Substance Abuse, Eating Disorders, Impulse Control Disorders PrepU

A client experiencing alcohol withdrawal wakes up and screams, "There is something crawling under my skin! Help me!" What should the nurse do in order of priority from first to last? All options must be used.

-Remind the client that this is a withdrawal symptom and that these symptoms will be treated. -Take the client's vital signs. -Assess the client for other withdrawal symptoms. -Administer a dose of lorazepam depending on the severity of the withdrawal symptoms.

A client, brought to the emergency department by the police, is found wandering the streets of town and appears to be disoriented. During initial contact by the nurse, the client begins to laugh inappropriately and states feeling dizzy. Which client behaviors suggest that the client is symptomatic for huffing aerosols? Select all that apply.

-an unsteady gait -impaired memory of where they had been -a slurred speech during conversation -hallucinations of spiders crawling on the bed

An intoxicated client is admitted to the hospital for alcohol withdrawal. What should the nurse do to help the client become sober?

Provide the client with a quiet room to sleep in.

Which medication is appropriate to administer, if prescribed, to a client experiencing symptoms of early alcohol withdrawal?

lorazepam

In a toddler, which injury is most likely the result of child abuse?

several small, dime-sized circular burns on the child's back

What information should the nurse plan to include when teaching the client and family about a substance abuse problem?

the physical, physiologic, and psychological effects of substances

The nurse is teaching unlicensed staff about caring for the client with alcohol dependency. Which statement by the staff indicates the need for additional teaching?

"The client is a weak individual and could stop if they desire."

A client with a history of substance abuse has been attending Alcoholics Anonymous meetings regularly in the psychiatric unit. One afternoon, the client tells a 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 the most appropriate response?

"The meetings are a part of your treatment. You seem upset about attending them."

During a private conversation, a client with borderline personality disorder asks a nurse to "keep this secret," then displays multiple, self-inflicted, superficial lacerations of the forearms. What is the nurse's best response?

"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 nurse is interviewing a client who will begin rehabilitation for alcohol dependency. Which approach by the nurse is most helpful to the client before starting the program?

"We will help you be successful so that you can stay alcohol-free."

A client with anxiolytic withdrawal is prescribed lorazepam in daily decreasing dosages for 2 weeks. The client had been taking 60 mg of diazepam daily for 8 months but now has been taking lorazepam for 3 days. The client states they feel shaky, are having problems sleeping, and do not want to continue with lorazepam. The client asks the nurse if they can stop taking the lorazepam now. What is the nurse's best response?

"You need to continue the lorazepam as prescribed to ensure a slow and safe withdrawal."

A community health nurse working with a group of fifth-grade females is planning primary prevention to help the students avoid developing eating disorders during their teen years. The nurse should focus on which factor(s)? Select all that apply.

-discussing ways to build positive self-esteem -helping the students accept and appreciate their bodies

During a unit meeting attended by clients and staff, several clients are criticizing their primary nurses. These clients have also been intimidating two other clients who have recently been admitted to the unit, and now the new clients have stopped sharing their opinions during the meeting. What is the first action for the nurse to take?

Ask the clients criticizing their nurses to suggest some possible solutions for the practices they are criticizing.

A client with a history of cocaine use disorder is receiving intravenous therapy and exits the hospital "to visit a friend." The client returns to the nursing unit 1 hour later, agitated, aggressive, combative, and reporting "chest pain." Place the nurse's actions in priority order from first to last. All options must be used.

Contact the security department. Obtain an electrocardiogram (ECG). Obtain a urine sample. Initiate a referral to obtain drug rehabilitation counseling.

A client on the adolescent psychiatric unit was admitted with a diagnosis of body dysmorphic disorder. The client has not been able to attend school or their part-time work over the past year as a result of certain body obsessions. Recently, the client shaved the hair all over their body, claiming, "It is all growing weird." What component of therapy would be most important for the nurse to apply to this client?

The client's body image is real to the client.

