Psych: Substance Use Disorders

A client admitted last night with a compound fracture of the femur, sustained in a fall while intoxicated, points to the traction apparatus and screams that she sees a hangman's noose. The assessment that can be made is that the client is experiencing a. an illusion. b. a delusion. c. hallucinations. d. hypnagogic phenomenon.

a. an illusion. The client is misinterpreting a sensory perception when she sees a noose instead of traction. Illusions are common in early withdrawal from alcohol. Option B: A delusion is a fixed, false belief. Option C: Hallucinations are sensory perceptions occurring in the absence of a stimulus. Option D: Hypnagogic phenomena are sensory disturbances that occur between waking and sleeping.

A client admitted for treatment of trauma sustained in a fall while intoxicated believes bugs are crawling on the bed. The client is anxious, agitated, and diaphoretic. The nurse can anticipate that the physician will order a a. benzodiazepine such as diazepam (Valium) or chlordiazepoxide (Librium). b. phenothiazine such as chlorpromazine (Thorazine) or thioridazine (Mellaril). c. monoamine oxidase inhibitor such as phenelzine (Nardil). d. narcotic such as codeine.

a. benzodiazepine such as diazepam (Valium) or chlordiazepoxide (Librium). Sedation allows for safe withdrawal from alcohol. Benzodiazepines are the drugs of choice in most regions because of their high therapeutic safety index and anticonvulsant properties.

If an intoxicated client admitted for trauma treatment last night at 2 AM is going to have withdrawal symptoms, nurses should be alert for the symptoms to begin a. between 8 and 10 AM today (6 to 8 hours after drinking stopped). b. about 2 AM tomorrow (24 hours after drinking stopped). c. about 2 AM of hospital day 2 (48 hours after drinking stopped). d. about 2 AM of hospital day 3 (72 hours after drinking stopped).

a. between 8 and 10 AM today (6 to 8 hours after drinking stopped). Alcohol withdrawal usually begins 6 to 8 hours after cessation or marked reduction of alcohol intake.

A client admits himself to an alcoholism rehabilitation program. During the third week of treatment, his wife tells the nurse that once her husband is discharged from the alcoholism rehabilitation program, she is sure everything will be "just fine." Which remark by the nurse will be most helpful to the client's wife? a. "It is good that you are supportive of your husband's sobriety and want to help him maintain it." b. "While your husband's sobriety solves some problems, new ones may come to light as he adjusts to living without alcohol." c. "It will be important for you to structure his life to avoid as much stress as you can. You will need to protect him." d. "Remember, your husband is basically a self-destructive person. You will need to observe his behavior carefully."

b. "While your husband's sobriety solves some problems, new ones may come to light as he adjusts to living without alcohol." During recovery, clients identify and use alternative coping mechanisms to reduce reliance on alcohol. Physical adaptations must occur. Emotional responses, formerly dulled by alcohol, are now fully experienced and may cause considerable anxiety. These changes inevitably have an effect on the spouse and children, who should be given anticipatory guidance. Option A does not provide anticipatory guidance. Option C provides inaccurate information. Option D provides inappropriate instruction.

The police bring a client to the emergency department to be examined after an automobile accident. He is ataxic, has slurred speech, and seems mildly confused. His blood alcohol level is 400 mg/dL (0.40 mg%). From the relation between his behavior and his blood alcohol level, the nurse can make the assessment that the client a. rarely drinks alcohol. b. has a high tolerance to alcohol. c. has been treated with disulfiram (Antabuse). d. has ingested both alcohol and sedative drugs recently.

b. has a high tolerance to alcohol. A nontolerant drinker would be in coma with a blood alcohol level of 400 mg/dL (0.40 mg%). The fact that the client is walking and talking shows a discrepancy between blood alcohol level and expected behavior and strongly suggests that the client's body has become tolerant to the drug. Option C: If disulfiram and alcohol are ingested together, an entirely different clinical picture would result. Option D: The blood alcohol level gives no information about ingestion of other drugs.

A client admitted for treatment of trauma sustained in a fall while intoxicated believes bugs are crawling on the bed. The client is anxious, agitated, and diaphoretic. While the client is experiencing sensory perceptual disturbances and clouded sensorium, the nursing intervention that should be instituted is a. checking the client every 15 minutes. b. providing one-on-one supervision. c. keeping the room dimly lit. d. rigorously encouraging fluid intake.

b. providing one-on-one supervision. One-on-one supervision will be necessary to promote physical safety until sedation reduces the client's feelings of terror. Option A: Checks every 15 minutes would not be sufficient to provide for safety. Option C: A dimly lit room promotes illusions. Option D: Excessive fluid intake can cause overhydration because fluid retention normally occurs when blood alcohol levels fall.

A client asks the nurse "What is Alcoholics Anonymous all about?" The best response for the nurse would be a. "It is a group that learns about drinking from a group leader." b. "It is a form of group therapy led by a psychiatrist." c. "It is a self-help group for which the norm is sobriety." d. "It is a group that advocates strong punishment for drunk drivers."

c. "It is a self-help group for which the norm is sobriety." Alcoholics Anonymous (AA) is a peer support group for recovering alcoholics. Neither professional nor peer leaders are appointed. Option D describes organizations such as Mothers Against Drunk Driving.

A client who admits himself to an alcoholism rehabilitation program tells the nurse that he is a social drinker, usually having a drink or two at brunch and a few cocktails during the afternoon, wine at dinner, and several drinks throughout the evening. The client can be assessed as demonstrating a. projection. b. rationalization. c. denial. d. introjection.

c. denial. Minimizing one's drinking is a form of denial of alcoholism. By his own description, he is more than a social drinker. Option A: Projection involves blaming another for one's faults or problems. Option B: Rationalization involves making excuses. Option D: Introjection involves taking a quality into one's self system.

