamide (LSD) use may reoccur spontaneously." 4. "Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless."

1. Cannabis is the second most widely abused drug in the United States. 2. This statement does not indicate a knowledge deficit. 3. This statement is true regarding LSD. 4. The nurse should determine that the client has a knowledge deficit related to substance use disorders when the client compares marijuana to smoking cigarettes and claims it to be harmless.

94. The nurse caring for a client who has been abusing amphetamines writes a problem of "cardiovascular compromise." Which nursing interventions should be implemented? 1. Monitor the telemetry and vital signs every four (4) hours. 2. Encourage the client to verbalize the reason for using drugs. 3. Provide a quiet, calm atmosphere for the client to rest. 4. Place the client on bedrest and a low- sodium diet.

1. Telemetry and vital signs would be done to monitor cardiovascular compromise. Amphetamine use causes tachycardia, vasoconstriction, hypertension, and arrhythmias. 2. This might be an intervention for a problem of altered coping. 3. This would be an intervention for a problem of insomnia. 4. These are interventions for heart failure. TEST TAKING HINT: The correct answer must address the problem of cardiovascular compromise, which eliminates options"2" and "3."

____ 5. A lonely, depressed divorcée has been self-medicating with small amounts of cocaine for the past year. Which term should a nurse use to best describe this individual's situation? 1. Psychological addiction 2. Codependence 3. Substance induced disorder 4. Social induced disorder

1. The nurse should use the term psychological addiction to best describe the client's situation. A client is considered to be psychologically addicted to a substance when there is an overwhelming desire to use a drug in order to produce pleasure or avoid discomfort. 2. Codependence describes depending on others for decision-making. 3. Substance induced disorders are induced by the use of a drug or substance. 4. Social induced disorders describe using a drug or substance in the presence of others, or socially.

____ 20. A nursing instructor is teaching nursing students about cirrhosis of the liver. Which of the following statements about the complications of hepatic encephalopathy should indicate to the nursing instructor that further student teaching is needed? (Select all that apply.) 1. "A diet rich in protein will promote hepatic healing." 2. "This condition results from a rise in serum ammonia, leading to impaired mental functioning." 3. "In this condition, an excessive amount of serous fluid accumulates in the abdominal cavity." 4. "Neomycin and lactulose are used in the treatment of this condition." 5. "This condition is caused by the inability of the liver to convert ammonia to urea."

1. 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. The treatment of hepatic encephalopathy requires abstention from alcohol and temporary elimination of protein from the diet. 2. This statement indicates that teaching has been effective. 3. This statement indicates that no further education is required. 4. The instructor should interpret this statement as accurate.

The patient with a history of alcohol abuse is being discharged to a treatment facility. Which prescription does the nurse anticipate for this patient? 1) Disulfiram 2) Naloxone 3) Bupropion hydrochloride 4) Varenicline

1) Disulfiram (Antabuse) causes the patient to become immediately and violently ill when consuming alcohol. 2) Naloxone is administered to patients who overdose on opiates. 3) Bupropion hydrochloride and varenicline are both medications to assist with smoking cessation. 4) Bupropion hydrochloride and varenicline are both medications to assist with smoking cessation.

The nurse is providing an educational seminar for the families of patients diagnosed with a substance use disorder. Which statement will the nurse include in the teaching session regarding the addictive process? 1) "Manifestations exhibited are similar to those exhibited with behavioral disorders." 2) "Manifestations exhibited are similar to those exhibited with cognitive disorders." 3) "Manifestations exhibited are caused by changes in neurochemistry." 4) "Manifestations exhibited are caused by changes in the emotional state."

1)/2) The manifestations are not similar to behavioral or cognitive disorders. 3) Patients diagnosed with a substance use disorder exhibit addictive behavior due to changes in neurochemistry. 4) The manifestations associated with the addictive process are not caused by changes in the emotional state.

____ 21. A clinic nurse is about to meet with a client diagnosed with a gambling disorder. Which of the following symptoms and/or behaviors is the nurse likely to assess? (Select all that apply.) 1. Stressful situations precipitate gambling behaviors. 2. Anxiety and restlessness can only be relieved by placing a bet. 3. Winning brings about feelings of sexual satisfaction. 4. Gambling is used as a coping strategy. 5. Losing at gambling meets the client's need for self-punishment.

1. In gambling disorder, the preoccupation with and impulse to gamble intensifies when the individual is under stress. 2. Many impulsive gamblers describe a physical sensation of restlessness and anticipation that can only be relieved by placing a bet. 3. Winning brings feelings of special status, power, and omnipotence, not sexual satisfaction. 4. Gambling is used as a coping strategy for dealing with stress and disappointments. 5. The gambler increasingly depends on this activity to cope with disappointments, problems, and negative emotional states.

The nurse is providing care to a patient with alcohol and opioid dependency. A family member states, "I don't understand why Naltrexone treatment is prescribed because it causes a high too, right?" Which response by the nurse is appropriate? 1) "Naltrexone will cause your daughter to become violently ill if she drinks alcohol or abuses drugs." 2) "Naltrexone is less potent than the street drugs your daughter is currently taking and therefore safer." 3) "Naltrexone diminishes the cravings your daughter will feel for alcohol and opioids." 4) "Naltrexone will prevent your daughter from getting drunk when she drinks."

1) Disulfiram, not naltrexone, will cause a person to become violently ill when alcohol is consumed. 2) This statement is not accurate. 3) Naltrexone diminishes the cravings for alcohol and opioids. 4) This statement is not accurate.

90. The client is diagnosed with Wernicke- Korsakoff syndrome as a result of chronic alcoholism. For which symptoms would the nurse assess? 1. Insomnia and anxiety. 2. Visual or auditory hallucinations. 3. Extreme tremors and agitation. 4. Ataxia and confabulation.

1. Insomnia and anxiety are symptoms of alcohol withdrawal, not Wernicke-Korsakoff syndrome. 2. Visual and auditory hallucinations are symptoms of delirium tremens. 3. Extreme tremors and agitation are symptoms of delirium tremens. 4. Ataxia, or lack of coordination, and con- fabulation, making up elaborate stories to explain lapses in memory, are both symptoms of Wernicke-Korsakoff syndrome. TEST TAKING HINT: The test taker can elimi- nate options "2" and "3" if the test taker knows the symptoms of delirium tremens.

____ 22. A nursing supervisor is about to meet with a staff nurse suspected of diverting client medications. Which of the following assessment data would lead the supervisor to suspect that the staff nurse is impaired? (Select all that apply.) 1. The staff nurse is frequently absent from work. 2. The staff nurse experiences mood swings. 3. The staff nurse makes elaborate excuses for behavior. 4. The staff nurse frequently uses the restroom. 5. The staff nurse has a flushed face.

1. There may be high absenteeism if the person's source is outside the work area. 2. Mood swings can be a sign of substance abuse. 3. The impaired nurse may make elaborate excuses for behavior. 4. The impaired nurse will frequently use the restroom. 5. A flushed face is a sign of drug use.

The nurse is caring for a patient who is experiencing alcohol withdrawal. Which is the priority nursing diagnosis for this patient? 1) Risk for Injury 2) Ineffective Coping 3) Disturbed Sensory Perception 4) Disturbed Thought Processes

1) A patient who is experiencing alcohol withdrawal is at risk for injury from delirium tremens. Death from delirium tremens can occur from volume depletion, electrolyte imbalance, or cardiac arrhythmia. 2) Ineffective coping is not the priority for the patient experiencing alcohol withdrawal. 3)/4) Disturbed thought processes and disturbed sensory perceptions are diagnoses used for delusions, hallucinations, and illusions that may occur during delirium tremens; however, these are not highest priority diagnoses.

____ 9. Which client statement demonstrates positive progress toward recovery from a substance use disorder? 1. "I have completed detox and therefore am in control of my drug use." 2. "I will faithfully attend Narcotic Anonymous when I can't control my cravings." 3. "As a church deacon, my focus will now be on spiritual renewal." 4. "Taking those pills got out of control. It cost me my job, marriage, and children."

1. This statement does not demonstrate positive progress in recovery. 2. Attending meetings infrequently puts the client at risk for relapse. 3. This statement does not indicate reflection and understanding on the impact of substance abuse. 4. A client who takes responsibility for the consequences of substance use disorder or substance addiction is making positive progress toward recovery. This would indicate completion of the first step of a 12-step program.

