Nursing 265 Week 12 EAQ

What does the term "smokeless tobacco" refer to? Select all that apply.

A substitute for cigarettes Tobacco products with carcinogenic chemicals Tobacco products placed in mouth but not ignited Rationale "Smokeless tobacco" is the term used for tobacco products that are cigarette substitutes. These items are consumed by placing them in mouth, but they are not ignited. Smokeless tobacco contains carcinogenic agents that are not safe in adolescents. Tobacco products that produce less smoke are not considered smokeless.

What drug does a nurse anticipate that the primary healthcare provider will prescribe for a client demonstrating clinical manifestations associated with an opioid overdose?

Naloxone Rationale Naloxone is a narcotic antagonist that displaces opioids from receptors in the brain, thereby reversing respiratory depression. Methadone is a synthetic opioid that causes central nervous system depression; it will add to the problem of overdose. Epinephrine and amphetamine will have no effect on respiratory depression related to opioid overdose.Test-Taking Tip: Calm yourself by closing your eyes, putting down your pencil, and relaxing. Deep-breathe for a few minutes (or as needed, if you feel especially tense) to relax your body and to relieve tension.

A client with a history of chronic alcoholism is admitted to the mental health unit. What does the nurse identify as the cause of a client's use of confabulation?

Marked loss of memory Rationale Alcoholic clients have loss of memory and adapt to this by unconsciously filling in with false information areas that cannot be remembered. Ideas of grandeur do not occur in this disease. A need to get attention is unrelated to confabulation. These individuals are not purposely lying but instead are trying to cover memory losses.STUDY TIP: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question.

What factors may cause an adolescent to develop a smoking addiction? Select all that apply.

Peer pressure Imitating adult behavior of smoking Imitating lifestyles portrayed in movies and advertisements Rationale Factors that influence an adolescent to smoke include peer pressure and imitating adult behavior of smoking and lifestyles portrayed in movies. Succeeding in academics and being involved in sports are not factors that cause an adolescent to begin smoking.

A nurse is providing information about Alcoholics Anonymous (AA) meetings to a client with a history of alcohol abuse. What will be required when the client attends AA meetings?

Acknowledging an inability to control the alcoholism Rationale A major premise of AA is that to be successful in achieving sobriety, clients with an alcohol abuse problem must acknowledge their inability to control the use of alcohol. There are no rules of attendance or speaking at meetings, although both actions are strongly encouraged. Maintaining controlled drinking after 6 months is not part of the AA program; this group strongly supports total abstinence for life.Test-Taking Tip: Answer every question. A question without an answer is always a wrong answer, so go ahead and guess.

A nurse is discussing Alcoholics Anonymous (AA) with a client. What behavior expected of members of AA should the nurse include in the discussion?

Acknowledging an inability to control the problem Rationale A major premise of AA is that to be successful in achieving sobriety, clients with alcohol abuse problems must acknowledge their inability to control their drinking. There are no rules about speaking at meetings, although members are encouraged strongly to do so. There are no rules of attendance at meetings, although members are encouraged strongly to attend as often as possible. Maintaining controlled drinking after 6 months is not part of AA; this group strongly supports total abstinence for life.

After a client on the mental health unit with a known history of opioid addiction has a visit from several friends, a nurse finds the client in a deep sleep and unresponsive to attempts at arousal. The nurse assesses the client's vital signs and determines that an overdose of an opioid has occurred. Which findings support this conclusion?

Blood pressure of 70/40 mm Hg, weak pulse, and respiratory rate of 10 breaths/min Opioids cause central nervous system depression, resulting in severe respiratory depression, hypotension, tachycardia, and unconsciousness. The other findings, particularly the respirations, are not indicative of an overdose of an opioid.

While a client is attending an Alcoholics Anonymous (AA) meeting, a nurse talks with the client's spouse about the purpose of AA. What is the priority goal of this self-help group?

Changing destructive behavior Rationale The purpose of a self-help group is for individuals to develop their strengths and new, constructive patterns of coping. Developing functional relationships, identifying how people present themselves to others, and understanding patterns of interaction within the group are purposes of group therapy.Test-Taking Tip: Answer every question. A question without an answer is always a wrong answer, so go ahead and guess.

A client has entered a drug rehabilitation facility as a result of a family intervention. Although this was done voluntarily, the client is agitated and angry. Two weeks after admission the client's parents come to the facility for a luncheon visit. At the last minute the client refuses to have lunch with them and angrily shouts at them to go away. What is the most therapeutic nursing intervention after the parents leave?

