Chp 19, 20, 21, 22
A client has been admitted to the inpatient unit after using inhalants recently. Upon assessment the nurse finds the client with slurred speech and nystagmus. Which of the following is an antidote to treat inhalant toxicity? A) Lorazepam B) Naloxone C) Disulfiram D) There is no antidote
d
A 16-year-old female with anorexia nervosa is admitted to the unit. Which is the most appropriate short-term outcome? A) The client will accept herself as having value and worth. B) The client will admit she has a fear of gaining weight. C) The client will follow a nutritionally balanced diet for her age. D) The client will identify her problems and potential alternative coping strategies.
b
A client has an eating disorder characterized by consuming an amount of food much larger than a person would normally eat. Afterward, the client often purges the food or exercises excessively. Between binges, the client often eats low-calorie foods or fasts. What is the client's most likely diagnosis? A) Anorexia nervosa B) Bulimia nervosa C) Pica D) Rumination
b
A client is being discharged from treatment for addiction to cocaine. Which statement made by the client would cause the most concern for the nurse? A) "I am going to take up a new hobby. It's time to start something new." B) "I can still hang out with my old friends. I am just not going to use." C) "I'm not very comfortable with being alone yet." D) "Shooting baskets helps me not think about getting high."
b
A client is readmitted to the substance abuse program for the second time in 6 months for alcohol abuse. On admission, he tells the nurse, "I am so ashamed." What should the nurse reply? A) "I really thought you would make it." B) "Tell me what has happened since your last admission." C) "You have nothing to be ashamed of." D) "Why did you start drinking again?"
b
A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which response by the nurse is most appropriate? A) "Thanks for checking in." B) "I will accompany you to the bathroom." C) "Let me know when you get back to the dayroom." D) "I'll stand outside your door to give you privacy."
b
A client with alcohol dependence is admitted to the hospital with pancreatitis. Which intervention should be included in the client's plan of care? A) Fluid restriction of 1000 mL per 24 hours B) Glucometer checks b.i.d. C) High-protein diet D) Protective isolation precautions
b
Several medications are prescribed for a client who has anorexia. Which medication may be prescribed to help treat the client's distorted body image? A) Amitriptyline B) Cyproheptadine C) Olanzapine D) Fluoxetine
c
The nurse is assessing the drinking history of a client with a history of alcohol abuse. The client is being admitted after being found unresponsive in a public place. Which statement would indicate the use of defense mechanisms? A) "I really need some help. My drinking is tearing my family apart." B) "I have tried so many times to stop drinking. It is so hard." C) "I don't really have a problem with alcohol. I've just been having a streak of bad luck lately." D) "I have no intention to stop drinking. I like the way it makes me feel."
c
The nurse is assisting the client with anorexia nervosa to express feelings more openly. Which response by the nurse would be most likely to encourage expression of feelings? A) "Are you sad?" B) "You look anxious" C) "Tell me what you are feeling right now." D) "Tell me when you feel bad."
c
A client in treatment for drug abuse makes the statement to some of the other clients, "I am a winner. You all are the losers because you can't beat this on your own." What common characteristic of persons addicted to drugs is revealed in this statement? A) Realistic understanding of successful recovery of drug addiction B) Indication of an underlying personality disorder C) Brain damages resulting from chronic drug use D) Defending against a negative self-concept
d
A client is admitted for a drug overdose with a barbiturate. Which is the priority nursing action when planning care for this client? A) Check the client's belongings for additional drugs. B) Pad the side rails of the bed because seizures are likely. C) Prepare a dose of ipecac, an emetic. D) Monitor respiratory function.
d
A client with a long history of bulimia nervosa is seen in the emergency department. The client is seeing things that others do not, is restless, and has dry mucous membranes. Which is most likely the cause of this client's symptoms? A) mood disorders, which often accompany the diagnosis of bulimia nervosa B) nutritional deficits, which are characteristic of bulimia nervosa C) binging, which causes abdominal discomfort D) vomiting, which may lead to dehydration and electrolyte imbalance
d
A nurse is presenting information to a community group about health. Which information should the nurse provide regarding calorie restriction diets at an early age in children? A) Dieting helps build a positive self-image in children. B) Dieting during childhood can promote self-discipline in children who are obese. C) Dieting at an early age teaches healthy eating habits. D) Dieting at an early age may lead to the development of eating disorders.