A patient is brought to the emergency department by a parent. The nursing assessment reveals that the patient has been acting strangely for the past three hours and is hypervigilant, grandiose, and irritable. Vital signs reveal hypertension, tachycardia, and some arrhythmias. Which substance does the nurse suspect that the patient has been using? 1) Alcohol 2) Marijuana 3) Heroin 4) Amphetamines

1) Alcohol intoxication may manifest in relaxed euphoria, lack of concentration, and decreased inhibitions. 2) Marijuana intoxication manifests in euphoria and relaxation and does not typically cause hypertension, tachycardia, or arrhythmias. 3) Heroin intoxication causes decreased respiratory rate and depth and bradycardia, not tachycardia. 4) Amphetamine intoxication includes symptoms of hypervigilance, grandiosity, and irritability.

The nurse is providing care to a patient diagnosed with alcoholism. The patient's physical examination reveals a BMI of 18. Which prescription does the nurse anticipate to manage the patient's nutritional status? 1) Sertraline 2) Methadone 3) Naloxone 4) Multivitamin with folic acid

1) Sertraline is used to reduce anxiety and stabilize mood. 2) Methadone is prescribed to manage heroin cravings. 3) Naloxone is used to manage an opiate overdose. 4) A patient with alcohol dependence may suffer from numerous nutritional deficiencies, including deficiencies in thiamine, folic acid, vitamin A, magnesium, and zinc. A multivitamin may be prescribed to help with these deficiencies.

A patient is admitted to the emergency department after overdosing on phencyclidine piperidine (PCP). Based on this actions, which actions are appropriate by the nurse? Select all that apply. 1) Obtain materials to assist with lavage 2) Start an IV 3) Initiate seizure precautions 4) Induce vomiting 5) Administer ammonium chloride

1) This is incorrect. Lavage would be an inappropriate treatment for inhalation of any substance. Narcan is a narcotic antagonist administered for opiate overdose. 2) This is correct. The patient has taken an overdose of phencyclidine piperidine (PCP), which can produce an adrenaline-like response, or "speed" reaction. PCP overdose is associated with possible hypertensive crisis, respiratory arrest, hyperthermia, and seizures. The patient will require an IV line. The patient will need to have seizure precautions such as padded side rails initiated. The patient may also be given ammonium chloride to acidify the urine to help excrete the drug. 3) This is correct. The patient has taken an overdose of phencyclidine piperidine (PCP), which can produce an adrenaline-like response, or "speed" reaction. PCP overdose is associated with possible hypertensive crisis, respiratory arrest, hyperthermia, and seizures. The patient will require an IV line. The patient will need to have seizure precautions such as padded side rails initiated. The patient may also be given ammonium chloride to acidify the urine to help excrete the drug. 4) This is incorrect. Vomiting is induced for overdoses of alcohol, barbiturates, and benzodiazepines. 5) This is correct. The patient has taken an overdose of phencyclidine piperidine (PCP), which can produce an adrenaline-like response, or "speed" reaction. PCP overdose is associated with possible hypertensive crisis, respiratory arrest, hyperthermia, and seizures. The patient will require an IV line. The patient will need to have seizure precautions such as padded side rails initiated. The patient may also be given ammonium chloride to acidify the urine to help excrete the drug.

____ 14. A nurse is reviewing the stat laboratory data of a client in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur? 1. 50 mg/dL 2. 100 mg/dL 3. 250 mg/dL 4. 300 mg/dL

1. Intoxication would not occur at this blood alcohol level. 2. 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. 3. Blood alcohol would have to be higher for intoxication to occur. 4. While the client would be intoxicated, this is not the minimum level at which intoxication would occur.

88. A 20-year-old female client who tried lysergic acid diethylamide (LSD) as a teen tells the nurse that she has bad dreams that make her want to kill herself. Which is the explanation for this occurrence? 1. These occurrences are referred to as "holdover reactions" to the drug. 2. These are flashbacks to a time when the client had a "bad trip." 3. The drug is still in the client's body and causing these reactions. 4. The client is suicidal and should be on one-to-one precautions.

1. These reactions are called "flashbacks." 2. Flashback reactions occur after the use of hallucinogens in which the client relives a bad episode that occurred while using the drug. 3. The drug is gone from the body, but the mind-altering effects can occur at any time in the form of memory flashbacks. 4. The client stated that the dreams are causing her distress. She is asking for help with the dreams, not planning her suicide. TEST TAKING HINT: The client is 20 years old and took the drug in her teens; drugs do not stay in the body for extended periods. This eliminates option "3."

The nurse is caring for a patient who is an intravenous drug user. The nurse anticipates the need for assessment for which complication? 1) Cardiac tamponade 2) Myocardial infarction 3) Congestive heart failure 4) Infective endocarditis

4) A relatively uncommon disease in the general population, infective endocarditis involves an infection of the interior surface of the heart, usually stemming from bacteria in the bloodstream. These infections then lead to destruction of cardiac tissue, causing irreparable damage to the valves of the heart and symptoms consistent with both systemic infection and cardiac dysfunction. Patients who abuse drugs by injection are at greatest risk for developing infective endocarditis. Cardiac tamponade, congestive heart failure, and myocardial infarction may occur in intravenous drug users; however, these individuals are at greatest risk for developing infective endocarditis.

886. A hospitalized client with a history of alcohol abuse tells the nurse, "I am leaving now. I have to go. I don't want any more 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 con- cerns with the client, the client dresses and begins to walk out of the hospital room. What action should the nurse take? 1. Call the nursing supervisor. 2. Call security to block all exit areas. 3. Restrain the client until the health care provider (HCP) can be reached. 4. Tell the client that the client cannot return to this hospital again if the client leaves now.

1 Rationale: Most health care facilities have documents that the client is asked to sign relating to the client's responsibilities when the client leaves against medical advice. The client should be asked to wait to speak to the HCP before leaving and to sign the "against medical advice" document before leaving. If the client refuses to do so, the nurse cannot hold the client against the client's 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 he or she cannot leave the hospital. Restraining the client and call- ing security to block exits constitutes false imprisonment. All clients have a right to health care and cannot be told otherwise. Test-Taking Strategy: Keeping the concept of false imprison- ment in mind, eliminate options 2 and 3 because they are com- parable or alike. Eliminate option 4, knowing that all clients have a right to health care. From the options presented, the best action is presented in the correct option.

The nurse is planning to implement addiction treatment groups at the inner city clinic. Which knowledge regarding addictions and its related therapies will facilitate implementation of the groups? 1) Relapse is a common feature of substance abuse. 2) Hereditary, as well as complex environmental influences, predisposes one to substance dependence. 3) Patients with a substance dependence cannot be held accountable for their actions. 4) Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are accepted treatment approaches.

1) Acknowledging relapse, treatment approaches, and behavioral intentions does not address the psychobiology of the illness. 2) Knowing the psychobiology aspects of heritability and predisposition to substance dependence, as well as the complex environmental influences, helps diminish stigma. 3) Acknowledging relapse, treatment approaches, and behavioral intentions does not address the psychobiology of the illness. 4) Acknowledging relapse, treatment approaches, and behavioral intentions does not address the psychobiology of the illness.

A nursing instructor is teaching a class about the role of dopamine in substance abuse. Which student statement indicates appropriate understanding? 1) "The dopamine D1 and dopamine D2 receptors are responsible for co-occurring disorders." 2) "Dopamine increases opioid transmission, and this reinforces the cycle of substance abuse." 3) "Dopamine causes changes in brain neurotransmission that enhance the cycle of substance abuse." 4) "The dopamine D3 receptor is involved in drug-seeking behaviors."

1) D1 and D2 receptors are not responsible for co-occurring disorders. 2) Ethanol, not dopamine, increases opioid transmission and reinforces the cycle of substance abuse. 3) Dopamine does not cause changes in brain neurotransmission that enhance the cycle of substance abuse. 4) Although most studies have focused on the role of dopamine D1 and dopamine D2 receptors in sustaining the addictive danger of drugs, recent studies also have shown that the dopamine D3 receptor is involved in drug-seeking behavior.