Confronting the client about the behavior Rationale Confronting the client about the behavior prevents the client from avoiding responsibility for the behavior; such avoidance is characteristic of the addicted individual. This approach may also help the client develop some self-awareness. Encouraging the client to have lunch ignores the client's behavior, which should be addressed. The focus should be on the client, not the parents. Although a visit to the gym to work off some of the hostility may provide an outlet for the anger, it supports acting out rather than control of feelings. A nurse who is assessing a recently hospitalized client with a diagnosis of opioid addiction should look for signs of withdrawal. What are these signs? Select all that apply.

Addicted clients commonly expect discrimination and lack of empathy from others. How can the nurse best overcome these expectations?

Demonstrating a nonjudgmental attitude Rationale Behaviors that reflect acceptance and consistency are the best approaches to overcoming these client expectations. What the nurse does is a better indicator of acceptance than the words or explanations that are verbalized. The nurse's actions over time are better indicators of acceptance than is verbal reassurance. Confrontational measures increase anxiety and are not therapeutic.

After a cocaine binge an individual is found unconscious and is admitted to the hospital with acute cocaine toxicity. What should the initial nursing action be directed toward?

Establishing a patent airway Rationale The client is unconscious and unable to meet physical needs; a patent airway, breathing, and circulation are essential needs. Understanding and support are important once the client's physical condition has stabilized. Maintaining a drug-free environment will be a priority later in the treatment program. Establishment of a therapeutic relationship will increase in importance once the client's physical condition has stabilized.STUDY TIP: Identify your problem areas that need attention. Do not waste time on restudying information you know.

A 45-year-old client who recently completed alcohol detoxification reports plans to begin using disulfiram (Antabuse) as part of the alcoholism treatment regimen. What important client teaching does the nurse share regarding this drug?

Foods, medications, and any topical preparation containing alcohol should be avoided. Rationale Disulfiram causes unpleasant physical effects when mixed with alcohol. Any substance that contains alcohol may trigger an adverse reaction. Voluntary compliance with the use of disulfiram is often very low because of the negative physical effects experienced by the individual if alcohol is ingested. For disulfiram to be effective, it must be taken orally every day. Disulfiram is not administered intramuscularly.

A nurse is caring for a client who is recovering from an acute episode of alcoholism. Which component of a therapeutic diet should the nurse encourage the client to consume?

High protein Rationale A high-protein diet helps correct the malnutrition associated with alcoholism. High fat places a demand on the compromised liver to produce bile. A low- to moderate-fat diet is preferred. A high-calorie, not low-calorie, diet is needed to promote tissue repair and improve nutritional status. A high-carbohydrate, not low-carbohydrate, diet is needed to prevent catabolism and promote anabolism.Test-Taking Tip: Try putting questions and answers in your own words to test your understanding.

A 65-year-old man is admitted to a mental health facility with a diagnosis of substance-induced persisting dementia resulting from chronic alcoholism. When conducting the admitting interview, the nurse determines that the client is using confabulation. What does the nurse recall precipitates the client's use of confabulation?

Marked memory loss Rationale A client with this disorder has a loss of memory and adapts by filling in areas that cannot be remembered with made-up information. Ideas of grandeur do not occur with this type of dementia. The use of confabulation is not attention-seeking behavior; the individual is attempting to mask memory loss. This person is not coping with the diagnosis; when confabulating, the individual is attempting to mask memory loss.STUDY TIP: A word of warning: do not expect to achieve the maximum benefits of this review tool by cramming a few days before the examination. It doesn't work! Instead, organize planned study sessions in an environment that you find relaxing, free of stress, and supportive of the learning process.

A client with a 40-year history of drinking two alcoholic beverages and smoking two packs of cigarettes daily comes to the outpatient clinic with an ischemic left foot. It is determined that the cause is arterial insufficiency. The nurse concludes that the pain in the client's foot is a result of inadequate blood supply. Which information from the client will cause the nurse to intervene?

Smoking cigarettes Rationale Nicotine (I am a social smoker) causes vasoconstriction and spasm of the peripheral arteries; therefore the nurse will intervene. Alcohol may stimulate dilation of blood vessels; one glass is not harmful. Lowering the limb enhances flow of blood into the foot by gravity to assist with the inadequate blood supply. Consuming water will decrease the viscosity of blood, possibly preventing the formation of thrombi.Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or responses that appear to be degrading.

A client with emphysema has a history of smoking two packs of cigarettes a day. What is the best approach for the nurse to help the client stop smoking?

