Addictions

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

"What do you find difficult about this situation?"

The nurse is preparing to perform an admission assessment on a client with a diagnosis of bulimia nervosa. Which assessment findings would the nurse expect to note? Select all that apply. Dental decay Moist, oily skin Loss of tooth enamel Electrolyte imbalances Body weight well below ideal range

Dental decay Loss of tooth enamel Electrolyte imbalances

The nurse is discussing pain management with a student who is caring for a one-day postoperative abdominal surgery client who is a known opioid substance abuser. What comment by the student indicates a need for further education? 1. Opioid substance abusers are less tolerant to opioids and require decreased doses. 2. These clients need to be allowed to choose their pain medications and dosing regimen. 3. Nonopioid therapies such as cutaneous stimulation are generally effective if used alone. 4. These clients are at an increased risk for abrupt physiological withdrawal when opioid agonists are abruptly withdrawn.

1. Opioid substance abusers are less tolerant to opioids and require decreased doses.

The nurse is working with a client who shows signs of benzodiazepine withdrawal. The nurse would suspect that the client has suddenly discontinued taking which prescribed medication? Sertraline Diazepam Fluoxetine Haloperidol

Diazepam

The client diagnosed with alcoholism has been prescribed medication therapy to assist in the maintenance of sobriety. The nurse will provide the client with education focused on which medication that will most likely be prescribed? Clonidine Disulfiram Pyridoxine hydrochloride Chlordiazepoxide hydrochloride

Disulfiram

A client experiencing cocaine toxicity is brought to the emergency department. The nurse would prepare to take which initial action? 1. Administer naloxone. 2. Ensure a patent airway. 3. Establish an intravenous access. 4. Obtain a 12-lead electrocardiogram (ECG).

2. Ensure a patent airway.

The nurse in the hospital emergency department is caring for a client with suspected opioid overdose and is preparing to administer the reversal agent via the intravenous route. Which statement is correct about the administration of this medication? 1. Prepare only one dose of the reversal agent. 2. Administer the entire dose by slow intravenous push. 3. Administer the medication rapidly by the intravenous route. 4. After the initial dose, prepare to administer additional intravenous doses if needed.

4. After the initial dose, prepare to administer additional intravenous doses if needed. Rationale: The reversal agent for opioids is naloxone hydrochloride, which needs to be titrated every 2 to 5 minutes according to client response. Therefore, the remaining options are incorrect. Test-Taking Strategy: Focus on the subject, the procedure for the administration of naloxone hydrochloride. Read each option carefully and note that the incorrect options contain the words only, entire, and rapidly.

The nurse is caring for a client with an addiction who has overdosed on amphetamines. The nurse anticipates noting which assessment finding in this client? 1. Bradypnea 2. Bradycardia 3. Hypothermia 4. Hypertension

4. Hypertension

A client with anorexia nervosa is a member of a predischarge support group. The client verbalizes an interest in buying new clothes, but expresses that money is limited. Group members have brought some used clothes to the client to replace the client's old clothes. The client believes that the new clothes are much too tight and has reduced personal caloric intake to 800 calories daily. How would the nurse evaluate this behavior? Normal behavior Evidence of the client's disturbed body image Regression as the client is moving toward the community Indicative of the client's ambivalence about hospital discharge

Evidence of the client's disturbed body image

The nurse is preparing to administer a dose of naloxone intravenously to a client with an opioid overdose. Which supportive medical equipment would the nurse plan to have at the client's bedside if needed? Nasogastric tube Paracentesis tray Resuscitation equipment Central line insertion tray

Resuscitation equipment

Which are the most likely characteristics of a client who abuses alcohol? Select all that apply. Seeks needed treatment Is not married Abuses drugs as well as alcohol Employed in a minimal wage job History of at least one suicide attempt

Seeks needed treatment Abuses drugs as well as alcohol History of at least one suicide attempt Rationale: A person who abuses alcohol is at a high risk for self-inflicted injury, and simultaneous use of more than one substance is very common. Few of those abusing alcohol receive needed treatment. Alcoholics are found at all economic strata and occur equally among married and single clients.

The nurse is performing an assessment on a client being admitted with a diagnosis of alcohol dependence who reports it's been 6 hours since the last drink. The information supports which assumption about the appearance of withdrawal symptoms? The danger time has passed. Signs may appear at any time. The next hour could be critical. Withdrawal has likely already started.

Signs may appear at any time.

