Substance Abuse

A client who abuses alcohol tells a nurse, "Alcohol helps me sleep." What is the most appropriate response by the nurse? a. " Alcohol doesn't help promote sleep." b. " Continued alcohol use causes insomnia." c. " One glass of alcohol at dinnertime can induce sleep." d. " Sometimes, alcohol can make one drowsy enough to fall asleep."

a. " Alcohol doesn't help promote sleep." Rationale: Alcohol use may initially promote sleep, but with continued use, it causes insomnia. Evidence shows that alcohol doesn't facilitate sleep. One glass of alcohol at dinnertime won't induce sleep. The last option doesn't give information about how alcohol affects sleep. It makes the client think alcohol use to induce sleep is an appropriate strategy to try.

A client who has been drinking alcohol for 30 years asks a nurse if permanent damage has occurred to his immune system. What is the best response by the nurse? a. " There is often less resistance to infections." b. " Sometimes, the body's metabolism will increase." c. " Put your energies into maintaining sobriety for now." d. " Drinking puts you at high risk for disease later in life."

a. " There is often less resistance to infections." Rationale: Chronic alcohol use depresses the immune system and causes increased susceptibility to infections. A nutritionally well-balanced diet that includes foods high in protein and B vitamins will help develop a strong immune system. The potential damage to the immune system doesn't increase the body's metabolism. The third option negates the client's concern and isn't an appropriate or caring response. Drinking alcohol may put the client at risk for immune system problems at any time in life.

A client addicted to alcohol tells a nurse, "Making friends used to be hard for me." The nurse determines that client teaching about relationships has been successful when the client makes which statement? a. "I've set limits on my behaviors toward others." b. "I need to be judgmental of others." c. "I won't become intimately involved with others." d. "I can't bear to see myself hurt again in a relationship."

a. "I've set limits on my behaviors toward others." Rationale: When the client can set personal limits and maintain boundaries, the ability to have successful interpersonal relationships can occur. Being judgmental is contraindicated if a client wants to have successful relationships. Setting arbitrary limits on relationships indicates the client needs to learn more interpersonal relationship skills. The universal truth about relationships is that they bring both joy and pain. The last statement indicates a need to learn more about relationships.

A client who abused alcohol for more than 20 years is diagnosed with cirrhosis of the liver. The nurse determines that teaching about the disease has been successful when the client makes which statement? a. "If I decide to stop drinking, I won't kill myself." b. "If I watch my blood pressure, I should be okay." c. "If I take vitamins, I can undo some liver damage." d. "If I use nutritional supplements, I won't have problems."

a. "If I decide to stop drinking, I won't kill myself." Rationale: This statement reflects the client's perception of the severity of the condition and the life-threatening complications that can result from continued use of alcohol. Aggressive treatment is required, not merely watching one's blood pressure. At this point in the illness, there is little likelihood that liver damage from cirrhosis can be altered. The fourth option denies the severity of the problem and negates the life-threatening complications common with a diagnosis of cirrhosis.

A client who uses cocaine finally admits he also abused other drugs to equalize the effect of cocaine. The nurse is aware that the client's drug history may include which substance? a. Alcohol b. Amphetamines c. Caffeine d. Phencyclidine

a. Alcohol Rationale: A cocaine addict will commonly use alcohol to decrease or equalize the stimulating effects of cocaine. Caffeine, phencyclidine, and amphetamines aren't used to equalize the stimulating effects of cocaine.

A nurse is caring for a client who is experiencing amphetamine withdrawal. The nurse should assess the client for which of the following? a. Disturbed sleep b. Increased yawning c. Psychomotor agitation d. Inability to concentrate

a. Disturbed sleep Rationale: It's common for a person withdrawing from amphetamines to experience disturbed sleep and unpleasant dreams. Increased yawning is seen with clients withdrawing from opioids. Psychomotor agitation is seen in cocaine withdrawal, and the inability to concentrate is seen in caffeine withdrawal.

When assessing a client with prolonged, chronic alcohol intake, the nurse would expect to find which of the following? a. Enlarged liver b. Nasal irritation c. Muscle wasting d. Limb paresthesia

a. Enlarged liver Rationale: A major effect of alcohol on the body is liver impairment, and an enlarged liver is a common physical finding. Nasal irritation is commonly seen with clients who snort cocaine. Muscle wasting and limb paresthesia don't tend to occur with clients who abuse alcohol.

A client who smoked marijuana daily for 10 years tells a nurse, "I don't have any goals, and I just don't know what to do." What is the most appropriate nursing intervention for this client? a. Focus the interaction. b. Use nonverbal methods. c. Use reflection techniques. d. Ask open-ended questions.

a. Focus the interaction. Rationale: A client with amotivational syndrome from chronic use of marijuana tends to talk in tangents and needs the nurse to focus the conversation. Nonverbal communication or reflection techniques wouldn't be useful as this client must focus and learn to identify and accomplish goals. Using only open-ended questions won't allow the client to focus and establish specific goals.

During a family therapy session, an alcoholic client tells a family member, "You made it easy for me to use alcohol. You always made excuses for my behavior." What should the nurse encourage the family to do? a. Give up enabling behaviors b. Manage the client's self-care c. Deal with negative behaviors d. Evaluate the home environment

a. Give up enabling behaviors Rationale: Enabling the behaviors of family members allows the client to continue the addiction by rationalizing, denying, or otherwise excusing the problem. Managing the client's self-care isn't an issue that needs to be addressed based on the client's statement. Dealing with negative behaviors and evaluating the home environment don't address the client's statement about the family's enabling behavior.

The nurse is caring for a client who is experiencing alcohol withdrawal. The nurse would be most concerned if the client exhibited which of the following? a. Hallucinations b. Nervousness c. Diaphoresis d. Nausea

a. Hallucinations Rationale: Hallucinations are a sign of late alcohol withdrawal. The nurse should stay with the client, have someone notify the physician, and institute seizure precautions. Nervousness, diaphoresis, and nausea are signs of early withdrawal.