Suggest that the client limit smoking to one pack of cigarettes a day Rationale Limiting the number of cigarettes smoked daily may be an effective first step toward smoking cessation[1][2]. An all-or-none approach often is not effective. The ultimate goal is to eliminate smoking entirely. Pursed-lip breathing improves exhalation of CO 2, but it will not help the client stop smoking. Emotional stress may or may not be associated with the client's smoking; usually it is an addiction to nicotine that drives the need to smoke. The client needs to be motivated to stop smoking; a referral without a personalized discussion is not enough for an addicted smoker to pursue a smoking-cessation program.

A nurse is counseling the spouse of a client who has a history of alcohol abuse. What does the nurse explain is the main reason for drinking alcohol in people with a long history of alcohol abuse?

They are dependent on it. Rationale Alcohol causes both physical and psychological dependence; the individual needs the alcohol to function. Alcoholism is a disorder that entails physical and psychological dependence. Because alcohol is so physiologically addictive, the client's body craves the alcohol, so most clients lack the motivation to stop because they will go into withdrawal. Clients who abuse alcohol have numbed their ability to utilize other coping mechanisms, so alcohol is used as an excuse for coping. People with alcoholism usually drink alone or feel alone in a crowd; socialization is not the prime reason for their drinking.

A client who is homeless is hospitalized for alcohol withdrawal. When considering the type of personal protective equipment that is needed for the client's care, what condition does the nurse recall that homeless persons are at risk for?

Tuberculosis Rationale Medically underserved clients such as the homeless, clients who are alcohol or drug dependent, and those who have human immunodeficiency virus (HIV) infections are at risk for developing tuberculosis. Being homeless does not increase a person's risk for developing prostatitis, osteoarthritis, or diverticulosis.Test-Taking Tip: Multiple-choice questions can be challenging, because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.

A client with a history of drug abuse begins group therapy. After attending the first meeting the client says to the nurse, "It helps to know that I'm not the only one with this type of problem." What concept does this statement reflect?

Universality Rationale Universality is the sense that one is not alone in any situation; one purpose of group therapy is to share feelings and gain support from others with similar thoughts and feelings. Altruism in group therapy is giving support, insight, and reassurance to others, which eventually promotes self-knowledge and growth. Catharsis involves group members relating to one another through the verbal expression of negative and positive feelings. Transference occurs when a client unconsciously assigns to the therapist feelings and attitudes originally associated with another important person in the client's life.STUDY TIP: Becoming a nursing student automatically increases stress levels because of the complexity of the information to be learned and applied and because of new constraints on time. One way to decrease stress associated with school is to become very organized so that assignment deadlines or tests do not come as sudden surprises. By following a consistent plan for studying and completing assignments, you can stay on top of requirements and thereby prevent added stress.

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 it is his nagging wife who causes him to drink. What is the most therapeutic response by the nurse?

"Everyone is responsible for his own actions." Rationale The comment "Everyone is responsible for his own actions" encourages the client to accept responsibility and does not support denial as a defense mechanism. Although the comment "I don't think that your wife is the problem" may be true, it may also close off communication; with a decrease in communication the nurse cannot be effective in helping break through the denial. Although suggesting marriage counseling may be appropriate, it does not address the issue of denial. The comment "Why do you think that your wife is the cause of your problems?" enables the client to continue to avoid responsibility for his own behavior.STUDY TIP: Try to decrease your workload and maximize your time by handling items only once. Most of us spend a lot of time picking up things we put down rather than putting them away when we have them in hand. Going straight to the closet with your coat when you come in instead of throwing it on a chair saves you the time of hanging it up later. Discarding junk mail immediately and filing the rest of your bills and mail as they come in rather than creating an ever-growing stack saves time when you need to find something quickly. Filing all items requiring further attention in some fashion helps you remember to take care of things on time rather than being so engrossed in your schoolwork that you forget about them. Many nursing students have had their power or telephone service cut off because the bill simply was forgotten or buried in a pile of old mail.

A salesman with a history of heavy drinking is on a detoxification unit. He asks the nurse's permission to skip the Alcoholics Anonymous (AA) meeting held each day. What is the nurse's initial response?

"What are your feelings about going to AA meetings?" Rationale The question "What are your feelings about going to AA meetings?" forces the client to face what going to AA meetings means to the client. The question "What is it that you dislike about going to AA meetings?" focuses the client on negative aspects; also, the client may be unable to answer this question. The response "It's all right to wait until you feel like going to AA meetings" reinforces avoidance, which delays dealing with the problem; the client may never feel like going to AA meetings. Although the response "An important part of your treatment is attending AA meetings" is true, it does not explore the client's feelings.Test-Taking Tip: Note the number of questions and the total time allotted for the test to calculate the times at which you should be halfway and three-quarters finished with the test. Look at the clock only every 10 minutes or so.