A patient is admitted to the emergency department with signs of drug use. The patient reports having ingested Percocet and is experiencing respiratory depression. Based on this data, which prescription does the nurse anticipate for this patient? 1) Diazepam 2) Haldol 3) Vitamin B12 4) Naloxone

1) Diazepam can be prescribed to manage signs of an overdose. 2) Haldol can be administered to manage an overdose of phencyclidine piperidine (PCP). 3) Vitamin B12 is used to manage the neurological symptoms that might accompany a nitrate overdose. 4) Percocet is a type of opiate. Naloxone is used to treat an overdose of opiates.

After an assessment of a patient, a nursing student expresses a belief that drug addiction is not a real illness, as these patients "did it to themselves." Which response by the staff nurse is appropriate? 1) "Sometimes a patient doesn't show much effort." 2) "We are legally obligated to provide care." 3) "It is important to remain nonjudgmental when caring for any patient, even a drug addict." 4) "You are right. I don't know why we bother."

1) Nurses must provide a nonjudgmental attitude with their patients in order to promote trust and respect. Even if a patient is not currently making much effort toward management of addiction disorders, the development of a trusting relationship with the nurse helps to set the stage for movement toward recovery in the future. 2) Although it is true that nurses are legally obligated to provide care, this response is not patient-focused and is therefore inappropriate. 3) Nurses must provide a nonjudgmental attitude with their patients in order to promote trust and respect. Even if a patient is not currently making much effort toward management of addiction disorders, the development of a trusting relationship with the nurse helps to set the stage for movement toward recovery in the future. 4) Nurses must provide a nonjudgmental attitude with their patients in order to promote trust and respect. Even if a patient is not currently making much effort toward management of addiction disorders, the development of a trusting relationship with the nurse helps to set the stage for movement toward recovery in the future.

The nurse is evaluating outcome goals written by a student for a patient diagnosed with alcoholism who is being discharged from a detoxification program. Which outcome is appropriate for this patient? 1) Follow a 2000-calorie high-carbohydrate diet 2) Sponsor a participant in Alcoholics Anonymous (AA) meetings 3) Obtain at least six to eight hours of sleep per night 4) Acknowledge the blame that family members must take for codependent behavior

1) The calorie requirement should be individualized and may not be 2000 calories. 2) New or returning members to AA should be sponsored and are not ready to sponsor another person. 3) Outcome measures for a patient discharging from alcohol detoxification are to obtain at least six to eight hours of sleep a night. 4) This patient should accept responsibility for his behavior in the family unit instead of assigning blame for codependent behavior.

A patient who is attending a Narcotics Anonymous (NA) program asks the nurse what the most important initial goal of attending the meetings is. When responding to the patient, which indication will the nurse take into account? 1) To admit to having a problem 2) To learn problem-solving skills 3) To take a moral inventory of self 4) To make amends to people they have hurt

1) The initial outcome for patients in substance abuse programs is to admit they have a problem with drugs or alcohol. Patients will be unable to participate fully in a recovery program until they can admit that they have a substance abuse problem, admit the extent of that problem, and acknowledge how abuse has impacted their lives. 2) Learning problem-solving skills is a later outcome for a substance abuse program. 3) Taking a moral inventory and making amends are the fourth and eighth steps of Narcotics Anonymous and would not be initial outcomes. 4) Taking a moral inventory and making amends are the fourth and eighth steps of Narcotics Anonymous and would not be initial outcomes.

Which are the priority nursing interventions when providing care to patients at various stages of the detoxification process? Select all that apply. 1) Vital signs 2) Medication administration 3) Motivational interviewing 4) Intake and output 5) Neurological assessment

1) This is correct. Priority nursing interventions for patients in the detoxification process are those that relate to patient safety and will include careful monitoring of vital signs, monitoring fluid volume and electrolyte levels, monitoring neurological status, and safe administration of medications to ensure patient medical conditions do not place patients at further risk for injury. 2) This is correct. Priority nursing interventions for patients in the detoxification process are those that relate to patient safety and will include careful monitoring of vital signs, monitoring fluid volume and electrolyte levels, monitoring neurological status, and safe administration of medications to ensure patient medical conditions do not place patients at further risk for injury. 3) This is incorrect. Motivational interviewing, including assessing patients' readiness to change, does not take priority over patient safety during the detoxification process. 4) This is correct. Priority nursing interventions for patients in the detoxification process are those that relate to patient safety and will include careful monitoring of vital signs, monitoring fluid volume and electrolyte levels, monitoring neurological status, and safe administration of medications to ensure patient medical conditions do not place patients at further risk for injury. 5) This is correct. Priority nursing interventions for patients in the detoxification process are those that relate to patient safety and will include careful monitoring of vital signs, monitoring fluid volume and electrolyte levels, monitoring neurological status, and safe administration of medications to ensure patient medical conditions do not place patients at further risk for injury.

The nurse is conducting a crisis assessment for a patient who admits to cocaine use. Which questions are appropriate for the nurse to ask the patient during this process? Select all that apply. 1) "Are recreational centers available?" 2) "What is the most significant stress/problem occurring in your life right now?" 3) "How long has this been a problem?" 4) "What are the living conditions of the neighborhood?" 5) "What other stresses do you have in your life?"

1) This is incorrect. Asking about recreational centers and the living conditions of the neighborhood are more appropriate when conducting a community crisis assessment. 2) This is correct. When conducting a crisis assessment for a patient who admits to using an illegal substance that is associated with addiction, the nurse will ask the patient about the most significant stress occurring in life right now, how long the problem has been occurring, and the other stresses in the patient's life. 3) This is correct. When conducting a crisis assessment for a patient who admits to using an illegal substance that is associated with addiction, the nurse will ask the patient about the most significant stress occurring in life right now, how long the problem has been occurring, and the other stresses in the patient's life. 4) This is incorrect. Asking about recreational centers and the living conditions of the neighborhood are more appropriate when conducting a community crisis assessment. 5) This is correct. When conducting a crisis assessment for a patient who admits to using an illegal substance that is associated with addiction, the nurse will ask the patient about the most significant stress occurring in life right now, how long the problem has been occurring, and the other stresses in the patient's life.

The nurse is caring for a patient with a substance use disorder who is admitted to the rehabilitation unit of the inpatient treatment facility. The nurse collaborates with the patient to establish and redefine mutual goals of treatment. What is the primary purpose of this action? 1) It develops the nurse-patient relationship. 2) It allows the nurse to self-reflect. 3) It encourages patient responsibility. 4) It provides evaluation of outcomes.

1) While this action may help to develop the nurse-patient relationship, this is not its primary purpose. 2) The primary purpose of collaboration is not to allow the nurse to self-reflect, nor is it to provide evaluation of outcomes. 3) The primary purpose of collaboration with the patient to establish and redefine mutual goals of treatment is to encourage patient responsibility. 4) The primary purpose of collaboration is not to allow the nurse to self-reflect, nor is it to provide evaluation of outcomes.

884. Which interventions are most appropriate for caring for a client in alcohol withdrawal? Select all that apply. 1. Monitor vital signs. 2. Provide a safe environment. 3. Address hallucinations therapeutically. 4. Provide stimulation in the environment. 5. Provide reality orientation as appropriate. 6. Maintain NPO (nothing by mouth) status.

1, 2, 3, 5 Rationale: When the client is experiencing withdrawal from alcohol, the priority for care is to prevent the client from harm- ing self or others. The nurse would monitor the vital signs closely and report abnormal findings. The nurse would provide a low-stimulation 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 thera- peutically. Adequate nutritional and fluid intake need to be maintained.Test-Taking Strategy: Note the strategic words, most appropri- ate. Thinking about the needs of the client in alcohol with- drawal and recalling the characteristics associated with alcohol withdrawal will assist in answering correctly. Also, use therapeutic communication techniques to assist in selecting the correct interventions.

____ 8. 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 48 hours. When the nurse reports to the ED physician, which client symptom should be the nurse's first priority? 1. Hearing and visual impairment 2. Blood pressure of 180/100 mm Hg 3. Mood rating of 2/10 on numeric scale 4. Dehydration

1. Hearing and visual impairment are not life threatening and do not indicate alcohol withdrawal. 2. The nurse should recognize that high blood pressure is a symptom of alcohol withdrawal syndrome and should promptly report this finding to the physician. Complications associated with alcohol withdrawal syndrome may progress to alcohol withdrawal delirium in about the second or third day following cessation of prolonged alcohol use. 3. A mood rating of 2/10 on numeric scale is not life threatening and does not indicate alcohol withdrawal. 4. Dehydration is not life threatening and does not indicate alcohol withdrawal.

