Mental Health practice test - Addiction and Substance Related Disorders

a client with a history of alcohol abuse is participating in a 12-step alcoholics anonymous (AA) program. the nurse determines that the client is at step 2 when he states which of the following? a. "I've admitted to myself and others the wrongdoings I've done." b. "I realize that there is a higher power that can help me." c. "I know now that I am powerless over alcohol." d. "I am making amends to all those that I've harmed."

I realize that there is a higher power that can help me Rationale: coming to believe that a power greater than oneself could help restore sanity reflects the second step of AA. Admitting to one's self and others about wrongdoings reflects step 5 of AA. Admitting powerlessness over alcohol is step 1. Making amends is part of step 9.

a client is receiving methadone maintenance therapy. after teaching the client about this treatment, the nurse determines that the education was successful when the client states which of the following? a. "I can have a glass of wine with dinner if I choose." b. "I should eat small frequent meals if I get nauseated." c. "I should take the drug on an empty stomach." d. "I might experience diarrhea with this drug."

I should eat small frequent meals if I get nauseated Rationale: a client receiving methadone maintenance therapy may experience nausea. therefore, the client should eat small, frequent meals to treat the nausea and loss of appetite, and should take the drug with food and lie quietly to minimize the nausea. alcohol should be avoided. constipation may occur, necessitating the use of a mild laxative.

A patient admitted to an alcoholism rehabilitation program tells the nurse, "I'm actually just a social drinker. I usually have a drink at lunch, two in the afternoon, wine with dinner, and a few drinks during the evening." The patient is using which defense mechanism? a. Denial b. Projection c. Introjection d. Rationalization

denial Rationale: Minimizing one's drinking is a form of denial of alcoholism. The patient is more than a social drinker. Projection involves blaming another for one's faults or problems. Rationalization involves making excuses. Introjectioninvolves incorporating a quality of another person or group into one's own personality.

a nurse is preparing an in-service program about substance abuse and its etiology. which of the following would the nurse most likely include in the presentation when discussing possible etiologies? a. mixed self-esteem b. genetic predisposition c. dysfunctional family d. peer influence

genetic predisposition Rationale: substance abuse encompasses the body, the mind and society's influence. human and animal studies confirm a genetic predisposition for drinking behaviors and self-administering mind-altering drugs, but as yet no precise genetic marker has been established. temperament, self-concept, age, motivation for change, social consequences for problematic behaviors, parental and family relationships, and peer pressure all contribute to expression of substance abuse - a chronic and progressive disorder. dysfunctional family and peer influence reflect social etiologies.

a client has a blood alcohol level of 0.05 mg%. the nurse would expect which behavior to occur? a. difficulty driving b. impaired judgement c. coma d. stupor

impaired judgement Rationale: behaviors that include impaired judgement, giddiness, and mood changes in indicative of a BAL of 0.05 mg% Difficulty driving and coordinating movements are indicative of a BAL of 0.10 mg% Motor functions severely impaired, resulting in ataxia; emotional lability are indicative of a BAL of 0.20 mg% Stupor, disorientation, and confusion are indicative of a BAL of 0.30 mg% Coma is indicative of a BAL of 0.40 mg% Respiratory failure, and death are indicative of BAL of 0.50mg%

a client with a history of alcoholism is found to have Wernicke encephalopathy associated with Korsakoff syndrome. what does the nurse anticipate will be prescribed? A. Traditional phenothiazine B. Judicious use of antipsychotics C. Intramuscular injections of thyamine D. Oral administration of chlorpromazine

intramuscular injections of thiamine Rationale: Thiamine is a coenzyme necessary for the production of energy from glucose. If thiamine is not present in adequate amounts, nerve activity is diminished and damage or degeneration of myelin sheaths occurs. A traditional phenothiazine is a neuroleptic antipsychotic that should not be prescribed because it is hepatotoxic. Antipsychotics are avoided; the use of these has a higher risk for toxic side effects in older or debilitated persons. Chlorpromazine, a neuroleptic, will not be used because it is severely toxic to the liver

a client is prescribed disulfiram as part of his alcohol treatment program to prevent relapse. the client asks a nurse, "How will this drug help me?" which response by the nurse would be most appropriate? a. "It will help to cure your alcoholism." b. "It can help to prevent you from drinking." c. "It makes the withdrawal symptoms less troublesome." d. "It helps to clear the alcohol out of your body."

it can help to prevent you from drinking Rationale: Disulfiram is not a treatment or cure for alcoholism, but it can be used as adjunct therapy to help deter some individuals from drinking while using other treatment modalities to teach new skills on coping with altering abuse behaviors. Disulfiram plus even small amounts of alcohol produces adverse effects. Disulfiram does not affect withdrawal symptoms and does not eliminate alcohol from the body.