A healthcare provider prescribes disulfiram for a client who abuses alcohol. The nurse teaches the client that disulfiram will have which action?

Cause a severe adverse reaction if alcohol is consumed Cause a severe adverse reaction if alcohol is consumed Rationale Disulfiram is an aversion therapy; a person who consumes alcohol while taking disulfiram will experience a severe reaction consisting of nausea, vomiting, hypotension, headache, tachycardia, tachypnea, and flushing. The drug does not affect short-term memory. Use of disulfiram may or may not foster a healthier lifestyle, and if it does occur, this is the result of multiple factors, not just disulfiram therapy. When taking disulfiram the client cannot tolerate any alcohol.Test-Taking Tip: On a test day, eat a normal meal before going to school. If the test is late in the morning, take a high-powered snack with you to eat 20 minutes before the examination. The brain works best when it has the glucose necessary for cellular function.

When planning for a client's care during the detoxification phase of acute alcohol withdrawal, what need should the nurse anticipate?

Checking on the client frequentlyDuring detoxification frequent checks help ensure safety and prevent suicide, which is a real threat. Bright light is preferable to dim light because it minimizes shadows that may contribute to misinterpretation of environmental stimuli (illusions). The client who is going through the detoxification phase of acute alcohol withdrawal usually does not lose his sense of hearing, so there is no need to shout. Restraints may upset the client further; they should be used only if the client is a danger to himself or others.

A client reports drinking two drinks per day every day with no negative consequences. How should this person be classified?

Daily drinker Rationale If a client drinks two drinks per day every day with no negative consequences, the client is considered a daily drinker. If a client drinks over two drinks per day every day, the client has a potential for future problems. This person does not meet the criteria for any substance abuse or dependence diagnosis because there is no evidence of tolerance or other signs of substance dependence and no negative sequelae. There is no functional alcoholic diagnosis in the Diagnostic and Statistical Manual of Mental Disorders.

A visitor says to the nurse, "Can I read my client's progress record? I am the sponsor from an alcohol recovery program." How should the nurse respond?

Do not allow the sponsor to review the record. Rationale The Health Information Portability and Accountability Act (HIPAA) (Canada: The Freedom of Information and Protection of Privacy Act [FOIPOP]) stipulates that clients' records are confidential and may be seen by only those who are associated with the direct care of the client. Although the sponsor can receive permission from the client to review the record, only those who have direct care responsibilities for the client can see it. Viewing a client's records is not allowed according to the privacy laws, despite the healthcare provider's approval. Although clients with a diagnosis of alcoholism need reassurance from their sponsors, it can be offered without reviewing the client's progress report.

While assessing an older adult client before noon the nurse smells alcohol on the man's breath. After noting certain other signs, the nurse suspects that the client is an alcoholic. What are these signs? Select all that apply.

Excessive mood swings Family conflict Poor hygiene Irritability Rationale Excessive mood swings are a sign of alcoholism. Many alcoholics have been pushed away by their families because of their drinking and the habits it fosters. Alcoholics tend to forget to bathe, wash their clothes, or even eat correctly. Irritability is often seen in alcoholics and is a definite sign to look for. Alcoholics have poor nutritional habits and often skip meals in favor of alcohol. Elders who drink to excess are susceptible to cognitive decline.Test-Taking Tip: The computerized NCLEX exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer presents the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass.

The nurse provides care for a Chinese client who is experiencing leg pain. The client states, "I don't want to take any medication that I may get addicted to." What is the best nursing intervention in this situation?

Give ibuprofen (Advil) to the client with hot tea Rationale People of Chinese decent may prefer to take medication with hot tea because of cultural beliefs that hot (or yang) foods have healing properties. Ibuprofen (Advil) does not pose an addiction risk, so the client may feel more comfortable taking it than morphine. Together hot tea and Advil may be the best way to treat this client. The nurse does not give morphine (Avinza) to the client, even with hot tea, because the client has already stated a desire to avoid addictive drugs and the nurse does not want to force the client. The nurse does not offer cold water with the Advil because a person from Chinese culture may avoid drinking cold water and other cold liquids during an illness. Postponing the medication administration may increase the severity of the pain in the client, so this is not an appropriate intervention.

A client who abused intravenous drugs was diagnosed with the human immunodeficiency virus (HIV) several years ago. What does the nurse explain to the client regarding the diagnostic criterion for acquired immunodeficiency syndrome (AIDS)?

