EAQ Schizophrenia and Substance Abuse

A client who is a polysubstance abuser has been ordered by the court to seek drug and alcohol counseling. When working with the client, the nurse identifies several treatment goals. List in priority order the outcome criteria for this client. Correct 1. Verbalizes that a substance abuse problem exists Correct 2. Discusses effect of drug use on self and others Correct 3. Expresses negative feelings about the current life situation Correct 4. Explore the use of substances and problematic behaviors

*already in order* The client must first acknowledge that a substance abuse problem exists and creates chaos in his life. The client can then discuss the numerous ways in which drug use has changed and controlled his life. Assistance from the nurse may be required at this time for the client to express and process negative feelings. Finally the client will require assistance in establishing the relationship between substance use and his current problems. Test-Taking Tip: Work with a study group to create and take practice tests. Think of the kinds of questions you would ask if you were composing the test. Consider what would be a good question, what would be the right answer, and what would be other answers that would appear right but would in fact be incorrect.

A nurse assesses a client recently admitted to an alcohol detoxification unit. What common clinical manifestation should the nurse expect during the initial stage of alcohol detoxification? 1 Nausea 2 Euphoria 3 Bradycardia 4 Hypotension

1 Nausea During the first stage of alcohol detoxification, nausea and anorexia are expected. Irritability, not euphoria, is experienced during this stage. Tachycardia, not bradycardia, is experienced during this stage. Hypertension, not hypotension, is experienced during this stage.

A young adult client is admitted to the hospital with a diagnosis of schizophrenia, paranoid type. The client has been saying, "The voices in heaven are telling me to come home to God." What should initial nursing care be focused on? 1 Disturbed self-esteem 2 Potential for self-harm 3 Dysfunctional verbal communication 4 Impaired perception of environmental stimuli

2 Client safety always is the priority over any other client need, and command hallucinations increase the risk of injury. Although promoting self-esteem is important, this is not a priority at this time. There are no data to support the need to focus on the client's ability to verbally communicate. Verbal hallucinations occur within the individual; they are not precipitated by an environmental stimulus.

A nurse uses the CAGE screening test for alcoholism to determine an individual's potential for a drinking problem. What is one of the four questions included on this test? 1. "Do you feel that you are a normal drinker?" 2. "Have you ever felt bad or guilty about your drinking?" 3. "Are you always able to stop drinking when you want to?" 4. "How often did you have a drink containing alcohol in the past year?"

2 The CAGE screening test for alcoholism contains four questions, corresponding to the letters CAGE: Have you ever felt you ought to Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink first thing in the morning (as an "Eye-opener") to steady your nerves or get rid of a hangover? "How often did you have a drink containing alcohol in the past year?" is one of the 10 questions on the Alcohol Use Disorders Identification Test (AUDIT). "Do you feel that you are a normal drinker?" and "Are you always able to stop drinking when you want to?" are two of the 26 questions on the Michigan Alcohol Screening Test (MAST).

A client with schizophrenia is admitted to a psychiatric unit. The client is talking while walking in the hall, is unkempt, and obviously has not washed in several days. What should the nurse say when trying to help this client shower? 1 "Would you like a shower?" 2 "I'll help you take your shower now." 3 "When do you want your shower, now or later?" 4 "You'll feel so much better if you have a shower."

2 The client is displaying a self-care deficit; stating the intention of helping the client shower is direct, does not require the client to make a decision, provides help, and meets the client's physiologic and psychological needs. The client may or may not be capable of making a decision; if the client says no, the nurse will be confronted with a dilemma: meeting the client's physiologic needs will contradict the client's wish not to bathe. The client may not be able to tell the nurse when the shower is desired, because the client may be incapable of making a decision. "You'll feel so much better if you have a shower" may be false reassurance; the client may not be able to process cause and effect.

A client who is experiencing acute alcohol withdrawal delirium appears frightened, points toward the bed, and says, "Bugs are crawling all over me and my bed!" What is the mosttherapeutic response by the nurse? 1. "Just try to brush them off." 2. "I don't see any bugs on you or your bed." 3. "They'll go away when you start feeling better." 4. "The bugs that you see are just the design on the bedspread."

2 The response "I don't see any bugs on you or your bed" points out reality and does not support the client's hallucinations. The response "Just try to brush them off" supports the client's hallucination and provides false reassurance. The response "They'll go away when you start feeling better" supports the client's hallucination and provides false reassurance. The response "The bugs that you see are just the design on the bedspread" constitutes false information. If the client said that the bugs were only on the bed and the bedspread had a design, then the client might have been experiencing an illusion.

Schizophrenia is associated with both positive and negative symptoms. While assessing a client with schizophrenia, the nurse notes that the client is experiencing positive symptoms; what does the nurse observe that leads to this conclusion? Select all that apply. 1. Poverty of speech 2. Agitated behavior 3. Lack of motivation 4. Delusions of grandeur 5. Auditory hallucinations

2 4 5 Agitated and restless behaviors are positive symptoms of schizophrenia. A delusion is a fixed false belief that is resistant to reasoning; when a person believes that he or she is a famous, historical or fictional omnipotent character this is called a delusion of grandeur; a delusion is a positive symptom associated with schizophrenia. An auditory hallucination is a sensory perception involving the sense of hearing that occurs in the absence of an external stimulus and is a positive symptom associated with schizophrenia. Decreased verbalization, including a sudden stoppage in the flow of speech (blocking) and lack of inflection, is a negative symptom associated with schizophrenia. Lack of motivation (avolition) and apathy are negative symptoms associated with schizophrenia. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.

Which client characteristic is an initial concern for the nurse when caring for a client with the diagnosis of paranoid schizophrenia? 1. Continual pacing 2. Suspicious feelings 3. Inability to socialize with others 4. Disturbed relationship with the family

2. The nurse must consider the client's suspicious feelings and establish basic trust to promote a therapeutic milieu. Continual pacing is not a problem, because the nurse can walk back and forth with the client. Inability to socialize with others and disturbed relationship with the family may be of long-range importance but have little influence on the nurse-client relationship at this time.

A 20-year-old carpenter falls from a roof and sustains fractures of the right femur and left tibia. The client reveals a history of substance abuse. What is the primary consideration for the nurse who is caring for this client? 1 Confronting the client about substance abuse 2 Avoiding calling attention to the client's drug abuse 3 Determining the amount and time of last use of the substance 4 Realizing that this client will need more pain medication than a nonabuser

3 Determining the amount and last use of the substance is the priority. Nurses should base their treatment of withdrawal symptoms on the time and amount of last use. Confronting the client is not the nurse's responsibility at this time. The client must be helped to recognize that a problem with drugs exists, but this is not the priority. Because of cross-tolerance the client may need larger doses of analgesia for pain relief than a nonabuser would, but this is not the priority. 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 nurse is assessing an adolescent client with the diagnosis of schizophrenia, undifferentiated type. Which signs and symptoms should the nurse expect the client to experience? 1 paranoid delusions and hypervigilance 2 Depression and psychomotor retardation 3 Loosened associations and hallucinations 4 Ritualistic behavior and obsessive thinking

3 Loosened associations and hallucinations are the primary behaviors associated with a thought disorder such as schizophrenia. Paranoid delusions and hypervigilance are more common in paranoid-type schizophrenia than in the undifferentiated type. Depression and psychomotor retardation are not characteristic of schizophrenia. Ritualistic behavior and obsessive thinking are generally associated with obsessive-compulsive disorders, not schizophrenia.