What is the priority nursing intervention for a client recovering from cocaine addiction? a. Help the client find ways to be happy and competent. b. Foster the creative use of self in community activities. c. Teach the client to handle stresses in the work setting. d. Help the client acknowledge the current level of dependency.

a. Help the client find ways to be happy and competent. Rationale: The major component of a treatment program for a client with cocaine addiction is to have the client feel happy and competent. Cocaine addiction is difficult to treat because the drug actions reinforce its use. There are often perceived positive effects. Clients often credit the drug with giving them creative energy instead of looking within themselves. Fostering the creative use of self may inadvertently reinforce the client's drug use. Teaching the client to handle stresses is appropriate but isn't the most immediate nursing action. Examining the client's level of dependency isn't the immediate choice, as the client needs to work on remaining drug free. Lisko, Susan (2013-10-01). NCLEX-RN Questions and Answers Made Incredibly Easy (Nclexrn Questions & Answers Made Incredibly Easy) (Kindle Locations 16449-16454). Lippincott Williams & Wilkins. Kindle Edition.

A nurse is performing a physical assessment on a client who uses heroin. It is most important for the nurse to assess the client for which of the following? a. Hepatitis b. Peptic ulcers c. Hypertension d. Chronic pharyngitis

a. Hepatitis Rationale: Hepatitis is the most common medical complication of heroin abuse. Peptic ulcers are more likely to be a complication of caffeine use, hypertension is a complication of amphetamine use, and chronic pharyngitis is a complication of marijuana use.

A nurse suggests to a client struggling with alcohol addiction that keeping a journal may be helpful. The goal of this nursing intervention is to help the client do what? a. Identify stressors and responses to them. b. Understand the diagnosis. c. Help others by reading the journal to them. d. Develop an emergency plan for use in a crisis.

a. Identify stressors and responses to them. Rationale: Keeping a journal enables the client to identify problems and patterns of coping. From this information, the difficulties the client faces can be addressed. A journal isn't necessarily kept to promote better understanding of the client's illness, but it helps the client understand himself better. Journals aren't read to other people unless the client wants to share a particular part. Journals aren't typically used for identifying an emergency plan for use in a crisis.

A client addicted to alcohol is scheduled to begin individual therapy with the nurse. What is the most important nursing intervention for the client? a. Learn to express feelings. b. Establish new roles in the family. c. Determine strategies for socializing. d. Decrease preoccupation with physical health.

a. Learn to express feelings. Rationale: The client must address issues, learn ways to cope effectively with life stressors, and express his needs appropriately. After the client establishes sobriety, the possibility of taking on new roles can become a reality. Determining strategies for socializing isn't the priority intervention for an addicted client. Usually, these clients need to change former socializing habits. Clients addicted to alcohol don't tend to be preoccupied with physical health problems.

A nurse is assessing a client with a history of substance abuse who has pinpoint pupils, a heart rate of 56 beats/ minute, a respiratory rate of 6 breaths/ minute, and temperature of 96.4 ° F. The nurse determines that which is the most likely cause of the client's symptoms? a. Opioids b. Amphetamines c. Cannabis d. Alcohol

a. Opioids Rationale: Opioids, such as morphine and heroin, can cause pinpoint pupils and a reduced heart rate, respiratory rate, and body temperature with intoxication. Amphetamine intoxication can lead to tachycardia, euphoria, and irritability. Cannabis (marijuana) intoxication can cause slowed reflexes, lethargy, and tachycardia. Alcohol intoxication leads to slurred speech, unsteady gait, and incoordination.

A client tells the nurse that he used amphetamines to be productive at work. The nurse is aware that abrupt discontinuation of the drug will produce which symptom? a. Severe anxiety b. Increased yawning c. Altered perceptions d. Amotivational syndrome

a. Severe anxiety Rationale: When amphetamines are abruptly discontinued, the client may experience severe anxiety or agitation. Increased yawning is a symptom of opioid withdrawal. Altered perceptions occur when a client is withdrawing from hallucinogens. Amotivational syndrome is seen with clients using marijuana.

A client has been admitted to the emergency department and states he just used cocaine. The nurse monitors the client for which condition? a. Tachycardia b. Hyperthermia c. Hypotension d. Bradypnea

a. Tachycardia Rationale: Tachycardia is common because cocaine increases the heart's demand for oxygen. Cocaine doesn't cause hyperthermia (elevated temperature), hypotension (decreased blood pressure), or bradypnea (decreased respiratory rate).

A client has received chlordiazepoxide (Librium) to control the symptoms of alcohol withdrawal. The chlordiazepoxide has been ordered as needed. The nurse assesses the client and determines an additional dose of medication is needed when the client displays which symptoms? Select all that apply. a. Tachycardia b. Mood swings c. Elevated blood pressure and temperature d. Piloerection e. Tremors f. Increasing anxiety

a. Tachycardia c. Elevated blood pressure and temperature e. Tremors f. Increasing anxiety Rationale: Benzodiazepines are usually administered based on elevations in heart rate, blood pressure, and temperature as well as on the presence of tremors and increasing anxiety. Mood swings are expected during the withdrawal period and are not an indication for further medication administration. Piloerection is not a symptom of alcohol withdrawal.