Has a CD4+ T lymphocyte level of less than 200 cells/µL Rationale AIDS is diagnosed when an individual with human immunodeficiency virus (HIV) develops one of the following: a CD4+T-cell lymphocyte level of less than 200 cells/µL (60%), wasting syndrome, dementia, one of the listed opportunistic cancers (e.g., Kaposi sarcoma [KS], Burkitt lymphoma), or one of the listed opportunistic infections (e.g., Pneumocystis jiroveci pneumonia, Mycobacterium tuberculosis). The development of HIV-specific antibodies (seroconversion), accompanied by acute retroviral syndrome (flulike syndrome with fever, swollen lymph glands, headache, malaise, nausea, diarrhea, diffuse rash, joint and muscle pain) 1 to 3 weeks after exposure to HIV reflects acquisition of the virus, not the development of AIDS. A client who is HIV positive is capable of transmitting the virus with or without the diagnosis of AIDS.Test-Taking Tip: Pace yourself when taking practice quizzes. Because most nursing exams have specified time limits, you should pace yourself during the practice testing period accordingly. It is helpful to estimate the time that can be spent on each item and still complete the examination in the allotted time. You can obtain this figure by dividing the testing time by the number of items on the test. For example, a 1-hour (60-minute) testing period with 50 items averages 1.2 minutes per question. The NCLEX exam is not a timed test. Both the number of questions and the time to complete the test varies according to each candidate's performance. However, if the test taker uses the maximum of 5 hours to answer the maximum of 265 questions, each question equals 1.3 minutes.

A community health nurse is educating a client who is interested in discontinuing cigarette smoking. What should the teaching plan include?

Helping the client set a date to stop smoking Rationale Setting a realistic target date to stop smoking[1][2] can be motivating because it provides time to gather personal resources while committing to a specific timeframe. The American Heart Association (Canada: Heart and Stroke Foundation of Canada) and the American Lung Association (Canada: Canadian Lung Association) are appropriate agencies for referral, not the American Red Cross. Increasing eating may result in a weight gain that can precipitate reestablishing the habit of smoking to return to the former weight. The client should be called every three to five days, not weeks, after the target date for optimum support.Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten.

A client with a long history of alcohol abuse develops cirrhosis of the liver. The client exhibits the presence of ascites. What does the nurse conclude is the most likely cause of this client's ascites?

Impaired portal venous return Rationale The congested liver impairs venous return, leading to increased portal vein hydrostatic pressure and an accumulation of fluid in the abdominal cavity. Although lymph channels in the abdomen become congested, facilitating the leakage of plasma into the peritoneal cavity, it is primarily the increased portal vein hydrostatic pressure that causes the accumulation of fluid in the abdominal cavity. Increased serum albumin causes hypervolemia, not ascites. As fluid is trapped in the peritoneal cavity, circulating blood volume drops and aldosterone secretion increases, not decreases; aldosterone secretion is related to the renin-angiotensin system.STUDY TIP: Record the information you find to be most difficult to remember on 3" × 5" cards and carry them with you in your pocket or purse. When you are waiting in traffic or for an appointment, just pull out the cards and review again. This "found" time may add points to your test scores that you have lost in the past.

What characteristic is the nurse likely to identify when planning care for a client who has abused multiple drugs?

Inability to delay gratification Rationale The addict is unable to delay gratification. The addict failed to develop coping skills and instead depends on substance abuse to cope. Drug users are concerned with reality; their drug use is an attempt to blur the pains of reality. These clients are insensitive to the needs of others. They are overly concerned about themselves and obtaining drugs. Education of the public has been extensive, but the new user of drugs does not believe that addiction will occur.Test-Taking Tip: Do not spend too much time on one question, because it can compromise your overall performance. There is no deduction for incorrect answers, so you are not penalized for guessing. You cannot leave an answer blank; therefore, guess. Go for it! Remember: You do not have to get all the questions correct to pass.

A client with a history of methamphetamine use is admitted to the medical unit. What clinical manifestation does the nurse expect when assessing the client?

Increased heart rateMethamphetamine is a stimulant that causes the release of adrenaline, which activates the sympathetic nervous system. The pupils will dilate, not constrict, because the sympathetic nervous system is activated. Clients withdrawing from opioids, not methamphetamine, experience diarrhea. The respirations will be increased, not decreased, because of the activation of the sympathetic nervous system.

A client with alcoholism was admitted a few hours ago for pancreatitis. For which symptoms should the nurse carefully monitor this client?