A client admitted for alcohol detoxification is taking disulfiram. The nurse should instruct the client to avoid ingestion of which food(s) or liquid(s)? Select all that apply.

beer communal wine at church cough syrup

A young adult client is admitted to a psychiatric unit with a diagnosis of alcohol use disorder and personality disorder. The client's parent states, "They're always in trouble, just like when they were little. Now they're just a bigger prankster and out of control." In view of the client's history, which intervention is most important initially?

closely observing the client's behavior to establish a baseline pattern of functioning

The spouse of a client with alcohol dependency tells the nurse, "I'm tired of making excuses to their boss and coworkers when they can't make it into work. I believe them every time they say they're going to quit drinking." The nurse recognizes the spouse's statement as indicating which behavior?

enabling

A nurse is caring for a client she believes has been abusing opiates. Assessment findings in a client abusing opiates such as morphine include:

euphoria and constricted pupils.

The nurse should suspect that the client taking disulfiram has ingested alcohol when the client exhibits which symptom?

nausea and flushing of the face and neck

A client with a history of cocaine addiction is admitted to the coronary care unit for evaluation of substernal chest pain. The electrocardiogram (ECG) shows a 1-mm ST-segment elevation in the anteroseptal leads and T-wave inversion in leads V3 to V5. Which medication should the nurse prepare to administer?

nitroglycerin

A client is recovering from narcotic addiction. Which outcome should the nurse use as the best measure to determine a client's progress in rehabilitation?

the number of drug-free days the client has

A client is in the emergency department with their partner. The client is just recovering from a temporary drug-induced psychosis from lysergic acid diethylamide (LSD). The client is still frightened and a little suspicious. Which nursing action is most appropriate?

having an unlicensed assistive personnel (UAP) stay with the client to decrease the client's fear

The nurse cares for a client who has bipolar disorder and alcohol use disorder. Which area is the priority for daily assessment?

mental status

A client admitted to the alcohol detoxification program asks the nurse if there is a medication to "stop me from wanting a drink so badly." The nurse should teach the client about:

naltrexone.

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

seizures

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

tension and irritability.

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

"I know it is going to be hard and relapse is a possibility. I will need help."

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

check the client frequently at irregular intervals.

The client is admitted to the hospital for alcohol detoxification. Which intervention(s) should the nurse use? Select all that apply.

-taking vital signs -monitoring intake and output -reinforcing reality if the client is disoriented or hallucinating -explaining to the client that the symptoms of withdrawal are temporary

A client is prescribed clonidine to treat alcohol withdrawal. Which assessment data will the nurse monitor for?

hypotension

The nurse teaches a group of adolescents about anorexia nervosa. The nurse should describe this disorder as being characterized by which factors?

intense fear of becoming obese, emaciation, and a disturbed body image

A nurse is working with a group of clients in an anger management program. Which client behavior is most likely to be an indirect expression of anger?

responding sarcastically to an invitation to join a unit activity

A nurse performing an assessment determines that a client with anorexia nervosa is currently unemployed and has a family history of affective disorders, obesity, and infertility. Based on this information, the nurse should monitor the client for which health concern?

suicide potential

A nurse is evaluating a client for probable amphetamine overdose. Which assessment finding supports this diagnosis?

tachycardia

A client is admitted to the hospital following an inadvertent overdose of oxycodone. The client reveals that they have chronic back pain that resulted from an injury on a construction site. The client states, "I know I took too much oxycodone at once, but I can't live with this pain without them. You can't take them away from me." Which response by the nurse is most appropriate?

"Your pain will be controlled by tapering doses of oxycodone and with other pain management strategies and medicines."

A couple seeks emergency crisis intervention because one client slapped the other client repeatedly the night before. The first client who inflicted the violence reports a childhood marred by an abusive relationship with a parent. To assess for the likelihood of further violence and abuse, the nurse should determine that the first client:

has learned violence as an acceptable behavior.

The nurse cares for a client experiencing severe symptoms of alcohol withdrawal. Which nursing action is contraindicated?

helping the client walk

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

initiating caloric and nutritional therapy as ordered

One of the goals for a client with anorexia nervosa is for the client to demonstrate increased individual coping by responding to stress in constructive ways. Which intervention will the nurse discuss with the client as the best way to work toward meeting the goal?

keeping a personal journal and discussing it with the nurse

A client experiencing alcohol withdrawal exhibits tremors, diaphoresis, and hyperactivity. Blood pressure is 190/87 mm Hg, and pulse is 92 bpm. Which medication should the nurse expect to administer?

lorazepam

A nurse is working with a client with bulimia. Which goal(s) should be included in the care plan? Select all that apply.

maintain a normal weight. will comply with medication therapy. achieve a positive self-concept. acknowledge the disorder.