d
The nurse is assessing a client with an eating disorder. Which of the following personality characteristic would the nurse expect to detect when interacting with the client? A) Careless B) Outspoken C) Defiant D) Eager to please
d
Which nursing intervention would be most likely to help the client with anorexia to establish healthy eating patterns? A) Leave the client alone to relax during meals. B) Offer liquid protein supplements if the client is unable to complete meal. C) Observe the client for 30 minutes after all meals. D) Weigh the client weekly in the same clothing at the same time of day.
b
The nurse is assessing a client with bulimia nervosa. Which of the following symptoms would the nurse expect to find? Select all that apply. A) Cold intolerance B) Normal weight for height C) Dental erosion D) Hypotension E) Metabolic alkalosis
b c e
Which of the following groups could benefit most from prevention programs? A) Children, prior to first use B) Adults who have already engaged in substance abuse C) Older adults D) Infants
a
A client asks the nurse, "What is Alcoholics Anonymous all about?" Which is the best response by the nurse? 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
A client is being admitted to the in-patient psychiatric unit with a diagnosis of bulimia nervosa. The nurse would expect this client to fall within which age range? A) 5 to 10 years old B) 10 to 14 years old C) 18 to 22 years old D) 25 to 35 years old
c
A client is being discharged on disulfiram. Which instruction for Antabuse should the client receive? A) Take disulfiram with food to avoid stomach upset. B) Skip the daily dose of disulfiram on days when consumption of alcoholic beverages is likely. C) Read products labels carefully to avoid all products containing alcohol. D) Disulfiram will prevent the desire to drink alcoholic beverages.
c
A client reports drinking one to two drinks when drinking behavior first began. Now the client reports drinking at least six drinks with every episode in order to "have a good time." Which term would best describe this phenomenon? A) Dependence B) Intoxication C) Tolerance D) Withdrawal
c
A client who has an eating disorder is becoming dependent on the nurse for direction in food choices. Which approach by the nurse would demonstrate the nurse's self-awareness? A) Approach the client with an adult-like objectivity. B) Give the support and direction that the client is seeking. C) Give approval for positive changes seen in the client. D) Take care of the needs that the client is neglecting.
a
A client with a history of heavy alcohol use, whose last drink was 24 hours ago, is seen in the emergency department. The nurse assesses the client and finds the client is oriented but is tremulous, weak, and sweaty and has some gastrointestinal (GI) symptoms. Which of the following is typical of these symptoms? A) Alcohol withdrawal syndrome B) Continuing intoxication C) Delirium tremens D) Wernicke-Korsakoff syndrome
a
An intoxicated client was admitted for trauma treatment last night at 2:00 AM (0200). When should the nurse expect to be alert for withdrawal symptoms? A) between 8:00 and 10:00 AM(0800 and 1000) today (6 to 8 hours after drinking stopped) B) about 2:00 AM (0200) tomorrow (24 hours after drinking stopped) C) about 2:00 AM (0200) of hospital day 2 (48 hours after drinking stopped) D) about 2:00 AM (0200) of hospital day 3 (72 hours after drinking stopped)
a
The nurse is assessing a client's risk factors for developing a substance abuse disorder. Which family characteristic would the nurse identify as the most significant risk factor? A) One parent who is an alcoholic B) Parents who practiced strict discipline C) Overprotective parents D) Being raised in an urban area
a
The nurse is discussing the principles of 12-step programs for recovery with a client. Which statement is consistent with the principles of 12-step programs? A) The client will need to abstain from all substances for successful recovery. B) Once sober, the person can safely return to life as it was before becoming addicted. C) The prognosis for recovery is enhanced with the aid of maintenance medications. D) Recovery requires adherence to a plan of achieving long-term goals.