A nurse has developed a relationship with a client who has an addiction problem. The nurse determines that the therapeutic interaction is in the working stage when the client does what? Select all that apply. a. The client addresses how the addiction has contributed to family distress. b. The client reluctantly shares the family history of addiction. c. The client verbalizes difficulty identifying personal strengths. d. The client discusses financial problems related to the addiction. e. The client expresses uncertainty about meeting with the nurse. f. The client acknowledges the addictions effects on the children.

a. The client addresses how the addiction has contributed to family distress. c. The client verbalizes difficulty identifying personal strengths. f. The client acknowledges the addictions effects on the children. Rationale: These statements are indicative of the nurse- client working phase, in which the client explores, evaluates, and determines solutions to identified problems. The remaining statements address what happens during the introductory phase of the nurse- client interaction.

A client tells the nurse, "I have been drinking ever since they told me I had learning disabilities." How does the nurse interpret this response? a. The client is self-medicating. b. The client has an excuse to drink. c. The client isn't a productive person. d. The client will be unable to stop drinking.

a. The client is self-medicating. Rationale: A client with learning disabilities may experience frustration, depression, or overall feelings of low self-esteem and may self-medicate with alcohol. Many people with learning disabilities don't resort to alcohol but develop other coping skills to handle the disability. People with learning disabilities can be very productive. A person with a learning disability can successfully recover from alcohol addiction.

A polyaddicted client is hospitalized for withdrawal complications. What is the most important goal for this client? a. The client will remain safe during the detoxification period. b. The client will develop an accurate perception of his drug problem. c. The client will abstain from mood-altering drugs. d. The client will learn coping strategies to help him stop relying on drugs.

a. The client will remain safe during the detoxification period. Rationale: Client safety takes highest priority during detoxification. During this time, it's unrealistic to expect clients to perceive their drug problems accurately; typically, they experience cognitive impairment or deny their addiction. In the hospital, the client usually doesn't have access to drugs and should be drug free; the goal of abstaining from mood-altering drugs takes highest priority after discharge. Learning coping strategies is an appropriate goal immediately after withdrawal and when medical care is completed.

The family of a client in rehabilitation following heroin withdrawal asks a nurse why the client is receiving naltrexone (ReVia). What is the best response by the nurse? a. To help reverse withdrawal symptoms b. To keep the client sedated during withdrawal c. To take the place of detoxification with methadone d. To decrease the client's memory of the withdrawal experience

a. To help reverse withdrawal symptoms Rationale: Naltrexone is an opioid antagonist and helps the client stay drug free. Keeping the client sedated during withdrawal isn't the reason for giving this drug. The drug doesn't decrease the client's memory of the withdrawal experience and isn't used in place of detoxification with methadone.

A client is receiving chlordiazepoxide (Librium) as needed for signs and symptoms of alcohol withdrawal. The nurse assesses the client and determines the need for medication when the client displays a. mild tremors, hypertension, tachycardia. b. bradycardia, hyperthermia, sedation. c. hypotension, decreased reflexes, drowsiness. d. hypothermia, mild tremors, slurred speech.

a. mild tremors, hypertension, tachycardia. Rationale: Chlordiazepoxide is given during alcohol withdrawal. Symptoms that indicate a need for this drug include tremors, hypertension, tachycardia, and elevated body temperature. Bradycardia, sedation, hypotension, decreased reflexes, hypothermia, and slurred speech aren't symptoms of alcohol withdrawal.

The nurse determines further teaching about nutrition is necessary when an alcoholic client makes which statement? a " I should avoid foods high in fat." b. " I should eat only one balanced meal per day." c. " I should take vitamin and mineral supplements." d. " I should eat large portions of food containing fiber."

b. " I should eat only one balanced meal per day." Rationale: If the client eats only one adequate meal each day, there will be a deficit of essential nutrients. It's appropriate for the client to take vitamin and mineral supplements to prevent deficiency in these nutrients. Avoiding foods high in fat content and consuming large portions of foods containing fiber indicate the client has good knowledge about nutrition. Lisko, Susan (2013-10-01). NCLEX-RN Questions and Answers Made Incredibly Easy (Nclexrn Questions & Answers Made Incredibly Easy) (Kindle Locations 15972-15975). Lippincott Williams & Wilkins. Kindle Edition.

A client with a history of alcohol abuse tells the nurse that he refuses to take his vitamins. What is the most appropriate response by the nurse? a. " It's important to take vitamins to stop your craving." b. " Prolonged use of alcohol can cause vitamin depletion." c. " For every vitamin you take, you'll help your liver heal." d. " By taking vitamins, you don't need to worry about your diet."

b. " Prolonged use of alcohol can cause vitamin depletion." Rationale: Chronic alcoholism interferes with the metabolism of many vitamins. Vitamin supplements can prevent deficiencies from occurring. Taking vitamins won't stop a person from craving alcohol or help a damaged liver heal. A balanced diet is essential in addition to taking multivitamins.

A client who is withdrawing from alcohol is being given lorazepam (Ativan). The client's family asks the nurse about the medication. What is the best response by the nurse? a. " Short-term use of lorazepam can lead to dependence." b. " The lorazepam will reduce the symptoms of withdrawal." c. " The lorazepam will make him forget about symptoms of withdrawal." d. " The lorazepam will also help with his heart disease."

b. " The lorazepam will reduce the symptoms of withdrawal." Rationale: Lorazepam is a short-acting benzodiazepine usually given for 1 week to help the client in alcohol withdrawal. Long-term (not short-term) use of lorazepam can lead to dependence. The medication isn't given to help forget the experience; it lessens the symptoms of withdrawal. It isn't used to treat coexisting cardiovascular problems.

A client recovering from alcohol abuse tells the nurse, "I get nothing out of Alcoholics Anonymous (AA) meetings." What is the best response by the nurse? a. " What were you told about going to AA meetings?" b. " What do you want to get out of the AA meetings?" c. " When do you think you'll stop going to the meetings?" d. " Do you think you can control what happens in a meeting?"

b. " What do you want to get out of the AA meetings?" Rationale: This response puts some of the responsibility for staying sober on the client and encourages the client to take a more active role. Asking what the client was told about AA meetings opens up a discussion that allows the client to continue to discuss disappointments rather than taking a proactive stand to support the value of AA meetings. The third option condones the client's desire to stop going to the meetings. The fourth option changes the issue from being responsible for staying sober to focusing on what the client can't control.

