Substance Abuse, Eating Disorders, Impulse Control Disorders NCLEX

A client admitted to the psychiatric unit for treatment of substance abuse says to the nurse, "It felt so wonderful to get high." Which of the following is an appropriate response?

" ""You told me you got fired from your last job for missing too many days after taking drugs at night.""

A client is admitted to a psychiatric facility by court order for evaluation for antisocial personality disorder. This client has a long history of initiating fights and abusing animals and recently was arrested for setting a neighbor's dog on fire. When evaluating this client for the potential for violence, the nurse should look for which behavioral clues?

"1. A rigid posture, restlessness, and glaring

A client is being treated for alcoholism. After a family meeting, the client's spouse asks the nurse about ways to help the family deal with the effects of alcoholism. The nurse should suggest that the family join which organization?

"1. Al-Anon

In group therapy, a client who has used I.V. heroin every day for the past year says, "I don't have a drug problem. I can quit whenever I want. I've done it before." Which defense mechanism is the client using?

"1. Denial

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

"1. Initiating caloric and nutritional therapy as ordered

"The nurse is caring for a client who has bulimia. What is a common metabolic complication associated with bulimia?

"1. Metabolic alkalosis

The nurse is caring for a client who exhibits pinpoint pupils and decreased blood pressure, pulse, respirations, and temperature. These signs may indicate which disorder?

"1. Opiate intoxication

(SELECT ALL THAT APPLY) Which of the following interventions would be supportive for a client with a nursing diagnosis of Imbalanced nutrition: Consuming less than the body requires due to dysfunctional eating patterns?

"1. Provide small, frequent feedings. 2. Monitor weight gain. 4. Encourage journaling to promote the expression of feelings. 5. Monitor the client at mealtimes and for 1 hour after meals."

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

"1. Seizures

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

"1. The client will establish adequate daily nutritional intake.

A young man is remanded by the courts for psychiatric treatment. His police record, which dates to his early teenage years, includes delinquency, running away, auto theft, and vandalism. He dropped out of school at age 16 and has been living on his own since then. His history suggests maladaptive coping, which is associated with:

"1. antisocial personality disorder.

A nurse is caring for a client who just separated from her husband because of his alcohol abuse problem. Which statement by the nurse conveys empathy?

"2. ""You made a very difficult decision. I'll be here if you want to talk.""

The nurse is caring for a client being treated for alcoholism. Before initiating therapy with disulfiram (Antabuse), the nurse teaches the client that he must read labels carefully on which product?

"2. Aftershave lotion

In the emergency department, a client with facial lacerations states that her husband beat her with a shoe. After the health care team repairs her lacerations, she waits to be seen by the crisis intake nurse, who will evaluate the continued threat of violence. Suddenly the client's husband arrives, shouting that he wants to "finish the job." What is the first priority of the health care worker who witnesses this scene?

"2. Calling a security guard and another staff member for assistance

"When planning care for a client who has ingested phencyclidine (PCP), which of the following is the highest priority?

"2. Client's safety needs

A client is admitted to the psychiatric unit with a diagnosis of anorexia nervosa. Although she is 5' 8" (1.7 m) tall and weighs only 103 lb (46.7 kg), she talks incessantly about how fat she is. Which approach should the nurse take first when caring for this client?

"2. Establish a trusting relationship with the client.

"The nurse is assigned to care for a suicidal client. Initially, which is the nurse's highest care priority?

"2. Exploring the nurse's own feelings about suicide

"Victims of domestic violence should be assessed for what important information?

"2. Readiness to leave the perpetrator and knowledge of resources

Which psychosocial influence has been causally related to the development of aggressive behavior and conduct disorder?

"2. Rejection by peers

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

"2. alcohol withdrawal.

A client is admitted to the emergency department after being found unconscious. Her blood pressure is 82/50 mm Hg. She is 5' 4" (1.6 m) tall, weighs 79 lb (35.8 kg), and appears dehydrated and emaciated. After regaining consciousness, she reports that lately she has had trouble eating and that she can't remember what she ate in the last 24 hours. She also states that she has had amenorrhea for the past year. She is convinced she is fat and refuses food. The nurse suspects that she has:

"2. anorexia nervosa.

A client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink 6 hours before admission. Based on this response, the nurse should expect early withdrawal symptoms to:

"2. begin anytime within the next 1 to 2 days.

A client whose husband just left her has a recurrence of anorexia nervosa. The nurse caring for her realizes that this exacerbation of anorexia nervosa results from the client's effort to:

"2. gain control of one part of her life.

A client is hospitalized with fractures of the right femur and right humerus sustained in a motorcycle accident. Police suspect the client was intoxicated at the time of the accident. Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl). The client later admits to drinking heavily for years. During hospitalization, the client periodically complains of tingling and numbness in the hands and feet. The nurse realizes that these symptoms probably result from:

"2. thiamine deficiency.