a
During an initial interview at a clinic, a young female client states that there is nothing wrong with her. Which would indicate to the nurse that this client might have anorexia nervosa? A) Episodes of overeating and excessive weight gain B) Expressions of a positive self-concept C) Flexible thought patterns and spontaneity D) Severe weight loss due to self-imposed dieting
d
The nurse is leading a family therapy group with a client addicted to alcohol. Which of the following statements made by the wife indicates the need for additional education regarding alcoholism as a family illness? A) "I have to call in sick for my husband when he is too hung over to go to work." B) "Last time he got arrested, I just let him sit in jail." C) "We have separated our finances so that I will not go broke." D) "I take my kids with me to Al-anon meetings every week."
a
The nurse is sitting with the client at mealtime. The nurse uses cognitive-behavioral approaches to assist the client with bulimia toward recovery. Which of the following statement by the nurse would be consistent with this approach? A) "Is there any way you can look at that sandwich as fuel for your body?" B) "You have to eat in moderation for good nutrition." C) "You seem to have a really hard time controlling your eating patterns." D) "Is this your way of showing your family that you can make decisions?"
a
A 15-year-old female is admitted for treatment of anorexia nervosa. Which is characteristic of anorexia nervosa? A) Body weight less than normal for age, height, and overall physical health B) Irregular menstrual cycles C) Absence of hunger feelings D) Erosion of dental enamel
a
A client calls the emergency department of the local hospital reporting that after 16 years of heavy drinking, he is tired and wants to quit "cold turkey." What would be the best response by the nurse? A) "It is not safe to stop drinking suddenly without medicine." B) "You sound really motivated. Come in and we will help you find a treatment center." C) "After a few days of rest, you should feel much better as long as you do not drink anything." D) "You will likely feel anxious and get a severe headache. Treat these symptoms with acetaminophen and rest, and come in if they do not get better in 3 to 5 days."
a
A client is admitted for treatment of trauma sustained in a fall. The client believes bugs are crawling on the bed. The client is anxious, agitated, diaphoretic, and has a history of chronic drinking. The nurse can anticipate that the physician will order which medication? A) benzodiazepine, such as diazepam or chlordiazepoxide B) phenothiazine, such as chlorpromazineor thioridazine C) monoamine oxidase inhibitor, such as phenelzine D) narcotic, such as codeine
a
A client is readmitted to the detox unit for the fourth time in three years. The nurse states in the morning report, "Not again! Why should we keep trying to help this guy? He obviously doesn't want it." Which of the following statements is reflective of the nurse? A) The nurse lacks the self-awareness to work effectively with this addicted client. B) The nurse understands the cycle of remission and relapse characteristic of addiction. C) The nurse has repressed negative emotions from past experiences with addiction. D) The nurse is trying to conceal his or her own addictions.
a
The nurse is teaching a client with bulimia to use self-monitoring techniques. Which of the following statements by the client would let the nurse know that this has been effective? A) "I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging." B) "I am beginning to understand how my lack of self-control is hurting me." C) "I am keeping a record of everything I eat and how I am feeling every day." D) "I am getting more comfortable confronting people when I have conflict with them."
a
When preparing a client with bulimia for the implementation of discharge, the nurse suggests that the client and family continue with family therapy on an outpatient basis. Which of the following is the rationale for this suggestion? A) Family members often need to learn role independence and autonomy. B) Family members need to learn to monitor for signs of client relapse. C) Family relationships need to be strengthened due to a lifetime of disengagement. D) Family members often feel jealous of the attention the client has been receiving in treatment.
a
Which of the following would be most supportive for family and friends of a client with an eating disorder? A) Emotional support, love, and attention B) Focus on food intake, calories, and weight C) Unlimited access to unhealthy foods that the client enjoys D) Positive reinforcement for weight gain
a
The nurse is dealing with a difficult client. Which reasons make it necessary for the nurse to examine his or her beliefs and attitudes about substance abuse? Select all that apply. A) The nurse may be overly harsh and critical of the client. B) The nurse may unknowingly act out old family roles and engage in enabling behavior. C) The nurse or close friends and family of the nurse may abuse substances. D) The nurse may have different attitudes about various substances of abuse. E) The nurse is not likely to have had any experience with substance abuse.
a b c d
Which statements are important reasons for why the problem of substance abuse must be addressed? Select all that apply. A) Increasing numbers of infants are suffering the physiologic and emotional consequences of prenatal exposure to alcohol or drugs. B) Chemical abuse results in increased violence. C) Alcohol abuse costs business and industry an estimated $223 billion annually. D) Alcohol abuse is a too frequent cause of or contributor to death. E) Substance abuse is decreasing.