Irritability and tremors Rationale The nurse should carefully monitor a client with alcoholism and pancreatitis for irritability and tremors when it has been a few hours since admission. Alcohol is a central nervous system depressant, and irritability and tremors are the body's neurologic adaptation during withdrawal of alcohol. Tachycardia, irritability, and tremors are the early signs of withdrawal and will appear 24 to 48 hours after the last alcoholic drink has been consumed. Although it has only been a few hours since admission, it is unknown how long it has been since the client last had an alcoholic drink or how much time was spent during transportation to the hospital, waiting to be seen, or in observation in the emergency department before admission. Yawning occurs with heroin withdrawal. Convulsions (delirium tremens, or DTs) are a later sign of severe withdrawal that occurs with alcohol withdrawal delirium. Delirium (paranoia and disorientation) is not an early sign of alcohol withdrawal and occurs 48 to 72 hours after abstinence. Fever and diaphoresis may occur during prolonged periods of delirium and are due to autonomic hyperactivity.STUDY TIP: When forming a study group, carefully select members for your group. Choose students who have abilities and motivation similar to your own. Look for students who have a different learning style than you. Exchange names, email addresses, and phone numbers. Plan a schedule for when and how often you will meet. Plan an agenda for each meeting. You may exchange lecture notes and discuss content for clarity or quiz one another on the material. You could also create your own practice tests or make flash cards that review key vocabulary terms.

A client with a 20-year history of excessive alcohol use has developed jaundice and ascites and is admitted to the hospital. What is the priority nursing action during the first 48 hours after the client's admission?

Monitor the client's vital signs. Rationale The vital signs, especially pulse and temperature, will increase before the client demonstrates any of the more severe signs and symptoms of withdrawal from alcohol. Increasing fluid intake is contraindicated initially because it may cause cerebral edema and the client has ascites. Although the client will be more comfortable on a foam mattress, it is not the priority. Improving nutritional status becomes a priority after problems of the withdrawal period have subsided.

A nurse is counseling clients who are attending an alcohol rehabilitation program. Which substance poses the greatest risk of addiction for these clients?

Nicotine Rationale Although polysubstance abuse is common, clients undergoing rehabilitation from alcohol dependence are more likely to use or develop a dependence on nicotine, another legal substance, than on an illegal substance such as heroin, cocaine, or marijuana.STUDY TIP: A helpful method for decreasing test stress is to practice self-affirmation. After you have adequately studied and really know the material, start looking in the mirror each time you pass one and say to yourself—preferably out loud—"I know this material, and I will do well on the test." After several times of watching and hearing yourself reaffirm your knowledge, you will gain inner confidence and be able to perform much better during the test period. This technique really works for students who are adventurous enough to use it. It may feel silly at first, but if it works, who cares? It will work for performing skills in clinical as well, as long as you have practiced the skill sufficiently.

The nurse observes that 12 hours after birth the neonate is hyperactive and jittery, sneezes frequently, has a high-pitched cry, and is having difficulty suckling. Further assessment reveals increased deep tendon reflexes and a diminished Moro reflex. What problem does the nurse suspect?

Opioid drug withdrawal Rationale These signs are indicative of withdrawal from an opioid with typical changes occurring in the central nervous system; the newborn should be monitored during the first 24 to 48 hours. The signs of cerebral palsy usually manifest later in infancy. The signs of syphilis are a low-grade fever and a copious serosanguineous discharge from the nose. The signs of fetal alcohol syndrome are growth deficiencies in length, weight, and head circumference, plus distinctive facies.Test-Taking Tip: Being prepared reduces your stress or tension level and helps you maintain a positive attitude.

The nurse encourages a client with Raynaud disease to stop smoking. Which primary goal is the nurse trying to achieve?

Prevent peripheral vasoconstriction Rationale Nicotine causes spasms and constriction of the smooth muscles of the arterial vasculature, compromising blood flow to the distal extremities. Nicotine does not directly cause pain and tingling, although these may occur as consequences of nicotine-induced vasoconstriction. Vasoconstriction from nicotine will not result in such severe effects as cyanosis and necrosis. Smoking increases the carboxyhemoglobin level in the blood; carbon monoxide combines with hemoglobin and occupies the sites on the hemoglobin molecule that bind with oxygen, thus decreasing oxygen content.Test-Taking Tip: Do not spend too much time on one question, because it can compromise your overall performance. There is no deduction for incorrect answers, so you are not penalized for guessing. You cannot leave an answer blank; therefore, guess. Go for it! Remember: You do not have to get all the questions correct to pass.

A client with the diagnosis of alcoholism explains to the nurse that alcohol has a calming effect and states, "I function better when I'm drinking than when I'm sober." What defense mechanism does the nurse identify?