Select the priority nursing intervention when caring for a patient after an overdose of amphetamines. a. Monitor vital signs. b. Observe for depression. c. Awaken the patient every 15 minutes. d. Use warmers to maintain body temperature.

monitor vital signs Rationale: Overdose of stimulants, such as amphetamines, can produce respiratory and circulatory dysfunction as well as hyperthermia. Concentration is impaired. This patient will be hypervigilant; it is not necessary to awaken the patient.

a nurse is working with a client who is addicted to heroin. the nurse engages in harm reduction by educating the client about which of the following? a. needle exchange programs b. problem solving c. healthy coping skills d. proper use of naltrexone

needle exchange programs Rationale: harm reduction initiatives range from widely accepted designated driver campaigns to controversial initiatives such as provision of condoms in schools, safe injection rooms, needle exchange programs, and heroin maintenance programs. problem solving, coping skills, and naltrexone would not be considered harm-reduction interventions.

a nurse is implementing a brief intervention with a client who is abusing alcohol. the nurse most likely would be involved with which of the following? a. asking the client questions about alcohol use b. negotiating a conversation with the client to reduce use c. pointing out the inconsistencies in thoughts, feelings and actions d. helping the client change the way he thinks about a situation

negotiating a conversation with the client to reduce use Rationale: Brief intervention involves a negotiated conversation between the nurse and the client that is designed to reduce the substance abuse. Asking the client questions about substance abuse refers to screening. Pointing out inconsistencies reflects confrontation. Helping the client change his or her way of thinking reflects a cognitive approach.

a client with a history of heavy alcohol use, whose last drink was 24 hours ago, is seen in the emergency department.. the nurse assesses the client and finds the client is oriented but is tremulous, weak, and sweaty and has some gastrointestinal (GI) symptoms. which is typical of these symptoms? a. alcohol withdrawal syndrome b. continuing intoxication c. Wernicke-Korsakoff syndrome d. delirium tremens

alcohol withdrawal syndrome Rationale: alcohol withdrawal syndrome includes symptoms of coarse hand tremors, sweating, elevated pulse and blood pressure, insomnia, anxiety, and nausea or vomiting. Severe or untreated withdrawal may progress to transient hallucinations, seizures, or delirium tremens Wernicke-Korsakoff syndrome is the coexistence of Wernicke's encephalopathy and Korsakoff's psychosis. Wernicke's encephalopathy is characterized by ataxia, nystagmus, ophthalmoplegia, and mental status changes. Korsakoff's psychosis involves gait disturbances, short-term memory loss, disorientation, delirium, confabulation, and neuropathy

A patient is thin, tense, jittery, and has dilated pupils. The patient says, "My heart is pounding in my chest. I need help." The patient allows vital signs to be taken but then becomes suspicious and says, "You could be trying to kill me." The patient refuses further examination. Abuse of which substance is most likely? a. PCP b. Heroin c. Barbiturates d. Amphetamines

amphetamines Rationale: The physical symptoms are consistent with CNS stimulation. Suspicion and paranoid ideation are also present. Amphetamine use is likely. PCP use would probably result in bizarre, violent behavior. Barbiturates and heroin would result in symptoms of CNS depression.

A patient diagnosed with alcoholism asks, "How will Alcoholics Anonymous (AA) help me?" Select the nurse's best response. a. "The goal of AA is for members to learn controlled drinking with the support of a higher power." b. "An individual is supported by peers while striving for abstinence one day at a time." c. "You must make a commitment to permanently abstain from alcohol and other drugs." d. "You will be assigned a sponsor who will plan your treatment program."

an individual is supported by peers while striving for abstinence one day at a time. Rationale: Admitting to being an alcoholic, making an attempt to remain alcohol-free for a day at a time, and receiving support from peers are basic aspects of AA. The other options are incorrect.

an adolescent client tells a nurse that he or she occasionally "sniffs airplane glue." when discussing the effects of long-term use of inhalants, which of the following would the nurse most likely include? a. tremors and central nervous system arousal b. enhanced normal heart rhythms c. enhanced attention on focus and memory d. brain damage and cognitive abnormalities

brain damage and cognitive abnormalities Rationale: long-term inhalant use is linked to widespread brain damage and cognitive abnormalities that can range from mild impairment ot severe dementia. tremors, central nervous system arousal, and cardiac changes are not associated with long-term inhalant use. Intoxication can lead to cardiac arrest.