a b c d
The nurse is observing her coworker that is having some questionable behavior. Which of the following are general warning signs of substance abuse that a nurse should be alert for in coworkers? Select all that apply. A) Poor work performance B) Frequent absenteeism C) Unusual behavior D) Slurred speech E) Isolation from peers F) Substance abuse is not a problem in health professionals
a b c d e
The nurse understands that which biologic factors may influence the development of an eating disorder? Select all that apply. A) Family history of eating disorders B) Dysfunction of the hypothalamus C) Norepinephrine imbalances D) First-degree relatives with psychotic disorder E) Decreased serotonin levels
a b c e
Which factors may contribute to the frequency of eating disorders in adolescents? Select all that apply. A) Media portrayal of slimness as an ideal B) Body dissatisfaction in adolescent females C) Stress-free existence of adolescents D) Body image disturbance E) Seeking autonomy F) Seeking to develop a unique identity
a b d e f
clients and families of drug-addicted individuals. The family of a cocaine addict is angry and cannot understand why the client cannot just stop using. The nurse guides the group to discuss their understanding of the nature of addiction. Which statement would the nurse identify as an accurate understanding of the nature of addiction? Select all that apply. A) It is a medical illness that is progressive. B) The client will eventually be cured. C) Relapses and remissions are part of the illness. D) Clients can learn to get control over the substance.
a c
A community health nurse is planning a substance abuse prevention program. Which group would be the best target audience for the nurse to plan a program? A) Teenagers in a high school health class B) School-age children in an after-school program C) Parents attending a parent-teacher association meeting D) Elementary school teachers and counselors
b
A nurse is exploring treatment options with a client addicted to heroin. Which information regarding the use of methadone is important for the nurse to include? A) Unlike heroin, methadone is nonaddicting. B) Methadone will meet the physical need for opiates without producing cravings for more. C) Methadone will produce a high similar to heroin. D) People taking methadone run the same risks associated with IV drug use as those taking heroin.
b
A nurse is speaking to a group of expectant mothers. One person asks, "what can expectant mothers do that would prevent most of the cases of mental retardation in newborns?" Which is the best response from the nurse? A) eat balanced meals B) abstain from alcohol C) avoid being in a crowd D) rest during the day
b
A nurse suspects a coworker is signing out narcotics for clients and is using them herself. Which action should be taken by the nurse who has these suspicions? A) Ignore suspicions and leave it to the supervisor to intervene. B) Report the observations to the supervisor. C) Follow behind the coworker to ensure client comfort and safety. D) Confront the coworker about suspicions.
b
A peer reports for work looking unkempt and disheveled. Her movements are uncoordinated, and her breath smells like mouthwash. Another nurse suspects this peer is intoxicated. What should be the action of the nurse who suspects that a peer is intoxicated? A) Immediately call the supervisor to report the peer's behavior. B) Ask the peer if she feels all right and express concern. C) Give the peer some information about the hospital's employee assistance program. D) Ignore the situation until someone else validates the observations.
b
The nurse has been teaching a client about bulimia. Which statement by the client indicates that the teaching has been effective? A) "I know if I eat pasta, I'll binge." B) "I'll eat small meals and snacks regularly." C) "I'll take my medication when I feel the urge to binge." D) "I'll limit my intake of carbohydrates and fats."
b
The nurse has been teaching the client's family about the client's eating disorder, anorexia nervosa. Which statement would indicate that teaching was effective? A) "We will eat our evening meals together with no exceptions." B) "We will negotiate resolutions to family conflicts." C) "We will spend less time discussing troublesome family members." D) "We will give her frequent encouragement for eating well and maintaining her weight."
b
The nurse has just completed her admission assessment of the client with anorexia. When documenting the mental status exam findings in the chart, the nurse notes poor judgment and insight. Which client statement would support this impression? A) "I know I have a problem. I need help." B) "Others are just trying to keep me from looking good." C) "I know my weight is a little below normal." D) "Those weight charts are for normal people. I am not normal."