A client has approached the nurse asking for advice on how to deal with his alcohol addiction. The nurse should tell the client that the only completely effective treatment for alcoholism is:

"2. total abstinence.

The nurse is interviewing a client on admission to the chemical dependency unit for alcohol detoxification. When the nurse asks about alcohol use, this client is most likely to:"

"2. underestimate the amount consumed.

A 15-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. The nurse conducts a health history interview. Which of the following comments indicates that the client may be suffering from anorexia nervosa?

"3. ""I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls.""

After completing chemical detoxification and a 12-step program to treat drug addiction, a client is being prepared for discharge. Which remark by the client indicates a realistic view of the future?

"3. ""I'm going to take 1 day at a time. I'm not making any promises.""

A client with a history of substance abuse has been attending Alcoholics Anonymous meetings regularly in the psychiatric unit. One afternoon, the client tells the nurse, "I'm not going to those meetings anymore. I'm not like the rest of those people. I'm not a drunk." What is an appropriate response?

"3. ""You seem upset about the meetings.""

Which drugs may be abused because of tolerance and physiologic dependence?

"3. Alprazolam (Xanax) and phenobarbital (Luminal)

The mother of a 3-year-old has been told that her child has a brain tumor. She initially begins to cry and accuses the physicians of lying. Which of the following stages is the mother most likely experiencing?

"3. Anger

"During which phase of alcoholism is loss of control and physical dependence evident?

"3. Crucial phase

A 23-year-old client with a history of bulimia states, "I can eat anything I want and never gain weight." After the evening meal, a nurse hears the client in the bathroom vomiting. Which action should the nurse take first?

"3. Encourage the client to go for a walk.

A nurse is working with a 23-year-old client with a history of alcohol abuse. The nurse uses the CAGE Screening Tool while performing her assessment. She begins explaining the significance of each letter contained in the acronym. The nurse should explain that the letter "A" represents which assessment question?

"3. Have people annoyed you by criticizing your drinking?

A client who reportedly consumes 1 qt of vodka daily is admitted for alcohol detoxification. To try to prevent alcohol withdrawal symptoms, the physician is most likely to prescribe which drug?

"3. Lorazepam (Ativan)

A nurse is assessing a client with a history of multiple substance abuse. The client reports that he's been experiencing nausea, vomiting, and diarrhea. The nurse observes flushing, piloerection, increased lacrimation, and rhinorrhea. These signs and symptoms most likely indicate withdrawal from what substance?

"3. Opioids

A client begins to experience alcoholic hallucinosis. What is the appropriate nursing intervention at this time?

"3. Providing a quiet environment and administering medication as needed and prescribed

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

"3. Set up a strict eating plan for the client.

One of the goals for a client with anorexia nervosa is that the client will demonstrate increased coping by responding to stress in constructive ways. Which of the following actions is a positive indicator that the client is working toward meeting the goal?

"3. The client keeps a journal and discusses it with the nurse.

A client is brought to the emergency department after being beaten by her husband, a prominent attorney. The nurse caring for this client understands that:

"3. domestic violence and abuse span all socioeconomic classes.

A client is admitted to the inpatient adolescent unit after being arrested for attempting to sell cocaine to an undercover police officer. The nurse assists in writing a behavioral contract. To best promote compliance, the contract should be written:

"3. jointly by the client and nurse.

A 16-year-old female was admitted to the hospital for treatment of anorexia nervosa. A nurse is teaching the client's mother about the disease process. The nurse recognizes that the teaching was effective when the mother states that anorexia nervosa is characterized by:

"3. refusal to maintain normal body weight.

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

"4. ""I know I've been arrested three times for drinking and driving, but the police are just trying to hassle me.""

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

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

A local high school recently identified a problem with alcohol-related accidents among student drivers; two of these accidents resulted in death. School officials developed a plan to address the problem. The school nurse begins her part by addressing primary prevention. Which intervention by the school nurse is appropriate?

"4. Arranging for a presentation by a local teenager who was involved in an alcohol-related traffic fatality

A client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is the nurse most likely to administer to reduce the symptoms of alcohol withdrawal?

"4. Chlordiazepoxide (Librium)

A client is admitted for detoxification after a cocaine overdose. The client tells the nurse that he frequently uses cocaine but he can control his use if he chooses. Which coping mechanism is he using?

"4. Denial

A client voluntarily admits himself to the substance abuse unit. He confesses that he drinks 1 qt or more of vodka each day. Later that afternoon, he begins to show signs of alcohol withdrawal. What are some early signs of this condition?

"4. Diaphoresis, tremors, and nervousness

"Which task is most important when developing a plan of care for a client with anorexia nervosa?