The nurse anticipates that a client undergoing nicotine withdrawal may make which statement? a. "I sometimes feel like I'm seeing things." b. "I feel lousy, and I'm grumpy with everybody." c. "I can't believe I feel fine after just having stopped smoking." d. "I'm always yawning now."

b. "I feel lousy, and I'm grumpy with everybody." Rationale: During nicotine withdrawal, the client is typically irritable and nervous. Seeing things (hallucinations) isn't linked to nicotine withdrawal. A client going through nicotine withdrawal is unlikely to "feel fine." Yawning is associated with withdrawal from opioids, not nicotine.

The nurse determines that teaching about cocaine has been effective when the client makes which statement? a. "I wasn't using cocaine to feel better about myself." b. "I started using cocaine more and more until I couldn't stop." c. "I'm not addicted to cocaine because I don't use it every day." d. "I'm not going to be a chronic user; I only use it on holidays."

b. "I started using cocaine more and more until I couldn't stop." Rationale: This statement reflects the trajectory or common pattern of cocaine use and indicates successful teaching. The first option reflects the client's denial. People gravitate to the drug and continue its use because it gives them a sense of well-being, competency, and power. Cocaine abusers tend to be binge users and can be drug free for days or weeks between use, but they still have a drug problem. The fourth option indicates the client is in denial about the drug's potential to become a habit. Effective teaching didn't occur.

A client tells a nurse, "I'm not going to have problems from smoking marijuana." What is the most appropriate response by the nurse? a. " Evidence shows it can cause major health problems." b. "Marijuana can cause reproductive problems later in life." c. "Smoking marijuana isn't as dangerous as smoking cigarettes." d. "Some people have minor or no reactions to smoking marijuana."

b. "Marijuana can cause reproductive problems later in life." Rationale: Marijuana causes cardiac, respiratory, immune, and reproductive health problems. Most people who smoke marijuana don't have major health problems. All people who smoke marijuana have symptoms of intoxication. The residues from marijuana are more toxic than those from cigarettes.

A family tells the nurse that they are concerned about a family member who stopped using amphetamines 3 months ago and is now acting paranoid. What is the best response by the nurse? a. "A person gets symptoms of paranoia with polysubstance abuse." b. "When a person uses amphetamines, paranoid tendencies may continue for months." c. "Sometimes, family dynamics and a high suspicion of continued drug use make a person paranoid." d. "Amphetamine abusers may have severe anxiety and paranoid thinking."

b. "When a person uses amphetamines, paranoid tendencies may continue for months." Rationale: After a client uses amphetamines, there may be long-term effects that exist for months after use. Two common effects are paranoia and ideas of reference. Even with polysubstance abuse, the paranoia comes from the chronic use of amphetamines. The third option blames the family when the paranoia comes from the drug use. Severe anxiety isn't typically manifested in paranoid thinking.

An alcoholic client tells the nurse, "I feel so depressed about what I've done to my family that I feel like giving up." It is most important for the nurse to assess the client for which of the following? a. Family support b. A plan for self-harm c. A sponsor for the client d. Other ambivalent feelings

b. A plan for self-harm Rationale: When a client talks about giving up, the nurse must explore the potential for suicidal behavior. Although questioning the client about family support, the availability of a sponsor, or ambivalent feelings is important, the priority action is to assess for suicide.

Family members of an alcoholic client ask the nurse to help them intervene. Which action is essential for a successful intervention? a. All family members must tell the client they're powerless. b. All family members must describe how the addiction affects them. c. All family members must come up with their share of financial support. d. All family members must become caregivers during the detoxification period.

b. All family members must describe how the addiction affects them. Rationale: After the family is taught about addiction, they must write down examples of how the addiction has affected each of them and use this information during the intervention. It isn't necessary to tell the client the family is powerless. The family is empowered through this intervention experience. In many cases, a third-party payer will help with treatment costs. Doing an intervention doesn't make family members responsible for financial support or providing care and support during the detoxification period.

A client withdrawing from alcohol tells the nurse that he is worried about periodic hallucinations. What is the most appropriate intervention by the nurse? a. Point out that the sensation doesn't exist. b. Allow the client to talk about the experience. c. Encourage the client to wash the body areas well. d. Determine if the client has a cognitive impairment.

b. Allow the client to talk about the experience. Rationale: The client needs to talk about the periodic hallucinations to prevent them from becoming triggers to acting out behaviors and possible self-injury. The client's experience of sensory-perceptual alterations must be acknowledged; therefore, denying that the client's hallucinations exist isn't a helpful strategy. Determining if the client has a cognitive impairment and encouraging the client to wash the body areas well don't address the problem of periodic hallucinations.

The nurse is caring for a client struggling with alcohol dependence. It is most important for the nurse to do which of the following? a. Speak briefly and directly. b. Avoid blaming or preaching to the client. c. Confront feelings and examples of perfectionism. d. Determine if nonverbal communication will be more effective.

b. Avoid blaming or preaching to the client. Rationale: Blaming or preaching to the client causes negativity and prevents the client from hearing what the nurse has to say. Speaking briefly to the client may not allow time for adequate communication. Perfectionism doesn't tend to be an issue. Determining if nonverbal communication will be more effective is better suited for a client with cognitive impairment.

The nurse is assessing a client who repeatedly abuses cocaine. It is important for the nurse to observe the client for which of the following? a. Panic attacks b. Bipolar cycling c. Attention deficits d. Expressive aphasia

b. Bipolar cycling Rationale: Clients who frequently use cocaine will experience the rapid cycling effect of excitement and then severe depression. They don't tend to experience panic attacks, expressive aphasia, or attention deficits.