When working with the client who has two family members with a history of substance abuse, the nurse would identify which assessment data as a primary biological factor? The client is a 25-year-old. The client is employed as a firefighter. The client is of non-American descent. The client has two family members who have abused.

The client has two family members who have abused.

A client with suspected opioid overdose has received a dose of naloxone hydrochloride. The client subsequently becomes restless, starts to vomit, and complains of abdominal cramping. The blood pressure increases from 110/72 mm Hg to 160/86 mm Hg. The nurse provides emotional support and reassurance while administering care to the client, knowing which piece of information? The client may next become suicidal. These are signs of opioid withdrawal. These effects will last only a few moments. The client may otherwise sign out against medical advice

These are signs of opioid withdrawal.

Thiamine supplementation and other nutritional vitamin support measures are prescribed for clients who have been using alcohol to prevent or decrease the risk of which complication? Cirrhosis Delirium tremens Esophageal varices Wernicke-Korsakoff syndrome

Wernicke-Korsakoff syndrome

The nurse is caring for a client who has been prescribed disulfiram. Which statement by the client indicates to the nurse the need for further teaching about this medication? "I'll have to check my aftershave lotion." "I must be careful taking cold medicines." "As long as I don't drink alcohol, I'll be fine." "I'll have to be careful with the ingredients I use for cooking."

"As long as I don't drink alcohol, I'll be fine."

The spouse of an alcohol-dependent client says, "If anyone had said I'd be henpecked, I'd have called them a liar, but now I realize that I'm codependent." Which statement by the nurse would be therapeutic? "Did you know that more people identify with just what you are saying?" "Which of the features that describe codependence caused you to recognize that?" "Can you tell me more about that? You see yourself as being codependent with your spouse?" "Have you discussed your feelings with your spouse? What does your spouse think about what you've said?"

"Can you tell me more about that? You see yourself as being codependent with your spouse?"

A postsurgical client with a history of heavy alcohol intake has returned to the nursing unit. Which signs/symptoms of delirium tremens would the nurse plan to continuously assess for? Coarse hand tremor, agitation, hallucinations, and hypotension Hypotension, ataxia, muscular rigidity, and tactile hallucinations Hypotension, stupor, agitation, headache, and auditory hallucinations Fever, hypertension, changes in level of consciousness, and hallucinations

Fever, hypertension, changes in level of consciousness, and hallucinations

The nurse would be prepared to manage which occurrence unique to the abuse of hallucinogenic drugs? Flashbacks Amotivational syndrome Enhanced physical strength Absence of pain perception

Flashbacks Rationale:Flashbacks, the recurrence of perceptual distortions, are unique to the use of hallucinogenic drugs. Enhanced physical strength and the inability to feel pain are indicative of phencyclidine use, whereas marijuana abuse can result in amotivational syndrome.

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

Hypertension, changes in level of consciousness, hallucinations

Before giving the client the initial dose of disulfiram, what would the psychiatric home health nurse determine? If there is a history of hyperthyroidism When the last full meal was consumed If there is a history of diabetes insipidus When the last alcoholic drink was consumed

When the last alcoholic drink was consumed Rationale: Disulfiram is an adjunctive treatment for some clients with chronic alcoholism to assist in maintaining enforced sobriety. Because clients must abstain from alcohol for at least 12 hours before the initial dose, the most important assessment is when the last alcoholic drink was consumed. The medication would be used cautiously in clients with hypothyroidism, diabetes mellitus, epilepsy, cerebral damage, nephritis, and hepatic disease. It is contraindicated in persons with severe heart disease, psychosis, or hypersensitivity to the medication. Food is not a consideration with this medication.

A client who is recovering from benzodiazepine dependence says, "I've lost so many people. First, my sibling dies of cancer; then my spouse leaves me for a 20-year-old. I wish I had one of those pills right now." Which statement by the nurse would be therapeutic? "Can you tell me what you think the pills can do for you?" "It sounds as if you feel that all of this has just happened to you." "It must have been a terrible loss for you when your sibling died." "How did your spouse's interest in a younger person make you feel?"

"Can you tell me what you think the pills can do for you?"

When assessing a client for a possible physical dependency on alcohol, the nurse would ask which priority question? "Are you drinking more than you did 5 years ago?" "How do you feel when you haven't had a drink all day?" "Does your drinking ever cause you problems with your family?" "Do you ever feel that you really need a drink to calm your nerves?"

"How do you feel when you haven't had a drink all day?"