b
The nurse is talking with the friend of a client with alcoholism. The friend tells the nurse that his relationship with the client was codependent and enabling. Which is an example of codependent behavior? A) The friend called Alcoholics Anonymous when the client expressed a need to stop drinking. B) The friend called the client every night to make sure he got home safely and went looking for him if he was not at home. C) The friend confronted the client on the effect of his drinking on their relationship. D) The friend refused to go out drinking with the client to celebrate the client's birthday.
b
The nurse is teaching the family of a client who has bulimia about nutritional needs. Which dietary pattern would be most helpful to assist the client in recovering from bulimia? A) Provide the client a diet of mainly vegetables and salads. B) Encourage the entire family to engage in a balanced and regular dietary pattern. C) Encourage autonomy by allowing the client to have total control over food choices. D) Insist that the client complete all meals provided.
b
The nurse is working in an intensive care unit and observes that some clients do not respond to injections of diazepam (Valium) when the injections are given by a particular nurse. This nurse returns from lunch exhibiting slurred speech and euphoria. Which is the best action for the nurse to take? A) Ask other nurses if they have noticed anything unusual. B) Call the manager and report the observations. C) Observe the nurse as injections are prepared and administered. D) Tell the nurse, "I know you've been stealing Valium."
b
What is the primary difference between anorexia nervosa and bulimia nervosa? A) Anorexia has a psychological basis, whereas the cause of bulimia is biologic. B) Clients who are anorexic are proud of their control over eating, and clients with bulimia are ashamed of their behavior. C) Bulimia can be life threatening, whereas anorexia is seldom so. D) There is no real difference between these two types of disorders.
b
When interviewing the family members of a client being treated for substance abuse problems, which behavior would alert the nurse to the possibility of codependency? A) Being flexible but angry B) Blaming themselves for the client's problems C) Expressing thoughts and feelings openly D) Taking pleasure in self-accomplishments
b
When working with the family of a client with anorexia nervosa, which of the following issues must be addressed? A) Codependence B) Control issues C) Self-discipline D) Sexual identity
b
Which characteristic of the 12-step program distinguishes it from other programs? A) The philosophy that it is possible to reduce the use of substances without abstaining. B) It is a self-help group that does not necessarily use health professionals as leaders. C) Persons who use this program are independent in their sobriety. D) Infrequent attendance is usually successful.
b
Which may help a person to overcome an eating disorder that causes weight gain? A) Being ashamed of his or her body image B) Believing that gaining weight is an effect of unhealthy lifestyle behaviors and losing weight is an effect of healthy lifestyle behaviors C) Being reminded that every morsel of food he or she consumes will make him or her fat D) Knowing that his or her current weight is abnormal
b
Which nursing diagnosis would be most difficult to successfully resolve in a client who had anorexia nervosa? A) Imbalanced nutrition—less than body requirements B) Disturbed body image C) Deficient knowledge (nutritious eating patterns) D) Social isolation
b
A client will be taking disulfiram after discharge from an alcohol treatment program. Which statement would indicate that teaching has been effective? A) "Disulfiram is safe to take with any over-the-counter cold medication." B) "Disulfiram will block my cravings for alcohol, so I'll have less desire to drink." C) "Drinking alcohol while taking disulfiram can cause dangerous symptoms." D) "If I drink while taking disulfiram, it will make me vomit before the alcohol affects me."
c
A nurse shows an understanding of the use of nursing outcomes regarding triggers for a client diagnosed with chronic alcohol abuse when making which statement? A) "Can you work on identifying three situations that cause you to abuse alcohol?" B) "I'll help you to identify three triggers for your drinking during today's session." C) "I'm pleased you've identified three situations that trigger your abuse of alcohol." D) "Do you think you will be able to avoid the three triggers that cause you to drink?"
c
The nurse is helping a client with an eating disorder to accept her body image, but she must first learn effective coping skills. Which of the following statement best describes the relationship between body image and coping skills? A) Coping skills are dependent on a supportive upbringing. B) When body image is positive, the client will develop better coping skills. C) Being able to cope in healthy ways improves the ability to accept a realistic body image. D) Neurotransmitters that are deficient in clients with eating disorders prohibit the development of effective coping skills.