____ 11. A client presents with symptoms of alcohol withdrawal and states, "I haven't eaten in three days." A nurse's assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97°F (36°C) with dry mucous membranes and poor skin turgor. What should be the priority nursing diagnosis? 1. Knowledge deficit 2. Fluid volume excess 3. Imbalanced nutrition: less than body requirements 4. Ineffective individual coping

1. Knowledge deficit is incorrect because it does not address the client's statement regarding lack of nutritional intake for three days. 2. Fluid volume excess is incorrect because it does not address the client's statement regarding lack of nutritional intake for three days. 3. 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. 4. Ineffective individual coping is incorrect because it does not address the client's statement regarding lack of nutritional intake for three days.

____ 2. 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 addiction? 1. Narcotic pain medication is contraindicated for all clients with active substance use disorders. 2. Clients who are addicted to alcohol or benzodiazepines may develop cross-tolerance to analgesics and require increased doses to achieve effective pain control. 3. There is no need to assess the client for substance addiction. There is an obvious PCA malfunction, because these clients have a higher pain tolerance. 4. The client is experiencing alcohol withdrawal symptoms and needs accurate assessment.

1. Narcotic pain medication should never be held because a client has a substance abuse disorder. 2. The nurse should assess the client for substance addiction, because clients who are addicted to alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. Cross-tolerance is exhibited when one drug results in a lessened response to another drug. 3. The client should be assessed for a substance abuse disorder as needed, so that proper follow up can be arranged for the client. 4. In this scenario, the client is not exhibiting signs of substance abuse withdrawal.

86. The chief executive officer (CEO) of a large manufacturing plant presents to the occupational health clinic with chronic rhinitis and requesting medication. On inspection, the nurse notices holes in the septum that separates the nasal passages. The nurse also notes dilated pupils and tachycardia. The facility has a "No Drug" policy. Which intervention should the nurse implement? 1. Prepare to complete a drug screen urine test. 2. Discuss the client's use of illegal drugs. 3. Notify the client's supervisor about the situation. 4. Give the client an antihistamine and say nothing.

1. No employee of a facility is above certain rules. In a company with a "No Drugs" policy, this includes the CEO. This client is exhibiting symptoms of cocaine abuse. 2. The nurse does not have a definitive knowledge that the client is using drugs until a positive drug screen result is obtained. If the nurse is not a trained substance abuse counselor, this intervention would be out of the realm of the nurse's expertise. 3. The client is the CEO of the facility; only the board of directors or parent company is above this client in supervisory rank. 4. Giving an antihistamine is prescribing with- out a license, and the nurse is obligated to intervene in this situation. TEST TAKING HINT: The title of the client— CEO—eliminates option "3." The nurse has noted a potential illegal situation.

____ 12. 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? 1. "Why do you assume responsibility for his behaviors?" 2. "I think you should start to confront his behavior." 3. "Your husband needs to deal with the consequences of his drinking." 4. "Do you understand what the term enabler means?"

1. Stating, "Why do you assume responsibility for his behaviors?" may come across as confrontational, and may cause the client's wife to avoid interaction with the nurse. 2. Stating, "I think you should start to confront his behavior." may come across as confrontational, and may cause the client's wife to avoid interaction with the nurse. 3. 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. Codependency is a typical behavior of spouses of alcoholics. Partners of clients with substance addiction must come to realize that the only behavior they can control is their own. 4. Stating, "Do you understand what the term enabler means?" may come across as confrontational, and may cause the client's wife to avoid interaction with the nurse.

87. The nurse is working with several clients in a substance abuse clinic. Client A tells the nurse that another client, Client B, has "started using again." Which action should the nurse implement? 1. Tell Client A the nurse cannot discuss Client B with him. 2. Find out how Client A got this information. 3. Inform the HCP that Client B is using again. 4. Get in touch with Client B and have the client come to the clinic.

1. The Health Insurance Portability and Accountability Act (HIPAA) requires that a health-care professional not divulge information about one person to an unau- thorized person. 2. This would be discussing Client B and a violation of HIPAA. 3. The nurse does not know Client B is using drugs, so notifying the HCP is not appropriate. 4. Client B would require an explanation for coming to the clinic, for which, if the nurse has not violated HIPAA, there is no explanation. TEST TAKING HINT: Nurses are required to practice within the laws of the state and within federal laws. HIPAA is a federal law and applies to all health-care professionalsin the United States. Legally the nurse can- not use the information provided by Client A, but morally the nurse might try to identify behavior in Client B that would warrant the nurse's intervention.

96. The nurse is working with clients and their families regarding substance abuse. Which statement is the scientific rationale for teaching the children new coping mechanisms? 1. The child needs to realize that the parent will be changing behaviors. 2. The child will need to point out to the parent when the parent is not coping. 3. Children tend to mimic behaviors of parents when faced with similar situations. 4. Children need to feel like they are a part of the parent's recovery.

1. The child will realize the changed behaviors when and if they happen. 2. This could cause problems between the par- ent and child. 3. Most coping behaviors are learned from parents and guardians. Children of sub- stance abusers tend to cope with life situations by becoming substance abusers unless taught healthy coping mechanisms. 4. Children can be a part of the parent's recovery, but this is not the rationale for teaching new coping mechanisms. TEST TAKING HINT: Most parents do not like to be corrected by their child; this could eliminate option "2." The correct answer must address a reason for teaching new cop- ing strategies.

28. Which client should the charge nurse on the substance abuse unit assign to the licensed practical nurse (LPN)? 1. The client with chronic alcoholism who has been on the unit three (3) days. 2. The client who is complaining of palpitations and has a history of cocaine abuse. 3. The client diagnosed with amphetamine abuse who tried to commit suicide. 4. The client diagnosed with cannabinoid abuse who is threatening to leave AMA.

1. The client should be assessed for delirium tremens and should be assigned to a registered nurse. 2. Palpitations indicate cardiac involvement, and because the client has a history of cocaine abuse, this client should be assigned to a registered nurse. 3. This client is at high risk for injury to self and should be assigned to a registered nurse and be on one-to-one precautions. 4. The client has a right to leave against medical advice (AMA), and marijuana abuse is not life threatening to him or to others. Therefore, the LPN could be assigned to this client.

____ 24. A nursing counselor is about to meet with a client suffering from codependency. Which of the following data would further support the assessment of this dysfunctional behavior? (Select all that apply.) 1. The client has a long history of focusing thoughts and behaviors on other people. 2. The client, as a child, experienced overindulgent and overprotective parents. 3. The client is a people pleaser and does almost anything to gain approval. 4. The client exhibits helpless behaviors but actually feels very competent. 5. The client can achieve a sense of control only through fulfilling the needs of others.

1. The codependent person has a long history of focusing thoughts and behavior on other people and is able to achieve a sense of control only through fulfilling the needs of others. 2. They usually have experienced abuse or emotional neglect as a child. 3. Codependent clients are "people pleasers" and will do almost anything to get the approval of others. 4. They outwardly appear very competent, but actually feel quite needy, helpless, or perhaps nothing at all. 5. Codependent clients achieve a sense of control when they are fulfilling the needs of others.

____ 7. A client diagnosed with chronic alcohol addiction is being discharged from an inpatient treatment facility after detoxification. Which client outcome, related to AA, would be most appropriate for a nurse to discuss with the client during discharge teaching? 1. After discharge, the client will immediately attend 90 AA meetings in 90 days. 2. After discharge, the client will rely on an AA sponsor to help control alcohol cravings. 3. After discharge, the client will incorporate family in AA attendance. 4. After discharge, the client will seek appropriate deterrent medications through AA.

1. 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 alcohol addiction. It accepts alcohol addiction as an illness and promotes total abstinence as the only cure. 2. Relying on a sponsor does not hold the client accountable. 3. Encouraging family attendance at AA meetings does not hold the client accountable. 4. Seeking further deterrent medications does not hold the client accountable.