A nurse is caring for a client undergoing treatment for acute alcohol dependence. The client tells the nurse, "I don't have a problem. My wife made me come here." Which defense mechanism does the nurse interpret the client's statement as representing? a. Projection and suppression b. Denial and rationalization c. Rationalization and repression d. Suppression and denial

b. Denial and rationalization Rationale: The client is using denial and rationalization. Denial is the unconscious disclaimer of unacceptable thoughts, feelings, needs, or certain external factors. Rationalization is the unconscious effort to justify intolerable feelings, behaviors, and motives. The client isn't using projection, suppression, or repression.

The nurse is caring for a client with a history of chronic alcoholism and is aware that the client may be predisposed to which of the following? a. Arteriosclerosis b. Heart failure c. Heart valve damage d. Pericarditis

b. Heart failure Rationale: Heart failure is a severe cardiac consequence associated with long-term alcohol use. Arteriosclerosis, heart valve damage, and pericarditis aren't medical consequences of alcoholism.

A client with a history of alcohol abuse has been diagnosed with nutritional deficits. What is the best intervention for the nurse to implement? a. Encourage the client to eat a diet high in calories. b. Help the client recognize and follow a balanced diet. c. Have the client drink liquid protein supplements daily. d. Have the client monitor the calories consumed each day.

b. Help the client recognize and follow a balanced diet. Rationale: Clients who abuse alcohol are usually malnourished and need help to follow a balanced diet. Increasing calories may cause the client to just eat empty calories. The client must be involved in the decision to supplement the daily dietary intake. The nurse can't force the client to drink liquid protein supplements. Having the client monitor calorie intake could be done only after the client recognizes the need to maintain a balanced diet. Calorie counts usually aren't needed in most recovering clients who begin to eat from the basic food groups.

A nurse is caring for a client addicted to heroin who is experiencing withdrawal symptoms. The nurse is aware that the withdrawal symptoms may be affected by which factor? a. Ego strength b. Liver function c. Seizure history d. Kidney function

b. Liver function Rationale: Liver function status is an important variable that can be used to indicate the severity of a client's drug withdrawal. Ego strength, seizure history, and kidney function aren't variables that can be used to predict the severity of withdrawal symptoms.

What is the most important teaching information for the nurse to provide a client who abuses prescription drugs? a. Herbal substitutes are safer to use. b. Medication should be used only for the reason prescribed. c. The client should consult a physician before using a drug. d. Consider if family members influence the client to use drugs.

b. Medication should be used only for the reason prescribed. Rationale: People often take prescribed drugs for reasons other than those intended, primarily to self-medicate or experience a sense of euphoria. The safety and efficacy of most herbal remedies haven't been established. Sometimes, over-the-counter medications are necessary for minor problems. There may be a family history of substance abuse, but it isn't a priority when planning nursing care.

A client who formerly used lysergic acid diethylamide (LSD) is seeking counseling. The nurse anticipates that the assessment of the client will include which finding? a. Lack of trust b. Panic attacks c. Recurrent depression d. Loss of ego boundaries

b. Panic attacks Rationale: Clients who used LSD typically have a history of panic attacks or psychotic behavior. This is often referred to as a "bad trip." Loss of ego boundaries, recurrent depression, and lack of trust don't tend to be problems for this type of client.

A nurse is caring for a client recovering from cocaine abuse. The priority intervention for this client would be? a. Skin care b. Suicide precautions c. Frequent orientation d. Nutrition consultation

b. Suicide precautions Rationale: Clients recovering from cocaine use are prone to "post-coke depression" and have a likelihood of becoming suicidal if they can't take the drug. Frequent orientation and skin care are routine nursing interventions but aren't the most immediate considerations for this client. Nutrition consultation isn't the most pressing intervention for this client.

A client experiencing alcohol withdrawal tells the nurse she is upset about going through detoxification. What is the most important goal for this client? a. The client will commit to a drug-free lifestyle. b. The client will work with the nurse to remain safe. c. The client will drink plenty of fluids on a daily basis. d. The client will make a personal inventory of strengths.

b. The client will work with the nurse to remain safe. Rationale: The priority goal is for client safety. Although drinking enough fluids, identifying personal strengths, and committing to a drug-free lifestyle are important goals, the nurse's first priority must be to promote client safety.

The nurse is performing an assessment of a client with a history of polysubstance abuse. What is the most important information for the nurse to obtain? a. Oral administration of any drug b. Time of last use of each drug c. How the drug was obtained d. The place the drug was used

b. Time of last use of each drug Rationale: The time of last use gives information about expected withdrawal symptoms of the drugs and what immediate treatment is necessary. How the drugs were obtained and the places the drugs were used aren't essential information for treatment, nor is administration.

What is the most important short-term goal for a client with a knowledge deficit about the effects of alcohol on the body? a. Test blood chemistries daily. b. Verbalize the results of substance use. c. Talk to a pharmacist about the substance. d. Attend a weekly aerobic exercise program.

b. Verbalize the results of substance use. Rationale: It's important for the client to talk about the health consequences of the continued use of alcohol. Testing blood chemistries daily gives the client minimal knowledge about the effects of alcohol on the body and isn't the most useful information in a teaching plan. A pharmacist isn't the appropriate health care professional to educate the client about the effects of alcohol use on the body. Although exercise is an important goal of self-care, it doesn't address the client's knowledge deficit about the effects of alcohol on the body.