c
Which is the primary objective of nursing interventions in the care of a client with anorexia nervosa? A) Changing her irrational thinking about her body B) Establishing a target weight to be achieved by discharge C) Restoring nutritional status to normal D) Gaining insight into the effects of anorexia on her physical health
c
Which nursing statement is most effective in communicating a positive expectation of the client? A) "I'll give you 90 minutes to eat." B) "I will allow you space to eat in peace." C) "I will sit here quietly with you while you eat." D) "There are people who would truly appreciate this food."
c
Which of the following interventions would be appropriate for a client with anorexia nervosa? A) Allowing the client to eat whenever she feels hungry B) Insisting that the client sit in the dining room until all food is eaten C) Having the client in view of staff for 90 minutes after each meal D) Permitting the client to eat any food she chooses, as long as she is eating
c
nurse is working with a couple seeking counseling for marital discord. The history indicates the husband was treated for substance abuse four years ago and attends AA meetings occasionally. Which statement made by the recovering husband should alert the nurse for the need for further education? A) "I still need to go to AA meetings even though I have been sober for years." B) "After all these years, I just don't have the will power to stop if I started using again." C) "She gets upset when I hang out with my old buddies on the weekends." D) "I wish I could be able to handle just one beer with dinner."
c
Which slogans would be used in a 12-step program? Select all that apply. A) "Pull yourself together." B) "Get control of your problem." C) "One day at a time." D) "Easy does it." E) "Let go and let God."
c d e
A client calls the emergency department of the local hospital reporting that after 16 years of heavy drinking, he is tired and wants to quit "cold turkey." What would be the best response by the nurse? A) "It is not safe to stop drinking suddenly without medicine." B) "You sound really motivated. Come in and we will help you find a treatment center." C) "After a few days of rest, you should feel much better as long as you do not drink anything." D) "You will likely feel anxious and get a severe headache. Treat these symptoms with acetaminophen and rest, and come in if they do not get better in 3 to 5 days."
d
A client diagnosed with anorexia nervosa is newly admitted to an in-patient psychiatric unit. Which nursing intervention takes priority? A) assessment of family issues and health concerns B) assessment of early disturbances in mother-daughter interactions C) assessment of the client's knowledge of selective serotonin reuptake inhibitors used in treatment D) assessment and monitoring of vital signs and lab values to recognize and anticipate medical problems
d
A nurse, sitting with a client diagnosed with anorexia nervosa, notices that the client has eaten 80 percent of lunch. The client asks the nurse, "What do you like better, hamburgers or spaghetti?" Which is the best response by the nurse? A) "I really enjoy a large plate of spaghetti." B) "I'll weigh you after your meal." C) "I like hamburgers a lot but why do you always talk about food" D) "Let's focus on your continued improvement. You ate 80 percent of your lunch."
d
All of the following nursing diagnoses are appropriate for the care of a client with anorexia nervosa. Which nursing diagnosis has the highest priority? A) Activity intolerance B) Ineffective coping C) Chronic low self-esteem D) Imbalanced nutrition: less than body requirements
d
The client asks the nurse, "What will happen if I drink while taking disulfiram?" What should be the nurse's reply? A) "You will not want to drink while taking Antabuse. It reduces the cravings." B) "You will not get any effect from the alcohol you drink." C) "Disulfiram will reverse the effects of alcohol." D) 'You will experience a severe reaction, including a throbbing headache and vomiting."
d
The wife of a client who is alcoholic asks the nurse how to respond to him in a helpful way when he is disruptive in family life. Which is the nurse's best response? A) "Help him avoid embarrassment by supporting him when he makes excuses for failing to meet obligations." B) "Include him in family outings even when he is drinking." C) "Search the house regularly for alcohol." D) "Try to maintain a normal home environment for yourself and the children."
d
Which of the following neurochemical influences is a probable cause of substance abuse? A) Imbalances of serotonin and norepinephrine in the brain B) Inhibition of GABA in the brain C) Excessive serotonin activity in the CNS D) Stimulation of dopamine pathways in the brain
d
While assessing the family dynamics of a client with an eating disorder, which of the following does the nurse most likely discover? A) Multiple siblings B) Lack of interest in the client by other family members C) Supportive and encouraging relationships D) Over controlling parents
d