A client's alcohol consumption suggests the development of a tolerance for alcohol. Which statement supports the existence of an alcohol tolerance problem? "I've never drunk so much that I've passed out." "I'm just a social drinker. I seldom drink when I'm alone." "I don't have to drink to feel good. I drink because I like the way it tastes." "I have a cocktail after work, wine with dinner, and no more than two drinks to sleep."

"I have a cocktail after work, wine with dinner, and no more than two drinks to sleep."

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

"I no longer feel that I deserve the beatings my partner inflicts on me."

The spouse of an alcoholic client is attending a support group and says to the group members, "It's all very well for everyone to label me an enabler, but if I didn't call my spouse in sick at work, my spouse would have lost the job. Where would we be then?" Which statement by the nurse co-leader would be therapeutic? "Does anyone in the group want to respond to that?" "So you only call your spouse in sick because you are worried about money?" "Hasn't the group discussed this before? What conclusion did you all come to?" "It is a difficult situation, but do you agree that enabling creates codependency?"

"It is a difficult situation, but do you agree that enabling creates codependency?"

An alcohol-troubled client says, "The 12 Steps of Alcoholics Anonymous (AA) meeting really upset me. I had to go for a drink after 1 hour with those people; they're fanatics!" Which statement by the nurse would be therapeutic? "You think AA is for fanatics?" "It sounds as if you look for any reason to drink!" "Not any one strategy for remaining sober is best for everyone." "I agree. AA is definitely not for you if you find it is a trigger to drink."

"Not any one strategy for remaining sober is best for everyone."

The mental health nurse is meeting with a client who has a long history of abusing drugs. During the session the client says to the nurse, "I'm feeling much better now, and I'm ready to stop using drugs." Which response by the nurse would be therapeutic? "You have said this many times before!" "Tell me what makes you feel that you are ready." "I'm so glad to hear you talking this way. I will let your psychiatrist know." "I need to see changes in you to believe that you are ready to stop using drugs."

"Tell me what makes you feel that you are ready." Rationale:Clients with a long history of drug abuse need to demonstrate motivation to change the behavior, not just verbalization of the intent to change the behavior. The therapeutic response by the nurse would be directed at assisting the client to look at the behaviors that indicate the change. The correct option is the only one that will provide this direction to the client. Test-Taking Strategy:Focus on the subject, drug abuse. Use therapeutic communication techniques to assist in answering the question. Avoid options that are insensitive and sarcastic and those that merely disagree with the client, rather than assisting him or her to verbalize how things would be different. Jumping to a conclusion with no data gathering provides a social response rather than a therapeutic one.

A heroin-addicted client who is taking methadone hydrochloride discontinues the methadone without consulting the primary health care provider. The client says to the nurse, "I thought I didn't need the methadone after 1 year. I had a job and was even saving money. I can't believe I ruined everything." Which statement by the nurse is therapeutic? "It sounds as if everything you do is either all or nothing." "Talk to your counselor; maybe everything isn't ruined yet." "You will need to restart your recovery, starting from the beginning." "We need to prepare you to recognize those things that trigger you to relapse."

"We need to prepare you to recognize those things that trigger you to relapse."

The nurse working in a detoxification unit is admitting a client for alcohol withdrawal. The client's spouse states, "I don't know why I don't get out of this rotten situation." Which response by the nurse addresses the spouse's concerns? "This is not a good time to make that decision." "What would your spouse think about your decision?" "What aspects of this situation are the most difficult for you?" "You seem to have a good grip on this situation. You probably need to get out."

"What aspects of this situation are the most difficult for you?"

A client with a diagnosis of anorexia nervosa, who is in a state of starvation, is in a two-bed room. A newly admitted client will be assigned to this client's room. Which client would be the best choice as a roommate for the client with anorexia nervosa? A client with pneumonia A client undergoing diagnostic tests A client who thrives on managing others A client who could benefit from the client's assistance at mealtime

A client undergoing diagnostic tests

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

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

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

Ask the client about the amount of drug use and its effect.

The nurse is providing a health promotion session to a group of teenagers and is discussing the abuse of barbiturates. The nurse would provide which information to the teenagers? Barbiturate use commonly results in a rush of energy. Barbiturate abuse is the cause of many drug overdose deaths. The primary outcome of barbiturate abuse is psychological dependency. A dangerous increase in blood pressure (BP) occurs with barbiturate abuse.