"4. Evaluating exercise activities

"A psychiatric client becomes angry and verbally abusive to a nurse. What must the nurse do to handle this situation?

"4. Identify her own feelings or responses to anger.

A nurse enters the room of a client who has recently been diagnosed with anorexia nervosa and finds the client engaging in strenuous exercise. Which nursing action is most important?

"4. Offering to go on a walk with the client

A client with anorexia nervosa describes herself as "a whale." However, the nurse's data collection reveals that the client is 5' 8" (1.7 m) tall and weighs only 90 lb (40.8 kg). Considering the client's unrealistic body image, which intervention should be included in the plan of care?

"4. Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy

A 38-year-old client is admitted for alcohol withdrawal. The most common early sign or symptom that this client is likely to experience is:

"4. perceptual disorders.

A client with a history of alcoholism returns to the hospital 3 hours later than the time specified on his day pass. His breath smells of alcohol and his gait is unsteady. What should the nurse say?

"Please go to bed now. We'll talk in the morning."

A client with a history of drug and alcohol abuse is concerned that this information will be provided to her employer without her knowledge. What can a nurse say to this client?

1. "Your personal health information can't be disclosed to your employer without your permission.

Which outcome criteria would be appropriate for a child diagnosed with oppositional defiant disorder?

1. Accept responsibility for own behaviors.

"Which of the following groups are considered to be at highest risk for suicide?

1. Adolescents, men older than age 45, and people who have made previous suicide attempts"

Which nursing interventions should be included in the treatment plan of a client diagnosed with bulimia nervosa?

1. Establish a contract with the client that specifies the amounts and types of food she must eat at each meal. 4. Reward the client for satisfactory weight gain.

(SELECT ALL THAT APPLY) While collecting data on a client the nurse observes symptoms that lead her to suspect opioid withdrawal. Which symptoms would the client likely exhibit?

1. Flushing 2. Piloerection 3. Nausea 4. Vomiting 5. Abdominal cramps"

"Which assessment finding is most consistent with early alcohol withdrawal?

1. Heart rate of 120 to 140 beats/minute

Which nursing action is best when trying to diffuse a client's impending violent behavior?

1. Helping the client identify and express feelings of anxiety and anger

The nurse is assigned to care for a client with anorexia nervosa. Initially, which nursing intervention is most appropriate for this client?

1. Providing one-on-one supervision during meals and for 1 hour afterward

The mother of a 3-year-old child is complaining that her son still throws temper tantrums when he doesn't get his way. How should the nurse advise the mother to respond?

1. Tell the mother to ignore the child because eventually he will stop having temper tantrums."

When interviewing the parents of an injured child, which of the following is an indicator that child abuse may be a problem?

1. The injury isn't consistent with the history or the child's age.

For a client with anorexia nervosa, the nurse plans to include the parents in therapy sessions along with the client. What fact should the nurse remember to be typical of parents of clients with anorexia nervosa?

1. They tend to overprotect their children."

On discharge after treatment for alcoholism, a client plans to take disulfiram (Antabuse) as prescribed. When teaching the client about this drug, the nurse emphasizes the need to:

1. avoid all products containing alcohol.

"A client who's at high risk for suicide needs close supervision. To best ensure the client's safety, the nurse should:

1. check the client frequently at irregular intervals throughout the night.

While collecting data on a client who was diagnosed with impulse control disorder (and who displays violent, aggressive, and assaultive behavior), the nurse can expect to find which of the following assessments?

1. client functions well in other areas of his life 2. The degree of aggressiveness is out of proportion to the stressor. 4. The client has a history of parental alcoholism and a chaotic, abusive family life.

A client is admitted for an overdose of amphetamines. When collecting data on this client, the nurse should expect to see:

1. tension and irritability"

An 16-year-old boy is admitted to the facility after acting out his aggressions inappropriately at school. Predisposing factors to the expression of aggression include:

1. violence on television.

The client tells the nurse he was involved in a car accident while he was intoxicated. What would be the an appropriate therapeutic response from the nurse?

2. ""Tell me how you feel about the accident.""

"A 15-year-old client is admitted for treatment of bulimia nervosa. Which intervention is a critical component in the care plan?

2. Monitoring the client for purging behaviors

"Which client is at highest risk for suicide?

2. One who plans a violent death and has the means readily available

A local celebrity is admitted to a drug and alcohol abuse unit for treatment. When leaving the unit for lunch, a nurse is approached by the media to give a statement about the client's condition. What should the nurse do?

2. Refer the media to the facility public relations department.

"Which sign should the nurse expect in a client with known amphetamine overdose?

2. Tachycardia

A client experiencing alcohol withdrawal is upset about going through detoxification. Which of the following goals is a priority?