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

methadone

A nurse is assessing a 15-year-old adolescent who's being admitted for treatment of anorexia nervosa. Which clinical manifestation is the nurse most likely to find?

muscle weakness

A client who is a victim of domestic violence is contemplating leaving the relationship. Which assessment should be a priority for the nurse?

readiness to leave the perpetrator and knowledge of helpful resources

After a dose-response test, the client with an overdose of barbiturates receives pentobarbital sodium at a nonintoxicating maintenance level for 2 days and at decreasing dosages thereafter. This regimen is effective if the client does not develop which complication?

seizures

While admitting a client to the alcohol treatment program, the nurse asks the client how long they have been drinking, how much they have been drinking, and when they had their last drink. The client replies that they have been drinking about a liter of vodka a day for the past week and their last drink was about an hour ago. This information helps the nurse to determine which factor?

severity of withdrawal symptoms

A client is having difficulty falling asleep at night because of withdrawal symptoms from alcohol, which are abating. Which nursing intervention is likely to be most effective?

teaching the client relaxation exercises to use before bedtime

Which nursing statement is most effective when the nurse is trying to defuse a client's impending violent behavior?

"Let's talk about what happened to make you this angry."

The nurse plans discharge with a client who is diagnosed with intermittent explosive disorder, characterized by sudden angry outbursts. The nurse determines that the client is ready for discharge when the client makes which comment?

"I'll be taking valproic acid and propranolol to help stay in control."

The nurse is caring for a client with a history of aggression toward staff. The client, who is currently being verbally threatening, stands up and says to the nurse, "What are you going to do about it?" What response by the nurse will best de-escalate the situation?

"I'm concerned about you. Can you tell me what you're going through right now?"

In an outpatient addiction group, a recovering client said that before treatment, their spouse drank on social occasions. "Now they drink at home, from the time they come home from work and to until they go to bed. They say that they don't like me anymore and that I expect them to do more work on the house and yard. I used to ignore that stuff. I don't know what to do." In which order of priority from first to last would the nurse make the comments? All options must be used.

-"I hear how confused and frustrated you are." -"It can happen that as one person sobers up, the spouse deteriorates." -"What have you tried to do about your spouse's behaviors?" -"What do you think you could do to have your spouse come in for an evaluation?"

A client is brought to the emergency department after being beaten by the spouse, a prominent attorney. The client describes the spouse's upbringing as chaotic. The nurse caring for this client understands that this situation is consistent with which fact about family violence:

domestic violence and abuse span all socioeconomic classes.

Before hospitalization, a client needed increasingly larger doses of barbiturates to achieve the same euphoric effect that they initially realized from the barbiturate use. From this information, the nurse develops a plan of care that considers the client is likely experiencing what problem?

drug tolerance

A client walks into the clinic and tells the nurse they have run out of money for crack and have crashed and they want something to help them feel better. Which factor is most important for the nurse to assess?

suicidal ideation

A client was discharged from an alcohol rehabilitation program on clonazepam 0.5 mg three times a day. Several months later, the client reports having insomnia, shakiness, sweating, and one seizure. The nurse should first assess the client for which possible cause of these symptoms?

stopping the clonazepam suddenly

The nurse suspects a client is experiencing an opioid overdose. Which findings support the nurse's assessment?

decreased respirations, constricted pupils, and pallor

A client admits to using cocaine and says, "When I stop using, I feel bad." Which effect is the client most likely to describe as occurring after they stop using cocaine?

depression

When developing a therapeutic relationship with a client who has withdrawn from alcohol, the nurse should first set goals with the client that involve which behavior?

developing effective coping skills

When teaching a client with bulimia nervosa about possible complications, which condition should the nurse emphasize?