89. The nurse observes a coworker acting erratically. The clients assigned to this coworker don'tseem to get relief when pain medications are administered. Which action should the nurse implement? 1. Try to help the coworker by confronting the coworker with the nurse's suspicions. 2. Tell the coworker that the nurse will give all narcotic medications from now on. 3. Report the nurse's suspicions to the nurse's supervisor or the facility's peer review. 4. Do nothing until the nurse can prove the coworker has been using drugs.

1. The nurse is not the coworker's supervisor, and confronting the coworker about the suspicions could lead to problems if the nurse is not trained to deal with substance abusers. 2. This is circumventing the problem. The co- worker will find another source of drugs if needed, and it is finding the coworker guilty without due process. 3. The coworker's supervisor or peer review committee should be aware of the nurse's suspicions so that the suspicions can be investigated. This is a client safety and care concern. 4. The nurse is obligated to report suspicious behavior to protect the clients the coworker is caring for. TEST TAKING HINT: The test taker can eliminate option "4" based on "do noth- ing." In this instance, direct confrontation is not recommended, but the nurse must do something—namely, report the suspicions to the supervisor or peer review.

____ 19. Which of the following nursing statements exemplify the cognitive process that must be completed by a nurse prior to caring for clients diagnosed with a substance-related disorder? (Select all that apply.) 1. "I am easily manipulated and need to work on this prior to caring for these clients." 2. "Because of my father's alcoholism, I need to examine my attitude toward these clients." 3. "I need to review the side effects of the medications used in the withdrawal process." 4. "I'll need to set boundaries to maintain a therapeutic relationship." 5. "I need to take charge when dealing with clients diagnosed with substance disorders."

1. The nurse should complete a cognitive process prior to caring for clients diagnosed with substance-abuse disorders. 2. It is important for nurses to identify potential areas of need within their own cognitions that may affect their relationships with clients diagnosed with this problem. 3. This statement does not exemplify the cognitive process that must be completed by a nurse prior to client care. 4. Determining the need to set boundaries is an example of a cognitive process that must be completed by a nurse prior to client care. 5. This statement does not exemplify the cognitive process that must be completed by a nurse prior to client care.

____ 15. A client diagnosed with major depressive episode and substance use disorder has an altered sleep pattern and demands a psychiatrist to prescribe a sedative. Which rationale explains why a nurse should encourage the client to first try nonpharmacological interventions? 1. Sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance. 2. Sedative-hypnotics are expensive and have numerous side effects. 3. Sedative-hypnotics interfere with necessary REM (rapid eye movement) sleep. 4. Sedative-hypnotics are known not to be as effective in promoting sleep as antidepressant medications.

1. The nurse should recommend nonpharmacological interventions to this client because sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance. The effects of central nervous system depressants are additive with one another, capable of producing physiological and psychological addiction. 2. These drugs do not have numerous side effects. 3. The drugs do not interfere with REM sleep. 4. These drugs are effective for inducing sleep.

____ 1. What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal? 1. Risk for injury R/T central nervous system stimulation 2. Disturbed thought processes R/T tactile hallucinations 3. Ineffective coping R/T powerlessness over alcohol use 4. Ineffective denial R/T continued alcohol use despite negative consequences

1. 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; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood; hallucinations; headache; and insomnia. 2. Disturbed thought processes R/T tactile hallucinations is important, but is not the priority nursing diagnosis. 3. Ineffective coping R/T powerlessness over alcohol use is important, but is not the priority nursing diagnosis. 4. Ineffective denial R/T continued alcohol use despite negative consequences is important, but is not the priority nursing diagnosis.

____ 17. A nurse is assessing a pathological gambler. What would differentiate this client's behaviors from the behaviors of a non-pathological gambler? 1. Pathological gamblers have abnormal levels of neurotransmitters, whereas non-pathological gamblers do not. 2. Pathological gambling occurs more commonly among women, whereas non-pathological gambling occurs more commonly among men. 3. Pathological gambling generally runs an acute course, whereas non-pathological gambling runs a chronic course. 4. Pathological gambling is not related to stress relief, whereas non-pathological gambling is related to stress relief.

1. There is a correlation between pathological gambling and abnormalities in the serotonergic, noradrenergic, and dopaminergic neurotransmitter systems. This is not the case with non-pathological gambling. 2. Pathological gambling occurs more commonly among men not women and generally runs a chronic, not acute course. 3. This statement is inaccurate regarding the pathological gambler. 4. For a pathological gambler, the preoccupation with and impulse to gamble intensifies when the individual is under stress.

91. The client diagnosed with delirium tremens when trying to quit drinking cold turkey is admitted to the medical unit. Which medications would the nurse anticipate administering? 1. Thiamine (vitamin B6) and librium, a benzodiazepine. 2. Dilantin, an anticonvulsant, and Feosol, an iron preparation. 3. Methadone, a synthetic narcotic, and Depakote, a mood stabilizer. 4. Mannitol, an osmotic diuretic, and Ritalin, a stimulant.

1. Thiamine is given in high doses to de- crease the rebound effect on the nervous system as it adjusts to the absence of alco-hol, and a benzodiazepine is given in high doses and titrated down over several days for the tranquilizing effect to prevent delirium tremens. 2. The client may have seizures, but Valium would control this. The client does not need a long-term anticonvulsant medication (Dilantin), and it is not known that the client needs an iron preparation (Feosol). The vitamin deficiency associated with delirium tremens is lack of thiamine, not iron. 3. Methadone is used for withdrawing clients from heroin, and Depakote can be used as a mood stabilizer in bipolar disorder or as an anticonvulsant. 4. The client does not need a diuretic, and a stimulant would produce an effect opposite to what is desired. TEST TAKING HINT: Option "3" could be elim- inated if the test taker knew the treatment for heroin withdrawal, and option "4" could be reasoned out because a stimulant would produce an undesired effect.

____ 18. A nursing instructor is teaching about the impaired nurse and the consequences of this impairment. Which statement by a student indicates that further instruction is needed? 1. "The state board of nursing must be notified with factual documentation of impairment." 2. "All state boards of nursing have passed laws that, under any circumstances, do not allow impaired nurses to practice." 3. "Many state boards of nursing require an impaired nurse to successfully complete counseling treatment programs prior to a return to work." 4. "After a return to practice, a recovering nurse may be closely monitored for several years."

1. This is an accurate statement regarding impaired nurses. 2. Several state boards of nursing have passed diversionary laws that allow impaired nurses to avoid disciplinary action by agreeing to seek treatment. This may require successful completion of inpatient, outpatient, group, or individual counseling treatment program(s); evidence of regular attendance at nurse support groups or 12-step program; random negative drug screens; and employment or volunteer activities during the suspension period. 3. This statement does not indicate that further education is required. 4. This statement indicates that teaching has been effective.

95. The client diagnosed with substance abuse is being discharged from a drug and alcohol rehabilitation facility. Which information should the nurse teach the client? 1. "Do not go anyplace where you can be tempted to use again." 2. "It is important that you attend a 12-step meeting regularly." 3. "Now that you are clean, your family will be willing to see you again." 4. "You should explain to all your coworkers what has happened."

1. This is unrealistic. Most restaurants serve some form of alcoholic beverage. It is good advice for the client to try to avoid situations that provide the temptation to use drugs or alcohol again. 2. The client will require a follow-up program such as 12-step meetings if the client is not to relapse. 3. The nurse does not know that this is true. 4. The client should discuss the history with the people the client chooses. TEST TAKING HINT: The test taker must no- tice descriptive words such as "all" or "do not go anywhere." These words or phrases are absolutes that should cause the test taker to eliminate the options containing them.

85. The friend of an 18-year-old male client brings the client to the emergency department (ED). The client is unconscious and his breathing is slow and shallow. Which action should the nurse implement first? 1. Ask the friend what drugs the client has been taking. 2. Initiate an IV infusion at a keep-open rate. 3. Call for a ventilator to be brought to the ED. 4. Apply oxygen at 100% via nasal cannula.

1. This should be done so that appropriate care can be provided, but it is not a priority action. 2. This should be done before the client ceases breathing and a cardiac arrest follows, but it is not the first action. 3. This would be a good step to take to prepare for the worst-case scenario, but it can be done last among these answer options. 4. Applying oxygen would be the priority ac- tion for this client. The client's breathing is slow and shallow. The greater amount of inhaled oxygen, the better the client's prognosis. TEST TAKING HINT: When the test taker is de- ciding on a priority, some guidelines should be used. Maslow's hierarchy of needs places oxygen at the top of the priority list.