A client who abuses alcohol tells a nurse, "I'm sure I can become a social drinker." What is the most appropriate response by the nurse? a. " When do you think you can become a social drinker?" b. " What makes you think you'll learn to drink normally?" c. " Does your alcohol use cause major problems in your life?" d. " How many alcoholic beverages can a social drinker consume?"

c. " Does your alcohol use cause major problems in your life?" Rationale: This question may help the client recall the problematic results of using alcohol and the reasons the client began treatment. Asking when he believes he can become a social drinker will only encourage the addicted person to deny the problem and develop an unrealistic, self-defeating goal. Asking how many alcoholic beverages a social drinker can consume and why the client thinks he can drink normally will encourage the addicted person to defend himself and deny the problem.

A client asks the nurse, "Why does it matter if I talk to my peers in group therapy?" What is the most appropriate response by the nurse? a. " Group therapy lets you see what you're doing wrong in your life." b. " Group therapy acts as a defense against your disorganized behavior." c. " Group therapy provides a way to ask for support as well as to support others." d. " In group therapy, you can vent your frustrations and others will listen."

c. " Group therapy provides a way to ask for support as well as to support others." Rationale: The best response addresses how group therapy provides opportunities to communicate, learn, and give and get support. Group members will give a client feedback, not just point out what a client is doing wrong. Group therapy isn't a defense against disorganized behavior. People can express all kinds of feelings and discuss a variety of topics in group therapy. Interactions are goal oriented and not just vehicles to vent one's frustrations.

The nurse is trying to determine if a client who abuses heroin has any drug-related problems. What is the most appropriate question for the nurse to ask? a. "When did your spouse become aware of your use of heroin?" b. "Do you have a probation officer that you report to periodically?" c. "Have you experienced any legal violations while being intoxicated?" d. "Do you have a history of frequent visits with the employee assistance program manager?"

c. "Have you experienced any legal violations while being intoxicated?" Rationale: This question focuses on obtaining direct information about drug-related legal problems. When a spouse becomes aware of a partner's substance abuse, the first action isn't necessarily to institute legal action. Even if the client reports to a probation officer, the offense isn't necessarily a drug-related problem. Asking if the client has a history of frequent visits with the employee assistance program manager isn't useful. It assumes any visit to the employee assistance program manager is related to drug issues.

A pregnant client is thinking about stopping cocaine use. The nurse determines that teaching about drug use and pregnancy has been effective when the client makes which statement? a. "Right after birth, I'll give the baby up for adoption." b. "I'll help the baby get through the withdrawal period." c. "I don't want the baby to have withdrawal symptoms." d. "It's scary to think the baby may have Down syndrome."

c. "I don't want the baby to have withdrawal symptoms." Rationale: Neonates born to mothers addicted to cocaine have withdrawal symptoms at birth. If the client says she'll give the baby up for adoption after birth or help the baby get through the withdrawal period, the teaching was ineffective because the mother doesn't see the impact of her drug use on the child.

A client recovering from cocaine abuse is participating in group therapy. The nurse determines that the client has benefited from the therapy when the client makes which statement? a. "I think the laws about drug possession are too strict in this country." b. "I'll be more careful about talking about my drug use to my children." c. "I finally realize the short high from cocaine isn't worth the depression." d. "I can't understand how I could get all these problems that we talked about in group."

c. "I finally realize the short high from cocaine isn't worth the depression." Rationale: This is a realistic appraisal of a client's experience with cocaine and how harmful the experience is. The first option indicates the client was distracting self from personal issues and isn't working on goals in the group setting. Talking about drugs to children must be reinforced with nonverbal behavior, and not talking about drugs may give children the wrong message about drug use. The fourth option indicates the client is in denial about the consequences of cocaine use.

The family of an adolescent who smokes marijuana asks a nurse if the use of marijuana leads to abuse of other drugs. What is the most appropriate response by the nurse? a. "Use of marijuana is a stage your child will go through." b. "Many people use marijuana and don't use other street drugs." c. "Use of marijuana can lead to abuse of more potent substances." d. "It's difficult to answer that question as I don't know your child."

c. "Use of marijuana can lead to abuse of more potent substances." Rationale: Marijuana is considered a "gateway drug" because it tends to lead to the abuse of more potent drugs. People who use marijuana tend to use or at least experiment with more potent substances. Marijuana isn't a part of a developmental stage that adolescents go through. It isn't important that the nurse knows the child.

A client recovering from alcohol abuse needs to develop effective coping skills to handle daily stressors. What is the most appropriate nursing intervention for this client? a. Determine the client's level of verbal skills. b. Help the client avoid areas that cause conflict. c. Discuss examples of successful coping behavior. d. Teach the client to accept uncomfortable situations.

c. Discuss examples of successful coping behavior. Rationale: The client needs help to identify successful coping behavior and develop ways to incorporate that behavior into daily functioning. There are many skills for coping with stress, and determining the client's level of verbal skills may not be important. Encouraging the client to avoid conflict prevents him from learning skills to handle daily stressors.

A group of teenagers tell the school nurse they used cocaine because they were bored. What is the most important goal for the nurse? a. Prepare a drug lecture. b. Restrict school privileges. c. Establish an activity schedule. d. Report the incident to their parents.

c. Establish an activity schedule. Rationale: Having an activity schedule enables the adolescents to develop coping skills to make better choices about what to do with their free time. Preparing a drug lecture or restricting school privileges won't be seen as useful by the adolescents and may inadvertently contribute to their inappropriate behavior. As the nurse works with the adolescents, it would be more effective to have the children talk to their parents about their drug use.

25. A nurse is working with a client on recognizing the relationship between alcohol abuse and interpersonal problem. Which of the following is the priority intervention? a. Help the client identify personal strengths. b. Help the client decrease compulsive behaviors. c. Examine the client's use of defense mechanisms. d. Have the client work with peers who can serve as role models.

c. Examine the client's use of defense mechanisms. Rationale: Defense mechanisms can impede the development of healthy relationships and cause the client pain. After identifying barriers to relationship problems, it would be appropriate to identify or clarify personal strengths. Compulsive behavior doesn't tend to be a problem for alcoholic clients who struggle with interpersonal problems. Working with peers who are role models would be useful after the client recognizes and gains some insight into the problems. It isn't the priority intervention.