diabetes mellitus

A physician orders naltrexone for a client participating in an outpatient drug and alcohol rehabilitation program. Which action reflects the nurse's knowledge about this medication and the client's informed consent?

discussing the health risks related to this medication

A clinic nurse is assigned to care for a suicidal client. During the preinteraction phase, what should the nurse's priority be?

exploring the nurse's own feelings about suicide

A female client who is hospitalized for an eating disorder weighs 15 lb (6.8 kg) less than the ideal body weight. Which goal is a priority for this client?

gaining 1 lb (0.5 kg) per week

During the nurse's assessment of a 15-year-old client diagnosed with bulimia nervosa, the nurse evaluates for findings that accompany binge eating. Which are most applicable? Select all that apply.

guilt dental caries self-induced vomiting normal weight

A client recovering from narcotic addiction states to the nurse, "I'm not going anymore to support group meetings. I felt out of place there." Which response by the nurse is best?

"Try attending a meeting at a different location; you may feel more comfortable there."

A client with alcohol dependence states, "I feel so bad because of what I've done to my wife and kids. I'm just no good." Which response by the nurse is most appropriate?

"Alcohol dependence is a disease that can be treated."

A nurse explains the guidelines for the unit's seclusion room to a client with an impulse control disorder. Which client statement indicates that the nurse has adequately communicated the client's rights?

"Although I don't think I will, I can ask to go into seclusion, but I know you can make me go into the seclusion room."

When doing discharge planning for a hospitalized client with impulse control disorder, a nurse explains how family members can participate effectively in the client's ongoing care. What instruction should the nurse include?

"Consistently reward positive behavior and reinforce consequences of negative behavior."

A 68-year-old client is admitted to the addiction unit after treatment in the emergency department for an overdose of oxycodone. The client's adult child calls the unit and expresses intense anger that their parent is being treated as a "common street addict." The child says the client has severe back pain and was given that prescription by their health care provider. "My parent just accidentally took a few too many pills last night." Which reply by the nurse is most therapeutic?

"I can hear how upset you are. You sound very concerned about your parent."

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 for the client to stop doing so. During an interview with the nurse, which client statement most strongly supports a diagnosis of a substance use disorder?

"I have been arrested for drunk driving three times, but I never had an accident."

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?

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

A client who has been arrested eight times in the past year for driving under the influence is admitted for alcohol treatment by judicial mandate. Which statement is most suggestive of alcohol dependence?

"I never drink alone, so I don't have a problem."

The nurse cares for a client admitted to the emergency department after being found lying on the bathroom floor with several empty pill bottles around them. While waiting for a psychiatric consult, the nurse discovers that the client's partner has recently broken up with them. Which response is most likely to build and maintain a therapeutic relationship within the emergency department?

"What can I do to help while you are here?"

A client's spouse reports that the client has been taking about 800 mg of secobarbital daily, besides drinking more alcohol than usual. The spouse asks anxiously, "Do you think they will live?" Which response by the nurse is most appropriate?

"Your spouse's condition is serious. You sound very worried about them."

A nurse is working with a client who abuses alcohol. Which fact should the nurse communicate to the client?

Abstinence is the basis for successful treatment.

When assessing a client withdrawing from alcohol, the nurse notes that the client is anxious, experiencing nausea, is restless, and has a tremor when both arms are extended. What should the nurse do next?

Administer a benzodiazepine as prescribed.

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

Al-Anon

Two nurses disagree on what is the most important information for the client with addictions to have during a discharge teaching session. How should the nurse assigned to provide the discharge teaching proceed?

Ask the client what is most important to them as they prepare for discharge.

A client who was discharged earlier in the day returns to the nursing unit and demands acetaminophen with codeine. The client is advised that the client is no longer being treated on the unit and this medication cannot be administered. The client states, "I know where you park your cars, and you'd better watch out when you leave here tonight." What is the next step that the nurse should take?

Call the police.

A client newly admitted to a psychiatric inpatient setting demands a soda from a staff member who tells him to wait until lunch arrives in 20 minutes. The client becomes angry, pushes over a sofa, throws an end table, and dumps a potted plant. Which goal should a nurse consider to be of primary importance?