a group of nursing students is reviewing information about substances that are abused. the students demonstrate understanding of the information when they identify which of the following as stimulants? select all that apply. a. alcohol b. cocaine c. heroin d. nicotine e. phencyclidine

cocaine nicotine Rationale: stimulants include cocaine and nicotine. alcohol is a depressant. heroin is an opioid derivative that depresses the central nervous system. phencyclidine is classified as a hallucinogen.

a client has been receiving oxycodone (oxycontin) for moderate pain associated with multiple injuries sustained in a motor vehicle collision. the client has returned three times for refills of the prescription. what behavior, in addition to the client's slurred speech, leads the nurse to suspect opioid intoxication? a. Mood lability b. Hypervigilance c. Constricted pupils d. Increased respirations

constricted pupils Rationale: opioid intoxication behaviors include euphoria, drowsiness, slurred speech, constricted pupils, impaired judgement, constipation.

A nurse reviews vital signs for a patient admitted with an injury sustained while intoxicated. The medical record shows these blood pressure and pulse readings at the times listed: 0200: 118/78 mm Hg and 72 beats/min 0400: 126/80 mm Hg and 76 beats/min 0600: 128/82 mm Hg and 72 beats/min 0800: 132/88 mm Hg and 80 beats/min 1000: 148/94 mm Hg and 96 beats/min What is the nurse's priority action? a. Force fluids. b. Consult the health care provider. c. Obtain a clean-catch urine sample. d. Place the patient in a vest-type restraint.

consult the health care provider Rationale: Elevated pulse and blood pressure may indicate impending alcohol withdrawal and the need for medical intervention. No indication is present that the patient may have a urinary tract infection or is presently in need of restraint. Hydration will not resolve the problem.

Which of the following medications is frequently used to detoxify a client in alcohol withdrawal? a.Diazepam (Valium) b.Haloperidol (Haldol) c.Clonidine (Capapres) d.Sertaline(Zoloft)

diazepam (valium) Rationale: bensodiazepines (lorazepam, chlordiazepoxide, oxazepam, diazepam) are titrated downwardly over several days as a substitution for the alcohol.

a client is brought into the emergency department because he was involved in an automobile accident. his blood alcohol level (BAL) is 0.10 mg%. Based on this finding, the nurse would expect to assess which of the following? a. difficulty with coordination b. stupor c. emotional lability d. ataxia

difficulty with coordination Rationale: a BAL of 0.10 mg% would be manifested by difficulty driving and coordinating movements. Ataxia and emotional lability would be associated with a BAL of 0.20 mg%. Stupor would be associated with a BAL of 0.30 mg%

a client with a history of opioid abuse is exhibiting manifestations of moderate withdrawal. which of the following would the nurse expect to assess? a. rhinorrhea b. lacrimation c. dilated pupils d. dysphoria

dilated pupils Rationale: with moderate opioid withdrawal, pupils are dilated. Rhinorrhea, lacrimation, and dysphoria are noted with mild withdrawal

Which assessment findings are likely for an individual who recently injected heroin? a. Anxiety, restlessness, paranoid delusions b. Muscle aching, dilated pupils, tachycardia c. Heightened sexuality, insomnia, euphoria d. Drowsiness, constricted pupils, slurred speech

drowsines, constricted pupils, slurred speech Rationale: Heroin, an opiate, is a CNS depressant. Blood pressure, pulse, and respirations will be decreased, and attention will be impaired. The distracters describe behaviors consistent with amphetamine use, symptoms of narcotic withdrawal, and cocaine use.

a client in the outpatient clinic is denying that he is addicted to alcohol. he tells the nurse that he is not an alcoholic and that is is his nagging wife who causes him to drink. what is the most therapeutic response by the nurse? a. "I don't think that your wife is the problem." b. "Everyone is responsible for his own actions." c. "Perhaps you should have marriage counseling." d. "Why do you think that your wife is the cause of your problems?

everyone is responsible for his own actions

Benzodiazepines are useful for treating alcohol withdrawal because they are associated with which action? a. Blocking cortisol secretion b. Increasing dopamine release c. Decreasing serotonin availability d. Exerting a calming effect

exert a calming effect Rationale:

A patient admitted for injuries sustained while intoxicated has been hospitalized for 48 hours. The patient is now shaky, irritable, anxious, diaphoretic, and reports nightmares. The pulse rate is 130 beats/min. The patient shouts, "Bugs are crawling on my bed. I've got to get out of here." Select the most accurate assessment of this situation. The patient: a. is attempting to obtain attention by manipulating staff. b. may have sustained a head injury before admission. c. has symptoms of alcohol-withdrawal delirium. d. is having an acute psychosis.

has symptoms of alcohol-withdrawal delirium Rationale: Symptoms of agitation, elevated pulse, and perceptual distortions indicate alcohol withdrawal delirium. The findings are inconsistent with manipulative attempts, head injury, or functional psychosis.

a nurse is obtaining a history from a client who drinks about six cups of coffee and several diet cola drinks per day. the client states, "I just cut down my coffee and soda intake to one per day." which of the following would the nurse most likely expect to assess? select all that apply. a. headache b. fatigue c. yawning d. flushing e. diuresis

headache fatigue yawning Rationale: The client's decreased intake of caffeine could lead to caffeine withdrawal, manifested by headache, drowsiness, fatigue, craving, impaired psychomotor performance, difficulty concentrating, yawning, and nausea. Flushing and diuresis would be characteristic of caffeine overdose.

a nurse is talking with a client 57 years of age who has been a heavy drinker for many years. the client is being treated for alcoholism, and this is her second week as an inpatient on the psychiatric unit. it is 5 a.m. and the client has been having difficulty sleeping. the client is an orthopedic nurse, and although she is clothed in a hospital-issued gown and robe, she is wearing a stethoscope around her neck that the nurse recognizes as belonging to one of the staff nurses. when the nurse asks why she is wearing the stethoscope and where she got it, the client gives her a long and involved reply that describes how her nursing supervisor came to visit and gave it to her to wear "so she'd remember to get well." the nurse suspects that the client may be experiencing which of the following? a. wernicke's syndrome b. delirium tremens c. korsakoff's amnesic syndrome d. malignant hyperthermia

korsakoff's amnesic syndrome Rationale: Korsakoff's amnesic syndrome, also known as psychosis, is associated with alcoholism and involves the heart and the vascular and nervous systems, but the primary problem is acquiring new information and retrieving memories. Symptoms include amnesia, confabulation (i.e. telling a plausible but imagined scenario to compensate for memory loss), attention deficit, disorientation, and vision impairment. Wernicke's encephalopathy, a degenerative brain disorder caused by thiamine deficiency, is characterized by vision impairment, ataxia, hypotension, confusion, and coma. Delirium tremens is an acute withdrawal syndrome characterized by autonomic hyperarousal, disorientation, hallucinations, and tremors. Malignant hyperthermia is characterized by a sharp increase in body temperature leading to muscle breakdown, kidney and cardiovascular failure, and death

A nurse is preparing an inservice program about substance abuse and its etiology. Which of the following would the nurse most likely include in the presentation when discussing possible psychologic etiologies? A) Low self-esteem B) Genetic predisposition C) Dysfunctional family D) Peer influence

low self-esteem Rationale: temperament, self-concept, age, motivation for change, social consequences for problematic behaviors, parental and family relationships, and peer pressure all contribute to psychologic etiologies. dysfunctional family and peer influence reflect social etiologies. Genetic predisposition reflects a physiologic etiology

a nurse is exploring treatment options with a client addicted to heroin. which information regarding the use of methadone is important for the nurse to include? a. methadone will produce a high similar to heroin b. unlike heroin, methadone is non-addicting c. people taking methadone run the same risks associated with intravenous drug use as those taking heroin d. methadone will meet the physical needs for opiates without producing cravings for more

methadone will meet the physical needs for opiates without producing cravings for more Rationale: methadone maintenance is the treatment for people with opioid addiction with a daily, stabilized dose of methadone. methadone is used because of its long half-life of 15-30 hours. methadone is a potent opioid and is physiologically addicting, but it satisfies the opioid craving without producing the subjective high of heroin. Methadone is available in tablet form, not in IV form.

a man 20 years of age arrives at the emergency department by ambulance. he is unconscious, with slow respirations and pinpoint pupils. there are "tracks" visible on his arms. the friend who came with him reports that the client had just "shot up" heroin when he became unconscious. which medication would the nurse most likely expect to administer? a. naloxone b. naltrexone c. bupropion d. varenicline

naloxone Rationale: naloxone, an opioid antagonist, is given to reverse respiratory depression, sedation, and hypertension. Naltrexone is used to treat alcohol dependence. Bupropion and varenicline are used to promote smoking cessation.

Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids? a. Bromocriptine (Parlodel) b. Methadone (Dolophine) c. Disulfiram (Antabuse) d. Naltrexone (ReVia)

naltrexone (Revia) Rationale: Naltrexone (ReVia) is useful for treating both opioid and alcohol addiction. An opioid antagonist blocks the action of opioids and the mechanism of reinforcement. It also reduces or eliminates alcohol craving

Symptoms of withdrawal from opioids for which the nurse should assess include: a. dilated pupils, tachycardia, elevated blood pressure, and elation. b. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia. c. mood lability, incoordination, fever, and drowsiness. d. excessive eating, constipation, and headache.

nausea, vomiting, diaphoresis, anxiety, and hyperreflexia Rationale: The symptoms of withdrawal from opioids are similar to those of alcohol withdrawal. Hyperthermia is likely to produce periods of diaphoresis.

A hospitalized patient diagnosed with an alcohol abuse disorder believes spiders are spinning entrapping webs in the room. The patient is fearful, agitated, and diaphoretic. Which nursing intervention is indicated? a. Check the patient every 15 minutes b. One-on-one supervision c. Keep the room dimly lit d. Force fluids

one-on-one supervision Rationale: One-on-one supervision is necessary to promote physical safety until sedation reduces the patient's feelings of terror. Checks every 15 minutes would not be sufficient to provide for safety. A dimly lit room promotes perceptual disturbances. Excessive fluid intake can cause overhydration, because fluid retention normally occurs when blood alcohol levels fall.

a client with a history of substance abuse is a member of a skills training group. which of the following would the client be involved in to enhance intrapersonal coping skills? select all that apply. a. substance refusal skills b. problem solving c. anger awareness d. emergency planning e. social support networking

problem solving anger awareness emergency planning Rationale: Topics in skills training groups addressing intrapersonal issues include problem solving, awareness and management of anger, and planning for emergencies. Substance refusal skills and social support networking skills are skills addressing interpersonal issues

a client has been prescribed naltrexone for treatment of alcohol dependence. the nurse has explained the drug's purpose to the client. the nurse determines that the client has understood the instructions when the client identifies which of the following about the drug? a. causes itching if alcohol is consumed b. produces the euphoria of alcohol c. reduces the appeal of alcohol d. improves appetite and nutritional status

reduces the appeal of alcohol Rationale: Naltrexone's effect is unknown. Reports from successfully treated clients suggest three kinds of effects: (1) can reduce craving (the urge or desire to drink), (2) can help maintain abstinence, and (3) can interfere with the tendency to want to drink more if a recovering client slips and has a drink.

A nurse cares for a patient diagnosed with an opioid overdose. Which focused assessment has the highest priority? a. Cardiovascular b. Respiratory c. Neurologic d. Hepatic

respiratory Rationale: Opioid overdose causes respiratory depression. Respiratory depression is the primary cause of death among opioid abusers. The assessment of the other body systems is relevant but not the priority. See relationship to audience response question.

A patient admitted yesterday for injuries sustained while intoxicated believes bugs are crawling on the bed. The patient is anxious, agitated, and diaphoretic. What is the priority nursing diagnosis? a. Disturbed sensory perception b. Ineffective coping c. Ineffective denial d. Risk for injury

risk for injury Rationale: The patient's clouded sensorium, sensory perceptual distortions, and poor judgment predispose a risk for injury. Safety is the nurse's priority. The other diagnoses may apply but are not the priorities of care.

A hospitalized patient diagnosed with an alcohol abuse disorder believes the window blinds are snakes trying to get in the room. The patient is anxious, agitated, and diaphoretic. The nurse can anticipate the health care provider will prescribe a(n): a. narcotic analgesic, such as hydromorphone (Dilaudid). b. sedative, such as lorazepam (Ativan) or chlordiazepoxide (Librium). c. antipsychotic, such as olanzapine (Zyprexa) or thioridazine (Mellaril). d. monoamine oxidase inhibitor antidepressant, such as phenelzine (Nardil).

sedative, such as lorazepam (Ativan) or chlordiazepoxide (Librium) Rationale: Sedation allows for safe withdrawal from alcohol. Benzodiazepines are the drugs of choice in most regions because of their high therapeutic safety index and anticonvulsant properties.