883. 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? 1. Ask the client why he started taking illegal drugs. 2. Ask the client about the amount of drug use and its effect. 3. Ask the client how long he thought that he could take drugs without someone finding out. 4. Not ask any questions for fear that the client is in denial and will throw the nurse out of the home.

2 Rationale: Whenever the nurse carries out an assessment for a client who is dependent on drugs, it is best for the nurse to attempt to elicit information by being nonjudgmental and direct. Option 1 is incorrect because it is judgmental and off- focus, and reflects the nurse's bias. Option 3 is incorrect because it is judgmental, insensitive, and aggressive, which is nontherapeutic. Option 4 is incorrect because it indicates pas- sivity on the nurse's part and uses rationalization to avoid the therapeutic nursing intervention.Test-Taking Strategy: Focus on the subject, providing appro- priate nursing care. Use of therapeutic communication tech- niques will assist in directing you to the correct option.

The nurse is caring for a patient who requires an opiate medication for chronic pain associated with a previous injury. The patient tells the nurse, "Even though I don't feel like I'm addicted to the medication, I get tremors in my hands if I miss a dose." What is the nurse's best response? 1) "You may be addicted to the medication, but not necessarily physically dependent." 2) "You may be physically dependent on the medication, but not necessarily addicted." 3) "The symptoms you describe are indicative of addiction, whether you feel you are or not." 4) "The symptoms you describe relate to your disease state and are not normal."

2) The patient may be physically dependent on the substance, but not necessarily addicted. Increasing frequency and amount of use creates physical dependence, in which the body becomes so dependent on the substance that without it, withdrawal symptoms will begin. Continued use leads to a breakdown in patterns of daily living, part of the addictive process. Addiction, not physical dependence, is considered a disease state.

25. Order the following stages of the codependency recovery process according to Cermak. ________ The Core Issues Stage ________ The Reintegration Stage ________ The Survival Stage ________ The Reidentification Stage

3, 4, 1, 2 Cermak in 1986 identified four stages in the recovery process for individuals with codependent personality. During the survival stage, the codependent must begin to let go of denial. During the reidentification stage, the individual begins to glimpse their true selves. During the core issues stage, the individual must face the fact that relationships cannot be managed by force or will. During the reintegration stage, control is achieved through self-discipline and self-confidence.

817. 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? 1. Ask the client why he started taking illegal drugs. 2. Ask the client about the amount of drug use and its effect. 3. Ask the client how long he thought that he could take drugs without someone finding out. 4. Do not ask any questions for fear that the client is in denial and will throw the nurse out of the home.

817. Answer: 2 Rationale: Whenever the nurse carries out an assessment for a client who is dependent on drugs, it is best for the nurse to attempt to elicit information by being nonjudgmental and direct. Option 1 is incorrect because it is judgmental and off- focus, and reflects the nurse's bias. Option 3 is incorrect because it is judgmental, insensitive, and aggressive, which is nontherapeutic. Option 4 is incorrect because it indicates passivity on the nurse's part and uses rationalization to avoid the therapeutic nursing intervention. Test-Taking Strategy: Focus on the subject, assessment of a client dependent on drugs. Use of therapeutic communication techniques will assist in directing you to the correct option.

819. 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? 1. "I no longer feel that I deserve the beatings my husband inflicts on me." 2. "My attendance at the meetings has helped me see that I provoke my husband's violence." 3. "I enjoy attending the meetings because they get me out of the house and away from my husband." 4. "I can tolerate my husband's destructive behaviors now that I know they are common among alcoholics."

819. Answer: 1 Rationale: 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 is the healthiest response because it exemplifies an understanding that the alcoholic partner is responsible for his behavior and cannot be allowed to blame family members for loss of control. Option 2 is incorrect, because the nonalcoholic partner should not feel responsible when the spouse loses control. Option 3 indicates that the group is viewed as an escape, not as a place to work on issues. Option 4 indicates that the wife remains codependent. Test-Taking Strategy: Focus on the subject, the therapeutic effect of attending an Al-Anon group. Noting the words benefiting from attending an Al-Anon group will direct you to the correct option.

820. A hospitalized client with a history of alcohol misuse tells the nurse, "I am leaving now. I have to go. I don't want any more 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 concerns with the client, the client dresses and begins to walk out of the hospital room. What action should the nurse take? 1. Call the nursing supervisor. 2. Call security to block all exit areas. 3. Restrain the client until the primary health care provider (PHCP) can be reached. 4. Tell the client that the client cannot return to this hospital again if the client leaves now.

820. Answer: 1 Rationale: Most health care facilities have documents that the client is asked to sign relating to the client's responsibilities when the client leaves against medical advice. The client should be asked to wait to speak to the PHCP before leaving and to sign the "against medical advice" document before leaving. If the client refuses to do so, the nurse cannot hold the client against the client's 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 she or he 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. Test-Taking Strategy: Keeping the concept of false imprisonment in mind, eliminate options 2 and 3 because they are comparable or alike. Eliminate option 4, knowing that all clients have a right to health care. From the options presented, the best action is presented in the correct option.

824. The nurse is assessing a client who was admitted 24 hours ago for a fractured humerus. Which findings should alert the nurse to the potential for alcohol withdrawal delirium? 1. Hypotension, ataxia, hunger 2. Stupor, lethargy, muscular rigidity 3. Hypotension, coarse hand tremors, lethargy 4. Hypertension, changes in level of consciousness, hallucinations

824. Answer: 4 Rationale: Symptoms associated with alcohol withdrawal delirium typically 2319 include anxiety, insomnia, anorexia, hypertension, disorientation, hallucinations, changes in level of consciousness, agitation, fever, and delusions. Test-Taking Strategy: Focus on the subject, findings associated with withdrawal delirium. Review each option carefully to ensure that all symptoms in the option are correct. Eliminate options 1 and 3 first, knowing that hypertension rather than hypotension occurs. From the remaining options, recalling that the client who is stuporous is not likely to exhibit withdrawal delirium will direct you to the correct option.

825. 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? 1. "Why don't you tell your spouse about this?" 2. "What do you find difficult about this situation?" 3. "This is not the best time to make that decision." 4. "I agree with you. You should get out of this situation."

825. Answer: 2 Rationale: The most helpful response is one that encourages the client to solve problems. Giving advice implies that the nurse knows what is best and can foster dependency. The nurse should not agree with the client, and the nurse should not request that the client provide explanations. Test-Taking Strategy: Note the strategic word, most. Use therapeutic communication techniques. Eliminate option 1 because of the word why, which should be avoided in communication. Eliminate option 3, because this option places the client's feelings on hold. Eliminate option 4, because the nurse is agreeing with the client. The correct option is the only one that addresses the client's feelings.

885. 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? 1. "I no longer feel that I deserve the beatings my husband inflicts on me." 2. "My attendance at the meetings has helped me to see that I provoke my husband's violence." 3. "I enjoy attending the meetings because they get me out of the house and away from my husband." 4. "I can tolerate my husband's destructive behaviors now that I know they are common among alcoholics."

1 Rationale: 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 behav- ioral changes. The correct option is the healthiest response because it exemplifies an understanding that the alcoholic part- ner is responsible for his behavior and cannot be allowed to blame family members for loss of control. Option 2 is incorrect because the nonalcoholic partner should not feel responsible when the spouse loses control. Option 3 indicates that the group is viewed as an escape, not as a place to work on issues. Option 4 indicates that the wife remains codependent. Test-TakingStrategy:Focuson thesubject,thetherapeuticeffect of attending an Al-Anon group. Noting the words benefiting from attending an Al-Anon group will direct you to the correct option.

____ 10. A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse's rationale for this intervention? 1. To assess for emotional strength 2. To assess for Wernicke-Korsakoff syndrome 3. To assess for tachycardia 4. To assess for fine tremors

1. The nurse is not checking for emotional strength by holding the client's hand. 2. The nurse is not assessing for Wernicke-Korsakoff syndrome. 3. The nurse is not assessing for tachycardia. 4. 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, and coarse tremors.