Demonstrating control over aggressive behavior

A client diagnosed with bulimia tells the nurse that they only eat excessively when upset with their best friend, and then they vomit to avoid gaining a lot of weight. What should the nurse do next?

Enroll the client in a coping skills group.

In developing a plan of care for a client who has had previous episodes of angry verbal outbursts, the nurse plans to take an educational approach to the problem. Arrange the following steps the nurse should take from first to last. All options must be used.

Help the client identify triggers for anger. Assist the client to recognize the early cues of anger. Identify alternate ways to express anger. Practice with the client appropriate ways to express anger.

A client is beginning to participate in the alcohol treatment program. Which nursing approach would be most effective in decreasing their denial about their alcoholism?

Point out concrete problems that are a direct consequence of his alcoholism.

A nurse works with a client diagnosed with bulimia. What is the most appropriate long-term client goal for this client?

Manage stresses in life without bingeing or purging.

A school nurse is completing height and weight screenings. A young client appears underweight for their height and also appears to have hair loss. As the client steps on to the scale, the client begins to cry. Which nursing intervention is most appropriate?

Request that the client stand backward on the scale when being weighed.

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

Set up a strict eating plan with the client.

A client is admitted to the hospital after sustaining a fracture of the femur sustained while intoxicated. The client's condition is stable; however, the client is shaky, irritable, and anxious. The next day the nurse finds the client restless and perspiring, with an elevated pulse. The client cries, "There are bugs crawling on my bed. I've got to get out of here," and begins to thrash about. What knowledge does the nurse use to manage the client's immediate care?

The client is experiencing withdrawal delirium.

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

The client will establish adequate daily nutritional intake.

A client experiencing acute alcohol withdrawal is upset about going through detoxification. Which goal should be the priority for the nurse?

The client will work with the nurse to remain safe.

A high school student is referred to the school nurse for suspected substance abuse. Following the nurse's assessment and interventions, what would be the most desirable outcome?

The student accepts a referral to a substance abuse counselor.

A client is admitted to the emergency department with an elevated blood alcohol level. The authorities state the client was driving on the wrong side of the road. The client is transferred to the acute care unit where they awaken the next morning. Vital signs are stable, and the client has a headache. What action should the nurse take first when caring for this client?

Work through personal feelings related to substance use disorder.

A client with alcohol dependency is started on a regimen of disulfiram. Which statement should the nurse include when teaching the client about the intended effects of the drug?

acts to deter alcohol consumption.

A client is remanded by the courts for psychiatric treatment. The police record, which dates to the client's early teenage years, includes delinquency, running away, auto theft, and vandalism. The client dropped out of school at age 16 and has been living alone then. This history suggests maladaptive coping, which is associated with:

antisocial personality disorder.

A client with a history of polysubstance abuse is admitted to the facility. The client reports nausea and vomiting 24 hours after admission. The nurse who assesses the client notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through withdrawal from which substance?

opioids

An adolescent client is being admitted with an eating disorder. Which initial assessment finding is of greatest concern for the nurse?

potassium level of 2.5 mEq/L (2.5 mmol/L)

A client is voluntarily admitted to a substance use disorder unit. The client admits to drinking at least 1 qt (1 L) of vodka each day and occasionally using cocaine. Several hours after admission, a nurse suspects that the client is likely experiencing early alcohol withdrawal. What assessment findings will the nurse document as evidence of alcohol withdrawal?

pulse of 135 beats/minute, blood pressure of 160/90 mmHg, and nervousness

The nurse is assessing a client for heroin addiction. Which finding indicates the client has used heroin?

pupils small and constricted

A client is hospitalized with fractures of the right femur and right humerus sustained in a motorcycle accident. Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dL; 43.2 mmol/dL). The client later admits to drinking heavily for years. The client periodically reports tingling and numbness in the hands and feet. Which finding does the nurse expect based on these symptoms?

thiamine deficiency

The nurse cares for a client who has overdosed on phencyclidine (PCP). The nurse should be especially cautious about which client behavior?

violent behavior

The health care provider prescribes a medication to help treat alcohol withdrawal in a client. Which assessment provides the best information about the client's physiologic response and the effectiveness of the medication?

vital signs