A client who abuses alcohol is admitted to an outpatient drug and alcohol treatment facility. The nurse determines that which of the following is the most objective way to determine if the client is still using alcohol? a. Having the client walk a straight line b. Smelling the client's breath c. Giving the client a breath alcohol test d. Asking the client if he has been drinking

c. Giving the client a breath alcohol test Rationale: A breath alcohol test is the most objective way to determine if the client is still using alcohol. Having him walk a straight line and smelling his breath aren't objective tests. Asking him if he has been drinking may not elicit an honest answer (many clients who abuse alcohol deny alcohol use).

A 20-year-old client is admitted with bone marrow depression. He tells the nurse he's been abusing drugs since age 13. The nurse reviews the client's history for use of which drug? a. Amphetamines b. Cocaine c. Inhalants d. Marijuana

c. Inhalants Rationale: Inhalants cause severe bone marrow depression. Marijuana, cocaine, and amphetamines don't cause bone marrow depression.

The nurse has just completed an assessment of a client recovering from alcohol addiction who has limited coping skills. During the assessment, the nurse also identified that the client is experiencing relationship problems. This assessment is supported by which finding? a. The client is prone to panic attacks. b. The client doesn't pay attention to details. c. The client has poor problem-solving skills. d. The client ignores the need to relax and rest.

c. The client has poor problem-solving skills. Rationale: To have satisfying relationships, a person must be able to communicate and problem solve. Relationship problems don't predispose people to panic attacks more than other psychosocial stressors. Paying attention to details isn't a major concern when addressing the client's relationship difficulties. Although ignoring the need for rest and relaxation is unhealthy, it shouldn't pose a major relationship problem.

The nurse is facilitating a family meeting for a client who abuses alcohol. During the meeting, the nurse observes the communication and determines an unhealthy pattern of a. use of descriptive jargon. b. disapproval of behaviors. c. avoidance of conflicting issues. d. unlimited expression of nonverbal communication.

c. avoidance of conflicting issues. Rationale: The interaction pattern of a family with a member who abuses alcohol often revolves around denying the problem, avoiding conflict, or rationalizing the addiction. Health care providers are more likely to use jargon. The family might have problems setting limits and expressing disapproval of the client's behavior. Nonverbal communication often gives the nurse insight into family dynamics.

A client discusses with the nurse how drug addiction has made life unmanageable. The nurse determines that information to assist the client with coping would include a. how peers have committed to sobriety. b. how to accomplish family of origin work. c. the addiction process and tools for recovery. d. how environmental stimuli serve as drug triggers.

c. the addiction process and tools for recovery. Rationale: When the client admits life has become unmanageable, the best strategy is to teach about the addiction, how to obtain support, and how to develop new coping skills. Information about how peers committed to sobriety would be shared with the client as the treatment process begins. Identification of how environmental stimuli serve as drug triggers would be a later part of the treatment process and family of origin work. Initially, the client must commit to sobriety and learn skills for recovery.

A client who abuses alcohol tells the nurse that everyone in his family has an alcohol problem and nothing can be done about it. What is the most appropriate response by the nurse? a. " You're right; it's much harder to become a recovering person." b. " This is just an excuse for you so you don't have to work on becoming sober." c. " Sometimes, nothing can be done, but you may be the exception in this family." d. " Alcohol problems can occur in families, but you can decide to take the steps to become and stay sober."

d. " Alcohol problems can occur in families, but you can decide to take the steps to become and stay sober." Rationale: This statement challenges the client to become proactive and take the steps necessary to maintain a sober lifestyle. The first option agrees with the client's denial and isn't a useful response. The second option confronts the client and may make him more adamant in defense of this position. The third option agrees with the client's denial and isn't a useful response.

A client recovering from alcohol addiction asks the nurse how to talk to his children about the impact of addiction on them. What is the best response by the nurse? a. " Try to limit references to the addiction and focus on the present." b. " Talk about all the hardships you've had in working to remain sober." c. " Tell them you're sorry and emphasize that you're doing so much better now." d. " Talk to them by acknowledging the difficulties and pain your drinking caused."

d. " Talk to them by acknowledging the difficulties and pain your drinking caused." Rationale: Part of the healing process for the family is to acknowledge the pain, embarrassment, and overall difficulties the client's drinking problem caused family members. The first option facilitates the client's ability to deny the problem. The second option prevents the client from acknowledging the difficulties the children endured. The third option leads the client to believe only a simple apology is needed. The addiction must be addressed and the children's pain acknowledged.

A client asks a nurse not to tell his parents about his alcohol problem. What is the most appropriate response by the nurse? a. " How can you not tell them? Is that being honest?" b. " Don't you think you'll need to tell them someday?" c. " Do alcohol problems run in either side of your family?" d. " What do you think will happen if you tell your parents?"

d. " What do you think will happen if you tell your parents?" Rationale: Clients who struggle with addiction problems often believe people will be judgmental, rejecting, and uncaring if they are told that the client is recovering from alcohol abuse. The first option challenges the client and will put him on the defensive. The second option will make the client defensive and construct rationalizations as to why his parents don't need to know. The third option is a good assessment question, but it isn't an appropriate question to ask a client who's afraid to tell others about his addiction.

The nurse is developing interventions to prevent a client who abused alcohol from relapsing. What is the most important intervention for the client? a. Avoid taking over-the-counter medications. b. Limit monthly contact with the family of origin. c. Refrain from becoming involved in group activities. d. Avoid people, places, and activities from the former lifestyle.

d. Avoid people, places, and activities from the former lifestyle. Rationale: Changing the client's old habits is essential for sustaining a sober lifestyle. Certain over-the-counter medications that don't contain alcohol will probably need to be used by the client at certain times. It's unrealistic to have the client abstain from all such medications. Contact with the client's family of origin may not be a trigger to relapse, so limiting contact wouldn't be useful. Refraining from group activities isn't a good strategy to prevent relapse. Going to Alcoholics Anonymous and other support groups will help prevent relapse.