A college student is incoherent after taking "downers with beer." For which health problem should the nurse also observe for in this patient? 1) Hallucinations 2) Respiratory depression 3) Seizure activity 4) Signs of withdrawal

2) Downers are central nervous system depressants. Barbiturates and alcohol are a lethal combination. The patient who has ingested both items is at risk for varying degrees of sedation, up to coma and death. Seizure activity, signs of withdrawal, and signs of hallucinations do not pose as great a risk for this patient as respiratory depression.

Which symptoms common to substance abuse will the nurse include in the assessment process for a patient who is suspected of having a substance use disorder? Select all that apply. 1) Disregard for religious beliefs while abusing the substance 2) Lack of desire to quit using the substance 3) Need for greater amounts of the substance to achieve the same effect 4) Neglect of normal activities due to focus on obtaining or using more of the substance 5) Persistent craving for the substance

Patients who have a substance use disorder experience some universal symptoms: a need for greater amounts of the substance to achieve the same effect, neglect of normal activities due to focus on obtaining or using more of the substance, and a persistent craving for the substance. The patient with a substance use disorder does not necessarily disregard his or her religious beliefs or lack the desire to quit. Some patients have a desire to reduce their use of the substance but have difficulty doing so. 3) This is correct. 4) This is correct. 5) This is correct.

A nurse working in the emergency department is caring for a patient who has overdosed on cocaine. The nurse receives a prescription to administer an antipsychotic medication from the health-care provider. Which symptom would this medication help to manage? Select all that apply. 1) Alkaline urine 2) Decreased deep tendon reflexes 3) Hyperpyrexia 4) Respiratory distress 5) CNS depression

Antipsychotic medications are used in the treatment of patients who have overdosed on crack or cocaine. These medications help to manage the hyperpyrexia, respiratory distress, acidic urine, and convulsions associated with the overdose. CNS depression and decreased deep tendon reflexes do not occur in acute cocaine overdose. 3) This is correct. 4) This is correct.

26. The concept of _______________________ arose out of a need to define the dysfunctional behaviors that are evident among members of the family of a chemically dependent person.

Codependency The concept of codependency arose out of a need to define the dysfunctional behaviors that are evident among members of the family of a chemically dependent person. The term has been expanded to include all individuals from families that harbor secrets of physical or emotional abuse, other cruelties, or pathological conditions.

The nurse is conducting a class in the community regarding alcohol use to a group of college seniors. During the class a participant admits to frequently using alcohol. Which is the priority action of the nurse? 1) Initiate a community assessment of the campus 2) Contact the campus nurse and refer the student 3) Notify campus security to watch for driving under the influence 4) Complete a crisis assessment

1) A community assessment is not an appropriate action at this time. 2) Contacting the campus nurse is not advised without the student's permission. 3) There is no evidence that the student is driving under the influence. 4) In a trusting relationship, the nurse will complete a crisis assessment to determine the appropriate action.

____ 6. Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during the substance induced disorder of alcohol withdrawal? 1. Antagonist therapy 2. Deterrent therapy 3. Codependency therapy 4. Substitution therapy

1. Antagonist therapy does not accurately describe this CNS depressant medication. 2. Deterrent therapy does not accurately describe this CNS depressant medication. 3. Codependency therapy does not accurately describe this CNS depressant medication. 4. Various medications have been used to decrease the intensity of symptoms in an individual who is withdrawing from, or who is experiencing the effects of excessive use of, alcohol and other drugs. This is called substitution therapy and may be required to reduce the life-threatening effects of alcohol withdrawal.

92. The client is withdrawing from a heroin addiction. Which interventions should the nurse implement? Select all that apply. 1. Initiate seizure precautions. 2. Check vital signs every eight (8) hours. 3. Place the client in a quiet, calm atmosphere. 4. Have a consent form signed for HIV testing. 5. Provide the client with sterile needles.

1. Chills, sweats, and gooseflesh occur with heroin withdrawal, but seizures do not usually occur, so seizure precautions are not necessary. 2. Vital signs should be taken more frequently, every two (2) to four (4) hours, depending on the client's condition. 3. The client should be in an atmosphere with little stimulation. The client will be irritable and fearful. 4. Heroin is administered intravenously. Heroin addicts are at high risk for HIV as a result of shared needles and thus should be tested for HIV. 5. The client is withdrawing from heroin, so providing needles is inappropriate. Providing sterile needles to IV drug users is controversial, but it attempts to decrease the incidence of HIV among drug users. TEST TAKING HINT: A "select all that apply" question will usually have more than one correct answer. One option cannot eliminate another.

____ 16. A client diagnosed with a gambling disorder asks the nurse about medications that may be ordered by the client's physician to treat this disorder. The nurse would give the client information on which medications? 1. Escitalopram (Lexapro) and clozapine (Clozaril) 2. Citalopram (Celexa) and olanzapine (Zyprexa) 3. Lithium carbonate (Lithobid) and sertraline (Zoloft) 4. Naltrexone (ReVia) and ziprasidone (Geodon)

1. Escitalopram (Lexapro) and clozapine (Clozaril) would not effectively treat this client. 2. Citalopram (Celexa) and olanzapine (Zyprexa) are not treatments of choice for this disorder. 3. Lithium carbonate (Lithobid) and sertraline (Zoloft) have been used successfully in the treatment of pathological gambling as a form of obsessive-compulsive disorder. 4. Naltrexone (ReVia) and ziprasidone (Geodon) would not appropriately treat this client.

____ 23. A nursing supervisor is offering an impaired staff member information regarding employee assistance programs. Which of the following facts should the supervisor include? (Select all that apply.) 1. A hotline number will be available in order to call for peer assistance. 2. A verbal contract detailing the method of treatment will be initiated prior to the program. 3. Peer support is provided through regular contact with the impaired nurse. 4. Contact to provide peer support will last for one year. 5. One of the program goals is to intervene early in order to reduce hazards to clients.

1. Most states provide either a hotline number that the impaired nurse may call or phone numbers of peer assistance committee members, which are made available for the same purpose. 2. Typically, a written, not verbal, contract is drawn up, detailing the method of treatment, which may be obtained from various sources, such as employee assistance programs, Alcoholics Anonymous, Narcotics Anonymous, private counseling, or outpatient clinics. 3. Peer support is provided through regular contact with the impaired nurse. 4. Peer support is usually for a period of two years, not one year. 5. The peer assistance programs strive to intervene early, to reduce hazards to clients, and increase prospects for the nurse's recovery.

41. The client is brought to the emergency department by the police for public disorderliness. The client reports feeling no pain and is unconcerned that the police have arrested him. The nurse notes the client has epistaxis and nasal congestion. Which substance should the nurse suspect the client has abused? 1. Marijuana. 2. Heroin. 3. Ecstasy. 4. Cocaine.

1. Symptoms of marijuana use are apathy, delayed time, and not wanting to eat. 2. Heroin symptoms include pupil changes and respiratory depression. 3. Ecstasy is a hallucinogen that is an "upper." 4. Disorderly behavior and the symptoms of epistaxis and nasal congestion would make 45. the nurse suspect cocaine abuse.

90. The client with a history of substance abuse presents to the emergency department complaining of right flank pain, and the urinalysis indicates microscopic blood. Which intervention should the nurse implement? 1. Determine the last illegal drug use. 2. Insert a #22 French indwelling catheter. 3. Give the client a back massage. 4. Medicate the client for pain.

1. This is not pertinent to the client's current situation. 2. The nurse should strain all the client's urine, but a large indwelling catheter does not need to be inserted into this client; this isn't a bladder stone, it is a ureteral stone. 3. A back massage is a nice thing to do, but it will not help renal colic caused by ureteral calculi. 4. The client should be medicated for pain, which is excruciating, and the client's history of substance abuse should not be an issue.

891. 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? 1. "Why don't you tell your spouse about this?" 2. "What do you find difficult about this situation?" 3. "This is not the best time to make that decision." 4. "I agree with you. You should get out of this situation."

2 Rationale: The most helpful response is one that encourages the client to solve problems. Giving advice implies that the nurse knows what is best and can foster dependency. The nurse should not agree with the client, and the nurse should not request that the client provide explanations. Test-Taking Strategy: Note the strategic word, most. Use ther- apeutic communication techniques. Eliminate option 1 because of the word why, which should be avoided in commu- nication. Eliminate option 3 because this option places the cli- ent's feelings on hold. Eliminate option 4 because the nurse is agreeing with the client. The correct option is the only one that addresses the client's feelings.