Rationalization- Rationale The attempt to justify a behavior by giving it acceptable motives is an example of rationalization. Sublimation is the substitution of a maladaptive behavior for a more socially acceptable behavior. Suppression is the intentional exclusion of things, people, feelings, or events from consciousness. Compensation is the attempt to emphasize a characteristic viewed as an asset to make up for a real or imagined deficiency.STUDY TIP: Enhance your time-management abilities by designing a study program that best suits your needs and current daily routines by considering issues such as the following: (1) Amount of time needed; (2) Amount of time available; (3) "Best" time to study; (4) Time for emergencies and relaxation.

Which physical assessment of the skin indicates that a client is addicted to phencyclidine?

Red and dry skin is associated with phencyclidine abuse.A client with alcohol abuse will have burns on the skin. Vasculitis is associated with cocaine abuse. Diaphoresis is associated with chronic abuse of sedative hypnotics.

A primary healthcare provider prescribes oxazepam for a client who is beginning to experience withdrawal symptoms while undergoing detoxification. What are the primary reasons that oxazepam is given during detoxification?

Reduces the anxiety-tremor state and prevents more serious withdrawal symptoms Rationale Oxazepam potentiates the actions of gamma-aminobutyric acid, especially in the limbic system and reticular formation and thus minimizes withdrawal symptoms. This drug helps reduce the risk for seizures but does not prevent injury or protect the client during a seizure. Enabling the client to sleep and eat better during periods of agitation is not the purpose of the drug. The ability of the client to accept treatment depends on the client's readiness to accept the reality of the problem.Test-Taking Tip: Prepare for exams when and where you are most alert and able to concentrate. If you are most alert at night, study at night. If you are most alert at 2 am, study in the early morning hours. Study where you can focus your attention and avoid distractions. This may be in the library or in a quiet corner of your home. The key point is to keep on doing what is working for you. If you are distracted or falling asleep, you may want to change when and where you are studying.

A nurse is counseling a client who abuses cocaine. The nurse recognizes that this drug is representative of which drug category?

STimulant Rationale Cocaine is classified as a stimulant. It is inhaled in its powdered form or smoked as crack; its use creates experiences similar to but more intense than those experienced with the amphetamines, and its withdrawal results in a deeper crash. Opioids and barbiturates are central nervous system depressants. Hallucinogens produce cerebral excitation that can yield a state similar to psychosis.

A recovering alcoholic joins Alcoholics Anonymous (AA) to help maintain sobriety. What type of group is AA?

Self-help group Rationale Alcoholics Anonymous is a self-help group of people who meet to attain and maintain sobriety. A social group centers on building interpersonal relationships through participation in mutual activities. A resocialization group centers on increasing social skills that may be diminished or lacking. A psychotherapeutic group treats mental and emotional disorders with the use of psychological techniques and always has a member of the healthcare profession as its leader.

A nurse provides smoking-cessation education to a client with chronic obstructive pulmonary disease (COPD). The nurse concludes that the client is ready to quit smoking when the client makes which statement?

The response "I'll cut back to a half pack a day" is a positive step in reducing smoking; it is the first step toward stopping. The response "I'll just finish the carton that I have at home" is postponing the decision to quit. The response "I find that smoking is the only way I can relax" is rationalizing why quitting smoking is too difficult. The response "I should find this easy" is unrealistic because giving up smoking is difficult regardless of if the client smokes when alcoholic beverages are consumed.

A nurse, understanding the possible cause of alcohol-induced amnestic disorder, should take into consideration that the client is probably experiencing which imbalance?

Thiamine deficiency-The deficiency of thiamine (vitamin B1) is thought to be a primary cause of alcohol-induced amnestic disorder. Rationale The deficiency of thiamine (vitamin B 1) is thought to be a primary cause of alcohol-induced amnestic disorder. Reduced iron intake, increased serotonin, and riboflavin malabsorption are all unrelated to alcohol-induced amnestic disorder.

A client with a known history of opioid addiction is treated for multiple stab wounds to the abdomen. After surgical repair the nurse notes that the client's pain is not relieved by the prescribed morphine injections. The nurse realizes that the failure to achieve pain relief indicates that the client is probably experiencing what phenomenon?

Tolerance Rationale Tolerance is a phenomenon that occurs in addicted individuals in which increasing amounts of the drug of addiction are needed to satisfy need; the client should receive adequate analgesia after surgery. Drug habituation is a mild form of psychological dependence; the individual develops a habit of taking the substance. A physical addiction is related to biochemical changes in body tissues, especially the nervous system. The tissues come to require the substance for usual function. Psychological dependence is emotional reliance on the substance to maintain a sense of well-being.