The nurse is preparing a teaching plan for a client who abused alcohol. What is the most important information for the nurse to include? a. Personal needs b. Illness exacerbation c. Cognitive distortions d. Communication skills

d. Communication skills Rationale: Addicted clients typically have difficulty communicating their needs in an appropriate way. Learning appropriate communication skills is a major goal of treatment. Next, behavior that focuses on the self and meeting personal needs will be addressed. The identification of cognitive distortions would be difficult if the client has poor communication skills. Teaching about illness exacerbation isn't a skill, but it is essential for relaying information about relapse.

A client says, "I started using cocaine as a recreational drug, but now I can't seem to control the use." The nurse interprets the client's statement as most consistent with which drug behavior? a. Toxic dose b. Dual diagnosis c. Cross-tolerance d. Compulsive use

d. Compulsive use Rationale: Compulsive drug use involves taking a substance for a period of time significantly longer than intended. A toxic dose is the amount of a drug that causes a poisonous effect. Dual diagnosis is the coexistence of a drug problem and a mental health problem. Cross-tolerance occurs when the effects of a drug are decreased and the client takes larger amounts to achieve the desired drug effect.

The nurse is preparing a client with the diagnosis of alcohol dependency for discharge from the hospital. What is the most important goal for the client? a. Find a way to drink socially. b. Allow self to grieve recent losses. c. Work to bring others into treatment. d. Develop relapse-prevention strategies.

d. Develop relapse-prevention strategies. Rationale: The primary goal for a client in outpatient treatment is to focus on strategies that prevent relapse. Finding ways to drink socially and working to bring others into treatment aren't goals of outpatient therapy. Allowing self to grieve the losses the addiction caused is a part of the early work of inpatient therapy and may be continued in outpatient therapy.

The nurse is caring for a client who uses cocaine and has been admitted to an intensive outpatient rehabilitation program. It is most important for the nurse to assess the client for which finding? a. GI distress b. Blurred vision c. Perceptual distortions d. Increased appetite

d. Increased appetite Rationale: Increased appetite is typical during cocaine or nicotine withdrawal. GI distress (especially nausea and vomiting) occurs during alcohol or opioid withdrawal. Blurred vision isn't typical in cocaine withdrawal. Perceptual distortions are common during withdrawal from phencyclidine (PCP, or "angel dust"), amphetamines, and hallucinogens.

A nurse is assessing a client with a history of cocaine abuse. The nurse is aware that the assessment may include which finding? a. Glossitis b. Pharyngitis c. Bilateral ear infections d. Perforated nasal septum

d. Perforated nasal septum Rationale: When cocaine is snorted frequently, the client often develops a perforated nasal septum. Bilateral ear infections, pharyngitis, and glossitis aren't common physical findings for a client with a history of cocaine abuse.

What is the most important assessment for a nurse to implement before starting a teaching session for a client who abuses alcohol? a. Sleep patterns b. Decision making c. Note-taking skills d. Readiness to learn

d. Readiness to learn Rationale: It's important to know if the client's current situation helps or hinders the potential to learn. Decision making and sleep patterns aren't factors that must be assessed before teaching about addiction. Note-taking skills aren't a factor in determining whether the client will be receptive to teaching.

A young, depressed adult woman with a history of alcohol abuse is admitted to the hospital after a motor vehicle accident. The nurse performs the admission assessment of the client and anticipates that the history will include which of the following? a. Defiant responses b. Infertility c. Memory loss d. Sexual abuse

d. Sexual abuse Rationale: Many women diagnosed with substance abuse problems also have a history of physical or sexual abuse. Alcohol abuse isn't a common finding in a young woman showing defiant behavior or experiencing infertility. Memory loss isn't a common finding in a young woman experiencing alcohol abuse.

A client with a history of cocaine abuse exhibits behavior changes following return from an inpatient treatment facility. The nurse anticipates that the physician will order which test? a Antibody screen b. Glucose screen c. Hepatic screen d. Urine screen

d. Urine screen Rationale: A urine toxicology screen would show the presence of cocaine in the body. Glucose, hepatic, or antibody screening wouldn't show the presence of cocaine in the body.

A client who uses cocaine denies that drug use is a problem. What is the best intervention by the nurse? a. State ways to cope with stress. b. Repeat the drug facts as needed. c. Identify the client's ambivalence. d. Use open-ended, factual questions.

d. Use open-ended, factual questions. Rationale: The use of open-ended, factual questions will help the client acknowledge that a drug problem is present. Stating ways to cope with stress and identifying the client's ambivalence won't be effective for breaking through a client's denial. Repeating drug facts won't be effective, as the client will perceive it as preaching or nagging.

78. A client with an alcohol addiction requests a prescription for disulfiram (Antabuse). To determine the client's ability to take the drug appropriately, the nurse should assess which of the following? a. Whether the client will take a prescription drug b. Whether the client's family accepts the use of this treatment strategy c. Whether the client is willing to follow the necessary dietary restrictions d. Whether the client is motivated to stay sober

d. Whether the client is motivated to stay sober Rationale: A client with a strong craving for alcohol (and a lack of impulse control) isn't a good candidate for disulfiram therapy. Disulfiram is a prescription drug. Accepting the treatment strategy is a decision that the client and health care provider make; although family input may be welcome, family members don't make the final decision. Significant dietary restrictions aren't necessary during disulfiram therapy (except for alcohol and foods prepared or cooked in it).