2. The client will work with the nurse to remain safe.

Tourette syndrome is characterized by the presence of multiple motor and vocal tics. A vocal tic that involves repeating one's own sounds or words is known as:

2. palilalia.

The nurse in the substance abuse unit is trying to encourage a client to attend Alcoholics Anonymous meetings. When the client asks the nurse what he must do first to become a member, the nurse should respond:

3. "Admit you're powerless over alcohol and that you need help."

After a 33-year-old male client displays violent behavior, he is placed in restraints. Which intervention by the nurse takes priority for this client?

3. Continuously monitoring the client

"Which drug will the physician most likely prescribe for the client admitted with a lorazepam (Ativan) overdose?

3. Flumazenil (Romazicon)

Which is the drug of choice for treating Tourette syndrome?

3. Haloperidol (Haldol)

"Which of the following is important when restraining a violent client?

3. Have an organized, efficient team approach after the decision is made to restrain the client

A nurse is caring for a 23-year-old client who was diagnosed with anorexia nervosa at the age of 14. The client continues to have fear related to eating. She admits that she has been using laxatives daily and occasionally will self-induce vomiting after eating. She is 5 feet 5 inches tall and weighs 100 pounds. The nurse expects to find which physical manifestations?

3. Hypotension and hypothermia

"Which nursing diagnosis takes priority for a client diagnosed with anorexia nervosa?

3. Imbalanced nutrition: Less than body requirements

An unemployed woman, age 24, seeks help because she feels depressed and abandoned and doesn't know what to do with her life. Last week, her boyfriend broke up with her after she drove his car into a tree after an argument. The client's initial diagnosis is borderline personality disorder. Which nursing observations support this diagnosis?

3. Lack of self-esteem, strong dependency needs, and impulsive behavior

The nurse is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important?

3. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal.

A psychiatric facility uses a team approach in caring for its clients. Which of the following interventions takes priority when using this approach for a 14-year-old male client diagnosed with bulimia nervosa?

3. Meeting with team members daily to discuss the client's maladaptive behaviors"

The nurse is collecting data on a 15-year-old female who's being admitted for treatment of anorexia nervosa. Which clinical manifestation is the nurse most likely to find?

3. Parotid gland tenderness

"In a toddler, which of the following injuries is most likely the result of child abuse?

3. Several small, dime-sized circular burns on the child's back

A parent brings a preschooler to the emergency department for treatment of a dislocated shoulder, which allegedly happened when the child fell down the stairs. Which action should make the nurse suspect that the child was abused?

3. The child doesn't cry when the shoulder is examined.

A client being treated for morbid obesity is 5' 3" tall and weighs 250 lb (113.4 kg). She has lost 60 lb (27 kg) over the past year. A nurse is advising the client about adding an exercise regimen to her diet program. Which exercise is the most appropriate for the nurse to suggest?

3. Walking for 20 minutes per day

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

3. identify anxiety-causing situations.

The nurse is providing care for a client undergoing opiate withdrawal. Opiate withdrawal causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with:

3. methadone.

During a private conversation, a client with borderline personality disorder asks the nurse to keep his secret and then displays multiple, self-inflicted, superficial lacerations on his forearms. What is the most appropriate way for the nurse to respond?

4. "The team needs to know when something important occurs in treatment. I need to tell the others, but let's talk about it first."

A client is found sitting on the floor of the bathroom in the day treatment clinic with moderate lacerations on both wrists. Surrounded by broken glass, she sits staring blankly at her bleeding wrists while staff members call for an ambulance. How should the nurse approach her initially?

4. Approach her slowly while speaking in a calm voice, calling her name, and telling her that the nurse is here to help her.

The nurse is caring for an adolescent female who reports amenorrhea, weight loss, and depression. Which additional data collection finding would suggest that the woman has an eating disorder?

4. Excessive and ritualized exercise"

A 40-year-old client is admitted to the hospital for alcohol abuse for the third time in the past 9 months. The health care team recommends rehabilitative treatment for this client. Why was this treatment recommended?

4. It helps the client identify the relationship between his problems and alcohol consumption.

A 33-year-old male client on a psychiatric unit throws a chair at a staff member and shouts, "If any of you come close to me, I'll make sure that you never walk again." What is the nurse's first priority?

4. Placing the client in restraints with the assistance of other staff members who are specially trained in restraint application

A client with anorexia nervosa tells the nurse, "When I look in the mirror, I hate what I see. I look so fat and ugly." Which strategy should the nurse use to deal with the client's distorted perceptions and feelings?

4. Provide objective data and feedback regarding the client's weight and attractiveness

The nurse is caring for a client who has been abusing opiates. Data collection findings in a client abusing opiates such as morphine include:

4. euphoria and constricted pupils.