A nurse notes that a client in the detoxification unit is exhibiting early signs of alcohol withdrawal. What clinical manifestations might the nurse have noted? Select all that apply.

Tremors Anorexia Rationale Hand tremors, related to dysfunction of the nervous system, are an early sign of withdrawal from alcohol. Alcohol depresses the central nervous system, interferes with nerve conduction, and results in peripheral neuropathy. Signs and symptoms of alcohol withdrawal begin within 12 hours of cessation or a decrease in alcohol consumption, peak in 48 to 72 hours, and usually begin to ease after 4 or 5 days. Anorexia, nausea, and vomiting are early signs of withdrawal from alcohol. Alcohol affects the gastrointestinal system and can cause gastritis, pancreatitis, hepatitis, and cirrhosis. Psychomotor agitation is a late, not early, sign of alcohol withdrawal. Transient visual, auditory, and tactile hallucinations, rather than delusions, are associated with alcohol withdrawal. Confusion, disorientation, and impaired cognition are not early signs of alcohol withdrawal; alcohol withdrawal delirium occurs in less than 10% of those who experience the alcohol withdrawal syndrome.Test-Taking Tip: Calm yourself by closing your eyes, putting down your pencil (or computer mouse), and relaxing. Deep-breathe for a few minutes (or as needed, if you feel especially tense) to relax your body and to relieve tension.

A nurse is in the process of developing a therapeutic relationship with a client who has an addiction problem. What client communication permits the nurse to conclude that they are making progress in the working stage of the relationship? Select all that apply.

Verbalizes difficulty identifying personal strengths Acknowledges the effects of the addiction on the family Addresses how the addiction has contributed to family distress Rationale Looking at one's strengths in addition to areas that need growth is difficult work, and sharing this difficulty demonstrates that the client is willing to work with the nurse to address personal issues. When he is willing to address cause and effect issues of personal behavior, the client is in the working phase of a therapeutic relationship. When people in a therapeutic relationship are able to address how their behavior affects others, they are taking the first step toward taking responsibility for their actions. The use of projection is a defense from taking responsibility for the addiction; this will impair the effectiveness of a working therapeutic relationship. Ambivalence about working with the nurse usually occurs during the introductory phase of the nurse-client relationship.

What behavior by a client with a long history of alcohol abuse is an indication that the client may be ready for treatment?

Verbalizing an honest desire for help Rationale When clients with alcohol problems voice a desire for help, it usually signifies that they are ready for treatment, because they are admitting they have a problem. Adherence to an alcohol treatment program requires abstinence. A week is too short a time to signal readiness for treatment. Hospitalization alone is not an indication that the client is really ready for treatment, because many factors can influence admission.STUDY TIP: Record the information you find to be most difficult to remember on 3" × 5" cards and carry them with you in your pocket or purse. When you are waiting in traffic or for an appointment, just pull out the cards and review again. This "found" time may add points to your test scores that you have lost in the past.

A client is admitted to the hospital with ascites. The client reports drinking a quart (liter) of vodka mixed in orange juice every day for the past three months. To assess the potential for withdrawal symptoms, which question would be appropriate for the nurse to ask the client?

When was your last drink of vodka?" Rationale The nurse must determine when the client had the last drink to gauge when the body may react to lack of alcohol (withdrawal). Factors that prompt drinking are important but do not affect the body's response to withdrawal from the substance. Whether the client also eats when the client drinks will not influence the body's response to withdrawal from the alcohol. Whether the client mixes vodka with orange juice will not influence the body's withdrawal from the alcohol.

Which physical or behavioral signs of substance abuse should a nurse look for in an adolescent? Select all that apply.

Worrying about being addicted Experiencing an overdose or withdrawal symptoms Manifesting bizarre behavior or confusion Rationale Worrying of being addicted, experiencing overdose or withdrawal symptoms, and manifesting bizarre behavior may be earliest signs of substance abuse. Showing high performance in social activities and worry about a friend or family member's substance abuse are not with a manifestation of substance abuse.

A nurse who is assessing a recently hospitalized client with a diagnosis of opioid addiction should look for signs of withdrawal. What are these signs? Select all that apply.

Yawning Muscle aches Seizures Rationale Seizures, yawning, and muscle aches are all clinical manifestations of opioid withdrawal, which occurs after cessation or reduction of prolonged moderate or heavy use of opioids. Insomnia, not drowsiness occurs with opioid withdrawal. Diarrhea, not constipation, occurs with opioid withdrawal..Test-Taking Tip: Answer every question. A question without an answer is always a wrong answer, so go ahead and guess.