a client is brought to the emergency department after having overdosed on cocaine. when assessing the client, which of the following would a nurse expect to find? select all the apply. a. euphoria b. seizures c. cardiac arrhythmia d. paranoia e. insomnia

seizures cardiac arrhythmia Rationale: manifestations of cocaine overdose include cardiac dysrhythmias or arrest, increased or reduced blood pressure, respiratory depression, chest pain, vomiting, seizures, psychosis, confusion, dyskinesia, dystonia, and coma. Euphoria, paranoia, and insomnia are effects of cocaine

a nurse is completing the admission of a client who is seeking treatment for alcoholism. he tells the nurse that the last time he had any alcohol to drink was a 10 a.m., before he left for the hospital. the nurse closely monitors the client. which of the following would lead the nurse to suspect that the client is experiencing stage 1 of alcohol withdrawal syndrome? select all that apply. a. slight diaphoresis b. hand tremors c. intermittent confusion d. heart rate of 135 beats/min e. normal blood pressure

slight diaphoresis hand tremors normal blood pressure Rationale: a person in stage 1 of alcohol withdrawal syndrome exhibits slight diaphoresis, hand tremors, no confusion, elevated heart rate, and normal or slightly elevated blood pressure. Intermittent confusion indicates stage 2, or moderate alcohol withdrawal syndrome. A heart rate of 135 bpm indicates stage 3, or severe alcohol withdrawal syndrome

Cocaine exerts which of the following effects on a client? a. Stimulation after 15 to 20 minutes b. Stimulation and euphoria c. Immediate imbalance of emotions d. Paranoia

stimulation and euphoria Rationale: cocaine effects include euphoria, CNS stimulation then depression, increased pulse, dilated pupils, wakefulness, talkativeness, decreased appetite, insomnia "cocaine rush" lasts only 10-20 minutes followed by a "cocaine crash"

a client tells a nurse that he is committed to trying to quit smoking. when educating the client on smoking cessation, which of the following would the nurse include? a. success usually involves more than one type of intervention b. relapse is fairly rare within the first year of quitting c. ear acupressure is a highly proven method for quitting d. the drug varenicline is widely used among patients with psychiatric disorders

success usually involves more than one type of intervention Rationale: successful smoking cessation usually requires more than one type of intervention, including social support and education. recent research has shown that nicotine addiction is extremely powerful and is at least as strong as addictions to other drugs, such as heroin and cocaine; 70% of those who quit relapse within 1 year. Auricular therapy, or ear acupressure, is being studied as a potential adjunctive treatment for nicotine addiction. Varenicline tartrate reduces the craving and regarding effects of nicotine by preventing nicotine from accessing one of the acetylcholine receptor sites involved with nicotine dependence, but it can cause depression and related psychiatric symptoms in some people. This side effect limits its usefulness for people with psychiatric disorders.

A patient diagnosed with an alcohol abuse disorder says, "Drinking helps me cope with being a single parent." Which therapeutic response by the nurse would help the patient conceptualize the drinking objectively? a. "Sooner or later, alcohol will kill you. Then what will happen to your children?" b. "I hear a lot of defensiveness in your voice. Do you really believe this?" c. "If you were coping so well, why were you hospitalized again?" d. "Tell me what happened the last time you drank."

tell me what happened the last time you drank Rationale: The correct response will help the patient see alcohol as a cause of the problems, not a solution, and begin to take responsibility. This approach can help the patient become receptive to the possibility of change. The other responses directly confront and attack defenses against anxiety that the patient still needs. They reflect the nurse's frustration with the patient.

a nurse is using motivational therapy with a female client suffering from alcoholism. the client, who is unwilling to consider changing her drinking behavior, emphatically states, "I am not an alcoholic; you can't make me stop drinking." which response by the nurse would be most appropriate? a. "you have to stop drinking and driving. you could kill someone." b. "you're right. you are not an alcoholic." c. "you should consider what you are doing to your marital relationship." d. "You're the only one who can make yourself stop drinking."

you're the only one who can make yourself stop drinking Rationale: the acronym FRAMES summarizes elements of brief interventions with clients using motivational interviewing. the nurse should emphasize both the client's freedom to chose to change as well as the client's responsibility to change. telling the client to stop drinking and driving is confrontational and not therapeutic in this situation; telling the client to think about what she is doing to her marriage is inappropriate because the client has yet to acknowledge that she has a problem. telling the client that she is not an alcoholic only reinforces the client's denial