Barbiturate abuse is the cause of many drug overdose deaths. Rationale: The abuse of barbiturates, a class of central nervous system (CNS) depressants, is a major cause of fatal drug overdoses. The abuse of barbiturates results in both physical and psychological dependency. Energy rushes and elevated BP result from the use of a CNS stimulant.

The nurse is preparing to administer an analgesic to a client in labor. Which analgesic is contraindicated for a client who has a history of opioid dependency? Fentanyl Morphine sulfate Butorphanol tartrate Meperidine hydrochloride

Butorphanol tartrate Rationale: Butorphanol tartrate is an opioid analgesic that can precipitate withdrawal symptoms in an opioid-dependent client. Therefore, it is contraindicated if the client has a history of opioid dependency. Fentanyl, morphine sulfate, and meperidine are opioid analgesics but do not tend to precipitate withdrawal symptoms in opioid-dependent clients

A hospitalized client with a history of alcohol abuse tells the nurse, "I am leaving now. I don't want help. I have other things to attend to that are more important." The nurse attempts to discuss the client's concerns, but the client dresses and begins to walk out of the hospital room. Which action would the nurse take at this time? Call the nursing supervisor. Call security to block the exits to the nursing unit. Restrain the client, and call the primary health care provider. Tell the client that readmission is not possible after leaving against medical advice.

Call the nursing supervisor.

A hospitalized client with a history of alcohol use disorder tells the nurse: "I am leaving now. I must go. I do not 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 would the nurse take? Call the nursing supervisor. Call security to block all exit areas. Restrain the client until the primary health care provider (PHCP) can be reached. Tell the client that the client cannot return to this hospital again if the client leaves now.

Call the nursing supervisor.

The nurse who works on the night shift enters the medication room and finds a coworker with a tourniquet wrapped around the upper arm. The coworker is about to insert a needle, attached to a syringe containing a clear liquid, into the antecubital area. Which is the most appropriate action by the nurse? Call security. Call the police. Call the nursing supervisor. Lock the coworker in the medication room until help is obtained.

Call the nursing supervisor.

The nurse explains to a group of clients that methamphetamine abuse results in which vascular system dysfunction? Emboli Hypotension Thrombophlebitis Impaired wound healing

Impaired wound healing Rationale: Methamphetamine abuse causes vasoconstriction, resulting commonly in poor wound healing and hypertension. Thrombophlebitis and emboli are not results of vasoconstriction and are not associated with methamphetamine.

The nurse would monitor a client with a history of opioid abuse for which signs and symptoms associated with opioid withdrawal? Increased appetite, irritability, anxiety, restlessness, and altered concentration Tachycardia, mild hypertension and fever, sweating, nausea, vomiting, and marked tremor Depression, high drug craving, fatigue, altered sleep patterns, hypertension, agitation, and paranoia Increased pulse and blood pressure, low-grade fever, yawning, restlessness, anxiety, diarrhea, and mydriasis

Increased pulse and blood pressure, low-grade fever, yawning, restlessness, anxiety, diarrhea, and mydriasis

The nurse is caring for a client who was admitted to the mental health unit recently for anorexia nervosa. The nurse enters the client's room and notes that the client is engaged in rigorous push-ups. Which nursing action is most appropriate? Allow the client to complete the exercise program. Interrupt the client and weigh the client immediately. Tell the client that exercising rigorously is not allowed. Interrupt the client and offer to take the client for a walk.

Interrupt the client and offer to take the client for a walk.

A client with a history of opiate abuse asks the nurse, "Why do I crave this stuff so much?" The nurse responds, knowing that the client's craving is a result of which factor? Development of tolerance for the drug Lack of naturally occurring endorphins Client's psychological dependency on opiates Typical abuse pattern for central nervous system depressants

Lack of naturally occurring endorphins Rationale: Craving opiates is a result of the diminished production of endorphins that occurs with long-term abuse of the drug. Tolerance is the need for increased amounts of the drug to achieve the desired effects. Psychological dependency is the emotional need for the drug. Cravings are not typical of all central nervous system depressant abuse.

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

Monitor vital signs. Provide a safe environment. Address hallucinations therapeutically. Provide reality orientation as appropriate.

The nurse would monitor the client with a history of heroin addiction for which signs/symptoms of heroin withdrawal? Constipation, insomnia, and hallucinations Staggering gait, slurred speech, and violent outbursts Nausea, vomiting, diarrhea, muscle aches, and diaphoresis Decreased heart rate and blood pressure, and dry nose, mouth, and skin

Nausea, vomiting, diarrhea, muscle aches, and diaphoresis