The nurse is conducting a health history for a patient and wants to determine the patient's alcohol use. What question from the nurse will provide the greatest amount of information? 1) "Are you a heavy drinker?" 2) "How many alcoholic beverages do you drink each day?" 3) "Is alcohol use a concern for you?" 4) "Drinking doesn't cause any problems for you, does it?"

2) Open-ended questions will elicit the greatest amount of information. Asking closed questions that can be answered with a "yes" or "no" will limit the information obtained.

The nurse is completing a health history and determines the patient would benefit from teaching about substance abuse. Which patient statement does not support the need for this teaching? 1) "I drink alcohol with my friends on the weekends." 2) "I smoke cigarettes on a daily basis." 3) "I get good grades in school." 4) "I became sexually active at the age of 13."

3) Getting good grades is not a risk factor for substance abuse. Early sexual activity, smoking cigarettes, and drinking alcohol are all risk factors for teenage substance abuse.

890. The nurse is monitoring a hospitalized client who abuses alcohol. Which findings should alert the nurse to the potential for alcohol withdrawal delirium? 1. Hypotension, ataxia, hunger 2. Stupor, lethargy, muscular rigidity 3. Hypotension, coarse hand tremors, lethargy 4. Hypertension, changes in level of consciousness, hallucinations.

4 Rationale: Symptoms associated with alcohol withdrawal delirium typically include anxiety, insomnia, anorexia, hyper- tension, disorientation, hallucinations, changes in level of con- sciousness, agitation, fever, and delusions.Test-Taking Strategy: Focus on the subject, findings associ- ated with withdrawal delirium. Review each option carefully to ensure that all symptoms in the option are correct. Eliminate options 1 and 3 first, knowing that hypertension rather than hypotension occurs. From the remaining options, recalling that the client who is stuporous is not likely to exhibit withdrawal delirium will direct you to the correct option.

The nurse is caring for a patient who is diagnosed with cocaine addiction. For which additional disorder should the nurse assess this patient? 1) Anxiety 2) Diabetes 3) Weight gain 4) Kidney stones

1) Cocaine stimulates the nervous system; therefore, the nurse should also assess this patient for anxiety. Weight gain, diabetes, and kidney stones are not linked to substance abuse.

A patient being treated for an alcohol use disorder asks the nurse, "Can my children inherit this?" Which response by the nurse is most appropriate? 1) "The role of genetics is minor in comparison to the role of the environment." 2) "Genetics does not seem to play a role in the development of substance use disorders." 3) "The role of genetics in substance use disorders has not been determined." 4) "Genetics plays a major role in the development of substance use disorders."

3) Research has not yet determined the relationship between genetics and substance use disorders, particularly regarding why some people are more prone to addiction than others.

The employee health nurse is providing care to an employee who was injured on the job. The patient has a history of drug addiction and is currently enrolled in a 12-step recovery program. In order to determine whether the employee was impaired at the time of the accident, which diagnostic tool will the nurse use? 1) Liver enzymes 2) Stool guaiac 3) Urine toxicology testing 4) Hair testing

1) Liver enzymes detect liver damage but are not specific to damage from substance abuse. A stool guaiac tests for blood. 2) Liver enzymes detect liver damage but are not specific to damage from substance abuse. A stool guaiac tests for blood. 3) Urine toxicology testing will determine whether the employee had drugs in his system during the shift in which the injury occurred. 4) Hair testing can detect substance use for up to 90 days and is not an accurate tool to determine whether the employee was impaired at the time of the injury.

Ten hours after admission to the ICU following an auto accident, a patient begins to exhibit mild tachycardia, irritability, and tremors. Three hours later the patient has a grand mal seizure. Which condition does the nurse suspect? 1) Wernicke encephalopathy 2) Korsakoff syndrome 3) Undetected internal bleeding 4) Alcohol withdrawal syndrome

1) Wernicke encephalopathy is a neurologic disease characterized by ataxia, sixth cranial nerve palsy, nystagmus, and confusion. 2) Korsakoff syndrome is a disturbance in short-term memory that occurs in individuals who have been drinking for many years 3) An undetected internal hemorrhage would not present with the symptoms outlined. 4) Alcohol withdrawal syndrome is marked by mild tachycardia, irritability, and tremors.

____ 3. On the first day of a client's alcohol detoxification, which nursing intervention should take priority? 1. Strongly encourage the client to attend 90 Alcoholics Anonymous (AA) meetings in 90 days. 2. Educate the client about the biopsychosocial consequences of alcohol abuse. 3. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. 4. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.

1. Encouraging AA meetings is important, but the administration of medication to prevent alcohol withdrawal takes priority due to client safety. 2. Education is important, but the administration of medication to prevent alcohol withdrawal takes priority due to client safety. 3. The priority nursing intervention for this client should be to administer ordered chlordiazepoxide in a dosage according to protocol. Chlordiazepoxide is a benzodiazepine and is often used for substitution therapy in alcohol withdrawal to reduce life-threatening complications. 4. Vitamin B1 administration is important, but the administration of medication to prevent alcohol withdrawal takes priority due to client safety.

93. The wife of the client diagnosed with chronic alcoholism tells the nurse, "I have to call his work just about every Monday to let them know he is ill or he will lose his job." Which would be the nurse's best response? 1. "I am sure that this must be hard for you. Tell me about your concerns." 2. "You are afraid he will lose his source of income." 3. "Why would you call in for your husband? Can't he do this?" 4. "Are you aware that when you do this you are enabling him?"

1. This is a therapeutic response. The spouse is not expressing feelings but is stating a fact. The nurse should address the problem. 2. This is a therapeutic response. The spouse is not expressing feelings but is stating a fact. The nurse should address the problem. 3. The spouse is not required to give an explanation to the nurse. 4. The spouse's behavior is enabling the cli- ent to continue to drink until he cannot function. TEST TAKING HINT: The stem of the question did not ask for a therapeutic response but did ask for the nurse's best response. The best response is to address the problem.

A patient addicted to heroin is prescribed methadone as part of the treatment process. The patient's spouse asks, "I don't understand the reason for the methadone treatment. Why replace heroin with methadone?" Which response by the nurse is accurate? 1) "Methadone is safe even in large doses." 2) "Methadone replaces a more potent drug." 3) "Methadone is a deterrent to using other drugs." 4) "Methadone blocks the craving for and the action of opiates."

4) Methadone blocks the craving for and the action of opiates such as heroin. Methadone does not replace more potent drugs or act as a deterrent to other drug use. The doses of methadone are strictly regulated and administered by health professionals.

____ 13. Which medication orders should a nurse anticipate for a client who has a history of benzodiazepine-withdrawal delirium? 1. Haloperidol (Haldol) and fluoxetine (Prozac) 2. Carbamazepine (Tegretol) and donepezil (Aricept) 3. Disulfiram (Antabuse) and lorazepan (Ativan) 4. Chlordiazepoxide (Librium) and phenytoin (Dilantin)

1. Haloperidol (Haldol) and fluoxetine (Prozac) would not effectively treat the client and are not appropriate. 2. Carbamazepine (Tegretol) and donepezil (Aricept) would not effectively treat the client and are not appropriate. 3. Disulfiram (Antabuse) and lorazepan (Ativan) would not effectively treat the client and are not appropriate. 4. The nurse should anticipate that a physician would order chlordiazepoxide and phenytoin for a client who has a history of benzodiazepine-withdrawal delirium. It is common for long-lasting benzodiazepines to be prescribed for substitution therapy.

818. Which interventions are most appropriate for caring for a client in alcohol withdrawal? Select all that apply. 1. Monitor vital signs. 2. Provide a safe environment. 3. Address hallucinations therapeutically. 4. Provide stimulation in the environment. 5. Provide reality orientation as appropriate. 6. Maintain NPO (nothing by mouth) status.

818. Answer: 1, 2, 3, 5 Rationale: When the client is experiencing withdrawal from alcohol, the priority for care is to prevent the client from harming self or others. The nurse would monitor the vital signs closely and report abnormal findings. The nurse would provide a low-stimulation 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. Test-Taking Strategy: Note the strategic words, most appropriate. Thinking about the needs of the client in alcohol withdrawal and recalling the characteristics associated with alcohol withdrawal will assist in answering correctly. Also, use therapeutic communication techniques to assist in selecting the correct interventions.