A client admitted with trauma sustained while intoxicated has withdrawal delirium. The client's sensorium cleared after 5 days. A few days later, the client tells the nurse that drinking helps her cope with being a single parent and working mother. Which response by the nurse would help the client view her drinking more objectively? a. "Sooner or later your drinking will kill you. Then what will happen to your child?" b. "I hear a lot of defensiveness in your voice. Do you really believe this?" c. "If you were coping so well, what are you doing here again?" d. "Tell me what happened the last time you drank."

d. "Tell me what happened the last time you drank." This response will help the client see alcohol as a cause of her problems, not a solution. This approach can help the client become receptive to the possibility of change. The other responses directly confront and attack defenses against anxiety that the client still needs. They reflect the nurse's frustration with the client.

A client who admits himself to an alcoholism rehabilitation program tells the nurse that he is a social drinker, usually having a drink or two at brunch and a few cocktails during the afternoon, wine at dinner, and several drinks throughout the evening. A response designed to help the client view his drinking more honestly would be a. "I see," and use interested silence. b. "I think you may be drinking even more than you report." c. "To me, being a social drinker involves having a drink or two once or twice a week." d. "You describe drinking rather steadily throughout the day and evening. Am I correct?"

d. "You describe drinking rather steadily throughout the day and evening. Am I correct?" Option D summarizes and validates what the client reported, but is acceptant rather than strongly confrontational, as are options B and C. Defenses cannot be removed until healthier coping strategies are in place. Strong confrontation does not usually take place so early in the program. Option A would not assist the client to begin to explore the problem.

The blood alcohol level of a client admitted last night with a compound fracture of the femur sustained in a fall while intoxicated was not assessed at the time of admission. The nurse should a. request that the blood be drawn stat for this test. b. do nothing because the time for the assessment has passed. c. obtain a Breathalyzer from the emergency department to assess blood alcohol level. d. ask the client about quantity and frequency of recent drinking and when she had her last drink.

d. ask the client about quantity and frequency of recent drinking and when she had her last drink. These questions allow the nurse to gain vital information about the likelihood of withdrawal symptoms occurring and the general time of their onset. The blood alcohol level at the time of admission is useful for assessment purposes but is not a necessity. Options A and C: Information relevant for planning can be obtained with option D. Option B is not the best solution. Ascertaining if and when withdrawal symptoms may appear is important.

A client admitted for trauma sustained while intoxicated has been hospitalized for 48 hours. He is shaky, irritable, and anxious and tells of having vivid nightmares for 2 nights. An hour later, the nurse finds the client restless and perspiring. His pulse is 130 beats/min. He shouts "There are bugs crawling on my bed. I have got to get out of here," and begins to thrash about. The most accurate assessment of the situation would be the client a. is attempting to obtain attention by manipulating staff. b. may have sustained a head injury before admission. c. is having a recurrence of an acute psychosis. d. is demonstrating symptoms consistent with withdrawal delirium.

d. is demonstrating symptoms consistent with withdrawal delirium. Symptoms of agitation, elevated pulse, and perceptual distortions point to alcohol withdrawal delirium, a medical emergency. Option A: His behaviors are inconsistent with manipulative attempts. Options B and C: The physical symptoms are inconsistent with both head injury and functional psychosis.

The blood pressure and pulse rates for a client admitted last night with a compound fracture of the femur sustained in a fall while intoxicated, are recorded as follows: admission 2 AM, 122/80 mm Hg and 72 beats/min 4 AM, 126/78 mm Hg and 76 beats/min 6 AM, 124/80 mm Hg and 72 beats/min 8 AM, 132/88 mm Hg and 80 beats/min 10 AM, 148/88 mm Hg and 96 beats/min The priority action for the nurse to take is to a. encourage the client to drink plenty of liquids. b. obtain a clean-catch urine sample. c. place the client in a vest-type restraint. d. notify the physician.

d. notify the physician. Elevated pulse and blood pressure may indicate that the client is going into withdrawal delirium and that additional sedation is warranted. None of the other options takes into account the possible need for sedation. Options B and C: No indication is present that the client may have a urinary tract infection or is presently in need of restraint. Option A is too nonspecific. Overhydration may bring on its own set of problems.

A client admitted for treatment of trauma sustained in a fall while intoxicated believes bugs are crawling on the bed. The client is anxious, agitated, and diaphoretic. A nursing diagnosis of high priority that should be developed is a. ineffective health maintenance. b. ineffective coping. c. ineffective denial. d. risk for injury.

d. risk for injury. The client's clouded sensorium, sensory perceptual distortions, and poor judgment put him at risk for injury. The scenario does not provide data to support the other diagnoses.

A client has been admitted for treatment of a compound fracture of the femur sustained when she fell while intoxicated. The nurse has cared for the client on previous admissions for similar problems. The nurse admits to feeling angry and frustrated at seeing the client in this condition. The action by the nurse that would be most beneficial for the client is to a. ask to be reassigned because he cannot help the client. b. cover his feelings by being particularly pleasant to the client. c. ask how he can help the client find a better solution to her problems. d. seek supervision to get help with negative feelings about the client.

d. seek supervision to get help with negative feelings about the client. The nurse who uses the approach of honestly acknowledging feelings is able to maintain congruence between nonverbal and verbal communication. This approach shows the nurse's concern for the client's well-being. Option A, an avoidant approach by the nurse, would confirm for the client her lack of worth and the hopelessness of her situation. Option B is not an honest approach. The nurse's true feelings would probably be conveyed nonverbally. Option C: This approach reveals the nurse's feelings of helplessness.